Archive for February 2021

What do you need to know/teach about TCAs?

What do you need to know/teach about TCAs?



Answer: Use cautiously in older adults and those with cardiac disorders, elevated intraocular pressure, urinary retention, hyperthyroidism, seizure disorders, and liver or kidney dysfunction. May be lethal in overdose and contraindicated in people taking MAOIs


What is the action of MAOIs?

What is the action of MAOIs?



Answer: Inhibits the enzyme monoamine oxidase, which breaksdown neurotransmitters, including serotonin and norepinephrine


Name some examples of MAOIs.

Name some examples of MAOIs.



Answer: Phenelzine (Nardil), Selegiline (Transdermal Sytemic Patch EMSAM), Tranylcypromine (Parnate)


Name some examples of TCAs.

Name some examples of TCAs.



Answer: Amitriptyline (Elavil), Clomipramine (Anafranil), Desipramine (Norpramin), Doxepin (Adapin, Sinequan), Imipramine (Tofranil), Nortriptyline (Aventyl, Pamelor), Protriptyline (Vivactil)


What are the side effects of TCAs?

What are the side effects of TCAs?



Answer: Dry mouth, constipation, urinary retention, blurred vision, orthostatic hypotension, cardiac toxicity, sedation


What do you need to know/teach about SNDIs?

What do you need to know/teach about SNDIs?



Answer: Contraindicated in people taking MAOIs, Drug induced somnolence exaggerated by alcohol, benzodiazepines, and other CNS depressants (antidepressant effects equal SSRIs and may occur faster)


What is the action of TCAs?

What is the action of TCAs?



Inhibits the re-uptake of serotonin and norepinephrine. Antagonizes adrenergic, histaominergic, and muscarinic receptors


What are the side effects of SNDIs?

What are the side effects of SNDIs?



Answer: Weight gain, sedation, dizziness, headache, sexual dysfunction is rare


What are the side effects of NDRIs?

What are the side effects of NDRIs?



Answer: Agitation, insomnia, headache, nausea and vomiting, seizures (0.4%)


What do you need to know/teach about NDRIs?

What do you need to know/teach about NDRIs?


Answer: High doses increase seizure risk, contraindicated in people taking MAOIs, used as an aid to quit smoking, may increase sexual desire, stimulant action may reduce appetite

What do you need to know/teach about SNRIs?

What do you need to know/teach about SNRIs?



Answer: Monitor BP with Effexor, contraindicated in people taking MAOIs, Effexor is a popular next-step strategy after trying SSRIs


What are the side effects of SNRIs?

What are the side effects of SNRIs?



Answer: HTN (with venlafexine), nausea, insomnia, dry mouth, sweating, agitation, headache, sexual dysfunction


What is the action of SNRIs?

What is the action of SNRIs?



Answer: Blocks the re-uptake of serotonin and norepinephrine

Name some examples of SNRI drugs?

Name some examples of SNRI drugs?



Answer: Venlafaxine (effexor) and Duloxetine (Cymbalta)

Name some examples of SSRI drugs?

Name some examples of SSRI drugs?


Answer: Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Fluvoxamine (Luvox), Paraxetine (Paxil), Sertaline (Zoloft)


What are the side effects of SSRIs?

What are the side effects of SSRIs?



Answer: Agitation, insomnia, headache, nausea and vomiting, sexual dysfunction, and hyponatremia

What is the action of SSRIs?

What is the action of SSRIs?



Answer: Blocks the re-uptake of serotonin


The key diagnostic finding for typical pneumonia is

The key diagnostic finding for typical pneumonia is



A. abnormal chemical electrolytes.


B. elevated WBC


C. lung consolidation on CXR.


D. a positive sputum culture.



Answer: C

A 57-year-old male patient is having his annual physical. Due to a family history of coronary artery disease and his sedentary lifestyle, his doctor orders a total blood cholesterol panel. What is the optimal level of total cholesterol in the blood for adults?

A 57-year-old male patient is having his annual physical. Due to a family history of coronary artery disease and his sedentary lifestyle, his doctor orders a total blood cholesterol panel. What is the optimal level of total cholesterol in the blood for adults?



A. 200 mg/dL


B. 200-239 mg/dL


C. 300-339 mg/dL


D. mg/dL



Answer: A

An 81-year-old male with arteriosclerosis and a long-standing history of taking Coumadin presents to his physician's Office for his biweekly prothrombin time (PT) test. The PT test is one of the most common hemostasis tests used as a presurgery screening and monitoring Coumadin (warfarin) therapy. This test evaluates

An 81-year-old male with arteriosclerosis and a long-standing history of taking Coumadin presents to his physician's Office for his biweekly prothrombin time (PT) test. The PT test is one of the most common hemostasis tests used as a presurgery screening and monitoring Coumadin (warfarin) therapy. This test evaluates


A. coagulation of the blood.


B. the iron-binding capacity of RBCs.


C. the oxygen-carrying capacity of RBCs.


D. the type and cross-match of blood.



Answer: A

A 13-year-old patient is brought to her pediatrician with a 2-week history of fatigue, an occasional low-grade fever, and malaise. The pediatrician indicates it is a possible infection but needs to know what type of infection. She orders a hematology laboratory test to determine the relative number and percentage of each type of leukocytes. This test is referred to as a

A 13-year-old patient is brought to her pediatrician with a 2-week history of fatigue, an occasional low-grade fever, and malaise. The pediatrician indicates it is a possible infection but needs to know what type of infection. She orders a hematology laboratory test to determine the relative number and percentage of each type of leukocytes. This test is referred to as a



A. hematocrit.


B. CBC.


C. WBC diff.


D. hemoglobin determination.



Answer: C

A 62-year-old female presents to her family doctor complaining of fatigue; constantly feeling cold, especially in her hands and feet; weakness; and pallor. 02 must be transported to the cells and exchanged with C02, which is then transported back to the lungs to be expelled. A hematology laboratory test that evaluates the oxygen-carrying capacity of blood is referred to as

A 62-year-old female presents to her family doctor complaining of fatigue; constantly feeling cold, especially in her hands and feet; weakness; and pallor. 02 must be transported to the cells and exchanged with C02, which is then transported back to the lungs to be expelled. A hematology laboratory test that evaluates the oxygen-carrying capacity of blood is referred to as


A. hematocrit.


B. CBC.


C. WBC diff.


D. hemoglobin determination.



Answer: D

A 68-year-old female patient has no visible bleeding, but remains anemic. Her physician is concerned about possible gastrointestinal bleeding. Which of the following tests might be ordered?

A 68-year-old female patient has no visible bleeding, but remains anemic. Her physician is concerned about possible gastrointestinal bleeding. Which of the following tests might be ordered?



A. DEXA scan 


B. guaiac smear test


C. Pap smear test


D. prostatic-specific antigen test



Answer: B

Which procedure will be used to initially diagnose the patient?

A patient's history includes the following documentation:


• Small ulcers (chancres) appeared on the genitalia and resolved after four to six weeks

• Elevated temperature, skin rash, and enlarged lymph nodes 


Which procedure will be used to initially diagnose the patient?



A. bone marrow test


B. chest x-ray


C. serology test 


D. thyroid scan



Answer: C

Coronary arteries may become blocked, either partially or totally, due to athereosclerosis and lead to an AMI. Which of the following procedures would be used to improve the coronary blood flow by building an alternate route for the blood to bypass the blockage by inserting a portion of another blood vessel, typically the saphenous vein?

Coronary arteries may become blocked, either partially or totally, due to athereosclerosis and lead to an AMI. Which of the following procedures would be used to improve the coronary blood flow by building an alternate route for the blood to bypass the blockage by inserting a portion of another blood vessel, typically the saphenous vein?


