Nokea
A nurse is providing care for a 44-year-old male client who is admitted with a diagnosis of fever of unknown origin (FUO). Which characteristic of the client's history is most likely to have a bearing on his current diagnosis?
- A. The client is a smoker.
- B. The client has a history of IV drug use.
- C. The client was treated for an STD 2 years ago.
- D. The client has a family history of cardiac disease.
Correct Answer: B
Rationale: A history of IV drug use is significant in cases of fever of unknown origin, as it increases the risk of infections like endocarditis, which can present with persistent fever. Smoking (Choice A) is not directly linked to FUO. While a history of STD treatment (Choice C) may be relevant, it is less likely to be associated with FUO compared to IV drug use. Family history of cardiac disease (Choice D) is not typically a primary factor in the diagnosis of FUO.
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Which of the following is the most likely indication for the use of immunosuppressant agents?
- A. Intractable seizure disorders
- B. Increased intracranial pressure
- C. Organ transplantation
- D. HIV/AIDS with multiple drug resistance
Correct Answer: C
Rationale: The correct answer is C: Organ transplantation. Immunosuppressant agents are commonly used in organ transplant recipients to prevent organ rejection by suppressing the immune system. Choices A, B, and D are incorrect. Intractable seizure disorders are often managed with antiepileptic drugs, increased intracranial pressure is managed through various means like surgery and medications, and HIV/AIDS with multiple drug resistance is typically treated with antiretroviral therapy, not immunosuppressant agents.
A patient is starting on atorvastatin (Lipitor) for hyperlipidemia. What critical instruction should the nurse provide?
- A. Take the medication at night to reduce the risk of muscle pain and other side effects.
- B. Avoid consuming grapefruit juice while taking this medication.
- C. Take the medication in the morning with breakfast to improve absorption.
- D. Take the medication with a high-fat meal to increase its effectiveness.
Correct Answer: A
Rationale: The correct answer is to take the medication at night to reduce the risk of muscle pain and other side effects. Atorvastatin, like other statins, is more effective when taken in the evening as the body produces more cholesterol at night. Taking it with a high-fat meal (choice D) is not recommended as it may reduce the drug's absorption. Grapefruit juice (choice B) should be avoided with atorvastatin as it can increase the risk of side effects. Taking the medication in the morning with breakfast (choice C) is not as effective as taking it at night.
What aspect of this woman's current health status would contraindicate the use of oral contraceptives?
- A. The woman has a diagnosis of type 2 diabetes.
- B. The woman has asthma and uses inhaled corticosteroids and bronchodilators.
- C. The woman has a family history of breast cancer.
- D. The woman takes an antiplatelet medication for coronary artery disease.
Correct Answer: A
Rationale: The correct answer is A. Women with type 2 diabetes are at higher risk of developing cardiovascular complications. Oral contraceptives further increase this risk due to their potential effects on blood pressure, lipid metabolism, and clotting factors. Choice B is incorrect as inhaled corticosteroids and bronchodilators do not contraindicate the use of oral contraceptives. Choice C is incorrect as a family history of breast cancer does not directly contraindicate the use of oral contraceptives. Choice D is also incorrect as taking an antiplatelet medication for coronary artery disease does not necessarily contraindicate the use of oral contraceptives.
In which of the following patients may the administration of a live vaccine be contraindicated?
- A. Patient with renal insufficiency
- B. Patient with hepatic failure
- C. Patient taking steroid therapy
- D. Patient over the age of 65 years
Correct Answer: C
Rationale: The correct answer is C. The administration of live vaccines may be contraindicated in patients taking steroid therapy. Steroids can suppress the immune system, reducing the effectiveness of live vaccines. Patients with renal insufficiency or hepatic failure can typically receive live vaccines as these conditions are not direct contraindications. Age alone, such as being over 65 years old, is not a contraindication for live vaccines unless there are other specific health considerations. Therefore, the patient taking steroid therapy is the most likely candidate for whom the administration of a live vaccine would be contraindicated.
What should the nurse assess in a patient experiencing breakthrough bleeding while taking oral contraceptives?
- A. Adherence to the medication schedule
- B. The possibility of pregnancy
- C. The need for an increased dosage
- D. The effectiveness of the current oral contraceptive
Correct Answer: A
Rationale: When a patient on oral contraceptives experiences breakthrough bleeding, the nurse should assess the patient's adherence to the medication schedule. Breakthrough bleeding is often a sign of non-adherence, potentially reducing the effectiveness of the contraceptives. Assessing the adherence to the schedule helps in determining if the medication is being taken correctly. The possibility of pregnancy (choice B) is less likely if the patient has been taking the contraceptives as prescribed. Increasing the dosage (choice C) without assessing adherence first can lead to unnecessary medication adjustments. Evaluating the effectiveness of the current oral contraceptive (choice D) comes after assessing adherence to the schedule.