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
Carotid endarterectomy should be considered only for symptomatic patients with greater than what percentage of stenosis?
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Only for 100% occlusion
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Greater than 25%
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Greater than 75%
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Greater than 50%
Explanation
Carotid endarterectomy (CEA) is recommended for symptomatic patients (those who have had a transient ischemic attack or stroke) with greater than 50% carotid artery stenosis as confirmed by imaging studies such as Doppler ultrasound or angiography. The procedure aims to remove atherosclerotic plaque and restore adequate blood flow to the brain, thereby reducing the risk of recurrent stroke. Evidence from major trials, including the NASCET (North American Symptomatic Carotid Endarterectomy Trial), shows that the greatest benefit occurs in patients with 70–99% stenosis, though patients with 50–69% stenosis may also benefit depending on symptoms and overall risk profile.
Which of the following causes of gastrointestinal bleeding is found in the lower gastrointestinal tract?
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Meckel’s diverticulum
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Duodenal ulcer
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Erosive esophagitis
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Gastric ulcer
Explanation
Meckel’s diverticulum is a congenital anomaly located in the distal ileum, making it a lower gastrointestinal (GI) source of bleeding. It results from a remnant of the vitelline duct and may contain ectopic gastric mucosa that secretes acid, leading to ulceration and bleeding in adjacent intestinal tissue. It is a classic cause of painless lower GI bleeding, especially in children and young adults.
When a patient has a carotid bruit, which of the following should the PCP gather from the patient history?
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History of seizure disorder
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History of peripheral vascular occlusive disease
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History of hemophilia
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History of sickle cell disease
Explanation
A carotid bruit is an abnormal whooshing sound heard over the carotid artery caused by turbulent blood flow, often due to atherosclerosis or arterial narrowing. Because these changes are part of systemic vascular disease, the clinician should ask about a history of peripheral vascular occlusive disease, as it indicates generalized atherosclerosis and an increased risk for stroke, transient ischemic attack (TIA), or myocardial infarction (MI). This connection helps guide further evaluation, such as carotid Doppler ultrasound and aggressive cardiovascular risk management.
A patient is seen in the clinic and diagnosed with Stage I renal cancer. The provider should refer the patient to a nephrologist for which of these treatments?
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Chemotherapy
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Nephrectomy
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Radiation
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Palliative treatment
Explanation
For Stage I renal cancer, the standard and most effective treatment is surgical removal of the tumor, typically through a partial or radical nephrectomy. Surgery is potentially curative at this early stage because the cancer is localized to the kidney and has not spread. A partial nephrectomy is preferred when possible to preserve kidney function, while a radical nephrectomy (removal of the entire kidney) may be necessary for larger or more invasive tumors.
Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)?
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A teenage male
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A 60-year-old female
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A 25-year-old female
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A 65-year-old male
Explanation
Multiple sclerosis (MS) most commonly affects young adult women between the ages of 20 and 40 years, with a peak onset in the mid-20s to early 30s. It is an autoimmune demyelinating disease of the central nervous system that leads to neurological symptoms such as visual disturbances, weakness, fatigue, and problems with coordination or balance. The condition is more prevalent in females and in populations living farther from the equator, where lower vitamin D levels are common.
The advance practice registered nurse (APRN) is providing a community health program for the prevention of Lyme disease. Which information should be included?
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Smoking cessation
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Hiking precautions
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Safe sex practices
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Vaccination schedules
Explanation
Lyme disease is transmitted through the bite of infected black-legged (deer) ticks, commonly encountered in wooded, grassy, or brushy outdoor areas. Prevention focuses on avoiding tick bites during outdoor activities like hiking. The APRN should educate participants about wearing long sleeves, tucking pants into socks, using tick repellents (DEET or permethrin), performing tick checks after outdoor exposure, and promptly removing ticks to reduce infection risk.
Which patient is most likely to have myasthenia gravis (MG)?
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A 55-year-old African American male
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A 31-year-old Hispanic woman
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A 75-year-old Caucasian woman
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A 10-year-old Middle Eastern male
Explanation
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by fluctuating muscle weakness that worsens with activity and improves with rest. It results from autoantibodies against acetylcholine receptors at the neuromuscular junction. MG most commonly affects younger women (ages 20–40) and older men (ages 60–80). Therefore, a 31-year-old woman fits the classic demographic profile for early-onset autoimmune MG.
Nitroglycerine (NTG) is given for a patient having ischemic chest pain. One tablet or one spray should be used under the tongue every 5 minutes for three doses. What should be done if the pain has not been relieved after three doses?
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The person should be given two aspirin to chew.
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One more dose of NTG may be tried.
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911 should be called, and the patient should be transported immediately to the emergency department.
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A portable defibrillator should be located to ascertain the cardiac rhythm.
Explanation
If chest pain persists after three doses of nitroglycerin given 5 minutes apart, it indicates that the pain may be due to an acute myocardial infarction (MI) rather than stable angina. At this point, the situation is a medical emergency, and emergency services (911) must be called immediately for prompt evaluation and advanced cardiac care. Continued ischemia can lead to myocardial tissue death, so rapid transport to an emergency department is essential for ECG assessment, cardiac enzyme testing, and initiation of reperfusion therapy.
Rachel is a patient complaining of a pruritic erythematous rash on her face and hands that became apparent this morning. Which of the following questions would help determine whether she has contact dermatitis?
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"Do you have a history of rosacea?"
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"Do you have any food allergies?"
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"Do you have a history of itchy rashes?"
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"Have you used any new face wash or soap?"
Explanation
Contact dermatitis is an inflammatory skin reaction triggered by direct exposure to an irritant or allergen, such as soaps, detergents, cosmetics, or metals. Asking whether the patient has recently used a new face wash, soap, lotion, or detergent helps identify potential external triggers responsible for the rash. This question is crucial for distinguishing contact dermatitis from other dermatologic conditions and guides management, which includes removing the offending agent and using topical corticosteroids for inflammation.
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?
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"Are you sexually active?"
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"Was your mother pregnant with you when she was of advanced maternal age?"
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"How long have you been underweight?"
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"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.
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