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
Fredericka is a 40-year-old Hispanic female with a history of diabetes mellitus, hypertension, and HIV. She has a tuberculosis (TB) skin test. What is the smallest diameter of induration that would indicate a positive result?
- 10 mm
- 8 mm
- 5 mm
- 2 mm
Explanation
An induration of 5 mm or greater is considered positive for tuberculosis (TB) in individuals at high risk, including those who are HIV-positive, have recent contact with active TB cases, or are immunocompromised. HIV infection significantly weakens the immune system, lowering the threshold for a positive result because the body’s reaction to the tuberculin antigen is diminished. This means even a small induration represents a meaningful immune response and warrants further evaluation with chest imaging and sputum testing.
Sam is a 25-year-old who has been diagnosed with low back strain based on his history of localized low back pain and muscle spasm along with a normal neurological examination. As the clinician, you explain to Sam that low back pain is a diagnosis of exclusion. Which of the following symptoms would alert the clinician to the more serious finding of a herniated nucleus pulposus or ruptured disc?
- Pathologic fractures, severe night pain, weight loss, and fatigue
- Fever, chills, and elevated erythrocyte sedimentation rate
- Unilateral radicular pain symptoms that extend below the knee and are equal to or greater than the back pain
- Morning stiffness and limited mobility of the lumbar spine
Explanation
A herniated nucleus pulposus (herniated or ruptured disc) compresses the spinal nerve root, leading to radicular pain—a hallmark symptom distinguishing it from simple muscle strain. The pain typically radiates down one leg (sciatica), extending below the knee and may be associated with numbness, tingling, or weakness in the affected dermatome. This pattern of pain equal to or greater than back pain signals nerve involvement and warrants further evaluation with MRI for confirmation.
Chris is a 28-year-old male who complains of lower back pain that began 3 days ago. The pain is worse when he stands or bends, and it is somewhat relieved when he sits. The clinician performs the straight-leg raise test and it is negative. Plain film x-ray is positive. Which diagnosis is most likely?
- Muscle strain
- Scoliosis
- Osteoarthritis
- Spinal stenosis
Explanation
A muscle strain is the most likely diagnosis for a 28-year-old presenting with acute lower back pain that worsens with movement (standing, bending) and improves with rest or sitting. The negative straight-leg raise test rules out nerve root compression such as herniated disc or sciatica. Plain x-rays may show normal findings or nonspecific changes, but they are typically ordered to exclude structural abnormalities. Muscle strain commonly results from improper lifting, twisting, or sudden exertion and improves with rest, NSAIDs, and gentle stretching.
Data from the Framingham Heart Study suggests that individuals who are normotensive at 55 years of age have how much lifetime risk of developing hypertension?
- 80%
- 75%
- 65%
- 90%
Explanation
The Framingham Heart Study demonstrated that adults who are normotensive at age 55 have about a 90% lifetime risk of developing hypertension. This statistic highlights how aging contributes to progressive vascular stiffness and increased blood pressure over time. Even in those with normal midlife readings, hypertension is highly likely later in life, making early prevention—through regular exercise, weight control, reduced sodium intake, and a heart-healthy diet—critical for long-term cardiovascular wellness.
A blood pressure (BP) of 150/90 is considered:
- Hypertensive
- Acceptable if the patient has diabetes mellitus (DM)
- Stage 2 hypertension
- Normal in healthy older adults
Explanation
A blood pressure of 150/90 mm Hg falls within the hypertensive range according to the American College of Cardiology/American Heart Association (ACC/AHA) guidelines. Normal BP is below 120/80 mm Hg, and hypertension is diagnosed when BP is ≥130/80 mm Hg on at least two separate occasions. Although 150/90 does not meet Stage 2 criteria, it clearly exceeds normal and Stage 1 thresholds and requires lifestyle modification and evaluation for secondary causes.
Marie has diabetes mellitus with proliferative retinopathy. How often should she see her ophthalmologist?
- Every 3 to 4 months
- Monthly
- Annually
- Every 2 months
Explanation
Patients with proliferative diabetic retinopathy require close monitoring by an ophthalmologist every 3 to 4 months to prevent progression to blindness. Proliferative retinopathy involves abnormal new vessel growth (neovascularization) that can lead to vitreous hemorrhage, retinal detachment, or vision loss. Frequent evaluations allow timely intervention, such as laser photocoagulation or anti-VEGF therapy, to preserve vision and monitor treatment response.
Janet is a 30-year-old who has recently been diagnosed with a herniated disc at the level of L5-S1. She is currently in the emergency room with suspicion of cauda equina compression. Which of the following is a sign or symptom of cauda equina compression?
- Numbness in the lateral foot
- A reduced or absent ankle reflex
- Saddle area anesthesia
- Gastrocnemius weakness
Explanation
Cauda equina syndrome is a neurologic emergency caused by compression of the lumbosacral nerve roots, usually from a massive herniated disc, trauma, or tumor. A hallmark symptom is saddle anesthesia—numbness or loss of sensation in the inner thighs, perineum, and buttocks (the area that would touch a saddle). Other key findings include bowel or bladder dysfunction, severe low back pain, and bilateral leg weakness. Immediate MRI and surgical decompression are required to prevent permanent deficits.
A 70-year-old patient presents with a poorly defined, pink, scaling rash on his face and scalp. When he asks what he can expect from this condition, you say:
- "This rash is most common in people that have poor hygiene, so you will have to shower at least once a day."
- "This condition does not run in families, so your children are not at risk of developing it."
- "If your rash is itchy, the itching may be worse when you are hot and sweaty."
- "This is probably a one-time rash and should not come back."
Explanation
The patient’s description—a poorly defined, pink, scaling rash on the face and scalp—is consistent with seborrheic dermatitis, a chronic, relapsing inflammatory skin condition affecting areas rich in sebaceous glands (scalp, face, behind ears). Itching and discomfort often worsen with heat, sweating, or stress, making statement C accurate. Seborrheic dermatitis is managed with topical antifungal or corticosteroid treatments and regular cleansing with medicated shampoos.
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 doses of statins decrease LDL by up to 50% on average?
- Fluvastatin 40 mg
- Pravastatin 40 mg
- Simvastatin 20 mg
- 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.
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