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
A 25-year-old sexually active male patient presents with penile lesions that are grouped, flat, flesh-colored, and painless. This condition is MOST likely associated with:
- syphilis.
- human papillomavirus.
- herpes simplex virus.
- cytomegalovirus.
Explanation
The description of grouped, flat, flesh-colored, and painless penile lesions is most consistent with human papillomavirus (HPV) infection, specifically genital warts caused by HPV types 6 and 11. These warts are typically painless and may appear flat or raised on the genitals. Syphilis (A) can cause painless sores (chancres), but these are typically firm, round, and ulcerated, not flat and flesh-colored. Herpes simplex virus (C) causes painful, grouped blisters or ulcers, not painless lesions. Cytomegalovirus (D) is typically associated with systemic symptoms in immunocompromised patients and is not commonly linked to genital lesions.
The most common laboratory finding in a 16-year-old patient with infectious mononucleosis is:
- neutrophilia.
- thrombocytosis.
- lymphocytosis.
- monocytosis.
Explanation
Infectious mononucleosis, typically caused by the Epstein-Barr virus (EBV), commonly presents with lymphocytosis, characterized by an increased number of lymphocytes in the blood. This is a hallmark finding in the laboratory evaluation of a patient with mononucleosis. The lymphocytes may also appear atypical (reactive) in the blood smear. Neutrophilia (A), thrombocytosis (B), and monocytosis (D) are not as commonly seen in this condition. Lymphocytosis with atypical lymphocytes is a more specific and frequent finding in infectious mononucleosis.
The minimum age for routine immunization with the MMR vaccine is:
- 6 months
- 12 months
- 2 years
- 4 years
Explanation
The MMR (measles, mumps, and rubella) vaccine is typically administered as the first dose at 12 months of age. This is the recommended age for routine immunization to protect against these serious diseases. The vaccine is an essential part of the childhood immunization schedule and is usually followed by a second dose at 4-6 years of age for additional protection. The timing at 12 months is crucial as it provides immunity before the child enters preschool or daycare, where exposure risk is higher.
A 25-year-old patient with hypertension has a BMI of 16. His blood pressure is 165/110 mm Hg. The nurse practitioner is highly suspicious for:
- benign essential hypertension.
- secondary hypertension.
- isolated systolic hypertension.
- whitecoat hypertension.
Explanation
The patient's extremely low BMI of 16 (which is considered underweight) along with severe hypertension (165/110 mm Hg) suggests the possibility of secondary hypertension, which is high blood pressure caused by an underlying condition, rather than primary (essential) hypertension. Secondary hypertension can result from various conditions, including renal disease, endocrine disorders (like hyperaldosteronism, pheochromocytoma, or hyperthyroidism), or vascular abnormalities. The patient's severe blood pressure elevation is atypical for benign essential hypertension, which generally develops more gradually and is not usually associated with extreme weight loss or a very low BMI.
A 57-year-old smoker who has chronic obstructive pulmonary disease (COPD) presents today with increased dyspnea and sputum production. His routine medications include ipratropium (Atrovent) 2-3 times daily. His medical record notes an allergy to penicillin. The nurse practitioner should avoid prescribing:
- doxycycline (Doryx).
- cefdinir (Omnicef).
- clarithromycin (Biaxin).
- levofloxacin (Levaquin).
Explanation
The patient has a known penicillin allergy, and cefdinir (Omnicef) is a cephalosporin antibiotic. Cephalosporins, particularly the first and second generations, have a similar beta-lactam structure to penicillins, which can cause cross-reactivity in patients with penicillin allergies. Therefore, cefdinir should be avoided in this patient due to the potential for an allergic reaction.
The nurse practitioner suspects that a 3-year-old child has a Still's murmur. The MOST appropriate intervention at this time would be to:
- refer the child to a pediatric cardiologist.
- order an echocardiogram.
- re-evaluate the child at the next routine visit.
- order a chest X-ray.
