Nursing
A 45-year-old woman by the name of Mary is identified with type 2 diabetes. She has a bit of weight, stays inactive, and has relatives who have had diabetes. Her blood sugar in the morning while fasting is one hundred and eighty milligrams per decilite
What type of diet should the nurse suggest?
A. She should eat a lot of candy and drink soda
B. Recommend eating a variety of nutrients with controlled carbohydrate amounts, and focus on consuming fruits, vegetables, whole grains, lean proteins, and good fats.
C. Recommend eating a pescatarian diet of fish, shrimp, crab, and other seafoods.
D. Recommend a vegetarian diet, eating greens and no meats or fats.
B; Recommend eating a variety of nutrients with controlled carbohydrate amounts, and focus on consuming fruits, vegetables, whole grains, lean proteins, and good fats.
A 70-year-old male with a history of hypertension and atrial fibrillation presents with sudden-onset weakness in his right arm and leg, slurred speech, and facial droop. What is the most likely cause?
A) Hypoglycemia
B) Stroke (Ischemic or Hemorrhagic)
C) Seizure
D) Transient ischemic attack (TIA)
B) Stroke (Ischemic or Hemorrhagic)
The patient’s sudden neurological deficit (hemiparesis, dysphasia, facial droop) along with his risk factors (hypertension, atrial fibrillation) point toward a stroke, likely ischemic due to his history of atrial fibrillation.
An 8-year-old boy presents to clinic accompanied by his parents, who are concerned about their son’s “hard blinking” over the past year. It is observed that the boy does appear to have a tic in which he blinks his eyes forcefully every 10 to 15 minutes. He denies being bothered by the behavior, and his parents agree that he seems to be oblivious to it. His teacher only noticed the blinking once the boy’s parents asked him about it. On review of psychiatric symptoms, he does not meet criteria for any other psychiatric disorder. Based on the Practice Parameter, what is an appropriate next step for the treating the child?
A. Explain that the boy’s tic is not causing impairment or distress at this time, and watchful waiting is a fine approach.
B. Provide psychoeducation on tic disorders and a recommendation to initiate habit reversal training as soon as possible.
C. Provide psychoeducation on tic disorders.
D. Explain that the boy’s tic is very likely to worsen if a behavioral therapy is not implemented in the near future.
C; provide psychoeducation on tic disorder
An OTR is reviewing hard-copy of client charts before a group session. While reviewing the charts, the OTR receives an urgent phone call and must leave the chart room. How can the OTR ensure that the charts remain protected during the OTR's absence?
a. Close the charts and stack them on the table
b. Lock the door to the chart room
c. Cover the charts with other documents to obscure them from view
d. Close the charts and return them to their original secure location
Close the charts and return them to their original secure location
75 mg/kg/day
Signs associated with acetaminophen toxicity can mimic influenza symptoms and may include nausea, vomiting, diarrhea, and excessive sweating.
This may lead parents and caregivers to administer more medication to the child. Care should be taken not to exceed this threshold by administering higher doses more frequently than recommended.
Mrs. Jones is a 72-year-old female who underwent total hip replacement surgery due to severe hip osteoarthritis. She has a history of hypertension and osteoporosis. Mrs. Jones lives alone and has limited mobility due to hip pain and stiffness prior to surgery. She was admitted to the orthopedic surgical unit and is now postoperative day 1 after her surgery.
What is the priority nursing diagnoses for Mrs. Jones?
A. Risk of disease due to long stay in the hospital
B. Cardiovascular issues from laying in bed for hours throughout the day
C. Risk for infection related to the surgical site and indwelling catheter
D. Onset depression due to limit mobility and social life
C; Risk for infection related to the surgical site and indwelling catheter
Which pairs of substances are released from exocrine glands?
A. Glucagon and tears
B. Bile and insulin
C. Insulin and digestive enzymes
D. Tears and bile
D; Tears and bile
Tears are secreted onto the eye’s surface from lacrimal glands near the eyes, and bile is secreted from the liver into the bile duct, from which it is released into the duodenum of the small intestine (recall that the epithelial surfaces of the stomach, intestines, and lungs border cavities that are in communication with the exterior of the body).
Both endocrine and exocrine cells are epithelial cells that produce substances released into the extracellular space. Exocrine secretions are released to the body’s “exterior,” such as the skin or the inner surface of the gut or lungs. Endocrine secretions are released into the blood.
