Nokea
The client is diagnosed with herpes simplex 2 and prescribed the antiviral medication valacyclovir (Valtrex). Which instructions should the nurse teach?
- A. This medication will prevent pregnancy and treat the virus.
- B. This medication must be tapered when discontinuing the medication.
- C. This medication will suppress symptoms but does not cure the disease.
- D. This medication may cause the client’s urine to turn orange.
Correct Answer: C
Rationale: Valacyclovir suppresses HSV-2 symptoms but does not cure it. It does not prevent pregnancy, require tapering, or change urine color.
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The nurse in a dermatology clinic is taking the history of a client. Which questions should the nurse ask the client? Select all that apply.
- A. When did you first notice the skin problem?
- B. What cosmetics or skin products do you use?
- C. Have you experienced any loss of sensation?
- D. What is your current and previous occupation?
- E. Do you experience any itching, burning, or tingling?
Correct Answer: A,B,C,D,E
Rationale: All listed questions assess onset, triggers, symptoms, and occupational exposures, critical for dermatologic history.
The nurse is planning the care for clients recovering from second- or third-degree burns. Which psychosocial nursing problem should be priority?
- A. Altered sensory perception
- B. Altered skin integrity
- C. Disturbed body image
- D. Disturbed personal identity
Correct Answer: C
Rationale: Disturbed body image occurs during the recovering stages of the burn condition and should be priority. Altered sensory perception and altered skin integrity are physiological problems. Disturbed personal identity is less likely to occur than disturbed body image.
Which signs and symptoms indicate that the nursing assistant has had an allergic reaction to the latex gloves? Select all that apply.
- A. Raised areas and blisters on the hands
- B. Itchy, red, watery eyes
- C. Nausea and vomiting
- D. Hives
- E. Chest tightness
Correct Answer: A,B,D,E
Rationale: These symptoms indicate a latex allergy, ranging from local to systemic reactions.
When assessing the client's skin the nurse notices a rounded area of hair loss with redness, pustules, and scales that appear greenish-yellow when exposed to a black light (Wood's lamp). The nurse should plan to implement treatment for which condition?
- A. Lyme disease
- B. Fungal infection
- C. Anaerobic infection
- D. Contact dermatitis
Correct Answer: B
Rationale: A fungal infection that manifests on the scalp with red, scaly lesions and hair loss will appear either greenish-yellow or bluish-green under a Wood's lamp. Lyme disease produces a bull's-eye rash that does not fluoresce. Anaerobic infections have diffuse redness and do not fluoresce. Contact dermatitis does not display a discrete, rounded area of hair loss or fluoresce.
The nurse is caring for the client with a large, open sternal wound resulting from a burn injury. The client is receiving enteral feeding, Oxepa (an anti-inflammatory, pulmonary 1.5 Cal/mL formula), at 25 mL/hour. Which laboratory value finding best indicates that the client is receiving inadequate nutrition?
- A. Phosphorus
- B. Platelets
- C. Prealbumin
- D. Potassium
Correct Answer: C
Rationale: Prealbumin is used to evaluate nutritional status. A low level of prealbumin indicates inadequate nutrition. Prealbumin has a half-life of 2 days and reflects changes in serum protein stores more rapidly than other indices. The phosphorus level decreases in malnutrition as well as other conditions, but this is not the best indicator of inadequate nutrition. Platelets are essential to blood clotting and may or may not be altered with inadequate nutrition. Potassium is the major cation within the cell and may be low due to renal failure or GI disorders.