Nokea
A client has the diagnosis of valley fever accompanied by myalgias and arthralgias. What treatment should the nurse educate the client on?
- A. Intravenous amphotericin B.
- B. Long-term anti-inflammatories.
- C. No specific treatment.
- D. Oral fluconazole (Diflucan).
Correct Answer: D
Rationale: Valley fever, or coccidioidomycosis, is a fungal infection. The presence of joint and muscle pain indicates a moderate infection that needs treatment with antifungal medications like oral fluconazole.
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The emergency department (ED) manager is reviewing client charts to determine how well the staff performs when treating clients with community-acquired pneumonia. What outcome demonstrates that goals for this client type have been met?
- A. Antibiotics started before admission.
- B. Blood cultures obtained within 20 minutes.
- C. Chest x-ray was obtained within 30 minutes.
- D. Pulse oximetry obtained on all clients.
Correct Answer: A
Rationale: Goals for treatment of community-acquired pneumonia include initiating antibiotics prior to inpatient admission or within 6 hours of presentation to the ED. This is a key indicator of effective treatment.
A client has been taking isoniazid (INH) for tuberculosis for 3 weeks. What laboratory results need to be reported to the health care provider immediately?
- A. Albumin: 5.1 g/dL.
- B. Alanine aminotransferase (ALT): 180 U/L.
- C. Red blood cell (RBC) count: 5.2 million/mm³.
- D. White blood cell (WBC) count: 12,500/mm³.
Correct Answer: B
Rationale: INH can cause liver damage, especially if the client drinks alcohol. The ALT (one of the liver enzymes) is extremely high and needs to be reported immediately, as it indicates potential liver toxicity.
A client in the emergency department is taking rifampin (Rifadin) for tuberculosis. The client reports yellowing of the sclera and skin and bleeding after minor trauma. What laboratory results correlate to this condition? (Select all that apply.)
- A. Blood urea nitrogen (BUN): 19 mg/dL.
- B. International normalized ratio (INR): 6.3.
- C. Prothrombin time: 35 seconds.
- D. Serum sodium: 120 mEq/L.
- E. White blood cell (WBC) count: 72,000/mm³.
Correct Answer: B,C
Rationale: Rifampin can cause liver damage, evidenced by the client's high INR and prothrombin time, which indicate coagulopathy due to liver dysfunction. The BUN, WBC count, and sodium levels are not directly related to this condition.
A nurse working in a geriatric clinic sees clients with cold symptoms and rhinitis. Which drug would be appropriate to teach these clients to take for their symptoms?
- A. Chlorphenamine (Chlor-Trimeton)
- B. Diphenhydramine (Benadryl)
- C. Fexofenadine (Allegra)
- D. Hydroxyzine (Vistaril)
Correct Answer: C
Rationale: First-generation antihistamines are not appropriate for use in the older population. These drugs include chlorphenamine, diphenhydramine, and hydroxyzine. Fexofenadine is a second-generation antihistamine, which is safer and more suitable for older adults.
A nurse in a family practice clinic is preparing discharge instructions for a client reporting facial pain that is worse when bending over, tenderness across the cheeks, and postnasal discharge. What instruction will be most helpful?
- A. Ice packs may help with the facial pain.
- B. Limit fluids to dry out your sinuses.
- C. Try warm, moist heat packs on your face.
- D. We will schedule you for a computed tomography scan this week.
Correct Answer: C
Rationale: This client has rhinosinusitis. Comfort measures for this condition include breathing in warm steam, hot packs, nasal saline irrigation, sleeping with the head elevated, increased fluids, and avoiding cigarette smoke. Warm, moist heat packs are particularly effective for relieving facial pain.