Review 2:
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QUESTIONS AND
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2025!!
,Which of the following is not an expected finding for a patient with Meniere's disease?
A positive Romberg test
An abnormal Rinne test
Lateralization during the Weber test
Hearing loss - ANSWER An abnormal Rinne test
An abnormal Rinne test. The Weber and Rinne tests are physical examination
techniques to assess for the presence of a conductive and/or sensorineural hearing loss
and findings can be suggestive of Meniere's disease. In Meniere's disease, the Weber
test shows lateralization to the unaffected ear. The Rinne test is usually normal (i.e., air
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conductance exceeds bone conductance). The Romberg test is positive, with the patient
showing difficulty staying balanced when standing with eyes closed.
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The nurse practitioner is performing Weber and Rinne tests on an 80-year-old woman
who reports a progressive worsening of her hearing in both ears. The NP removes a
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large amount of cerumen from the patient's ears with stated resolution of her hearing
problem. Her hearing loss was likely of what nature?
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Sensory
Sensorineural
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Conductive
Neural - ANSWER Conductive
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Conductive. In this situation, the hearing loss was due to obstruction with cerumen in
the external ear canal. Another common reason for conductive hearing loss includes
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middle ear effusion. Sensorineural loss is the most common form of progressive,
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high-frequency hearing loss due to presbycusis or aging. Sensorineural hearing loss
can have many causes and results in the gradual loss of sound receptors and nerve
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endings. Conductive hearing loss is usually temporary while sensorineural hearing loss
is permanent.
A 57-year-old man with a history of myocardial infarction is taking dual antiplatelet
therapy with low-dose aspirin and clopidogrel. He complains about intermittent
headaches and says his friend mentioned about the use of feverfew. You caution the
patient that feverfew can be associated with:
Hypertension.
Increased bleeding risk.
QTc prolongation.
,Ventricular arrhythmia. - ANSWER Increased bleeding risk.
Increased bleeding risk. Feverfew is an herb belonging to the chrysanthemum family
and the supplement is derived from the leaves of the plant. Feverfew is used for
migraine and other types of headaches, as well as dizziness, rheumatoid arthritis, fever,
and abdominal pain, among other conditions. Its mechanisms of action include inhibiting
platelet aggregation, exhibiting anti-prostaglandin effects, and decreasing serotonin
release. Due to its antiplatelet effect, there is an increased risk of bleeding with use of
feverfew and should be used with caution or avoided altogether with concomitant
antiplatelet therapy, such as aspirin and/or clopidogrel.
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The most important component of the initial assessment of an asthma exacerbation
includes a(n):
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SaO2.
Objective measurement of lung function.
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Chest X-ray.
Arterial blood gases. - ANSWER Objective measurement of lung function.
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Objective measurement of lung function. Asthma exacerbations, characterized by a
decrease in peak expiratory flow, are identified by spirometric assessment, which is the
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most important and immediate indicator. After the exacerbation is managed, a
comprehensive health history will contribute to the holistic chronic management. Arterial
blood gases and SaO2 can be indicated later in the assessment if the patient continues
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to deteriorate despite initial interventions. A chest radiograph is usually unchanged in an
asthma exacerbation and is not part of the initial assessment.
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Which of the following statements about migraine headache is most accurate?
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The pain is described as pulsating.
Migraines are more common in men than women.
Migraine with aura is more common than without aura.
The pain is typically bilateral. - ANSWER The pain is described as pulsating.
The pain is described as pulsating. Migraine headache is one of the three most
common primary headache syndromes, and may occur with or without aura; migraine
without aura is the more common type. Migraine is most common in women of
childbearing age. The pain is typically described as unilateral and pulsating.
Risk factors for urinary tract infection in a 62-year-old woman can include each of the
following except:
, Uterine prolapse.
Renal stones.
Diabetes mellitus.
Well-controlled hypertension. - ANSWER Well-controlled hypertension.
Well-controlled hypertension. UTIs occur more frequently in women than men and the
frequency increases with age. UTI rates are higher in postmenopausal women due to
decreased estrogen that can impact the vaginal flora, as well as the presence of uterine
prolapse that can cause incomplete bladder emptying. Comorbid chronic medical
conditions, such as diabetes, can also increase UTI risk. The presence of renal or
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kidney stones can also increase risk of infection. Well-controlled hypertension is not a
substantial risk factor for UTI.
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A 27-year-old woman presents complaining of pain on her upper thighs related to spilled
hot coffee on her lap. Physical examination reveals a burn site that is red, dry and
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blanches briefly with pressure but without blisters. The NP categorizes this burn as:
First degree.
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Second degree.
Third degree.
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Fourth degree. - ANSWER First degree.
First degree. A first degree burn is a superficial burn that affects only the epidermis. The
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appearance of first degree burns is a burn site that is red, painful, dry, and without
blisters. A second degree burn can involve the upper layers of papillary dermis
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(superficial partial thickness) or deeper layers of the dermis (deep partial thickness).
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These burns appear red, blistered, and can be swollen. A third degree burn can involve
the dermis and underlying fat and can appear white or charred.
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You see a 58-year-old man with a history of poorly-controlled hypertension. At this visit
his blood pressure is 185/110 mm Hg but does not report any symptoms. Auscultation
will likely reveal:
S3 heart sound heard during early diastole
S3 heart sound heard during late diastole
S4 heart sound heard during early diastole
S4 heart sound heard during late diastole - ANSWER S4 heart sound heard during
late diastole