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APEA Exam Review – complete solution.docx, Exams of Nursing

Walden UniversityNursing

APEA Exam Review – complete solution.docx

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APEA Exam Review – complete
solution
Which headache sign does not warrant an immediate
investigation?
1) aggravated or relieved by change of position
2) precipitated by Valsalva manuever
3) new onset after age 50
4) relieved with use of common analgesics
Relieved with use of common analgesics
Headaches that respond and are relieved by common
analgesics (like over-the-counter pain relief medications) are
usually indicative of primary headache disorders like tension-
type headaches or migraines, which are less likely to be
associated with serious underlying conditions.
In contrast, headaches that are aggravated or relieved by
change of position, precipitated by Valsalva maneuver (like
coughing, bending, or lifting), or new onset after age 50 can be
indicative of more serious underlying conditions and typically
warrant further medical investigation.
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APEA Exam Review – complete

solution

Which headache sign does not warrant an immediate investigation?

  1. aggravated or relieved by change of position
  2. precipitated by Valsalva manuever
  3. new onset after age 50
  4. relieved with use of common analgesics Relieved with use of common analgesics Headaches that respond and are relieved by common analgesics (like over-the-counter pain relief medications) are usually indicative of primary headache disorders like tension- type headaches or migraines, which are less likely to be associated with serious underlying conditions. In contrast, headaches that are aggravated or relieved by change of position, precipitated by Valsalva maneuver (like coughing, bending, or lifting), or new onset after age 50 can be indicative of more serious underlying conditions and typically warrant further medical investigation.

During a migraine, what happens to the cerebral arteries?

  1. They dilate
  2. They constrict
  3. They vibrate
  4. They pulsate They dilate The pathophysiology of migraines is complex and involves various neurological and vascular changes. One of the vascular changes believed to occur during a migraine is the dilation of cerebral arteries. This dilation can contribute to the sensation of throbbing or pulsating pain, which is a characteristic feature of migraine headaches. You are evaluating a 15-year-old patient for bipolar disorder. His parents tell you that he has severe mood swings, is easily distracted, and constantly corrects his teachers. You would have a high suspicion for bipolar if which symptom was present?
  5. He is forgetful
  6. He sleeps less than 4 hours nightly
  7. He does not complete tasks
  8. He blurts out answers in class inappropriately He sleeps less than 4 hours nightly Decreased need for sleep, especially significantly less sleep like less than 4 hours nightly without feeling fatigued, is a common symptom during manic or hypomanic episodes in bipolar disorder. This symptom can be part of a broader pattern of

postmenopausal obesity - are recognized risk factors for breast cancer. A 26-year-old woman with bulimia is likely to be:

  1. Of average weight
  2. Not concerned with weight
  3. Very underweight
  4. Very overweight Of average weight Individuals with bulimia nervosa often maintain a body weight that is average or slightly above or below average. This differentiates bulimia from anorexia nervosa, where individuals are typically very underweight. People with bulimia engage in recurrent episodes of binge eating followed by inappropriate compensatory behaviors such as purging, fasting, or excessive exercise. However, these behaviors do not typically result in the significant weight loss seen in anorexia nervosa, leading many individuals with bulimia to maintain an average weight range. What medication is used to relieve acute wheezing in a patient with asthma?
  5. Oral corticosteroid
  6. Short-acting beta-agonist
  7. Long-acting beta-agonist
  8. Inhaled corticosteroid Short-acting beta-agonist Short-acting beta-agonists, such as albuterol, are commonly used to provide quick relief from acute bronchoconstriction and

wheezing in asthma. These medications work by rapidly relaxing the muscles in the airways, making it easier to breathe. They are often administered via an inhaler or a nebulizer for immediate effect. You are evaluating an 80-year-old patient for recent episodes of incontinence and confusion. His family states that this is unusual for him, and he has become increasingly forgetful over the past two weeks. Which medication might be responsible for this?

  1. Coumadin (warfarin)
  2. Vitamin B-
  3. Tagamet (cimetidine)
  4. Altace (ramipril) Tagamet (cimetidine) Cimetidine, a medication used to treat heartburn and other conditions involving stomach acid, is known to cross the blood- brain barrier and can cause confusion, especially in elderly patients. Its side effects can also include cognitive impairment. This is particularly relevant in older adults, who may be more sensitive to the central nervous system side effects of various medications. While the other listed medications can have side effects, they are less commonly associated with acute cognitive changes and incontinence in the manner described. Warfarin (Coumadin) is an anticoagulant and is more associated with bleeding risks; Vitamin B-12 is generally not associated with such side effects

bones, synovial membrane lining the joint capsule, and ligaments that support the joint. Synovial joints are the most common type of joint in the body and allow for a wide range of movement. The shoulder joint, specifically, is a ball-and-socket synovial joint, allowing for extensive mobility in multiple directions. A 67-year-old woman with atrial fibrillation and an ejection fraction of 48% is on digoxin and has had normal digoxin levels of 0.8-2 ng/dl for the past 9 months. Today, the level is 0. ng/dl. What could account for this change?

