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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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).
A patient has been taking trimethoprim-sulfamethoxazole (TMP/SMX) for 14 days. The patient calls the primary care nurse practitioner (NP) to report fever, rash, and enlarged lymph nodes. The NP should suspect:
- A. serum sickness reaction.
- B. immediate sensitivity reaction.
- C. cytotoxic hypersensitivity reaction.
- D. cell-mediated hypersensitivity reaction.
Correct Answer: A
Rationale: The correct answer is A because serum sickness (fever, rash, lymphadenopathy) occurs days to weeks after TMP/SMX. Choice B is incorrect (immediate within 30 minutes). Choice C is wrong (blood-related, 7-14 days). Choice D is inaccurate (rash syndromes, 48-72 hours).
An adolescent girl reports having heavy menstrual periods. Her hemoglobin is consistently on the low end of the normal range. The primary care NP should prescribe:
- A. iron supplements.
- B. a folic acid supplement.
- C. oral contraceptive pills.
- D. increased red meats in her diet.
Correct Answer: C
Rationale: The correct answer is C because oral contraceptives reduce menstrual blood loss, preventing iron-deficiency anemia. Choice A is incorrect (iron for active anemia). Choice B is wrong (folic acid not preventive here). Choice D is inaccurate (diet insufficient).
A healthcare professional is assessing a client who is taking digoxin. Which of the following findings should the healthcare professional report to the provider?
- A. Weight gain
- B. Dry cough
- C. Hypokalemia
- D. Bradycardia
Correct Answer: D
Rationale: Bradycardia is a significant finding in a client taking digoxin as it is a sign of digoxin toxicity. Bradycardia can indicate that the client is experiencing an adverse reaction to the medication, potentially leading to serious complications. Therefore, it is crucial for the healthcare professional to report bradycardia to the provider promptly for further evaluation and intervention. Weight gain, dry cough, and hypokalemia are not typically associated with digoxin toxicity and may have other underlying causes. While weight gain and cough can be monitored, bradycardia requires immediate attention due to its potential link to digoxin toxicity.
Therapeutic drug levels are drawn when a drug reaches steady state. Drugs reach steady state:
- A. After the second dose
- B. After four to five half-lives
- C. When the patient feels the full effect of the drug
- D. One hour after IV administration
Correct Answer: B
Rationale: Choice B is correct because steady state is reached after four to five half-lives, when absorption equals elimination, stabilizing drug levels for therapeutic monitoring. Choice A is incorrect as the second dose is too early for steady state. Choice C is wrong because patient perception doesn't define pharmacokinetics. Choice D is incorrect since IV timing varies and doesn't inherently match steady state.