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.
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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.
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 is in the family practice clinic reporting a severe cough that has lasted for 5 weeks. The client is so exhausted after coughing that work has become impossible. What action by the nurse is most appropriate?
- A. Arrange for immediate hospitalization.
- B. Facilitate polymerase chain reaction testing.
- C. Have the client produce a sputum sample.
- D. Obtain two sets of blood cultures.
Correct Answer: B
Rationale: Polymerase chain reaction testing is used to diagnose pertussis, which this client is showing manifestations of. This is the most appropriate action to confirm the diagnosis.
A client has been hospitalized with tuberculosis (TB). The client's spouse is fearful of entering the room where the client is in isolation and refuses to visit. What action by the nurse is best?
- A. Ask the spouse to explain the fear of visiting in further detail.
- B. Inform the spouse the precautions are meant to keep other clients safe.
- C. Show the spouse how to follow the isolation precautions to avoid illness.
- D. Tell the spouse that he or she has already been exposed, so it's safe to visit.
Correct Answer: A
Rationale: The nurse needs to obtain further information about the spouse's specific fears so they can be addressed. This will decrease stress and permit visitation, which will be beneficial for both client and spouse.
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.
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