NR 603 WEEK 1 EXAM 1 |2026-2027
VERIFIED QUESTIONS AND CORRECT
ANSWERS WITH EXPLANATIONS GRADED
A+ CHAMBERLAIN
A 31-year-old woman presents with a purpural rash covering her arms, legs, and abdomen. She
also has fever, chills, nausea, abdominal tenderness, tachycardia, and generalized myalgias. Prior
to the development of the rash, the patient noted that she had a headache, cough, and sore throat.
Laboratory studies were positive for Gram-negative diplococci in the blood, along with
thrombocytopenia and an elevation in PMNs. Urinalysis showed blood, protein, and casts. Vital
signs are as follows: PB 92/66, P 96, RR 14, T 39. The patient denies any foreign travel and does
not have any sick contacts. However, she does work part time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the hospital and placed in
respiratory isolation. What major course of therapy should this patient receive?
Answer Choices
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici
Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred drug for active
infection is penicillin G. For those allergic to penicillin, chloramphenicol and cephalosporins (ie,
cefotaxime, cefuroxime) may be used as alternatives.
,Patients will also receive supportive care, but antibiotic therapy must be initiated quickly if the
patient is to survive. Intensive care placement may be necessary if organ failure is imminent.
Ventilatory support, inotropic support, and IV fluids are necessary in some. If adrenal
insufficiency occurs, corticosteroid replacement may be considered. A central venous line helps
to provide large amounts of volume expanders and inotropic medications for adequate tissue
perfusion.
Steroids have not been shown to play a major role in the treatment of meningococcemia.
However, they have been used in addition to antibiotic therapy. In the case of adrenal
insufficiency, for example, steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient suffers from a
devastating coagulopathy, blood or blood products may be replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the granules of neutrophils. It
binds to endotoxin in vitro and neutralizes it. This technique is experimental, and it is not used in
everyday treatment of meningococcemia.
In myasthenia gravis, weakness is a result of insufficient acetylcholine transmission at the
neuromuscular junction; however, weakness can also occur with overdosing of the cholinergic
medications used to treat myasthenia. What symptom helps differentiate a myasthenic crisis from
a cholinergic crisis?
Answer Choices
1 Respiratory failure
2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
ANS: 3
Muscle Fasiculations
,Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea, lacrimation, salivation,
increased bronchial secretions, nausea, or diarrhea. The presence of any of these suggests that the
patient's weakness may be due to cholinergic crisis. The other signs are due to weakness and can
occur in either condition.
A 54-year-old man presents after having a generalized seizure. The patient is HIV positive, but
he has been unable to afford antiretroviral therapy since losing his job 2 years ago. Other than
cachexia, the physical exam is unremarkable. Upon further inquiry, the patient also notes that he
has become short-tempered and hypercritical; at times, he seems confused. An MRI of the brain
is performed, and it reveals several cortical ring-enhancing lesions.
Question
What is the most likely diagnosis?
Answer Choices
1 AIDS dementia complex
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis
4 Progressive multifocal leukoencephalopathy
5 Toxoplasma encephalitis
ANS:5
Toxoplasma encephalitis
The patient's symptoms and MRI findings are most consistent with the diagnosis of toxoplasma
encephalitis. Toxoplasmosis is the most common cerebral mass lesion among HIV-positive
patients. Infection with the Toxoplasma gondii parasite is relatively common and usually
asymptomatic. Reactivation occurs in HIV positive patients due to failing cellular immunity, and
it causes a multifocal necrotizing encephalitis. Seizures may be the initial manifestation of
central nervous system (CNS) infection; other common clinical manifestations include focal
neurologic deficits, such as impaired speech and hemiparesis. Personality change, lethargy,
headache, and confusion are also observed. The MRI in patients with toxoplasma encephalitis
characteristically reveals multiple, ring-enhancing lesions with surrounding edema; these lesions
usually occur bilaterally in the frontal and parietal cortices.
