Question 1

Panic disorders may be associated with abnormal activation in which part of the human brain?

Accepted Answer

Panic disorders are associated with abnormal activation in Amygdala that forms part of the human brain. The amygdala has been shown to respond to severe traumas with an un-erasable fear response in adults and children alike.

Question 2

A 45-year-old woman presents to the emergency department for evaluation of a 12 hour episode of intermittent, debilitating, postprandial right upper quadrant pain associated with nausea and occasional vomiting. The pain can last from 30 minutes to 2 hours, often radiates to the upper back between the shoulder blades, and is not associated with bowel movements or exercise. The patient is also quite jaundiced; however, she denies any fever, weight loss or night sweats. Additionally, she states she has been using antacids and H2-blockers but they have been ineffective. She denies significant alcohol use. What is the most likely diagnosis for this patient?

Accepted Answer

In a situation when the patient exhibits episode of intermittent, debilitating, postprandial right upper quadrant pain associated with nausea and occasional vomiting along with pain radiating to the upper back between the shoulder blades, the patient is likely to diagnose for Cholecystitis. The most common presenting symptom of acute Cholecystitis is upper abdominal pain, often radiating to the tip of the right scapula.

Question 3

A 47 year old man, develops symptoms of weakness in his hands, unsteady gait and inability to dorsiflex his foot. He has also developed a tremor of his extremities, slurred speech and difficulty swallowing. As the muscles of the diaphragm weaken, a respirator is needed to help with breathing. After an extensive work-up, you arrive at a diagnosis of Amyotrophic Lateral Sclerosis (ALS). He has no family history of this disease. What is the most likely additional symptom he may develop as this disease progresses?

Accepted Answer

In a situation when a patient is diagnosed of Amyotrophic Lateral Sclerosis (ALS), the patient is likely to show symptoms of inability to cough as the disease progresses. In ALS, the patient's muscles in the throat are affected, speech becomes slurred or slowed, and the patient may have difficulty swallowing and experience inability to cough.

Question 4

All of the following diagnostic tests are part of the diagnostic workup of Amyotrophic Lateral Sclerosis (ALS), except

Accepted Answer

All of the above diagnostic tests are part of the diagnostic workup of Amyotrophic Lateral Sclerosis (ALS), except Lumbar puncture. ALS is diagnosed by a thorough physical examination and a study of the patient's medical history and pattern of symptoms. While there is no specific diagnostic test for ALS, the doctor will order tests like EMG, CBC and CT scans of the brain and nervous system to rule out other causes. Lumbar puncture, also called spinal tap, is used to certain diseases of the brain and spinal cord.

Question 5

All of the following are potential causes of a Hysterectomy, except

Accepted Answer

All of the above are potential causes of a Hysterectomy, except Ectopic pregnancy.
Hysterectomy is the surgical removal of the uterus. It is used for treatment uterine, ovarian, or cervical cancer; severe endometriosis; fibroid tumors that are causing bleeding and other complications; or heavy, uncontrollable vaginal bleeding.

Question 6

A 39 year old woman has had several months' history of heavy menstrual periods. On physical exam you are able to palpate a mass on her lower abdomen. She has diagnostic testing done with a pelvic and abdominal ultrasound and is found to have large uterine fibroids. A Hysterectomy is scheduled for her. If this patient has had her ovaries removed during her Hysterectomy, to reduce the risk of heart disease and osteoporosis, what would she benefit from?

Accepted Answer

A women with several months' history of heavy menstrual periods and who have had her overies removed during her Hysterectomy to reduce the risk of heart disease and osteoporosis will benefit from Estrogen Replacement Therapy. Estrogen Replacement Therapy is a medical treatment for symptoms of menopause.

Question 7

A 47 year old man is admitted to the ICU for severe injuries as a result of a motor vehicle accident. He has lost a lot of blood and his blood pressure is 70/35. After a few hours he goes into cardiac arrest. The patient has 'DNR' orders in his medical records. But his brother who is present wants doctors to do everything they can to save him. What is the appropriate action at this time of emergency?

Accepted Answer

An appropriate action when a patient is admitted to the ICU for severe injuries and has lost lot of blood would be to NOT to resuscitate. A "Do Not Resuscitate" or DNR order is a written order from a doctor that resuscitation should not be attempted if a person suffers cardiac or respiratory arrest.

Question 8

If a patient has a DNR order, doctors and other health care providers must not do any of the following, except

Accepted Answer

If a patient has a DNR order, doctors and other health care providers must not do any of the above, except providing pain medication. If a patient has a DNR order, doctors and other health care providers can suction the airway, administer oxygen, position for comfort, splint or immobilize, control bleeding, provide pain medication, provide emotional support, and contact other appropriate health care providers.

Question 9

A 73 year old woman is brought by her husband of 45 years to you. He is quite concerned because her memory is getting worse with each passing month. She often gets lost of her way to and back from the neighborhood corner store. They have lived in the same house for decades. Recently she has become more anxious and agitated. She has a family history of these symptoms in her older sister who is now 80. What is the most likely disease she has developed?

Accepted Answer

In a situation when a patient shows signs of anxiety and agitation along with loss of memory, the patient is likely to develop disease called Dementia. Dementia is characterized by a general decline in mental ability, such as memory, language skills, judgment, and concentration.

Question 10

A 67 year old lady is diagnosed of Alzheimer's disease. All of the following medications have been used in the treatment of this disease, except

Accepted Answer

A women who has been diagnosed of Alzheimer's disease may be administered all of the above except Levadopa. Donepezil (Aricept), Galantamine (Razadyne) and Rivastigmine (Exelon) are all recommended medications for patients with Alzheimer's disease. However, Levadopa is used as a medication for treating Parkinson's disease.

