Nokea
The client with diabetes mellitus has gangrene of the toes to the midfoot. Which goal should be included in this client's plan of care?
- A. Restore skin integrity.
- B. Prevent infection.
- C. Promote healing.
- D. Improve nutrition.
Correct Answer: B
Rationale: Preventing infection is crucial in clients with gangrene to halt the spread of infection and avert further complications. Infections can exacerbate tissue damage and lead to systemic complications, making infection prevention a priority in the care plan for this client. Restoring skin integrity and promoting healing may not be achievable goals until the infection is under control. Improving nutrition is important for overall health but may not be the priority when the immediate concern is preventing infection.
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When determining drug treatment, the NP prescriber should:
- A. Always use evidence-based guidelines
- B. Individualize the drug choice for the specific patient
- C. Rely on his or her experience when prescribing for complex patients
- D. Use the newest drug on the market for the condition being treated
Correct Answer: B
Rationale: Choice B is correct because tailoring treatment to the patient's unique factors—age, comorbidities, preferences—optimizes efficacy and safety. Choice A is incorrect as guidelines inform but don't dictate every case. Choice C is wrong because experience alone may lack evidence support. Choice D is incorrect since newest drugs aren't always best—evidence and patient fit matter more.
Food or drink that should be avoided when taking a prescription for simvastatin includes:
- A. Milk
- B. Orange juice
- C. Grapefruit juice
- D. Green leafy vegetables
Correct Answer: C
Rationale: Choice C is correct because grapefruit juice inhibits CYP3A4, which metabolizes simvastatin, increasing drug levels and rhabdomyolysis risk, so it's to be avoided. Choice A is incorrect as milk doesn't affect simvastatin significantly. Choice B is wrong because orange juice has no notable interaction. Choice D is incorrect since green leafy vegetables don't impact simvastatin metabolism.
A primary care NP is preparing to prescribe a fluoroquinolone for a patient who has a history of alcohol abuse that has caused liver damage. The NP should choose:
- A. norfloxacin.
- B. levofloxacin.
- C. gemifloxacin.
- D. ciprofloxacin.
Correct Answer: B
Rationale: The correct answer is B because levofloxacin has lower hepatic risk, safer for liver-damaged patients. Choices A, C, and D are incorrect (higher hepatic risk).
An adolescent girl has decided to become a vegetarian. The primary care NP should counsel her about iron intake and considering a vitamin containing:
- A. zinc.
- B. vitamin A.
- C. vitamin C.
- D. potassium.
Correct Answer: A
Rationale: The correct answer is A because vegetarians often lack zinc, critical alongside iron. Choice B is incorrect (vitamin A not primary). Choice C is wrong (vitamin C aids iron, not primary). Choice D is inaccurate (potassium unrelated).
A client is wearing a continuous cardiac monitor, which begins to alarm at the nurse's station. The nurse sees no electrocardiographic complexes on the screen. What should the nurse do first?
- A. Call a code blue.
- B. Call the healthcare provider.
- C. Check the client's status and lead placement.
- D. Press the recorder button on the ECG console.
Correct Answer: C
Rationale: The correct first action for the nurse to take is to check the client's status and lead placement. This step is crucial to ensure that the alarm is not triggered by a simple issue such as lead displacement. Calling a code blue (choice A) is premature without assessing the client first. Contacting the healthcare provider (choice B) can be done after ruling out basic causes for the alarm. Pressing the recorder button (choice D) is not as urgent as checking the client's status and lead placement in this scenario.