Nokea
A 72-year-old man with colonic diverticulosis was admitted to the hospital with gastrointestinal bleeding and abdominal pain. The following day, the patient was positive on the Confusion Assessment Method (CAM) performed by geriatric consultation services. Which of the following is NOT predisposed by delirium in this patient?
- A. Higher risk of institutionalization
- B. Increased risk of dementia
- C. Shorter length of stay in the hospital
- D. Increased mortality
Correct Answer: C
Rationale: Delirium is associated with increased mortality and risk of dementia, but it generally leads to longer hospital stays.
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A 40-year-old admits to multiple sex partners and presents with several lesions over his body. Findings reveal hemorrhagic vesiculopustular lesions over the hands and feet. These lesions are most likely associated with:
- A. Gonococcemia
- B. Infective endocarditis
- C. Hyperthyroidism
- D. Peripheral vascular disease
Correct Answer: A
Rationale: Hemorrhagic vesiculopustular lesions, particularly on the hands and feet, are associated with gonococcemia.
The remission rate of depressed patients who are 65 years and older to initial antidepressant treatment is:
- A. 30%
- B. 40%
- C. 70%
- D. 80%
Correct Answer: C
Rationale: Older adults have a higher remission rate from antidepressant treatment compared to younger populations.
Which immunization reduces a patient’s risk for infection with the virus that causes painful localized blistering rash?
- A. Smallpox vaccine
- B. Varicella vaccine (chicken pox)
- C. Shingles (herpes zoster) vaccine
- D. Meningococcal vaccine
Correct Answer: C
Rationale: Shingles vaccine reduces the risk of herpes zoster, which causes painful rash.
A patient calls the nurse practitioner and states that he missed his morning daily dose of warfarin, 5 mg, yesterday and today. The nurse practitioner instructs the patient to:
- A. Wait until tomorrow and resume daily dosing of warfarin 5 mg
- B. Take warfarin 10 mg now
- C. Take warfarin 5 mg now, warfarin 5 mg at 5 pm today, and resume the daily warfarin 5 mg dose in the morning as scheduled
- D. Take warfarin 5 mg now and resume the warfarin 5 mg daily dose in the morning as scheduled
Correct Answer: D
Rationale: The patient should resume the usual warfarin dose and avoid doubling it.
Explain why late inspiratory crackles in the lower third of the chest are indicative of heart failure rather than other respiratory conditions.
- A. They indicate airway obstruction typical of asthma.
- B. They suggest fluid accumulation in the alveoli due to heart failure.
- C. They are a sign of chronic bronchial inflammation.
- D. They are associated with hyperinflation of the lungs in COPD.
Correct Answer: B
Rationale: Late inspiratory crackles indicate fluid in the alveoli, a hallmark of heart failure.