WGU D027 Objective Assessment Review (Latest 2023/ 2024 Update) Advanced Pathopharmacological Foundations| Questions and Verified Answers| 100% Correct| Grade A
WGU D027 Objective Assessment Review
(Latest 2023/ 2024 Update) Advanced
Pathopharmacological Foundations|
Questions and Verified Answers| 100%
Correct| Grade A
Q: What is the proportion of the population affected by a disease at the specific point in time?
Answer:
Prevalence rate –
Incidence rate refers to how many new cases there are of a disease within a period of time
divided by the number of the population’s individuals. The prevalence rate is affected by the
incidence rate and how long the affected patients survive. Risk factor is anything that could lead
to disease. Relative risk is the measure of a risk factor effect.
Q: Which of the following should be completed when a disease is multifactorial but has a larger
genetic component?
Answer:
Get a thorough family history –
Environment and lifestyle choices may influence a disease, but diseases such as breast cancer are
hereditary, so the family history should be reviewed.
Q: Which action is the purpose of the inflammatory process?
Answer:
To destroy foreign, invasive microorganisms –
The general purpose of inflammation is to initiate the destruction of foreign or invasive
organisms. As a secondary effect, it increases the healing and immune response processes of the
body.
Q: What causes edema that occurs during the inflammatory process?
Answer:
Increased vascular permeability –
Increased pressure in the vasculature secondary to the vasodilatory effects of inflammation will
result in the leakage of fluid into third spaces (i.e., edema).
Previousquestion
Q: In what structure do B lymphocytes mature and become B cells?
Answer:
Bone marrow –
The bone marrow is where immature immune cells, such as B and T lymphocytes, reside to
mature into B cells. After this maturation process, these cells migrate to other organ sites such as
the thyroid, spleen, and thymus to enter their final stages of differentiation and development.
Q: Which type of immunity occurs when antibodies are transferred from donor to recipient?
Answer:
Passive acquired immunity –
Active immune processes are the self-originating processes of the immune system that occur
from (acquired) or without (innate) prior exogenous simulation or exposure to foreign antigens.
Passive immunity is stabilized. Existing immune responses that are present with or without
simulation can arise or be created from oneself (innate) or acquired from an outside source (e.g.
donor antibodies).
Q: What does T-cell activity cause in older adults?
Answer:
Increased susceptibility for infection –
As the human body ages, the immune system’s effectiveness to coordinate responses to
pathogens and other foreign antigens wanes and the risk for disease increases.
Q: What is a dermatitis caused by prolonged exposure to chemicals such as acids or soaps also
known as?
Answer:
Irritant contact dermatitis –
Prolonged, superficial skin exposure to foreign irritants (e.g., acids or soaps) is a manifestation of
an innate, local inflammatory response. The conditions of allergic, stasis, and atopic dermatitis
involve more systemic processes of the immune system and vasculature.
Q: Which of the following is a self-limiting disease associated with Herpes type viruses and a
herald patch?
Answer:
Pityriasis rosea –
Lichen planus, acne vulgaris, and erythema multiforme are conditions generally associated with
or caused by autoimmune dysregulation, bacteria, and varieties of foreign antigen (medications,
virus, etc.). Pityriasis rosea in particular is associated with and triggered by Herpes viruses,
manifesting itself as a herald patch.
Q: What is a furuncle?
Answer:
An infection of the hair follicle that extends to the surrounding tissue –
Abscess, dermis, and fungal infections are generally more widespread or larger processes that
require broad or systemic treatment. A furuncle, though uncomfortable to painful, is a generally
localized infection that is self-resolving or that requires local, minor treatment.
Q: What type of lesion may be malignant in the form of squamous cell carcinoma (SCC)?
Answer:
Actinic keratosis –
Actinic keratosis, which is caused by exposure to UV radiation, is a precursor lesion of SCC
Q: What type of abnormal cell growth does carcinoma refer to?
Answer:
Epithelial cells –
Carcinoma refers to dysplastic epithelial cells that have penetrated the entire thickness of the
epithelium into the basement membrane.
Q: What is a characteristic of a malignant tumor?
Answer:
Absence of normal tissue organization –
Healthy tissue is made up of non-cancerous cells that are well-differentiated, connected via a
well-organized stroma and that stay put. Malignant tumors lack those characteristics as well as
normal tissue organization.
Q: Which lifestyle factor has not been linked to the development of cancer?
Answer:
Extreme exercise –
Tobacco use, obesity, and alcohol consumption are causal for numerous cancers, which can be
prevented. Exercise helps prevent colon cancer and likely helps prevent endometrial, breast, and
other cancers as well.
Q: Which pediatric malignancy is linked to the family of origin?
Answer:
Wilms tumor –
Wilms tumor is kidney cancer in childhood caused by inherited genes. The main causes of liver
cancer are hepatitis, fatty liver disease, and alcohol use. The main cause of cervical cancer is
HPV infection. Leukemia is caused by mutations to hematopoietic stem cells.
Q: Which of the following drugs is classified as hormonal treatment for breast cancer?
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Celiac disease is suspected. Which follow-up tissue test, the gold standard for this suspected diagnosis, should be ordered?
Endoscopy with small intestine biopsy
A 44-year-old woman has recently been diagnosed with advanced metastatic non-small-cell lung cancer. Genetic testing is ordered to determine if the patient’s tumor has any genomic alterations and to guide treatment decisions. A few weeks later, the patient’s test results come back positive for a genetic mutation. The APN starts osimertinib (Tagrisso). Based on this information, what type of genetic mutation does this patient have?
EGFR mutation
A 20-year-old male meets with an advanced professional nurse (APN) to discuss symptoms that have been slowly progressing over the past several years. He is mainly concerned because he has been falling frequently. Since childhood, his gait has consisted of walking on his toes. During middle school, he was able to participate in sports but was unable to participate in high school sports due to difficulty with running and jumping. Lately, he has noticed it takes longer and is more difficult to change positions from sitting to standing than it used to in the past. He has also been waking up with muscle and joint stiffness. The APRN notes that his family history is not significant for any chronic or genetic diseases. Which condition is likely to be the cause of these symptoms?
Becker muscular dystrophy
A patient with systemic lupus erythematosus (SLE) is diagnosed with idiopathic thrombocytopenic purpura (ITP). Which statement should the provider give the patient regarding the pathophysiology of SLE and its relation to thrombocytopenia?
SLE disrupts immune homeostasis and promotes development of self-reactive antibodies.
A female patient presents to an office to establish care. Her previous primary care provider told her to follow up regarding an elevated ferritin level. She has no previous medical history and is currently asymptomatic. She is concerned about the elevated ferritin and would like to know if she should be worried. What should the provider do next for this patient?
Order a liver function test
A 75-year-old female presents to the emergency department with an irregular heart rate of 130. What can be ascertained about this patient’s findings given the limited information?
She is diagnosed with atrial fibrillation and needs her heart rate controlled with metoprolol (Lopressor).
A 75-year-old male presents with a history of transient ischemic attack, acute myocardial infarction, angina, and atrial fibrillation. The patient’s echocardiogram shows low cardiac output and loss of contractility. Which condition from this patient’s medical history is contributing to the loss of contractility?
Acute myocardial infarction
A patient presents to an emergency room with blurred vision, fatigue, shortness of breath, and disorientation. Some of the preliminary lab results reveal the following: glucose >400 mg/dL, sodium 150 mEq/L, potassium 7 mEq/L, serum bicarbonate 12 mEq/L, serum creatinine 3 mg/dL. Which condition is this patient suffering from?
Diabetic ketoacidosis
A 45-year-old female fears that she is having a stroke and takes herself to an emergency room. After several diagnostic and laboratory tests, the patient is diagnosed with Cushing disease. Which lab abnormality would be present in this patient?
