APEA STU 25FL2 NUR 611 Univ Predictor Exam 111525 at St. Thomas University
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Free APEA STU 25FL2 NUR 611 Univ Predictor Exam 111525 at St. Thomas University Questions
Which of the following may be an absolute contraindication to administration of the inactivated influenza vaccine?
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A history of wheezing after previous vaccination
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An egg allergy that causes urticaria
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Asplenia
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Presence of an acute illness with fever
Explanation
A history of wheezing or a severe allergic reaction (such as anaphylaxis) after a previous dose of the inactivated influenza vaccine is considered an absolute contraindication to further vaccination with the same vaccine. This is due to the risk of severe allergic reactions upon subsequent doses. The vaccine should not be given to patients with a known history of such reactions.
A 50-year-old male experiences difficulty achieving and maintaining an erection. This condition is MOST likely a result of:
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obstructive sleep apnea
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cardiovascular disease
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an endocrine disorder
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benign prostatic hypertrophy
Explanation
Erectile dysfunction (ED) in middle-aged men is most commonly associated with cardiovascular disease (CVD). This is because CVD can lead to poor blood flow to the penis due to atherosclerosis or other vascular issues, impairing the ability to achieve or maintain an erection. Obstructive sleep apnea (A) can also contribute to ED, but it is less directly linked to erectile issues compared to CVD. Endocrine disorders (C), such as low testosterone, can cause ED, but they are less common than cardiovascular causes in this age group. Benign prostatic hypertrophy (D) primarily affects urinary function and does not directly cause erectile dysfunction, although medications for BPH may contribute to ED.
A 42-year-old female with a history of surgically-induced menopause complains of continuing stress incontinence. She reports that nonpharmacologic measures have not been helpful. The MOST appropriate intervention for this patient is:
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a referral to a gynecologist for surgical evaluation.
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vaginal topical estrogen cream.
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vaginal progesterone cream.
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oxybutynin (Ditropan).
Explanation
In this patient with surgically-induced menopause and continuing stress incontinence, vaginal topical estrogen is often the first-line pharmacologic treatment. Estrogen therapy can help improve urethral tone and support the strength of the pelvic floor muscles, both of which can help manage stress incontinence. Since the patient has already failed nonpharmacologic measures, topical estrogen can help address any vaginal atrophy and urethral dysfunction that may be contributing to her symptoms.
Once their levothyroxine dosage is stabilized, patients with hypothyroidism should be monitored with annual or semiannual clinical evaluations and:
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serum T3 and T4 measurement.
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serum thyroid-stimulating hormone (TSH) and T4 measurement.
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serum thyroid-stimulating hormone (TSH), free T3 and free T4 measurement.
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serum thyroid-stimulating hormone (TSH) measurement.
Explanation
Once a patient's levothyroxine dosage for hypothyroidism is stabilized, the most important test for monitoring is serum TSH measurement. TSH is the best indicator of thyroid function, as it is highly sensitive to changes in thyroid hormone levels and is used to guide treatment adjustments. Free T3 and free T4 (C) measurements are not typically necessary once levothyroxine dosage is stabilized, as TSH alone is sufficient for monitoring. Serum T3 and T4 (A and B) measurements are less commonly used for routine monitoring of hypothyroidism treatment because TSH reflects the overall thyroid function more accurately.
A 16-year-old patient with mild inflammatory facial acne seeks treatment. The nurse practitioner should prescribe:
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a topical antibiotic as monotherapy.
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topical benzoyl peroxide combined with a systemic antibiotic.
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a systemic antibiotic alone.
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combination therapy with a topical retinoid and an antimicrobial.
Explanation
For mild inflammatory acne, the most effective treatment strategy typically includes combination therapy. A topical retinoid (such as adapalene) helps prevent the clogging of pores and improves overall skin turnover, while an antimicrobial agent (such as a topical antibiotic or benzoyl peroxide) helps reduce inflammation and bacterial load. This combination works synergistically to target the primary causes of acne—blocked pores, inflammation, and bacteria. Using both a retinoid and an antimicrobial is generally more effective than using either alone. Oral antibiotics or topical antibiotics alone are not typically first-line treatments for mild inflammatory acne.
