D446 Adult Health II - Set 2 - Part 1

Correct Answer: Reduces venous return

Upright positioning decreases venous return to the heart, reducing pulmonary congestion and fluid backing into lungs, thereby improving breathing in left-sided heart failure.
Option b is incorrect because while sitting may allow better chest expansion, the primary benefit is reducing pulmonary vascular congestion, not mechanical expansion.
Option c is incorrect because body position doesn't directly improve the heart's contractile strength; it only affects preload and fluid distribution.
Option d is incorrect because airway resistance isn't the primary problem in heart failure; pulmonary edema from fluid overload causes breathing difficulty.

Correct Answer: Lipase enzyme absent

Pancreatic lipase deficiency prevents fat digestion, causing undigested fats to pass through intestines creating bulky, foul-smelling, fatty stools characteristic of pancreatic insufficiency.
Option a is incorrect because amylase deficiency affects carbohydrate digestion, causing different symptoms but not the fatty stools seen with steatorrhea.
Option c is incorrect because protease deficiency impairs protein digestion leading to muscle wasting and edema, not specifically fatty stools.
Option d is incorrect because lactase is an intestinal enzyme affecting dairy digestion, causing gas and diarrhea but not steatorrhea.

Correct Answer: Hemosiderin deposits forming

Chronic venous insufficiency causes red blood cells to leak into tissues where hemoglobin breaks down into hemosiderin, creating characteristic brown ankle discoloration.
Option a is incorrect because arterial ischemia causes pale or cyanotic skin from poor oxygenation, not brown pigmentation from blood breakdown products.
Option c is incorrect because melanin changes create different pigmentation patterns and aren't related to vascular insufficiency or blood pooling.
Option d is incorrect because bacterial colonization causes redness, warmth, and possible drainage, not the brown staining from hemosiderin deposits.

Correct Answer: Slows decline modestly

Riluzole reduces motor neuron damage, potentially slowing disease progression by months, but doesn't cure ALS or dramatically alter the fatal outcome.
Option a is incorrect because no current medication cures ALS; riluzole only provides modest slowing of the inevitable progressive deterioration.
Option c is incorrect because riluzole cannot reverse existing muscle weakness or restore lost motor function; it only slows further decline.
Option d is incorrect because respiratory failure remains the eventual outcome in ALS despite riluzole therapy, though timing may be delayed.

Correct Answer: Maintains airway pressure

Pursed-lip breathing creates positive pressure keeping airways open longer during exhalation, preventing early airway collapse common in COPD and improving ventilation.
Option a is incorrect because pursed-lip breathing primarily affects exhalation and airway patency, not the amount of oxygen inhaled during inspiration.
Option c is incorrect because while it may help with gas exchange, the primary mechanism is preventing airway collapse, not CO2 removal.
Option d is incorrect because this technique doesn't strengthen muscles; it's a compensatory mechanism to overcome airway obstruction during exhalation.

Correct Answer: Assess swallowing ability

Swallowing assessment prevents aspiration pneumonia, a leading cause of death after stroke, by identifying dysphagia before allowing oral intake that could enter lungs.
Option a is incorrect because while CT scan determines stroke type for treatment, preventing aspiration takes immediate priority to avoid pneumonia complications.
Option c is incorrect because although hypoglycemia can mimic stroke, protecting the airway from aspiration is more immediately life-threatening post-stroke.
Option d is incorrect because physical therapy is important for recovery but not an immediate priority over preventing aspiration and maintaining safety.

Correct Answer: Mental cloudiness developing

Aluminum accumulation in the brain causes cognitive impairment and dementia-like symptoms, distinguishing aluminum toxicity from other dialysis complications requiring binder change.
Option a is incorrect because muscle cramps commonly occur from rapid fluid shifts during dialysis, not specifically from aluminum toxicity buildup.
Option c is incorrect because itching in dialysis patients usually results from uremia or calcium-phosphate imbalances, not aluminum accumulation specifically.
Option d is incorrect because weight gain indicates fluid retention between dialysis sessions, not aluminum toxicity which affects neurological function.

Correct Answer: Hyperglycemia levels elevated

Cortisol excess stimulates gluconeogenesis and decreases insulin sensitivity, causing hyperglycemia that may progress to steroid-induced diabetes requiring glucose monitoring and control.
Option a is incorrect because cortisol raises blood glucose through multiple mechanisms; hypoglycemia would indicate adrenal insufficiency, not Cushing's disease.
Option c is incorrect because Cushing's typically causes sodium retention and hypokalemia from mineralocorticoid effects, not hyponatremia which suggests SIADH.
Option d is incorrect because excess cortisol causes potassium wasting leading to hypokalemia, not hyperkalemia which would indicate adrenal insufficiency.

Correct Answer: Adjust evening medication

Dawn phenomenon results from early morning hormone surges; adjusting evening long-acting medication provides coverage during this critical pre-dawn period effectively.
Option a is incorrect because morning insulin treats existing hyperglycemia but doesn't prevent the dawn phenomenon's hormonal glucose surge occurring earlier.
Option b is incorrect because bedtime snacks might worsen morning hyperglycemia; the problem is hormonal surge, not overnight hypoglycemia rebound.
Option d is incorrect because skipping breakfast would delay treatment of morning hyperglycemia and could worsen glucose control throughout the day.

Correct Answer: Rifampin medication given

Rifampin causes harmless orange-red discoloration of body fluids including urine, tears, and sweat, which is expected and doesn't indicate toxicity.
Option a is incorrect because isoniazid can cause peripheral neuropathy and hepatotoxicity but doesn't cause the characteristic orange urine discoloration.
Option c is incorrect because ethambutol's main concern is optic neuritis affecting vision, not causing changes in urine color.
Option d is incorrect because pyrazinamide can cause hyperuricemia and joint pain but doesn't produce orange discoloration of body fluids.

