~quiz 2/ exam 3~ Flashcards
pyelonephritis, glomerulonephritis, kidney stones, viral and bacterial meningitis, and enchephalitis
A nurse is caring for a patient diagnosed with calcium oxalate kidney stones. Which dietary modification should the nurse recommend to reduce the risk of recurrence?
A. Increase intake of calcium-rich foods
B. Decrease intake of foods high in oxalate
C. Avoid drinking more than 1 liter of water daily
D. Increase intake of high-purine foods
Answer: B. Decrease intake of foods high in oxalate
Rationale: Calcium oxalate stones are the most common type of kidney stones. Limiting high-oxalate foods (e.g., spinach, nuts, rhubarb) can reduce the risk of stone recurrence. Increasing water intake to produce 2.5 L of urine daily is essential. High-purine foods can contribute to uric acid stones but not calcium oxalate stones.
A patient with severe flank pain, nausea, and vomiting is admitted with suspected renal colic. What is the priority nursing intervention?
A. Encourage ambulation to aid stone passage
B. Administer prescribed opioids for pain relief
C. Prepare the patient for extracorporeal shock wave lithotripsy (ESWL)
D. Obtain a 24-hour urine specimen for analysis
Answer: B. Administer prescribed opioids for pain relief
Rationale: Pain management is the priority for a patient with renal colic. Severe pain can cause additional stress and exacerbate symptoms. While ambulation and urine analysis are important, they are secondary to pain relief. ESWL is only considered after diagnostic evaluation confirms the need.
The nurse is educating a patient with uric acid stones about dietary changes. Which food should the nurse advise the patient to avoid?
A. Milk
B. Spinach
C. Red meat
D. Potatoes
Answer: C. Red meat
Rationale: Uric acid stones are associated with high-purine foods, such as red meat, organ meats, and shellfish. Avoiding these foods can reduce uric acid production. Milk and potatoes are not high in purine, while spinach is high in oxalate and would be more relevant for calcium oxalate stones.
A patient with a history of kidney stones is prescribed tamsulosin (Flomax). What is the primary purpose of this medication?
A. To dissolve the kidney stone
B. To relax the smooth muscle in the ureter
C. To increase urine production
D. To prevent urinary tract infections
Answer: B. To relax the smooth muscle in the ureter
Rationale: Tamsulosin is an alpha-adrenergic blocker that relaxes the smooth muscle in the ureter, facilitating the passage of the stone. It does not dissolve stones or increase urine production, and it is not an antibiotic.
Which statement by a patient with recurrent kidney stones indicates the need for further teaching?
A. “I should drink 3 liters of water daily.”
B. “I will limit my sodium intake.”
C. “I should avoid physical activity to prevent stone movement.”
D. “I will avoid foods high in oxalate.”
Answer: C. “I should avoid physical activity to prevent stone movement.”
Rationale: Physical activity, including ambulation, can help move stones through the urinary tract. Adequate hydration, sodium restriction, and avoiding high-oxalate foods are appropriate measures to prevent stone recurrence.
A nurse is caring for a patient undergoing extracorporeal shock wave lithotripsy (ESWL). What is the most important nursing action post-procedure?
A. Encourage fluid intake of 1 liter per day
B. Assess for hematuria and strain all urine
C. Restrict ambulation for 24 hours
D. Provide a low-calcium diet
Answer: B. Assess for hematuria and strain all urine
Rationale: Hematuria is a common post-ESWL finding. Straining urine is crucial to collect stone fragments for analysis. High fluid intake (3 L/day) is recommended to help flush fragments, and dietary restrictions depend on the stone type.
A patient presents with flank pain and hematuria. The nurse anticipates which diagnostic test to confirm the presence of kidney stones?
A. Complete blood count (CBC)
B. Non-contrast CT scan
C. Abdominal x-ray
D. Voiding cystourethrogram
Answer: B. Non-contrast CT scan
Rationale: A non-contrast CT scan is the gold standard for diagnosing kidney stones. It provides detailed imaging to identify the size and location of stones. An abdominal x-ray is less sensitive, and a voiding cystourethrogram is used for bladder-related issues.
What is the primary goal of dietary and fluid modifications in patients with recurrent kidney stones?
A. To dilute urine and reduce crystal formation
B. To enhance the absorption of calcium and oxalate
C. To decrease the need for surgical interventions
D. To prevent the development of UTIs
Answer: A. To dilute urine and reduce crystal formation
Rationale: Adequate hydration and dietary modifications aim to dilute urine, preventing supersaturation of minerals and reducing the risk of stone formation. Dietary changes are specific to the type of stone.
The nurse is teaching a patient about preventing calcium phosphate kidney stones. Which recommendation is appropriate?
A. Limit vitamin C supplements
B. Increase intake of purine-rich foods
C. Restrict sodium in the diet
D. Avoid foods high in oxalate
Answer: C. Restrict sodium in the diet
Rationale: Sodium restriction reduces calcium excretion in the urine, which is crucial for preventing calcium phosphate stone formation. Limiting oxalate and purines is not specifically relevant for calcium phosphate stones. Vitamin C does not significantly affect calcium phosphate stone formation.
A patient is suspected of having kidney stones. Which diagnostic test is the most accurate for confirming the size and location of the stone?
A. Abdominal x-ray
B. Non-contrast CT scan
C. Intravenous pyelogram (IVP)
D. Renal ultrasound
Answer: B. Non-contrast CT scan
Rationale: A non-contrast CT scan is the gold standard for diagnosing kidney stones because it provides detailed imaging of the size, location, and composition of the stones. While IVP and ultrasound are helpful, they are less sensitive and may miss smaller stones.
The nurse is reviewing a patient’s urinalysis results. Which finding is most consistent with the presence of a kidney stone?
A. Specific gravity of 1.005
B. Proteinuria
C. Crystalluria
D. Leukocyte esterase
Answer: C. Crystalluria
Rationale: Crystalluria indicates the presence of crystals in the urine, which is a common finding in kidney stone disease. Specific gravity indicates hydration status, proteinuria suggests glomerular damage, and leukocyte esterase indicates infection.
Which laboratory test is most useful in determining if a patient’s kidney stones are composed of uric acid?
A. Serum calcium
B. Serum uric acid
C. BUN and creatinine
D. 24-hour urine sodium
Answer: B. Serum uric acid
Rationale: Elevated serum uric acid levels indicate an increased risk for uric acid stone formation. Serum calcium is more relevant for calcium stones, and BUN and creatinine measure kidney function.
The nurse is caring for a patient with recurrent kidney stones. A 24-hour urine collection is ordered. What is the primary purpose of this test?
A. To determine the presence of a urinary tract infection
B. To evaluate kidney function
C. To measure excretion of substances contributing to stone formation
D. To assess urine output and fluid status
Answer: C. To measure excretion of substances contributing to stone formation
Rationale: A 24-hour urine test evaluates levels of calcium, oxalate, uric acid, and other substances that contribute to kidney stone formation. It helps guide preventive treatment.
A patient has a suspected struvite stone. What urine characteristic should the nurse anticipate in the urinalysis report?