A mother presents to the clinic with her 10 year old son, who is tapping his feet loudly at home and church for the past year. This has caused repeated disruptions and she is frustrated. She explains that "He doesn't do it at school with his friends. He knows how to control it." During the history, it is noted that the mother shrugs her shoulders, suddenly, numerous times. She also frequently clears her throat. She says that she has done these behaviors for as long as she can remember. Based on this Practice Parameter, which of the following pieces of information is most appropriate to share with the boy's mother?
a. A child with chronic tic disorder may be suppress tics volitionally for periods of time. Additionally, her son is at 10 to 100 fold increased risk of chronic tic disorder compared to the general population based on observations of the mother's behavior.
b. A child with chronic tic disorder will not be able to suppress tics, even in front of friends, so her son's behavior is likely volitional. However, based on your observations of the mothers behaviors, the boy is at 10 to 100 fold increased risk of chronic tic disorder compared to the general population
c. A child with foot tapping does not qualify for a diagnosis of tic disorder due to the complexity of the movement. However, the mother's shoulder shrugging is a simple motor tic and would increase the risk of simple motor tics in her child by 50% compared to the general population.
d. A child with chronic tic disorder may be able to suppress tics volitionally for periods of time. The mother's throat clearing and shoulder shrugging do to qualify as tics, so her son is at the same risk of chronic tic disorder as a general population.
A; A child with chronic tic disorder may be suppress tics volitionally for periods of time. Additionally, her son is at 10 to 100 fold increased risk of chronic tic disorder compared to the general population based on observations of the mother's behavior.
A large outpatient hand clinic employs certified hand therapists who are either licensed OTRs or licensed PT's. COTAs are used to efficiently manage caseloads. Which description of the supervision requirement for COTA working in this environment is most accurate?
a. Must be supervised by a licensed OTR in accordance with state licensure and scope of practice for COTAs
b. Does not require supervision if the COTA has a minimum of 5 years of experience treating clients with upper extremity conditions
Must be supervised by a licensed OTR in accordance with state licensure and scope of practice for COTAs
Prescription antiviral medications with influenza virus activity may be useful adjuncts in influenza prevention and treatment and are most effective when administered within _______ of symptom onset.
a. 24 hours
b. 48 hours
c. 72 hours
d. 4 days
e. 12 hours
Within 48 hours
Mr. Thompson is a 68-year-old male with a history of type 2 diabetes for the past 15 years. He has a sedentary lifestyle and a BMI of 32, indicating obesity. Mr. Thompson has a history of poor glycemic control with frequent episodes of hyperglycemia and occasional non-adherence to his diabetic medications due to financial constraints.
He presents to the clinic with a complaint of a non-healing ulcer on his right foot for the past 2 weeks. He reports that he accidentally bumped his foot against a hard object and developed a small blister that has since progressed to a deep, painful ulcer with foul-smelling drainage.
What are the risk factors for the development of diabetic foot ulcer in Mr. Thompson?
A. A family history of diabetic foot ulcers
B. His older age of 68
C. His comorbid disease of hypoglycemia
D. Sedentary lifestyle and obesity
D; Sedentary lifestyle and obesity
A 25-year-old woman presents with a sudden onset of severe abdominal pain in the right lower quadrant. She has fever, nausea, and vomiting. On examination, there is rebound tenderness and guarding in the right lower quadrant. What is the most likely diagnosis?
A) Ectopic pregnancy
B) Ovarian cyst rupture
C) Acute appendicitis
D) Pelvic inflammatory disease (PID)
The patient's symptoms, including localized abdominal pain, fever, nausea, and rebound tenderness, are classic signs of acute appendicitis.
Ectopic pregnancy is a common cause of abdominal pain in women of childbearing age, but the pain in ectopic pregnancy is usually more diffuse and may be accompanied by vaginal bleeding and a positive pregnancy test. Localized pain is more common, but ovarian cyst rupture typically presents with pain in the lower abdomen or pelvis, not necessarily localized to the right lower quadrant. Rebound tenderness and guarding in PID are typically less localized, whereas in acute appendicitis, these signs are localized to the right lower quadrant because of the inflammation and irritation of the peritoneum from the inflamed appendix.
Among the general population, which of the following disorders is most commonly comorbid in anorexia nervosa?
A. Somatic disorders
B. Obsessive-compulsive disorder
C. Bipolar disorders
D. Major depressive disorder
Major Depressive Disorder
Major depressive disorder is the most commonly comorbid condition in patients with anorexia nervosa. A nationally representative survey found 56% of anorexic patients had comorbid psychiatric diagnoses.