Correct Answer: CD4 count dropping

CD4 counts below specific thresholds indicate severe immunosuppression requiring prophylactic medications to prevent life-threatening opportunistic infections in HIV patients.
Option a is incorrect because while viral load indicates HIV activity, CD4 count specifically determines immune function and prophylaxis timing needs.
Option c is incorrect because elevated white cells might indicate infection but don't reflect HIV-specific immune status requiring prophylaxis decisions.
Option d is incorrect because platelet counts affect bleeding risk but don't indicate immune suppression level determining opportunistic infection prophylaxis needs.

Correct Answer: Use saline irrigation

Gentle saline irrigation cleanses the area without trauma, removes debris, and maintains moisture balance promoting healing of radiation-damaged skin effectively.
Option a is incorrect because antibiotic ointments aren't routinely recommended and may cause allergic reactions or resistance in radiation skin injury.
Option c is incorrect because occlusive dressings can trap moisture and bacteria, potentially worsening radiation dermatitis and delaying healing processes.
Option d is incorrect because exposed moist desquamation risks infection and excessive drying, requiring appropriate wound care for optimal healing.

Correct Answer: Sunscreen application thorough

UV exposure triggers lupus flares and worsens the photosensitive butterfly rash, making high-SPF sunscreen essential for preventing disease exacerbation outdoors.
Option a is incorrect because antihistamines treat allergic reactions but don't prevent UV-triggered lupus flares or protect photosensitive skin effectively.
Option c is incorrect because prophylactic steroids aren't recommended; they're used for active flares, and sunscreen prevents the trigger.
Option d is incorrect because while moisturizers help dry skin, they don't provide UV protection needed to prevent lupus rash exacerbation.

Correct Answer: Red cell casts

Red blood cell casts form in kidney tubules indicating glomerular bleeding and inflammation, specifically diagnostic of glomerulonephritis versus simple urinary infection.
Option a is incorrect because white blood cells indicate inflammation or infection anywhere in the urinary tract, not specifically glomerular damage.
Option c is incorrect because bacteria presence suggests urinary tract infection, which can occur independently of glomerular kidney disease.
Option d is incorrect because positive nitrites indicate bacterial infection converting nitrates, not the glomerular inflammation seen in glomerulonephritis.

Correct Answer: Hyperkalemia developing significantly

Spironolactone is potassium-sparing, potentially causing dangerous hyperkalemia manifesting as muscle weakness and cardiac arrhythmias requiring immediate intervention and monitoring.
Option a is incorrect because while spironolactone can affect sodium, muscle weakness with cardiac changes specifically suggests potassium imbalance, not hyponatremia.
Option c is incorrect because spironolactone doesn't directly affect calcium levels; hypocalcemia presents with different neuromuscular symptoms like tetany.
Option d is incorrect because magnesium imbalances aren't a primary concern with spironolactone; potassium retention is the main electrolyte risk.

Correct Answer: Increases inflammation acutely

Starting allopurinol during acute gout mobilizes uric acid crystals, potentially worsening inflammation and prolonging the painful attack before stabilization occurs.
Option b is incorrect because allopurinol doesn't cause kidney damage when started during flares; it may actually protect kidneys long-term.
Option c is incorrect because allopurinol and colchicine can be used together safely; they work through different mechanisms without interaction.
Option d is incorrect because effectiveness isn't reduced by starting during flares; the concern is worsening acute symptoms, not efficacy.

Correct Answer: Lower portal pressure

Propranolol reduces portal venous pressure by decreasing cardiac output and causing splanchnic vasoconstriction, preventing variceal bleeding in cirrhotic patients effectively.
Option a is incorrect because while propranolol does reduce heart rate, the therapeutic goal in cirrhosis is specifically reducing portal pressure.
Option c is incorrect because propranolol doesn't have anticoagulant properties; it works by reducing pressure in the portal venous system.
Option d is incorrect because propranolol doesn't improve liver function; it only reduces complications from portal hypertension like variceal bleeding.

Correct Answer: Urine output adequate

Urine output directly reflects kidney perfusion and overall tissue perfusion, making it the most reliable indicator of adequate fluid resuscitation effectiveness.
Option a is incorrect because blood pressure can be maintained by compensatory mechanisms even with inadequate fluid resuscitation in burn patients.
Option c is incorrect because heart rate varies with pain, anxiety, and medications, making it less reliable than urine output monitoring.
Option d is incorrect because skin turgor is unreliable in burn patients due to tissue damage and edema affecting assessment accuracy.

Correct Answer: Bone marrow suppression

Methotrexate can cause bone marrow suppression leading to pancytopenia, manifesting as fatigue from anemia and bruising from thrombocytopenia requiring immediate evaluation.
Option a is incorrect because liver toxicity from methotrexate typically presents with jaundice and elevated enzymes, not primarily fatigue and bruising.
Option c is incorrect because kidney dysfunction causes different symptoms like edema and decreased urine output, not bruising and fatigue specifically.
Option d is incorrect because methotrexate rarely causes cardiac toxicity; bone marrow suppression is a known serious adverse effect requiring monitoring.

Correct Answer: Reduces dilutional effect

Fluid restriction prevents further dilution of serum sodium by excess water retention, allowing sodium concentration to normalize despite inappropriate ADH secretion.
Option a is incorrect because fluid restriction doesn't increase sodium production; it addresses the dilutional hyponatremia from excess water retention.
Option c is incorrect because fluid restriction doesn't directly affect ADH clearance; it manages the consequences of inappropriate hormone secretion.
Option d is incorrect because fluid restriction doesn't enhance kidney function; it reduces the water available for inappropriate retention.