A. High pH (alkaline urine)
B. Low specific gravity
C. Proteinuria
D. Presence of glucose
Answer: A. High pH (alkaline urine)
Rationale: Struvite stones are associated with urinary tract infections caused by urea-splitting bacteria, leading to alkaline urine. Other findings, like proteinuria or glucose, are not specific to struvite stones.
Which diagnostic test is least invasive and can identify stones in the kidneys or urinary tract in pregnant patients?
A. Non-contrast CT scan
B. Abdominal x-ray
C. Intravenous pyelogram (IVP)
D. Renal ultrasound
Answer: D. Renal ultrasound
Rationale: Renal ultrasound is the safest diagnostic test for pregnant patients as it avoids radiation exposure. A non-contrast CT scan and IVP involve radiation, which is contraindicated during pregnancy.
The nurse is preparing a patient for a urinalysis as part of a kidney stone evaluation. What instructions should the nurse provide?
A. “Collect the first voided urine of the morning.”
B. “Provide a clean-catch midstream urine sample.”
C. “Collect all urine voided over 24 hours.”
D. “Avoid eating or drinking 12 hours before the test.”
Answer: B. “Provide a clean-catch midstream urine sample.”
Rationale: A clean-catch midstream urine sample is used for urinalysis to assess for hematuria, crystalluria, and signs of infection. A 24-hour urine collection is different and used to measure excretion levels of substances contributing to stone formation.
A patient is scheduled for an intravenous pyelogram (IVP). What is the priority nursing action before the procedure?
A. Administer a laxative to clear the bowel
B. Check for a history of iodine or shellfish allergy
C. Encourage fluid intake before the test
D. Assess for signs of urinary retention
Answer: B. Check for a history of iodine or shellfish allergy
Rationale: IVP uses contrast dye, so checking for a history of iodine or shellfish allergy is critical to prevent an allergic reaction. Administering a laxative may be necessary but is not the priority.
Which diagnostic study provides information on the metabolic risk factors contributing to kidney stone formation?
A. Non-contrast CT scan
B. 24-hour urine collection
C. Intravenous pyelogram (IVP)
D. Renal ultrasound
Answer: B. 24-hour urine collection
Rationale: A 24-hour urine collection assesses metabolic factors, such as excretion levels of calcium, oxalate, and uric acid, which contribute to stone formation. Imaging studies like CT scans and ultrasounds evaluate stone location and size.
A patient with severe flank pain undergoes a non-contrast CT scan, which confirms the presence of a 7 mm kidney stone. What additional diagnostic test might be ordered to identify the stone composition?
A. Urinalysis
B. Cystoscopy
C. Retrieval and analysis of the stone
D. Serum calcium and phosphate levels
Answer: C. Retrieval and analysis of the stone
Rationale: Stone retrieval and analysis provide definitive information about the stone’s composition, which is essential for determining the underlying cause and guiding treatment to prevent recurrence.
A nurse is assessing a patient suspected of having acute pyelonephritis. Which symptom is the most indicative of this condition?
A. Suprapubic pain
B. Flank pain with costovertebral angle (CVA) tenderness
C. Bright yellow urine
D. Constipation
Answer: B. Flank pain with costovertebral angle (CVA) tenderness
Rationale: Flank pain with CVA tenderness is a hallmark symptom of acute pyelonephritis, often accompanied by fever and chills. Suprapubic pain is more typical of cystitis, and urine color changes are not specific to pyelonephritis.
Which finding in a patient’s urinalysis is most consistent with acute pyelonephritis?
A. Proteinuria
B. Pyuria and WBC casts
C. Ketones
D. Increased specific gravity
Answer: B. Pyuria and WBC casts
Rationale: Pyuria (pus in the urine) and WBC casts indicate renal parenchymal inflammation, a classic finding in pyelonephritis. Proteinuria is common in other renal conditions, and ketones are seen in diabetic ketoacidosis.
A patient with suspected pyelonephritis has hematuria. How would the nurse describe the appearance of the patient’s urine?
A. Dark red and cloudy
B. Clear and pale yellow
C. Bright orange
D. Foamy
Answer: A. Dark red and cloudy
Rationale: Hematuria often results in dark, cloudy urine due to the presence of red blood cells and possibly bacteria. Bright orange urine is typically caused by certain medications, such as phenazopyridine.
Which diagnostic imaging study is most commonly performed first to assess for acute pyelonephritis?
A. CT scan
B. Renal ultrasound
C. Abdominal x-ray
D. MRI
Answer: A. CT Scan
Rationale: CT scans may be performed if complications are suspected.
A nurse is reviewing the results of a complete blood count (CBC) for a patient with pyelonephritis. Which finding is most likely?
A. Elevated WBC count with neutrophilia
B. Low hemoglobin and hematocrit
C. Decreased platelet count
D. Elevated eosinophils
Answer: A. Elevated WBC count with neutrophilia
Rationale: Pyelonephritis is a bacterial infection, and an elevated WBC count with neutrophilia is a common finding. Low hemoglobin or eosinophilia are not typically associated with pyelonephritis.
A patient with pyelonephritis is scheduled for a CT scan. What should the nurse assess for before the procedure?
A. History of iodine allergy
B. Recent antibiotic use
C. Presence of flank pain
D. Hematuria
Answer: A. History of iodine allergy
Rationale: CT scans often use contrast dye, so it is critical to assess for an iodine allergy to avoid a potential allergic reaction. The other factors do not directly impact the safety of the procedure.
What is the most significant laboratory finding that indicates a systemic infection in a patient with pyelonephritis?
A. Elevated serum creatinine
B. Positive blood cultures
C. Low urine pH
D. Hyperkalemia
Answer: B. Positive blood cultures
Rationale: Positive blood cultures indicate bacteremia, a sign of systemic infection or urosepsis. Elevated creatinine indicates kidney dysfunction but is not specific to systemic infection.
The nurse is caring for a patient with chronic pyelonephritis. Which diagnostic test provides the best information about renal scarring?
A. MRI
B. Renal ultrasound
C. Renal biopsy
D. Voiding cystourethrogram (VCUG)
Answer: C. Renal biopsy
Rationale: A renal biopsy provides detailed information about renal scarring, inflammation, and loss of functioning nephrons in chronic pyelonephritis. Ultrasound and MRI are useful but less specific.
A patient is being evaluated for chronic pyelonephritis. Which urinalysis finding is most concerning?
A. WBC casts
B. Low urine specific gravity
C. Dark brown urine
D. High pH
Answer: A. WBC casts
Rationale: WBC casts indicate renal parenchymal involvement, suggesting ongoing inflammation in the kidneys. Low specific gravity and high pH are less specific findings.
Which laboratory result in a patient with suspected pyelonephritis requires immediate attention?
A. Elevated BUN and creatinine levels
B. Positive leukocyte esterase in urine
C. Hematuria in urinalysis
D. Serum potassium of 6.5 mEq/L
Answer: D. Serum potassium of 6.5 mEq/L
Rationale: Hyperkalemia (potassium >5.5 mEq/L) is a medical emergency that can indicate kidney dysfunction leading to impaired potassium excretion. Elevated BUN and creatinine suggest kidney injury but are not immediately life-threatening.
Which of the following best describes glomerulonephritis?