A patient presents to the inpatient rehabilitation unit who has suffered a vertebro-basilar CVA and has difficulty adducting and depressing his eyes. Which cranial nerve (CN) is the MOST likely cause of this impairment?
CN IV
CN IV is the trochlear nerve. It innervates the superior oblique. Difficulty adducting and depressing the eye is indicative of Trochlear nerve involvement.
A 35-year-old man who is a regular patient of yours comes to your pharmacy counter with a new prescription. His shoulders appear tense and his eyebrows are knit tightly.
He says to you, “I can’t believe I have to fill another prescription today. I was just in three weeks ago and spent $75 dollars on some fancy new medication that didn’t do a darn thing!” What might be an appropriate active listening response to this patient?
a. It must be very frustrating to have to try something new.
b. It’s too bad we can’t take a prescription back for a refund.
c. I can provide you with a smaller quantity this time.
d. Your doctor is trying to find the best medication for you.
A; It must be very frustrating to have to try something new
Answer “b” does not acknowledge the patient’s feelings; answer “c” moves to finding a solution without acknowledging the patient’s feelings and “d” is placating.
Mrs. Johnson is a 62-year-old female who was admitted to the hospital with a complaint of severe headache and dizziness. She has a past medical history of hypertension for the past 5 years, and she has been on antihypertensive medications.
She has a family history of hypertension and heart disease, with her mother and brother both diagnosed with hypertension. Mrs. Johnson is currently working as a school teacher and lives with her husband. She has a sedentary lifestyle and reports occasional non-adherence to her medications due to forgetfulness
What are the risk factors for hypertension in this case study?
A. Nonadherence to medication
B. 4th cousin has hypertension
C. Teaches students with hypertension
D. Has headaches
A; Nonadherence to medication
A 45-year-old woman presents with a 2-week history of intermittent palpitations, sweating, and a sensation of anxiety. She also reports unexplained weight loss despite an increased appetite. On examination, her pulse is 110 bpm, and her hands are warm and moist. What is the most likely diagnosis?
A) Panic disorder
B) Hyperthyroidism
C) Generalized anxiety disorder
D) Pheochromocytoma
Answer: B) Hyperthyroidism
Explanation: The patient’s symptoms, including weight loss despite increased appetite, palpitations, sweating, and tachycardia, suggest hyperthyroidism. The warm, moist hands further support this diagnosis, which is commonly due to conditions like Graves' disease. Panic disorder and generalized anxiety disorder might also cause palpitations and anxiety but wouldn't explain the other systemic symptoms such as weight loss and warmth. Pheochromocytoma is less likely, though it can cause palpitations and anxiety, it usually presents with more pronounced hypertension.
B) Hyperthyroidism
The patient’s symptoms, including weight loss despite increased appetite, palpitations, sweating, and tachycardia, suggest hyperthyroidism. The warm, moist hands further support this diagnosis, which is commonly due to conditions like Graves' disease. Panic disorder and generalized anxiety disorder might also cause palpitations and anxiety but wouldn't explain the other systemic symptoms such as weight loss and warmth. Pheochromocytoma is less likely, though it can cause palpitations and anxiety, it usually presents with more pronounced hypertension.
Which medication used to treat dementia is matched with its correct neurobiological mechanism?
A. Memantine – gamma-secretase inhibitor
B. Rivastigmine – acetylcholinesterase inhibitor
C. Alpha-tocopherol – butyrylcholinesterase inhibitor
D. Donepezil – NMDA receptor antagonist
Rivastigmine
Rivastigmine is a cholinesterase inhibitor. It is FDA-approved to treat mild to moderate cases of dementia. As an acetylcholinesterase inhibitor, it causes a buildup in acetylcholine. The increased availability of acetylcholine can enhance memory in some patients or slow the decline of cognition in those with dementia.
A 30 year old male presents to outpatient rehabilitation with numbness and tingling on the 4th and 5th fingers of the left hand consistent with nerve entrapment symptoms. Upon further examination, it is noted that the patient has normal sensation on the dorsum of the hand on the ulnar side. Where is the MOST likely source of nerve entrapment?
Guyan's Canal
The ulnar nerve provides the sensory innervation for the 4th and 5th digits, narrowing the answer to either the cubital tunnel or Guyon’s canal. The ulnar nerve has a dorsal cutaneous branch that innervates the dorsum of the hand. This branch does not pass through Guyon’s tunnel, therefore it is preserved in this condition. Because the dorsal sensation is intact, the nerve must be trapped at Guyon’s canal.