A. PTCA


B. CABG


C. carotid endarterectomy


D. cardiac catheterization



Answer: C

A stapedectomy is a common treatment for

A stapedectomy is a common treatment for



A. atherosclerosis.


B. multiple sclerosis.


C. otosclerosis.


D. scoliosis.



Answer: A

Maria Giovanni is in the hospital recovering from colon resection surgery. Based on her symptoms, her doctors are concerned about the possibility that she has developed a pulmonary embolism. Which of the following procedures will provide the definitive diagnosis?

Maria Giovanni is in the hospital recovering from colon resection surgery. Based on her symptoms, her doctors are concerned about the possibility that she has developed a pulmonary embolism. Which of the following procedures will provide the definitive diagnosis?



A. chest x-ray 


B. lung scan


C. pulmonary angiography


D. none of the above



Answer: B

The positive belief in a drug and its ability to cure a patient's illness, even if this drug is an inactive or inert substance, typically positively influences a patient's perception of their outcome. This effect is termed a

The positive belief in a drug and its ability to cure a patient's illness, even if this drug is an inactive or inert substance, typically positively influences a patient's perception of their outcome. This effect is termed a



A. synergistic effect.


B. potentiation effect.


C. placebo effect. 


D antagonistic effect.



Answer: B

Why must influenza immunizations be developed and administered on an annual basis?

Why must influenza immunizations be developed and administered on an annual basis?




A. The virus mutates significantly each year.


B. People develop resistance to the vaccine.


C. The immunization is only strong enough for one year.


D. The pharmaceutical companies produce the lowest dosage possible.



Answer: C

A patient, who is HIV positive, has raised red or purple lesions that appear on his skin, in his mouth, and most anywhere on his body. What is the stage of his disease process in today's medical terminology?

A patient, who is HIV positive, has raised red or purple lesions that appear on his skin, in his mouth, and most anywhere on his body. What is the stage of his disease process in today's medical terminology?



A. ARC


B. AIDS


C. AZT


D. HIV positive



Answer: C

Full-blown AIDS sets in as

Full-blown AIDS sets in as



A. CD4 receptors increase.


B. helper T-cell concentrations decrease.


C. HIV virus concentrations decrease.


D. immunity to HIV increases.



Answer: C

The HPV vaccine, Gardasil, is recommended for all children/young adults between the ages Of 9 and 26 years. It is a quadrivalent vaccine. What is the definition of quadrivalent?

The HPV vaccine, Gardasil, is recommended for all children/young adults between the ages Of 9 and 26 years. It is a quadrivalent vaccine. What is the definition of quadrivalent? 



A. It must be administered every 4 years to be effective.


B. It is administered in a series of four shots over a 6-month period.


C. It prevents infection from the four most prevalent types of HPV that cause cervical cancer.


D. It reduces the risk of infection by four times.



Answer: C

A bee stung little Bobby. He experiences itching, erythema, and respiratory distress caused by laryngeal edema and vascular collapse. In the emergency room where he is given an epinephrine injection, Bobby is diagnosed with

A bee stung little Bobby. He experiences itching, erythema, and respiratory distress caused by laryngeal edema and vascular collapse. In the emergency room where he is given an epinephrine injection, Bobby is diagnosed with



A. allergic rhinitis.


B. allergic sinusitis.


C. anaphylactic shock.


D. asthma.



Answer: C

Sam Spade has been severely injured in an MVA because he was not wearing a seat belt. The organ in his body, situated at the upper left of his abdominal cavity, under the ribs, that is part of his lymphatic system has been ruptured, and he is bleeding internally. Sam needs a surgical procedure known as

Sam Spade has been severely injured in an MVA because he was not wearing a seat belt. The organ in his body, situated at the upper left of his abdominal cavity, under the ribs, that is part of his lymphatic system has been ruptured, and he is bleeding internally. Sam needs a surgical procedure known as



A. sequestrectomy. 


B. sialoadenectomy.


C. sigmoidoscopy.


D. splenectomy.



Answer: D

Sex-linked genetic diseases

Sex-linked genetic diseases



A. are transmitted during sexual activity.


B. involve a defect on a chromosome.


C. occur equally between males and females.


D. occur only in males.



Answer: C

Before leaving the hospital, all newborns are screened for an autosomal recessive genetic disorder of defective enzymatic conversion in protein metabolism. With early detection and a protein-restricted diet, brain damage is prevented. This disease is

Before leaving the hospital, all newborns are screened for an autosomal recessive genetic disorder of defective enzymatic conversion in protein metabolism. With early detection and a protein-restricted diet, brain damage is prevented. This disease is



A. cystic fibrosis.


C. phenylketonuria.


B. hereditary hemochromatosis.


D. Tay—Sachs disease.



Answer: B

Rheumatoid arthritis typically affects the

Rheumatoid arthritis typically affects the



A. intervertebral disks. 


B. hips and shoulders.


C. knees and small joints of the hands and feet.


D. large, weight-bearing joints.



Answer: C

Fractures occur in patients with osteoporosis due to

Fractures occur in patients with osteoporosis due to 



A. falling from loss of balance.


B. fibrous joint adhesions tearing apart small bones.


C. loss of bone mass.


D. a tendency to fall from a lack of joint mobility.



Answer: A

Henrietta Dawson presents with a chief complaint of pain and weakness in her arms and neck. After an H and P and a review of diagnostic tests that include a myelogram, her doctor diagnoses ____ level of her spine.

Henrietta Dawson presents with a chief complaint of pain and weakness in her arms and neck. After an H and P and a review of diagnostic tests that include a myelogram, her doctor diagnoses ____ level of her spine. 



A. cervical


B. lumbar


C. sacral 


D. thoracic



Answer: A

Pain is a symptom of which of the following conditions?

Pain is a symptom of which of the following conditions?



A. first-degree burn (superficial)


B. second-degree burn (partial thickness)


C. third-degree burn (full thickness)


D. both A B



Answer: C

Impetigo can be

Impetigo can be



A. spread through autoinoculation. 


B. caused by Streptococcus pyogenes. 


C. caused by Staphylococcus aureus.


D. either A or B.



Answer: D

A common contraceptive that is implanted in the uterus induces slight endometrial inflammation, which attracts neutrophils to the uterus. These neutrophils are toxic to sperm and Prevent the fertilization of the ovum. This contraception is termed

A common contraceptive that is implanted in the uterus induces slight endometrial inflammation, which attracts neutrophils to the uterus. These neutrophils are toxic to sperm and Prevent the fertilization of the ovum. This contraception is termed



A. oral contraceptives.


B. progestin injections. 


C. spermicides.


D. an IUD.



Answer: B

A 28-year-old female presents to her general practitioner with morning nausea and vomiting, weight gain, and two missed menstrual cycles. The physician orders a pregnancy test. What chemical in the urine does this lab test detect?

A 28-year-old female presents to her general practitioner with morning nausea and vomiting, weight gain, and two missed menstrual cycles. The physician orders a pregnancy test. What chemical in the urine does this lab test detect?