A. Inflammation of the renal pelvis and parenchyma
B. Scarring and inflammation of the glomeruli in both kidneys
C. Sudden onset of urinary retention due to infection
D. Chronic inflammation limited to the renal tubules
Answer: B. Scarring and inflammation of the glomeruli in both kidneys
Rationale: Glomerulonephritis is characterized by inflammation and scarring of the glomeruli, affecting both kidneys equally. It can be acute or chronic and may progress to renal failure if untreated.
A patient with acute poststreptococcal glomerulonephritis (APSGN) presents with periorbital edema and dark-colored urine. What does the nurse understand about the urine color?
A. Indicates dehydration
B. Results from hematuria
C. Suggests proteinuria
D. Is caused by pyuria
Answer: B. Results from hematuria
Rationale: Dark or red-to-brown urine in APSGN is caused by hematuria due to glomerular damage and bleeding into the urinary tract.
Which risk factor is most strongly associated with the development of acute poststreptococcal glomerulonephritis (APSGN)?
A. Recent streptococcal throat infection
B. Long-term use of NSAIDs
C. Viral hepatitis infection
D. History of diabetic nephropathy
Answer: A. Recent streptococcal throat infection
Rationale: APSGN commonly develops 1–3 weeks after a streptococcal throat infection due to antigen-antibody complexes depositing in the glomeruli.
A patient with suspected glomerulonephritis undergoes a urinalysis. Which findings are most consistent with the condition?
A. Pyuria and bacteria
B. Hematuria and proteinuria
C. Ketones and glucose
D. High specific gravity and ketones
Answer: B. Hematuria and proteinuria
Rationale: Glomerulonephritis is characterized by hematuria and proteinuria due to inflammation and damage to the glomeruli.
The nurse is reviewing diagnostic studies for a patient with suspected chronic glomerulonephritis. Which imaging study is most commonly used to confirm renal scarring?
A. Abdominal x-ray
B. CT scan
C. Renal ultrasound
D. Voiding cystourethrogram (VCUG)
Answer: C. Renal ultrasound
Rationale: Renal ultrasound is commonly used to assess for structural abnormalities and scarring in chronic glomerulonephritis.
A patient with chronic glomerulonephritis has a blood urea nitrogen (BUN) level of 65 mg/dL and a serum creatinine level of 3.5 mg/dL. What do these lab results indicate?
A. Normal kidney function
B. Severe dehydration
C. Significant renal impairment
D. High protein intake
Answer: C. Significant renal impairment
Rationale: Elevated BUN and serum creatinine levels indicate reduced kidney function, commonly seen in chronic glomerulonephritis.
What is the priority nursing assessment for a patient with acute glomerulonephritis?
A. Monitoring for signs of infection
B. Checking blood glucose levels
C. Assessing blood pressure and fluid balance
D. Monitoring for neurological changes
Answer: C. Assessing blood pressure and fluid balance
Rationale: Hypertension and fluid retention are common complications of glomerulonephritis due to decreased glomerular filtration.
A patient with anti-glomerular basement membrane (GBM) disease presents with hematuria, proteinuria, and hemoptysis. What additional test is likely to confirm the diagnosis?
A. Streptozyme test
B. Renal biopsy
C. Urine culture
D. Voiding cystourethrogram (VCUG)
Answer: B. Renal biopsy
Rationale: A renal biopsy can confirm the diagnosis of anti-GBM disease by identifying specific antibody deposits in the glomeruli.
Which symptom is most commonly associated with rapidly progressive glomerulonephritis (RPGN)?
A. Sudden onset of renal failure
B. Painless hematuria
C. Chronic, low-grade fever
D. Polyuria and nocturia
Answer: A. Sudden onset of renal failure
Rationale: RPGN is characterized by rapid progression to renal failure, often accompanied by hematuria, edema, and hypertension.
A nurse is teaching a patient with acute glomerulonephritis about their dietary restrictions. Which statement by the patient indicates the need for further teaching?
A. “I should limit my sodium intake to reduce swelling.”
B. “I should drink plenty of fluids to flush out my kidneys.”
C. “I may need to restrict protein if my kidney function worsens.”
D. “I will monitor my fluid intake to avoid overloading my kidneys.”
Answer: B. “I should drink plenty of fluids to flush out my kidneys.”
Rationale: In acute glomerulonephritis, fluid intake is often restricted to prevent fluid overload and worsening hypertension. The other statements reflect appropriate dietary adjustments.
Which of the following best defines meningitis?
A. Chronic inflammation of the spinal cord
B. Inflammation of the meningeal tissues surrounding the brain and spinal cord
C. Progressive autoimmune disease affecting the CNS
D. Acute infection of the cerebrum and cerebellum
Answer: B. Inflammation of the meningeal tissues surrounding the brain and spinal cord
Rationale: Meningitis is an acute inflammation of the meninges, which are the protective membranes covering the brain and spinal cord.
What is the primary pathophysiological mechanism of bacterial meningitis?
A. Increased cerebral perfusion pressure
B. Activation of inflammatory response leading to increased cerebrospinal fluid (CSF) production and ICP
C. Decreased production of cerebrospinal fluid due to infection
D. Direct destruction of neuronal tissue by bacterial toxins
Answer: B. Activation of inflammatory response leading to increased cerebrospinal fluid (CSF) production and ICP
Rationale: Bacterial meningitis triggers an inflammatory response, increasing CSF production, leading to swelling, and raising intracranial pressure.
Which patient is at the highest risk for developing meningitis?
A. A college student living in a dormitory
B. A preschool-aged child with asthma
C. A middle-aged adult with diabetes
D. A senior citizen living independently
Answer: A. A college student living in a dormitory
Rationale: Meningitis risk is higher in close-contact environments, such as dormitories, where infections can spread easily.
A nurse suspects meningitis in a patient presenting with fever, severe headache, and nuchal rigidity. Which additional symptom is most specific to bacterial meningitis?
A. Photophobia
B. Non-blanching petechial rash
C. Abdominal pain
D. Tachycardia
Answer: B. Non-blanching petechial rash
Rationale: A non-blanching petechial rash is a hallmark symptom of meningococcal meningitis, a form of bacterial meningitis.
What laboratory finding is most indicative of bacterial meningitis in cerebrospinal fluid (CSF)?
A. Low glucose and high protein levels
B. Elevated red blood cells and low protein levels
C. Decreased white blood cells and normal glucose levels
D. Elevated glucose and decreased protein levels
Answer: A. Low glucose and high protein levels
Rationale: In bacterial meningitis, glucose is consumed by bacteria, leading to low levels, while inflammation increases protein levels in the CSF.
Which imaging study is considered the gold standard for confirming the diagnosis of meningitis?
A. X-ray of the skull
B. Lumbar puncture with CSF analysis
C. CT scan without contrast
D. Magnetic resonance imaging (MRI)
Answer: B. Lumbar puncture with CSF analysis
Rationale: A lumbar puncture with CSF analysis is the gold standard for diagnosing meningitis, providing data on glucose, protein, WBCs, and bacterial culture.
The nurse is assessing a patient with suspected meningitis. Which complication would require immediate intervention?