When considering a diagnosis of Addison's disease, the MOST appropriate diagnostic study is the:
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comprehensive metabolic panel.
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adrenocorticotrophic hormone (ACTH) stimulation test.
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thyroid-stimulating hormone (TSH) levels.
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prolactin testing.
Explanation
Addison's disease is characterized by primary adrenal insufficiency, where the adrenal glands do not produce enough cortisol. The ACTH stimulation test is the most appropriate diagnostic study for this condition. In this test, synthetic ACTH is administered, and the cortisol response is measured. In Addison's disease, the adrenal glands fail to produce an adequate cortisol response. A comprehensive metabolic panel may reveal electrolyte imbalances (e.g., hyponatremia, hyperkalemia), but it is not a definitive test for Addison’s disease. TSH levels and prolactin testing are used to assess thyroid and pituitary function, respectively, and are not specific to Addison's disease.
The majority of patients with vitamin D deficiency:
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present with complaints of muscle spasms.
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are asymptomatic.
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also have elevated calcium levels.
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should also be evaluated for osteoporosis.
Explanation
The majority of individuals with vitamin D deficiency are asymptomatic or present with mild, nonspecific symptoms such as fatigue or muscle weakness, but often do not show clinical signs. Vitamin D deficiency is typically identified through blood tests, as it can go unnoticed unless levels become very low, leading to conditions like osteomalacia or secondary hyperparathyroidism.
An 18-year-old patient presents with severe unilateral sore throat, muffled voice, swallowing difficulty, drooling, and fever of 101.5 degrees Fahrenheit. The history suggests that the patient is underimmunized. The most immediate appropriate action is to:
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perform a Streptococcal swab.
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administer a dexamethasone injection.
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use a tongue depressor to examine the patient.
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refer the patient to the nearest emergency department.
Explanation
The patient's presentation is highly concerning for epiglottitis, a potentially life-threatening condition often caused by Haemophilus influenzae type B (Hib), especially in underimmunized patients. The classic signs of severe sore throat, muffled voice, difficulty swallowing, drooling, and fever point towards upper airway obstruction, which can rapidly worsen, leading to respiratory distress. Immediate referral to the emergency department is necessary to secure the airway and manage the condition appropriately. Epiglottitis can cause airway obstruction, and attempting to examine the throat with a tongue depressor can provoke further airway compromise, which is dangerous. The patient needs emergency evaluation and intervention, such as intubation or a surgical airway, and intravenous antibiotics.
An 18-year-old mother who is breastfeeding her 2-week-old infant female expresses concern about how much milk the baby is getting. Which of the following parameters is reassuring to the nurse practitioner that the infant is receiving adequate nutrition?
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The infant is nursing six times per day.
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The infant has at least six wet diapers per day.
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The infant has a formed stool once daily.
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The infant is sleeping 3 hours between meals.
Explanation
One of the key indicators that an infant is receiving adequate nutrition while breastfeeding is the number of wet diapers. A well-nourished infant typically has at least six wet diapers per day, which indicates adequate hydration and that the baby is getting enough breast milk. Nursing six times per day (A) may not be enough to ensure sufficient milk intake. Formed stool once daily (C) is not a reliable indicator, as newborns, especially those breastfeeding, typically have multiple soft or loose stools daily. Sleeping 3 hours between meals (D) is not a specific indicator of adequate nutrition and can vary based on the infant's growth and development.
A patient who presents with fluid retention, pruritus, and breath with an ammonia odor is likely to have:
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Helicobacter pylori infection.
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heart failure.
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pancreatitis.
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uremia.
Explanation
Uremia is a condition that occurs when there is a build-up of waste products, including nitrogen, in the blood due to kidney dysfunction. Common symptoms include fluid retention, pruritus (itching), and uremic fetor (breath with an ammonia odor). The ammonia odor in the breath is a characteristic sign of uremia. Heart failure (B) can cause fluid retention but does not typically present with ammonia breath or pruritus. Helicobacter pylori infection (A) is linked to gastric issues and ulcers, and pancreatitis (C) presents with abdominal pain, not the symptoms described here.
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