Nokea
A female patient who is 8 weeks pregnant is seen by a primary care nurse practitioner (NP) after a routine prenatal screen was positive for human immunodeficiency virus (HIV). A CD4 cell count is 750 cells/mm. The NP should:
- A. begin immediate therapy with zidovudine and lamivudine.
- B. begin therapy with zidovudine when she is in her second trimester.
- C. delay treatment with antiretroviral medications until after her pregnancy.
- D. initiate therapy with zidovudine if her CD4 cell count decreases to 500 cells/mm.
Correct Answer: B
Rationale: The correct answer is B because antiretrovirals like zidovudine are recommended in pregnancy but avoided in the first trimester if possible. Choice A is incorrect (first trimester risk). Choice C is wrong (delay risks transmission). Choice D is inaccurate (CD4 threshold not applicable).
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Risks to the fetus in the third trimester include:
- A. Exposure to teratogens causing abnormal organ development
- B. Maternal use of tobacco causing low birth weight
- C. Maternal hypertension causing placental insufficiency
- D. All of the above
Correct Answer: C
Rationale: Choice C is correct because the third trimester focuses on fetal growth and placental function, and maternal hypertension can impair it, risking insufficiency. Choice A is incorrect as teratogenic organ defects occur earlier. Choice B is wrong because tobacco's low birth weight is cumulative, not third-trimester specific. Choice D is incorrect since C is the key third-trimester risk.
In every state, prescriptive authority for NPs includes the ability to write prescriptions:
- A. for controlled substances.
- B. for specified classifications of medications.
- C. without physician-mandated involvement.
- D. with full, independent prescriptive authority.
Correct Answer: B
Rationale: The correct answer is B because all states grant NPs some prescriptive authority, but it’s often limited to specific drug classes. Choice A is incorrect as not all states allow controlled substances. Choice C is wrong since physician involvement is required in many states. Choice D is inaccurate as full independence isn’t universal.
A client has a new prescription for verapamil. Which of the following instructions should the nurse include?
- A. Monitor your heart rate daily.
- B. Take the medication at bedtime.
- C. Avoid consuming grapefruit juice.
- D. Take the medication with food.
Correct Answer: A
Rationale: The correct answer is to instruct the client to monitor their heart rate daily when taking verapamil. Verapamil is a calcium channel blocker that can cause bradycardia, making it crucial to monitor the heart rate regularly to detect any changes promptly. Choice B, taking the medication at bedtime, is not specifically related to verapamil administration. Choice C, avoiding grapefruit juice, is more relevant to medications metabolized by CYP3A4 enzymes, not verapamil. Choice D, taking the medication with food, is not a specific instruction for verapamil, as it can be taken with or without food.
Herbal products that should be avoided when a patient is taking warfarin include:
- A. Ginkgo biloba
- B. Echinacea
- C. Valerian root
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because ginkgo biloba has antiplatelet effects, enhancing warfarin's anticoagulation and bleeding risk, so it should be avoided. Choice B is incorrect as echinacea doesn't significantly interact with warfarin. Choice C is wrong because valerian root's sedative effects don't notably affect anticoagulation. Choice D is incorrect since only ginkgo biloba poses a clear risk.
A healthcare professional is assessing a client who has a new prescription for warfarin. Which of the following findings should the healthcare professional report to the provider?
- A. Weight gain
- B. Frequent urination
- C. Hypokalemia
- D. Bleeding gums
Correct Answer: D
Rationale: Bleeding gums are a sign of excessive anticoagulation with warfarin, indicating a potential risk of bleeding complications. It is crucial to report this finding promptly to the provider for further assessment and adjustment of the medication regimen to prevent serious bleeding events. Weight gain, frequent urination, and hypokalemia are not typically associated with warfarin use and are not immediate concerns that require urgent reporting to the provider.