NR 603 WEEK 1 EXAM PRACTICE QUESTIONS COMPLETE WITH VERIFIED ANSWERS

NR 603 WEEK 1 EXAM PRACTICE QUESTIONS COMPLETE WITH VERIFIED ANSWERS 1. A 28-year-old male presents with fever, petechial rash, and signs of septic shock. Blood cultures reveal Neisseria meningitidis. The patient reports a severe allergy to penicillin. Which antibiotic should be prescribed as first-line therapy? A) Vancomycin B) Ceftriaxone C) Doxycycline D) Azithromycin Answer: B) Ceftriaxone Rationale: For patients with meningococcemia who are allergic to penicillin, chloramphenicol and cephalosporins such as ceftriaxone, cefotaxime, and cefuroxime are appropriate alternatives. Ceftriaxone is a third-generation cephalosporin with excellent central nervous system penetration and meningococcal coverage. Vancomycin does not provide adequate coverage for Neisseria meningitidis. Doxycycline and azithromycin are not recommended as first-line agents for this life-threatening infection. ________________________________________ 2. A patient with myasthenia gravis presents with acute respiratory distress and profound weakness. The patient is on pyridostigmine. Which finding would most strongly suggest a cholinergic crisis rather than a myasthenic crisis? A) Bilateral ptosis B) Respiratory failure requiring intubation C) Increased bronchial secretions and salivation D) Normal muscle stretch reflexes Answer: C) Increased bronchial secretions and salivation Rationale: Cholinergic crisis results from overmedication with acetylcholinesterase inhibitors, leading to excessive acetylcholine at muscarinic and nicotinic receptors. Symptoms include muscle fasciculations, rhinorrhea, lacrimation, salivation, increased bronchial secretions, nausea, diarrhea, and bradycardia. Increased bronchial secretions and salivation are hallmark signs of cholinergic excess. Bilateral ptosis, respiratory failure, and normal reflexes can occur in both myasthenic and cholinergic crises and do not help differentiate between them. ________________________________________ 3. A 45-year-old man is diagnosed with meningococcemia. The patient develops hypotension that is unresponsive to fluid resuscitation. Which of the following interventions is most appropriate for managing this patient's hemodynamic instability? A) Initiate norepinephrine infusion B) Administer high-dose corticosteroids C) Transfuse packed red blood cells D) Start dobutamine infusion Answer: A) Initiate norepinephrine infusion Rationale: In septic shock due to meningococcemia, patients may require inotropic support and vasopressor therapy. Norepinephrine is the first-line vasopressor for septic shock according to Surviving Sepsis Campaign guidelines. A central venous line is often necessary to provide large amounts of volume expanders and inotropic medications for adequate tissue perfusion. Corticosteroids are only indicated if adrenal insufficiency occurs. Transfusion is not a primary treatment unless coagulopathy develops. Dobutamine may be considered in certain circumstances but is not the primary agent for hypotension. ________________________________________ 4. A 32-year-old HIV-positive patient with a CD4 count of 45 cells/μL presents with headache, fever, and altered mental status. MRI reveals multiple ring-enhancing lesions in the cerebral cortex. Which diagnosis is most likely? A) AIDS dementia complex B) Cryptococcal meningitis C) Toxoplasmosis D) Primary central nervous system lymphoma Answer: C) Toxoplasmosis Rationale: Toxoplasma encephalitis is the most common cause of ring-enhancing brain lesions in HIV-positive patients with CD4 counts below 100 cells/μL. The typical MRI finding is multiple ring-enhancing lesions, often located in the basal ganglia or corticomedullary junction. AIDS dementia complex presents with cognitive decline without ring-enhancing lesions. Cryptococcal meningitis typically presents with meningitis symptoms and may show cryptococcomas but less commonly ring-enhancing lesions. Primary CNS lymphoma can present with ring enhancement but is less common than toxoplasmosis in this clinical scenario. ________________________________________ 5. A patient with meningococcemia develops adrenal insufficiency. What is the recommended treatment approach? A) Immediate cessation of antibiotics B) Corticosteroid replacement therapy C) Transfusion of fresh frozen plasma D) Initiation of bactericidal/permeability-increasing protein Answer: B) Corticosteroid replacement therapy Rationale: In patients with meningococcemia who develop adrenal insufficiency, corticosteroid replacement has been shown to be beneficial. The adrenal glands can be affected by the hemorrhagic necrosis associated with Waterhouse-Friderichsen syndrome. Steroids have not been shown to play a major role in routine treatment of meningococcemia, but they are indicated when adrenal insufficiency is documented. Antibiotic therapy must continue as the primary treatment. Transfusion is only indicated for coagulopathy, and bactericidal/permeability-increasing protein remains experimental. ________________________________________ 6. Which of the following is considered an experimental treatment for meningococcemia and is NOT used in routine clinical practice? A) Penicillin G B) Cefotaxime