A. Persistent photophobia
B. Increased intracranial pressure (ICP)
C. Nuchal rigidity
D. Severe headache
Answer: B. Increased intracranial pressure (ICP)
Rationale: Increased ICP is a life-threatening complication of meningitis and can lead to herniation, requiring immediate medical intervention.
Which treatment should be initiated immediately after bacterial meningitis is suspected, and cultures are obtained?
A. High-dose IV antibiotics
B. Administration of corticosteroids
C. Fluid restriction
D. Antipyretics for fever control
Answer: A. High-dose IV antibiotics
Rationale: Immediate antibiotic therapy is critical to reduce the mortality and morbidity associated with bacterial meningitis. Antibiotics are started after obtaining culture specimens.
A nurse is teaching a patient about the prevention of bacterial meningitis. Which statement indicates effective understanding?
A. “I will avoid all dairy products to reduce the risk of infection.”
B. “Receiving the meningococcal vaccine can help protect me against this disease.”
C. “Regular exercise can completely prevent meningitis.”
D. “Taking a daily multivitamin will reduce my risk of infection.”
Answer: B. “Receiving the meningococcal vaccine can help protect me against this disease.”
Rationale: Vaccination is an effective preventive measure for meningitis caused by Neisseria meningitidis.
A patient recovering from bacterial meningitis reports chronic headaches. What is the most appropriate nursing intervention?
A. Administer IV antibiotics
B. Encourage complete bed rest
C. Provide codeine as prescribed for pain relief
D. Perform a lumbar puncture
Answer: C. Provide codeine as prescribed for pain relief
Rationale: Chronic headaches can persist after meningitis. Codeine provides pain relief without excessive sedation. Other options are inappropriate or unnecessary at this stage.
Which of the following best defines viral meningitis?
A. Acute bacterial infection of the meninges
B. Inflammation of the meninges caused by a viral infection
C. Chronic autoimmune condition affecting the brain and spinal cord
D. Degenerative disease of the central nervous system
Answer: B. Inflammation of the meninges caused by a viral infection
Rationale: Viral meningitis is an acute inflammation of the meninges due to a viral cause, such as enteroviruses or herpes simplex virus.
What is the most common pathophysiological mechanism of viral meningitis?
A. Bacterial toxins causing inflammation in the meninges
B. Viral invasion of the central nervous system leading to lymphocytic infiltration
C. Direct damage to neurons by viral toxins
D. Increased cerebrospinal fluid (CSF) production causing hydrocephalus
Answer: B. Viral invasion of the central nervous system leading to lymphocytic infiltration
Rationale: Viral meningitis occurs when viruses invade the CNS, triggering an inflammatory response marked by lymphocytic infiltration in the CSF.
Which of the following is a primary risk factor for viral meningitis?
A. Close contact with someone with bacterial meningitis
B. Direct contact with respiratory secretions carrying enteroviruses
C. History of chronic sinus infections
D. Prolonged use of immunosuppressive drugs
Answer: B. Direct contact with respiratory secretions carrying enteroviruses
Rationale: Enteroviruses, a common cause of viral meningitis, spread through contact with respiratory secretions or fecal matter from infected individuals.
A patient presents with fever, headache, photophobia, and nuchal rigidity. Which clinical feature is most specific to viral meningitis?
A. Nuchal rigidity
B. Photophobia
C. Clear cerebrospinal fluid (CSF)
D. High fever
Answer: C. Clear cerebrospinal fluid (CSF)
Rationale: Clear or cloudy CSF with lymphocytosis and no organisms on Gram stain is characteristic of viral meningitis.
Which diagnostic test provides a rapid confirmation of enterovirus in viral meningitis?
A. Gram stain of CSF
B. Xpert EV test
C. Complete blood count (CBC)
D. Polymerase chain reaction (PCR)
Answer: B. Xpert EV test
Rationale: The Xpert EV test uses a CSF sample to quickly confirm the presence of enterovirus, with results available within hours.
What CSF findings are most consistent with viral meningitis?
A. High protein, low glucose, neutrophilic predominance
B. Normal protein, normal glucose, lymphocytic predominance
C. High protein, low glucose, lymphocytic predominance
D. Low protein, high glucose, no white blood cells
Answer: B. Normal protein, normal glucose, lymphocytic predominance
Rationale: Viral meningitis typically presents with normal protein and glucose levels in CSF, along with lymphocytic predominance.
A nurse is caring for a patient with suspected viral meningitis. Which imaging study is most commonly performed before a lumbar puncture to rule out complications?
A. Magnetic resonance imaging (MRI)
B. X-ray of the skull
C. Computed tomography (CT) scan
D. Positron emission tomography (PET) scan
Answer: C. Computed tomography (CT) scan
Rationale: A CT scan is often performed before a lumbar puncture to rule out increased intracranial pressure or obstructive lesions.
What is the primary treatment approach for viral meningitis?
A. High-dose IV antibiotics
B. Symptomatic management and supportive care
C. Long-term antiviral medications
D. Surgical drainage of excess CSF
Answer: B. Symptomatic management and supportive care
Rationale: Viral meningitis is self-limiting, and treatment focuses on managing symptoms such as fever and pain.
Which statement by a patient recovering from viral meningitis indicates a need for further teaching?
A. “I can expect a full recovery from this illness.”
B. “Antibiotics are needed to treat this viral infection.”
C. “Persistent headaches may occur after recovery.”
D. “I should rest and stay hydrated to help my recovery.”
Answer: B. “Antibiotics are needed to treat this viral infection.”
Rationale: Antibiotics are not effective against viral infections and are only used initially until bacterial meningitis is ruled out.
A patient with viral meningitis reports persistent headaches weeks after diagnosis. What is the most appropriate nursing intervention?
A. Recommend over-the-counter pain medications such as acetaminophen
B. Initiate antibiotics to prevent complications
C. Perform a repeat lumbar puncture to rule out bacterial infection
D. Encourage bed rest and limit fluid intake
Answer: A. Recommend over-the-counter pain medications such as acetaminophen
Rationale: Persistent headaches are a common sequela of viral meningitis and can be managed with appropriate pain medications. Antibiotics and fluid restriction are not indicated in this case.
Which of the following best defines encephalitis?
A. Chronic inflammation of the meninges
B. Acute inflammation of the brain tissue
C. Degeneration of the cerebral cortex
D. Infection of the spinal cord
Answer: B. Acute inflammation of the brain tissue
Rationale: Encephalitis is defined as an acute inflammation of the brain, typically caused by viral infections.
What is the most common cause of acute nonepidemic viral encephalitis?
A. Measles virus
B. Cytomegalovirus
C. Herpes simplex virus (HSV)
D. West Nile virus
Answer: C. Herpes simplex virus (HSV)
Rationale: HSV is the most common cause of acute nonepidemic viral encephalitis and requires prompt antiviral treatment.
Which of the following is a significant risk factor for developing epidemic encephalitis?
A. Traveling to areas with tick or mosquito populations
B. History of chronic sinus infections
C. Recent exposure to someone with bacterial meningitis
D. Receiving the MMR vaccine
Answer: A. Traveling to areas with tick or mosquito populations
Rationale: Epidemic encephalitis is often transmitted by mosquitoes and ticks, with viruses like West Nile and eastern equine encephalitis.
