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
George has COPD and an 80% forced expiratory volume in 1 second. How would you classify the severity of his COPD?
- Stage 3 severe COPD
- Stage 5 very severe COPD
- Stage 1 mild COPD
- Stage 2 moderate COPD
Explanation
According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, Stage 1 (mild) COPD is defined as a FEV₁ ≥ 80% of predicted after bronchodilator use. Patients may have mild airflow limitation and chronic cough or sputum production but often are asymptomatic. Management focuses on smoking cessation, vaccination (influenza and pneumococcal), and bronchodilator use as needed to prevent progression.
A 27-year-old female presents with a chief complaint of burning and pain on urination. She has no previous history of urinary tract infection (UTI). What are some additional symptoms consistent with a diagnosis of lower UTI?
- Fever, chills, costovertebral angle (CVA) tenderness
- Thick, green discharge
- Foul-smelling discharge, perineal itch
- Blood in urine and frequency
Explanation
A lower urinary tract infection (cystitis) commonly presents with dysuria (burning on urination), urinary frequency, urgency, and sometimes hematuria (blood in the urine). These symptoms result from inflammation and irritation of the bladder and urethral mucosa. The infection is usually limited to the bladder and does not cause systemic symptoms such as fever or flank pain. Diagnosis is confirmed with a urinalysis showing pyuria, bacteriuria, and possibly hematuria.
Which of the following indicates a diagnosis of dementia?
- Hard time finding words
- Onset after an infection
- Difficulty with long-term memory
- Abrupt onset over a week
Explanation
Dementia is a chronic, progressive decline in cognitive function that interferes with daily activities. One of the early hallmark features is aphasia, or having a hard time finding words, which reflects cortical involvement, particularly in Alzheimer’s disease. Other cognitive deficits include memory loss, impaired judgment, and difficulty performing familiar tasks. The onset is typically gradual, and symptoms worsen over time.
The forced vital capacity is decreased in:
- Asthma
- Restrictive disease
- Chronic bronchitis
- 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 20-year-old Hispanic male presents with multiple noninflammatory comedones on his chest and back with four small papules on his right upper arm. Which diagnosis is accurate?
- Mild acne
- Severe acne
- Moderate acne
- Nodulocystic acne
Explanation
Mild acne is characterized primarily by noninflammatory comedones (open and closed blackheads and whiteheads) with only a few small inflammatory lesions such as papules or pustules. The absence of nodules, cysts, or widespread inflammation indicates a mild form of acne vulgaris. Treatment typically includes topical retinoids, benzoyl peroxide, or salicylic acid, which help clear comedones and prevent new lesions.
A 15-year-old girl is seen in the clinic because she has not yet had her first period. Which of the following questions would help the clinician determine the cause?
- "Are you sexually active?"
- "Was your mother pregnant with you when she was of advanced maternal age?"
- "How long have you been underweight?"
- "Have you noticed any changes in your moods lately?"
Explanation
Being underweight or having a low body fat percentage can lead to hypothalamic amenorrhea, a common cause of primary amenorrhea (failure to start menstruation by age 15). Adequate body fat is essential for estrogen production and normal hypothalamic-pituitary-ovarian axis function. Conditions like eating disorders, excessive exercise, or chronic illness can delay menarche. Asking about weight history helps determine whether nutritional or metabolic factors are contributing.
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?
- The clinician can definitively diagnose open-angle glaucoma based on the subjective complaints of the patient.
- Early diagnosis is essential in order to reverse any damage that has occurred to the optic nerve.
- The presence of increased intraocular pressure measured by tonometry is definitive for the diagnosis of open-angle glaucoma.
- 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.
You have a patient who is positive for strep on rapid antigen testing (rapid strep test). You order amoxicillin after checking for drug allergies (patient is negative), but he returns 3 days later reporting that his temperature has gone up, not down (101.5°F in office). You also note significant lymphadenopathy in the posterior and anterior cervical chains, some hepatosplenomegaly, and a diffuse rash. You decide:
- To refer the patient
- That he possibly has mononucleosis concurrent with his strep infection
- That his antibiotic dosage is not sufficient and should be changed
- That he is having an allergic response and needs to be changed to a macrolide antibiotic
Explanation
The patient’s worsening fever, diffuse rash after starting amoxicillin, posterior cervical lymphadenopathy, and hepatosplenomegaly are classic signs of infectious mononucleosis, caused by the Epstein-Barr virus (EBV). Administering amoxicillin or ampicillin to a patient with undiagnosed mononucleosis often produces a characteristic maculopapular rash, not a true allergy. The appropriate next step is to stop the antibiotic, confirm EBV infection (via Monospot or EBV serology), and provide supportive care.
When administered at the beginning of an attack, oxygen therapy may help this kind of headache?
- Stress
- Cluster
- Migraine
- Tension
Explanation
Cluster headaches are severe, unilateral headaches often centered around one eye, accompanied by tearing, nasal congestion, and restlessness. Administering 100% oxygen via a non-rebreather mask at 7–10 L/min for 15–20 minutes at the onset of an attack can effectively abort or greatly reduce pain in most patients. Oxygen therapy works by causing cerebral vasoconstriction and decreasing trigeminal nerve activation. It is considered first-line acute treatment for cluster headaches.
Which of the following is a condition that results in colicky abdominal pain?
- Gallstones
- Glisson’s capsule around the liver
- Peptic ulcers
- Peritoneum irritation
Explanation
Gallstones (cholelithiasis or biliary colic) cause colicky abdominal pain due to intermittent obstruction of the cystic or common bile duct by a stone. The pain is typically severe, cramp-like, and located in the right upper quadrant or epigastrium, often radiating to the right shoulder or back. It usually follows a fatty meal and occurs as the gallbladder contracts against the obstruction. Pain subsides when the stone moves and the duct clears.
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