Pharmacists should be able to recognise red flag signs of Postnatal depression (PND) and refer these patients immediately. Which of the following is/are Red flag signs or symptoms for postnatal depression?
I. Recent significant change in mental state or emergence of new psychiatric symptoms
II. New thoughts or acts of violent self-harm.
III. New and persistent expressions of incompetency as a mother, such as being over-critical for not recognising what the baby needs.
a. I only
b. I and II only
c. II and III only
d. All
All
Patients with suicidal thoughts must be referred immediately to specialist perinatal mental health services.
Upon admission, Mrs. Lucas' vital signs are as follows: blood pressure (BP) 180/100 mmHg, heart rate (HR) 88 beats per minute (BPM), respiratory rate (RR) 18 breaths per minute, and temperature 98.6°F.
She is alert and oriented but complains of a throbbing headache and lightheadedness. Her skin is warm and dry, and there is no visible edema. Her lungs are clear on auscultation, and her heart sounds are normal with no murmurs. Her abdominal assessment reveals no tenderness or masses. Mrs. Johnson's laboratory results show an elevated fasting blood glucose level of 135 mg/dL, cholesterol level of 240 mg/dL, and serum creatinine level of 1.2 mg/dL. She has a body mass index (BMI) of 30, which indicates obesity.
What are the signs and symptoms of hypertension in Mrs. Lucas?
A. Respiratory rate (18 breaths pm)
B. Warm, dry skin
C. Elevated blood pressure (180/100)
D. Cholesterol level of 240 mg/dL
C; Elevated blood pressure (180/100)
A 45-year-old man with a history of alcohol abuse presents with confusion, ataxia (a lack of muscle coordination), and nystagmus (involuntary, rhythmic eye movements). He also has difficulty with memory, especially short-term recall. What is the most likely diagnosis?
A) Wernicke-Korsakoff syndrome
B) Delirium tremens (rapid confusion)
C) Hepatic encephalopathy (brain disorder)
D) Normal pressure hydrocephalus (buildup of cerebrospinal fluid (CSF) in the brain)
A) Wernicke-Korsakoff syndrome
Wernicke-Korsakoff syndrome is commonly associated with chronic alcohol abuse and thiamine deficiency. The combination of confusion, ataxia, nystagmus, and memory issues fits this diagnosis.
A 17-year-old girl presents to the clinic for followup. She details that since starting college she has had to find her new place within social groups via developing new friends, cliques, and making a name for herself at this new school. At the same time, she has pursued a relationship with another individual at college and has developed a sense of fidelity toward him. According to Eriksonian life cycle development, the patient is MOST likely in which of the following stages?
A. Autonomy vs shame and doubt
B. Identity vs role confusion
C. Integrity vs despair
D. Intimacy vs isolation
E. Trust vs mistrust
Identity vs role confusion
In particular, identity vs role confusion is the fifth stage of life cycle development during approximately 13-20 years of age. Physical maturation during this time includes onset of puberty. During this phase, individuals become increasingly concerned about how they appear to those around them, joining cliques, identifying social roles, and developing individual identity. Furthermore, falling in love and developing virtues of fidelity are primary in this stage.
ou are assessing a traumatic brain injury patient and note that the patient is very agitated, moving around in his bed almost non-stop (requiring restraints at times). The patient is also very confused and follows very few one-step commands. According to the Rancho Los Amigos Levels of Cognitive Function Scale, your patient is at:
1. Level II
2. Level III
3. Level IV
4. Level V
Level IV
C is the correct answer because according to the Rancho Scale Level IV is confused, agitated. Agitation is the key in this answer. Level II and III are less responsive and only responding to certain stimuli. By Level V the agitation has subsided, but the confusion remains.
Which of the following information is/are TRUE ABOUT Naloxone? [Select All That Apply].
a. Naloxone hydrochloride is a pure opioid antagonist that competitively binds to μ-opioid receptors only when opioids are present.
b. No tolerance or dependence is associated with naloxone use
c. When comparing the μ-opioid receptor affinity of naloxone with that of most opioids, including heroin, naloxone has a greater affinity to bind to the receptor site.
d. Naloxone has a short duration of activity about 30 to 90 minutes.
All.
Naloxone hydrochloride is a pure opioid antagonist that competitively binds to μ-opioid receptors only when opioids are present and bound at the receptor site. Naloxone demonstrates no effect on mu, kappa, or delta receptors in a person who has not taken opioids. No tolerance or dependence is associated with naloxone use.