A. alpha-fetoprotein


B. creatine phosphokinase


C. carcinoembryonic antigen


D. human chorionic gonadotropin



Answer: A

Microbiological lab culture and sensitivity tests were performed on the skin scrapings of a groin lesion on a 27-year-old male patient who presented to a local health department clinic. The results confirm infection with Treponema pallidum. He was given a prescription for penicillin and told to return for a follow-up visit in 2 weeks. His diagnosis is

Microbiological lab culture and sensitivity tests were performed on the skin scrapings of a groin lesion on a 27-year-old male patient who presented to a local health department clinic. The results confirm infection with Treponema pallidum. He was given a prescription for penicillin and told to return for a follow-up visit in 2 weeks. His diagnosis is


A. syphilis.


B. HIV.


C. herpes.


D. HPV.



Answer: D

A 37-year-old female goes to her family physician complaining of dysuria, urgency, fever, and malaise. A UA is performed and upon gross examination is found to be turbid and has an unusual odor. Microscopic examination reveals a rod-shaped microorganism. A 24-hour culture produces a colony count greater than 100,000/mL of Escherichia coli. This would indicate a diagnosis of

A 37-year-old female goes to her family physician complaining of dysuria, urgency, fever, and malaise. A UA is performed and upon gross examination is found to be turbid and has an unusual odor. Microscopic examination reveals a rod-shaped microorganism. A 24-hour culture produces a colony count greater than 100,000/mL of Escherichia coli. This would indicate a diagnosis of



A. UTI.


B. FUO.


C. PID.


D. KUB.



Answer: A

Common kidney stone treatments that allow small particles to be flushed out of the body through the urinary system include all of the following EXCEPT

Common kidney stone treatments that allow small particles to be flushed out of the body through the urinary system include all of the following EXCEPT 



A. extracorporeal shock wave lithotripsy.


B. fluid hydration.


C. ureteroscopy and stone basketing.


D. using medication to dissolve the stone(s).



Answer: A

Genital warts are caused by

Genital warts are caused by



A. HAV.


B. HIV.


C. HPV. 


D. VZV.



Answer: C

One of the most common causes of peptic ulcer disease is the consumption of aspirin and NSAIDs. Another common cause is infection by Helicobacter pylori, and the usual treatment for this condition is use of

One of the most common causes of peptic ulcer disease is the consumption of aspirin and NSAIDs. Another common cause is infection by Helicobacter pylori, and the usual treatment for this condition is use of




A. antivirals.


B. antibiotics.


C. antifungals 


D. antiemetics



Answer: C

Early detection programs apply screening guidelines to detect cancers at an early stage, which provides the likelihood of increased survival and decreased morbidity. Which of the following would NOT be a diagnostic or screening test for colorectal cancer?

Early detection programs apply screening guidelines to detect cancers at an early stage, which provides the likelihood of increased survival and decreased morbidity. Which of the following would NOT be a diagnostic or screening test for colorectal cancer?



A. double contrast barium enema


B. sigmoidoscopy 


C. fecal occult blood test 


D. upper GI x-ray



Answer: D

Prevention programs identify risk factors and use strategies to modify attitudes and behaviors to reduce the chance of developing cancers. Which of the following would NOT be an identified risk factor for colorectal cancer?

Prevention programs identify risk factors and use strategies to modify attitudes and behaviors to reduce the chance of developing cancers. Which of the following would NOT be an identified risk factor for colorectal cancer?



A. alcohol use


B. physical inactivity


C. a high-fiber diet 


D. obesity



Answer: C

Mycobacterium tuberculosis is the organism that causes tuberculosis (TB), typically a respiratory disorder. It is currently experiencing resurgence in the United States and many other countries. What is the average timeframe in which all patients with new, previously untreated TB must have daily antibiotic therapy?

Mycobacterium tuberculosis is the organism that causes tuberculosis (TB), typically a respiratory disorder. It is currently experiencing resurgence in the United States and many other countries. What is the average timeframe in which all patients with new, previously untreated TB must have daily antibiotic therapy?



A. 4-7 days


B. 6—9 months


C. 6-9 weeks


D. 4-7 years



Answer: B

A sweat test was done on a patient with the following symptoms: frequent respiratory infections, chronic cough, and foul-smelling bloody stools. Which of the following diseases is probably suspected?

A sweat test was done on a patient with the following symptoms: frequent respiratory infections, chronic cough, and foul-smelling bloody stools. Which of the following diseases is probably suspected? 



A. cystic breast disease


B. cystic fibrosis


C. cystic lung disease 


D. cystic pancreas



Answer: B

Which of the following BEST describes tuberculosis?

Which of the following BEST describes tuberculosis?



A. a chronic, systemic disease whose initial infection is in the lungs


B. an acute bacterial infection of the lung


C. an ordinary lung infection


D. a viral infection of the lungs



Answer: A

Most carbon dioxide is carried in the

Most carbon dioxide is carried in the



A. blood as C02 gas.


B. blood bound to hemoglobin.


C. blood plasma in the form of carbonic acid.


D. red blood cells.



Answer: D

Which of the following sequences correctly depicts the flow of blood through the heart to the lungs in order for gas exchange to occur?

Which of the following sequences correctly depicts the flow of blood through the heart to the lungs in order for gas exchange to occur?



A. right atrium, right ventricle, lungs, pulmonary artery


B. right atrium, right ventricle, pulmonary artery, lungs


C. right ventricle, right atrium, lungs, pulmonary artery


D. right ventricle, right atrium, pulmonary artery, lungs



Answer: B

A common cardiac glycoside medication that increases the force of the cardiac contraction without increasing the oxygen consumption, thereby increasing the cardiac output is typically given to patients with heart failure. However, a very narrow therapeutic window between effectiveness and toxicity and the patient must be monitored closely. This common cardiac medication is

A common cardiac glycoside medication that increases the force of the cardiac contraction without increasing the oxygen consumption, thereby increasing the cardiac output is typically given to patients with heart failure. However, a very narrow therapeutic window between effectiveness and toxicity and the patient must be monitored closely. This common cardiac medication is



A. COX-2 inhibitor.


B. nitroglycerin.


C. digoxin.


D. acetylsalicylic acid.



Answer: C

Margaret Vargas needs to have her mitral valve replaced. Her surgeon will discuss which of the following issues with her before the surgery?

Margaret Vargas needs to have her mitral valve replaced. Her surgeon will discuss which of the following issues with her before the surgery?



A. A mechanical valve will require that she take a "blood thinner" for the rest of her life.


B. A biological valve (usually porcine) will last 10 to 15 years.


C. A mechanical valve increases the risk of blood clots that can cause stroke.


D. All of the above.



Answer: D

Henry experienced sudden sharp chest pain that he described as heavy and crushing. His pain and past medical history caused Dr. James to suspect that Henry was having an acute myocardial infarction (AMI). Which of the following tests is a more specific marker for an AMI?

Henry experienced sudden sharp chest pain that he described as heavy and crushing. His pain and past medical history caused Dr. James to suspect that Henry was having an acute myocardial infarction (AMI). Which of the following tests is a more specific marker for an AMI?


A. AST


C. LDHI


B. CK-MB


D. Troponin I



Answer: B

Diastole occurs when

Diastole occurs when



A. cardiac insufficiency is present. 


B. the atria contracts.


C. the ventricles contract.


D. the ventricles fill.



Answer: D

Which of the following is a lethal arrhythmia?

Which of the following is a lethal arrhythmia?



A. atrial fibrillation 


B. atrial tachycardia


C. bradycardia


D. ventricular fibrillation



Answer: D

Etiologies of dementia include

Etiologies of dementia include



A. brain tumors.


B. ischemia.


C. trauma.


D. all of the above.



Answer: D

A condition that involves the fifth cranial nerve, also known as "tic douloureux," causes intense pain in the eye and forehead; lower lip, the section of the cheek closest to the ear and the outer segment of the tongue; or the upper lip, nose, and cheek.

A condition that involves the fifth cranial nerve, also known as "tic douloureux," causes intense pain in the eye and forehead; lower lip, the section of the cheek closest to the ear and the outer segment of the tongue; or the upper lip, nose, and cheek.


A. Bell's palsy


B. thrush


C. trigeminal neuralgia


D. Tourette's disorder



Answer: C

Why are there "black box warnings" on antidepressant medications regarding children and adolescents?

Why are there "black box warnings" on antidepressant medications regarding children and adolescents?



