"Snap, Crackle, Pop"
Which of the following is the most sensitive modality for detecting a meniscal tear?
A. x-ray
B. Ultrasound
C. MRI
D. CT scan
C. MRI
MRI is the most sensitive imaging modality for detecting the extent and type of meniscal tear.
A 67-year-old female patient who regularly takes diphenhydramine (Benadryl) as a sleep aid is at risk of which of the following conditions?
A. Confusion
B. Bradycardia
C. Hypertension
D. Cardiac arrhythmias
A. Confusion.
Diphenhydramine (Benadryl) is an antihistamine that causes sedation and is used as a hypnotic. Older patients have increased sensitivity to the drug's effects. Diphenhydramine use place the patient at risk for confusion, urinary retention and incontinence, and sedation. Diphenhydramine is not specifically associated with bradycardia, hypertension, or cardiac arrhythmias in older patients.
An elderly female patient is diagnosed with trigeminal neuralgia. Which assessment finding would the nurse practitioner expect?
A. Bilateral joint stiffness and aching in the shoulders and upper arms.
B. Shooting pain at the base of the head.
C. Shock-like facial pain.
D. Severe pain in or around one eye.
C. Shock-like facial pain.
Trigeminal neuralgia presents with extreme, shock-like facial pain that lasts from a few seconds to 2 minutes per event. Bilateral stiffness and aching in the posterior neck, shoulders, and upper arms is associated with polymyalgia rheumatica. Shooting pain at the base of the head is a symptom of occipital neuralgia. Severe pain in or around one eye is a symptom of cluster headaches.A 40-year old female patient has recently been diagnosed with obsessive-compulsive disorder (OCD) by her therapist. Which of the following medications is indicated for treatment of OCD?
A. Paroxetine (Paxil)
B. Haloperidol (Haldol)
C. Alprazolam (Xanax)
D. Imipramine (Elavil)
A. Paroxetine (Paxil)
The first-line medication usually considered for OCD is a selective serotonin reuptake inhibitor (SSRI), such as paroxetine (Paxil CR). Haloperidol (Haldol) is an antipsychotic, alprazolam (Xanax) is a benzodiazepine, and imipramine (Elavil) is a tricyclic antidepressant (TCA).
True or False
According to Advancing Health Equity: A Guide to Language, Narrative and Concepts (AMA, 2021), a health equity-based public narrative would:
Avoid both blaming individuals for their condition or assuming that inequity can be resolved through programmatic fixes that ignore the social responsibility of corporations and government agencies.
True!
A health equity-based public narrative would include avoiding both blaming individuals for their condition or assuming that inequity can be resolved through programmatic fixes that ignore the social responsibility of corporations and government agencies.
The result of a postmenopausal patient's dual-energy x-ray absorption (DEXA) scan shows osteopenia. Which of the following T-scores is indicative of osteopenia?
A. -1.0 or higher
B. -1.0 to 2.5
C. Less than -2.5
D. Normal results
B. -1.0 to 2.5.
Osteopenia is defined as a T-score of -1.0 to -2.5. Osteoporosis is defined as a T-score of -2.5 or below.
Thiazide diuretics have been shown to have a beneficial effect on the bones, making them a desirable treatment option in hypertensive female patients with osteopenia or osteoporosis. What is the mechanism of action for their effect on the bones?
A. Thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoblast production.
B. Thiazide diuretics increase both calcium and magnesium retention by the kidneys.
C. Thiazide diuretics decrease bone mineral density (BMD).
D. Thiazide diuretics reduce electrolyte excretion by the kidneys.
A. Thiazide diuretics decrease calcium excretion by the kidneys and stimulate osteoblast production. This positive side effect of thiazides -decreasing calcium excretion and stimulating osteoblast production - results in a decrease in calcium bone loss and an increase in BMD. Thiazides can increase excretion of potassium and magnesium as well as sodium in the kidneys. If not monitored carefully during treatment, this can lead to significant hypokalemia, hypomagnesemia, and hyponatremia.
The nurse practitioner sees an adult patient who reports frequent headaches over the past few months. The patient has tried acetaminophen and ibuprofen without relief. The patient has a history of myocardial infarction (MI), bradycardia, and kidney stones. Which medication is most appropriate for this patient?
A. Topiramate (Topamax)
B. Sumatriptan (Imitrex)
C. Amitriptyline (Elavil)
D. Atenolol (Tenormin)
C. Amitriptyline (Elavil)
Based on the patient's medical history, amitriptyline is an appropriate medication to prescribe. Topiramate is not appropriate because of a history of kidney stones. Atenolol is not appropriate because of a history of bradycardia. Sumatriptan is not a safe medication because of history of MI.An older adult female patient with peripheral neuropathy due to diabetes mellitus is recently diagnosed with major depression. The patient refuses psychotherapy and wants medication. She denies suicidal or homicidal ideation. Which of the following pharmacologic agents is the best choice for this patient?
