Nokea
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).
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Drugs that should be avoided in the elderly include:
- A. Acetaminophen
- B. Amitriptyline
- C. Amoxicillin
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because amitriptyline, a tricyclic antidepressant, is avoided in the elderly (per Beers Criteria) due to anticholinergic effects causing confusion, constipation, and falls. Choice A is incorrect as acetaminophen is safe. Choice C is wrong because amoxicillin is appropriate with dose adjustment. Choice D is incorrect since only amitriptyline fits.
Risks to the fetus in the second trimester include:
- A. Exposure to teratogens causing abnormal organ development
- B. Maternal use of tobacco causing intrauterine growth restriction
- C. Maternal hypertension causing placental insufficiency
- D. All of the above
Correct Answer: B
Rationale: Choice B is correct because the second trimester involves growth, and tobacco restricts it via vasoconstriction, a key risk then. Choice A is incorrect as teratogens primarily affect organ development in the first trimester. Choice C is wrong because hypertension's placental effects are more third-trimester prominent. Choice D is incorrect since B is the specific second-trimester concern.
Drugs that use CYP 3A4 isoenzymes for metabolism may:
- A. Induce the metabolism of another drug
- B. Inhibit the metabolism of another drug
- C. Both 1 and 2
- D. Neither 1 nor 2
Correct Answer: C
Rationale: Choice C is correct because CYP 3A4 drugs can induce (speed up) or inhibit (slow down) metabolism of other drugs sharing this pathway, affecting their levels and efficacy. Choice A is incorrect as it's only half the story—induction happens, but inhibition does too. Choice B is wrong because it misses induction potential. Choice D is incorrect since both effects are well-documented with CYP 3A4.
The healthcare professional is assisting in the care of a client diagnosed with heart failure. The client is receiving furosemide (Lasix). Which laboratory value should the healthcare professional monitor most closely?
- A. Serum calcium
- B. Serum potassium
- C. Serum sodium
- D. Serum glucose
Correct Answer: B
Rationale: Furosemide is a loop diuretic that can lead to significant potassium loss, making it crucial to monitor the client's serum potassium levels. Hypokalemia (low potassium levels) can result from furosemide use, potentially leading to adverse effects such as cardiac dysrhythmias. Therefore, close monitoring of serum potassium levels is essential to prevent complications in clients receiving furosemide. Monitoring serum calcium, sodium, or glucose levels is not the priority when administering furosemide.
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.