NUR 611 AP1 25 FL2 Adult Health at St. Thomas University
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Free NUR 611 AP1 25 FL2 Adult Health at St. Thomas University Questions
A 65-year-old man presents to the clinician with complaints of increasing bilateral peripheral vision loss, poor night vision, and frequent prescription changes that started 6 months previously. Recently, he has also been seeing halos around lights. The clinician suspects chronic open-angle glaucoma. Which of the following statements is true concerning the diagnosis of chronic open-angle glaucoma?
- A. The clinician can definitively diagnose open-angle glaucoma based on the subjective complaints of the patient.
- B. Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve.
- C. The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma.
- D. Physical diagnosis relies on gonioscopic evaluation of the angle by an ophthalmologist.
Explanation
Chronic open-angle glaucoma is a progressive optic neuropathy characterized by gradual loss of peripheral vision, typically associated with elevated intraocular pressure (IOP) and optic nerve cupping. The definitive diagnosis is made through a comprehensive ophthalmologic evaluation, including gonioscopy, which visualizes the anterior chamber angle to confirm that it is open and to exclude angle-closure glaucoma. Additional diagnostic tools include tonometry (for IOP measurement), ophthalmoscopy (to assess optic nerve damage), and visual field testing to quantify peripheral vision loss.
Which question should the clinician ask to determine the most frequent cause of diabetic ketoacidosis?
- A. "Which type of infection have you experienced recently?"
- B. "What type of diet have you been following?"
- C. "Is there any reason you don't like taking your medications?"
- D. "How often are you taking the insulin?"
Explanation
The most frequent cause of diabetic ketoacidosis (DKA) is insulin omission or inadequate insulin administration. DKA occurs when the body lacks sufficient insulin, leading to unchecked lipolysis, ketone production, metabolic acidosis, and hyperglycemia. Asking about insulin use frequency helps identify poor adherence, missed doses, or dosing errors. Addressing barriers to insulin use—such as cost, fear of injections, or misunderstanding—is key to preventing recurrence.
When proteinuria is detected in a low-risk patient, which laboratory testing should be ordered in addition to Bence Jones proteins?
- A. Serum glucose
- B. Cerebrospinal fluid (CSF) lumbar puncture
- C. Lipid panel
- D. Hemoglobinopathy
Explanation
When proteinuria is detected in a low-risk patient, one of the most important next steps is to check a serum glucose level to screen for diabetes mellitus, a common cause of glomerular proteinuria. Hyperglycemia damages the renal basement membrane, leading to increased urinary protein excretion. Along with assessing for Bence Jones proteins (which indicate multiple myeloma), serum glucose testing helps distinguish between diabetic nephropathy and other renal or systemic causes of proteinuria.
Which of the following disease-modifying antirheumatic drugs is a folic acid antagonist?
- A. Methotrexate (Rheumatrex)
- B. Rituximab (Rituxan)
- C. Etanercept (Enbrel)
- D. Anakinra (Kineret)
Explanation
Methotrexate is a folic acid antagonist and one of the most commonly used disease-modifying antirheumatic drugs (DMARDs). It inhibits dihydrofolate reductase, blocking the conversion of folic acid to its active form needed for DNA synthesis. This suppresses the proliferation of inflammatory cells, thereby reducing joint inflammation and slowing disease progression in rheumatoid arthritis. Because methotrexate interferes with folate metabolism, patients are routinely prescribed folic acid supplements to minimize side effects such as stomatitis, nausea, and cytopenias.
A provider is examining a patient with temporomandibular joint disease (TMJ). Which of the following results would the provider expect from the exam?
- A. The patient is able to open the mouth without pain or sound.
- B. The mandible deviates to the left side.
- C. There are no sounds elicited from the exam.
- D. The mandibular opening is 40 mm.
Explanation
In temporomandibular joint (TMJ) disease, the mandible often deviates toward the affected side when the mouth opens because of restricted joint movement or muscle imbalance. This occurs due to dysfunction or inflammation of the joint capsule and associated muscles. Other findings may include clicking, popping, or crepitus, tenderness over the joint, and limited range of motion. Pain is usually exacerbated by chewing or jaw movement.
Which of the following treatments is appropriate for a patient who has acute otitis media and has an allergy to penicillin?
- A. Suprax 400 mg daily for 7 days
- B. Augmentin 875 mg two times daily for 10 days
- C. Zithromax 500 mg on day 1, and then 250 mg daily for 4 days
- D. Amoxicillin 500 mg every 8 hours for 10 days
Explanation
Azithromycin (Zithromax) is a macrolide antibiotic that serves as an effective alternative for patients allergic to penicillin. It covers common pathogens in acute otitis media, including Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Its convenient once-daily dosing and short course improve compliance while avoiding the risk of allergic reactions associated with beta-lactam antibiotics like penicillins and cephalosporins.
Which of the following doses of statins decrease LDL by up to 50% on average?
- A. Fluvastatin 40 mg
- B. Pravastatin 40 mg
- C. Simvastatin 20 mg
- D. Atorvastatin 80 mg
Explanation
Atorvastatin 80 mg is considered a high-intensity statin therapy, which can reduce low-density lipoprotein (LDL) cholesterol by approximately 50% or more. High-intensity statins, including atorvastatin 40–80 mg and rosuvastatin 20–40 mg, are prescribed for patients at high cardiovascular risk—such as those with established coronary artery disease, recent myocardial infarction, or diabetes with additional risk factors. These doses provide maximal LDL reduction by increasing hepatic LDL receptor activity and reducing cholesterol synthesis in the liver.
The clinician is assessing Sally's diffuse hip pain. How should the clinician begin the examination?
- A. The patient should move the hip prior to radiographic studies to determine whether they are necessary.
- B. Begin the range-of-motion examination with an assessment of the motion that causes pain.
- C. Flexion and extension of the affected hip’s extremity should only be performed with the knee straight.
- D. Physical examination of the hip must first assess its position at rest.
Explanation
When evaluating hip pain, the clinician should first inspect and assess the position of the hip at rest before performing any movement or palpation. The resting position provides essential diagnostic clues — such as external rotation in hip fracture, internal rotation in posterior dislocation, or shortening of the limb in trauma. This initial observation helps determine whether there is structural deformity, muscular imbalance, or acute injury before range-of-motion testing, which could exacerbate pain or injury.
The forced vital capacity is decreased in:
- A. Asthma
- B. Restrictive disease
- C. Chronic bronchitis
- D. Emphysema
Explanation
Forced Vital Capacity (FVC) measures the maximum amount of air a person can exhale forcefully after a deep inhalation. In restrictive lung disease, such as pulmonary fibrosis or sarcoidosis, lung expansion is limited due to reduced compliance or decreased lung volume, resulting in a decreased FVC. Both total lung capacity (TLC) and FVC are proportionally reduced, while the FEV₁/FVC ratio remains normal or increased, differentiating restrictive from obstructive disorders.
A patient is seen with complaints of diarrhea. Which of the following should be included in the patient’s differential diagnosis?
- A. Decreased physical activity
- B. Recent use of Imodium
- C. Gastroenteritis
- D. Lack of dietary fiber
Explanation
Gastroenteritis—an inflammation of the stomach and intestines caused by viruses, bacteria, or parasites—is one of the most common causes of acute diarrhea. It typically presents with watery stools, abdominal cramping, nausea, and sometimes vomiting or fever. The clinician should assess recent food intake, travel history, and possible exposure to contaminated water or infected individuals to confirm the diagnosis and rule out other causes.
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