Increased cortisol
A 16-year-old female presents to the clinic with complaints of coughing and wheezing. The symptoms have been going on for several months, and she reports that her coughing and wheezing becomes worse during soccer practice. Occasionally, she wakes up at night and feels short of breath. She has a history of seasonal allergies but has no personal or family history of respiratory diseases. Based on the patient’s presentation, which disease process is the patient likely exhibiting?
Asthma
A two-year-old child presents with a clear runny nose and cough which has lasted 3 days. The child’s mother reports the cough sounds like a barking noise. The child is sleeping in the mother’s arms and appears to have stridor. The child’s mother also reports an axillary temperature of 101°F last night. Which management technique is appropriate for this child’s symptoms?
Oral steroids and breathing treatments
A patient who is elderly presents with recent memory loss, urinary incontinence, and hallucinations. The patient’s family also states she is having daytime sleepiness and impaired judgment. Which lab and diagnostic tests should be ordered as part of the patient’s assessment?
Complete blood count, complete metabolic profile, and urinalysis
An 18-year-old male is involved in a motorcycle crash while not wearing a helmet. He is brought into an emergency room and is immediately taken for a CT scan. The provider tells the patient’s parents he has bleeding between the dura mater and the skull. What is this patient’s condition called?
Epidural hematoma
A 40-year-old female comes to a clinic with abdominal pain and diarrhea. She reports that every time she eats, her diarrhea gets worse. Her labs and stool studies are normal, and a colonoscopy is performed. The colonoscopy reveals the patient has skip lesions throughout her colon. What is the appropriate diagnosis for this patient?
Crohn’s disease
A 15-year-old male comes into an office with pain in his scrotum. He states his pain started this morning and has been increasing. He reports feeling very nauseated. Which diagnostic test is appropriate to order for this patient?
Ultrasound
A 45-year-old male is being seen in the clinic for a yearly check-up and lab work. His history includes hypertension and hyperlipidemia for which he currently takes Norvasc 5 mg daily and Lipitor 20 mg nightly. Patient has a family history of diabetes, hypertension, heart disease, and hyperlipidemia. After obtaining lab work, the provider notices the patient’s hgbA1c is elevated at 7.5. The patient is already on a DASH diet and watching the amount of sweets and carbohydrates he eats daily. The patient is not overweight and participates in moderate physical activity at least 4-5 days a week. He was started on Metformin three months ago, and his hemoglobin A1c is now 6.9. The nurse expects to see a class of medication prescribed which is proven to reduce the risk of cardiovascular events.Considering the treatment guidelines from the American College of Cardiology, which medication should be recommended for this patient?
Invokana 100 mg daily
A 78-year-old female presents to the clinic for a checkup and refills on her medications. She is currently taking lisinopril (Zestril), metformin (Glucophage), and levothyroxine (Synthroid). The patient has a history of hypertension, type 2 diabetes, hypothyroidism, GERD, and gastric ulcers. The patient is concerned about heart disease and wants to start taking a low-dose aspirin. Which aspirin regimen recommendation should the advanced professional nurse (APN) give to the patient?
Low-dose enteric coated aspirin 81 mg daily
After testing is completed, the patient is diagnosed with Hashimoto’s thyroiditis. The patient is currently in a hypothyroid state.In reviewing the patient’s thyroid-stimulating hormone (TSH) level, which result correlates with her hypothyroid symptoms?
5.31 mIU/L
A 74- year-old male with Cushing syndrome presents to the emergency department (ED) with pain in his left leg, and is diagnosed with a deep vein thrombosis (DVT).What is this patient’s symptoms related to?
Elevated Von Willebrand factor
A 42-year-old asthmatic who has been using beta-adrenergic agonists for several years began to experience premature atrial contractions (PACs). To treat the PACs, metoprolol (Toprol XL) therapy was started.What is a likely consequence of this patient taking metoprolol (Toprol XL)?
Metoprolol (Toprol XL) worsened asthma symptoms, but improved the PACs.
Which inhaler prescription would support long-acting treatment for twice-daily use in controlled asthma management?
Fluticasone propionate/salmeterol (Advair Diskus)
A 65-year-old male presents for a visit regarding his type 2 diabetes. He has been dealing with diabetes for the last 15 years. He has a history of diabetic neuropathy in his feet. Six months ago his symptoms were mild to almost nonexistent. He currently describes the neuropathy as painful, and it wakes him up at night.Which medication would be the first line treatment for this patient?
Pregabalin (Lyrica)
A 55-year-old male presents for a new diagnosis of Parkinson’s Disease. He has experienced gait disorders and a pill rolling tremor. The patient was a former boxer with a history of multiple concussions. He was started on carbidopa-levodopa (Sinemet), which has decreased his symptoms.How would an antipsychotic medication such as haloperidol (Haldol) cause an interaction with this patient?
By antagonizing dopamine
A 25-year-old female is 35 weeks pregnant and presents for lower back pain. She has a history of moderate lower back pain that she normally controls with stretching, yoga, and ice. The patient reports not being able to engage in stretching and yoga because of the state of her pregnancy. Ice use has been ineffective. After a benign exam and a negative urinalysis, the provider is convinced that the pain is musculoskeletal. The patient inquires if there are any medications she can take for the pain.Which medication does the provider tell the patient she can safely take?
Acetaminophen (Tylenol)
A nurse is administering medication to a 67-year-old patient in liver failure, secondary to end-stage cirrhosis. Liver dysfunction can influence drug pharmacokinetics and pharmacodynamics. Which pharmacokinetic phase is affected in this patient?
Metabolism
A 40-year-old Trinidadian male comes into a clinic complaining of burning chest pain, indigestion, nausea, and belching after eating certain foods. He is a single father living and working in New York City. He recently obtained his green card after living in the United States for more than 10 years. He has a GED and works as an IT help desk technician earning $42,000 a year. He has health insurance through the New York health marketplace because it is cheaper than his employer’s plan. Because of the high cost of living in New York, the patient is unable to afford an apartment on his own; therefore, he and his child share a home with his mother and older sister. As the nurse begins to explore his social history regarding his alcohol use, the patient states, “I have two to three beers every night to help me sleep. I have been doing this for the past year.” The patient also states he has trouble falling asleep and staying asleep at night. He often wakes up tired. He admits he has taken a friend’s pain pill on occasion to help him sleep, but he is not doing this currently. He is worried about balancing work and parenting a 15-year-old since he is constantly stressed. The patient currently do
The patient’s lifestyle structure
A 40-year-old Trinidadian male comes into a clinic complaining of burning chest pain, indigestion, nausea, and belching after eating certain foods. He is a single father living and working in New York City. He recently obtained his green card after living in the United States for more than 10 years. He has a GED and works as an IT help desk technician earning $42,000 a year. He has health insurance through the New York health marketplace because it is cheaper than his employer’s plan. Because of the high cost of living in New York, the patient is unable to afford an apartment on his own; therefore, he and his son share a home with his mother and older sister. As the nurse begins to explore his social history regarding his alcohol use, the patient states, “I have two to three beers every night to help me sleep. I have been doing this for the past year.” The patient also states he has trouble falling asleep and staying asleep at night. He often wakes up tired. He admits he has taken a friend’s pain pill on occasion to help him sleep, but he is not doing this currently. He is worried about balancing work and parenting a 15-year-old since he constantly is stressed. The patient currently does
Seeking higher or advanced education in his field
A 72-year-old male patient comes into the clinic complaining of shortness of breath, wheezing, chills, and hot flashes at night for over three weeks. He is currently only prescribed a blood pressure medication but is unsure of the name and has not had any refills in the last several months. He reports being unsure if he has been exposed to any respiratory illnesses. He continues to report he is homeless and lives in different shelters or outside. He is unemployed but does receive assistance money from an unknown donor which averages $300 per month. He states he does not have any family or social support. The patient states he only has an eighth-grade education and is unable to read very well. He is unable to write his name, although he has always learned easily by watching and interacting with live instructions. He denies illegal drug use and uses public transportation.The assessment findings include a blood pressure of 152/90, temperature of 100° F, pulse of 90, and respirations of 24. He is 5 feet, 11 inches and weighs 145 lbs. Skin is pink but is slightly damp. He has faint bilateral carotid bruits on examination. Lung sounds are coarse and cough sounds very congested. Heart sounds S1
Lack of income and poverty level
A 32-year-old female presents to the emergency room (ER) with headache, fatigue, and shortness of breath on exertion. A complete blood count reveals a hemoglobin of 4.4g/dl. During the gynecological review of systems, she reports a change of a fully saturated pad every two hours for the first three out of six days of a 28-day menstrual cycle. She states she thought this was normal and has never sought gynecological care. She does not follow with a primary care physician.Which factor in the “health and healthcare” domain of the social determinants of health contributed to this patient’s hemoglobin of 4.4g/dl?