A. Quetiapine (Seroquel)
B. Duloxetine (Cymbalta)
C. Escitalopram (Lexapro)
D. Olanzapine (Zyprexa)
B. Duloxetine (Cymbalta)
Duloxetine (Cymbalta) is a selective norepinephrine reuptake inhibitor (SNRI) that is used for depression, chronic anxiety, and the management diabetic peripheral neuropathy. Quetiapine (Seroquel) and olanzapine (Zyprexa) are atypical antipsychotics. Escitalopram (Lexapro) is an SSRI used for depression and generalized anxiety disorder, but it does not have an indication for peripheral neuropathy.
Strategies to avoid stigmatizing language in the medical record include all of the following EXCEPT:
A. Use person-first language
B. Lead with race, ethnicity, language, socioeconomic status, and other social identifiers
C. Avoid language that attributes responsibility to patients for their conditions
D. Choose inclusive language
B. Lead with race, ethnicity, language, socioeconomic status, and other social identifiers
Healthcare providers should AVOID leading with social identifiers which may unconsciously trigger bias in colleagues and contribute to the perpetuation of health disparities.
A left-hand-dominant high-school tennis player presents with a concern of left elbow pain. Which signs and symptoms suggest that the patient is suffering from tennis elbow? (SELECT ALL THAT APPLY)
A. Elbow pain that worsens with pulling activity
B. Lateral elbow pain with tenderness over the lateral epicondyle
C. Elbow pain with grasping movement
D. Medical elbow pain with tenderness at the medial epicondyle
B. Lateral elbow pain with tenderness over the lateral epicondyle
C. Elbow pain with grasping movement
Tennis elbow, or lateral epicondylitis, is inflammation of the tendon insertion of the extensor carpiradialis brevis muscle. It is associated with lateral tenderness at the insertion site. Pain worsens with grasping or twisting movements. Pain with pulling and at the medial epicondyle is associated with medical epicondylitis, or golfer elbow.A male patient presents with a chief complaint of a cough that he has had for several weeks. He denies shortness of breath or chest pain. His previous medical history is significant for newly diagnosed hypertension. On physical exam, the lung fields are clear without any retractions. Which of the following is the most likely cause of his symptoms?
A. Atenolol
B. Amlodipine
C. Diltiazem
D. Enalapril
D. Enalapril.
Enalapril is an angiotensin-converting enzyme (ACE) inhibitor. A fairly common side effect of ACE inhibitors is a dry cough, which may occur a few hours after the first dose or within weeks to months. If the patient had a history of asthma or COPD, atenolol (a beta-blocker) might be causing bronchospasm, but the physical exam would likely reveal wheezing. Adverse effects of amlodipine, a dihydropyridine CCB, include peripheral edema, headaches, flushing, and lightheadedness. Diltiazem, a nondihydropyridine CCB, can worsen cardiac output and cause bradycardia and constipation.
Abrupt loss of consciousness and stiffening of the muscles, followed by jerking of the muscles for 1 to 2 minutes, following by a postictal period characterizes what type of seizure?
A. Absence
B. Generalized tonic-clonic
C. Atonic
D. Myoclonic
B. Generalized tonic-clonic.
A generalized tonic-clonic seizure starts with abrupt loss of consciousness and stiffening of the muscles (tonic phase). After about a minute, the muscles start to jerk for 1 to 2 minutes (clonic phase). Cessation of muscle twitching signals the start of the postictal period. During this period, the person may be asleep (and gradually wake up) or may become agitated or confused. Do not insert anything in the mouth (such as tongue blades). Help the person lie on the floor on their side. Absence seizure consists of brief periods of behavior interruption (staring spells). Atonic seizure involves abrupt loss of muscle control that causes the individual to drop to the ground. Myoclonic seizures involve sudden, brief muscle contractions but no loss of consciousness.
Which patient is of LOWEST concern when assessing for risk of suicide?
A. 66-year-old male whose spouse of 40 years recently died
B. High school student with a history of bipolar disorder
C. 45-year-old woman with depression and a family history of suicide
D. 17-year-old female with only one close friend in school
D. 17-year-old female with only one close friend in school.
A, B., and C. An elderly male who recently lost his spouse, a history of depression or bipolar disorder and family history of suicide are all risk factors for suicide. A 17-year-old female with only one close friend in school is not a specific risk factor for suicide.
According to Advancing Health Equity: A Guide to Language, Narrative and Concepts (AMA, 2021), Health Inequities are defined as:
A. Differences in health that are naturally created by biological differences between groups of people
B. Differences in health that are created by poor decisions of individuals
C. Differences in health that could be eliminated with availability of universal health care
D. Differences in health that are avoidable, systematic, measurable and unjust
D. Differences in health that are avoidable, systematic, measurable and unjust.
According to the Advancing Health Equity (AMA, 2021) "health inequities—defined as differences in health that are avoidable, systematic, measurable and unjust—are well documented throughout the U.S...Health inequities are directly related, indeed, produced and reinforced by inequities in other parts of society, including the workplace, housing, education and criminal justice systems. These inequities are produced by historical, contemporary, individual and collective decisions made by people; they are not natural or inevitable."