D444 Adult Health I - Set 1 - Part 1

Correct Answer: Provide supplemental oxygen

Option b is correct because maintaining adequate oxygenation prevents respiratory acidosis and ARDS, the most serious complications that can develop rapidly in pneumonia patients.
Option a is incorrect because cough suppressants are contraindicated in pneumonia as they prevent the clearing of infectious secretions from the lungs.
Option c is incorrect because while fluid intake is important for thinning secretions, it does not address the immediate risk of hypoxemia.
Option d is incorrect because positioning helps breathing comfort but does not directly prevent the serious complications of inadequate gas exchange.

Correct Answer: Prepare BiPAP ventilation

Option b is correct because BiPAP is the priority intervention for hypercapnic respiratory failure when carbon dioxide exceeds sixty, requiring immediate ventilatory support.
Option a is incorrect because high-flow oxygen can worsen hypercapnia in COPD patients by suppressing their hypoxic drive to breathe effectively.
Option c is incorrect because pursed-lip breathing is helpful for mild hypercapnia but insufficient for critical carbon dioxide retention requiring mechanical support.
Option d is incorrect because positioning alone cannot adequately address severe hypercapnic respiratory failure requiring immediate ventilatory assistance for survival.

Correct Answer: Closed-angle glaucoma

Option c is correct because closed-angle glaucoma causes rapid intraocular pressure increase requiring immediate treatment with mannitol to prevent optic nerve damage.
Option a is incorrect because primary open-angle glaucoma develops gradually with mild symptoms and is managed with eye drops rather than emergency interventions.
Option b is incorrect because secondary open-angle glaucoma also develops slowly and does not present with the acute severe symptoms described.
Option d is incorrect because chronic simple glaucoma is another term for open-angle glaucoma which has gradual onset without acute crisis.

Correct Answer: Begin continuous irrigation immediately

Option b is correct because immediate and continuous irrigation with sterile saline or water minimizes chemical damage to ocular tissues regardless of chemical type.
Option a is incorrect because covering the eye would trap the chemical against the tissue, increasing damage before the chemical is removed.
Option c is incorrect because visual acuity assessment delays critical treatment; irrigation must begin immediately to prevent permanent vision loss.
Option d is incorrect because applying ointment before removing the chemical would trap the substance and worsen tissue damage significantly.

Correct Answer: Isoniazid and acetaminophen

Option d is correct because both isoniazid and acetaminophen are hepatotoxic drugs that act synergistically, significantly increasing risk of liver failure.
Option a is incorrect because while rifampin is hepatotoxic, the combination with acetaminophen poses less synergistic risk than isoniazid combinations.
Option b is incorrect because ethambutol primarily causes ocular toxicity rather than hepatotoxicity, making this combination less dangerous for liver.
Option c is incorrect because although pyrazinamide affects the liver, its combination with acetaminophen creates less synergistic hepatotoxicity than isoniazid.

Correct Answer: Nasogastric tube insertion

Option b is correct because nasogastric tube insertion is contraindicated in esophageal varices as it can cause mechanical trauma and worsen bleeding.
Option a is incorrect because vasoconstrictors are appropriate treatment to reduce portal pressure and decrease bleeding from esophageal varices effectively.
Option c is incorrect because balloon tamponade is an emergency intervention used specifically to compress bleeding varices when other methods fail.
Option d is incorrect because non-selective beta blockers are standard treatment for reducing portal hypertension and preventing variceal bleeding episodes.

Correct Answer: Aminosalicylates and corticosteroids

Option b is correct because aminosalicylates like sulfasalazine combined with corticosteroids effectively reduce inflammation and manage Crohn's disease long-term.
Option a is incorrect because antidiarrheals only treat symptoms without addressing the underlying inflammatory process causing intestinal damage and complications.
Option c is incorrect because continuous antibiotics are not indicated unless treating specific complications like abscesses or fistulas in Crohn's.
Option d is incorrect because proton pump inhibitors treat gastric acid issues but do not address intestinal inflammation characteristic of Crohn's.

Correct Answer: Eighty-eight to ninety-three percent

Option b is correct because COPD patients typically maintain oxygen saturations between eighty-eight and ninety-three percent to preserve hypoxic respiratory drive.
Option a is incorrect because maintaining normal oxygen saturations in COPD patients can suppress their hypoxic drive and cause carbon dioxide retention.
Option c is incorrect because oxygen saturations below eighty-five percent indicate inadequate oxygenation even for COPD patients requiring intervention immediately.
Option d is incorrect because saturations below eighty percent represent severe hypoxemia requiring immediate intervention regardless of underlying COPD diagnosis.

Correct Answer: Wear glasses not contacts

Option b is correct because rifampin causes red-orange discoloration of body fluids that permanently stains contact lenses, requiring glasses instead.
Option a is incorrect because increasing fluid intake does not prevent or reduce the discoloration of body fluids caused by rifampin.
Option c is incorrect because artificial tears do not prevent the staining effect of rifampin on contact lenses or reduce discoloration.
Option d is incorrect because orange tears are an expected side effect of rifampin that does not require physician notification immediately.

Correct Answer: Excessive salivation develops

Option b is correct because excessive salivation indicates cholinergic crisis from medication overdose, requiring atropine administration as the antidote immediately.
Option a is incorrect because worsening ptosis suggests myasthenic crisis from insufficient medication rather than cholinergic crisis from medication excess.
Option c is incorrect because increasing diplopia indicates worsening myasthenia gravis symptoms rather than cholinergic crisis from medication overdose specifically.
Option d is incorrect because progressive dysphagia suggests myasthenic crisis requiring more medication rather than cholinergic crisis requiring atropine administration.

