Spit, Cough, Wheeze
A potential adverse effect of inhaled corticosteroid use is:
A. oral candidiasis
B. tachycardia
C. gastrointestinal upset
D. insomnia
A. oral candidiasis
The anti-inflammatory action of an ICS can increase the risk of certain adverse effects, such as sore throat, oral candidiasis, and hoarseness. Adverse effects can be minimized by rinsing the mouth after each use as well as using a spacer.
This cranial nerve controls trapezius and sternocleidomastoid muscles:
A. Oculomotor III
B. Trochlear IV
C. Vagus X
D. Spinal Accessory XI
D. Spinal Accessory XI. The spinal accessory cranial nerve controls trapezius and sternocleidomastoid muscles, and swallowing movements.
Oculomotor III: eyelid movement and EOM
Trochlear IV: EOM
Vagus X: senses aortic blood pressure, slows heart rate, stimulates digestive organs, taste
The elite old are classified as:
A. 65 to 74 years old
B. 75 to 84 years old
C. 85 to 100 years old
D. more than 100 years old
D. more than 100 years old = elite old
Young old: 65 to 74 years old
Old old: 75 to 84 years old
Oldest old: 85 to 100 years old
Elite old: more than 100 years old
Which of the following is most consistent with the diagnosis of bulimia nervosa?
A. patients with bulimia nervosa usually present asking for treatment
B. periods of anorexia often occur
C. hyperkalemia often results from laxative abuse
D. most patients with bulimia nervosa are significantly obese
B. periods of anorexia often occur. Individuals with bulimia nervosa can undergo periods of anorexia as part of the compensatory behavior following a binge episode. Compensatory behaviors can include fasting, excessive exercise, vomiting, or taking laxatives and diuretics. Bulimia nervosa is a secretive disease that can present for many years before the condition is noted by a health-care provider. Hypokalemia, rather than hyperkalemia, can result from the use of laxatives. Individuals with bulimia nervosa are typically not obese but can have a normal or slightly above normal BMI, further challenging a timely diagnosis of the condition.
Which University has the nation’s first and only center dedicated to anti-racism in nursing?:
A. Washington State University (WSU)
B. Oregon Health Sciences University (OHSU)
C. University of Washington (UW)
D. Western Washington University (WWU)
C. University of Washington (UW). In 2022, the University of Washington School of Nursing established the Manning Price Spratlen Center for Anti-Racism & Equity in Nursing (MPS CARE), the first and only center dedicated to anti-racism in nursing. The Center is committed to training students, educators, medical providers, and community collaborators through models of education and leadership rooted in social justice"
Clinical findings characteristic of poorly controlled asthma include all of the following EXCEPT:
A. a recurrent spasmodic cough that is worse at night
B. recurrent shortness of breath and chest tightness with exercise
C. a congested cough that is worse during the day
D. wheezing with and without associated respiratory infections
C. a congested cough that is worse during the day. A congested cough that is worse during the day is more likely to be associated with a respiratory tract infection than asthma. Characteristic symptoms for asthma include recurrent cough, wheeze, shortness of breath, and/or chest tightness. Symptoms such as cough are often worse at night and with exercise.
You examine a 29-year-old woman, Cecilia, who reports a sudden onset of right-sided facial asymmetry. She is unable to close her right eyelid tightly, frown, or smile on the affected side. She states, "I was fine last night when I went to bed and woke up like this." Her health history and physical examination are otherwise unremarkable. Her medications include a multivitamin daily and a progestin implant for contraception. She is not a smoker. This presentation likely presents paralysis of CN:
A. III
B. IV
C. VII
D. VIII
C. VII. This is a typical presentation for Bell's palsy, which is associated with dysfunction of CN VII. Patients with Bell's palsy will frequently have an unremarkable medical history with sudden development of symptoms. CN VII is involved in facial movement and expression. CN III and CN IV are involved in movement of the eye but not facial muscles. CN VIII is involved in hearing and balance.
Besides aging, a risk factor for age-related macular degeneration is:
A. hypertension
B. hyperlipidemia
C. tobacco use
D. alcohol abuse
C. tobacco use. Risk factors for macular degeneration include tobacco use, sun exposure, and a family history of the condition.
Hypertension, hyperlipidemia and alcohol abuse are not risk factors for macular degeneration.
An alternative to methadone that can be used to help with maintenance therapy in the treatment of opioid use disorder is:
A. gabapentin
B. buprenorphine plus naloxone
C. methylnaltrexone
D. topiramate
B. buprenorphine plus naloxone. Methadone is a long-acting opioid that is commonly used as part of a comprehensive treatment plan to treat opioid addiction. However, methadone can only be dispensed through a qualified opioid treatment program. An alternative to methadone is the combination of buprenorphine (opioid agonist) and naloxone (opioid antagonist), which can be prescribed by qualified clinicians in a variety of settings and offers safety advantages over methadone. Topiramate, an anticonvulsant, has shown some benefits in reducing cravings in alcohol abuse, but evidence does not support its use in opioid addiction. Gabapentin is an antiepileptic drug that is used to treat neuropathic pain, but it is not helpful in opioid addiction. Methylnaltrexone is a mu-opioid receptor antagonist that is used to treat opioid-induced constipation.
