Nokea
The nurse is assessing the client with herpes zoster. The nurse determines that acyclovir is an effective treatment when which finding is noted?
- A. Drying and crusting of genital lesions
- B. Crusting and healing of vesicular skin lesions
- C. Urticaria decreased and pruritus relieved
- D. Decrease in intensity of chicken pox lesions
Correct Answer: B
Rationale: A: Drying and crusting of genital lesions would indicate acyclovir's effectiveness for treating genital herpes, not herpes zoster. B: Herpes zoster produces painful vesicular skin eruptions along the course of a nerve. Crusting and healing of the vesicular skin lesions indicate that acyclovir (Zovirax) is effective. C: Urticaria (swollen, raised areas) and pruritus (itching) are not symptoms of herpes zoster. D: The lesions of chicken pox are generalized, whereas herpes zoster lesions occur along the course of a nerve. Herpes zoster occurs when the chicken pox (varicella zoster) virus that has incorporated itself into nerve cells is reactivated years after the initial infection, but it is not chicken pox.
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The nurse is reviewing the client's medication list illustrated, prepared by the client's daughter. The nurse is most concerned about which finding?
- A. Some medication doses are missing.
- B. Some administration routes are missing.
- C. Some medications are being duplicated.
- D. Some medications have drug-drug interactions.
Correct Answer: C
Rationale: A: Missing doses of medication is important to address; however, duplicate medications should be addressed first. B: It is important to address the administration routes, but the duplication of medications is the priority to address. C: Hydrochlorothiazide + captopril (Capozide) is a combination product. The nurse should first determine if the client is taking the combination product along with the individual products due to the potential for overdosing. The client may be clear regarding the dose and the route but may not realize that two medications were replaced with one combination product. D: Drug-drug interactions are important to address and should be addressed, but the duplicate medications are the priority.
The major electrolytes in the extracellular fluid are:
- A. potassium and chloride.
- B. potassium and phosphate.
- C. sodium and chloride.
- D. sodium and phosphate.
Correct Answer: C
Rationale: Sodium and chloride are the major electrolytes in the extracellular fluid.
The nurse is teaching the parent of the 3-year-old being treated with vincristine sulfate for Wilms' tumor. The nurse should inform the parents to immediately notify the HCP of which most significant adverse effect?
- A. The child develops diarrhea.
- B. The child's hair begins to fall out.
- C. The child develops dysphagia and paresthesia.
- D. The child has signs or symptoms of depression.
Correct Answer: C
Rationale: A: Both diarrhea and severe constipation are adverse effects of vincristine, and prophylactic treatment is implemented at the beginning of therapy to decrease the potential of these occurring. B: Hair loss is a common adverse reaction to the medication and is reversible. C: Dysphagia and paresthesia are CNS adverse effects from vincristine sulfate (Oncovin). The nurse should teach the parent to notify the HCP immediately if these occur. D: Three-year-olds may not show signs or symptoms of depression. If present, the signs and symptoms should be distinguished as being associated with the neoplastic disease itself or as side effects of the medication.
The 8-year-old child with gastroenteritis is prescribed to receive 500 mL of lactated Ringer's (LR) solution over the next 10 hours. How many milliliters per hour should the nurse administer?
Correct Answer: 50
Rationale: 500 mL / 10 hr = 50 mL/hr
Cyclosporine and methotrexate are prescribed for the client with severe rheumatoid arthritis. What information should the nurse address when teaching the client? Select all that apply.
- A. Drink grapefruit juice to enhance the medication effects.
- B. Drink plenty of fluids to prevent becoming dehydrated.
- C. Avoid use of St. John's wort, echinacea, and melatonin.
- D. These medications are administered weekly by injection.
- E. Methotrexate and cyclosporine suppress the immune system.
Correct Answer: B,C,E
Rationale: A: Grapefruit juice should be avoided because it can increase the concentration of cyclosporine. B: Adequate hydration minimizes the risk of adverse effects. C: St. John's wort decreases cyclosporine levels. Echinacea and melatonin interact with cyclosporine to alter immunosuppression. D: Methotrexate and cyclosporine can be taken orally instead of by injection. It is incorrect that both medications are taken weekly. Only methotrexate is taken weekly, whereas cyclosporine is usually taken twice daily. E: Methotrexate and cyclosporine both have immunosuppressive effects.