The medication that blocks the transportation of glucose across the intestines into the bloodstream to target prandial blood glucose is:
- A. Metformin (Glucophage XR)
- B. Acarbose (Precose)
- C. Rosiglitazone (Avandia)
- D. Glipizide (Glucotrol XL)
Correct Answer: B
Rationale: The correct answer is B: Acarbose (Precose). Acarbose is an alpha-glucosidase inhibitor that blocks the breakdown of carbohydrates into glucose in the intestines, reducing glucose absorption and lowering postprandial blood glucose levels. Metformin (A) works by decreasing glucose production in the liver. Rosiglitazone (C) is a thiazolidinedione that improves insulin sensitivity. Glipizide (D) is a sulfonylurea that stimulates insulin release from the pancreas. Acarbose specifically targets postprandial blood glucose by blocking glucose absorption in the intestines.
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What is the most common cause of erectile dysfunction in older men?
- A. Psychological stress
- B. Adverse drug reaction
- C. Atherosclerosis
- D. Autonomic neuropathy
Correct Answer: C
Rationale: The correct answer is C: Atherosclerosis. Atherosclerosis is the most common cause of erectile dysfunction in older men as it leads to reduced blood flow to the penis, affecting the ability to achieve and maintain an erection. Psychological stress (A) can contribute to erectile dysfunction but is not the primary cause. Adverse drug reactions (B) can also lead to erectile dysfunction, but it is not as common as atherosclerosis. Autonomic neuropathy (D) can affect nerve impulses in the penis but is not as prevalent as atherosclerosis in causing erectile dysfunction in older men.
The nurse is teaching an older client with hypertension about lifestyle changes. Which of the following is most effective in managing high blood pressure?
- A. Reducing sodium intake
- B. Increasing intake of fatty foods
- C. Limiting physical activity
- D. Reducing fiber in the diet
Correct Answer: A
Rationale: The correct answer is A: Reducing sodium intake. High sodium intake can lead to fluid retention and increased blood pressure. By reducing sodium intake, blood pressure can be effectively managed. Increasing intake of fatty foods (B) can contribute to heart disease and worsen hypertension. Limiting physical activity (C) can lead to weight gain and higher blood pressure. Reducing fiber in the diet (D) can negatively impact overall health and increase the risk of hypertension.
The most appropriate medication indicated for reversing the anticoagulated effects of dabigatran etexilate (Pradaxa) is:
- A. Idarucizumab (Praxbind)
- B. Vitamin K
- C. Protamine sulfate
- D. Fondaparinux (Arixtra)
Correct Answer: A
Rationale: Step-by-step rationale:
1. Idarucizumab is a specific reversal agent for dabigatran, directly binding to dabigatran to neutralize its anticoagulant effects.
2. Vitamin K is ineffective for dabigatran reversal, as it mainly works on reversing the effects of vitamin K antagonist anticoagulants like warfarin.
3. Protamine sulfate is used for heparin reversal, not for direct thrombin inhibitor reversal like dabigatran.
4. Fondaparinux is a factor Xa inhibitor and not effective for reversing the effects of dabigatran.
A 19-year-old college student, Todd, is brought to your clinic by his mother. She is concerned that there is something seriously wrong with him. She states for the past 6 months his behavior has become peculiar and he has flunked out of college. Todd denies any recent illness or injuries. His past medical history is remarkable only for a broken foot. His parents are both healthy. He has a paternal uncle who had similar symptoms in college. The patient admits to smoking cigarettes and drinking alcohol. He also admits to marijuana use but none in the last week. He denies using any other substances. He denies any feelings of depression or anxiety. While speaking with Todd and his mother you do a complete physical examination, which is essentially normal. When you question him on how he is feeling, he says that he is very worried that Microsoft has stolen his software for creating a better browser. He tells you he has seen a black van in his neighborhood at night and he is sure that it is full of computer tech workers stealing his work through special gamma waves. You ask him why he believes they are trying to steal his programs. He replies that the technicians have been telepathing their intents directly into his head. He says he hears these conversations at night so he knows this is happening. Todd's mother then tells you, "See, I told you . . . he's crazy. What do I do about it?" While arranging for a psychiatry consult, what psychotic disorder do you think Todd has?
- A. Schizoaffective disorder
- B. Psychotic disorder due to a medical illness
- C. Substance-induced psychotic disorder
- D. Schizophrenia
Correct Answer: D
Rationale: The correct answer is D: Schizophrenia. Todd presents with a history of peculiar behavior, academic decline, paranoid delusions, and auditory hallucinations. These are classic symptoms of schizophrenia, a chronic and severe mental disorder. Schizoaffective disorder (A) involves a mix of schizophrenia symptoms and mood disturbances, but Todd does not exhibit significant mood symptoms. Psychotic disorder due to a medical illness (B) would require evidence of a medical condition causing Todd's symptoms, which is not present. Substance-induced psychotic disorder (C) would require Todd's symptoms to be solely due to substance use, but his symptoms persist despite marijuana abstinence. Therefore, based on Todd's symptoms and history, the most likely diagnosis is schizophrenia.
Which lesion is dark, raised, and asymmetric with an irregular border?
- A. Nevus
- B. Actinic keratosis
- C. Keratoacanthoma
- D. Melanoma
Correct Answer: D
Rationale: The correct answer is D, Melanoma. Melanoma is a type of skin cancer that typically presents as a dark, raised lesion with an irregular border and asymmetry. This is due to the abnormal growth of melanocytes, the pigment-producing cells in the skin. Nevus (A) is a common mole that is usually symmetrical and has a regular border. Actinic keratosis (B) is a precancerous lesion that is typically rough and scaly, not dark or raised. Keratoacanthoma (C) is a low-grade skin cancer that often appears as a dome-shaped lesion with a central crater, not necessarily dark or asymmetric.