Nokea
During admission, 82-year-old Mr. Robeson is brought to the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client's daughter best supports the diagnosis?
- A. "Maybe it's just caused by aging. This usually happens by age 82."
- B. "The changes in his behavior came on so quickly! I wasn't sure what was happening."
- C. "Dad just didn't seem to know what he was doing. He would forget what he had for breakfast."
- D. "Dad has always been so independent. He's lived alone for years since mom died."
Correct Answer: B
Rationale: The correct answer is B because sudden onset of behavioral changes is a typical symptom of delirium. Delirium is characterized by an acute and fluctuating disturbance in attention, awareness, and cognition. Choice A is incorrect because delirium is not a normal part of aging. Choice C describes memory issues, which can be seen in delirium but are less specific than sudden behavioral changes. Choice D, while it mentions the patient's independence, does not directly support the diagnosis of delirium.
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In which patient is alpha-1 antitrypsin deficiency the likely cause of chronic obstructive pulmonary disease?
- A. A 30-year-old who has smoked for 3 years
- B. A 65-year-old man who worked as a taxi driver most of his life
- C. A 70-year-old woman who smoked for 40 years
- D. A 50-year-old with exposure to secondhand smoke
Correct Answer: A
Rationale: The correct answer is A. Alpha-1 antitrypsin deficiency is a genetic condition that can lead to COPD at a young age, even in light smokers. Choice B is less likely as the patient's occupation does not directly correlate with alpha-1 antitrypsin deficiency. Choice C, a 70-year-old woman with a long smoking history, is more likely to have COPD due to smoking rather than alpha-1 antitrypsin deficiency. Choice D, exposure to secondhand smoke, is not a common cause of alpha-1 antitrypsin deficiency-related COPD.
Abrupt withdrawal or discontinuation of prednisone can cause:
- A. adrenal crisis.
- B. hypercortisolism.
- C. ACTH stimulation.
- D. thyroid crisis.
Correct Answer: A
Rationale: The correct answer is A: adrenal crisis. Abrupt discontinuation of prednisone can lead to adrenal insufficiency, resulting in adrenal crisis. Prednisone is a corticosteroid that suppresses the adrenal glands' ability to produce cortisol. Abrupt withdrawal can cause a sudden drop in cortisol levels, leading to adrenal crisis with symptoms like fatigue, weakness, abdominal pain, and potentially life-threatening low blood pressure. Choices B, C, and D are incorrect because hypercortisolism refers to excess cortisol levels, ACTH stimulation would not result from prednisone withdrawal, and thyroid crisis is not directly related to corticosteroid discontinuation.
A 30-year-old woman presents with joint pain, a malar rash, and photosensitivity. Which of the following is the most likely diagnosis?
- A. Rheumatoid arthritis
- B. Systemic lupus erythematosus
- C. Psoriatic arthritis
- D. Dermatomyositis
Correct Answer: B
Rationale: The correct answer is B: Systemic lupus erythematosus. Joint pain, a malar rash, and photosensitivity are classic symptoms of systemic lupus erythematosus. Choice A, Rheumatoid arthritis, is incorrect as it typically presents with symmetric joint involvement and morning stiffness. Psoriatic arthritis (Choice C) is characterized by joint pain associated with psoriasis, which is not described in the case. Dermatomyositis (Choice D) presents with muscle weakness, skin rash, and elevated muscle enzymes, different from the symptoms presented in the case.
Which of the following findings is commonly associated with congestive heart failure?
- A. Decreased jugular venous pressure
- B. Pulmonary edema
- C. Hyperactive bowel sounds
- D. Weight loss
Correct Answer: B
Rationale: Pulmonary edema is a common finding in congestive heart failure. In congestive heart failure, the heart is unable to pump effectively, leading to fluid buildup in the lungs, causing pulmonary edema. This results in symptoms like shortness of breath, coughing, and wheezing. Choices A, C, and D are not typically associated with congestive heart failure. Jugular venous pressure is often elevated, not decreased in heart failure. Hyperactive bowel sounds and weight loss are not specific findings for congestive heart failure.
A patient presents with a sudden onset of severe chest pain radiating to his back. His blood pressure is significantly higher in the right arm than in the left arm. Which of the following conditions is most likely?
- A. Acute myocardial infarction
- B. Pulmonary embolism
- C. Aortic dissection
- D. Pericarditis
Correct Answer: C
Rationale: The correct answer is C, aortic dissection. Aortic dissection is characterized by sudden, severe chest pain that can radiate to the back. The discrepancy in blood pressure between the arms (higher in the right arm) is known as a 'pulse deficit' and is a classic finding in aortic dissection. This condition involves a tear in the inner layer of the aorta, leading to the abnormal flow of blood within the aortic wall. Acute myocardial infarction (choice A) presents with chest pain but typically does not cause discrepancies in blood pressure between arms. Pulmonary embolism (choice B) usually presents with chest pain and difficulty breathing but does not cause unequal blood pressures in the arms. Pericarditis (choice D) can cause chest pain exacerbated by breathing or lying down, but it does not typically lead to differences in blood pressure between arms.