EXAM 3
Which of the following client statements indicate that the nurse's
teaching about the immunization was effective? Select all that
apply.
A. "I will need a booster shot every 10 years."
B. "My boyfriend should get this shot too."
C. "Now I won't need to worry about having Pap smears."
D. "I need to come back in 2 months for another shot."
E. "This shot can keep me from getting some kinds of cancer."
F. "I need to have a blood test when I'm an adult to see if I'm still immune."
G. "This shot will keep me from getting herpes."
Explanation
Correct Answer: B,D,E
Solution
A. "I will need a booster shot every 10 years.": The HPV vaccine series does
not require a booster every 10 years. The vaccine series typically consists of
two or three doses depending on the client’s age at initiation.
B. "My boyfriend should get this shot too.": HPV vaccination is recommended
for both males and females. It helps prevent the spread of HPV and protects
against certain cancers and genital warts in all genders.
C. "Now I won't need to worry about having Pap smears.": Pap smears
remain essential for cervical cancer screening. The HPV vaccine does not
protect against all oncogenic HPV strains or other causes of cervical
abnormalities.
D. "I need to come back in 2 months for another shot.": For a three-dose
series, the second dose is typically administered 1–2 months after the first,
with the third dose given six months after the first.
E. "This shot can keep me from getting some kinds of cancer.": The HPV
vaccine protects against high-risk HPV strains responsible for most cervical,
anal, oropharyngeal, and genital cancers.
F. "I need to have a blood test when I'm an adult to see if I'm still immune.":
There is no routine blood test to check HPV immunity, and the protection
from vaccination is considered long-term without need for antibody testing.
,G. "This shot will keep me from getting herpes.": The HPV vaccine protects
only against human papillomavirus, not herpes simplex virus (HSV), which is
a separate sexually transmitted infection.
client reports for a scheduled appointment to discuss increased
heartburn and acid reflux. Client has a history of hypothyroidism
and hypertension. Client states, "I used to take my thyroid medicine
first thing in the morning, but it really upsets my stomach, so I've
started to take it right after breakfast with the rest of my pills and
that seems to help some." Provider visit completed. Laboratory
prescriptions received.
Day 2:
Follow up phone call to client to discuss laboratory results and provider
prescriptions. Provided education regarding therapeutic medication regimen.
A nurse is caring for a client in an outpatient clinic.
Explanation
Correct Answer:
Dropdown Group 1: decreased absorption
Dropdown Group 2: medication interactions
Solution
Decreased absorption: Levothyroxine should be taken on an empty stomach, typically 30–
60 minutes before breakfast, to ensure optimal absorption in the gastrointestinal tract.
Taking it with food or other medications, such as a multivitamin or esomeprazole, reduces
its bioavailability and can blunt its therapeutic effect over time.
Medication interactions: The client takes levothyroxine with multiple morning medications,
including a multivitamin and esomeprazole. Calcium, iron, and proton pump inhibitors
(like esomeprazole) interfere with levothyroxine absorption by altering stomach pH or
binding the drug in the gut, increasing the risk for subtherapeutic effects.
Toxicity: Toxicity is unlikely in this scenario because taking levothyroxine with food or
interacting medications reduces, not enhances, absorption. This would more likely result in
hypothyroid symptoms rather than hyperthyroidism.
, Goiter: Although poor thyroid hormone levels can eventually contribute to goiter
development, this is a long-term effect of untreated or severe hypothyroidism and not an
immediate concern linked to current medication timing.
Lab results: The client’s TSH and free T4 levels are currently within normal range,
suggesting stable thyroid function. The main issue is the administration timing and
potential interactions, not an abnormal lab result.
Dosage strength: The prescribed levothyroxine dosage (100 mcg) appears appropriate
based on the current lab values. The problem lies in how the medication is taken rather than
the dose itself.
Walk-in clinic visit for 16-year-old client accompanied by their parent. The
parent states, "My daughter has a boyfriend and I want to be sure that she
has some birth control before becoming sexually active." The client states, "I
want to be sure I don't get pregnant or get an STI."
0915:
Witnessed consent signed by client and parent. Assisted provider with
placement of intrauterine device (IUD). Client tolerated procedure well.
1000:
Administered immunization as prescribed. Provided client with a package of
condoms.
A nurse is caring for an adolescent client in a community health clinic.
A nurse is reviewing a client's medical record before administering
acetaminophen 650 mg PO every 6 hr. Which of the following
findings indicates a need for the nurse to notify the provider?
A. Hypothyroidism
B. BP 92/60 mm Hg
C. History of alcohol use disorder
D. Recurrent headaches
Explanation
Correct Answer : C
Hypothyroidism: Hypothyroidism does not directly affect acetaminophen
metabolism or increase risk of toxicity. It does not require notifying the
provider before administration.