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What is an appropriate step in the initial management of the seven patients receiving atypical antipsychotics?
- A. No action is necessary, because one potential indication for atypical antipsychotic use is refractory behavioral disturbance in persons with significant dementia.
- B. Taper to discontinue the atypical antipsychotic; after a 2-week washout, begin therapy with zolpidem.
- C. Taper to discontinue the atypical antipsychotic, and create day programs that allow patients to develop a sleep deficit/need through the morning/afternoon/early evening.
- D. Start modafinil or a similar short-acting stimulant to minimize daytime sleepiness.
Correct Answer: C
Rationale: Creating day programs that help establish a sleep deficit and discontinuing antipsychotics is appropriate for managing the patients’ sleep issues.
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Children born with Down syndrome often have other anomalies. They especially require evaluation of what body system?
- A. Orthopedic
- B. Gastrointestinal
- C. Cardiac
- D. Endocrine
Correct Answer: C
Rationale: Children with Down syndrome often have congenital heart defects.
During an acute attack of gout, the nurse practitioner knows NOT to prescribe:
- A. Colchicine (Colcrys)
- B. Allopurinol (Zyloprim)
- C. Steroids
- D. NSAIDs
Correct Answer: B
Rationale: Allopurinol should not be used during an acute gout attack as it may worsen symptoms.
Joyce Mitchell is a 73-year-old frail female with a history of frequent falls, presenting with nausea, vomiting, sweating, and horizontal nystagmus. She is diagnosed with vestibular neuritis. What is the best initial course of treatment?
- A. Vestibular rehabilitation
- B. Supportive care with anti-nausea and anti-vertigo medication
- C. Fluids
- D. Epley maneuver
Correct Answer: B
Rationale: Supportive care with anti-nausea and anti-vertigo medication is appropriate for vestibular neuritis.
On examination, a patient is noted to have a "mask-like" face with decreased blinking and a characteristic stare. These features may be characteristic of:
- A. Nephrotic syndrome
- B. Myxedema
- C. Cushing’s syndrome
- D. Parkinson disease
Correct Answer: D
Rationale: A "mask-like" face is a classic feature of Parkinson’s disease.
A patient presents with an elongated head with bony prominence of the forehead, nose, and lower jaw. These facial features could be suggestive of:
- A. Nephrotic syndrome
- B. Acromegaly
- C. Cushing’s syndrome
- D. Parkinson’s disease
Correct Answer: B
Rationale: Acromegaly is characterized by enlargement of bones and soft tissues, leading to features like a prominent jaw and forehead.