Nokea
The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which assessment question posed to the parents is likely to be most useful in the differential diagnosis?
- A. Has your child received all recommended vaccinations?
- B. Has your child been feeding poorly or showing signs of constipation?
- C. Has your child been exposed to any sick individuals?
- D. Has your child been displaying signs of respiratory distress?
Correct Answer: B
Rationale: The correct answer is B. Poor feeding and constipation are common early symptoms of infant botulism, which is caused by a neurotoxin that impairs muscle function. Option A is unrelated to the presentation of botulism. Option C does not directly relate to the symptoms of botulism. Option D is more indicative of respiratory issues rather than the constellation of symptoms seen in botulism.
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A patient began antiretroviral therapy several weeks ago for the treatment of HIV, and he has now presented to the clinic for a scheduled follow-up appointment. He states to the nurse, "I've been pretty good about taking all my pills on time, though it was a bit hit and miss over the holiday weekend." How should the nurse best respond to this patient's statement?
- A. "Remember that if you miss a dose, you need to take a double dose at the next scheduled time."
- B. "It's acceptable to miss an occasional dose as long as your symptoms don't worsen, but it's important to strive for consistent adherence."
- C. "Remember that your antiretroviral drugs will only be effective if you take them consistently and as prescribed."
- D. "If you're not consistent with taking your medications, you're likely to develop more side effects."
Correct Answer: C
Rationale: The correct response is to remind the patient that antiretroviral drugs are most effective when taken consistently and as prescribed. Choice A is incorrect because taking a double dose after missing a dose is not recommended, as it can lead to medication toxicity. Choice B is incorrect as it may give the impression that missing doses is acceptable, which can reduce the effectiveness of the treatment. Choice D is incorrect because while consistency is important, the focus should be on treatment effectiveness rather than side effects.
What long-term risks should the nurse discuss with a patient starting on hormone replacement therapy (HRT)?
- A. HRT is associated with increased risks of cardiovascular events and breast cancer, so these risks should be discussed with the patient.
- B. HRT can improve mood and energy levels, but it also increases the risk of osteoporosis.
- C. HRT can increase the risk of venous thromboembolism, so patients should undergo regular screening.
- D. HRT decreases the risk of fractures, but it also increases the risk of developing diabetes.
Correct Answer: A
Rationale: The correct answer is A. When starting on hormone replacement therapy (HRT), the nurse should discuss the increased risks of cardiovascular events and breast cancer with the patient. These risks are important to consider to make an informed decision. Choice B is incorrect as HRT does not increase the risk of osteoporosis; in fact, it may help prevent it. Choice C is incorrect as while HRT can increase the risk of venous thromboembolism, regular screening is not the primary focus for discussion. Choice D is incorrect as HRT does not decrease the risk of fractures and is not primarily associated with an increased risk of developing diabetes.
A nurse is providing discharge teaching to a patient who will be taking sildenafil (Viagra). Which of the following should the nurse include in the instructions?
- A. Take this medication 1 hour before sexual activity.
- B. Do not take more than one dose in a 24-hour period.
- C. Seek immediate medical attention if you experience vision or hearing loss.
- D. Take this medication on an empty stomach.
Correct Answer: B
Rationale: The correct answer is B: 'Do not take more than one dose in a 24-hour period.' It is essential for the nurse to emphasize this instruction to prevent potential adverse effects from taking multiple doses of sildenafil. Choice A is incorrect because sildenafil should be taken approximately 30 minutes to 4 hours before sexual activity, not specifically 1 hour before. Choice C is important but not the priority; while vision or hearing loss are potential serious side effects of sildenafil, the immediate concern should be focused on dose frequency. Choice D is incorrect as sildenafil can be taken with or without food.
A patient with systemic candidiasis has been prescribed flucytosine. The nurse should be aware of the need to administer this drug with which of the following?
- A. Vitamin D and calcium supplements
- B. Fluconazole (Diflucan)
- C. Amphotericin B
- D. Penicillin G
Correct Answer: C
Rationale: The correct answer is C: Amphotericin B. When treating systemic candidiasis, Amphotericin B is the drug of choice, not flucytosine. Amphotericin B is an antifungal medication used to treat severe fungal infections like systemic candidiasis. Choices A, B, and D are incorrect because vitamin D and calcium supplements, fluconazole, and penicillin G are not the drugs of choice for treating systemic candidiasis.
A client with multiple sclerosis (MS) is experiencing a relapse. Which of the following factors is most likely contributing to the relapse?
- A. Taking an over-the-counter multivitamin
- B. Experiencing high levels of emotional stress
- C. Getting a flu shot
- D. Engaging in strenuous physical activity
Correct Answer: B
Rationale: Emotional stress can trigger a relapse in multiple sclerosis by exacerbating symptoms. While taking an over-the-counter multivitamin and getting a flu shot are generally safe, they are not typically known to trigger MS relapses. Engaging in strenuous physical activity, if done carefully, can actually have benefits for individuals with MS by improving strength and mobility, so it is less likely to be the cause of a relapse.