Nokea
Which drug should not be used to control secondary hypertension in a sexually active adolescent female who uses intermittent birth control?
- A. Beta blockers
- B. Calcium channel blockers
- C. ACE inhibitors
- D. Diuretics
Correct Answer: C
Rationale: ACE inhibitors and angiotensin II receptor blockers are teratogenic and should be avoided in sexually active adolescents using birth control.
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Cristina, a mother of a 4-year-old child tells the nurse that her child is a very poor eater. What’s the nurse’s best recommendation for helping the mother increase her child’s nutritional intake?
- A. Allow the child to feed herself
- B. Use specially designed dishes for children – for example, a plate with the child’s favorite cartoon character
- C. Only serve the child’s favorite foods
- D. Allow the child to eat at a small table and chair by herself
Correct Answer: A
Rationale: Allowing the child to feed herself promotes independence and may increase interest in eating.
Regarding cafe-au-lait spots:
- A. They can be normal findings
- B. They are found in tuberous sclerosis
- C. When present in a child, > 4 spots each > 0.5 cm, is diagnostic of neurofibromatosis type II
- D. Typical appearance in neurofibromatosis is of a smooth border
Correct Answer: A
Rationale: Cafe-au-lait spots can be a normal variant and do not always indicate an underlying pathology.
The following statements are true:
- A. Unexplained vaginal discharge in a 3-year-old might be a sign of sexual abuse
- B. Spiral fracture of femur is always non-accidental
- C. Retinal bleeding in a 3-month-old unconscious baby is a sign of 'shaken baby' syndrome
- D. Bruises on the elbows and knees in a 4-year-old are suggestive of physical abuse
Correct Answer: C
Rationale: Retinal bleeding in a 3-month-old unconscious baby is a sign of 'shaken baby' syndrome: Retinal bleeding in infants, especially with other signs of physical abuse, is a key indicator of 'shaken baby' syndrome.
A 12-year-old male tries out for a middle school hockey team. He has a history of a heart murmur as an infant, but the doctor thought it would go away. During the tryout, he experiences severe dyspnea and becomes light-headed. At your office, he has a normal rhythm, pulse, and blood pressure and is no longer dizzy. There is a grade 4/6 systole ejection murmur that radiates to the neck. There is also an ejection click. An ECG reveals left ventricular hypertrophy. The next approach to his management includes
- A. chest x-ray
- B. exercise test
- C. digitalization
- D. echocardiography
Correct Answer: D
Rationale: Echocardiography is essential to evaluate the severity of aortic stenosis and its effects on the heart.
A 16-year-old being treated for hypertension has laboratory values of: Hemoglobin: 16 g/dL Hematocrit: 43% Sodium: 139 mEq/L Potassium: 4.4 mEq/L Total cholesterol: 220 mg/dL Which drug does the nurse suspect the patient takes based on the total cholesterol?
- A. Beta blockers
- B. Calcium channel blockers
- C. ACE inhibitors
- D. Diuretics
Correct Answer: A
Rationale: Beta blockers are used with caution in patients with hyperlipidemia, hyperglycemia, and impotence.