Rhogam is most often used to treat____ mothers that have a ____ infant.
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Solution
Rhogam prevents the production of anti-RH antibodies in the mother that has a Rh-positive fetus.
A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect?
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Solution
Hypercalcemia can cause polyuria, severe abdominal pain, and confusion.
Option A: Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the large intestine; most people don’t have symptoms.
Option C: Hypocalcemia is low calcium levels in the blood; it is asymptomatic in mild forms but can cause paresthesia, tetany, muscle cramps, and carpopedal spasms in severe hypocalcemia.
Option D: Irritable bowel syndrome is a widespread condition involving recurrent abdominal pain and diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal infection.
You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect?
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Solution
All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of anorexia nervosa is self-imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic abuse.
Option A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged.
Option C: On the other hand, bulimia nervosa features binge eating followed by a feeling of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, use of laxatives or diuretics.
Option D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue.
A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect?
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Solution
Autonomic neuropathy (also known as Diabetic Autonomic Neuropathy) affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs. Paralysis of the bladder is a common symptom of this type of neuropathy.
Option A: Atherosclerosis, or hardening of the arteries, is a condition in which plaque builds up inside the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium and fibrin (a clotting material in the blood).
Option B: Diabetic nephropathy (DN) is typically defined by macroalbuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and decline in GFR, hypertension, and a high risk of cardiovascular morbidity and mortality.
Option D: Somatic neuropathy affects the whole body and presents with diverse clinical pictures, most common is the development of diabetic foot followed by diabetic ulceration and possible amputation.
A second-year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that nursing student should take?
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Solution
Azidothymidine (AZT) treatment is the most critical intervention. It is an antiretroviral medication used to prevent and treat HIV/AIDS by reducing the replication of the virus.
Options A and D: Other interventions mentioned are to be done later.
Option C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis pneumonia
A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb?
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Solution
IgG is the only immunoglobulin that can cross the placental barrier.
Option A: IgA antibodies protect body surfaces that are exposed to outside foreign substances.
Option B: IgD antibodies are found in small amounts in the tissues that line the belly or chest.
Option C: IgE antibodies cause the body to react against foreign substances such as pollen, spores, animal dander.
You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drug, if found inside the fridge, should be removed?
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Solution
Nadolol (Corgard) is stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat, moisture, and light. Do not store in the bathroom and keep bottle tightly closed.
Option B: Humulin N injection if unopened (not in use) is stored in the fridge and is used until the expiration date, or stored at room temperature and used within 31 days. If opened (in-use), store the vial in a refrigerator or at room temperature and use within 31 days. Store the injection pen at room temperature (do not refrigerate) and use within 14 days. Keep it in its original container protected from heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has been frozen.
Option C: Urokinase (Kinlytic) is refrigerated at 2–8°C.
Option D: Epoetin alfa IV (Epogen) vials should be stored at 2°C to 8°C (36°F to 46°F); Do not freeze. Do not shake. Protect from light.
A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration?
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Solution
Aspirin is not known to cause discoloration of the urine.
Option A: Sulfasalazine may discolor the urine or skin to an orange-yellow color.
Option B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color.
Option C: Phenolphthalein can discolor the urine to a red color.
A nurse is reviewing a patient’s past medical history (PMH). The history indicates the patient has photosensitive reactions to medications. Which of the following drugs is associated with photosensitive reactions? Select all that apply:
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Solution
Answers: A, B, C, D, and E.
Photosensitivity is an extreme sensitivity to ultraviolet (UV) rays from the sun and other light sources. A type of photosensitivity called Phototoxic reactions are caused when medications in the body interact with UV rays from the sun. Antiinfectives are the most common cause of this type of reaction.
A nurse is reviewing a patient’s medication during shift change. Which of the following medications would be contraindicated if the patient were pregnant? Select all that apply:
A. Warfarin (Coumadin)
B. Finasteride (Propecia, Proscar)
C. Celecoxib (Celebrex)
D. Clonidine (Catapres)
E. Transdermal nicotine (Habitrol)
F. Clofazimine(Lamprene)
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Solution
Answers: A, and B.
Option A: Warfarin (Coumadin). Has a pregnancy category X and associated with central nervous system defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when given anytime during pregnancy and a fetal warfarin syndrome when given during the first trimester.
Option B: Finasteride (Propecia, Proscar). Also has a pregnancy category X which has a high risk of causing permanent damage to the fetus.
Option C: Celecoxib (Celebrex). Large doses cause birth defects in rabbits; not known if the effect on people is the same.
Option D: Clonidine (Catapres). Crosses the placenta but no adverse fetal effects have been observed.
Option E: Transdermal nicotine (Habitrol). Nicotine replacement products have been assigned to pregnancy category C (nicotine gum) and category D (transdermal patches, inhalers, and spray nicotine products).
Option F: Clofazimine (Lamprene). Clofazimine has been assigned to pregnancy category C.