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
The therapeutic international normalized ratio (INR) for a patient taking warfarin (Coumadin) to manage chronic atrial fibrillation is expected to be:
- increased.
- decreased.
- the same as the partial thromboplastin time (PTT).
- three times the expected prothrombin time (PT).
Explanation
The therapeutic INR for a patient on warfarin (Coumadin) for chronic atrial fibrillation is typically targeted between 2.0 and 3.0. This corresponds to a prothrombin time (PT) that is approximately 2 to 3 times longer than the normal PT. The INR helps standardize PT results across different laboratories. Warfarin therapy increases the INR, but the most accurate description is that the INR is approximately three times the normal PT when it is therapeutically adjusted for anticoagulation therapy in patients with atrial fibrillation.
A 6-year-old male presents with complaints of sore throat and fever for the past 2 days. He has multiple vesiculated ulcerations on his tonsils and uvula. No other remarkable findings are present. What is the most likely diagnosis?
- Viral pharyngitis
- Herpangina
- Bacterial pharyngitis
- Tonsillitis
Explanation
Herpangina is a viral infection typically caused by coxsackievirus, characterized by the sudden onset of fever, sore throat, and the presence of small vesicles or ulcers, particularly on the tonsils and uvula. The lesions are often painful and may appear alongside fever. This condition commonly affects children and is typically self-limited, resolving on its own within a few days. The clinical presentation of vesicular lesions on the tonsils and uvula points toward herpangina over other types of pharyngitis or tonsillitis.
A 53-year-old male presents with complaints of anuria. The MOST likely differential diagnosis in the presence of anuria is:
- hydronephrosis.
- chronic kidney disease.
- acute renal failure.
- severe pyelonephritis.
Explanation
Anuria refers to the absence of urine output, typically defined as less than 50 mL of urine per day. The most likely cause of anuria in this patient is acute renal failure (ARF), which occurs when there is a sudden decline in kidney function, resulting in a sharp reduction in urine output. ARF can be caused by various factors, such as prerenal causes (e.g., hypoperfusion due to dehydration or shock), intrarenal causes (e.g., acute tubular necrosis, glomerulonephritis), or postrenal causes (e.g., obstruction).
The majority of patients with vitamin D deficiency:
- present with complaints of muscle spasms.
- are asymptomatic.
- also have elevated calcium levels.
- 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.
A 50-year-old male experiences difficulty achieving and maintaining an erection. This condition is MOST likely a result of:
- obstructive sleep apnea
- cardiovascular disease
- an endocrine disorder
- 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.
Which of the following may predispose the patient to impaired glucose tolerance?
- Glucocorticosteroids
- Beta-adrenergic blockers
- Alcohol
- Oral contraceptives
Explanation
Glucocorticosteroids, such as prednisone, increase blood glucose levels by promoting gluconeogenesis in the liver and reducing insulin sensitivity. These medications are well-known to predispose individuals to impaired glucose tolerance, especially with long-term use. This can lead to hyperglycemia and potentially steroid-induced diabetes. While beta-adrenergic blockers, alcohol, and oral contraceptives may have effects on glucose metabolism, they are not as directly associated with impaired glucose tolerance as glucocorticosteroids.
The most common presenting sign or symptom of Hodgkin's lymphoma is:
- granulocytopenia.
- asymptomatic lymphadenopathy.
- lymphoblasts.
- fatigue and night sweats.
Explanation
The most common presenting symptom of Hodgkin's lymphoma is asymptomatic lymphadenopathy, particularly in the cervical or supraclavicular lymph nodes. The enlarged lymph nodes are typically painless in the early stages of the disease. Lymphadenopathy is the hallmark sign of Hodgkin’s lymphoma and is often the first noticeable symptom that prompts the patient to seek medical attention.
A 24-year-old female is diagnosed with trichomoniasis. In addition to initiating metronidazole (Flagyl), the nurse practitioner instructs the patient:
- to avoid spermicides.
- that it was likely contracted from a partner in the last 6 weeks.
- to clean sexual aids or toys.
- that there is no need to treat female partners.
Explanation
Trichomoniasis is a sexually transmitted infection caused by the protozoan parasite Trichomonas vaginalis. In addition to initiating treatment with metronidazole (Flagyl), it is important to advise the patient to clean sexual aids or toys thoroughly, as they can harbor the organism and contribute to reinfection. The parasite can survive on these surfaces, so cleaning them properly helps reduce the risk of transmission.
A 59-year-old patient complains of severe shoulder pain that worsens at night. The pain has been present for the past 2 months. The patient has decreased active and passive range of motion and reports no history of trauma. Which diagnosis should be included as a differential?
- Adhesive capsulitis
- Rotator cuff tendinopathy
- Rotator cuff tear
- Acromioclavicular (AC) joint arthritis
Explanation
The patient's symptoms — severe shoulder pain, worsening pain at night, decreased active and passive range of motion, and no history of trauma — are most consistent with adhesive capsulitis, also known as frozen shoulder. This condition typically presents with gradual shoulder pain and restricted range of motion, often without a history of trauma, and can worsen at night. It is characterized by inflammation and stiffness of the shoulder capsule.
Primary hypoparathyroidism is a condition of parathyroid hormone (PTH) deficiency in which:
- Vitamin D levels fall below the reference range.
- Ionized calcium concentration in the extracellular fluid falls below the reference range.
- The parathyroid hormone concentration is low and the serum calcium concentration is elevated.
- Hyperalbuminemia causes a drop in total calcium concentration.
Explanation
In primary hypoparathyroidism, the parathyroid glands fail to produce enough parathyroid hormone (PTH), which is responsible for regulating calcium and phosphate levels in the body. PTH deficiency leads to low ionized calcium levels in the extracellular fluid (the active form of calcium in the blood). Without enough PTH, the kidneys do not retain calcium, and the bones do not release calcium into the bloodstream as they should, leading to hypocalcemia (low blood calcium).
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