A nurse is assessing a patient with encephalitis. Which clinical manifestation is most concerning?
A. Headache and photophobia
B. Nausea and vomiting
C. Personality changes and decreased LOC
D. Fever and fatigue
Answer: C. Personality changes and decreased LOC
Rationale: Personality changes and decreased LOC indicate central nervous system involvement, which may progress to severe complications like seizures or coma.
What cerebrospinal fluid (CSF) findings are most indicative of viral encephalitis?
A. Normal glucose, elevated protein, lymphocytic pleocytosis
B. Low glucose, elevated protein, neutrophilic predominance
C. High glucose, low protein, and no white blood cells
D. Low protein, low glucose, neutrophilic predominance
Answer: A. Normal glucose, elevated protein, lymphocytic pleocytosis
Rationale: In viral encephalitis, CSF typically shows normal glucose, elevated protein, and lymphocytic predominance due to the viral inflammatory response.
A patient over 50 years old presents with fever, headache, and altered mental status during late summer. Which test would be most appropriate for diagnosing West Nile encephalitis?
A. Blood test for viral RNA
B. MRI of the brain
C. PET scan
D. Lumbar puncture with Gram stain
Answer: A. Blood test for viral RNA
Rationale: A blood test to detect viral RNA is the preferred diagnostic test for West Nile encephalitis, especially in patients over 50 during mosquito season.
Which diagnostic test is most effective for detecting herpes simplex virus (HSV) in encephalitis?
A. X-ray of the skull
B. Polymerase chain reaction (PCR) of CSF
C. CT scan without contrast
D. Serum antibody titers
Answer: B. Polymerase chain reaction (PCR) of CSF
Rationale: PCR testing of CSF is highly sensitive and specific for detecting HSV in viral encephalitis.
What is the primary treatment for HSV encephalitis?
A. Acyclovir (Zovirax)
B. Broad-spectrum antibiotics
C. IV corticosteroids
D. Antipyretics and fluid restriction
Answer: A. Acyclovir (Zovirax)
Rationale: Acyclovir is the antiviral treatment of choice for HSV encephalitis. It reduces mortality and should be initiated early.
A nurse is teaching a community group about preventing encephalitis. Which statement indicates effective understanding?
A. “We should avoid crowded places during flu season.”
B. “Using insect repellent can help prevent mosquito-borne encephalitis.”
C. “Drinking bottled water can reduce the risk of viral encephalitis.”
D. “Taking daily vitamins will boost our immunity against encephalitis.”
Answer: B. “Using insect repellent can help prevent mosquito-borne encephalitis.”
Rationale: Insect repellent is an effective preventive measure against mosquito-borne viruses, such as those causing epidemic encephalitis.
Which imaging studies are commonly used in diagnosing encephalitis?
A. X-ray and ultrasound
B. LP, CT, MRI, and PET scans
C. Fluoroscopy and angiography
D. Doppler studies and echocardiography
Answer: B. LP, CT, MRI, and PET scans
Rationale: LP, CT, MRI, and PET scans are used to assess brain inflammation and complications such as cerebral edema or hemorrhage in encephalitis.
A patient with acute pyelonephritis presents with fever, flank pain, and dysuria. What is the priority nursing intervention?
A. Administer antipyretics
B. Obtain a urine culture
C. Encourage fluid intake
D. Administer prescribed antibiotics
Correct Answer: B. Obtain a urine culture
Rationale: A urine culture should be collected before administering antibiotics to identify the causative organism and guide treatment.
Which statement by a patient with pyelonephritis indicates the need for further teaching?
A. “I will take all my prescribed antibiotics.”
B. “I can stop the antibiotics when I feel better.”
C. “Drinking fluids is essential to flush out bacteria.”
D. “I should contact my provider if my symptoms worsen.”
Correct Answer: B. “I can stop the antibiotics when I feel better.”
Rationale: Patients must complete their full course of antibiotics to prevent recurrence or resistance.
A patient with glomerulonephritis reports periorbital edema and cola-colored urine. Which is the priority nursing intervention?
A. Assess blood pressure
B. Monitor urine output
C. Administer diuretics
D. Collect a 24-hour urine sample
Correct Answer: A. Assess blood pressure
Rationale: Hypertension is a common and potentially severe complication of glomerulonephritis.
What laboratory finding is expected in a patient with glomerulonephritis?
A. Decreased serum albumin
B. Elevated GFR
C. Hypokalemia
D. Increased hemoglobin
Correct Answer: A. Decreased serum albumin
Rationale: Proteinuria in glomerulonephritis leads to hypoalbuminemia.
A patient with suspected urinary calculi reports severe flank pain radiating to the groin. What is the priority diagnostic test?
A. Urinalysis
B. Abdominal ultrasound
C. Intravenous pyelogram
D. Non-contrast CT scan
Correct Answer: D. Non-contrast CT scan
Rationale: A CT scan is the gold standard for detecting urinary calculi and determining size and location.
Which dietary recommendation should a nurse provide to prevent calcium oxalate stones?
A. Increase intake of spinach and nuts
B. Reduce sodium and animal protein
C. Consume more citrus fruits
D. Limit calcium intake
Correct Answer: B. Reduce sodium and animal protein
Rationale: High sodium and animal protein can increase calcium excretion, raising the risk of stone formation.
A patient with stage 4 CKD reports fatigue and pruritus. What should the nurse monitor?
A. Serum potassium levels
B. Blood glucose levels
C. Urine output
D. Hemoglobin levels
Correct Answer: A. Serum potassium levels
Rationale: Hyperkalemia is a life-threatening complication in advanced CKD.
What dietary advice is appropriate for a patient with CKD?
A. High protein, low phosphorus
B. Increased fluids and potassium
C. Low sodium, low potassium
D. Low carbohydrate, high calcium
Correct Answer: C. Low sodium, low potassium
Rationale: Sodium and potassium restriction helps manage fluid balance and hyperkalemia in CKD.
What clinical sign is characteristic of meningitis?
A. Brudzinski’s sign
B. Babinski reflex
C. Kernig’s sign
D. A and C
Correct Answer: D. A and C
Rationale: Both Brudzinski’s and Kernig’s signs are indicative of meningeal irritation.
What is the hallmark clinical manifestation of acute pyelonephritis?
A. Hypertension
B. Flank pain and fever
C. Hematuria and edema
D. Dysuria with clear urine
Correct Answer: B. Flank pain and fever
Rationale: Acute pyelonephritis typically presents with fever, chills, and flank pain.
Which diagnostic finding is consistent with pyelonephritis?
A. Positive blood cultures
B. Proteinuria without hematuria
C. Positive nitrites and leukocyte esterase in urine
D. Low urine-specific gravity
Correct Answer: C. Positive nitrites and leukocyte esterase in urine
Rationale: These findings indicate bacterial infection in the urinary tract.
What is the priority nursing intervention for a patient with pyelonephritis?
A. Place on bed rest
B. Encourage oral fluids
C. Administer IV antibiotics
D. Insert a Foley catheter
Correct Answer: C. Administer IV antibiotics
Rationale: Early antibiotic therapy is critical to treat the infection.
