WGU D027 UP-TO-DATE MEDICAL EXAM QUESTIONS AND VERIFIED CORRECT ANSWERS| GRADED A+|QUICK REVIEW!

A female UTI is treated with either a single-dose, short course, or long course of antibiotics, depending on the etiology. Eighty percent of female recurrent UTIs are due to reinfection versus relapse and should be treated as a new infection with a short course of antibiotics. Short-course therapy is more efficacious than single dose therapy in treating uncomplicated UTIs in nonpregnant women with symptoms that last less than seven days. A patient who has traveler's diarrhea asks the nurse about using loperamide to stop the symptoms. What will the nurse tell the patient about this drug? - Answer "Use of this drug may prolong symptoms by slowing peristalsis and should not be used for infectious diarrhea." - Loperamide is recommended to treat mild diarrheal illness. It should not be used for infectious diarrhea due to its slowing the body's mechanisms of expelling the infectious agent. A nurse is teaching a group of women about medications. The women want to know why so many drugs have unpredictable effects in women. The nurse should tell them which of the following? - Answer Most known drug effects are based on drug trials in men - Most drug studies have been conducted on subjects who are white and male. This creates an opportunity for unexpected side effects in females that would otherwise have been known had enough women been enrolled in drug trials. A nurse administers the same medication in the same preparation in the same dose to several patients and notes that some patients have a better response to the drug than others. What is the most likely explanation for this phenomenon? - Answer Pharmacogenomic differences among individuals - Varying individual responses to drugs are driven by genetic differences between persons. The study of genes and drug responses is pharmacogenomics. A patient has been taking narcotic analgesics for chronic pain for several months. The nurse caring for this patient notes that the prescribed dose is higher than the recommended dose. The patient has normal vital signs, is awake and alert, and reports mild pain. What should the nurse recognize about this patient? - Answer This patient has developed pharmacodynamic tolerance, which has increased the minimal effective concentration (MEC) needed for an analgesic effect - After taking narcotic analgesics for several months, the patient has developed pharmacodynamic tolerance due to chronic binding to G protein-coupled receptors. This leads to an increased MEC needed to reduce pain. A nursing student asks a nurse what the natural medicines brand evidence-based rating (NMBER) system that rates dietary supplements means. The nurse should respond that the NMBER system _________. - Answer helps consumers evaluate the safety and efficacy of products - A patient with type 2 diabetes mellitus takes glipizide. The patient develops a urinary tract infection, and the prescriber orders trimethoprim/sulfamethoxazole (TMP/SMZ). What will the nurse tell the patient? - Answer "The patient should check the blood glucose level more often while taking TMP/SMZ." - The SMZ in TMP/SMZ increases the effect of glipizide, which puts the patient at risk of hypoglycemia. (Blood glucose should be tested more frequently while taking TMP/SMZ.) A young, nonpregnant female patient with a history of a previous urinary tract infection (UTI) is experiencing dysuria, urinary urgency and frequency, and suprapubic pain of three days' duration. She is afebrile. A urine culture is positive for more than 100,000/mL of CFU urine. Which treatment should the nurse caring for this patient recommend? - Answer A three-day course of trimethoprim/sulfamethoxazole [Bactrim] - A patient complains of painful urination. A physical examination reveals vesicles on her labia, vagina, and the foreskin of her clitoris. The nurse will expect to teach this patient about which medication? - Answer Acyclovir [Zovirax] - Vesicular infections caused by herpes simplex genitalis are treated with antiviral agents like acyclovir and valacyclovir [Valtrex]. 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 disease (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 Atorvastatin (Lipitor) 20mg - Atorvastatin is more effective in reducing total cholesterol having a greater impact on lowering LDL cholesterol. The American College of Cardiology guidelines on blood cholesterol management emphasize that the greater the reduction in the LDL-C on statin therapy, the greater the subsequent risk reduction. A 73-year-old man with congestive heart failure (CHF) 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 1500. Using the 2017 heart failure guidelines, which medication change should be recommended for this patient? - Answer Stop angiotensin receptor blockers (ARB) and add sacubitril/valsartan (Entresto) - In this case, the elevated BNP indicates significant heart failure. Guidelines recommend replacing an ARB or ACE inhibitor with an ARNI such as Entresto. 