  1. Regular use of an antacid
  2. Increased exercise
  3. Weight loss
  4. Decreased creatinine clearance Regular use of an antacid. Antacids can interfere with the absorption of digoxin in the gastrointestinal tract, leading to lower blood levels of the drug. If a patient begins using antacids regularly, it could reduce the absorption of digoxin and therefore lower its blood concentration, as seen in this case. The other options listed are less likely to be directly responsible for a decrease in digoxin levels. Increased exercise and weight loss can have various health effects, but they do not typically result in decreased digoxin levels. Decreased creatinine clearance, indicative of reduced kidney function, would more

likely increase digoxin levels due to reduced excretion of the drug, not decrease them. Which medication is contraindicated in a child with acute sinusitis?

  1. Nasal steroids
  2. Decongestants
  3. Expectorants
  4. Antihistamines Antihistamines. Antihistamines are typically not recommended for treating acute sinusitis, especially in children. They can thicken mucus and potentially worsen sinus drainage, which can exacerbate the symptoms of sinusitis. The other medications listed - nasal steroids, decongestants, and expectorants - are often used to manage the symptoms of sinusitis, although their use and effectiveness can vary depending on the individual case and age of the child. It's always important to consult with a healthcare provider for the appropriate treatment, particularly for children. Which best describes the lower extremity calf pain associated with peripheral artery disease?
  5. Electric shock
  6. Pulsating pain
  7. Sharp, stabbing pain
  8. Dull aching or cramping

disease?

  1. Hepatitis C
  2. Typhoid fever vaccine
  3. Hepatitis A
  4. Hepatitis B Hepatitis B. The Hepatitis B vaccine provides protection against the Hepatitis B virus, which is transmitted through blood and body fluids. Chronic infection with this virus can lead to serious conditions such as liver cirrhosis and liver cancer. The Hepatitis B vaccine is an effective way to prevent these complications. A pediatric patient has areas of scaling on the scalp with round patches of hair loss. What is the likely diagnosis?
  5. Alopecia areata
  6. Trichotillomania
  7. Tinea capitis
  8. Seborrheic dermatitis Tinea capitis. Tinea capitis, commonly known as scalp ringworm, is a fungal infection of the scalp. It typically presents with scaly, circular areas of hair loss and may be accompanied by itching. It is common in children and is treated with antifungal medications. The presence of scaling is particularly indicative of a fungal infection rather than the other conditions listed. Your 70-year-old patient complains of a sore mouth that prevents her from eating. On exam, you note a beefy red,

glossy smooth tongue. What do you suspect?

  1. Cheilosis, a serious disease of the mouth and oropharynx
  2. Secondary hypothyroidism
  3. Pernicious anemia due to insufficient intrinsic factor
  4. A neurological disorder such as Parkinson's disease Pernicious anemia due to insufficient intrinsic factor. Pernicious anemia, a type of vitamin B12 deficiency, often presents with oral symptoms, including a sore and red tongue (often described as "beefy red") and mouth soreness. This condition occurs due to a lack of intrinsic factor, which is essential for the absorption of vitamin B12. Older adults are more commonly affected by pernicious anemia, and it can lead to various symptoms, including those affecting the mouth and gastrointestinal tract. A 62-year-old male presents with leg pain and occasional numbness that is worse with ambulation and improved with lumbar flexion. What is the likely diagnosis?
  5. Ankylosing spondylitis
  6. Cauda equina syndrome
  7. Bursitis
  8. Spinal stenosis Spinal stenosis. Spinal stenosis is a condition where the spinal canal narrows, putting pressure on the nerves. This pressure can lead to symptoms like pain and numbness in the legs, which typically worsen when walking (especially walking a long distance or

A pregnant patient presents for her 16-week prenatal visit. Her blood pressure had reduced from 118/79 to 109/68. What hemodynamic change is responsible for this?

  1. Decrease cardiac output
  2. Decrease in systemic vascular resistance
  3. Decrease stroke volume
  4. Decrease in preload Decrease in systemic vascular resistance. During pregnancy, there is a natural decrease in systemic vascular resistance. This is primarily due to the hormonal changes that lead to vasodilation and an increased blood flow to support the growing fetus. This vasodilation can result in a decrease in blood pressure, as seen in this patient. It is a normal physiological change during pregnancy and usually does not cause concern unless the blood pressure drops too low or other symptoms are present. The other options, such as decrease in cardiac output, stroke volume, and preload, typically would not decrease during a normal pregnancy. In fact, cardiac output and stroke volume often increase during pregnancy to meet the increased demand for blood flow to the uterus and other organs. Your 62-year-old patient has been taking Griseofulvin 500 mg PO BID for 3 weeks to treat tinea capitis and has only had marginal improvement. What is your next step?
  5. Have the patient shave his head and warn him that hair growth will be slow
  1. Continue the current therapy for 6-8 weeks
  2. Add 2.5% selenium sulfide shampoo twice weekly to the regimen
  3. Prescribe a short course of oral steroids Continue the current therapy for 6-8 weeks. Tinea capitis, a fungal infection of the scalp, often requires prolonged treatment with oral antifungal medications. Griseofulvin is a commonly used antifungal for this condition, and treatment duration is typically 6-8 weeks, as the infection can be slow to resolve. It is not unusual to see only marginal improvement at the 3-week mark. Continued treatment is usually necessary for more significant results. The other options are less appropriate for the management of tinea capitis in this context. Shaving the head is not typically necessary and does not significantly impact the effectiveness of the treatment. Adding selenium sulfide shampoo can be helpful as an adjunct therapy in some cases, but it's not a primary treatment change if the current therapy hasn't been given adequate time to work. Prescribing oral steroids is not a standard approach for tinea capitis and could potentially worsen the infection.