What is essential in patient education for preventing recurrent pyelonephritis?
A. Avoiding fluid intake before bedtime
B. Using perfumed hygiene products
C. Completing the full course of antibiotics
D. Limiting physical activity
Correct Answer: C. Completing the full course of antibiotics
Rationale: Completing antibiotics ensures eradication of the infection.
Which symptom is most indicative of acute glomerulonephritis?
A. Frothy urine
B. Severe abdominal pain
C. Polyuria
D. Dark urine (Cola-colored urine)
Correct Answer: D. Dark urine (Cola-colored urine)
Rationale: Hematuria gives urine a dark or cola-colored appearance in glomerulonephritis.
What is a priority nursing action for a patient with acute glomerulonephritis?
A. Restrict sodium and fluids
B. Monitor blood glucose levels
C. Administer insulin as needed
D. Encourage protein-rich foods
Correct Answer: A. Restrict sodium and fluids
Rationale: Fluid and sodium restrictions help manage edema and hypertension.
What is the most effective nursing intervention for acute pain caused by kidney stones?
A. Encourage ambulation
B. Apply a heating pad to the lower abdomen
C. Administer prescribed analgesics
D. Restrict fluid intake
Correct Answer: C. Administer prescribed analgesics
Rationale: Pain management is a priority in patients with kidney stones.
Which patient statement indicates effective teaching for preventing kidney stones?
A. “I will increase my intake of dairy products.”
B. “I need to drink at least 2 to 3 liters of fluid daily.”
C. “I should avoid all green vegetables.”
D. “I will limit physical activity.”
Correct Answer: B. “I need to drink at least 2 to 3 liters of fluid daily.”
Rationale: Adequate hydration helps prevent stone formation.
Which finding is a complication of CKD?
A. Hypercalcemia
B. Hyperkalemia
C. Metabolic alkalosis
D. Polycythemia
Correct Answer: B. Hyperkalemia
Rationale: CKD impairs potassium excretion, leading to hyperkalemia.
Which dietary recommendation is appropriate for a patient with CKD?
A. High potassium, high protein
B. Low protein, low phosphorus
C. Low calcium, low sodium
D. High carbohydrate, high potassium
Correct Answer: B. Low protein, low phosphorus
Rationale: Reducing protein and phosphorus intake minimizes kidney workload and prevents complications.
What is a key sign of bacterial meningitis?
A. Positive Kernig’s sign
B. Positive Babinski reflex
C. Decreased deep tendon reflexes
D. Hyperglycemia
Correct Answer: A. Positive Kernig’s sign
Rationale: Kernig’s sign indicates meningeal irritation.
Which is the priority nursing intervention for bacterial meningitis?
A. Administer antipyretics
B. Provide seizure precautions
C. Place the patient in droplet isolation
D. Monitor blood pressure
Correct Answer: C. Place the patient in droplet isolation
Rationale: Droplet isolation prevents the spread of infection.
What is a common clinical manifestation of encephalitis?
A. Hypotension
B. Seizures
C. Peripheral edema
D. Jaundice
Correct Answer: B. Seizures
Rationale: Encephalitis can cause cerebral irritation, leading to seizures.
What is the priority medication for ischemic stroke?
A. Heparin
B. Alteplase (tPA)
C. Warfarin
D. Aspirin
Correct Answer: B. Alteplase (tPA)
Rationale: tPA dissolves clots and restores blood flow in ischemic stroke.
Which assessment finding is specific to a hemorrhagic stroke?
A. Sudden severe headache
B. Gradual onset of weakness
C. Numbness of the face
D. Dysarthria
Correct Answer: A. Sudden severe headache
Rationale: A “thunderclap” headache is characteristic of hemorrhagic stroke.
What is the immediate nursing intervention during a generalized seizure?
A. Restrain the patient
B. Protect the patient’s airway
C. Administer oxygen
D. Place the patient in a supine position
Correct Answer: B. Protect the patient’s airway
Rationale: Maintaining airway patency is critical during a seizure.
What is a hallmark symptom of multiple sclerosis?
A. Unilateral weakness
B. Polyuria
C. Visual issues (ie, diplopia)
D. Bradykinesia
Correct Answer: C. Visual issues (ie, diplopia).
Rationale: Visual disturbances, such as double vision, are common in MS.
Which medication is commonly used in myasthenia gravis?
A. Pyridostigmine
B. Methotrexate
C. Furosemide
D. Propranolol
Correct Answer: A. Pyridostigmine
Rationale: Pyridostigmine enhances communication between nerves and muscles because it has an anticholinergic agent.
Which laboratory finding is most consistent with pyelonephritis?
A. Low white blood cell (WBC) count
B. Presence of casts in the urine
C. Elevated serum creatinine only
D. Decreased specific gravity of urine
Correct Answer: B. Presence of casts in the urine
Rationale: White blood cell casts in the urine are indicative of upper urinary tract infection.
What is a key teaching point for a patient at risk of recurrent pyelonephritis?
A. “Take cranberry supplements daily.”
B. “Avoid emptying your bladder frequently.”
C. “Urinate after sexual activity.”
D. “Restrict your fluid intake at bedtime.”
Correct Answer: C. “Urinate after sexual activity.”
Rationale: Post-coital voiding helps flush out bacteria and reduces infection risk.
A patient with post-streptococcal glomerulonephritis should avoid which dietary item?
A. Whole-grain bread
B. Fresh fruits
C. Processed meats
D. Leafy greens
Correct Answer: C. Processed meats
Rationale: Processed meats are high in sodium, which can exacerbate hypertension and fluid retention.
What is the primary treatment goal for acute glomerulonephritis?
A. Increase protein intake
B. Manage fluid overload and hypertension
C. Enhance renal perfusion
D. Treat hyperkalemia
Correct Answer: B. Manage fluid overload and hypertension
Rationale: Managing blood pressure and fluid balance is essential to prevent complications.
A patient has a uric acid kidney stone. What dietary recommendation should the nurse provide?
A. Avoid high-purine foods such as organ meats and shellfish.
B. Increase intake of dairy products.
C. Restrict sodium and calcium intake.
D. Consume more oxalate-rich foods like spinach.
Correct Answer: A. Avoid high-purine foods such as organ meats and shellfish.
Rationale: Uric acid stones are associated with a high-purine diet.
What is the most common initial clinical manifestation of urinary calculi?
A. Fever and chills
B. Severe, colicky flank pain
C. Hematuria without pain
D. Edema in lower extremities
Correct Answer: B. Severe, colicky flank pain
Rationale: Acute pain occurs as the stone moves through the urinary tract.
Which stage of CKD is characterized by a GFR of 15–29 mL/min/1.73m²?
A. Stage 1
B. Stage 2
C. Stage 4
D. Stage 5
Correct Answer: C. Stage 4
Rationale: Stage 4 CKD involves severe reduction in GFR.
Which clinical finding in a patient with CKD indicates the need for immediate intervention?
A. Serum potassium of 6.5 mEq/L
B. Serum calcium of 8.0 mg/dL
C. Hemoglobin of 9 g/dL
D. GFR of 25 mL/min/1.73m²
Correct Answer: A. Serum potassium of 6.5 mEq/L
Rationale: Hyperkalemia poses a risk for cardiac arrhythmias and requires urgent intervention.