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 (Lipitor), 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 Beta blockers - The use of nonselective beta blockers is contraindicated in the management of patients with a history of COPD or asthma because they impact both beta 1 and beta 2 receptors and precipitate bronchospasms. Cardioselective beta blockers, while less likely to cause bronchospasms, may still add to the risk of respiratory compromise. Which statement regarding hypertension (HTN) is true? - Answer One of the most important factors affecting blood pressure is sodium intake - A family history of HTN accounts for upwards of 40% of variation in blood pressure. Stress, obesity, lifestyle, and dietary intake of sodium especially are significant causes of HTN. What statement regarding type 2 diabetes is true? - Answer It accounts for 90-95% of all cases of diabetes - Only 5% of all individuals with diabetes are diagnosed with type 1 diabetes, while 90-95% of individuals with diabetes are diagnosed with type 2 (Rosenthal, L., & Burchum, J. (2018), p. 485). The natural medicines brand evidence-based rating (NMBER) allows the consumer to evaluate natural products on a scale of 1 (lowest rated) to 10 (highest rated), which allows for a more informed process in choosing safe, effective products. A patient admitted to the emergency department with abdominal pain tells the nurse he has been taking kava. Which action is the nurse's priority at this time? - Answer Review liver function studies - Kava, an herbal treatment for anxiety and insomnia, is hepatotoxic and has been linked to liver failure. Which of the following statements are true? - Answer Overweight individuals who lose weight can reduce their blood pressure 60-80% - The DASH diet, exercise, and weight loss all reduce BP. Nicotine replacement has no effect on BP, while smoking and excessive alcohol use both increase BP (Rosenthal, L., & Burchum, J. (2018), p. 377). The United States Affordable Care Act (ACA) has __________. - Answer improved healthcare disparities for those who have encountered problems in coverage and access - The ACA has improved healthcare disparities by making health insurance more accessible. Problems with access, cost, and quality of healthcare still remain. What is an important principle for understanding healthcare disparities? - Answer Constraints on clinician and patient decision-making affect healthcare disparities - Artificial restraints on patient-provider decision-making due to third-party payment systems, pre-approval processes, and the many inefficiencies of a fee-for-service model create disparities for patients. Which statement is true regarding childhood cancer? - Answer Leukemia is the most common malignancy in children - Cancer in childhood is rare. (Yet it is the leading cause of death for children.) Adult cancers are theorized to be due to early exposure to environmental factors (long latency period). However, childhood and adolescent cancers do not appear to have a long latency period. Leukemia is the most common type of cancer in childhood. Which statement is true concerning the prognosis of childhood cancers? - Answer Nearly 85% of childhood cancers are cured - Survival rates have improved over time for children diagnosed with cancer. Currently, 85% of children with cancer will survive. This improvement in survivability is due to combination therapy. Unfortunately, young children are more likely to develop long-term sequelae related to cancer therapy. Which of the following changes can be caused by aging of the nervous system? - Answer Sleep disturbances - Aging is associated with decreased memory, increased sleep disturbances, decreased tendon reflexes, and a decreased sense of taste. What indicates hypokalemia? - Answer Serum K decreases to less than 3.5 - Normal serum potassium (K), also known as eukalemia, is generally 3.5-5.5 mEq/L, with some variations of +/- 0.1-0.3 mEq/L depending on the laboratory testing, age, and other potential patient-specific conditions and variations. Alterations in fluid volume or the administration of a supplement alone do not necessarily contribute to the development of hypokalemia. What is an example of both hyperplasia and hypertrophy? - Answer Uterine enlargement due to pregnancy - Hyperplasia is the increase in the number of cells of an organ or tissue, while hypertrophy is the enlargement of the cells of a given organ or tissue without a change in the number of cells. Muscle cells grow and enlarge (hypertrophy) in response to increased work or stress from exercise or increased cardiovascular pressures. When a liver is damaged or part of it is removed, it is the one internal solid organ capable of regeneration to repair itself creating more cells (hyperplasia). During pregnancy, the uterus must both grow to create more cells and enlarge those existing cells in preparation for the support of a fetus. What regulates the sodium balance? - Answer Aldosterone - Aldosterone is a regulatory hormone produced by the adrenal glands to affect the kidneys' regulation of sodium, potassium, and water excretion. What is the alteration if the extracellular fluid volume is less than normal? - Answer Hypotonic - In hypotonic states, the cell size is increased as a result of water moving from the extracellular fluid (ECF) into the cell to increase intracellular