A 31-year-old man comes into the office for an exam. He is 6' 5 " with a high-pitched voice,
and he has a moderate degree of mental impairment. It is discovered upon exam that his
body hair is sparse, his testes are small, and he has gynecomastia.
Which genetic disorder should this patient be tested for? - ANSWER kleinfelters
sign of becker muscle dystrophy in kids? - ANSWER may begin to waddle, walk on their
toes or push their abdomen forward when walking
A six-month-old female infant with failure to thrive comes in to the office with her parents. It
is noticed upon exam that the patient has facial deformities and is jaundiced. A complete
blood count (CBC) is ordered, which reveals anemia. When that patient's blood is examined
under a microscope, the red blood cells appear small and abnormally shaped. A mutational
analysis is ordered, and alpha thalassemia is diagnosed.
What is the likelihood of incidence of these parent's future children having alpha thalasse-
mia? - ANSWER 100%
A 23-year-old woman comes in for prenatal counseling. While completing her family history,
she reports her brother has cystic fibrosis. She does not know if she is a carrier. She asks if
her children will be affected by the disease.
What is an accurate way to determine the likelihood of this patient's children being af-
fected? - ANSWER A genetic or a carrier test
A 64-year-old male truck driver comes in complaining of pain in his lower left calf. He states
he drives eight to ten hours per day. Upon exam, swelling and mottled coloring are noted in
the patient's calf. A D-dimer test is ordered and comes back positive.
Which additional test should be ordered to confirm a diagnosis in this patient? - ANSWER
Doppler U/S
1
,A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92. After a re-
check 15 minutes later, his BP is 140/90. He states he suffers from "white coat hyperten-
sion." He states he has no history of high blood pressure and no family history of high blood
pressure.
Which nursing intervention would assist this patient in receiving a clinical diagnosis of hyper-
tension? - ANSWER Completing an ambulatory blood pressure assessment
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening with re-
cumbent position. She states she has had a low-grade fever for two days. Upon exam, the
patient has a friction rub. An EKG reveals sinus tachycardia with inflammatory changes. An
ultrasound is performed, and she is diagnosed with an acute pericarditis.
Which condition would make pericarditis more likely in this patient? - ANSWER Lupus
A 54-year-old Caucasian man comes in for a lab review. His lipids reveal an LDL of 180, an
HDL of 52, and triglycerides of 326. He has no history of atherosclerotic cardiovascular dis-
ease (ASCVD) or diabetes. His blood pressure is 118/64. He has a pulse rate of 64, and he
weighs 320 lb. He smokes one pack of cigarettes per day, and his ASCVD risk score is 12.8.
Which medication should this patient be started on? - ANSWER Lipitor 20 mg
A 73-year-old man with Systolic congestive heart failure (CHF) with reduced ejection fraction
(HFrEF) comes to a clinic complaining of shortness of breath. He is currently taking 6.25 mg
carvedilol (Coreg) twice a day and 50 mg losartan (Cozaar) and 20 mg furosemide (Lasix)
daily. His oxygen saturation is 95%, and he has a pulse of 64. His BP is 138/82, and his BNP is
1150.
Using the 2017 heart failure guidelines, which medication change should be recommended
for this patient? - ANSWER Stop angiotensin receptor blockers (ARB) and add sacubi-
tril/valsartan (Entresto), if BNP high replace ARB w/ ACE or ARNI
A 45-year-old Muslim woman presents to a clinic for an intervention for her type 2 diabetes.
She is prescribed metformin (Glucophage) 500 mg BID. During a follow-up phone call a week
later, it is discovered she has not been taking the metformin. A second visit is scheduled.
During this visit, she states that she cannot take the medication as prescribed because it is
Ramadan, a month-long period of religious observances. Due to her religious beliefs, she
2
,fasts from dawn to sunset. When the pharmacist told her to take metformin with breakfast
and dinner, she decided not to start the medication due to her fasting.
Which nursing intervention should be made for this patient? - ANSWER Start metformin
XR (Glucophage XR) 250 mg once a day and reevaluate after Ramadan
A 78-year-old man comes in with stable angina. He reports he has been having more angina
recently. He is currently taking the following medications: lisinopril (Zestril), atorvastatin (Lip-
itor), aspirin, and nitrostat PRN for chest pain. He has a history of COPD with bronchospasm.
His blood pressure is 145/88, and he has a pulse of 74.
Which class of medications should be avoided for this patient? - ANSWER BBs, BB contra-
indicated in pts w/ COPD/ asthma
A 45-year-old Jewish man is visiting a clinic for an adjustment of his diabetes medications.
Though the patient is taking oral medications, his blood sugar levels continue to increase,
and a decision is made to start him on insulin. Although the patient is comfortable with the
concept of starting insulin, he is concerned with the formulation of the insulin saying, "I
heard insulin was made from pigs. If that is the case, I cannot take it due to my faith."
Which response should be given to this patient? - ANSWER While insulin did have por-
cine sources in the past, it is now synthetically made.
