NR547 PMHNP Pre-clinical Diagnostic Exam Chamberlain University.
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Which of the following levels should the nurse practitioner observe for potentially harmful elevation with the prescription of Valsartan (Diovan)?
- Calcium.
- Potassium.
- Pro-BNP.
- BNP.
Explanation
Explanation:
Correct Answer: (B) Potassium
Valsartan is an angiotensin II receptor blocker (ARB). By blocking the effects of angiotensin II, it reduces aldosterone secretion. Since aldosterone normally promotes potassium excretion in the kidneys, its reduction leads to potassium retention. This can result in hyperkalemia (elevated potassium), which is potentially dangerous as it can cause life-threatening cardiac arrhythmias. Potassium levels must be monitored regularly in patients on ARBs.
Why Other Options are Incorrect:
A. Calcium levels are not significantly affected by valsartan therapy. ARBs do not have a direct mechanism that would cause harmful elevation of serum calcium.
C. Pro-BNP (N-terminal pro-brain natriuretic peptide) is a marker of cardiac wall stress and heart failure severity. While it may be monitored in heart failure patients taking valsartan, it is not an electrolyte that becomes dangerously elevated as a direct result of valsartan's mechanism of action.
D. BNP (brain natriuretic peptide) is similarly a cardiac biomarker used to assess heart failure. Like Pro-BNP, it is not an electrolyte that rises to harmful levels as a direct pharmacological consequence of valsartan therapy.
A patient with which of the following chronically administered medications stopped abruptly would not be at risk for Addisonian crisis?
- Spironolactone (Aldactone).
- Prednisone (Deltasone).
- Fludrocortisone (Florinef).
- Hydrocortisone (Hydrocortisone).
Explanation
Explanation:
Correct Answer: (A) Spironolactone (Aldactone)
Spironolactone is a potassium-sparing diuretic and aldosterone antagonist used for conditions such as heart failure, hypertension, and hyperaldosteronism. It does not suppress the hypothalamic-pituitary-adrenal (HPA) axis and therefore abrupt discontinuation does not cause Addisonian crisis.
Why Other Options are Incorrect:
B. Prednisone is an exogenous corticosteroid that suppresses the HPA axis with chronic use. Abrupt discontinuation can precipitate Addisonian crisis due to adrenal insufficiency from prolonged suppression.
C. Fludrocortisone is a synthetic mineralocorticoid used in adrenal insufficiency and other conditions. Stopping it abruptly in a dependent patient can trigger an adrenal crisis due to lack of mineralocorticoid activity.
D. Hydrocortisone is a corticosteroid with both glucocorticoid and mineralocorticoid activity. Chronic use suppresses the HPA axis, and abrupt discontinuation can lead to life-threatening Addisonian crisis.
A patient with acute symptoms of Crohn's disease would most likely be started on which of the following medications to manage the acute flare?
- Methotrexate (Trexall).
- Ibuprofen (Advil).
- Prednisone (Deltasone).
- Adalimumab (Humira).
Explanation
Explanation:
Correct Answer: (C) Prednisone (Deltasone)
Corticosteroids such as prednisone are the first-line treatment for inducing remission during acute flares of Crohn's disease. They rapidly suppress the inflammatory response, providing quick symptom relief. However, they are not used for long-term maintenance due to significant side effects with prolonged use.
Why Other Options are Incorrect:
A. Methotrexate is an immunomodulator used for maintenance therapy in Crohn's disease to sustain remission, not for managing acute flares due to its slower onset of action.
B. Ibuprofen is an NSAID that can actually worsen inflammatory bowel disease symptoms and increase the risk of gastrointestinal complications. It is generally avoided in Crohn's disease patients.
D. Adalimumab (Humira) is a biologic TNF-alpha inhibitor used for moderate to severe Crohn's disease maintenance therapy. While it can induce remission, it is not typically the first agent initiated for an acute flare compared to the faster-acting corticosteroids.
You are about to perform a diaphragmatic excursion test on your healthy patient. Which one of the following results would you expect to see in a healthy patient with no abnormalities?
- Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration.
- Absent or no change in movement of the diaphragm noted between full inspiration and full expiration measurement.