A. Antidepressants increase the risk of suicidal thinking and behavior in some children and adolescents.


B. Dosage requirements must be significantly higher in children and adolescents compared to adults.


C. There is no established medical need for treatment of depression in children and adolescents.


D. Antidepressants interfere with physiological growth patterns in children and adolescents.



Answer: A

An African American couple are undergoing genetic counseling to determine the likelihood of producing children with a recessively genetic blood condition. The genetic tests reveal that the father carries the trait to produce abnormal hemoglobin, HbS, which causes crystallization in RBCs and deforms their shape when 02 is low. This condition causes painful crises and multiple infarcts and is termed

An African American couple are undergoing genetic counseling to determine the likelihood of producing children with a recessively genetic blood condition. The genetic tests reveal that the father carries the trait to produce abnormal hemoglobin, HbS, which causes crystallization in RBCs and deforms their shape when 02 is low. This condition causes painful crises and multiple infarcts and is termed

 


A. hemophilia.


B. thalassemia.


C. sickle cell anemia.


D. iron-deficiency anemia.



Answer: C

02 is carried in the blood

02 is carried in the blood



A. bound to hemoglobin.


B. in the form of carbonic acid.


C. plasma.


D. serum.



Answer: A

A 75-year-old patient has a sore tongue with tingling and numbness of the hands and feet. She has headaches and is fatigued. Following diagnostic workup, the doctor orders monthly injections of vitamin BIX This patient most likely has which of the following conditions?

A 75-year-old patient has a sore tongue with tingling and numbness of the hands and feet. She has headaches and is fatigued. Following diagnostic workup, the doctor orders monthly injections of vitamin BIX This patient most likely has which of the following conditions?



A. aplastic anemia


C. pernicious anemia


B. autoimmune hemolytic anemia


D. sickle cell anemia



Answer: C

The etiology of aplastic anemia is

The etiology of aplastic anemia is



A. acute blood loss.


B. bone marrow failure.


C. chronic blood loss.


D. inadequate iron intake.



Answer: B

How can Graves' disease be treated?

How can Graves' disease be treated?



A. antithyroid drugs 

B. radioactive iodine therapy

C. surgery 

D. all of the above



Answer: D

Which of the following is characteristic of Graves' disease?

Which of the following is characteristic of Graves' disease?



A. It is an autoimmune disease.

B. It most commonly affects males. 

C. It usually cannot be treated.

D. It usually affects the elderly.



Answer: A

Clinical manifestations of this disease include polydipsia, polyuria, polyphagia, weight loss, and hyperglycemia. Which of the following tests would be ordered to confirm the disease?

Clinical manifestations of this disease include polydipsia, polyuria, polyphagia, weight loss, and hyperglycemia. Which of the following tests would be ordered to confirm the disease?



A. fasting blood sugar

B. glucagon

C. glucose tolerance test

D. postprandial blood sugar



Answer: C

Diabetic microvascular disease occurs

Diabetic microvascular disease occurs



A. as a direct result of elevated serum glucose.


B. as a result of elevated fat in blood.


C. due to damage to nerve cells.


D. only in patients with type 1 diabetes.



Answer: A

Which of the following is an effect of insulin?

Which of the following is an effect of insulin? 



A. decreases glycogen concentration in live

B. increases blood glucose 

C. increases the breakdown of fats 

D. increases glucose metabolism



Answer: D

Mary Mulholland has diabetes. Her physician has told her about some factors that put her more at risk for infections. Which of the following factors would probably NOT be applicable?

Mary Mulholland has diabetes. Her physician has told her about some factors that put her more at risk for infections. Which of the following factors would probably NOT be applicable?



A. hypoxia

B. increased glucose in body fluids 

C. increased blood supply

D. both A and C



Answer: C

Mary Smith, a 48-year-old patient, is receiving an IV mixture of four different medications to treat stage 2 invasive ductal breast carcinoma. Each of the medications acts upon a different aspect of the cancer cells. This mixture is typically termed a(n)

Mary Smith, a 48-year-old patient, is receiving an IV mixture of four different medications to treat stage 2 invasive ductal breast carcinoma. Each of the medications acts upon a different aspect of the cancer cells. This mixture is typically termed a(n) 



A. amalgamation.

B. cocktail.

C. blend.

D. mash-up.



Answer: B

Which of the following BEST summarizes the current treatment of cervical cancer?

Which of the following BEST summarizes the current treatment of cervical cancer?



A. A new three-shot vaccination series protects against the types of HPV that cause most cervical cancer cases.

B. All stages have extremely high cure rates.

C. Early detection and treatment of cervical cancer does not improve patient survival rates.

D. Over 99% of cases are linked to long-term HPV infections.



Answer: A

The most fatal type of lung cancer is

The most fatal type of lung cancer is



A. adenocarcinoma.


B. large cell cancer.


C. small cell cancer.


D. squamous cell cancer.



Answer: C

There has been a significant increase in the number of cases and deaths from pertussis. Health care professionals attribute this disease trend to which of the following?

There has been a significant increase in the number of cases and deaths from pertussis. Health care professionals attribute this disease trend to which of the following?



A. A decrease in the number of people immunized with TDaP


B. An increase in the virulence of the bacteria


C. Drug-resistant strains of the bacteria


D. All of the above



Answer: A

A 19-year-old college student, who lives on campus in a dormitory, is brought to the ER by his roommates, complaining of a severe headache, nuchal rigidity, fever, and photophobia. The ER physician performs an LP and orders a CSF analysis with a bacterial culture and sensitivity. The young man is admitted to the ICU with a provisional diagnosis of

A 19-year-old college student, who lives on campus in a dormitory, is brought to the ER by his roommates, complaining of a severe headache, nuchal rigidity, fever, and photophobia. The ER physician performs an LP and orders a CSF analysis with a bacterial culture and sensitivity. The young man is admitted to the ICU with a provisional diagnosis of



A. a group A beta-hemolytic streptococcal throat infection.


B. a methicillin-resistant Staphylococcus aureus skin infection.


C. tuberculosis with drug-resistant Mycobacterium tuberculosis-positive sputum.


D. meningitis due to Neisseria meningitidis-positive cerebrospinal fluid.



Answer: D

A pharyngeal culture is taken from a 13-year-old male patient presenting to the ER with fever, painful cervical lymph nodes, purulent tonsillar exudate, and difficulty swallowing. A blood agar culture plate shows complete hemolysis around Streptococcus pyogenes bacterial colonies. The patient is given a prescription for erythromycin. The diagnosis in this case is

A pharyngeal culture is taken from a 13-year-old male patient presenting to the ER with fever, painful cervical lymph nodes, purulent tonsillar exudate, and difficulty swallowing. A blood agar culture plate shows complete hemolysis around Streptococcus pyogenes bacterial colonies. The patient is given a prescription for erythromycin. The diagnosis in this case is



A. a group A beta-hemolytic streptococcal throat infection.


B. a methicillin-resistant Staphylococcus aureus skin infection.


C. tuberculosis with drug-resistant Mycobacterium tuberculosis-positive sputum.


D. meningitis due to Neisseria meningitidis-positive cerebrospinal fluid.



Answer: A

Ingrid Anderson presents with a skin infection that began as a raised, itchy bump, resembling an insect bite. Within 1 to 2 days, it developed into a vesicle. Now it is a painless ulcer, about 2 cm in diameter, with a black necrotic area in the center. During the history, her doctor learns that she has recently returned from an overseas vacation and becomes concerned that she may have become infected with anthrax. He will prescribe an

Ingrid Anderson presents with a skin infection that began as a raised, itchy bump, resembling an insect bite. Within 1 to 2 days, it developed into a vesicle. Now it is a painless ulcer, about 2 cm in diameter, with a black necrotic area in the center. During the history, her doctor learns that she has recently returned from an overseas vacation and becomes concerned that she may have become infected with anthrax. He will prescribe an



A. antibiotic.


B. antineoplastic.


C. antiparasitic.


D. antiviral.



Answer: A

The childhood viral disease that unvaccinated pregnant women should be prevented from contracting because it may be passed to the fetus, thus causing congenital anomalies such as mental retardation, blindness, and deafness, is

The childhood viral disease that unvaccinated pregnant women should be prevented from contracting because it may be passed to the fetus, thus causing congenital anomalies such as mental retardation, blindness, and deafness, is



A. rickets.


B. rubeola.


C. rubella.


D. tetanus.



Answer: C

A patient being treated for an MI has been transferred to a step-down unit from the intensive care unit. She uses the call bell as often as every 15 minutes. Each time a staff member responds, the patient complains about her care or makes a seemingly small request. Several staff tell the primary nurse that the patient is "obnoxious" and that they feel inadequate because they can never seem to satisfy her needs. The primary nurse can be most helpful by:

A patient being treated for an MI has been transferred to a step-down unit from the intensive care unit. She uses the call bell as often as every 15 minutes. Each time a staff member responds, the patient complains about her care or makes a seemingly small request. Several staff tell the primary nurse that the patient is "obnoxious" and that they feel inadequate because they can never seem to satisfy her needs. The primary nurse can be most helpful by:



a. explaining that the demanding behavior is due to the patient's increasing anxiety.

b. "laying down the law" to the patient, limiting use of the call light to once per hour.

c. rotating caregivers to give each person a much-needed respite from her complaints.

d. asking the patient's family to sit with her and help meet her need for attention.