Health literacy
A 17-year-old male patient presents to a clinic during a physical, and he has a diagnosis of moderate glucose-6-phosphate dehydrogenase (G6PD) deficiency. During the exam, he states he is going to study abroad in Egypt during his sophomore year, and he has concerns about his nutrition while being away from home. Which counseling and education about G6PD deficiency should the provider to give to this patient about his diagnosis for while he studies abroad?
Acetaminophen (Tylenol) is safe to consume.
A 55-year-old Asian American male presents for new onset atrial fibrillation that has proved resistant to cardioversion and ablation. To decrease risk of stroke, the patient will be started on an anticoagulant. Due to cost considerations, warfarin (Coumadin) is selected. Which strategy should be employed when dosing the Coumadin for this patient?
Start at half the standard dosing for Coumadin.
Which medication would be contraindicated for a 46-year-old male patient diagnosed with beta thalassemia?
Ferrous sulfate (Feosol)
An advanced professional nurse (APN) is administering medications on the pediatric floor and treating an infant with thrush who is currently taking Nystatin oral suspension (Mycostatin). The APN knows the infant is unable to follow the directions of swishing the medication and swallowing. How should the APN administer this infant’s suspension?
Swab the infected area
A two-week-old newborn presents to the pediatric clinic with her mother for a check-up. The nurse discusses the recommended vaccination guidelines from the Centers for Disease Control and Prevention (CDC), including the hepatitis B vaccine.What is the recommended schedule for this patient receiving the hepatitis B vaccination?
Three immunizations with one injection now (if not given at birth), one injection at two months, and one injection at six months
On a follow-up appointment, a mother of a newborn reports the infant draws up the legs, clenches fists, and cries as if in pain. The mother reports the symptoms usually occur during the evening but the baby tolerates formula well. The nurse tells the mother that the baby has infantile colic. The mother inquires about the child’s prognosis.How should the nurse describe the prognosis of infantile colic to the patient’s mother?
Children usually outgrow the condition at about three months of age.
An emergency room (ER) nurse is in a room caring for a patient when the ER suddenly becomes very busy and fills all available rooms. When the nurse completes the care of the current patient, he finds an emergency medical technician (EMT) ready to report on each of the new patients.Which patient from the report should be seen first?
The 25-year-old female complaining of lower right abdominal pain for the last two to three hours
The 40-year-old male with crushing chest pain who denies any injury or prior history of heart disease
The 16-year-old football player with a possible leg fracture
The 52-year-old female complaining of a headache for the last one to two hours and with no other deficits noted
The 40-year-old male with crushing chest pain who denies any injury or prior history of heart disease
An advanced professional nurse (APN) on the float team was assigned to provide care of four postoperative patients on the medical-surgical unit. Which patient should the APN see first?
The patient who is four days post right lobectomy with a heart rate of 120, cold sweats, and lightheadedness
The patent with a left chest tube drainage of 20mls and who complains of pain to the insertion site
The patient eight hours post laparoscopic cholecystectomy with nausea
A patient one day post appendectomy with no bowel movement.
The patient who is four days post right lobectomy with a heart rate of 120, cold sweats, and lightheadedness
Four patients are sitting in an emergency room (ER) waiting to be seen. Each patient checked into the ER using an electronic kiosk that required the reason for the visit. The nurse reviews the data entered by each patient.Which patient should the nurse assist first?
A 28-year-old female with a migraine headache for four days.
A 53-year-old male with right mandibular swelling and tooth pain.
A 19-year-old male with a temperature of 101°F and a stiff neck.
A 74-year-old female with a history of hypertension and blood pressure of 150/90 needing a refill of her medication.
A 19-year-old male with a temperature of 101°F and a stiff neck.
A cardiac advanced professional nurse (APN) receives and assesses a report of her patients at the beginning of her shift. Her report includes the following patients:
a patient who received furosemide (Lasix) two hours ago and is complaining of excessive urination
a post-op cardiac catheterization patient who received hydrocodone bitartrate and acetaminophen (Norco) and is now complaining of drowsiness
a patient who received metoprolol (Toprol XL) with a heart rate of 42 and who is complaining of extreme weakness and dizziness
a patient who is day two post-myocardial infarction and is requesting medication for constipation
Which patient should the APN see first?
The patient who received metoprolol (Toprol XL)
A 72-year-old male patient with chronic atrial fibrillation is currently taking digoxin (Lanoxin). The nurse knows this medication helps with irregular heartbeat but that it can have side effects.What should the nurse do before administering this patient’s next dose of digoxin?
Obtain the patient’s apical pulse
An intravenous (IV) therapy nurse receives several pages within a few minutes from various places within the hospital on a Saturday morning. The IV therapy nurse returns all the pages to obtain additional triage information.Which patient should the IV therapy nurse see first?
A patient in the emergency room who needs IV access for an IV antibiotic
A patient on the med/surg floor with an infiltrated IV who is receiving IV heparin
A patient on the cancer floor with a clogged PICC line who needs labs drawn
A patient in the intensive care unit (ICU) who needs IV access for an insulin drip
A patient in the intensive care unit (ICU) who needs IV access for an insulin drip
A 76-year-old female with a history of hypertension (HTN) and chronic obstructive pulmonary disease (COPD) presents with abdominal pain and approximately three to four watery stools a day. She has a basic metabolic panel (BMP) revealing the following: sodium 140, potassium 4.0, chloride 90, glucose 155, blood urea nitrogen (BUN) 46, creatinine 1.6, and estimated glomerular filtration rate (eGFR) 40. The patient’s medications include lisinopril (Zestril), fluticasone/salmeterol (Advair), and tiotropium (Spiriva). She has no other significant medical history. Vital signs are as follows: temperature of 98°F, heart rate of 78, blood pressure of 120/80, respiratory rate of 18, and oxygen saturation (SpO2) of 98%.Which treatment should the nurse administer first based on this patient’s lab results?
Administer intravenous fluids
After reviewing symptoms and completing further testing, the patient is diagnosed with postural orthostatic tachycardia syndrome (POTS).Which activity should the nurse suggest for the patient after she verbalizes an interest in an exercise activity to engage in?
Rowing
A 71-year-old male with metastatic prostate cancer and type 2 diabetes mellitus with neuropathy presents to an appointment with his primary care provider to address many physical and emotional complaints secondary to his worsening pain. The patient explains that he has been struggling with increased sadness over arranging his end-of-life care and feels that his exacerbation of pain coincides with the timing of his increased sorrow. Patient reports struggling with poor sleep due to grief and aches and restlessness in his legs. He reports increased fatigue and poor energy.Which pharmacological treatment would be helpful for the patient to manage his symptoms and lead to improved sleep?
Mirtazapine (Remeron)
Additionally, the patient explains that he has been struggling with increased sadness over arranging his end-of-life care and feels that his exacerbation of pain coincides with the timing of his increased sorrow. Patient reports struggling with poor sleep due to grief and aches and restlessness in his legs. He reports increased fatigue and poor energy.The patient takes gabapentin (Neurontin), ibuprofen (Motrin), a multivitamin, calcium, and vitamin D supplements. He also receives leuprolide acetate (Lupron) injections every six months and zoledronic acid (Zometa) infusions monthly.Which non-pharmacological treatment does the advanced professional nurse educate may be helpful for targeting the patient’s symptoms of sadness, sorrow, and grief?