- Ascension of 8–12 inches of the diaphragm noted bilaterally on expiration, though often much less on the right side due to the location of the heart and great vessels.
- Much greater descent of the diaphragm on the right side due to the liver present (two–three times larger).
Explanation
Explanation:
Correct Answer: (A) Approximately equal level of change in the descent of the diaphragm bilaterally during maximal inspiration and expiration.
In a healthy patient, diaphragmatic excursion should be approximately equal on both sides, typically ranging from 3 to 5 centimeters of movement between full inspiration and full expiration. Symmetrical bilateral movement indicates normal diaphragmatic function and healthy lung expansion.
Why Other Options are Incorrect:
B. Absent or no change in diaphragmatic movement would indicate a pathological condition such as diaphragmatic paralysis or severe hyperinflation, not a finding in a healthy patient.
C. The normal diaphragmatic excursion is measured in centimeters, not inches. A movement of 8–12 inches would be anatomically impossible and does not represent a normal finding.
D. While the liver sits below the right hemidiaphragm, a healthy patient does not show dramatically greater descent on the right side. Significantly asymmetric excursion would suggest pathology.
Patients diagnosed with seborrheic dermatitis may be successfully treated with which of the following medications?
- Isotretinoin (Accutane).
- Fluorouracil (5-FU).
- Salycilic Acid.
- Ketoconazole shampoo.
Explanation
Explanation:
Correct Answer: (D) Ketoconazole shampoo
Seborrheic dermatitis is a chronic inflammatory skin condition closely associated with overgrowth of Malassezia yeast on the scalp and face. Ketoconazole is an antifungal agent that targets this yeast, reducing fungal colonization and the resulting inflammatory response. Ketoconazole shampoo is a well-established and highly effective first-line treatment for seborrheic dermatitis.
Why Other Options are Incorrect:
A. Isotretinoin (Accutane) is a retinoid used for severe, nodular, or treatment-resistant acne vulgaris. It is not indicated for seborrheic dermatitis and carries a significant side effect profile that would not be appropriate for this condition.
B. Fluorouracil (5-FU) is a topical chemotherapy agent used for actinic keratosis and certain superficial skin cancers. It has no role in the treatment of seborrheic dermatitis.
C. Salicylic acid has keratolytic properties and can help remove scale in seborrheic dermatitis as an adjunct treatment, but it does not address the underlying Malassezia yeast colonization, making it less effective as a standalone treatment compared to ketoconazole.
Which one of the following patients would you most anticipate to complain of a low forced expiratory volume over the first second (FEV1)?
- Severe asthmatic.
- Congestive heart failure with bilateral pleural effusions.
- Strep pharyngitis.
- Lung cancer.
Explanation
Explanation:
Correct Answer: (A) Severe asthmatic.
FEV1 (forced expiratory volume in the first second) is a key measure of obstructive lung disease. In severe asthma, widespread bronchoconstriction, airway inflammation, and mucus plugging significantly obstruct airflow, resulting in a markedly reduced FEV1. Asthma is a classic obstructive airway disease where FEV1 is disproportionately reduced relative to FVC, producing a low FEV1/FVC ratio.
Why Other Options are Incorrect:
B. Congestive heart failure with bilateral pleural effusions primarily causes a restrictive pattern on pulmonary function testing, where both FEV1 and FVC are reduced proportionally, maintaining a relatively normal FEV1/FVC ratio. It does not primarily cause the obstructive pattern with a disproportionately low FEV1.
C. Strep pharyngitis is a bacterial infection of the throat and does not affect the lower airways or lung function. It would not produce any significant abnormality on spirometry or FEV1 measurement.
D. Lung cancer can affect lung function depending on its size and location, but it is not the most classic or predictable cause of a significantly reduced FEV1 compared to severe obstructive conditions like asthma.
While assessing a patient with Cushing's disease, you might expect to find which of the following?
- Kyphosis.
- Low blood pressure.
- Low body temperature.
- Moon face.
Explanation
Explanation:
Correct Answer: (D) Moon face.
Moon face (rounded, puffy facial appearance) is one of the most classic and recognizable signs of Cushing's disease, caused by the redistribution of fat deposits due to excess cortisol. Other characteristic features include buffalo hump, central obesity, and purple striae.