According to the The Power in Our Words: Reducing Bias in Clinical Communication (Healy & Kidia, 2023) article, strategies to avoid stigmatizing language in medical records include all of the following EXCEPT:
A. Use person-first language
B. Do not weaponize quotes
C. Do not lead with race, ethnicity, language, socioeconomic status, and other social identifiers
D. Use language that attributes responsibility to patients for their conditions
D. Use language that attributes responsibility to patients for their conditions. Avoiding language that attributes responsibility to patients for their conditions, using person-first language, not weaponizing quotes, and not leading with race, ethnicity, language and socioeconomic status and other social identifiers can help reduce stigmatizing language in medical records.
You see a 67-year-old individual with very severe COPD (GOLD 4) who asks, "When should I use my home oxygen?" You respond:
A. As needed when short of breath
B. Primarily during sleep hours
C. Preferably during waking hours
D. For at least 15 hours a day
D. For at least 15 hours a day. When oxygen therapy is prescribed for severe COPD, it is recommended to be used for at least 15 hours each day, as this prolonged duration is needed to correct hypoxemia and reduce heart workload. The long-term administration of oxygen therapy has been shown to increase survival in patients with severe resting hypoxemia. Oxygen therapy can be used during waking or sleeping hours and should not be limited to only when the individual is short of breath. Many patients who wait until they are breathless before starting oxygen therapy and/or only use oxygen therapy on an as-needed basis will fail to achieve the maximum benefits of this therapy.
A transient ischemic attack (TIA) is characterized as an episode of reversible neurological symptoms that can last:
A. 1 hour
B. 12 hours
C. 24 hours
D. 48 hours or more
C. 24 hours. A TIA episode typically lasts only a few minutes but can persist for up to 24 hours, and the effects are fully reversible once the episode ends. For episodes lasting longer than 24 hours, this is usually indicative of a stroke.
The most common etiology of dementia is:
A. vascular disease
B. Alzheimer's Disease
C. traumatic head injury
D. drug-drug interaction induced
B. Alzheimer's Disease. The most common etiology of dementia is due to Alzheimer's Disease, which accounts for the majority of cases. Other types of dementia include vascular or multi-infarct dementia, which accounts for approximately 10% to 20% of cases, and Parkinson's disease, which accounts for 5% of cases. Traumatic head injury and drug-drug interactions would not be causes of dementia but could be triggers for delirium.
In providing primary care for a patient with PTSD, you consider that all of the following are likely to be reported EXCEPT:
A. numbing of emotions
B. feeling of detachment
C. hyperarousal
D. poor recall of the precipitating event
D. poor recall of the precipitating event. PTSD an occur after experiencing a traumatic event that results in prolonged feeling of horror and helplessness. Patients have an intrusive recall of the precipitating event and can lead to numbing of emotions, detachment, hyperarousal, and impaired social and occupational functioning.
True or False
In the article Ableism - The Undiagnosed Malady Afflicting Medicine (Janz, 2019), health related quality of life and function are the same thing.
False. According to the Janz (2019) article researchers comparing non-disabled and disabled groups frequently confound health related quality of life and function. "Such erroneous judgments about the quality of life experienced by people with disabilities can result in treatment options for people with disabilities being either limited, or altogether eliminated" (Janz, 2019, p. E479)
All of the following are consistent findings during COPD exacerbation EXCEPT:
A. increased FEV1
B. increased cough
C. increased sputum purulence
D. increased sputum production
A. increased FEV1. A COPD exacerbation is associated with an increase in COPD symptoms as well as decreased lung function that could be at least partially irreversible. This would lead to a decrease rather than increase in FEV1, values as determined by spirometry. Characteristic findings during COPD exacerbation are typically increase in symptoms, including increased cough and wheezing, sputum production, and shortness of breath. Sputum can also have increased purulence, suggesting the presence of a bacterial infection and/or higher levels of white blood cells.
You are examining a 65-year-old patient who has a history of acute coronary syndrome (ACS) and migraine. Which of the following agents represents the best choice of acute headache (abortive) therapy for this patient?
A. verapamil
B. ergotamine
C. acetaminophen
D. sumatriptan
C. acetaminophen. Analgesics, such as acetaminophen, can be effective in relieving pain caused by migraines. Patients should be aware of the risk of rebound headache with frequent, long-term use of acetaminophen. For patients with a history of coronary artery disease, the use of agents with vasoconstrictor properties, such as triptans and ergot derivatives, should be avoided. Calcium channel blockers, such as verapamil, are not recommended for acute treatment of migraines.