Attend weekly group on radical acceptance
A 71-year-old male with stage IV metastatic prostate cancer and type 2 diabetes mellitus with neuropathy presents to an appointment with his primary care provider to address many physical and emotional complaints secondary to his worsening pain. The assessment findings include a blood pressure of 128/72, P 74 and R 18. The patient is 6 foot, 1 inch tall and weighs 188 pounds. The patient has a normal sinus rhythm and regular rate. Lung sounds are clear bilaterally, however, the patient complains of pain in his chest at the sternum, which he rates a 4 on a numeric scale of 0-10. He identifies pain in his lower spine post fall yesterday morning and rates it a 7 and aching pain in bilateral lower extremities that has increased from an intermittent 3 to a consistent 5 on a numerical scale of 0-10 over the past month. Additionally, the patient explains that he has been struggling with increased sadness over arranging his end-of-life care and feels that his exacerbation of pain coincides with the timing of his increased sorrow. Patient reports struggling with poor sleep due to grief and aches and restlessness in his legs. He reports increased fatigue and poor energy.The patient takes gabapenti
Bone scan
A 70-year-old male with a history of myocardial infarction, chronic obstructive pulmonary disease (COPD), and epilepsy arrives at a neurologist’s office for a battery of tests to assess his memory function. His family reports some decline in cognitive functioning, with memory impairment as the primary complaint. The family states they have heard ginkgo biloba is helpful for improving memory. The neurologist asks the family if the patient has ever been prescribed a prescription medication such as donepezil (Aricept) for memory function, which the family denies. The family informs the neurologist that the patient is on the following medications: clopidogrel (Plavix) 75 mg every day, ipratropium bromide and albuterol sulfate (Combivent) 1 puff four times daily, and levetiracetam (Keppra) 500 mg twice daily.What is a potential adverse effect of ginkgo biloba based on this patient’s profile?
Increased risk of bleeding
A 26-year-old male presented to the emergency department accompanied by his mother with complaints of an exacerbation of psychotic symptoms secondary to his diagnosis of schizophrenia. He explained that he was diagnosed at age 20 and has struggled to sustain his typical baseline functioning for any extended period of time despite multiple antipsychotic medication trials. He has been taking risperidone (Risperdal) for approximately six months. A focused assessment revealed the following: Patient has been struggling with auditory and visual hallucinations that are command in nature. He reports experiencing suicidal ideation. Patient denies homicidal ideation. He has temporarily been residing with his mother for the past week due to intrusive suicidal thoughts and hallucinations that increase when at his apartment. The mother reported that this morning the patient became increasingly agitated and was screaming and throwing furniture in her home, demanding that she drive him back to his apartment. The patient identified current stressors to be his decline in functioning: lack of social support, lack of financial balance, and inability to maintain a job, as he was fired from his job last week
Prazosin hydrochloride (Minipress)
A 51-year-old female was voluntarily admitted to the inpatient adult unit at the psychiatric hospital with complaints of excessive worry, panic, anhedonia, difficulty concentrating, and endorsed hopelessness and helplessness. Following a focused assessment, depression has been ruled out. Which as-needed (PRN) medication should be started to support the management of this patient’s symptoms?
Hydroxyzine (Vistaril)
To promote restful sleep, which caffeine-free herbal tea should the nurse encourage the patient to consider consuming before bed?
Lavender lemon balm
Which of the following is not a cellular function?
Excretion
Absorption
Reproduction
Combustion
Combustion
What are mitochondria responsible for?
Energy production
Which if the following can cause edema?
increased lymphatic pressure (increased lymphatic pressure will readily result in the pooling of lymphatic drainage into third spaces (i.e. edema).)
Which of the following best describes the result of cellular reproduction?
Two diploid cells, called daughter cells, are produced.
What indicates hypokalemia?
Serum K decreases to less than 3.5
What is an example of both hyperplasia (Increase in the # of cells of an organ or tissue) and hypertrophy (enlargement of the cells of a given organ or tissue)?
Uterine enlargement due to pregnancy
What regulates the sodium balance?
Aldosterone
What is the alteration if the extracellular fluid volume is less than normal?
Hypotonic
When in excess, what do buffers absorb?
Hydrogen
Which of the following would a patient with metabolic acidosis have?
pH below 7.35
Bicarbonate level below 22 mEq/L
What is the process by which RNA directs the synthesis of polypeptides?
Translation
What is the recurrence rate for autosomal dominant disease?
50%
Which of the following statements is true about autosomal recessive disease?
It affects both men and women equally.
What is the proportion of the population affected by a disease at the specific point in time?
Prevalence rate
Which of the following should be completed when a disease is multifactorial but has a larger genetic component?
Get a thorough family history
Which action is the purpose of the inflammatory process?
To destroy foreign, invasive microorganisms
What causes edema that occurs during the inflammatory process?
Increased vascular permeability
In what structure do B lymphocytes mature and become B cells?
Bone marrow
Which type of immunity occurs when antibodies are transferred from donor to recipient?
Passive acquired immunity
What does T-cell activity cause in older adults?
Increased susceptibility for infection
What is a dermatitis caused by prolonged exposure to chemicals such as acids or soaps also known as?
Irritant contact dermatitis
Which of the following is a self-limiting disease associated with Herpes type viruses and a herald patch?
Pityriasis rosea
What is a furuncle?
An infection of the hair follicle that extends to the surrounding tissue
What type of lesion may be malignant in the form of squamous cell carcinoma (SCC)?
Actinic keratosis (caused by UV radiation, precursor to SCC)
What type of abnormal cell growth does carcinoma refer to?
Epithelial cells
What is a characteristic of a malignant tumor?
Absence of normal tissue organization
Which lifestyle factor has not been linked to the development of cancer?
Tobacco use
Alcohol consumption
Extreme exercise
Obesity
Extreme exercise
Which pediatric malignancy is linked to the family of origin?
Wilms tumor (Kidney Cancer)
Which of the following drugs is classified as hormonal treatment for breast cancer?
Tamoxifen
Where do the cancers treated with glucocorticoids stem from?
Lymphoid tissue
A 23-year-old woman comes in for prenatal counseling. While completing her family history, she reports her brother has cystic fibrosis. She does not know if she is a carrier. She asks if her children will be affected by the disease.
What is an accurate way to determine the likelihood of this patient’s children being affected?
A genetic or a carrier test
A 31-year-old man comes into the office for an exam. He is 6′ 5 ” with a high-pitched voice, and he has a moderate degree of mental impairment. It is discovered upon exam that his body hair is sparse, his testes are small, and he has gynecomastia.
Which genetic disorder should this patient be tested for?
Klinefelter syndrome (XXY)
A six-month-old female infant with failure to thrive comes in to the office with her parents. It is noticed upon exam that the patient has facial deformities and is jaundiced. A complete blood count (CBC) is ordered, which reveals anemia. When that patient’s blood is examined under a microscope, the red blood cells appear small and abnormally shaped. A mutational analysis is ordered, and alpha thalassemia is diagnosed.
What is the likelihood of incidence of these parent’s future children having alpha thalassemia?
25%
Which chamber of the heart has the thinnest muscle in the heart?
Right atrium
During diastole, which part of the heart is filling with blood?
Both ventricles
Oxygenated blood flows through which vessel?
Pulmonary vein
Which complex (wave) represents the sum of all ventricular muscle cell depolarizations?
QRS
What effect does atherosclerosis have on the development of an aneurysm?
Erodes the vessel wall
What is the effect of oxidized low-density lipoproteins (LDLs) in atherosclerosis?
LDLs cause smooth muscle proliferation.