A 45-year-old man reports his preference for natural methods of treating illness. He states
he takes natural supplements that he orders from China to boost his health and well-being.
One of the supplements he takes daily is red yeast rice.
Which medication should be avoided with this patient's supplement? - ANSWER Lovas-
tatin (Mevacor), red yeast rice contains this
A 40-year-old man presents to a clinic with an onset of a frequent cough. The patient states
the cough started when he started his new blood pressure medication two weeks ago. The
patient does not remember the name of the drug that was started. After a thorough assess-
ment, it is determined the cough is not being caused by an infection. It is determined the
likely cause of the frequent cough is the new blood pressure medication.
Which medication is the likely cause of this patient's symptoms? - ANSWER Lisinopril
3
, A 68-year-old female patient on a medical surgical floor received a dose of morphine (Du-
ramorph) 30 minutes ago for postoperative pain into an IV in her left hand. She has been on
the floor for two days and has received several doses of morphine over that time. The pa-
tient's call light is now lit. When the nurse goes into the room, the patient has several com-
plaints.
Which complaint should be addressed first in this patient? - ANSWER A rash around the
injection site going up the left arm
An advanced practice nurse (APN) is floated to a medical or surgical floor midshift to assist
an understaffed unit. After receiving a brief report, the APN assumes care of four individuals
for the remainder of the shift. No recent assessment has been completed on these patients.
Which patient should the APN assess first? - ANSWER A 65-year-old man with dementia
who is one day post-operation of a transurethral resection of his prostate and is sometimes
passing blood-tinged urine through his foley, d/t cognitive issues and being post-op
A 55-year-old female patient presents to a clinic for exacerbation of her chronic low back
pain. She is taking morphine extended-release tablets (MS Contin), hydrocodone (Vicodin)
PRN, and duloxetine (Cymbalta). The patient denies any drug allergies. She rates her pain at
a ten out of ten and is requesting something stronger for pain.
When considering adding a medication for this patient's pain, which medication could have a
significant interaction with her current medications? - ANSWER tramadol, d/t serotonin
syndrome
A 45-year-old female patient presents to a clinic complaining of chronic generalized pain and
wishes to be evaluated for fibromyalgia and chronic pain syndrome. A thorough history and
physical is conducted, and the findings are negative. The patient is not taking any medica-
tions, has no allergies to medicines, and has a negative past medical history.
What is an appropriate first intervention for this patient? - ANSWER Assess the patient's
sleep hygiene and make recommendations.
What fluid for nutrient changes/ osmolality changes? - ANSWER 0.9 NS
4
and he has a moderate degree of mental impairment. It is discovered upon exam that his
body hair is sparse, his testes are small, and he has gynecomastia.
Which genetic disorder should this patient be tested for? - ANSWER kleinfelters
sign of becker muscle dystrophy in kids? - ANSWER may begin to waddle, walk on their
toes or push their abdomen forward when walking
A six-month-old female infant with failure to thrive comes in to the office with her parents. It
is noticed upon exam that the patient has facial deformities and is jaundiced. A complete
blood count (CBC) is ordered, which reveals anemia. When that patient's blood is examined
under a microscope, the red blood cells appear small and abnormally shaped. A mutational
analysis is ordered, and alpha thalassemia is diagnosed.
What is the likelihood of incidence of these parent's future children having alpha thalasse-
mia? - ANSWER 100%
A 23-year-old woman comes in for prenatal counseling. While completing her family history,
she reports her brother has cystic fibrosis. She does not know if she is a carrier. She asks if
her children will be affected by the disease.
What is an accurate way to determine the likelihood of this patient's children being af-
fected? - ANSWER A genetic or a carrier test
A 64-year-old male truck driver comes in complaining of pain in his lower left calf. He states
he drives eight to ten hours per day. Upon exam, swelling and mottled coloring are noted in
the patient's calf. A D-dimer test is ordered and comes back positive.
Which additional test should be ordered to confirm a diagnosis in this patient? - ANSWER
Doppler U/S
1
,A 54-year-old man comes into a clinic for a routine visit. His initial BP is 148/92. After a re-
check 15 minutes later, his BP is 140/90. He states he suffers from "white coat hyperten-
sion." He states he has no history of high blood pressure and no family history of high blood
pressure.
Which nursing intervention would assist this patient in receiving a clinical diagnosis of hyper-
tension? - ANSWER Completing an ambulatory blood pressure assessment
A 58-year-old woman comes in complaining of retrosternal chest pain, worsening with re-
cumbent position. She states she has had a low-grade fever for two days. Upon exam, the
patient has a friction rub. An EKG reveals sinus tachycardia with inflammatory changes. An
ultrasound is performed, and she is diagnosed with an acute pericarditis.
Which condition would make pericarditis more likely in this patient? - ANSWER Lupus
A 54-year-old Caucasian man comes in for a lab review. His lipids reveal an LDL of 180, an
HDL of 52, and triglycerides of 326. He has no history of atherosclerotic cardiovascular dis-
ease (ASCVD) or diabetes. His blood pressure is 118/64. He has a pulse rate of 64, and he
weighs 320 lb. He smokes one pack of cigarettes per day, and his ASCVD risk score is 12.8.
