Nokea
The healthcare provider is evaluating the effects of care for a client with deep vein thrombosis (DVT). Which limb observations should the provider note as indicating the least success in meeting the outcome criteria for this problem?
- A. Pedal edema that is 3+
- B. Slight residual calf tenderness
- C. Skin warm, equal temperature in both legs
- D. Calf girth 1/8 inch larger than the unaffected limb
Correct Answer: A
Rationale: Significant pedal edema, indicated by 3+, suggests ongoing or worsening venous insufficiency. This can be a sign that the care provided has not been effective in managing the deep vein thrombosis (DVT) and the associated complications. Monitoring and addressing pedal edema is crucial in the evaluation of DVT treatment outcomes and overall patient care. Choices B, C, and D are not indicative of the least success in meeting the outcome criteria for DVT. Slight residual calf tenderness, skin warmth, and a slightly larger calf girth do not necessarily point towards treatment failure or lack of improvement in DVT management.
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The parent of a 3-year-old is concerned that the child's legs are not straight. The primary care NP notes marked bowing of the child's lower extremities. Radiologic studies show decreased ossification of the child's bones. The NP should:
- A. prescribe vitamin D supplements.
- B. recommend calcium supplements.
- C. counsel the parent to increase the child's milk intake.
- D. ensure that the parent is buying vitamin D-fortified milk.
Correct Answer: A
Rationale: The correct answer is A because vitamin D deficiency causes rickets, leading to bowing legs, corrected with supplements. Choice B is incorrect (calcium needs vitamin D). Choice C is wrong (milk alone insufficient). Choice D is inaccurate (fortified milk not enough).
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.
Men may require higher doses of which drug class due to differences in body composition?
- A. Lipid-soluble drugs
- B. Water-soluble drugs
- C. Drugs that are highly protein bound
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because men's greater lean mass dilutes water-soluble drugs, often requiring higher doses for efficacy, unlike others. Choice A is incorrect as lipid-soluble drugs align with fat, lower in men. Choice C is wrong because protein binding isn't sex-specific here. Choice D is incorrect since only water-soluble drugs apply.
Drugs that should be avoided in transgender men receiving testosterone therapy include:
- A. Estrogen
- B. Alpha blockers
- C. Beta blockers
- D. All of the above
Correct Answer: A
Rationale: Choice A is correct because estrogen counteracts testosterone's masculinizing effects in transgender men, conflicting with therapy aims, so it's avoided. Choice B is incorrect as alpha blockers don't interfere with testosterone goals. Choice C is wrong because beta blockers are unrelated to therapy effects. Choice D is incorrect since only estrogen applies.
A client in the emergency department is bleeding profusely from a gunshot wound to the abdomen. In what position should the nurse immediately place the client to promote maintenance of the client's blood pressure above a systolic pressure of 90 mm Hg?
- A. Place the client in a 45-degree Trendelenburg position to promote cerebral blood flow.
- B. Turn the client prone to apply pressure on the abdominal wound to help staunch the bleeding.
- C. Maintain the client in a supine position to reduce diaphragmatic pressure and visualize the wound.
- D. Put the client on the right side to apply pressure to the liver and spleen to stop hemorrhaging.
Correct Answer: C
Rationale: In a client with profuse bleeding from a gunshot wound to the abdomen, maintaining the client in a supine position is essential to manage blood pressure. This position helps in reducing diaphragmatic pressure and allows for proper visualization of the wound, aiding in prompt assessment and intervention to control the bleeding and stabilize the client's condition. Placing the client in a 45-degree Trendelenburg position (Choice A) could worsen the bleeding by increasing intrathoracic pressure and venous return, potentially leading to further hemorrhage. Turning the client prone (Choice B) may not be feasible in this situation and can delay essential interventions. Placing the client on the right side (Choice D) does not address the immediate need to manage the bleeding and stabilize the client's condition.