A nurse is collecting data from a client who has encephalitis due to West Nile virus. Which of the following findings should the nurse expect? (Select all that apply.)
Unilateral weakness
Stiff neck
Photophobia
Epigastric pain
Lethargy
Correct Answer : B,C,E
Choice A reason: Unilateral weakness is an incorrect finding, because it is more indicative of a stroke or a brain tumor than encephalitis. Encephalitis is an inflammation of the brain that can cause neurological symptoms, but they are usually bilateral and symmetrical.
Choice B reason: Stiff neck is a correct finding, because it is a sign of meningeal irritation, which can occur in encephalitis due to the involvement of the meninges (the membranes that cover the brain and spinal cord).
Choice C reason: Photophobia is a correct finding, because it is another sign of meningeal irritation, which can cause sensitivity to light and sound.
Choice D reason: Epigastric pain is an incorrect finding, because it is not related to encephalitis. Epigastric pain is more likely to be caused by a gastrointestinal disorder, such as gastritis or peptic ulcer.
Choice E reason: Lethargy is a correct finding, because it is a sign of altered mental status, which can occur in encephalitis due to the damage to the brain tissue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This is an incorrect finding, because elevated blood pressure is not a sign of hypoparathyroidism, which is a condition that occurs when the parathyroid glands produce insufficient parathyroid hormone (PTH). PTH regulates the calcium and phosphorus levels in the blood and bones. Elevated blood pressure can be a sign of hyperparathyroidism, which is the opposite condition.
Choice B reason: This is the correct finding, because involuntary muscle spasms are a sign of hypoparathyroidism, which causes hypocalcemia, or low blood calcium levels. Hypocalcemia can cause neuromuscular irritability and tetany, which are manifested by muscle spasms, twitching, cramps, or seizures.
Choice C reason: This is an incorrect finding, because cold intolerance is not a sign of hypoparathyroidism, but a sign of hypothyroidism, which is a condition that occurs when the thyroid gland produces insufficient thyroid hormone. Thyroid hormone regulates the metabolism and body temperature. Cold intolerance can also be a sign of Hashimoto's thyroiditis, which is an autoimmune disease that causes inflammation and destruction of the thyroid gland.
Choice D reason: This is an incorrect finding, because weight loss is not a sign of hypoparathyroidism, but a sign of hyperthyroidism, which is a condition that occurs when the thyroid gland produces excessive thyroid hormone. Thyroid hormone increases the metabolism and energy expenditure. Weight loss can also be a sign of Graves' disease, which is an autoimmune disease that causes overstimulation and enlargement of the thyroid gland.
Correct Answer is B
Explanation
Choice A reason: This is an incorrect route, because maternal-fetal transmission of hepatitis A is very rare and occurs only if the mother has acute hepatitis A during the third trimester of pregnancy.
Choice B reason: This is the correct route, because fecal-oral contamination of hepatitis A is the most common mode of transmission. Hepatitis A is a viral infection that affects the liver and is spread through ingestion of contaminated food or water, or contact with infected feces.
Choice C reason: This is an incorrect route, because genital sexual contact of hepatitis A is uncommon and occurs only if there is oral-anal contact with an infected person.
Choice D reason: This is an incorrect route, because blood to blood transmission of hepatitis A is also uncommon and occurs only if there is exposure to infected blood or blood products, such as through needle sharing or transfusion.
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