Correct Answer: Elevated ammonia levels

Option c is correct because elevated ammonia causes hepatic encephalopathy with mental status changes that lactulose treats by promoting ammonia excretion.
Option a is incorrect because elevated bilirubin causes jaundice but does not directly cause the mental status changes of hepatic encephalopathy.
Option b is incorrect because low albumin indicates poor liver synthesis but does not directly cause the confusion associated with encephalopathy.
Option d is incorrect because elevated liver enzymes indicate hepatocellular damage but do not directly cause mental status changes requiring lactulose.

Correct Answer: Tachycardia occurs

Option b is correct because tachycardia is an expected effect of epinephrine indicating successful reversal of anaphylactic shock through adrenergic stimulation.
Option a is incorrect because epinephrine causes tachycardia not bradycardia due to its beta-adrenergic effects on the heart muscle.
Option c is incorrect because epinephrine causes alertness and anxiety rather than drowsiness due to its sympathetic nervous system stimulation.
Option d is incorrect because epinephrine does not cause hypothermia; anaphylaxis itself may cause temperature changes unrelated to treatment.

Correct Answer: Low fat intake

Option b is correct because fat stimulates pancreatic enzyme secretion more than other nutrients, worsening inflammation in acute pancreatitis patients.
Option a is incorrect because protein restriction is not necessary in pancreatitis; protein does not stimulate pancreatic secretions as significantly.
Option c is incorrect because carbohydrates are generally well-tolerated in pancreatitis and do not significantly stimulate pancreatic enzyme secretion.
Option d is incorrect because sodium restriction is not specifically indicated for pancreatitis management unless concurrent hypertension or fluid retention exists.

Correct Answer: NSAIDs like ibuprofen

Option c is correct because NSAIDs inhibit prostaglandin production, reducing gastric protective mechanisms and worsening ulceration with H. pylori infection.
Option a is incorrect because proton pump inhibitors are part of standard H. pylori treatment, reducing acid production and promoting healing.
Option b is incorrect because histamine receptor blockers help treat H. pylori by reducing stomach acid production and promoting ulcer healing.
Option d is incorrect because antibiotics like amoxicillin are essential components of H. pylori eradication therapy, not contraindicated medications.

Correct Answer: Straining during bowel movements

Option c is correct because straining during defecation significantly increases intraocular pressure, risking displacement of the lens implant post-surgery.
Option a is incorrect because reading does not significantly increase intraocular pressure though eye strain should be avoided initially after surgery.
Option b is incorrect because watching television from appropriate distance does not increase intraocular pressure or risk surgical complications significantly.
Option d is incorrect because gentle walking is encouraged post-operatively and does not increase intraocular pressure when done carefully.

Correct Answer: Rice cereal with milk

Option c is correct because rice is naturally gluten-free and safe for celiac disease patients, while milk provides additional nutrition.
Option a is incorrect because whole wheat contains gluten which triggers intestinal damage and malabsorption in celiac disease patients immediately.
Option b is incorrect because bulk bin oatmeal often has cross-contamination with gluten-containing grains, making it unsafe for celiac patients.
Option d is incorrect because rye contains gluten proteins that cause inflammatory damage to the small intestine in celiac disease.

Correct Answer: Absent breath sounds

Option c is correct because absent breath sounds indicate severe airway obstruction with air trapping requiring immediate emergency intervention to prevent arrest.
Option a is incorrect because wheezing indicates some air movement through narrowed airways, less critical than completely absent breath sounds.
Option b is incorrect because accessory muscle use indicates increased work of breathing but not the complete obstruction suggested by silent chest.
Option d is incorrect because prolonged expiration indicates air trapping but still shows air movement unlike the critical absent breath sounds.

Correct Answer: Airborne precautions required

Option c is correct because tuberculosis spreads via airborne particles requiring N95 masks and negative pressure rooms to prevent transmission effectively.
Option a is incorrect because contact precautions alone cannot prevent airborne transmission of tuberculosis bacteria through respiratory droplet nuclei in air.
Option b is incorrect because droplet precautions using surgical masks cannot filter the small airborne particles that transmit tuberculosis bacteria.
Option d is incorrect because standard precautions are insufficient for preventing airborne transmission of tuberculosis requiring specialized respiratory protection equipment.

Correct Answer: Vitamin B6 supplement

Option b is correct because isoniazid interferes with vitamin B6 absorption causing peripheral neuropathy that pyridoxine supplementation prevents effectively.
Option a is incorrect because vitamin B12 deficiency causes different neurological symptoms and is not specifically depleted by isoniazid therapy.
Option c is incorrect because vitamin D supplementation does not prevent the peripheral neuropathy caused by isoniazid-induced B6 deficiency specifically.
Option d is incorrect because vitamin C does not prevent peripheral neuropathy and is not affected by isoniazid tuberculosis treatment.

Correct Answer: Elevating head of bed

Option c is correct because elevating the head of bed uses gravity to prevent stomach acid from refluxing into the esophagus.
Option a is incorrect because lying flat immediately after eating or at night worsens GERD by allowing acid to reflux easily.
Option b is incorrect because elevating legs does not prevent acid reflux and may actually increase abdominal pressure worsening symptoms.
Option d is incorrect because side-lying alone without head elevation does not adequately prevent gravitational reflux of stomach acid.