Explanation
A Still's murmur is a common physiologic (innocent) murmur heard in children, particularly between the ages of 2 and 6 years. It is typically benign and non-pathologic, caused by the turbulent blood flow through the heart. Still's murmurs are often characterized as soft, systolic, and vibratory and are typically heard along the left sternal border or the apex. In the absence of other symptoms or abnormal findings, the most appropriate intervention is to re-evaluate the child at the next routine visit, as Still's murmurs tend to resolve on their own with age.
The guardian of a healthy 3½-year-old male reports continuous unsuccessful attempts at toilet training over the past 6 months. The guardian states that the child is incontinent of urine at least once daily and a few nights a week. He wears "pull-up" diapers and successfully uses a toddler toilet chair for bowel movements only. Urine dipstick is negative for blood and leukocytes. The most appropriate intervention is to:
- Provide the most current and proven recommendations for toilet training.
- Prescribe desmopressin (DDAVP) nightly.
- Encourage continued toilet training. This is normal for a child his age, and he may need a little more time.
- Encourage the mother to seek a psychological evaluation for her child.
Explanation
Toilet training can vary significantly from child to child, and incontinence at the age of 3½ is relatively common. The child in this scenario has been attempting to toilet train for 6 months but still has some difficulties, which is typical at this stage of development. Most children are not fully toilet trained, especially for nighttime continence, until 3 to 4 years old, and it's not uncommon for children to have daytime accidents even longer.
A 46-year-old patient presents with complaints of sudden left-side flank pain that radiates downward in waves and fluctuates in intensity. She also complains of nausea and dysuria. This is suggestive of:
- interstitial cystitis.
- nephrolithiasis.
- diverticular disease.
- intestinal obstruction.
Explanation
The description of sudden, severe flank pain that radiates downward in waves, along with nausea and dysuria, is most suggestive of nephrolithiasis, or kidney stones. The pain, often described as colicky and fluctuating in intensity, is caused by the movement of the stone within the urinary tract. Interstitial cystitis (A) typically causes pelvic pain and urinary urgency but does not present with flank pain or radiating pain. Diverticular disease (C) usually presents with lower abdominal pain, often left-sided, and is not typically associated with the radiating pain pattern described here. Intestinal obstruction (D) would cause generalized abdominal pain, bloating, and vomiting, not the flank pain and urinary symptoms seen in nephrolithiasis.
A 38-year-old patient reports that they may have been exposed to syphilis. The patient was treated for syphilis 4 years ago. The nurse practitioner knows that:
- a T. pallidum enzyme immunoassay (TP-EIA) is a qualitative test and will determine if she has been reinfected.
- a fluorescent treponemal antibody absorption (FTA-ABS) test will confirm a diagnosis of syphilis in this patient.
- there is no need to retest the patient; she should be treated empirically.
- a rapid plasma reagin (RPR) test will provide a semiquantitative result, and a fourfold increase may indicate a new infection.
Explanation
In this case, the RPR test is the most appropriate initial test to assess for syphilis and monitor for reinfection. It provides a semiquantitative result, which allows for monitoring changes in titers over time. A fourfold increase in RPR titers is often indicative of a new infection or reinfection. The TP-EIA (A) is a qualitative test that detects antibodies to T. pallidum but does not differentiate between past and current infection. FTA-ABS (B) is a confirmatory test that detects treponemal antibodies, but it can remain positive for life after a previous infection, making it less useful for distinguishing between a current infection and past exposure. Empiric treatment (C) is not recommended without confirmation of a current infection.
A 69-year-old patient presents with signs of depression. The initial evaluation should include:
- sedimentation rate
- an ECG
- hemoglobin and hematocrit
- CT scan
Explanation
In older adults presenting with depression, it is important to assess for underlying medical conditions that can contribute to depressive symptoms. Evaluating hemoglobin and hematocrit helps identify anemia, which is common in the elderly and can mimic or exacerbate depression. Correcting anemia may improve mood and energy levels. Initial laboratory testing focuses on simple, noninvasive tests that can reveal reversible causes before pursuing more complex or costly evaluations like imaging.
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