AIDS dementia complex describes a constellation of cognitive symptoms seen among HIV
positive patients. The condition occurs when HIV virus disseminates to the CNS. Within the
, CNS, the virus tends to concentrate in the basal ganglia and subcortical regions. Symptoms
include a constellation of cognitive, behavioral, and motor disturbances that cause varying
degrees of functional impairment. Characteristic MRI findings include non-enhancing white
matter, cerebral atrophy, and ventricular enlargement. The diagnosis requires that other central
nervous system infections, carcinoma, as well as general medical conditions and substance abuse
have been excluded.
Cryptococcal meningitis is caused by the encapsulated fungus Cryptococcus neoformans.
Among HIV positive patients, the illness may be the result of new infection or reactivation of
latent infection. Presenting signs are often nonspecific; they include headache, fev
A 1-year-old boy presents with increasing lethargy. He is barely responsive, and his parents deny
any trauma or injury. What is the most common cause of nontraumatic altered levels of
consciousness?
Answer Choices
1 Seizure disorder
2 Diabetic ketoacidosis
3 Inborn errors of metabolism
4 Toxic ingestion
5 Infection
ANS:5
infection
Awareness of self and the surrounding environment or consciousness may be altered into
different abnormal states of consciousness. Consciousness can shift from loss of clear thinking or
confusion, usually accompanied by disorientation, to delirium, a succession of confused and
unconnected ideas manifested in children as extreme mental and motor excitement, to lethargy, a
profound type of slumber where movement or speech is limited, to stupor or deep sleep where
arousal is achieved only by repeated vigorous stimuli, finally to coma, unresponsiveness to even
painful stimuli. Non-traumatic coma is most common in infants and toddlers with another
smaller peak of occurrence in adolescence. The most common cause of non-traumatic altered
level of consciousness in children is infection of either the brain (encephalitis), meninges
(meningitis), or both; infections account for more than 1/3 of cases.
VERIFIED QUESTIONS AND CORRECT
ANSWERS WITH EXPLANATIONS GRADED
A+ CHAMBERLAIN
A 31-year-old woman presents with a purpural rash covering her arms, legs, and abdomen. She
also has fever, chills, nausea, abdominal tenderness, tachycardia, and generalized myalgias. Prior
to the development of the rash, the patient noted that she had a headache, cough, and sore throat.
Laboratory studies were positive for Gram-negative diplococci in the blood, along with
thrombocytopenia and an elevation in PMNs. Urinalysis showed blood, protein, and casts. Vital
signs are as follows: PB 92/66, P 96, RR 14, T 39. The patient denies any foreign travel and does
not have any sick contacts. However, she does work part time as a nurse in a local hospital.
Question
The patient is diagnosed with Meningococcemia; she is admitted to the hospital and placed in
respiratory isolation. What major course of therapy should this patient receive?
Answer Choices
1 Steroids
2 Supportive care
3 Antibiotics
4 Transfusion
5 Bacterici
Antibiotics
Antibiotics are the treatment of choice for meningococcemia. The preferred drug for active
infection is penicillin G. For those allergic to penicillin, chloramphenicol and cephalosporins (ie,
cefotaxime, cefuroxime) may be used as alternatives.
,Patients will also receive supportive care, but antibiotic therapy must be initiated quickly if the
patient is to survive. Intensive care placement may be necessary if organ failure is imminent.
Ventilatory support, inotropic support, and IV fluids are necessary in some. If adrenal
insufficiency occurs, corticosteroid replacement may be considered. A central venous line helps
to provide large amounts of volume expanders and inotropic medications for adequate tissue
perfusion.
Steroids have not been shown to play a major role in the treatment of meningococcemia.
However, they have been used in addition to antibiotic therapy. In the case of adrenal
insufficiency, for example, steroid replacement has been shown to be beneficial.
Transfusion does not generally play a major role in treatment. If the patient suffers from a
devastating coagulopathy, blood or blood products may be replaced as necessary.
Bactericidal/permeability-increasing protein is a protein stored in the granules of neutrophils. It
binds to endotoxin in vitro and neutralizes it. This technique is experimental, and it is not used in
everyday treatment of meningococcemia.
