Nokea
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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Examination of the hair reveals a fine silky appearance. This finding may be seen in patients that have:
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Type 2 diabetes
- D. Celiac disease
Correct Answer: B
Rationale: Hyperthyroidism can lead to fine, silky hair due to the effects of thyroid hormones.
What specific part of the eye is primarily examined using an ophthalmoscope?
- A. Cornea
- B. Lens
- C. Retina
- D. Iris
Correct Answer: C
Rationale: An ophthalmoscope is used to examine the retina, which includes the optic disc and blood vessels.
When assessing a patient's condition, which of the following scenarios would be considered critical trauma?
- A. An elderly woman has fallen and has broken her collarbone.
- B. A 32-year-old man has cut his hand with a kitchen knife.
- C. A child has sustained a fracture of his femur.
- D. A teenager has fallen from a height of greater than 20 feet.
Correct Answer: D
Rationale: A fall from a height greater than 20 feet is considered critical trauma.
Lenore White is an 80-year-old woman who smokes two packs of cigarettes per day. What two ethical principles are in conflict?
- A. Beneficence and community
- B. Nonmaleficence and justice
- C. Autonomy and justice
- D. Autonomy and nonmaleficence
Correct Answer: D
Rationale: The nurse faces a dilemma between respecting autonomy (the patient’s choice to smoke) and preventing harm (nonmaleficence).
A 78-year-old man has an emergency partial colectomy for lower gastrointestinal bleeding. A localized colonic adenocarcinoma is completely resected. The surgeon did not dissect lymph nodes for metastatic sampling. The patient wants to know if he should have chemotherapy. Should he?
- A. Yes because without knowing his complete staging it would be safer.
- B. No because he can be followed with serial carcinoembryonic antigens and CT scans.
- C. Yes because the severe bleeding indicates advanced disease.
- D. No because he is too old and will not likely have any problems during his lifetime.
Correct Answer: B
Rationale: Follow-up with serial carcinoembryonic antigens and CT scans is appropriate after resection of localized disease.