Which of the following interventions is most appropriate for a patient experiencing an acute asthma exacerbation with severe respiratory distress and hypoxemia?

Correct Answer: B

Rationale: In a patient experiencing an acute asthma exacerbation with severe respiratory distress and hypoxemia, the most appropriate intervention is to initiate non-invasive positive pressure ventilation (NIPPV). NIPPV can help improve ventilation, decrease work of breathing, and correct hypoxemia by providing positive pressure to keep the airways open, reduce air trapping, and increase the elimination of carbon dioxide. This intervention can help improve oxygenation and reduce the need for invasive mechanical ventilation in patients with severe asthma exacerbations. Administering high-flow oxygen via nasal cannula alone may not provide enough support for patients with severe respiratory distress. Nebulized albuterol/ipratropium combination therapy and intravenous corticosteroid therapy are also important treatments for asthma exacerbations but are not the first-line interventions for patients with severe respiratory distress and hypoxemia.

Correct Answer: B

Rationale: When managing a conscious patient with a severe nosebleed (epistaxis), the appropriate intervention is to have the patient sit upright and lean slightly forward to prevent blood from flowing into the throat and causing choking or swallowing. Pinching the soft part of the nose just below the bony part can help apply pressure to the bleeding vessel and stop the bleeding. This maneuver also helps compress the blood vessels in the nose, promoting clot formation and stopping the bleeding. It is important not to tilt the head back as this can cause blood to flow into the throat and potentially lead to swallowing, choking, or aspiration. Packing the nose with cotton gauze should be done by medical professionals if the bleeding does not stop with direct pressure. Applying direct pressure to the forehead is not effective for managing nosebleeds; pressure should be applied to the nostrils instead.

Correct Answer: C

Rationale: In a pregnant patient with suspected pulmonary embolism (PE), the most appropriate imaging modality for evaluation is contrast-enhanced computed tomography (CT) pulmonary angiography. This imaging technique has been shown to be safe for the fetus when necessary, especially if the benefits of making a diagnosis outweigh the minimal risks associated with radiation exposure. It provides quick and accurate detection of PE with high sensitivity and specificity.

Correct Answer: A

Rationale: Rheumatoid arthritis is a common cause of secondary osteoporosis. Chronic inflammation in rheumatoid arthritis can lead to bone loss due to increased osteoclast activity and decreased bone formation. Patients with rheumatoid arthritis are at an increased risk for developing osteoporosis, resulting in decreased bone density and increased fracture risk. Monitoring and managing bone health is an important aspect of care for individuals with rheumatoid arthritis to help prevent osteoporosis-related complications.

Correct Answer: C

Rationale: Subacute thyroiditis is an inflammatory disorder of the thyroid gland that causes gland destruction and release of pre-formed thyroid hormone leading to hyperthyroidism. The fine-needle aspiration biopsy findings of granulomatous inflammation and multinucleated giant cells are characteristic of subacute thyroiditis. This condition typically presents with a painful, tender thyroid gland and may be preceded by a viral illness. Unlike Graves' disease, which is an autoimmune disorder resulting in hyperthyroidism with diffuse goiter and positive thyroid stimulating immunoglobulins, subacute thyroiditis is typically self-limited and resolves spontaneously without the need for long-term treatment.