Nokea
The primary care NP performs a physical examination on an 89-year-old patient who is about to enter a skilled nursing facility. The patient reports having had chickenpox as a child. The NP should:
- A. obtain a varicella titer.
- B. administer the Varivax vaccine.
- C. give the patient the Zostavax vaccine.
- D. plan to prescribe Zovirax if the patient is exposed to shingles.
Correct Answer: C
Rationale: The correct answer is C because Zostavax is recommended for adults over 60 to prevent shingles, regardless of prior chickenpox. Choice A is incorrect (titer not needed). Choice B is wrong (Varivax not for shingles). Choice D is inaccurate (prophylaxis not standard).
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The client is taking interferon alfa-2a (Roferon-A) and ribavirin (Virazole) combination therapy for hepatitis C and reports overwhelming feelings of depression. Which action should the nurse implement first?
- A. Recommend mental health counseling.
- B. Review the medication actions and interactions.
- C. Assess the client's daily activity level.
- D. Provide information about a support group.
Correct Answer: B
Rationale: The priority action for the nurse is to review the medication actions and interactions. Interferon alfa-2a and ribavirin combination therapy for hepatitis C can lead to neuropsychiatric side effects, including depression. By assessing the medication actions and interactions, the nurse can identify if the depression is a known side effect of the medications, and further intervention or adjustment of the treatment plan may be required to address the client's emotional well-being. Recommending mental health counseling (choice A) may be necessary but should come after ensuring that the depression is not solely caused by medication side effects. Assessing the client's daily activity level (choice C) and providing information about a support group (choice D) are important interventions but addressing the medication's potential contribution to the depression takes precedence.
The NP chooses to give cephalexin every 8 hours based on knowledge of the drug's:
- A. Propensity to go to the target receptor
- B. Biological half-life
- C. Pharmacodynamics
- D. Safety and side effects
Correct Answer: B
Rationale: Choice B is correct because dosing cephalexin every 8 hours aligns with its biological half-life, the time it takes for half the drug to be eliminated, ensuring steady therapeutic levels. Choice A is incorrect as ‘propensity to target receptor' isn't a standard pharmacokinetic term for dosing decisions. Choice C is wrong because pharmacodynamics (drug effects) informs efficacy, not timing. Choice D is incorrect since safety and side effects influence drug choice, not specifically the 8-hour interval.
Over-the-counter drugs that are safe to use include:
- A. Acetaminophen
- B. Aspirin
- C. Ibuprofen
- D. All of the above
Correct Answer: D
Rationale: Choice D is correct because acetaminophen, aspirin, and ibuprofen are safe OTC options for pain/fever when used per guidelines, with well-established profiles. Choice A is incorrect alone as it's one drug. Choice B is wrong by itself because aspirin is just part. Choice C is incorrect solo since ibuprofen is only one option.
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.
A CNM:
- A. may treat only women.
- B. has prescriptive authority in all 50 states.
- C. may administer only drugs used during labor and delivery.
- D. may practice only in birthing centers and home birth settings.
Correct Answer: B
Rationale: The correct answer is B because CNMs have prescriptive authority in all 50 states. Choice A is incorrect as they can treat partners for STDs. Choice C is wrong since their authority isn’t limited to labor drugs. Choice D is inaccurate as they practice in various settings.