Which medication should this patient be started on? - ANSWER Lipitor 20 mg
A 73-year-old man with Systolic congestive heart failure (CHF) with reduced ejection fraction
(HFrEF) comes to a clinic complaining of shortness of breath. He is currently taking 6.25 mg
carvedilol (Coreg) twice a day and 50 mg losartan (Cozaar) and 20 mg furosemide (Lasix)
daily. His oxygen saturation is 95%, and he has a pulse of 64. His BP is 138/82, and his BNP is
1150.
Using the 2017 heart failure guidelines, which medication change should be recommended
for this patient? - ANSWER Stop angiotensin receptor blockers (ARB) and add sacubi-
tril/valsartan (Entresto), if BNP high replace ARB w/ ACE or ARNI
A 45-year-old Muslim woman presents to a clinic for an intervention for her type 2 diabetes.
She is prescribed metformin (Glucophage) 500 mg BID. During a follow-up phone call a week
later, it is discovered she has not been taking the metformin. A second visit is scheduled.
During this visit, she states that she cannot take the medication as prescribed because it is
Ramadan, a month-long period of religious observances. Due to her religious beliefs, she
2
,fasts from dawn to sunset. When the pharmacist told her to take metformin with breakfast
and dinner, she decided not to start the medication due to her fasting.
Which nursing intervention should be made for this patient? - ANSWER Start metformin
XR (Glucophage XR) 250 mg once a day and reevaluate after Ramadan
A 78-year-old man comes in with stable angina. He reports he has been having more angina
recently. He is currently taking the following medications: lisinopril (Zestril), atorvastatin (Lip-
itor), aspirin, and nitrostat PRN for chest pain. He has a history of COPD with bronchospasm.
His blood pressure is 145/88, and he has a pulse of 74.
Which class of medications should be avoided for this patient? - ANSWER BBs, BB contra-
indicated in pts w/ COPD/ asthma
A 45-year-old Jewish man is visiting a clinic for an adjustment of his diabetes medications.
Though the patient is taking oral medications, his blood sugar levels continue to increase,
and a decision is made to start him on insulin. Although the patient is comfortable with the
concept of starting insulin, he is concerned with the formulation of the insulin saying, "I
heard insulin was made from pigs. If that is the case, I cannot take it due to my faith."
Which response should be given to this patient? - ANSWER While insulin did have por-
cine sources in the past, it is now synthetically made.
A 45-year-old man reports his preference for natural methods of treating illness. He states
he takes natural supplements that he orders from China to boost his health and well-being.
One of the supplements he takes daily is red yeast rice.
Which medication should be avoided with this patient's supplement? - ANSWER Lovas-
tatin (Mevacor), red yeast rice contains this
A 40-year-old man presents to a clinic with an onset of a frequent cough. The patient states
the cough started when he started his new blood pressure medication two weeks ago. The
patient does not remember the name of the drug that was started. After a thorough assess-
ment, it is determined the cough is not being caused by an infection. It is determined the
likely cause of the frequent cough is the new blood pressure medication.
Which medication is the likely cause of this patient's symptoms? - ANSWER Lisinopril
3
, A 68-year-old female patient on a medical surgical floor received a dose of morphine (Du-
ramorph) 30 minutes ago for postoperative pain into an IV in her left hand. She has been on
the floor for two days and has received several doses of morphine over that time. The pa-
tient's call light is now lit. When the nurse goes into the room, the patient has several com-
plaints.
Which complaint should be addressed first in this patient? - ANSWER A rash around the
injection site going up the left arm
An advanced practice nurse (APN) is floated to a medical or surgical floor midshift to assist
an understaffed unit. After receiving a brief report, the APN assumes care of four individuals
for the remainder of the shift. No recent assessment has been completed on these patients.
Which patient should the APN assess first? - ANSWER A 65-year-old man with dementia
who is one day post-operation of a transurethral resection of his prostate and is sometimes
passing blood-tinged urine through his foley, d/t cognitive issues and being post-op
A 55-year-old female patient presents to a clinic for exacerbation of her chronic low back
pain. She is taking morphine extended-release tablets (MS Contin), hydrocodone (Vicodin)
PRN, and duloxetine (Cymbalta). The patient denies any drug allergies. She rates her pain at
a ten out of ten and is requesting something stronger for pain.
When considering adding a medication for this patient's pain, which medication could have a
significant interaction with her current medications? - ANSWER tramadol, d/t serotonin
syndrome
A 45-year-old female patient presents to a clinic complaining of chronic generalized pain and
wishes to be evaluated for fibromyalgia and chronic pain syndrome. A thorough history and
physical is conducted, and the findings are negative. The patient is not taking any medica-
tions, has no allergies to medicines, and has a negative past medical history.
What is an appropriate first intervention for this patient? - ANSWER Assess the patient's
sleep hygiene and make recommendations.
What fluid for nutrient changes/ osmolality changes? - ANSWER 0.9 NS
4
