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The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask?
- A. How old is the bottle you are using?'
- B. May I take your temperature?'
- C. Are you using any other inhaled medications?'
- D. How long have you been using the medication?'
Correct Answer: D
Rationale: Oxymetazoline, a nasal decongestant, can cause rebound congestion (rhinitis medicamentosa) if used beyond 3-5 days, worsening symptoms due to vascular dependence. The best assessment question is how long the client has used it, as prolonged use is the likely culprit, guiding the nurse to educate on discontinuation or seek medical advice. The bottle's age might affect potency but isn't the primary concern for worsening symptoms. Temperature checks for infection, a secondary issue here. Other inhaled medications could interact but don't directly explain rebound effects. The nurse prioritizes duration to pinpoint misuse, a common issue with topical decongestants, making choice D critical for accurate assessment and intervention.
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What should you monitor when administering Clopidogrel to a patient?
- A. Signs of thrombotic thrombocytopenic purpura
- B. Bleeding during therapy
- C. CBC with differential and platelet count
- D. All of the above
Correct Answer: D
Rationale: When administering Clopidogrel, it is crucial to monitor for signs of thrombotic thrombocytopenic purpura, bleeding during therapy, and changes in CBC with differential and platelet count. Thrombotic thrombocytopenic purpura is a rare but serious condition associated with Clopidogrel use, characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, fever, and renal dysfunction. Monitoring for signs of thrombotic thrombocytopenic purpura is essential to detect this potentially life-threatening condition early. Monitoring for bleeding helps to assess the risk of hemorrhagic events, a known side effect of Clopidogrel. Additionally, regular monitoring of CBC with differential and platelet count is necessary to evaluate the drug's impact on blood cell counts and detect any abnormalities that may require intervention. Therefore, monitoring all these parameters is vital to ensure patient safety and appropriate management during Clopidogrel therapy.
Which of the following most accurately describes the antibacterial mechanism of penicillin:
- A. inhibits DNA synthesis
- B. inhibits the terminal step in peptidoglycan synthesis
- C. Inhibits protein synthesis in growing bacterial cells
- D. disrupts the integrity of the cell membrane
Correct Answer: B
Rationale: Penicillin is a type of antibiotic that works by inhibiting bacterial cell wall synthesis. Peptidoglycan is a critical component of the bacterial cell wall, providing structural support and preventing the cell from bursting. Penicillin specifically targets the final step in peptidoglycan synthesis, known as cross-linking, by binding to and inhibiting the enzyme transpeptidase. Without proper cross-linking of peptidoglycan, the bacterial cell wall becomes weak and compromised, leading to cell lysis and bacterial death. This mechanism makes penicillin highly effective in combating bacterial infections.
The adolescent is supposed to go to the school nurse at 12:00 to receive his medication for attention-deficit hyperactivity disorder (ADHD). He often does not go for the medication. What best describes the nurse's understanding of this situation?
- A. The adolescent is embarrassed in front of his peers
- B. The adolescent does not understand the need for the medication
- C. The adolescent forgets that he is supposed to take the medication
- D. The adolescent has made a conscious decision not to take the medication
Correct Answer: A
Rationale: Adolescents prioritize peer image-skipping ADHD meds (e.g., Ritalin) at school likely stems from embarrassment, a developmental trait. Lack of understanding or forgetting is possible but less likely with routine. Conscious refusal needs evidence (e.g., verbal rejection). Embarrassment fits social sensitivity, guiding intervention.
Drugs can cause adverse events in a patient. Bone marrow toxicity is one of the most frequent types of drug-induced toxicity. The most serious form of bone marrow toxicity is:
- A. Aplastic anemia.
- B. Thrombocytosis.
- C. Leukocytosis.
- D. Granulocytosis.
Correct Answer: A
Rationale: Aplastic anemia is the most severe form of bone marrow toxicity, characterized by pancytopenia and bone marrow failure. It can be life-threatening and requires immediate intervention. Thrombocytosis, leukocytosis, and granulocytosis are not typically associated with drug-induced bone marrow toxicity.
A healthcare professional is reviewing the medical history of a client who has a new prescription for Metformin to treat type 2 diabetes. Which of the following findings should the healthcare professional report to the provider?
- A. Hemoglobin A1C of 7.5%
- B. Creatinine level of 1.2 mg/dL
- C. BUN level of 18 mg/dL
- D. Liver function tests showing AST of 50 units/L
Correct Answer: D
Rationale: The correct answer is D. Elevated AST levels in liver function tests should be reported to the provider when a client is prescribed Metformin due to the potential risk of hepatotoxicity associated with the medication. Elevated Hemoglobin A1C (choice A), Creatinine level within normal range (choice B), and BUN level within normal range (choice C) are not directly concerning when initiating Metformin therapy.