A patient with a history of multiple myeloma presents with weakness, bone pain, and recurrent infections. Laboratory tests reveal anemia, hypercalcemia, renal insufficiency, and monoclonal spike on serum protein electrophoresis. Which of the following conditions is most likely to cause these findings?

Correct Answer: D

Rationale: Multiple myeloma is a plasma cell neoplasm characterized by the presence of abnormal monoclonal plasma cells in the bone marrow, which produce a monoclonal spike on serum protein electrophoresis. The clinical presentation of weakness, bone pain, and recurrent infections is typical of multiple myeloma. Anemia can result from bone marrow infiltration by the abnormal plasma cells, hypercalcemia is due to bone destruction and release of calcium, renal insufficiency can result from hypercalcemia and protein deposition in the kidneys, and the monoclonal spike in serum protein electrophoresis indicates the presence of a monoclonal protein. Waldenström macroglobulinemia, Hodgkin lymphoma, and chronic lymphocytic leukemia do not typically present with the classic tetrad of findings seen in multiple myeloma.

Correct Answer: A

Rationale: Educating the client about the importance of balanced nutrition and frequent monitoring of blood glucose levels should be prioritized to address the client's concerns about managing blood sugar levels while breastfeeding. This intervention helps empower the client to make informed choices about her diet and monitor her blood sugar levels effectively. By focusing on balanced nutrition and regular blood glucose monitoring, the client can better manage her blood sugar levels during the postpartum period and while breastfeeding, reducing the risk of complications associated with gestational diabetes. It also promotes overall health and well-being for both the mother and the baby.

Correct Answer: B

Rationale: T cell exhaustion is a state of T cell dysfunction that arises during chronic viral infections or cancer. In the case of a chronic viral infection, the persistent exposure to viral antigens leads to continuous stimulation of CD8+ cytotoxic T cells. Over time, this sustained stimulation can lead to T cell exhaustion, characterized by the upregulation of inhibitory receptors, impaired effector functions, and reduced proliferative capacity. As a result, despite the elevated levels of CD8+ T cells in the blood, their function may be compromised, ultimately impacting the immune response against the viral infection. In contrast, activation-induced cell death (AICD) may contribute to T cell loss during chronic infections but would not explain the persistently elevated CD8+ T cell levels. Thymic involution refers to the age-related decline in thymus function, which is not directly related to the observed increase in CD8+ T cells. Antigenic

Correct Answer: A

Rationale: A nurse can be charged with negligence when they give the patient the wrong medication. Negligence in healthcare typically refers to a situation where a healthcare provider fails to provide a standard level of care, resulting in harm to the patient. Giving the wrong medication can lead to serious consequences for the patient, including adverse reactions, worsening of the condition, or even death. It is a clear violation of the duty of care that a nurse owes to their patients, and such a mistake can have legal and professional repercussions for the nurse.

Correct Answer: B

Rationale: The best response for a nurse when a patient expresses dissatisfaction with the care they received during their hospital stay is to listen actively to the patient's concerns, apologize for any shortcomings, and offer to address the issues. It is crucial for healthcare providers to acknowledge the patient's perspective, validate their feelings, and work towards resolving any issues that may have contributed to their dissatisfaction. This approach demonstrates empathy, professionalism, and a commitment to patient-centered care, fostering trust and effective communication between the patient and the healthcare team. Dismissing the patient's concerns (option A), ignoring their dissatisfaction (option C), or telling them that their concerns are unfounded (option D) can further escalate the situation and lead to a breakdown in the patient-provider relationship.

Correct Answer: D

Rationale: Spiral CT angiography is the most appropriate test for confirming the diagnosis of pulmonary embolism (PE) in a patient with suspected PE. It is a non-invasive imaging modality that can detect filling defects within the pulmonary vasculature indicative of a clot. This diagnostic test has high sensitivity and specificity for diagnosing PE, making it a valuable tool in the management of patients with suspected PE.

Correct Answer: B

Rationale: In a professional setting like a classroom or a meeting, it is important for the CI (chief instructor) to set the atmosphere by welcoming everyone and discussing the objectives of the ward class. By discussing the objectives, the CI can provide a clear direction for the session and ensure that everyone is on the same page in terms of what needs to be accomplished. This not only helps focus the participants but also creates a sense of purpose and organization, setting a positive tone for the rest of the interaction. Showing a picture of the breast or giving an anecdote about an old man may not be appropriate or relevant in this context. Going ahead with the first part of the lecture without any welcoming or setting the atmosphere may make the participants feel rushed or disconnected from the session's purpose.

Correct Answer: D

Rationale: A subarachnoid hemorrhage is characterized by bleeding within the subarachnoid space, the area between the arachnoid mater and the pia mater surrounding the brain. Patients typically present with a sudden-onset severe headache, altered mental status, and focal neurological deficits due to the mass effect of the blood in the subarachnoid space. Imaging, such as a CT scan, can confirm the presence of the hemorrhagic lesion. Ischemic stroke results from a blockage in the blood vessels supplying the brain, leading to tissue infarction and neurological deficits. Subdural hematoma is a collection of blood between the dura mater and the arachnoid mater, commonly seen following head trauma. Intracerebral hemorrhage involves bleeding within the brain tissue itself, often leading to focal neurological deficits.

Correct Answer: C

Rationale: The presentation of persistent, severe headache, visual disturbances, and epigastric pain in a postpartum client could indicate the development of postpartum preeclampsia or eclampsia, which are serious conditions that require immediate medical attention. Prompt notification of the healthcare provider is essential to ensure timely assessment, diagnosis, and treatment to prevent potential complications for both the mother and baby. Encouraging rest, providing acetaminophen, or offering a massage are not appropriate interventions for addressing these symptoms, as they do not address the underlying cause and urgency of the situation.