Answer: A

A patient who has been diagnosed with breast cancer has many questions related to surgery, radiation therapy, and chemotherapy. The nurse provides education about the disease and treatments but perceives that the patient has further questions about coping with day-to-day situations. The action of greatest benefit to the patient would be:

A patient who has been diagnosed with breast cancer has many questions related to surgery, radiation therapy, and chemotherapy. The nurse provides education about the disease and treatments but perceives that the patient has further questions about coping with day-to-day situations. The action of greatest benefit to the patient would be:



a. suggesting cognitive-behavioral therapy with a counselor.

b. teaching her to monitor her stress level while at home.

c. suggesting she enroll in a pain-management program.

d. referring her to a support group for persons with breast cancer.



Answer: D

A man with severe mental illness has difficulty with boredom, feels that attending the day program does not challenge him, and wishes to earn money. Which of the following options would be most appropriate for addressing these issues?

A man with severe mental illness has difficulty with boredom, feels that attending the day program does not challenge him, and wishes to earn money. Which of the following options would be most appropriate for addressing these issues?



a. Involve him in volunteer work at the consumer-run clubhouse program at the mental health center.

b. Help the patient apply for services at the state's Bureau of Vocational Rehabilitation.

c. Rapidly pace him in a competitive job of his choosing, accompanied by a coach on the job site.

d. First involve the patient in prevocational training, then in employment in a sheltered workshop.



Answer: C

A middle-class family is talking with the nurse about the impact a seriously mental ill son has had on the family. Insurance has only partially covered treatment expenses, and the family has spent much of their savings to care for him. The patient's younger sister mentions she feels lost because her parents are so focused on her brother that it seems as though they have no time for her. The parents are concerned that when the siblings move out and they themselves become aged, there will be no one to care for the patient. Which response would be most helpful?

A middle-class family is talking with the nurse about the impact a seriously mental ill son has had on the family. Insurance has only partially covered treatment expenses, and the family has spent much of their savings to care for him. The patient's younger sister mentions she feels lost because her parents are so focused on her brother that it seems as though they have no time for her. The parents are concerned that when the siblings move out and they themselves become aged, there will be no one to care for the patient. Which response would be most helpful?



a. Acknowledge their concerns, and indicate that you will consult with the treatment team about ways to bring the patient's symptoms under better control.

b. Give them the names of financial advisors and banks that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one.

c. Refer them to crisis intervention services to learn ways to manage caregiver stress, and provide the titles of some helpful books for families of SMI persons.

d. Discuss the benefits of participating in National Alliance on Mental Illness programs, and discuss ways to help the son become more independent.



Answer: D

A patient with paranoid schizophrenia and anosognosia has had several hospitalizations. He responds quickly to antipsychotic medication but stops taking the medication soon after discharge. Discharge planning will include follow-up at the mental health clinic, placement in a group home, and daily attendance at a psychosocial day program. Which medication strategy will most likely be used as he transitions from hospital to community?

A patient with paranoid schizophrenia and anosognosia has had several hospitalizations. He responds quickly to antipsychotic medication but stops taking the medication soon after discharge. Discharge planning will include follow-up at the mental health clinic, placement in a group home, and daily attendance at a psychosocial day program. Which medication strategy will most likely be used as he transitions from hospital to community?



a. Administer a second-generation antipsychotic to help negative symptoms.

b. Prescribe a long-acting intramuscular antipsychotic medication.

c. Involve the patient in the decision about which medication is best.

d. Prescribe a quick-dissolving formulation to reduce "cheeking."



Answer: C

The brother of a patient who is seriously mentally ill asks why the patient has been assigned a case manager. The nurse's reply should cite the major advantage of the use of case management as:

The brother of a patient who is seriously mentally ill asks why the patient has been assigned a case manager. The nurse's reply should cite the major advantage of the use of case management as:



a. "The case manager can modify traditional psychotherapy for homeless patients so that it is more flexible."

b. "Case managers coordinate services and help with accessing them, making sure the patient gets what he needs."

c. "The case manager can focus on social skills training and esteem building out in the real world where he lives."

d. "Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money."



Answer: B

A victim of a sexual assault sits in the emergency department rocking back and forth and repeatedly saying, "I can't believe I've been raped." This behavior is characteristic of:

A victim of a sexual assault sits in the emergency department rocking back and forth and repeatedly saying, "I can't believe I've been raped." This behavior is characteristic of:



a. the acute phase reaction.

b. the angry stage of rape-trauma syndrome.

c. a delayed reaction to rape-trauma syndrome.

d. the long-term phase of rape-trauma syndrome.



Answer: A

A nurse works a rape telephone hotline. Communication should focus on:

A nurse works a rape telephone hotline. Communication should focus on:



a. explaining immediate steps victims should take.

b. providing callers with a sympathetic listener.

c. obtaining information for law enforcement.

d. arranging long-term counseling.



Answer: A

The nursing diagnosis Rape-trauma syndrome is established for a rape victim in the emergency department. Select the most important outcome to achieve before discharging the patient.

The nursing diagnosis Rape-trauma syndrome is established for a rape victim in the emergency department. Select the most important outcome to achieve before discharging the patient.



a. The patient will describe feelings of safety and relaxation.

b. The memory of the rape will be less vivid and less frightening.

c. Physical symptoms of pain and discomfort are no longer present.

d. The patient will agree to keep a follow-up appointment with a rape victim advocate.



Answer: D

An emergency department nurse prepares to assist with evidence collection for a sexual assault victim. Prior to photographs and pelvic examination, what documentation is important?

An emergency department nurse prepares to assist with evidence collection for a sexual assault victim. Prior to photographs and pelvic examination, what documentation is important?



a. The patient's vital signs

b. Consent signed by the patient

c. Supervision and credentials of the examiner

d. Storage location of the patient's personal effects



Answer: B

After a rape victim visited a rape crisis counselor weekly for 8 weeks, which finding best demonstrates that reorganization was successful?

After a rape victim visited a rape crisis counselor weekly for 8 weeks, which finding best demonstrates that reorganization was successful?



a. Absence of signs or symptoms of posttraumatic stress disorder

b. Presence of mild somatic reactions

c. Moderate doubts about self-worth

d. Occasional episodic nightmares



Answer: A

Which aspect of assessment has priority when a nurse interviews a rape victim?

Which aspect of assessment has priority when a nurse interviews a rape victim?


a. Coping mechanisms the patient is using

b. The patient's previous sexual experiences

c. Adequacy of the patient's interpersonal relationships

d. Whether the patient has ever had a sexually transmitted disease



Answer: A

A victim of partner abuse, parent of one child, describes the partner as someone who is easily frustrated and more likely to be abusive after a experiencing an event in which self-esteem is challenged. The most recent episodes of violence were related to feeling "upset" over a job loss. What type of therapy would provide the greatest help to the abuser?