In myasthenia gravis, weakness is a result of insufficient acetylcholine transmission at the
neuromuscular junction; however, weakness can also occur with overdosing of the cholinergic
medications used to treat myasthenia. What symptom helps differentiate a myasthenic crisis from
a cholinergic crisis?
Answer Choices
1 Respiratory failure
2 Bilateral ptosis
3 Muscle fasciculations
4 Diplopia
5 Normal muscle stretch reflexes
ANS: 3
Muscle Fasiculations
,Signs of cholinergic overdosage include muscle fasciculation, rhinorrhea, lacrimation, salivation,
increased bronchial secretions, nausea, or diarrhea. The presence of any of these suggests that the
patient's weakness may be due to cholinergic crisis. The other signs are due to weakness and can
occur in either condition.
A 54-year-old man presents after having a generalized seizure. The patient is HIV positive, but
he has been unable to afford antiretroviral therapy since losing his job 2 years ago. Other than
cachexia, the physical exam is unremarkable. Upon further inquiry, the patient also notes that he
has become short-tempered and hypercritical; at times, he seems confused. An MRI of the brain
is performed, and it reveals several cortical ring-enhancing lesions.
Question
What is the most likely diagnosis?
Answer Choices
1 AIDS dementia complex
2 Cryptococcal meningitis
3 Cytomegalovirus encephalitis
4 Progressive multifocal leukoencephalopathy
5 Toxoplasma encephalitis
ANS:5
Toxoplasma encephalitis
The patient's symptoms and MRI findings are most consistent with the diagnosis of toxoplasma
encephalitis. Toxoplasmosis is the most common cerebral mass lesion among HIV-positive
patients. Infection with the Toxoplasma gondii parasite is relatively common and usually
asymptomatic. Reactivation occurs in HIV positive patients due to failing cellular immunity, and
it causes a multifocal necrotizing encephalitis. Seizures may be the initial manifestation of
central nervous system (CNS) infection; other common clinical manifestations include focal
neurologic deficits, such as impaired speech and hemiparesis. Personality change, lethargy,
headache, and confusion are also observed. The MRI in patients with toxoplasma encephalitis
characteristically reveals multiple, ring-enhancing lesions with surrounding edema; these lesions
usually occur bilaterally in the frontal and parietal cortices.
AIDS dementia complex describes a constellation of cognitive symptoms seen among HIV
positive patients. The condition occurs when HIV virus disseminates to the CNS. Within the
, CNS, the virus tends to concentrate in the basal ganglia and subcortical regions. Symptoms
include a constellation of cognitive, behavioral, and motor disturbances that cause varying
degrees of functional impairment. Characteristic MRI findings include non-enhancing white
matter, cerebral atrophy, and ventricular enlargement. The diagnosis requires that other central
nervous system infections, carcinoma, as well as general medical conditions and substance abuse
have been excluded.
Cryptococcal meningitis is caused by the encapsulated fungus Cryptococcus neoformans.
Among HIV positive patients, the illness may be the result of new infection or reactivation of
latent infection. Presenting signs are often nonspecific; they include headache, fev
A 1-year-old boy presents with increasing lethargy. He is barely responsive, and his parents deny
any trauma or injury. What is the most common cause of nontraumatic altered levels of
consciousness?
Answer Choices
1 Seizure disorder
2 Diabetic ketoacidosis
3 Inborn errors of metabolism
4 Toxic ingestion
5 Infection
ANS:5
infection
Awareness of self and the surrounding environment or consciousness may be altered into
different abnormal states of consciousness. Consciousness can shift from loss of clear thinking or
confusion, usually accompanied by disorientation, to delirium, a succession of confused and
unconnected ideas manifested in children as extreme mental and motor excitement, to lethargy, a
profound type of slumber where movement or speech is limited, to stupor or deep sleep where
arousal is achieved only by repeated vigorous stimuli, finally to coma, unresponsiveness to even
painful stimuli. Non-traumatic coma is most common in infants and toddlers with another
smaller peak of occurrence in adolescence. The most common cause of non-traumatic altered
level of consciousness in children is infection of either the brain (encephalitis), meninges
(meningitis), or both; infections account for more than 1/3 of cases.