What is an early clinical sign of meningitis?
A. Nuchal rigidity
B. Widened pulse pressure
C. Cyanosis
D. Peripheral edema
Correct Answer: A. Nuchal rigidity
Rationale: Stiffness in the neck is a hallmark of meningitis.
Which cerebrospinal fluid (CSF) finding is consistent with bacterial meningitis?
A. Clear appearance, low protein
B. Cloudy appearance, elevated WBCs and protein, with low glucose
C. Normal glucose levels and elevated protein.
D. Increased red blood cells
Correct Answer: B. Cloudy appearance, elevated WBCs protein, with low glucose
Rationale: Bacterial meningitis typically presents with purulent CSF and elevated WBCs.
What is the cornerstone treatment for viral encephalitis?
A. Intravenous antibiotics
B. Antiviral medications and supportive care
C. Corticosteroid therapy
D. Plasma exchange
Correct Answer: B. Antiviral medications and supportive care
Rationale: Antiviral medications like acyclovir are used, with supportive measures to manage symptoms.
Which virus is the most common cause of encephalitis in the United States?
A. West Nile virus
B. Hepatitis C virus
C. Influenza virus
D. HIV
Correct Answer: A. West Nile virus
Rationale: West Nile virus is the leading cause of viral encephalitis in the U.S.
What is the most common risk factor for ischemic stroke?
A. Smoking
B. Hypertension
C. Atrial fibrillation
D. Diabetes mellitus
Correct Answer: B. Hypertension
Rationale: Hypertension is the leading modifiable risk factor for stroke.
What is the primary goal of therapy during the acute phase of an ischemic stroke?
A. Decrease intracranial pressure
B. Maintain cerebral perfusion
C. Prevent infection
D. Reduce body temperature
Correct Answer: B. Maintain cerebral perfusion
Rationale: Adequate cerebral perfusion prevents further ischemic damage.
Which action should the nurse take first for a patient experiencing status epilepticus?
A. Administer lorazepam
B. Place the patient in a side-lying position
C. Monitor oxygen saturation
D. Call the provider immediately
Correct Answer: A. Administer lorazepam
Rationale: Benzodiazepines are the first-line treatment for status epilepticus.
What is a key nursing consideration for a patient with myasthenia gravis?
A. Schedule activities in the afternoon
B. Administer medications before meals
C. Increase environmental stimuli
D. Avoid anticholinesterase medications
Correct Answer: B. Administer medications before meals
Rationale: Medications enhance muscle strength, making eating safer.
What is the goal of disease-modifying therapies in multiple sclerosis?
A. Cure the disease
B. Relieve all symptoms
C. Reduce the frequency of relapses
D. Eliminate fatigue
Correct Answer: C. Reduce the frequency of relapses
Rationale: These therapies slow disease progression and reduce relapse rates.
Which factor increases a patient’s risk for developing pyelonephritis?
A. Chronic use of NSAIDs
B. Recurrent urinary tract infections
C. High fluid intake
D. Regular physical activity
Correct Answer: B. Recurrent urinary tract infections
Rationale: Recurrent UTIs can allow bacteria to ascend into the upper urinary tract, leading to pyelonephritis.
Which finding is most concerning in a patient with pyelonephritis?
A. Temperature of 101.2°F (38.4°C)
B. Costovertebral angle tenderness
C. Worsening flank pain despite antibiotic therapy
D. Frequent urination
Correct Answer: C. Worsening flank pain despite antibiotic therapy
Rationale: Persistent or worsening pain may indicate treatment failure or a complication like an abscess.
Which intervention is a priority for a patient with severe edema due to glomerulonephritis?
A. Increase fluid intake
B. Maintain bed rest
C. Administer loop diuretics as prescribed
D. Restrict dietary potassium
Correct Answer: C. Administer loop diuretics as prescribed
Rationale: Diuretics help manage fluid retention and reduce edema in glomerulonephritis.
What is a common cause of acute glomerulonephritis?
A. Hypertension
B. Group A beta-hemolytic streptococcal infection
C. Hepatitis B
D. Diabetes mellitus
Correct Answer: B. Group A beta-hemolytic streptococcal infection
Rationale: Post-streptococcal glomerulonephritis occurs after an untreated or inadequately treated streptococcal infection.
What nursing intervention is essential after lithotripsy for kidney stones?
A. Keep the patient NPO for 24 hours
B. Strain all urine
C. Administer anti-diarrheal medications
D. Restrict fluid intake
Correct Answer: B. Strain all urine
Rationale: Straining urine allows the collection of stone fragments for analysis.
Which patient is at the highest risk for developing calcium phosphate kidney stones?
A. A patient with gout
B. A patient who is immobile
C. A patient with recurrent infections
D. A patient who consumes excessive caffeine
Correct Answer: B. A patient who is immobile
Rationale: Immobility can lead to bone resorption, increasing calcium levels and the risk of stone formation.
What is a common complication in patients with end-stage renal disease?
A. Hypernatremia
B. Anemia
C. Polyuria
D. Hypercalcemia
Correct Answer: B. Anemia
Rationale: Decreased erythropoietin production in CKD leads to anemia.
Which laboratory value is expected in a patient with stage 5 CKD?
A. Increased serum phosphate
B. Decreased serum potassium
C. Elevated hematocrit
D. Decreased creatinine
Correct Answer: A. Increased serum phosphate
Rationale: CKD results in impaired phosphate excretion, leading to hyperphosphatemia.
Which action is appropriate when performing a lumbar puncture on a patient with suspected meningitis?
A. Place the patient in a prone position
B. Administer antibiotics after the procedure
C. Position the patient sitting upright
D. Ensure the patient is well-hydrated
Correct Answer: B. Administer antibiotics after the procedure
Rationale: Antibiotics should be initiated promptly to reduce the risk of complications.
What clinical manifestation differentiates viral from bacterial meningitis?
A. Fever
B. Stiff neck
C. Normal glucose levels in cerebrospinal fluid
D. Severe headache
Correct Answer: C. Normal glucose levels in cerebrospinal fluid
Rationale: Viral meningitis often presents with normal glucose levels, while bacterial meningitis causes decreased glucose.
What is a priority nursing action for a patient diagnosed with encephalitis?
A. Monitor for increased intracranial pressure
B. Restrict fluids to prevent cerebral edema
C. Administer prophylactic antibiotics
D. Assess for peripheral edema
Correct Answer: A. Monitor for increased intracranial pressure
Rationale: Cerebral edema can lead to increased intracranial pressure, a severe complication of encephalitis.
Which symptom indicates worsening encephalitis?
A. Decreased level of consciousness
B. Persistent headache
C. Nausea and vomiting
D. Fever of 101°F
Correct Answer: A. Decreased level of consciousness
Rationale: A decline in mental status suggests worsening inflammation or increased intracranial pressure.
What is the primary nursing intervention for a patient with dysphagia following a stroke?
A. Place the patient in a supine position
B. Provide a full liquid diet
C. Ensure the patient is upright during meals
D. Insert a nasogastric tube
Correct Answer: C. Ensure the patient is upright during meals
Rationale: Upright positioning minimizes the risk of aspiration.