We have an expert-written solution to this problem!
Which factor is responsible for the hypertrophy of the myocardium associated with hypertension?
Angiotensin II
Most cardiovascular developments occur between which weeks of gestation?
Fourth and seventh weeks
Which compensatory mechanism is spontaneously used by children diagnosed with tetralogy of Fallot (TOF) to relieve hypoxic spells?
Squatting
Which condition is consistent with the cardiac defect of transposition of the great vessels?
The aorta arises from the right ventricle.
What produces ADH?
Hypothalamus
The thyroid gland hormones (T3 and T4) are regulated by __.
TSH
What do the pancreas beta cells produce?
Insulin
What do high levels of ADH cause?
SIADH (Syndrome of Inappropriate ADH)
Which condition is indicated by a high level of TSH and low T4?
Hypothyroidism
What diagnosis results if a patient’s anterior pituitary produces none of the normal pituitary hormones?
Panhypopituitarism
Which of the following symptoms is not indicative of metabolic syndrome?
Cachexia
Elevated fasting glucose
Hypertension
Dyslipidemia
Cachexia (Metabolic syndrome if 3/5 of these: Central obesity, high triglycerides, low HDL, BP high, Fasting BG high)
What is occlusion of the capillaries due to diabetes called?
Microvascular disease
Which of the following is anorexia of aging associated with?
Poor dentition, decreased gastric emptying, and the effects of medication
A BMI greater than what indicates obesity?
30 kg/m2
Which term identifies the movement of blood into and out of the capillary beds of the lungs to body organs and tissues?
Perfusion
What is the mechanism of defense for the alveolar macrophages?
To ingest and remove bacteria from the alveoli by phagocytosis
If an individual aspirates, where would a nurse expect abnormal breath sounds?
Right lung
Besides a cough, the most common symptom of pulmonary disease is __.
dyspnea
A condition caused by postoperative patients’ reluctance to change position or breathe deeply is _.
pulmonary atelectasis
What is an abnormal permanent enlargement of gas-exchange airways accompanied by destruction of alveolar wall without obvious fibrosis?
Emphysema
Which type of pneumonia is acquired by infection from inhaling microorganisms in a shopping mall?
CAP (Community acquired pneumonia)
Which type of croup is most common?
Laryngotracheitis
How is asthma confirmed in children over the age of six?
Pulmonary function testing
What are most cases of acute bronchitis are caused by?
Viruses
Where is the region responsible for the motor aspects of speech located?
The Broca area in the frontal lobe
Which area of the brain controls reflex activities concerned with heart rate, blood pressure, respirations, sneezing, swallowing, and coughing?
Medulla oblongata
A failure to recognize the form and nature of objects is __.
agnosia
What are transient disorders of awareness that may have an either sudden or gradual onset?
Acute confusional states
A traumatic brain injury that results in bleeding between the dura mater and the skull is called __.
an epidural hematoma
A stroke that is caused by fragments that break off from a thrombus in the heart is called _.
an embolic stroke
A tear in a tendon is __.
a strain
A tear in a ligament is _.
a sprain
The condition when blood flows to an affected area is compromised because of increased venous pressure is called what?
Compartment syndrome
A chronic, systemic inflammatory autoimmune disorder that affects the joints is called what?
Rheumatoid arthritis
A type of dystrophy caused by a deletion of one or more exons of the DMD gene on the X chromosome is what?
Duchenne muscular dystrophy
How is Crohn disease (CD) different from ulcerative colitis (UC)?
CD affects any part of the GI tract and involves skip lesions.
What is the most common type of peptic ulcer?
Duodenal ulcer
Patients with celiac disease must avoid foods with what?
Gluten
A GFR of 20 mL/min would be what stage of chronic kidney disease?
Stage 4 (GFR is rated as severe when it is in the range of 15-29)
What is the most common infecting microorganism that causes urinary tract infections (UTIs)?
Escherichia coli
What is condition in which a child has never been continent?
Primary incontinence
What is a symptom of PCOS?
Obesity
HPV testing is recommended at the same time as a pap test in women at which ages?
30-65
What does the treatment of a torsion of the testis require?
Surgical intervetion
The incubation period for primary syphilis ranges from how many days?
10-90 days
A 64-year-old male truck driver comes in complaining of pain in his lower left calf. He states he drives eight to ten hours per day. Upon exam, swelling and mottled coloring are noted in the patient’s calf. A D-dimer test is ordered and comes back positive.
Which additional test should be ordered to confirm a diagnosis in this patient?
A Doppler Ultrasound
A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92. After a recheck 15 minutes later, his BP is 140/90. He states he suffers from “white coat hypertension.” He states he has no history of high blood pressure and no family history of high blood pressure.
Which nursing intervention would assist this patient in receiving a clinical diagnosis of hypertension?
Completing an ambulatory blood pressure assessment
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening with recumbent position. She states she has had a low-grade fever for two days. Upon exam, the patient has a friction rub. An EKG reveals sinus tachycardia with inflammatory changes. An ultrasound is performed, and she is diagnosed with an acute pericarditis.
Which condition would make pericarditis more likely in this patient?
Lupus
A patient begins taking an ACE inhibitor and complains of a dry cough. What does the nurse correctly tell the patient about this symptom?
This symptom is common. If it does not stop, then your medication can be changed.
A patient has a chronic congestive heart failure. The prescriber has ordered spironolactone to be added to this patient’s drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching?
“I need to stop taking my potassium supplement.” (potassium-sparing diuretic)
A female patient taking an ACE inhibitor learns that she is pregnant. What will the nurse tell this patient?
The patient should stop taking the medication and contact her provider immediately.
A patient begins taking nifedipine along with metoprolol to treat hypertension. The nurse understands that metoprolol is used to __.
prevent reflex tachycardia
A patient is taking a vasodilator that relaxes smooth muscles in veins. To help minimize drug side effects, the nurse caring for this patient will __.
caution the patient not to get up abruptly
A 60-year-old African-American patient has a blood pressure of 120/80 mm Hg and reports a family history of hypertension. The patient has a body mass index of 22.3. The patient reports consuming alcohol occasionally. Which therapeutic lifestyle change will the nurse expect to teach this patient?
Sodium restriction
A patient is recovering from a myocardial infarction (MI) but does not have symptoms of heart failure. The nurse will expect to teach this patient about what?
ACE inhibitors and beta blockers
Which two classes of antidysrhythmic drugs have nearly identical cardiac effects?
Beta blockers and calcium channel blockers (Both beta blockers and calcium channel blockers reduce heart rate, suppress AV conduction, and reduce myocardial contractility.)
A patient who is taking simvastatin develops an infection, and the provider orders azithromycin to treat the infection. The nurse should be concerned if the patient complains of what?
Muscle pain (watch for with statins)
A patient who is taking warfarin has just vomited blood. The nurse notifies the provider, who orders laboratory work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer __.
phytonadione (vitamin K) 1 mg IV over 1 hour
The nurse assesses a newly diagnosed patient for short-term complications of diabetes. What does this assessment include?
Evaluation for hyperglycemia, hypoglycemia, and ketoacidosis
A patient with type 1 diabetes is eating breakfast at 7:30 a.m. Blood sugars are on a sliding scale and are ordered before a meal and at bedtime. The patient’s blood sugar level is 317 mg/dL. Which formulation of insulin should the nurse prepare to administer?
Lispro (short acting)
A nurse provides dietary counseling for a patient newly diagnosed with type 1 diabetes. Which instruction should be included?
“You should use a carbohydrate counting approach to maintain glycemic control.”
What is the most reliable measure for assessing diabetes control over the preceding three-month period?
Glycosylated hemoglobin level (HgbA1c)
Insulin glargine is prescribed for a hospitalized patient who has diabetes. When will the nurse expect to administer this drug?
