Nokea
The septum of the nasal cavity is innervated by
- A. Nasopalatine nerve from cranial nerve V2
- B. Posterior ethmoidal nerve from V1
- C. Greater palatine nerve from V2
- D. Lesser palatine nerve from V2
Correct Answer: A
Rationale: The nasopalatine nerve, a branch of the maxillary division (V2) of the trigeminal nerve, supplies sensation to the nasal septum. It is important in nasal surgeries and anesthesia.
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You are caring for a patient who has just had open carpal tunnel release surgery. The surgeon has requested that the patient's hand and arm remain elevated above the level of the heart after the surgery. This is to
- A. Reduce lymphatic drainage.
- B. Reduce postoperative swelling.
- C. Restrict hand movements.
- D. Decrease possibility of nosocomial infection.
Correct Answer: B
Rationale: Elevation reduces swelling by improving venous and lymphatic return.
The nurse practitioner is assessing an adult patient with a seizure disorder that is well controlled on phenytoin (Dilantin). What new finding indicates that a phenytoin drug level assessment is needed?
- A. Hypertrophic gums
- B. Vitamin D supplements
- C. BP 125/78 mmHg and pulse 95 bpm
- D. Flat affect and anxiety
Correct Answer: D
Rationale: The correct answer is D because a flat affect and anxiety can indicate potential phenytoin toxicity, which warrants a drug level assessment. Phenytoin toxicity can manifest as neurological symptoms such as mood changes and cognitive impairment. Options A and B are unrelated to phenytoin levels. Option C indicates normal vital signs and is not a specific indicator of phenytoin toxicity.
A husband visiting his wife in the hospital suddenly becomes confused and has difficulty with speech and starts slurring his words. The physician caring for his wife recognizes this as a cerebrovascular accident. What would you expect the physician to do?
- A. Administer TPA since this is within 3 hours of the CVS.
- B. Assess if the husband had an ischemic or hemorrhagic CVS.
- C. Tell the husband to go home, get rest, and to call the physician in the morning if the symptoms continue.
- D. Admit the husband and place him on bed rest.
Correct Answer: B
Rationale: It's critical to determine the type of stroke (ischemic or hemorrhagic) before treatment.
The x-ray shows that the patient's fracture is at the remodeling stage. What characteristics of the fracture healing process are happening at this stage (select one that doesn't apply)?
- A. Radiologic union
- B. Absorption of excess cells
- C. Return to preinjury strength and shape
- D. Semisolid blood clot at the ends of fragments
Correct Answer: D
Rationale: During the remodeling stage, radiologic union occurs, excess cells are absorbed, and the bone returns to its preinjury strength and shape.
A previously healthy 26-year-old male is brought to the emergency department due to muscle weakness. He reports mild weakness in his legs that has progressively worsened over a few days to the point that he can barely move his legs. He has some numbness in his legs and his arms feel weak. He has recently recovered from a respiratory infection. 1/5 muscle strength is noted throughout the lower extremities, as well as absent patellar and ankle reflexes. 3 to 4-/5 muscle strength is appreciated throughout his upper extremities. A lumbar puncture is performed, which shows the following: Cell count: 4 cells/mm3, Glucose: 67 mg/dL, Protein: 187 mg/dL Gram stain: no organisms Spirometry is performed, which shows a forced vital capacity of 0.85 L. Which of the following is the best next step in management?
- A. Intravenous (IV) immunoglobulin
- B. Intubation
- C. IV corticosteroids
- D. Immunomodulating agent
Correct Answer: B
Rationale: The patient's presentation of rapidly progressive weakness, areflexia, and elevated cerebrospinal fluid protein with normal cell count (albuminocytologic dissociation) is classic for Guillain-Barre syndrome (GBS). The forced vital capacity of 0.85 L indicates respiratory failure, necessitating immediate intubation to protect the airway and provide mechanical ventilation. Intravenous immunoglobulin and plasma exchange are treatments for GBS but are secondary to securing the airway in this critically ill patient.