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An adolescent patient is taking combination retroviral therapy for HIV infection. He is not
responding as expected. Which action by the nurse is most appropriate?
A. Asking why he does not take the medications
B. Assessing the patient for noncompliance
C. Consulting a pediatric social worker
D. Starting a simpler drug regimen for the HIV
ANS: A
Adolescents are notorious for wanting to fit in with their peers, even at the cost of their
health, and are frequently noncompliant with medication regimens. This is compounded by
the very complex nature of multi-drug therapy for HIV. The nurse needs to assess for
noncompliance first. Asking "why" questions often puts people on the defensive and may not
lead to a truthful response. Consulting a social worker may be needed, but not as the first
step. Unfortunately, simple drug regimens for HIV do not exist.
A teenage girl is diagnosed with systemic lupus erythematosus (SLE). Which health promotion
guidance is important for the nurse to provide?
A. "Acetaminophen (Tylenol) is best for daily pain."
B. "Consider adding vitamin D to your daily routine."
C. "Plan to choose a career that is sedentary."
D. "You should consider elective sterilization."
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,ANS: B
Sun exposure is a frequent cause of SLE exacerbations, so patients with SLE must use
sunscreen and avoid prolonged time in the sun. This decreases vitamin D synthesis, which is
required to metabolize and utilize calcium, leading to increased risk of osteoporosis. A side
effect of steroid use is also osteoporosis, so patients with SLE (women especially) need to
guard against this occurrence by adding supplemental vitamin D. NSAIDs are best for the pain
and inflammation that accompany SLE. The patient does not have to be sedentary; a balance
of rest and activity is needed. Pregnancy is not absolutely contraindicated in the patient with
SLE; however, it must be considered cautiously in consultation with the health-care provider.
An immunocompromised child has been admitted to the hospital with Fifth's disease. Which
action by the nurse is most appropriate?
A. Place the child in contact precautions.
B. Place the child in droplet precautions.
C. Place the child in protective isolation.
D. Place the child on standard precautions.
ANS: B
Fifth's disease is spread through respiratory droplets, so droplet precautions are appropriate.
Of course standard precautions should be used with all patients, but this is not enough in this
situation. Contact and protective precautions are not needed for this disease.
The clinic nurse is assessing a teenage girl who reports fever, chills, sore throat, and extreme
fatigue during the last 2 weeks. Which focused assessment should the nurse perform?
A. Assess lymph nodes.
B. Collect buccal swabs.
C. Obtain a urinalysis.
D. Palpate the abdomen.
ANS: A
This girl's age and symptoms are highly suggestive of infectious mononucleosis. The nurse
should assess for swollen and tender occipital and cervical lymph nodes. The nurse should not
palpate the abdomen because the spleen, if enlarged, can rupture under pressure. Buccal
swabs and urinalysis are not related.
A child has been diagnosed with influenza and is prescribed oseltamivir (Tamiflu). Which
instruction by the nurse is most important?
A. "Do not use aspirin with this drug."
B. "Encourage plenty of liquids."
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, C. "Rinse the inhaler after each use."
D. "This will cure the flu in 5 days."
ANS: B
Common side effects of Tamiflu include nausea, vomiting, GI distress, and diarrhea. The child
should drink plenty of fluids to avoid dehydration. Aspirin is not used in children at all due to
the risk of Reye's syndrome. Tamiflu is not given via inhaler. The medication is not curative.
A child hospitalized with heart failure has manifestations related to increased preload. Which
drug does the nurse prepare to administer?
A. Digoxin (Lanoxin)
B. Dopamine (Intropin)
C. Furosemide (Lasix)
D. Metoprolol (Toprol)
ANS: C
Furosemide is a diuretic, used to rid the body of excess fluid, and it is excess fluid that leads to
increased preload. Digoxin is often used in heart failure for its positive inotropic actions.
Dopamine increases contractility. Metoprolol is a beta blocker, and its major effect is blocking
sympathetic nervous system activity.
A student nurse asks the faculty why a child with patent ductus arteriosus (PDA) is taking a
nonsteroidal anti-inflammatory drug (NSAID). Which response by the faculty is the most
appropriate?
A. Decreases venous stasis, lowering risks of clotting
B. Inhibits prostaglandin, which helps close the PDA
C. Provides long-lasting pain and inflammation control
D. Reduces swelling around the PDA, making surgery easier
ANS: B
Prostaglandin helps keep the PDA open, so an NSAID that inhibits prostaglandin synthesis will
help close the opening. This is especially beneficial for premature infants. It is not used for
venous stasis, pain relief, or swelling.
A nurse is assessing patients for the presence of patent ductus arteriosus (PDA). Which patient
should the nurse assess first?
A. 1-year old, history of frequent colds
B. 4-year old, blood pressure of 102/36 mm Hg
C. Infant with history of poor feeding
D. Toddler with murmur at right sternal border
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