Once daily at bedtime
A patient arrives in the emergency department with a heart rate of 128 beats/minute and a temperature of 105°F. The patient’s skin feels hot and moist. The free T4 level is 4 ng/dL. The free T3 level is 685 pg/dL, and the TSH level is 0.1 microunits/mL. The nurse caring for this patient will expect to administer __.
propylthiouracil (PTU)
A nurse obtaining an admission history on an adult patient notes that the patient has a heart rate of 62 beats per minute, a blood pressure of 105/62 mm Hg, and a temperature of 96.2°F. The patient appears pale and complains of always feeling cold and tired. The nurse will contact the provider to discuss tests for which condition?
Hypothyroidism
The nurse is caring for a pregnant patient recently diagnosed with hypothyroidism. The patient tells the nurse she does not want to take medications while she is pregnant. What will the nurse explain to this patient?
Neuropsychological deficits in the fetus can occur if the condition is not treated.
The nurse prepares a patient with Graves disease for radioactive iodine (I131) therapy. Which statement made by the patient best demonstrates understanding of radioactive iodine (I131) therapy?
“This drug will be taken up by the thyroid gland and will destroy the cells to reduce my hyperthyroidism.
A nurse caring for a patient, notes that the patient has a temperature of 40°C (104°F) and a heart rate of 110 beats per minute. The patient’s skin is warm and moist, and the patient complains that the room is too warm. The patient appears nervous and has protuberant eyes. The nurse will contact the provider to discuss _.
Graves disease
A nurse is teaching a group of nursing students about antihistamines. Which statement by a student indicates an understanding of the mechanism of action of the antihistamines?
“Antihistamines block H1 receptors to prevent actions of histamine at these sites.”
A prescriber orders hydroxyzine for a patient with acute urticaria. The nurse will include what information when teaching the patient about this drug?
The patient should avoid drinking alcohol while taking the drug.
A patient with asthma will be using a metered dose inhaler (MDI) for delivery of an inhaled medication. The provider has ordered two puffs to be given twice daily. It is important for the nurse to teach this patient that _______.
the patient should wait one minute between puffs
A patient with persistent, frequent asthma exacerbations asks a nurse about a long-acting beta2 agonist (LABA) medication. What will the nurse tell this patient?
LABAs should be combined with an inhaled glucocorticoid.
A nurse is teaching a group of nursing students about the different formulations of beta2-adrenergic agonist medications. Which statement by a student indicates an understanding of the teaching?
“Oral beta2 agonists are not useful for short-term treatment.”
Which medication should be used for asthma patients as part of step 1 management?
Short-acting beta2 agonists (For PRN use)
A patient with stable COPD receives prescriptions for an inhaled glucocorticoid and an inhaled beta2-adrenergic agonist. Which statement by the patient indicates an understanding of this medication regimen?
“The glucocorticoid is used as prophylaxis to prevent exacerbations.”
A patient with stable COPD is prescribed a bronchodilator medication. Which type of bronchodilator is preferred for this patient?
A long-acting inhaled beta2 agonist (LABA)
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin _.
helps stimulate the flow of secretions to increase cough productivity
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct?
“You should take oral antihistamines daily during each allergy season to get maximum effects.”
A nursing student asks the nurse why epinephrine and not other adrenergic agonists is used to treat anaphylactic shock. What will the nurse tell the student?
“Epinephrine has the ability to activate multiple types of adrenergic receptors.”
The nurse is discussing home management with a patient who will begin taking an alpha-adrenergic antagonist for hypertension. Which statement by the patient indicates an understanding of the teaching?
“I should take the first dose at bedtime.”
A nurse is discussing motor symptoms with a patient with Parkinson disease who has been taking levodopa or carbidopa (Sinemet) for nine months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?
“I may need to try a lower dose of Sinemet to reduce my tics.”
A nurse is caring for an older adult man who has Alzheimer disease (AD). The patient’s daughter wants to know if testing can be done to determine her risk for developing the disease. What will the nurse tell her?
Advancing age and family history are known risk factors. (Not sure the exact cause so can’t run a test)
A patient is going to begin taking phenytoin (Dilantin) for seizures. The patient tells the nurse that she is taking oral contraceptives. What will the nurse tell the patient?
She should consider a different form of birth control while taking phenytoin.
A nurse is caring for a patient who has been taking an antiepileptic drug for several weeks. The nurse asks the patient if the therapy is effective. The patient reports little change in seizure frequency. What will the nurse do?
Contact the provider to request an order for serum drug levels
A patient who takes daily doses of aspirin is scheduled for surgery next week. The nurse should advise the patient to do what?
Stop using aspirin immediately (discontinue one week prior)
A 60-year-old female patient is about to begin long-term therapy with a glucocorticoid. Which of the following will be important for minimizing the risk of osteoporosis?
Calcium and vitamin D supplements
A patient who has been diagnosed with rheumatoid arthritis (RA) for one month and who has generalized symptoms is taking high-dose nonsteroidal anti-inflammatory drugs (NSAIDs) and an oral glucocorticoid. The provider has ordered methotrexate (Rheumatrex). The patient asks the nurse why methotrexate is necessary since pain and swelling have been well controlled with the other medications. The nurse will tell the patient that _.
starting methotrexate early can help delay joint degeneration
A patient has had three gout flare-ups in the past year. Which drug class will the nurse expect the provider to order for this patient?
Urate lowering drugs
A nurse provides teaching to a group of nursing students about the risks and benefits of hormone therapy (HT), including estrogen therapy (ET) and combination estrogen and progestin therapy (EPT). Which statement by a student indicates an understanding of the teaching?
“The principal benefits of ET are the suppression of menopausal symptoms and prevention of bone loss.”
A nurse working in a family planning clinic is teaching a class on intrauterine devices (IUDs). Which patient should be advised against using an IUD for contraception?
An 18-year-old woman with multiple sexual partners
A nurse is teaching a male adult patient about the use of testosterone gel. Which statement by the patient indicates an understanding of the teaching?
“I should not let my child touch the gel.”
Which finding would indicate that terazosin has been effective for a patient with benign prostatic hyperplasia (BPH)?
Improved urinary hesitation
When metronidazole [Flagyl] is a component of the H. pylori treatment regimen, the patient must be instructed to do what?
Avoid any alcoholic beverages
A patient’s provider has recommended a bulk-forming laxative for occasional constipation. Which statement by the patient indicates understanding of the teaching about this agent?
“I should take each dose with a full glass of water.”
A patient who has traveler’s diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug?
“Use of this drug may prolong symptoms by slowing peristalsis and should not be used for infectious diarrhea.”
A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders trimethoprim/sulfamethoxazole (TMP/SMZ). What will the nurse tell the patient?
“The patient should check the blood glucose level more often while taking TMP/SMZ.” (Glipizide increases effects of SMZ causing hypoglycemia)
A young, nonpregnant female patient with a history of a previous urinary tract infection (UTI) is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of three days’ duration. She is afebrile. A urine culture is positive for more than 100,000/mL of CFU urine. Which treatment should the nurse caring for this patient recommend?
A three-day course of trimethoprim/sulfamethoxazole [Bactrim]
A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication?
Acyclovir [Zovirax]
A 54-year-old Caucasian man comes in for a lab review. His lipids reveal an LDL of 180, an HDL of 52, and triglycerides of 326. He has no history of atherosclerotic cardiovascular disease (ASCVD) or diabetes. His blood pressure is 118/64. He has a pulse rate of 64, and he weighs 320 lb. He smokes one pack of cigarettes per day, and his ASCVD risk score is 12.8.
Which medication should this patient be started on?
Atorvastatin (Lipitor) 20mg
A 73-year-old man with Systolic congestive heart failure (CHF) with reduced ejection fraction (HFrEF) comes to a clinic complaining of shortness of breath. He is currently taking 6.25 mg carvedilol (Coreg) twice a day and 50 mg losartan (Cozaar) and 20 mg furosemide (Lasix) daily. His oxygen saturation is 95%, and he has a pulse of 64. His BP is 138/82, and his BNP is 1150.
