A nurse practitioner working in a community health clinic sees a male patient who expresses concern about starting a homosexual relationship with a new
... [Show More] partner. Which of the following is the best plan to follow during this visit? (Select all that apply.)
Contact the patient's partner to schedule HIV testing
Educate the patient about using barrier devices during sex
Prescribe daily oral PrEP
Draw a blood sample for a combination HIV antigen/antibody test
Schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP - Educate the patient about using barrier devices during sex; draw a blood sample for a combination HIV antigen/antibody test; schedule a follow-up appointment in 1 month to review test results and discuss options for PrEP
Education on using barriers during sexual activity (e.g., condom/dental dams) is important. Daily oral preexposure prophylaxis (PrEP), such as tenofovir emtricitabine, is recommended for sexually active persons who are at risk for HIV. PrEP is used in HIV-negative persons, so the nurse practitioner must wait for the test results before prescribing. It is appropriate to schedule a 1-month follow-up to review the test results and discuss PrEP options (if test is negative). It is not appropriate ethically or legally to contact the partner; however, it would be appropriate for the patient to encourage his partner to get tested.
An older adult male presents with complaints of sharp flank and back pain. The patient has difficulty answering questions because of severity of pain. Blood pressure is 90/60 mmHg. The patient has a 20-pack-year smoking history. Abdomen is distended upon palpitation. Which diagnosis is most likely?
Congestive heart failure
Infective endocarditis
Dissecting abdominal aortic aneurysm
Acute myocardial infarction - Dissecting abdominal aortic aneurysm.
Dissecting abdominal aortic aneurysm is a sudden onset of severe, sharp, excruciating pain located in the abdomen, back, or flank area, accompanied by a distended abdomen and hypotension. Older male adults with a smoking history and hypertension are at higher risk. Congestive heart failure symptoms are dyspnea, fatigue, dry cough, and swollen feet and ankles. Patients with infective endocarditis present with fever, chills, and malaise, along with the presence of a new murmur. Acute myocardial infarction generally presents with a gradual onset of intense and heavy chest discomfort that feels like a squeezing, tightness, and heavy pressure in the chest.
Mrs. Harris a 67-year-old woman who is in the early stages of Alzheimer disease. She suffers from mild dementia. In this type of Alzheimer dementia which of the following would you use as the mainstay treatment?
Vitamin E 1000 IU twice daily
cholinesterase inhibitors
NSAIDS
Selgiline 5 mg twice daily - cholinesterase inhibitors
The mainstay treatment for mild to moderate stage Alzheimer-type dementia is the use of cholinesterase inhibitors. These include donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). They have a clear, although minor and time-limited benefit.
When listening to your 86-year-old patient's heart murmur, you note that it is so loud that it can be heard with the stethoscope completely off the chest. How do you grade the murmur?
IV/VI.
I/VI.
V/VI.
VI/VI. - VI/VI.
Grading heart murmurs follows this system: I/VI: Heart murmur makes faint sound and may not be heard when patient changes position. II/VI: Heart murmur is quiet but can be heard as soon as the stethoscope is placed on the chest. III/VI: Heart murmur is moderately loud. IV/VI: Heart murmur is loud and accompanied by a palpable thrill. V/VI: Heart murmur is very loud and can be heard with the stethoscope partially off the chest. VI/VI: Heart murmur is very loud and can be heard with the stethoscope completely off the patient's chest.
Which of the following persons would not be a candidate for the antipneumococcal vaccine?
a 65-year-old healthy female living with her family
a 35-year-old patient with HIV infection
a 58-year-old male resident of a nursing home
a 55-year-old female living alone - a 55-year-old female living alone
The antipneumococcal vaccine is not indicated for an otherwise healthy person who is under the age of 65 unless there are other health factors involved. Living alone has no bearing on the need for the vaccine. The vaccine is indicated for persons with HIV infection, persons living in nursing homes, and all adults 65 years or older regardless of health status.
Which of the following diseases is more likely to cause chronic pelvic pain rather than acute pelvic pain?
ectopic pregnancy
PID
ovarian cysts
interstitial cystitis - interstitial cystitisInterstitial cystitis is more likely to cause chronic pelvic pain rather than acute pelvic pain as in the other choices. Other causes of chronic pelvic pain include: endometriosis, leiomyomas, and malignancy.
You have a 58-year-old male patient with possible pancreatic cancer. You will not order an abdominal ultrasound for diagnosis because it is limited by which of the following?
previous history of pancreatic disease
patient's age
the presence of intestinal gas
size of tumor - the presence of intestinal gas [Show Less]