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 male patient with diabetes asks the clinician why he needs to check his blood sugar at home even when he feels good. Which response by the clinician would be most appropriate?
- "Regularly checking blood sugar will help you."
- "Monitoring glucose will promote a sense of connectedness."
- "Because you know it is the right thing to do for your disease."
- "Control of glucose will help postpone or delay complications."
Explanation
The most appropriate and therapeutic response emphasizes the importance of glucose control in preventing or delaying long-term complications of diabetes, such as neuropathy, nephropathy, retinopathy, and cardiovascular disease. Even when patients feel well, blood glucose can fluctuate silently. Regular monitoring allows for timely adjustments in diet, medication, and activity, maintaining glucose within the target range and preserving overall health.
A 45-year-old male presents with throbbing podagral pain and tophi in the ear pinnae. Which medication should the clinician prescribe for this acute attack?
- Colchicine (Colcrys)
- Pegloticase (Krystexxa)
- Allopurinol (Zyloprim)
- Probenecid (Benemid)
Explanation
Colchicine (Colcrys) is indicated for the acute management of gout attacks. It works by reducing inflammation and neutrophil activity at the site of urate crystal deposition, providing rapid relief of pain and swelling. In this patient with acute podagral pain (first metatarsophalangeal joint) and tophi, immediate treatment with colchicine or NSAIDs is appropriate to control the acute flare. Long-term urate-lowering therapy (like allopurinol) should not be started during an active flare, as it can worsen symptoms.
The clinician has instructed Sirius, a 23-year-old patient with low back strain, to use NSAIDs to manage his symptoms of pain and discomfort. Which of the following statements would be most appropriate when teaching Sam about the use of NSAIDs?
- "It is important to take NSAIDs on an empty stomach in order to increase absorption."
- "You should start with the lowest dose that is effective in managing your pain to avoid developing tolerance to the medication."
- "You should take the maximum recommended dose of NSAIDs so that you will not need to take narcotics to control your pain."
- "You should start with the lowest dose that is effective in managing your pain, because long-term use of NSAIDs can result in gastrointestinal (GI) disorders such as ulcers and hemorrhage."
Explanation
The safest and most effective approach to NSAID therapy is to use the lowest effective dose for the shortest duration necessary to control symptoms. Long-term or high-dose NSAID use can damage the gastric mucosa by inhibiting prostaglandin synthesis, leading to ulcers, GI bleeding, and gastritis. Patients should take NSAIDs with food or milk to minimize stomach irritation and be educated to report any signs of GI bleeding (black stools, vomiting blood).
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.
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.
Which of the following persons fits the classic description of a patient with multiple sclerosis (MS)?
- A teenage male
- A 60-year-old female
- A 25-year-old female
- 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.
Which medication used for scabies is safe for children 2 months and older?
- Crotamiton lotion and cream
- Ivermectin
- Permethrin cream
- Lindane
Explanation
Permethrin 5% cream is the first-line treatment for scabies and is considered safe for use in children aged 2 months and older. It acts as a neurotoxin to the mites, killing both the scabies organisms and their eggs. The cream should be applied from the neck down (and on the scalp in infants), left on for 8–14 hours, then washed off. A repeat application in 7 days ensures eradication.
The nurse practitioner (NP) suspects a patient has a peptic ulcer. Which of the following items on the history would lead the NP to this conclusion?
- Cigarette smoking
- Prednisone use
- Use of fish oil vitamin
- Ethanol avoidance
Explanation
Prednisone, a corticosteroid, increases the risk of peptic ulcer disease (PUD), especially when used long-term or in combination with nonsteroidal anti-inflammatory drugs (NSAIDs). Corticosteroids can impair mucosal defense mechanisms and delay healing of gastric or duodenal tissue, making the stomach lining more vulnerable to acid injury. Patients on prednisone should be monitored for gastrointestinal symptoms and may require gastroprotective therapy, such as a proton pump inhibitor (PPI).
A 44-year-old patient with breast cancer is prescribed tamoxifen by her surgeon. She is complaining about hot flashes. Which of the following responses by the clinician would be most appropriate?
- "You must be having menopause."
- "Tamoxifen use has no increased incidence of endometrial cancer."
- "The hot flashes are a result of the antiestrogenic effects of tamoxifen."
- "The drug will have no effect on vaginal lubrication."
Explanation
Tamoxifen is a selective estrogen receptor modulator (SERM) that acts as an antiestrogen in breast tissue while exerting estrogen-like effects in other tissues such as the bone and endometrium. Its antiestrogenic effects on the hypothalamus can lead to vasomotor symptoms, including hot flashes and night sweats, similar to those experienced during menopause. These symptoms are common and generally manageable with lifestyle modifications or non-hormonal treatments.
Sam, age 78, presents to the clinic with respiratory symptoms. His pulmonary function tests are as follows: a normal total lung capacity, a decreased PaO₂, and an increased PaCO₂. On assessment, you auscultate coarse crackles and forced expiratory wheezes. What is your diagnosis?
- Influenza
- Emphysema
- Chronic bronchitis
- Asthma
Explanation
Chronic bronchitis is a form of chronic obstructive pulmonary disease (COPD) characterized by chronic productive cough for at least 3 months in 2 consecutive years. The classic findings include normal total lung capacity, hypoxemia (low PaO₂), and hypercapnia (elevated PaCO₂) due to poor ventilation and mucus obstruction. On physical exam, coarse crackles and wheezes are heard from airway narrowing and mucus accumulation. These patients are often referred to as “blue bloaters” because of cyanosis and fluid retention secondary to hypoxia and right heart strain.
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