A patient who had a total gastrectomy one year ago complains of a sore mouth, indigestion, and tingling in the lower extremities. Which test is ordered by the family nurse practitioner?

Correct Answer: B

Rationale: In this scenario, the correct test to order for the patient who had a total gastrectomy and is presenting with symptoms of a sore mouth, indigestion, and tingling in the lower extremities is a Complete Blood Count (CBC), which is option B. A CBC is a routine test that provides important information about the types and numbers of cells in the blood, including red blood cells, white blood cells, and platelets. In this case, the symptoms described by the patient could be indicative of potential nutritional deficiencies, such as anemia or vitamin deficiencies, which can be detected through abnormalities in the CBC results. Option A, a Blood Urea Nitrogen (BUN) level, is primarily used to assess kidney function and would not directly provide information related to the symptoms described by the patient. Option C, a Liver Function Study, is more focused on assessing liver health and would not be the most appropriate test given the patient's symptoms. Educationally, by understanding the rationale behind selecting a CBC in this case, healthcare providers can learn to correlate patient symptoms with appropriate diagnostic tests, enhancing their clinical reasoning skills and ability to provide effective patient care. It also highlights the importance of considering nutritional deficiencies in patients who have undergone procedures like a total gastrectomy.

Correct Answer: B

Rationale: The correct answer is B) sharply dorsiflexing and maintaining the foot in this position, while supporting the knee. This action elicits ankle clonus, a series of abnormal reflex movements in response to sudden stretch of the muscle. Ankle clonus is characterized by rhythmic contractions and relaxations of the calf muscle when the foot is quickly dorsiflexed. This assessment technique helps the nurse practitioner to evaluate the integrity of the reflex arc and assess for any neurological abnormalities. Option A) applying a low-pitched tuning fork firmly to the lateral malleolus is incorrect as this is a method used to assess vibration sense, not ankle clonus. Option C) striking the Achilles tendon with the percussion hammer after flexing the leg at the knee and rotating it externally is incorrect as this elicits the Achilles reflex, not ankle clonus. Option D) stroking the lateral aspect of the sole with the sharp end of the percussion hammer from the heel to the ball of the foot is incorrect as this elicits the plantar reflex, not ankle clonus. Understanding how to correctly assess for ankle clonus is essential for healthcare providers, especially those working with geriatric populations who may be more prone to neurological issues. By knowing the correct technique, practitioners can accurately assess their patients and provide appropriate interventions if needed.

Correct Answer: B

Rationale: Iron deficiency anemia is a common type of anemia characterized by a deficiency of iron, leading to decreased production of red blood cells. In the early stages of iron deficiency anemia, blood studies typically show microcytic (small cell size) and hypochromic (pale color) red blood cells. Option B, microcytic hypochromic, is the correct answer because it accurately describes the characteristic red blood cell indices seen in iron deficiency anemia. Microcytic refers to the smaller size of red blood cells due to decreased hemoglobin synthesis, while hypochromic indicates a paler color due to reduced hemoglobin content. Option A, macrocytic normochromic, is incorrect because macrocytic red blood cells are seen in conditions like megaloblastic anemia, not iron deficiency anemia. Normochromic indicates a normal hemoglobin content, which is not typical in iron deficiency anemia. Option C, normochromic normocytic, is incorrect because normocytic red blood cells are of normal size, which is not characteristic of iron deficiency anemia where cells are typically microcytic. Additionally, normochromic cells have a normal hemoglobin content, which is not consistent with the low hemoglobin levels seen in iron deficiency anemia. Option D, pancytopenic hypocytic, is incorrect as pancytopenia refers to a decrease in all blood cell types (red blood cells, white blood cells, and platelets), not just red blood cells. Hypocytic is not a recognized term in the context of anemia classification. Understanding the characteristic blood findings in iron deficiency anemia is crucial for diagnosing and managing this common condition across the lifespan. Educating healthcare professionals about these specific laboratory findings can aid in early detection and appropriate treatment, ultimately improving patient outcomes.

Correct Answer: D

Rationale: The correct answer, D) watchful waiting, is appropriate for an 84-year-old patient who questions the need for colorectal screening. As individuals age, the risks associated with invasive procedures like colonoscopy increase due to comorbidities, frailty, and potential complications. Watchful waiting allows for a personalized approach considering the patient's age, health status, and previous screening history. It involves monitoring the patient's condition closely while avoiding unnecessary interventions. Option A) a colonoscopy may pose higher risks for older adults, including bowel perforation and sedation-related complications. Option B) a fecal DNA test may not be the best choice for an initial screening in this age group due to potential false positives or negatives. Option C) flexible sigmoidoscopy may not provide a comprehensive evaluation of the entire colon, potentially missing lesions. Educationally, it is crucial to consider individualized care based on the patient's age, health status, and previous screening history when making recommendations for preventive screenings. Understanding the risks and benefits of different screening modalities in the context of aging physiology and potential complications is essential for healthcare providers working with older adult populations.

Correct Answer: B

Rationale: In the context of Safety Pharmacology Across the Lifespan, understanding the misuse of antitussives containing dextromethorphan is crucial for healthcare professionals. The correct answer is B) teenagers. Teenagers are more prone to abusing dextromethorphan due to factors such as experimentation, peer pressure, and easy accessibility. Adolescents often seek a quick high or altered state of consciousness, leading to misuse of over-the-counter medications like antitussives. Option A) adults between the ages of 21-25 years is incorrect because while this age group may engage in substance misuse, teenagers are statistically more at risk for dextromethorphan abuse. Option C) adults 65 years and older is less likely as this age group typically has lower rates of substance abuse. Option D) adults between the ages of 35-50 years are less likely to abuse dextromethorphan compared to teenagers. Educationally, it is essential to highlight the vulnerability of teenagers to substance abuse and educate both adolescents and caregivers about the dangers of misusing medications. Healthcare providers should be equipped to screen for substance abuse in teenagers during clinical encounters and provide appropriate interventions and education to prevent misuse of drugs like dextromethorphan.