The use of second-generation antipsychotic medications in older adults with dementia is associated with an increased risk for:
A. stroke and cardiovascular events
B. hypoglycemia
C. psychosis
D. hypertension
A. stroke and cardiovascular events. Antipsychotics can be considered to help manage patients with dementia who are experiencing agitation and psychosis and who fail other approaches. However, the use of second-generation antipsychotics has been associated with an increased risk of serious adverse effects, including stroke and cardiovascular events in older adults. They are not associated with increased risk of hypoglycemia, psychosis or hypertension.
Concomitant use of an SSRI with which of the following nutritional supplements can potentially lead to serotonin syndrome?
A. St. John's wort
B. kava kava
C. gingko biloba
D. valerian root
A. St. John's wort. St. John's wort has exhibited some efficacy in the treatment of depression. However, this nutritional supplement can interfere with the CYP450 enzyme system involved in drug metabolism via enzymatic induction. As such, its use is not recommended with concomitant use of SSRIs, TCAs, or MAOIs due to risk of serotonin syndrome.
True or False
Healthcare providers are often unaware of their implicit biases towards sexual and gender minority patients.
True. According to the Malta (2023) article "health-care providers are likely to underestimate or to be unaware of their implicit biases towards
sexual and gender minority patients, particularly when rushed or fatigued, which can affect their behaviour and judgments and deepen health disparities for this population...To improve this situation, health-care providers need to be pre-
pared to identify and address their own implicit biases" (p. 1).
In a 78-year-old individual with a history of COPD, HTN, and dyslipidemia, who is taking lovastatin and amlodipine, which of the following is the most appropriate antimicrobial treatment for CAP according to the ATS/IDSA Guidelines:
A. oral clindamycin
B. oral amoxicillin-clavulanate with oral doxycycline
C. oral clarithromycin
D. IM ceftriaxone
B. oral amoxicillin-clavulanate with oral doxycycline. For individuals with risk factors for antimicrobial-resistant infection, including the presence of significant comorbidities such as COPD, treatment can include monotherapy with an oral respiratory fluoroquinolone or combination therapy with oral formulations of doxycycline, azithromycin, or clarithromycin plus a beta-lactam (amoxicillin-clavulanate or a cephalosporin). A combination of amoxicillin-clavulanate plus doxycycline would be appropriate.
Which of the following statements regarding Giant Cell Arteritis (GCA) is FALSE?
A. It results in inflammation of temporal and other arteries
B. Normal arterial sections can be found in between affected sections
C. It primarily impacts smaller-sized vessels
D. GCA can result in a finding of a tender and/or nodular, pulseless vessel
C. It primarily impacts smaller-sized vessels. GCA is characterized by inflammation of medium- to larger-sized blood vessels, including the temporal artery as well as extracranial branches of the carotid artery. The inflammation often impacts segments of the artery with normal sections appearing between affected sections. This is the rationale of why multiple biopsies are needed to make the diagnosis of GCA. The inflammation can often result in a tender or nodular, pulseless vessel.
The use of physical restraints in older adults is appropriate:
A. as a form of reinforcement to prevent future potentially dangerous behavior
B. when needed to meet a health-care need
C. to prevent wandering outside an institution
D. under no circumstances
B. when needed to meet a health-care need. Physical restraints should not be used for staff convenience or as a form of discipline but can be considered in situations to meet a health-care need. The Omnibus Reconciliation Act of 1987 states that residents of long-term care facilities should be free of physical and chemical restraints in situations where they are not required to meet a health-care need. Physical restraints should not be used as a form of discipline or to prevent wandering outside an institution, as alternative approaches can be effective (e.g., alarms). Physical restraints can be considered when required to meet a health-care need.
When discontinuing benzodiazepine treatment after prolonged use, you recommend:
A. terminating treatment immediately
B. decreasing the dose by 20% per week
C. decreasing the dose by 25% per week
D. decreasing the dose by 50% per week
C. decreasing the dose by 25% per week. Abrupt discontinuation of benzodiazepines in an individual with physical dependence on these agents will potentially result in serious and life-threatening adverse effects including tremors, hallucinations, seizures, and a delirium tremens-like state. Discontinuation of benzodiazepines should be done with a gradual tapering regimen, such as reducing the dose by 25% per week.
Health At Every Size is:
A. A paradigm that supports size‐acceptance, to end weight discrimination, and to lessen the cultural obsession with weight loss and thinness.
B. Encourages the goal of a BMI between 18.5 and 24.9 kg/m2
C. Assumes anyone who has a BMI > 25 kg/m2 has a personal goal of weight loss.
D. Uses scientific evidence to educate patients on the importance of dieting and weight loss to achieve optimal health.
A. A paradigm that supports size‐acceptance, to end weight discrimination, and to lessen the cultural obsession with weight loss and thinness.
According to the Mauldin et al. (2022) article: "A paradigm that supports 'size‐acceptance, to end weight discrimination, and to lessen the cultural
obsession with weight loss and thinness' and promotes 'balanced eating, life‐enhancing physical
activity, and respect for the diversity of body shapes and sizes'"(p. 1292).