Answers to Part 4
ANSWERS:
1. Correct Answer: 4
Rationale:Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. The low blood pressure suggests that the pentamidine infusion rate may need to be slowed. The other responses indicate a need for independent nursing actions (such as establishing a new IV site and encouraging oral intake) but are not associated with pentamidine infusion.
Rationale:Pentamidine can cause fatal hypoglycemia, so the low blood glucose level indicates a need for a change in therapy. The low blood pressure suggests that the pentamidine infusion rate may need to be slowed. The other responses indicate a need for independent nursing actions (such as establishing a new IV site and encouraging oral intake) but are not associated with pentamidine infusion.
2. Correct Answer: 4
Rationale:Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool. The health care provider should be notified so that actions such as testing a stool specimen for occult blood and administering proton pump inhibitors can be prescribed. The other symptoms are common in patients with RA and will require further assessment or intervention, but do not indicate that the patient is experiencing adverse effects from the medications.
Rationale:Both naproxen (a nonsteroidal anti-inflammatory drug [NSAID]) and prednisone (a corticosteroid) can cause gastrointestinal bleeding, and the stool appearance indicates that blood may be present in the stool. The health care provider should be notified so that actions such as testing a stool specimen for occult blood and administering proton pump inhibitors can be prescribed. The other symptoms are common in patients with RA and will require further assessment or intervention, but do not indicate that the patient is experiencing adverse effects from the medications.
3. Correct Answer: 1
Rationale:Nausea and vomiting are common adverse effects of interferon alfa-2a, but continued vomiting should be reported to the physician, because dehydration may occur. The medication may be given by either the subcutaneous or intramuscular route. Flulike symptoms such as a mild temperature elevation, headache, muscle aches, and anorexia are common after initiation of therapy but tend to decrease over time.
Rationale:Nausea and vomiting are common adverse effects of interferon alfa-2a, but continued vomiting should be reported to the physician, because dehydration may occur. The medication may be given by either the subcutaneous or intramuscular route. Flulike symptoms such as a mild temperature elevation, headache, muscle aches, and anorexia are common after initiation of therapy but tend to decrease over time.
4. Correct Answer: 3
Rationale:Patients taking immunosuppressive medications are at increased risk for development of cancer. A nontender swelling or lump may signify that the patient has lymphoma. The other data indicate that the patient is experiencing common side effects of the immunosuppressive medications.
Rationale:Patients taking immunosuppressive medications are at increased risk for development of cancer. A nontender swelling or lump may signify that the patient has lymphoma. The other data indicate that the patient is experiencing common side effects of the immunosuppressive medications.
5. Correct Answer: 4
Rationale:Viral load testing measures the amount of HIV genetic material in the blood, so a decrease in viral load indicates that the HAART is effective. The CD4 level, total lymphocytes, and complete blood count will also be used to assess the impact of HIV on immune function but will not directly measure the effectiveness of antiretroviral therapy.
Rationale:Viral load testing measures the amount of HIV genetic material in the blood, so a decrease in viral load indicates that the HAART is effective. The CD4 level, total lymphocytes, and complete blood count will also be used to assess the impact of HIV on immune function but will not directly measure the effectiveness of antiretroviral therapy.
6. Correct Answer: 2
Rationale:Methotrexate is teratogenic and should not be used by patients who are pregnant. The physician will need to discuss the use of contraception during the time the patient is taking methotrexate. The other patient information may require further patient assessment or teaching, but does not indicate that methotrexate may be contraindicated for the patient.
Rationale:Methotrexate is teratogenic and should not be used by patients who are pregnant. The physician will need to discuss the use of contraception during the time the patient is taking methotrexate. The other patient information may require further patient assessment or teaching, but does not indicate that methotrexate may be contraindicated for the patient.
7. Correct Answer: 2
Rationale:The varicella (chickenpox) vaccine is a live-virus vaccine and should not be administered to patients who are receiving immunosuppressive medications such as prednisone. The other medical orders are appropriate. Prednisone doses should be tapered gradually when patients have received long-term steroid therapy, but tapering is not necessary for short-term prednisone use. Measurement of C-reactive protein level is not the most specific test for monitoring treatment, but the test is inexpensive and frequently used. High doses of NSAIDs such as ibuprofen are more likely to cause side effects such as gastrointestinal bleeding but are useful in treating the joint pain associated with SLE exacerbations.
Rationale:The varicella (chickenpox) vaccine is a live-virus vaccine and should not be administered to patients who are receiving immunosuppressive medications such as prednisone. The other medical orders are appropriate. Prednisone doses should be tapered gradually when patients have received long-term steroid therapy, but tapering is not necessary for short-term prednisone use. Measurement of C-reactive protein level is not the most specific test for monitoring treatment, but the test is inexpensive and frequently used. High doses of NSAIDs such as ibuprofen are more likely to cause side effects such as gastrointestinal bleeding but are useful in treating the joint pain associated with SLE exacerbations.
8. Correct Answer: 3
Rationale:Albuterol is the most rapidly acting of the medications listed. Corticosteroids are helpful in preventing allergic reactions but are not rapidly acting. Cromolyn is used as a prophylactic medication to prevent asthma attacks but not to treat acute attacks. Aminophylline is not a first-line treatment for bronchospasm.
Rationale:Albuterol is the most rapidly acting of the medications listed. Corticosteroids are helpful in preventing allergic reactions but are not rapidly acting. Cromolyn is used as a prophylactic medication to prevent asthma attacks but not to treat acute attacks. Aminophylline is not a first-line treatment for bronchospasm.
9. Correct Answer: 4
Rationale:Although all of these laboratory values are outside of the normal range, the magnesium level is furthest from normal. With a magnesium level this low, the client is at risk for ECG changes and life-threatening ventricular dysrhythmias.
Rationale:Bilateral moist crackles indicate fluid-filled alveoli, which interferes with gas exchange. Furosemide is a potent loop diuretic that will help mobilize the fluid in the lungs. The other orders are important, but are not urgent.
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