Using the 2017 heart failure guidelines, which medication change should be recommended for this patient?
Stop angiotensin receptor blockers (ARB) and add sacubitril/valsartan (Entresto)
A 78-year-old man comes in with stable angina. He reports he has been having more angina recently. He is currently taking the following medications: lisinopril (Zestril), atorvastatin (Lipitor), aspirin, and nitrostat PRN for chest pain. He has a history of COPD with bronchospasm. His blood pressure is 145/88, and he has a pulse of 74.
Which class of medications should be avoided for this patient?
Beta blockers
Which statement regarding hypertension (HTN) is true?
One of the most important factors affecting blood pressure is sodium intake.
What statement regarding type 2 diabetes is true?
The rates increase in patients who regularly exercise.
You cannot reduce your risk of diabetes if you have a family history
It accounts for 90-95% of all cases of diabetes.
It requires immediate insulin replacement.
It accounts for 90-95% of all cases of diabetes.
A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse should tell them which of the following?
Most known drug effects are based on drug trials in men
A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely explanation for this phenomenon?
Pharmacogenomic differences among individuals
A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What should the nurse recognize about this patient?
This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for an analgesic effect
A nursing student asks a nurse what the natural medicines brand evidence-based rating (NMBER) system that rates dietary supplements means. The nurse should respond that the NMBER system _.
helps consumers evaluate the safety and efficacy of products
A patient admitted to the emergency department with abdominal pain tells the nurse he has been taking kava. Which action is the nurse’s priority at this time?
Review liver function studies (Kava herbal treatment for anxiety/insomnia is hepatotoxic)
Which of the following statements are true?
Smoking has no effect on BP, while nicotine gum and patches, as a rule, increase BP.
Overweight individuals who lose weight can reduce their blood pressure 60-80%.
Excessive alcohol use reduces blood pressure through diuresis.
The DASH diet should be avoided due to its negative effect on BP.
Overweight individuals who lose weight can reduce their blood pressure 60-80%.
The United States Affordable Care Act (ACA) has __.
improved healthcare disparities for those who have encountered problems in coverage and access
What is an important principle for understanding healthcare disparities?
Constraints on clinician and patient decision-making affect healthcare disparities.
Which statement is true regarding childhood cancer?
Leukemia is the most common malignancy in children.
Which statement is true concerning the prognosis of childhood cancers?
Nearly 85% of childhood cancers are cured.
Which of the following changes can be caused by aging of the nervous system?
Sleep disturbances
Which of the following are affected by the endocrine changes brought on by aging?
The parathyroid gland
The adrenal glands
The thyroid gland
The pituitary gland
The thyroid gland
Which of the following cannot be caused by anorexia of aging?
Increased orexigenic signals (Appetite stimulating hormones decreases with age)
What causes hot flashes associated with declining ovarian function with age?
Decreased estrogen levels
What can aging in the cardiovascular system lead to?
Left ventricular hyertrophy
Which of the following is not included as standard management of hypertension (HTN) in children?
Use of ACE inhibitors in sexually active females
Which criterion is used to confirm a diagnosis of asthma in an eight-year-old child?
Reduced expiratory flow rates confirmed by spirometry testing
Cystic fibrosis is characterized by which symptom?
Excessive, thick mucus production
A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding would be most concerning?
Drinks two glasses of wine every night
A patient reports that a medication prescribed for recurrent migraine headaches is not working. Which action should be taken first?
Ask the patient about the number and frequency of tablets taken.
A patient recently diagnosed with HIV is prescribed several medications to treat the condition. All the following factors could negatively impact the patient’s ability to follow the treatment regimen, except which?
The patient works three part-time jobs.
The patient is uninsured.
Patient has a twelfth-grade reading comprehension level.
The medication regimen includes six different pills.
Patient has a twelfth-grade reading comprehension level.
One of the social determinants of health for Healthy People 2020 is to improve the health literacy of the population. What is one way to increase health literacy?
Providing handouts in multiple languages
What three domains are included as part of the PEN-3 model?
Cultural identity, relationships and expectations, and cultural empowerment
According to the Trans Mental Health Survey of 2012, what percent of transgender individuals aged 26 or younger attempted suicide?
48%
A 45-year-old Muslim woman presents to a clinic for an intervention for her type 2 diabetes. She is prescribed metformin (Glucophage) 500 mg BID. During a follow-up phone call a week later, it is discovered she has not been taking the metformin. A second visit is scheduled. During this visit, she states that she cannot take the medication as prescribed because it is Ramadan, a month-long period of religious observances. Due to her religious beliefs, she fasts from dawn to sunset. When the pharmacist told her to take metformin with breakfast and dinner, she decided not to start the medication due to her fasting.
Which nursing intervention should be made for this patient?
Start metformin XR (Glucophage XR) 250 mg once a day and reevaluate after Ramadan
A 45-year-old Jewish man is visiting a clinic for an adjustment of his diabetes medications. Though the patient is taking oral medications, his blood sugar levels continue to increase, and a decision is made to start him on insulin. Although the patient is comfortable with the concept of starting insulin, he is concerned with the formulation of the insulin saying, “I heard insulin was made from pigs. If that is the case, I cannot take it due to my faith.”
Which response should be given to this patient?
While insulin did have porcine sources in the past, it is now synthetically made.
A 45-year-old man reports his preference for natural methods of treating illness. He states he takes natural supplements that he orders from China to boost his health and well-being. One of the supplements he takes daily is red yeast rice.
Which medication should be avoided with this patient’s supplement?
Lovastatin (Mevacor) (red yeast rice has naturally occurring lovastatin)
In 2003, it was estimated that adult patients only receive what percent of the 439 recommended clinical services?
55%
How many months after discharge does the Persistence of Beta-Blocker Treatment After a Heart Attack core measure state a patient will receive a persistent beta blocker?
6 months
According to the Comprehensive Diabetes Care core measure “HbA1c poor control,” what HgA1c percentage is defined as poor control?
9.0%
According to core measures, medication reconciliation after discharge from an inpatient facility needs to be completed within how many days?
30 days
Per core measures, how frequently should cervical cancer screening for women ages 21-29 with cytology be completed?
Every three years
Adult stage 1 hypertension is defined as _.
systolic between 130-139 or diastolic between 80-90
The HgA1c goal for patients without concurrent illness and low glycemic risk is _.
equal to or less than 6.5%
For a patient with pneumonia, what CURB-65 score indicates that the patient needs admission to the hospital?
greater than or equal to 3
In high risk ASCVD (Atherlosclorosis Cardiovascular Disease), LDL levels should be reduced to levels _.
equal to or below 70 mg/dl
A low dose ICS (inhaled corticosteroid) should be started in an asthma patient when which of the following occurs?
Patient wakes from sleep because of asthma more than once a month
The parents of a child with asthma ask the nurse why their child cannot use oral corticosteroids more often because they are so effective. The nurse should offer which information that is true for children?
Chronic steroid use can inhibit growth.
A prescriber has ordered medication for a newborn. The medication is eliminated primarily by hepatic metabolism. The nurse should expect the prescriber to _.
order a dose that is lower than an adult dose
When giving the medication, the nurse will assess the infant for __.
signs of drug toxicity
A nurse is making a home visit to an older adult woman who was recently discharged home from the hospital with a new prescription. The nurse notes that a serum drug level drawn the day before was subtherapeutic. What should the nurse do next?
Count the pills in the prescription bottle
A nurse is concerned about renal function in an 84-year-old patient who is taking several medications. What should the nurse assess?
Creatinine clearance
A university student who is agitated and restless and has tremors is brought to the emergency department. The patient’s heart rate is 110 beats a minute, the respiratory rate is 18 breaths a minute, and the blood pressure is 160/95 mm Hg. The patient reports using concentrated energy drinks to stay awake during finals week. What complication will the nurse monitor for in this patient?