What finding suggests a transient ischemic attack (TIA) rather than a stroke?
A. Symptoms resolve within 24 hours
B. Persistent motor deficits
C. Positive Babinski reflex
D. Hemorrhage on imaging
Correct Answer: A. Symptoms resolve within 24 hours
Rationale: TIAs are temporary episodes of neurologic dysfunction without lasting damage.
Which teaching point is essential for a patient with epilepsy?
A. “You can stop taking medication if your seizures stop.”
B. “Avoid alcohol and fatigue as they may trigger seizures.”
C. “Driving is safe as long as you take your medications.”
D. “You should restrain yourself during a seizure.”
Correct Answer: B. “Avoid alcohol and fatigue as they may trigger seizures.”
Rationale: Alcohol and fatigue are common seizure triggers, and avoiding them helps reduce seizure frequency.
Case: A 32-year-old female presents to the emergency department with a fever of 101.8°F (38.8°C), flank pain, dysuria, and nausea. A urinalysis shows positive nitrites and leukocyte esterase. The patient is diagnosed with acute pyelonephritis.
Question: What is the priority nursing intervention for this patient?
A. Administer the prescribed oral antibiotics and discharge the patient.
B. Obtain blood and urine cultures before initiating antibiotics.
C. Encourage the patient to drink at least 2 liters of fluid per day.
D. Provide acetaminophen for fever relief.
Correct Answer: B. Obtain blood and urine cultures before initiating antibiotics. Then A, D, and B.
Rationale: Cultures are essential to identify the causative organism and guide antibiotic therapy. Antibiotics should be started after cultures are obtained.
Case: A 10-year-old boy is brought to the clinic with swelling around his eyes and dark, cola-colored urine. The mother reports a sore throat two weeks ago that resolved without treatment. Laboratory tests reveal hematuria, proteinuria, and elevated antistreptolysin O (ASO) titers.
Question: What is the most appropriate nursing action?
A. Encourage a high-protein diet.
B. Restrict sodium and fluid intake.
C. Administer corticosteroids as prescribed.
D. Obtain a throat culture.
Correct Answer: B. Restrict sodium and fluid intake.
Rationale: Sodium and fluid restrictions help manage edema and hypertension commonly seen in glomerulonephritis.
Case: A 45-year-old male presents with severe colicky flank pain radiating to the groin, hematuria, and nausea. A CT scan confirms the presence of a 6 mm calcium oxalate stone in the ureter.
Question: What is the priority nursing intervention?
A. Encourage the patient to ambulate frequently.
B. Administer prescribed IV fluids and analgesics.
C. Educate the patient to avoid high-calcium foods.
D. Prepare the patient for immediate lithotripsy.
Correct Answer: B. Administer prescribed IV fluids and analgesics.
Rationale: IV fluids promote urine flow to help pass the stone, and analgesics are crucial for managing severe pain.
Case: A 20-year-old college student presents with a fever, headache, photophobia, and nuchal rigidity. A lumbar puncture reveals cloudy cerebrospinal fluid with elevated WBCs and decreased glucose levels.
Question: What is the priority nursing action?
A. Administer prescribed antibiotics immediately.
B. Place the patient in a private room with droplet precautions.
C. Administer acetaminophen for fever.
D. Encourage the patient to increase oral fluid intake.
Correct Answer: B. Please patient in a private room with droplet precaution. Then administer prescribed antibiotics immediately after LP.
Rationale: Bacterial meningitis requires prompt antibiotic treatment to prevent complications and reduce mortality.
Case: A 65-year-old patient with stage 4 CKD reports fatigue, pruritus, and swollen legs. Lab results reveal potassium 6.2 mEq/L, hemoglobin 9 g/dL, and GFR 25 mL/min.
Question: What is the nurse’s priority intervention?
A. Administer erythropoietin as prescribed.
B. Restrict dietary potassium and administer sodium polystyrene sulfonate (Kayexalate).
C. Encourage the patient to increase fluid intake.
D. Prepare the patient for hemodialysis.
Correct Answer: B. Restrict dietary potassium and administer sodium polystyrene sulfonate (Kayexalate).
Rationale: Hyperkalemia is life-threatening and must be managed immediately. Kayexalate helps lower potassium levels.
Case: A 50-year-old patient presents with a fever, confusion, and seizures. The patient recently returned from a trip to an area with high mosquito activity. MRI shows inflammation of the brain. The provider suspects viral encephalitis.
Question: What is the nurse’s priority intervention?
A. Administer intravenous acyclovir as prescribed.
B. Encourage the patient to rest and avoid stimuli.
C. Perform frequent neurological checks.
D. Administer antipyretics for fever.
Correct Answer: D. But administer intravenous acyclovir as prescribed if virus was HSV
Rationale: Acyclovir is the treatment of choice for viral encephalitis, particularly herpes simplex virus-related cases.
Case: A 70-year-old patient presents with right-sided weakness, facial drooping, and slurred speech. The patient’s symptoms began 90 minutes ago. A CT scan confirms an ischemic stroke.
Question: What is the priority nursing action?
A. Administer tissue plasminogen activator (tPA) as prescribed.
B. Elevate the patient’s legs to improve circulation.
C. Administer aspirin immediately.
D. Perform a swallowing evaluation before feeding.
Correct Answer: A. Administer tissue plasminogen activator (tPA) as prescribed.
Rationale: tPA is the gold standard for ischemic stroke within 4.5 hours of symptom onset to restore cerebral blood flow.
Case: A 25-year-old female with a history of epilepsy presents to the emergency department after experiencing a tonic-clonic seizure that lasted 6 minutes.
Question: What is the priority intervention?
A. Administer intravenous lorazepam as prescribed.
B. Place the patient in a supine position.
C. Check the patient’s blood glucose level.
D. Document the seizure duration and characteristics.
Correct Answer: A. Administer intravenous lorazepam as prescribed.
Rationale: Prolonged seizures (status epilepticus) require immediate treatment with benzodiazepines to stop seizure activity.
Case: A 38-year-old patient with relapsing-remitting multiple sclerosis reports fatigue, muscle weakness, and difficulty walking. The patient is concerned about worsening symptoms.
Question: What is the best nursing intervention?
A. Encourage bed rest to reduce fatigue.
B. Administer prescribed corticosteroids for acute relapse.
C. Teach the patient to perform exercises during exacerbations.
D. Increase the patient’s protein intake.
Correct Answer: B. Administer prescribed corticosteroids for acute relapse.
Rationale: Corticosteroids reduce inflammation and manage acute MS exacerbations.
Case: A 55-year-old patient with myasthenia gravis reports increasing muscle weakness and difficulty swallowing. The patient is scheduled for a dose of pyridostigmine.
Question: What is the priority nursing action?
A. Administer pyridostigmine 30 minutes before meals.
B. Withhold the medication and notify the provider.
C. Perform a neurological assessment before administering the medication.
D. Place the patient in a semi-Fowler’s position.
Correct Answer: A. Administer pyridostigmine 30 minutes before meals.
Rationale: Pyridostigmine improves muscle strength and should be timed before meals to enhance swallowing and reduce aspiration risk.
