Nokea
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.
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Racial disparities have been a part of US healthcare for many decades. How might this impact the expectations of older Black Americans?
- A. Reluctance to participate in medical research because of unethical studies in the past
- B. Underrepresentation of Black physicians in the geriatric workforce
- C. Cumulative effects of differences in access to healthcare providers
- D. All of these
Correct Answer: D
Rationale: The correct answer is D because each of the choices addresses a different aspect of how racial disparities in healthcare can impact the expectations of older Black Americans. A is correct because unethical studies in the past can lead to reluctance to participate in medical research. B is correct because the underrepresentation of Black physicians may affect the quality of care older Black Americans receive. C is correct because differences in access to healthcare providers can result in cumulative negative effects on health outcomes for older Black Americans. Therefore, the combination of these factors can significantly impact the expectations and experiences of older Black Americans in healthcare.
Which of the following drug classes is not indicated for the treatment of depression?
- A. Buspirone (Buspar)
- B. Selective Serotonin Reuptake Inhibitor (SSRI)
- C. Tricyclic antidepressant (TCA)
- D. Bupropion (Wellbutrin)
Correct Answer: A
Rationale: The correct answer is A: Buspirone (Buspar). Buspirone is not indicated for the treatment of depression; it is primarily used to treat anxiety disorders. SSRIs and TCAs are commonly prescribed for depression due to their ability to increase serotonin levels. Bupropion is an atypical antidepressant that works on norepinephrine and dopamine, making it a suitable option for depression treatment. Buspirone's mechanism of action differs from antidepressants, focusing on serotonin and dopamine receptors rather than directly targeting depression symptoms. Therefore, Buspirone is not a recommended drug class for depression treatment.
The nurse is caring for a client with dementia. Which intervention is most likely to reduce agitation in this client?
- A. Provide a calm environment with minimal stimulation.
- B. Increase social activities to promote interaction.
- C. Encourage frequent visitors to engage with the client.
- D. Provide a variety of activities to keep the client busy.
Correct Answer: A
Rationale: The correct answer is A: Provide a calm environment with minimal stimulation. This intervention is most likely to reduce agitation in a client with dementia because excessive stimulation can overwhelm and confuse them, leading to increased agitation. By creating a calm environment with minimal stimuli, the client can feel more relaxed and less agitated.
Summary:
B: Increasing social activities may actually worsen agitation as it can be overwhelming for a client with dementia.
C: While social engagement is important, too many visitors can increase agitation.
D: Providing a variety of activities may lead to confusion and frustration instead of reducing agitation.
A 12-year-old presents to the clinic with his father for evaluation of a painful lump in the left eye. It started this morning. He denies any trauma or injury. There is no visual disturbance. Upon physical examination, there is a red raised area at the margin of the eyelid that is tender to palpation; no tearing occurs with palpation of the lesion. Based on this description, what is the most likely diagnosis?
- A. Dacryocystitis
- B. Chalazion
- C. Hordeolum
- D. Xanthelasma
Correct Answer: C
Rationale: The correct answer is C: Hordeolum. A hordeolum, also known as a stye, presents as a red raised tender area at the margin of the eyelid. In this case, the absence of tearing upon palpation of the lesion suggests it is localized to the eyelid itself. Dacryocystitis (choice A) involves the lacrimal sac and would present with tearing. A chalazion (choice B) is a painless nodule on the eyelid, unlike the tender lesion described here. Xanthelasma (choice D) is characterized by yellowish plaques on the eyelids, not a red raised tender area.
A 37-year-old nurse comes for evaluation of colicky right upper quadrant abdominal pain. The pain is associated with nausea and vomiting and occurs 1 to 2 hours after eating greasy foods. Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?
- A. Abdomen is soft, nontender, and nondistended, without hepatosplenomegaly or masses.
- B. Abdomen is soft and tender to palpation in the right lower quadrant, without rebound or guarding.
- C. Abdomen is soft and tender to palpation in the right upper quadrant with inspiration, to the point of stopping inspiration, and there is no rebound or guarding.
- D. Abdomen is soft and tender to palpation in the mid-epigastric area, without rebound or guarding.
Correct Answer: C
Rationale: The correct answer is C because tenderness in the right upper quadrant with inspiration points towards Murphy's sign, indicative of cholecystitis. This sign is elicited by palpating the right upper quadrant while the patient takes a deep breath. This maneuver causes the gallbladder to descend and come into contact with the inflamed peritoneum, reproducing pain and halting inspiration. Choices A, B, and D do not describe physical examination findings specific to cholecystitis such as Murphy's sign or tenderness in the right upper quadrant with inspiration. Therefore, they are incorrect.