Why Other Options are Incorrect:
A. Kyphosis is not a primary feature of Cushing's disease. While osteoporosis caused by excess cortisol can lead to vertebral compression fractures and a stooped posture, kyphosis itself is not a hallmark assessment finding.
B. Cushing's disease characteristically causes hypertension (high blood pressure), not low blood pressure, due to the mineralocorticoid effects of excess cortisol causing sodium and water retention.
C. Excess cortisol increases metabolic activity and tends to cause elevated rather than low body temperature. Low body temperature is more associated with hypothyroidism or adrenal insufficiency (Addison's disease).
Which of the following are functions of the liver?
- Erythrocyte formation
- Clotting factor formation
- Platelet formation
- Thrombocyte formation
Explanation
Explanation:
Correct Answer: (B) Clotting factor formation
The liver is responsible for synthesizing the majority of clotting factors, including fibrinogen, prothrombin, and factors V, VII, IX, and X. This is why patients with severe liver disease such as cirrhosis develop coagulopathy and are at increased risk for bleeding.
Why Other Options are Incorrect:
A. Erythrocyte (red blood cell) formation occurs in the red bone marrow, not the liver. In fetal life, the liver does participate in hematopoiesis, but this function ceases after birth.
C. Platelet formation occurs in the bone marrow through the differentiation of megakaryocytes, not in the liver.
D. Thrombocytes are simply another name for platelets, and like option C, their formation takes place in the bone marrow, not the liver.
The most common side effect profile of tricyclic antidepressants are which of the following?
- Cholinergic symptoms.
- Bradycardia and agitation.
- Anticholinergic symptoms.
- None of these are correct.
Explanation
Explanation:
Correct Answer: (C) Anticholinergic symptoms
Tricyclic antidepressants (TCAs) such as amitriptyline, nortriptyline, and imipramine strongly block muscarinic acetylcholine receptors, producing a classic anticholinergic side effect profile. These symptoms include dry mouth, urinary retention, constipation, blurred vision, confusion, and tachycardia. This side effect burden is one of the primary reasons TCAs have been largely replaced by SSRIs in modern practice.
Why Other Options are Incorrect:
A. Cholinergic symptoms such as increased secretions, bradycardia, and diaphoresis are caused by agents that stimulate or enhance acetylcholine activity. TCAs do the opposite by blocking muscarinic receptors, producing anticholinergic, not cholinergic, effects.
B. Bradycardia is actually a cholinergic effect and is not associated with TCAs. TCAs characteristically cause tachycardia as part of their anticholinergic profile, along with cardiac conduction abnormalities such as QT prolongation.
D. This is incorrect because anticholinergic symptoms are a well-documented and clinically significant side effect profile of tricyclic antidepressants, supported by extensive pharmacological and clinical evidence.
Which of the following agents is most appropriate to use for chronic treatment of rosacea?
- Isotretinoin (Accutane).
- Niacin extended release (Niacin).
- Doxycycline (Vibramycin).
- Cefuroxime (Ceftin).
Explanation
Explanation:
Correct Answer: (C) Doxycycline (Vibramycin)
Doxycycline is a tetracycline-class antibiotic with well-established anti-inflammatory properties that make it effective for the chronic management of rosacea, particularly the papulopustular subtype. Low-dose doxycycline (40 mg modified-release) is FDA-approved specifically for rosacea and is used long-term to control inflammation without significant antibiotic resistance concerns at sub-antimicrobial doses.
Why Other Options are Incorrect:
A. Isotretinoin (Accutane) is reserved for severe, treatment-resistant rosacea or rhinophyma and is not a standard first-line chronic treatment. Its significant side effect profile and teratogenicity make it inappropriate for routine chronic rosacea management.
B. Niacin extended release is used to manage dyslipidemia and is not indicated for rosacea. Notably, niacin can actually trigger flushing, which would worsen rosacea symptoms.
D. Cefuroxime (Ceftin) is a second-generation cephalosporin antibiotic used for bacterial infections such as respiratory tract infections and Lyme disease. It has no established role in the treatment of rosacea.
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