Nokea
Which of the following findings could indicate a need for further evaluation of the cardiac patient?
- A. Hematocrit 42%
- B. Potassium 4.2 mg/dl
- C. Sodium 140 mEq/dl
- D. Low-density lipoprotein of 190 mg/dl
Correct Answer: D
Rationale: LDL levels over 160 mg/dl warrant further evaluation for cardiovascular risk.
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Several years later, Mr. Hunter, who is now 75 years old, seeks additional intervention for his urinary symptoms that have progressed further. He now experiences slow urinary stream, hesitancy, straining, and a feeling of incomplete emptying in addition to the previous urinary urgency and frequency. At times, he has noted blood in his urine. He has had five urinary tract infections (UTIs) in the past 2 years. His current IPSS is 24, with a bother score of 5 indicating severe voiding symptoms with high impact on his quality of life. Mr. Hunter’s updated medical history includes hypertension, coronary artery disease, benign prostatic hyperplasia, cataract surgery 4 years ago, and two falls within the past year while rushing to the bathroom during the night. Current medications are aspirin, metoprolol, finasteride, and tamsulosin. Physical examination reveals an enlarged, nontender prostate, about 50 g in size without discrete nodules. Upon further evaluation, the intermittent hematuria is attributed to BPH. Postvoid residual volume is 110 mL. Uroflowmetry reveals urinary flow rate of 12 mL/s. Which of the following is the best next step in management?
- A. Start tadalafil.
- B. Switch from tamsulosin to silodosin.
- C. Switch from finasteride to dutasteride.
- D. Perform surgical resection of prostate.
Correct Answer: D
Rationale: Given the severity of his symptoms and the failure of medical therapy, surgical resection of the prostate is the best option.
When interpreting a complete blood count (CBC) lab report, which of the following results describes the size of the RBCs?
- A. Hemoglobin
- B. Mean corpuscular volume (MCV)
- C. Red cell distribution width (RDW)
- D. Hematocrit
Correct Answer: B
Rationale: MCV measures the average size of red blood cells.
The nurse practitioner palpates an enlarged right epitrochlear lymph node in a 30-year-old patient. The Nurse Practitioner should assess the patient's:
- A. Throat, face, and right ear
- B. Neck and supraclavicular region
- C. Right forearm and hand
- D. Right groin and abdomen
Correct Answer: C
Rationale: Enlarged epitrochlear nodes are associated with infections or conditions in the hand or forearm.
Explain why late inspiratory crackles in the lower third of the chest are indicative of heart failure rather than other respiratory conditions.
- A. They indicate airway obstruction typical of asthma.
- B. They suggest fluid accumulation in the alveoli due to heart failure.
- C. They are a sign of chronic bronchial inflammation.
- D. They are associated with hyperinflation of the lungs in COPD.
Correct Answer: B
Rationale: Late inspiratory crackles indicate fluid in the alveoli, a hallmark of heart failure.
The nurse is assessing a client with diabetes and notes that the client has a strong odor of acetone on their breath. What action should the nurse take next?
- A. Check the client’s blood glucose level.
- B. Offer the client a glass of water.
- C. Assess the client's urine for signs of infection.
- D. Administer insulin immediately.
Correct Answer: A
Rationale: The acetone odor on the breath is a sign of ketosis, which may indicate that the client’s blood glucose is elevated. Immediate blood glucose monitoring is needed.