A victim of partner abuse, parent of one child, describes the partner as someone who is easily frustrated and more likely to be abusive after a experiencing an event in which self-esteem is challenged. The most recent episodes of violence were related to feeling "upset" over a job loss. What type of therapy would provide the greatest help to the abuser?



a. Voluntary individual or group therapy

b. Court-ordered individual or group therapy

c. Voluntary couples or family therapy

d. Court-ordered couples or family therapy



Answer: A

A child, aged 11 years, has to stay home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The father appears to be emotionally abusive. Which intervention could be used for the primary prevention of problems such as these?

A child, aged 11 years, has to stay home from school to care for his siblings while his mother works, because the family cannot afford a babysitter. The father appears to be emotionally abusive. Which intervention could be used for the primary prevention of problems such as these?



a. Involve the parents in a parenting support group, and help them find affordable childcare.

b. Meet with elected officials to lobby for subsidized childcare and increasing the minimum wage.

c. Screen for signs of abuse and neglect in all children so that it can be discovered and treated early.

d. Provide supportive counseling services for those who have survived neglect or abuse.



Answer: B

A nurse is working with a perpetrator of family violence who has a long history of violent rages when frustrated, with periods of remorse after each outburst. The nurse is most likely to establish the nursing diagnosis of:

A nurse is working with a perpetrator of family violence who has a long history of violent rages when frustrated, with periods of remorse after each outburst. The nurse is most likely to establish the nursing diagnosis of:



a. Risk for injury related to victim reprisal.

b. Risk for other-directed violence related to stress.

c. Ineffective coping related to poor anger management.

d. Caregiver role strain related to feelings of being overwhelmed.



Answer: C

An 82-year-old widow with Alzheimer's disease lives with her daughter's family, which owns a catering business. During the week, the patient attends a day care center for patients with dementia. During the evenings, members of the family care for the patient. One day, the nurse at the day care center notices the patient's appearance is disheveled and that she startles easily. She has a strong odor of urine, and her hair is uncombed. When the nurse escorts the patient to the bathroom, she notices bruises on her wrists and back. What most likely explains the nurse's observations?

An 82-year-old widow with Alzheimer's disease lives with her daughter's family, which owns a catering business. During the week, the patient attends a day care center for patients with dementia. During the evenings, members of the family care for the patient. One day, the nurse at the day care center notices the patient's appearance is disheveled and that she startles easily. She has a strong odor of urine, and her hair is uncombed. When the nurse escorts the patient to the bathroom, she notices bruises on her wrists and back. What most likely explains the nurse's observations?



a. The patient is being neglected and abused within the family.

b. The dementia is progressing, reducing self-care and increasing falls.

c. The patient is being inadequately cared for, resulting in accidents.

d. The patient has developed delirium, resulting in poor hygiene and injuries.



Answer: A

A victim of physical abuse by her domestic partner is being treated for a broken humerus. Which indicator for the outcome of Abuse protection is most important to achieve before the patient leaves the emergency department?

A victim of physical abuse by her domestic partner is being treated for a broken humerus. Which indicator for the outcome of Abuse protection is most important to achieve before the patient leaves the emergency department?



a. The patient has completed and reviewed a workable safety plan.

b. She agrees to seek a restraining order limiting contact by the perpetrator.

c. The patient demonstrates insight into the abusive nature of the relationship.

d. She has been referred to counseling and battered-person support groups.



Answer: A

A patient being treated in the burn injury unit has demonstrated good coping skills for several weeks. Today, a new nurse is assigned to care for him and has proven to be poorly organized. The patient's usual schedule has not been followed, and by midafternoon, he is angry and raises his voice to complain to the nurse clinician. Which course of action for the nurse clinician would be best?

A patient being treated in the burn injury unit has demonstrated good coping skills for several weeks. Today, a new nurse is assigned to care for him and has proven to be poorly organized. The patient's usual schedule has not been followed, and by midafternoon, he is angry and raises his voice to complain to the nurse clinician. Which course of action for the nurse clinician would be best?



a. Explain the reasons for the problem, and take over his care for the rest of the shift.

b. Validate his distress, review the options, and ask what he would like to happen.

c. Apologize and ask that he be patient with the situation for the rest of the shift.

d. Ask him to control his anger, and ask him if he too wasn't once new at something.



Answer: B

A patient with severe orthopedic injuries after an automobile accident is irritable, angry, and belittles the nurses who provide his care. While the nurse is changing the dressing over a deep laceration, the patient screams, "Don't touch me! You are so stupid; you're only making it worse!" Which intervention would be most therapeutic?

A patient with severe orthopedic injuries after an automobile accident is irritable, angry, and belittles the nurses who provide his care. While the nurse is changing the dressing over a deep laceration, the patient screams, "Don't touch me! You are so stupid; you're only making it worse!" Which intervention would be most therapeutic?



a. Wordlessly leave the room and ask to switch assignments with another nurse who may be more acceptable to the patient.

b. Apologize, explain that the dressing change is necessary to prevent infection, and jointly explore ways to decrease the discomfort involved.

c. State: "Since you believe we nurses aren't able to change your dressing, perhaps you would like to change it yourself."

d. State: "This is frustrating for both of us, but there is no choice because your doctor has ordered this dressing change."



Answer: B

A patient on a medical unit has a history of hostile and menacing behavior toward staff and sometimes even strikes them. Which plan would be best for forestalling such incidents?

A patient on a medical unit has a history of hostile and menacing behavior toward staff and sometimes even strikes them. Which plan would be best for forestalling such incidents?



a. Give the patient lorazepam (Ativan) every 4 hours to reduce anxiety.

b. Explain that the response to any violence will be to use restraints.

c. Arrange for security personnel to stand by during all nursing care.

d. Point out the problem and help the patient identify things that are causing frustration.



Answer: D

An elderly patient with multi-infarct dementia is striking out with her arms and kicking at people who walk past in the hall. The nurse determines that the patient believes she is at home and that the other patients have broken into her home. The clinical nurse specialist suggests that staff use validation. Which of the following responses reflect this intervention?

An elderly patient with multi-infarct dementia is striking out with her arms and kicking at people who walk past in the hall. The nurse determines that the patient believes she is at home and that the other patients have broken into her home. The clinical nurse specialist suggests that staff use validation. Which of the following responses reflect this intervention?



a. "I'm a nurse who has come to check on you. Tell me about your home."

b. "You are in a nursing home. The others here are patients, just like you are."

c. "I wish you could be home, but you have been sick and are in a nursing home."

d. "You are not at home. This is a nursing home. It is September 10th, 2010."



Answer: A

An elderly patient with multi-infarct dementia is striking out with her arms and kicking at people who walk past in the hall. Intervention by the nurse should begin by:

An elderly patient with multi-infarct dementia is striking out with her arms and kicking at people who walk past in the hall. Intervention by the nurse should begin by:



a. gently touching the patient's arm.

b. saying the patient's name to gain contact.

c. asking the patient what she needs.

d. approaching from behind to reassure her.



Answer: B

A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say:

A patient is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the patient by name and say:



a. "Please quiet down."

b. "Hey, what's up?"

c. "You seem upset. Tell me about it."

d. "You need to go to your room to get control of yourself."



Answer: C

Which situation would involve the highest risk for violence?

Which situation would involve the highest risk for violence?



a. A nurse is about to set limits on a patient.

b. Shift change and report are about to begin.

c. A PRN medication is to be offered.

d. The patient is a young adult male.



Answer: A

The measure that would be considered a form of primary prevention for suicide is:

The measure that would be considered a form of primary prevention for suicide is:



a. psychiatric hospitalization of a suicidal patient.

b. referral of a formerly suicidal patient to a support group.

c. helping school children learn to manage stress and be resilient.

d. suicide precautions for 24 hours for newly admitted patients.



Answer: C

A staff nurse tells another nurse, "I just used the SAD PERSONS scale to evaluate a man who sometimes thinks about suicide; his score was 8. I'm wondering if I should send him home after arranging for follow-up." The best reply by the second nurse would be:

A staff nurse tells another nurse, "I just used the SAD PERSONS scale to evaluate a man who sometimes thinks about suicide; his score was 8. I'm wondering if I should send him home after arranging for follow-up." The best reply by the second nurse would be:



a. "That would seem appropriate, but I'd consult the on-call resident first."

b. "Be sure he is followed up closely; he may require hospitalization later on."

c. "I think you should consider hospitalization just to be safe."

d. "A score of 7 or higher usually requires immediate hospitalization."