Seizures
A child will begin taking methylphenidate [Ritalin] for attention-deficit and hyperactivity disorder. Important baseline information about this patient will include the __.
height and weight
Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct?
“Infants are more susceptible to central nervous system effects than adults are.”
The nurse at a public health infant immunization clinic is acting as a preceptor for a nursing student. To assess the student’s understanding of vaccinations, the nurse asks the student where the hepatitis B vaccine (HepB) should be administered. The student would be correct to respond that the hepatitis B vaccine should be administered in the __.
anterolateral thigh in infants
A nurse at an immunization clinic is providing vaccines to children. The parent of a child waiting to receive vaccines tells the nurse that the child has an immune deficiency disorder. Which vaccine should not be administered to this child?
Varicella virus
A 40-year-old man presents to a clinic with an onset of a frequent cough. The patient states the cough started when he started his new blood pressure medication two weeks ago. The patient does not remember the name of the drug that was started. After a thorough assessment, it is determined the cough is not being caused by an infection. It is determined the likely cause of the frequent cough is the new blood pressure medication.
Which medication is the likely cause of this patient’s symptoms?
Lisinopril (Zestril)
A 68-year-old female patient on a medical surgical floor received a dose of morphine (Duramorph) 30 minutes ago for postoperative pain into an IV in her left hand. She has been on the floor for two days and has received several doses of morphine over that time. The patient’s call light is now lit. When the nurse goes into the room, the patient has several complaints.
Which complaint should be addressed first in this patient?
A rash around the injection site going up the left arm
An advanced practice nurse (APN) is floated to a medical or surgical floor midshift to assist an understaffed unit. After receiving a brief report, the APN assumes care of four individuals for the remainder of the shift. No recent assessment has been completed on these patients.
Which patient should the APN assess first?
A 63-year-old woman with a flare of Crohn disease who is receiving IV steroids and has had three loose stools over the past 12 hours and negative hemoccults
A 65-year-old man with dementia who is one day post-operation of a transurethral resection of his prostate and is sometimes passing blood-tinged urine through his foley
A 64-year-old woman with an exacerbation of chronic obstructive pulmonary disease (COPD) and an oxygen saturation of 90% on two liters of oxygen
A 62-year-old man who had an open cholecystectomy one day ago and who is having serosanguinous drainage from his JP drain and requesting pain medications every six hours
A 65-year-old man with dementia who is one day post-operation of a transurethral resection of his prostate and is sometimes passing blood-tinged urine through his foley
If an individual aspirates, where would a nurse expect abnormal breath sounds?
Right lung
Where in the CNS does a person’s learned pain response occur?
Cerebral contex
Pain that warns of actual or impending tissue injury is referred to as what?
Acute
Enkephalins and endorphins act to relieve pain by which process?
Attaching to opiate receptor sites
A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern?
Nervousness and tachycardia
A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug?
Rotate the sites for the patches
A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient’s pupils are constricted and that the patient is drowsy and lethargic. The patient’s heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What should the nurse do?
Prepare to administer naloxone and possibly ventilatory support
A patient who has recurrent migraine headaches is prescribed sumatriptan [Imitrex]. Which aspect of this patient’s history is of concern when taking this drug?
Coronary artery disease
Supplemental oxygen has been shown to help reduce symptoms for which type of headache?
Cluster
A patient who has cancer asks the nurse about using acupuncture to manage cancer pain. What should the nurse tell this patient?
“Studies to date do not clearly indicate the effectiveness of acupuncture for alleviating cancer pain.”
A patient newly diagnosed with cancer reports having pain at a level of seven to eight on a scale of ten. Which type of pain management will be used initially to treat pain in this patient?
Opioid analgesics
A patient reports frequent nightmares. For which of these should the healthcare professional assess the patient?
History of a traumatic event
Which explanation accurately represents validation of the monoamine-deficiency hypothesis of depression?
Drugs that intensify monoamine-mediated neurotransmission relieve depression.
What is a notable complication of a panic disorder?
Agoraphobia
A criterion for a diagnosis of generalized anxiety disorder (GAD) is a period of excessive worrying that lasts for at least how many months?
6
A patient taking an FGA medication develops severe parkinsonism and is treated with amantadine (Symmetrel). The amantadine is withdrawn two months later, and the parkinsonism returns. What should the nurse will expect the provider to do?
Give anticholinergic medications
A patient whose spouse has died recently reports feeling down most of every day for the past two months. On further questioning, the nurse learns that the patient has quit participating in social activities, has difficulty falling asleep, and has lost five pounds. The patient reports feeling tired and confused but does not have suicidal thoughts. What does this collection of behaviors suggest?
Major depression
A patient is diagnosed with major depression with severe symptoms and begins taking an antidepressant medication. Three weeks after beginning therapy, the patient tells the nurse that the drug is not working. What should the nurse counsel the patient to ask the provider about?
Using nondrug therapies to augment the medication
A patient who is experiencing alcohol withdrawal is given a benzodiazepine. Why is benzodiazepine effective for treating alcohol withdrawal?
The drug physiologically decreases CNS overstimulation.
A patient is diagnosed with anxiety after describing symptoms of tension, poor concentration, and difficulty sleeping that have persisted for over six months. Which medication, if prescribed by the provider, is known to have the fewest dependency issues?
Buspirone (Buspar)
Which statement accurately describes some of the potential side effects of SSRIs used to treat depression?
Gastrointestinal disturbances
A student asks the healthcare professional how immunity is decreased by stress. The professional responds that during a stress response, the helper T(Th)1 response is suppressed by which hormone?
Cortisol
Exhaustion occurs if stress continues when which stage of the general adaptation syndrome is not successful?
Adaptation
What is the most influential factor in whether a person will experience a stress reaction?
Ability to cope
A severely stressed patient has cold, clammy skin. The healthcare professional quizzes the student about this effect. The student correctly answers that this effect is directly from which action?
Norepinephrine constricting blood vessels in the skin
What are the signs that a patient is in the adaptive stage of the general adaptation syndrome?
The patient perceives his or her only options are to run away or fight back.
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A reduction in an individual’s number of natural killer (NK) cells appears to correlate with an increased risk for the development of what?
Depression
A severely stressed patient has hyperglycemia each time the patient’s blood glucose is checked. The healthcare professional should order laboratory tests to measure which hormone in the patient’s blood?
Cortisol
Post-traumatic stress disorder is diagnosed how many weeks after the exposure to trauma?
Four
First-line treatment for acute stress disorder is __.
cognitive behavior therapy
Prolonged use of benzodiazepines in ASD may be detrimental to _ and carry the potential for .
adaptation, addiction
A 55-year-old female patient presents to a clinic for exacerbation of her chronic low back pain. She is taking morphine extended-release tablets (MS Contin), hydrocodone (Vicodin) PRN, and duloxetine (Cymbalta). The patient denies any drug allergies. She rates her pain at a ten out of ten and is requesting something stronger for pain.
When considering adding a medication for this patient’s pain, which medication could have a significant interaction with her current medications?
Tramadol (Ultram)
A 45-year-old female patient presents to a clinic complaining of chronic generalized pain and wishes to be evaluated for fibromyalgia and chronic pain syndrome. A thorough history and physical is conducted, and the findings are negative. The patient is not taking any medications, has no allergies to medicines, and has a negative past medical history.
What is an appropriate first intervention for this patient?
Assess the patient’s sleep hygiene and make recommendations.
A 55-year-old male patient is on a medical floor for respite care. He is currently in hospice for end-stage pancreatic cancer. During assessment, a nurse notices that he is diaphoretic, moaning, and clutching his abdomen. He rates his pain at a nine out of ten. The nurse notes that his abdomen is distended, and he has rebound tenderness in all four quadrants.
What is an appropriate nursing intervention for this patient?
Giving a dose of intravenous morphine (Duramorph)