A 21-year-old man with a T-5 spinal cord injury presents to the urgent care clinic where the nurse practitioner (NP) is working. He says he was out to dinner with a friend when he suddenly began to feel lightheaded. Now, he reports symptoms of diaphoresis, flushed face and neck, and severe headache. Upon assessment, the NP finds bradycardia and severe hypertension. Which of the following has NOT been used as treatment for autonomic dysreflexia?

Minocycline (Minocin)

OnabotulinumtoxinA (Botox)

Nifedipine (Adalat)

Lidocaine (Xylocaine)

Answer and Explanation

The Correct Answer is A

Choice A reason: Minocycline is a tetracycline antibiotic and has not been established as a treatment for autonomic dysreflexia. While it has neuroprotective and anti-inflammatory properties in experimental models, it is not part of the clinical management protocol for autonomic dysreflexia.

Choice B reason: OnabotulinumtoxinA (Botox) has been used in patients with neurogenic bladder or spasticity, which can contribute to autonomic dysreflexia. It helps reduce bladder overactivity and prevent triggering episodes.

Choice C reason: Nifedipine, a calcium channel blocker, is commonly used to manage acute hypertension in autonomic dysreflexia. It reduces blood pressure quickly and is considered a first-line agent in emergent settings.

Choice D reason: Lidocaine may be used to suppress afferent stimuli during procedures such as catheterization, which can trigger autonomic dysreflexia. It helps block nociceptive input and prevent reflex sympathetic discharge.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

Choice A reason: Trichomonas is a sexually transmitted infection that typically causes vaginal discharge, itching, and irritation. It does not cause uterine tenderness or systemic symptoms like fever and flu-like illness in the postpartum period.

Choice B reason: A urinary tract infection may cause fever and abdominal discomfort, but it does not typically result in a tender, subinvoluted uterus or foul-smelling lochia. The symptoms described are more consistent with a uterine infection.

Choice C reason: Endometriosis is a chronic condition involving ectopic endometrial tissue, causing pelvic pain and infertility. It is not an acute postpartum infection and does not present with fever or foul-smelling discharge.

Choice D reason: Endometritis is an infection of the uterine lining, commonly occurring postpartum, especially after prolonged labor or cesarean delivery. Symptoms include uterine tenderness, fever, subinvolution, and malodorous lochia. This diagnosis best fits the clinical presentation.

A. PDB is a progressive disease that damages or destroys synovial joint structure and articular cartilage of the joints. B. Excess osteoclastic activity is followed by compensatory osteoblastic activity, leading to the formation of bone that is less compact, mechanically weaker, and more susceptible to fracture. C. PDB is an autoimmune disorder in which inflammation of the synovium leads to joint destruction and deformity. D. PDB is caused by an imbalance of bone resorption and bone remodeling that leads to decreased skeletal mass.

Correct Answer is B

Explanation

Choice A reason: This describes osteoarthritis, not Paget’s disease. Osteoarthritis involves degeneration of joint cartilage and synovial structures, whereas Paget’s disease affects bone remodeling.

Choice B reason: Paget’s disease of bone is characterized by excessive osteoclastic bone resorption followed by disorganized osteoblastic bone formation. The newly formed bone is structurally abnormal—larger, less dense, and more vascular—making it prone to deformity and fracture. This explains the patient’s bowing and neurological symptoms due to nerve compression.

Choice C reason: This describes rheumatoid arthritis, an autoimmune condition affecting the synovium. Paget’s disease is not autoimmune and does not primarily involve joint inflammation.

Choice D reason: While PDB does involve abnormal bone remodeling, it does not lead to decreased skeletal mass. Instead, it results in structurally unsound bone that may be enlarged but weakened.

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Naxlex Comprehensive Predictor Exams

A 32-year-old woman who is 36 hours postpartum experiences lower abdominal pain, fever, flu-like symptoms, a tender uterus that is subinvoluted, and foul-smelling discharge. Which of the following is most consistent with this presentation?

Correct Answer is D

Explanation

A 63-year-old White man presents with bowing deformity of his legs, gait abnormality, and tingling and weakness in his left leg. The nurse practitioner suspects Paget’s disease of bone (PDB). Which of the following most closely describes the pathophysiology of PDB?

Correct Answer is B

Explanation

A 61-year-old married woman exhibits eccentric behavior, has few friends, uses odd word choices, and has magical thinking related to social media. Her son says, "She's always been weird. That's just Mom." What is the most likely diagnosis?

An 8-year-old boy presents to the nurse practitioner with acute onset of "really itchy" small erythematous plaques, predominantly on the trunk. Approximately 2 weeks ago, the boy was treated for tonsillitis. Which of the following most closely explains his condition?

A 49-year-old man reports epigastric abdominal pain, early satiety, and fullness following a meal. The nurse practitioner suspects peptic ulcer disease (PUD). What is the pathophysiology underlying this disease process?

A 62-year-old woman sees the APRN for evaluation of hypertension. According to JNC 8 guidelines for hypertension, what is the threshold for treating hypertension?

The PMHNP is treating a 69-year-old man with ziprasidone (Geodon) for schizophrenia and orders an electrocardiogram. Which QTc interval places the patient at greatest risk for torsades de pointes?

What are the expected assessment findings in a patient with central diabetes insipidus?

A 26-year-old married woman presents to the nurse practitioner and reports: "I think I have an STD from my husband cheating on me." Upon physical examination, the NP finds a single, painless, indurated labial lesion. This finding is most consistent with which of the following?

A 59-year-old man presents to the nurse practitioner with a poorly demarcated, warm, erythematous area on his lower right leg. It is associated with edema and produces tenderness on palpation. What is the pathogenesis of cellulitis?