Answer: D

A tearful, anxious man comes to the clinic with the chief complaint, "I should be dead." The first task of the nurse conducting the assessment interview is to:

A tearful, anxious man comes to the clinic with the chief complaint, "I should be dead." The first task of the nurse conducting the assessment interview is to:



a. assess the lethality of his suicide plan.

b. establish initial rapport with the patient.

c. encourage the expression of anger.

d. determine risk factors for suicide.



Answer: B

A college student who attempted suicide by overdose was treated in the emergency department. Because she had no available social supports, she was hospitalized. An outcome related to the nursing diagnosis Risk for self-directed violence is that the patient will:

A college student who attempted suicide by overdose was treated in the emergency department. Because she had no available social supports, she was hospitalized. An outcome related to the nursing diagnosis Risk for self-directed violence is that the patient will:



a. exercise self-control by refraining from attempting to harm herself.

b. verbalize a desire and intent to live by the end of the second hospital day.

c. demonstrate two new coping mechanisms by the fourth hospital day.

d. discuss two personal strengths by the end of first week of hospitalization.



Answer: A

Which of these statements about suicide is accurate?

Which of these statements about suicide is accurate?


a. The majority of persons who attempt suicide have given overt or covert indications of their intentions to others.

b. A background in health care has a protective effect, leading to a lower rate of suicide among physicians and nurses than in the general public.

c. Most persons with previous suicide attempts survived because they did not truly intend to die; they are at lower risk than those making their first attempt.

d. Use of a low-lethality means or likelihood of being discovered in time to prevent death are merely suicide gestures, not genuine attempts.



Answer: A

A 20-year-old economics major became severely depressed after failing two examinations in economics. She cried for 2 hours, then called her parents who live in a neighboring state, planning to ask if she could return home. However, her parents were in Europe. When her roommate went home for the weekend, the patient gave her three expensive sweaters to keep. Later, the dormitory resident assistant returned a book to the patient's room and found her unconscious on the floor, with an empty pill bottle nearby. The patient behavior that provided a clue to the suicide attempt was:

A 20-year-old economics major became severely depressed after failing two examinations in economics. She cried for 2 hours, then called her parents who live in a neighboring state, planning to ask if she could return home. However, her parents were in Europe. When her roommate went home for the weekend, the patient gave her three expensive sweaters to keep. Later, the dormitory resident assistant returned a book to the patient's room and found her unconscious on the floor, with an empty pill bottle nearby. The patient behavior that provided a clue to the suicide attempt was:



a. calling her parents.

b. staying in her dorm room.

c. giving away her sweaters.

d. excessive crying.



Answer: C

The nursing diagnosis of Powerlessness related to impaired problem solving has been established for a patient seeking crisis counseling. An appropriate outcome for this nursing diagnosis would be that the patient will:

The nursing diagnosis of Powerlessness related to impaired problem solving has been established for a patient seeking crisis counseling. An appropriate outcome for this nursing diagnosis would be that the patient will:



a. agree to sign a no-suicide contract within 30 minutes.

b. resume meeting pre-crisis role expectations within 36 hours.

c. state he feels less anxious within 4 hours of the interview.

d. describe two possible solutions during the first interview.



Answer: D

An appropriate question for the nurse to ask to assess support systems is:

An appropriate question for the nurse to ask to assess support systems is:



a. "Has anything upsetting occurred in the last few days?"

b. "What led you to seek help at this time?"

c. "How does this problem affect your life?"

d. "Who can be helpful to you during this time?"



Answer: D

The assumption that will be most useful to the nurse planning crisis intervention for any patient who is experiencing a crisis is that the patient:

The assumption that will be most useful to the nurse planning crisis intervention for any patient who is experiencing a crisis is that the patient:



a. is experiencing a type of mental illness.

b. is experiencing a state of disequilibrium.

c. has high potential for self-injury.

d. poses a threat of violence to others.



Answer: B

A woman expecting to pick her husband up at the airport has instead just been told that he has been killed in an airplane crash. Crisis counselors are present to help loved ones cope with the sad and sudden news. Which response by the counselor would be most appropriate to make next?

A woman expecting to pick her husband up at the airport has instead just been told that he has been killed in an airplane crash. Crisis counselors are present to help loved ones cope with the sad and sudden news. Which response by the counselor would be most appropriate to make next?



a. State, "I will stay with you," and allow for a period of silence so she can process the news of her loss.

b. Ask, "What would help you in this difficult time? Would you like to speak with a chaplain?"

c. Ask, "Is there is someone who's supportive, who can take you home and spend time with you over the next few days?"

d. State, "We realize this is very sudden and unexpected and very upsetting. The airline is committed to helping you in this difficult time."



Answer: A

A woman goes to the airport to pick up her husband, returning from one of many business trips. Persons awaiting his flight are directed to a conference room where airline counselors explain that the flight crashed into the ocean, and it is believed that there are no survivors. The woman tells a counselor that it is too soon to be sure, he might still be alive, clinging to wreckage and waiting to be found. The patient is demonstrating:

A woman goes to the airport to pick up her husband, returning from one of many business trips. Persons awaiting his flight are directed to a conference room where airline counselors explain that the flight crashed into the ocean, and it is believed that there are no survivors. The woman tells a counselor that it is too soon to be sure, he might still be alive, clinging to wreckage and waiting to be found. The patient is demonstrating:



a. trial-and-error problem solving.

b. adaptive denial.

c. ineffective denial.

d. acute confusion.



Answer: B

A patient being interviewed on his first visit to the crisis center says he is there because he needs help, but then he falters and cannot continue his explanation. Which question would be of value in helping him relate his perception of the precipitating event?

A patient being interviewed on his first visit to the crisis center says he is there because he needs help, but then he falters and cannot continue his explanation. Which question would be of value in helping him relate his perception of the precipitating event?



a. "It will be hard to help you if we cannot get more information."

b. "Tell me about what happened that led you to come in today."

c. "Who is available to help and support you with your problem?"

d. "What things do you usually do to get through difficult times?"



Answer: B

A patient, aged 16 years, comes to the crisis clinic and tells the nurse that an uncle tried to rape her yesterday. The patient had told her mother of the uncle's behavior, but the mother accused the daughter of lying and, contrary to the patient's hopes, indicated she would still allow the uncle to visit the family. The patient describes feeling "all confused" and shows minor lacerations on her forearms to the nurse, which she indicates she did out of desperation rather than a wish to die. Which nursing diagnosis would be most appropriate as her primary diagnosis?

A patient, aged 16 years, comes to the crisis clinic and tells the nurse that an uncle tried to rape her yesterday. The patient had told her mother of the uncle's behavior, but the mother accused the daughter of lying and, contrary to the patient's hopes, indicated she would still allow the uncle to visit the family. The patient describes feeling "all confused" and shows minor lacerations on her forearms to the nurse, which she indicates she did out of desperation rather than a wish to die. Which nursing diagnosis would be most appropriate as her primary diagnosis?



a. Powerlessness

b. Disturbed thought processes

c. Rape-trauma syndrome

d. Interrupted family process



Answer: A

A nurse with a history of narcotic abuse became unconscious in the locker room after overdosing. After stabilization, the nurse was transferred to the inpatient psychiatric unit. Which action by nursing staff may be enabling?

A nurse with a history of narcotic abuse became unconscious in the locker room after overdosing. After stabilization, the nurse was transferred to the inpatient psychiatric unit. Which action by nursing staff may be enabling?



a. Empathizing when the nurse discusses fears of disciplinary action by the state board of nursing.

b. Pointing out that work problems are the result, not the cause, of substance abuse.

c. Conveying understanding that pressures associated with nursing practice cause substance abuse.

d. Providing health teaching about stress management.