Question 11

A 60 year old woman comes worried to her family physician because she has noticed a lump in her right breast during self exam at home. She states that she had felt it initially about a month ago, but it has grown in size since then. She also states that she has had some bloody discharge from nipple. On breast exam, you are able to palpate a movable lump and you notice the skin of her breast is a little dimpled. You also detect some axillary Lymphadenopathy. What is the main risk factor for developing this condition?

Accepted Answer

The main risk factor for developing the condition of breast lumps and axillary Lymphadenopathy is age over 60. Most breast cancers occur in women over 60. Although rare, men can develop breast cancer, and their risk also increases with age.

Question 12

A patient has myocardial infarction on his health records. A nurse observes that the patient suddenly develops a loud systolic murmur. What might have caused this condition?

Accepted Answer

A patient with myocardial infraction and experiencing sudden and loud systolic murmur may be experiencing this due to ruptured papillary muscle. Diagnosis of papillary muscle rupture is secondary to myocardial infarction.

Question 13

A patient with unstable angina has an Intra-aortic balloon pump (IABP) inserted. The patient's hemodynamics are: HR = 148 (sinus tachycardia); MAP = 40 mm Hg; PCWP = 25 mm Hg; CI = 1.4 L/min/m2. Which of the following should be included in this patient's plan of care?

Accepted Answer

A patient with unstable agina who has been inserted an Intra-aortic balloon pump, needs to be checked for timing of the IABP by decreasing balloon to 1:2 frequency. This procedure forms part of the plan of care for patients with IABP inserted.

Question 14

As a nurse, you must be aware of the visiting policy of the health care center. What would you do if the family of a critically ill patient wishes to spend the night, which is contrary to visiting policy?

Accepted Answer

If the family of a critically ill patient wishes to spend the night, which is contrary to visiting policy, the nurse's best action would be to allow one or two family members to stay, then evaluate the patient's response.

Question 15

Members of the nursing staff need to develop written patient education materials for a group of patients with diverse reading abilities. What would be the most effective for the staff to do?

Accepted Answer

When members of the nursing staff develop written patient education materials for a group of patients with diverse reading abilities, they should try to write the material at a fourth-grade reading level. In general, all medical educational materials for patients are meant to be simple, clear and understandable by patients of all ages.

Question 16

A 50-year-old patient who is 72 hours post-operative repair of a ruptured abdominal aortic aneurysm suddenly becomes dyspneic and his respiratory rate increases from 24 to 40/min. An arterial blood gas sample obtained while the patient is receiving oxygen via a nasal cannula at 6L/min reveals pH of 7.50, pCO2 of 31 and pO2 of 48. A chest x-ray is obtained and a "ground-glass-like appearance" is reported. Auscultation of the lungs reveals basilar rales that were not previously present. On the basis of this information, the nurse should suspect that the patient has developed

Accepted Answer

A patient with 72 hours post-operative repair of a ruptured abdominal aortic aneurysm and who has become dyspneic with increased respiratory rate increases from 24 to 40/min is likely to develop Acute Respiratory Distress Syndrome (ARDS). ARDS is a severe lung disease characterized by inflammation of the lung parenchyma leading to impaired gas exchange with concomitant systemic release of inflammatory mediators causing inflammation, hypoxemia and frequently resulting in multiple organ failure. This condition is often fatal, usually requiring mechanical ventilation and admission to an intensive care unit. A less severe form is called acute lung injury (ALI).

Question 17

Even though a nursing staff is resists, she is being assigned to a disruptive patient. What would be an appropriate resolution to this situation?

Accepted Answer

In case a nursing staff resists to be assigned to a disruptive patient, the best way to handle the situation would be to hold a nursing team conference to discuss possible alternatives.

Question 18

A 36-year-old obese male is one day post-gastroplasty. He has a sudden onset of restlessness, dyspnea, and chest pain. His heart rate is 122/min., and auscultation of heart sound reveals an increased intensity of a pulmonary S2. The nurse should expect which of the following to confirm the patient's diagnosis?

Accepted Answer

For a patient who has undergone gastroplasty and is experiencing sudden onset of restlessness, dyspnea and chest pain including high heard rate, the nurse should expect pulmonary radioisotope scan to confirm patient's diagnosis. A pulmonary radioisotope scan uses inhaled and injected radioactive material (radioisotopes) to measure breathing (ventilation) and circulation (perfusion) in all areas of the lungs.

Question 19

What is the neurotransmitter that is found to be in low levels in patients with Alzheimer's disease?

Accepted Answer

The neurotransmitter that is found to be in low levels in patients with Alzheimer's disease is Acetylcholine. Alzheimer's disease changes the brain in many ways. One of the changes results in a decrease in the levels of acetylcholine, a chemical messenger that's believed to be important for alertness, memory, thought and judgment. Cholinesterase inhibitors are a type of drug that improves the effectiveness of acetylcholine either by increasing the amount of it in the brain or by enhancing nerve cells' response to it.

Question 20

A 62 year old man comes to the ER complaining of severe pain located in his mid abdominal area. He does have a history of smoking and his past medical history includes hypertension for which he takes metoprolol, hydrochlorothiazide and hyperlipidemia for which he takes vytorin. He states that the pain came on suddenly, is excruciating and travels to his back. His vitals at this time are BP 90/50, HR 115, R 24, Temp 99. On physical exam, he is found to have a pulsating, tender mass in the middle of his abdomen. All of the following are risk factors for this condition, except

Accepted Answer

For a patient who has a history of smoking and experiencing sudden pains, tender mass in the middle of abdomen and severe pain located in his mid abdominal area; alcohol may not be the possible risk factor for his condition.

Quiz 1: Adult