Nokea
A 24-year-old man seeks medical attention for complaints of claudication in the arch of the foot. The nurse also notes superficial thrombophlebitis of the lower leg. What should the nurse check the client for next?
- A. Smoking history
- B. Recent exposure to allergens
- C. History of recent insect bites
- D. Familial tendency toward peripheral vascular disease
Correct Answer: A
Rationale: In this case, the nurse should check the client's smoking history next. Smoking is a significant risk factor for peripheral vascular disease, leading to the development of thrombophlebitis and claudication. It is important to assess this risk factor as it can significantly impact the client's vascular health and the progression of their current symptoms. Choices B, C, and D are incorrect because they are not directly related to the symptoms described by the client. Recent exposure to allergens or insect bites would typically present with different symptoms, and familial tendency toward peripheral vascular disease is not the immediate concern in this case.
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An 86-year-old patient is seen in clinic for a scheduled follow-up after starting a new oral medication 1 month prior. The patient reports no change in symptoms, and a laboratory test reveals a subtherapeutic serum drug level. The NP caring for this patient should:
- A. consider ordering more frequent dosing of the drug.
- B. titrate the patient's dose upward and recheck in 1 month.
- C. ask the patient about any increased frequency of bowel movements.
- D. determine the number of pills left in the patient's prescription bottle.
Correct Answer: D
Rationale: The correct answer is D because elderly patients often have adherence issues due to cost or confusion, so checking pill count assesses compliance before adjusting dose. Choice A is incorrect as frequency isn’t the first step. Choice B is wrong since dose increase without compliance check is premature. Choice C is inaccurate as bowel changes aren’t the primary concern.
Immunomodulators such as azathioprine may cause a delayed adverse drug reaction known as a type D reaction because they are known:
- A. Teratogens
- B. Carcinogens
- C. To cause hypersensitivity reactions
- D. Hypothalamus-pituitary-adrenal axis suppressants
Correct Answer: B
Rationale: Choice B is correct because azathioprine's type D ADR (delayed) relates to its carcinogenic potential, like leukemia, emerging years after use. Choice A is incorrect as teratogenicity is a separate risk, not type D's focus. Choice C is wrong because hypersensitivity is type B, not delayed. Choice D is incorrect since it suppresses immunity, not the HPA axis directly.
The nurse is caring for a client with hypertension who is prescribed enalapril (Vasotec). The nurse should monitor the client for which potential adverse effect?
- A. Hypertension
- B. Hypotension
- C. Tachycardia
- D. Hyperglycemia
Correct Answer: B
Rationale: The correct answer is B: Hypotension. Enalapril is an ACE inhibitor that works by dilating blood vessels and reducing blood pressure. Therefore, a potential adverse effect of enalapril is hypotension, not hypertension (choice A), tachycardia (choice C), or hyperglycemia (choice D). Monitoring for hypotension is crucial to prevent complications.
A client diagnosed with thrombophlebitis 1 day ago suddenly complains of chest pain and shortness of breath. The LPN/LVN understands that a life-threatening complication of this condition is which?
- A. Pneumonia
- B. Pulmonary edema
- C. Pulmonary embolism
- D. Myocardial infarction
Correct Answer: C
Rationale: The correct answer is C, Pulmonary embolism. Pulmonary embolism is a critical complication of thrombophlebitis where a blood clot dislodges and travels to the lungs, obstructing blood flow. This obstruction can lead to chest pain, shortness of breath, and potentially fatal consequences, making it a life-threatening emergency that requires prompt intervention. Choices A, B, and D are incorrect because pneumonia, pulmonary edema, and myocardial infarction are not directly associated with thrombophlebitis and would not present with the sudden onset of chest pain and shortness of breath in this context.
What is the initial action the nurse should take for a client who had a myocardial infarction (MI) and is experiencing restlessness, agitation, and an increased respiratory rate?
- A. Administer oxygen.
- B. Administer morphine sulfate.
- C. Notify the healthcare provider.
- D. Take the client's blood pressure.
Correct Answer: A
Rationale: Administering oxygen is the priority action for a client experiencing restlessness, agitation, and an increased respiratory rate after a myocardial infarction (MI). This intervention helps ensure adequate oxygenation, improve cardiac function, and reduce the workload on the heart. Oxygen therapy takes precedence over administering medications like morphine sulfate or notifying the healthcare provider as it addresses the immediate need for oxygenation. Checking the blood pressure is also important but not as urgent as ensuring proper oxygen supply.