Answer: C

When a patient comes to an outpatient appointment, a nurse smells alcohol. The nurse should:

When a patient comes to an outpatient appointment, a nurse smells alcohol. The nurse should:



a. explore the patient's reasons for drinking today.

b. arrange admission to an inpatient psychiatric unit.

c. coordinate emergency admission to a detoxification unit.

d. tell the patient, "We cannot see you today because you have been drinking."



Answer: D

What are some of the reasons for increased healthcare costs attributable to the providers of medical care?

What are some of the reasons for increased healthcare costs attributable to the providers of medical care?



• Providers in many instances set their own charges, which are higher than what the same charges would be under free-market conditions.

• Providers are in a position to induce demand for services, leading to higher utilization than what is necessary. Many of the procedures performed are medically unnecessary.

• Providers have done little to promote healthy lifestyles and the prevention of disease because they have mainly espoused the medical model for healthcare delivery.

• Because of legal risks, providers have engaged in the practice of defensive medicine to protect themselves against potential malpractice lawsuits.

• Small area variations suggest that physicians can vary widely in their medical decision making and use of healthcare resources. Scarce medical resources are wasted when they are inappropriately used.


What are the challenges faced in rural health?

What are the challenges faced in rural health?



Answer: The challenges faced in rural health include poverty or poor economic conditions, lack of healthcare professionals in rural settings, and low population density

Age is not the primary determinant for long-term care. Comment on this statement, explaining why this is or is not true.

Age is not the primary determinant for long-term care. Comment on this statement, explaining why this is or is not true.



Age is not the primary determinant for long-term care; functional impairment and ensuing dependency are. Although functional impairment may be more common among the elderly, it does not mean that all elderly people require long-term care. Some children need long-term care from an early age because they were born with physical or mental limitations. Others may develop limited functional capacity in youth as a result of severe trauma or a crippling disease


How does hospital utilization vary according to a person's age, gender, and socioeconomic status?

How does hospital utilization vary according to a person's age, gender, and socioeconomic status?



Hospital utilization increases with age. For example, the elderly age 85 and over have the highest utilization. Among younger age groups, children under 1 year of age have the highest utilization. In general, females incur higher use of hospital services than men do, even after childbirth-related utilization is factored out. Generally, hospital use is higher among people of lower socioeconomic status (SES) than the more affluent because poorer population groups are generally in poorer health and have less access to routine primary care.

Why is the hospital emergency department sometimes used for nonurgent conditions? What are the consequences?

Why is the hospital emergency department sometimes used for nonurgent conditions? What are the consequences?



Reasons for emergency department use for nonurgent care include erroneous self-perceptions of the severity of ailment or injury, the 24-hour open-door policy, convenience, and unavailability of primary care providers. Since many private physicians do not provide services to Medicaid enrollees because of low reimbursement rates, Medicaid beneficiaries often have no primary care provider. Since emergency departments are required by law to evaluate every patient regardless of ability to pay, Medicaid patients and the uninsured frequently use them for primary care treatments. 


Even the insured sometimes feel that they need medical attention immediately regardless of how their problem might be classified by a provider. Such patients present themselves at the emergency department because they cannot find needed care elsewhere. Since the emergency department requires sophisticated facilities and highly trained personnel and must be accessible 24 hours a day, costs are high and services are not designed for nonurgent care. Inappropriate use of the emergency department wastes precious resources.

Discuss the gatekeeping role of primary care.

Discuss the gatekeeping role of primary care.



In a gatekeeping system, patients do not visit specialists without a referral from their primary care physicians. On the surface, gatekeeping may appear to be a controlling mechanism for denying needed care. In most cases, however, the interposition of primary care protects patients from unnecessary procedures and overtreatment. 


This is because specialists are much greater users of tests and procedures, and such interventions carry a definite risk of iatrogenic complications. Gatekeeping must emphasize the coordinating role of primary care to ensure comprehensiveness and continuity of care.


Describe how some of the changes in the health services delivery system have led to a decline in hospital inpatient days and a growth in ambulatory services.

Describe how some of the changes in the health services delivery system have led to a decline in hospital inpatient days and a growth in ambulatory services.



Answer: Medicare reimbursement and cost-saving efforts of managed care are the two main factors that have led to a decline in hospital inpatient days and a growth in ambulatory services. Medicare instituted the prospective payment system (PPS) for reimbursing hospitals in the mid-1980s. PPS reimbursement based on DRGs provides fixed case-based payment to hospitals. Hospitals, therefore, have a strong incentive to minimize the inpatient length of stay and continue treatment in an outpatient setting. The outpatient sector has fewer payment restrictions. 


Cost-containment strategies adopted by managed care also stress lower inpatient utilization, with a corresponding emphasis on outpatient services. These financial factors, for instance, have provided a major impetus for the unprecedented growth of home health care. Such changes, coupled with the availability of new technology, have also shifted a number of inpatient surgical procedures to the outpatient setting.


What are the differences between the retrospective and prospective methods of reimbursement?

What are the differences between the retrospective and prospective methods of reimbursement?



Retrospective:


a. Reimbursement is based on actual costs incurred in the past. In other words, costs are evaluated retrospectively.

b. The total reimbursement is directly related to length of stay, services rendered, and the cost of providing the services.

c. Providers have an incentive to increase costs and not be sensitive to the need for efficiency and cost containment in the delivery of services.

d. Cost increases generally become essential for maximizing reimbursement and profits.



Prospective:


a. Certain preestablished criteria, not costs, are used to determine in advance the amount of reimbursement.

b. Reimbursement is related to resource inputs.

c. Because of the fixed reimbursement, providers have an incentive to reduce costs and provide services more efficiently

d. Cost increases generally lead to a loss to be absorbed by the provider.


How does the Supreme Court ruling on the ACA affect Medicaid? How does the ACA affect the program?

How does the Supreme Court ruling on the ACA affect Medicaid? How does the ACA affect the program?



The ACA had authorized the DHHS to withhold the federal share of financing as a penalty for states that refused to expand Medicaid. The US Supreme Court struck down this mandate. Consequently, states now had a choice to either expand or not expand their Medicaid programs without any penalty from the federal government. 


The ACA requires coverage for legal residents under the age of 65 with income up to 138% of the FPL. States can no longer use the assets test. Federal matching will be provided at 100% for newly eligible individuals for 3 years (2014-2016), with a gradual reduction each year to 90% in 2020. Beneficiaries who were already in the Medicaid program, coverage for preventive services is at the discretion of the state. States have the option to establish Health Homes (not to be confused with home health care) for Medicaid beneficiaries who have chronic conditions, including serious and persistent mental health conditions.

What are Medicare trust funds? Discuss the current state and the future challenges faced by the Medicare trust funds. What main factors pose these challenges?

What are Medicare trust funds? Discuss the current state and the future challenges faced by the Medicare trust funds. What main factors pose these challenges?



Answer: The HI trust fund provides the money pool for Part A services, and the SMI trust fund provides the money pool for Parts B and D. Each trust fund accounts for incomes and expenditures.

Briefly describe the Medicare Advantage program.

Briefly describe the Medicare Advantage program.



Answer: Medicare Advantage is also called Part C, but it does not add specifically-defined new services. It merely provides some additional choices of health plans with the objective of channeling a greater number of beneficiaries into managed care plans


What is Medicare Part A? Discuss the financing and cost-sharing features of Medicare Part A. What benefits does Part A cover? What benefits are not covered?

What is Medicare Part A? Discuss the financing and cost-sharing features of Medicare Part A. What benefits does Part A cover? What benefits are not covered?



Part A, the hospital insurance (HI) portion of Medicare, is financed by special payroll taxes collected for Social Security

Part A covers hospital inpatient services, care in a skilled nursing facility (SNF), home health visits, and hospice care.

The noncovered services are long-term care

custodial services, and personal convenience services

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