fluid. Iso- or normotonic states are a balanced state between intra- and extracellular fluid volumes. Hypertonic states cause water to shift out of the cell to increase the ECF above normal. When in excess, what do buffers absorb? - Answer Hydrogen - Excesses of acid or base, H+ or hydroxyl ion (OH−), are absorbed for the purpose of maintaining pH homeostasis (pH of 7.38-7.42) Which of the following would a patient with metabolic acidosis have? - Answer pH below 7.35; Bicarbonate level below 22 mEq/L - The diagnosis of metabolic acidosis requires that the testing of arterial blood finds that the pH is less than 7.35 and the bicarbonate level is less than 22 mEq/L. What is the process by which RNA directs the synthesis of polypeptides? - Answer Translation - Translation refers to this process. Transcription is another process in which RNA is synthesized. Mutation means genetic material has been modified through inheritance. Creation is a term that does not apply in this context. Which of the following are affected by the endocrine changes brought on by aging? - Answer The thyroid gland - Changes to the thyroid gland and pancreas that are associated with aging affect metabolism and insulin secretion. Which of the following cannot be caused by anorexia of aging? - Answer Increased orexigenic signals - Sense of smell and taste decline with age along with orexigenic (appetite stimulating) hormones, which leads to decreased hunger. Additionally, decreased thyroid hormone, less lean muscle mass, and reduced physical activity lead to reduced energy needs. What causes hot flashes associated with declining ovarian function with age? - Answer High estrogen levels - The erratic, high production of estrogen during the transition to menopause is the cause of hot flashes. What can aging in the cardiovascular system lead to? - Answer Left ventricular hypertrophy - Cardiovascular changes associated with aging include the stiffening of arteries, which can lead to increased blood pressure, left ventricular hypertrophy, and decreased exercise capacity. Which of the following is not included as standard management of hypertension (HTN) in children? - Answer Use of ACE inhibitors in sexually active females - Ambulatory BP monitoring and an echocardiogram should be used to determine the severity and any underlying primary causes of hypertension (HTN) in children. Lifestyle modification should be the first step in reducing blood pressure, and childhood HTN should be treated as it is in adults. ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin 2 receptor blockers) should be avoided in sexually active females who may become pregnant, due to the risk of fetal harm. Parents ask the nurse why an over-the-counter cough suppressant with sedative side effects is not recommended for infants. Which response by the nurse is correct? - Answer "Infants are more susceptible to central nervous system effects than adults are." - Because the blood brain barrier in infants is less developed, the CNS depressant medication will have a larger effect. The most common antitussives contain opioid medications and are not approved for use in infants. The nurse at a public health infant immunization clinic is acting as a preceptor for a nursing student. To assess the student's understanding of vaccinations, the nurse asks the student where the hepatitis B vaccine (HepB) should be administered. The student would be correct to respond that the hepatitis B vaccine should be administered in the ______. - Answer anterolateral thigh in infants - Because the clinic is for infants, the site for the hepatitis B injection is the anterolateral thigh. A nurse at an immunization clinic is providing vaccines to children. The parent of a child waiting to receive vaccines tells the nurse that the child has an immune deficiency disorder. Which vaccine should not be administered to this child? - Answer Varicella virus - Immunocompromised children should not receive live vaccines due to the likelihood that the live virus or bacteria will proliferate and cause the severe illness that the vaccination is supposed to protect against. Injected polio vaccine is the inactive form, while the oral form contains the live, attenuated virus. Neither the DTaP nor the Hib vaccines are made from live bacteria. 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 assessment, 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 (Zestril) - ACE inhibitors such as lisinopril (Zestril) are associated with dry, persistent coughing in many patients. They prevent the breakdown of protussive mediators such as bradykinin and substance P leading to an increase of these mediators in the respiratory tract. The cough is actually a compensatory response of the body to force kinins out of the lungs. A 68-year-old female patient on a medical surgical floor received a dose of morphine (Duramorph) 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 patient's call light is now lit. When the nurse goes into the room, the patient has several complaints. Which complaint should be addressed first in this patient? - Answer A rash around the injection site going up the left arm - Morphine (Duramorph) is a noncytotoxic vesicant, which means it is irritating and potentially harmful to tissues if it leaks out of the vessel. The reaction local to the site may be an indication of local inflammatory response either caused by irritation, slow leakage of the drug into surrounding tissue, or a sensitivity. However the extension of the rash up the arm is more concerning and may reflect phlebitis or the beginning of an allergic presentation. This presentation warrants priority assessment. 