Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A 56-year-old man with Type 2 diabetes reports pain in his feet that has a burning quality. Which of the following is the most appropriate treatment?
A. Hydrocodone (Norco)
Hydrocodone is an opioid and is generally not first-line for chronic neuropathic pain, due to dependency risks and limited efficacy for burning neuropathic pain.
B. Gabapentin (Neurontin)
This choice is correct because gabapentin is a first-line treatment for diabetic neuropathic pain. It targets nerve hyperexcitability and reduces burning, tingling, and neuropathic discomfort.
C. Acetaminophen (Tylenol)
Acetaminophen is useful for nociceptive pain but is not effective for neuropathic pain caused by diabetic peripheral neuropathy.
D. Botulinum toxin (Botox)
Botulinum toxin is used for muscle spasticity or localized pain syndromes, not generalized diabetic neuropathy.
This question is an excerpt from Nurse Dive's nursing test bank - Mental Health Northern Kentucky University Proctored Exam 6. Take the full exam now
Full Explanation
Choice A reason: Hydrocodone is an opioid and is generally not first-line for chronic neuropathic pain, due to dependency risks and limited efficacy for burning neuropathic pain.
Choice B reason: This choice is correct because gabapentin is a first-line treatment for diabetic neuropathic pain. It targets nerve hyperexcitability and reduces burning, tingling, and neuropathic discomfort.
Choice C reason: Acetaminophen is useful for nociceptive pain but is not effective for neuropathic pain caused by diabetic peripheral neuropathy.
Choice D reason: Botulinum toxin is used for muscle spasticity or localized pain syndromes, not generalized diabetic neuropathy.
Similar Questions
A 16-year-old girl of South Asian descent presents to the PMHNP accompanied by her father. He reports that since the death of her mother 3 months ago, his daughter has been having episodes of strange behavior. He describes these episodes as beginning with a stomach ache and dizziness. Then she behaves as though her dead mother has taken control of her body. After a few minutes, she is back to herself again. Afterward, the patient states she cannot remember anything about these episodes. Which culture-bound syndrome should the PMHNP include in the differential diagnosis?
A. Amok
Amok is a culture-bound syndrome mostly reported in Southeast Asia characterized by sudden episodes of aggressive or homicidal behavior, usually followed by amnesia. This does not match the described symptoms of dissociation and possession.
B. Khayal
Khayal is a culture-bound syndrome from South Asia involving panic-like symptoms with palpitations, dizziness, and fear of death, often related to wind sensations. While it shares somatic features, it does not involve the sense of a deceased person controlling the body.
C. Possession syndrome
This choice is correct because possession syndrome involves episodes where an individual believes a spirit or supernatural entity has taken control of their body, often accompanied by dissociative amnesia. The patient’s behavior, post-episode memory loss, and cultural context fit this syndrome.
D. Ataque de nervios
Ataque de nervios is commonly reported in Latin American populations and includes intense emotional outbursts such as crying, trembling, and shouting, which are culturally specific and do not align with the presentation described here.
Full Explanation
Choice A reason: Amok is a culture-bound syndrome mostly reported in Southeast Asia characterized by sudden episodes of aggressive or homicidal behavior, usually followed by amnesia. This does not match the described symptoms of dissociation and possession.
Choice B reason: Khayal is a culture-bound syndrome from South Asia involving panic-like symptoms with palpitations, dizziness, and fear of death, often related to wind sensations. While it shares somatic features, it does not involve the sense of a deceased person controlling the body.
Choice C reason: This choice is correct because possession syndrome involves episodes where an individual believes a spirit or supernatural entity has taken control of their body, often accompanied by dissociative amnesia. The patient’s behavior, post-episode memory loss, and cultural context fit this syndrome.
Choice D reason: Ataque de nervios is commonly reported in Latin American populations and includes intense emotional outbursts such as crying, trembling, and shouting, which are culturally specific and do not align with the presentation described here.
A 63-year-old man was recently placed on warfarin (Coumadin) by his nurse practitioner. Which of the following supplements will he need to discontinue?
A. Sam-e
Sam-e is primarily used for depression and joint pain. While it may have mild anticoagulant effects, it is not as significant in potentiating warfarin’s effects as omega-3 fatty acids.
B. Omega-3 fatty acids
This choice is correct because omega-3 fatty acids have antiplatelet properties and can increase the risk of bleeding when combined with warfarin. Patients on anticoagulants are typically advised to limit or discontinue omega-3 supplementation.
C. Melatonin
Melatonin is a sleep-regulating supplement and does not significantly affect coagulation or interact with warfarin to increase bleeding risk.
D. Tryptophan
Tryptophan is an amino acid precursor to serotonin used for sleep or mood regulation. It does not have a clinically significant interaction with warfarin.
Full Explanation
Choice A reason: Sam-e is primarily used for depression and joint pain. While it may have mild anticoagulant effects, it is not as significant in potentiating warfarin’s effects as omega-3 fatty acids.
Choice B reason: This choice is correct because omega-3 fatty acids have antiplatelet properties and can increase the risk of bleeding when combined with warfarin. Patients on anticoagulants are typically advised to limit or discontinue omega-3 supplementation.
Choice C reason: Melatonin is a sleep-regulating supplement and does not significantly affect coagulation or interact with warfarin to increase bleeding risk.
Choice D reason: Tryptophan is an amino acid precursor to serotonin used for sleep or mood regulation. It does not have a clinically significant interaction with warfarin.
The PMHNP is working on an inpatient geropsychiatric unit. He is conducting the Montreal Cognitive Assessment (MoCA) on an 89-year-old woman with suspected dementia. He asks her to draw a clock to test her praxis abilities. Which area of the brain is responsible for this function?
A. Left (dominant) parietal
The left parietal lobe is primarily involved in language, calculation, and sequential tasks, not spatial construction and praxis, which are essential for clock drawing.
B. Right (nondominant) parietal
This choice is correct because the right (nondominant) parietal lobe is responsible for visuospatial processing and praxis, including the ability to perceive spatial relationships and reproduce them accurately, as required in clock-drawing tasks.
C. Temporal lobe
The temporal lobe is involved in memory, auditory processing, and language comprehension, not visuospatial praxis.
D. Occipital lobe
The occipital lobe is responsible for primary visual processing, but the integration of spatial planning for drawing tasks involves parietal lobe function.
Full Explanation
Choice A reason: The left parietal lobe is primarily involved in language, calculation, and sequential tasks, not spatial construction and praxis, which are essential for clock drawing.
Choice B reason: This choice is correct because the right (nondominant) parietal lobe is responsible for visuospatial processing and praxis, including the ability to perceive spatial relationships and reproduce them accurately, as required in clock-drawing tasks.
Choice C reason: The temporal lobe is involved in memory, auditory processing, and language comprehension, not visuospatial praxis.
Choice D reason: The occipital lobe is responsible for primary visual processing, but the integration of spatial planning for drawing tasks involves parietal lobe function.