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 - There is no greater criticality based on age. All patients other than the 65-year-old male appear to be stable. The post-operation patient is at greater risk for bleeding, pain, and confusion and may not only require physical assessment and intervention, but also cognitive interventions including creative education. The patient's confusion may lead to greater fear, acting out, pulling on tubes, and other actions that increase his risk. Where in the CNS does a person's learned pain response occur? - Answer Cerebral cortex - The learned pain response and perception of pain is processed in the cerebral cortex. Pain that warns of actual or impending tissue injury is referred to as what? - Answer Acute - Acute pain warns the patient of a current or potential tissue injury. Chronic pain serves no known purpose, lasts longer than three to six months, and outlasts tissue healing. Phantom limb pain is a type of chronic pain associated with a missing limb. Psychogenic pain is associated with emotional or mental pain versus tissue damage. Enkephalins and endorphins act to relieve pain by which process? - Answer Attaching to opiate receptor sites - Enkephalins, endorphins, dynorphins, and endomorphins are neurohormones that bind to opiate receptors (G-protein-coupled opioid receptors) to relieve pain. A nurse is preparing a patient to go home from the emergency department after receiving sutures for a laceration on one hand. The provider used lidocaine with epinephrine as a local anesthetic. Which symptom in this patient causes the most concern? - Answer Nervousness and tachycardia - Difficulty moving the fingers on the affected hand could be due to the effect of the drug or a potential tendon injury. It is expected that there will be numbness and difficulty feeling pressure at the site. As the medication effect wanes, the sensation of pain will return to the wound. Nervousness and tachycardia could represent plasma toxicity or allergy. A patient will receive buprenorphine [Butrans] as a transdermal patch for pain. What is important to teach this patient about the use of this drug? - Answer Rotate the sites for the patches - The Butrans patch, which is replaced every seven days, is recommended to be used only on eight skin sites and rotated among the sites, not to be repeated at any one site, within 21 days. A patient who has had abdominal surgery has been receiving morphine sulfate via a patient-controlled analgesia (PCA) pump. The nurse assesses the patient and notes that the patient's pupils are constricted and that the patient is drowsy and lethargic. The patient's heart rate is 84 beats per minute, the respiratory rate is 10 breaths per minute, and the blood pressure is 90/50 mm Hg. What should the nurse do? - Answer Prepare to administer naloxone and possibly ventilatory support - The patient demonstrates the classic triad of morphine toxicity: pinpoint pupils, hypopnea, and coma. Preparing naloxone to reverse the toxic effects of morphine and provide potential ventilatory support is the correct decision to prevent death. A patient who has recurrent migraine headaches is prescribed sumatriptan [Imitrex]. Which aspect of this patient's history is of concern when taking this drug? - Answer Coronary artery disease - Sumatriptan [Imitrex] should be avoided in individuals with CAD due to the risk of angina secondary to coronary vasospasm. Supplemental oxygen has been shown to help reduce symptoms for which type of headache? - Answer Cluster - Cluster headaches may be successfully aborted through oxygen therapy (100% O2 at 7-10 liters per minute for 15-20 minutes). A patient who has cancer asks the nurse about using acupuncture to manage cancer pain. What should the nurse tell this patient? - Answer "Studies to date do not clearly indicate the effectiveness of acupuncture for alleviating cancer pain." - Cancer pain is severe pain, and currently studies do not support the efficacy of acupuncture in alleviating this type of pain. A patient newly diagnosed with cancer reports having pain at a level of seven to eight on a scale of ten. Which type of pain management will be used initially to treat pain in this patient? - Answer Opioid analgesics - The National Comprehensive Cancer Network recommends that patients diagnosed with cancer who report a pain level greater than or equal to four out of ten should be treated with opioids as the first-line treatment option. A patient reports frequent nightmares. For which of these should the healthcare professional assess the patient? - Answer History of a traumatic event - Frequent nightmares can be a manifestation of a personal history of a traumatic event and is an example of re-experiencing. ...