Choice A rationale

Losartan is an angiotensin II receptor blocker (ARB) which works by preventing angiotensin II from binding to its receptors in vascular smooth muscle, thereby causing vasodilation and lowering blood pressure. Hypertension is the condition losartan is prescribed to treat, not an adverse effect, because its mechanism directly counteracts the vasoconstrictive effects of angiotensin II. The intended therapeutic effect is a reduction in systemic vascular resistance and blood pressure.

Choice B rationale

Double vision, also known as diplopia, is not a recognized common or significant adverse effect of losartan. The mechanism of action of losartan primarily targets the renin-angiotensin-aldosterone system (RAAS), influencing blood pressure regulation and fluid balance, not directly affecting the central nervous system or ocular motor function. This symptom would be more indicative of neurological or ophthalmological issues unrelated to the medication's primary action.

Choice C rationale

Dizziness is a common adverse effect of losartan. This is a direct consequence of its therapeutic action, which is to lower blood pressure. The resulting vasodilation and reduced blood pressure can lead to orthostatic hypotension, causing feelings of lightheadedness or dizziness, especially when a person changes positions, like standing up. The brain's reduced perfusion pressure triggers this sensation as a physiological response.

Choice D rationale

Hyperactivity is not an expected adverse effect of losartan. The medication primarily affects the cardiovascular system by modulating the RAAS to lower blood pressure. It does not have known stimulant properties that would lead to increased energy, restlessness, or hyperactivity. Such a finding would likely be attributed to other factors or a different underlying condition, not the pharmacological action of this medication. *.

Choice A rationale

Sitting in chairs with low, soft backs can worsen osteoarthritis symptoms and increase joint stress. Low chairs require more force from the hips and knees to stand up, which can strain these joints. Soft backs provide inadequate support, leading to poor posture and increased stress on the spine and other joints. Proper joint protection involves maintaining good posture and minimizing strain on affected joints.

Choice B rationale

Using both hands to hold objects distributes the weight and stress evenly across multiple joints, such as those in both wrists and hands, thereby reducing the workload on any single joint. This technique minimizes the risk of joint deformation and pain associated with osteoarthritis by preventing excessive force from being applied to a single joint, a key principle of joint protection.

Choice C rationale

Pushing up from a bed with fingers puts a concentrated, high-impact force on the small joints of the fingers, which are often affected by osteoarthritis. This action can lead to pain, inflammation, and potential deformity over time. Instead, individuals should use their palms or forearms to push up, distributing the force over a larger, stronger surface area.

Choice D rationale

Turning doorknobs clockwise or in any specific direction with a forceful grip can exacerbate joint pain and strain in the fingers and wrist. This motion places significant torque on the affected joints. To protect joints, clients should be advised to use lever-style doorknobs or adaptive devices that require less grip strength and a different motion. *.

Choice A rationale

Sitting in chairs with low, soft backs can worsen osteoarthritis symptoms and increase joint stress. Low chairs require more force from the hips and knees to stand up, which can strain these joints. Soft backs provide inadequate support, leading to poor posture and increased stress on the spine and other joints. Proper joint protection involves maintaining good posture and minimizing strain on affected joints.

Choice B rationale

Using both hands to hold objects distributes the weight and stress evenly across multiple joints, such as those in both wrists and hands, thereby reducing the workload on any single joint. This technique minimizes the risk of joint deformation and pain associated with osteoarthritis by preventing excessive force from being applied to a single joint, a key principle of joint protection.

Choice C rationale

Pushing up from a bed with fingers puts a concentrated, high-impact force on the small joints of the fingers, which are often affected by osteoarthritis. This action can lead to pain, inflammation, and potential deformity over time. Instead, individuals should use their palms or forearms to push up, distributing the force over a larger, stronger surface area.

Choice D rationale

Turning doorknobs clockwise or in any specific direction with a forceful grip can exacerbate joint pain and strain in the fingers and wrist. This motion places significant torque on the affected joints. To protect joints, clients should be advised to use lever-style doorknobs or adaptive devices that require less grip strength and a different motion. *.

Choice A rationale

A corn tortilla with black beans is an excellent recommendation for a child with celiac disease. Corn is a naturally gluten-free grain, making corn tortillas a safe choice. Black beans are also gluten-free and provide essential protein, fiber, and iron, which are often deficient in a gluten-free diet. This meal provides a balanced and safe option for the child.

Choice B rationale

Low sodium vegetable soup with barley is an inappropriate recommendation because barley is a grain that contains gluten. Celiac disease is an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine. Barley, along with wheat and rye, must be completely avoided to prevent an immune response and associated symptoms and intestinal damage.

Choice C rationale

Whole wheat pasta with shrimp is contraindicated for a child with celiac disease. Whole wheat is a form of wheat, which is a major source of gluten. Consuming whole wheat pasta would trigger an autoimmune reaction, causing inflammation and damage to the small intestinal villi, leading to malabsorption and a range of gastrointestinal symptoms.

Choice D rationale

A bologna sandwich on rye bread is a harmful choice for a child with celiac disease. Rye bread is made from rye grain, which is a source of gluten and must be avoided. The consumption of rye bread, like other gluten-containing grains, will provoke an immune response that damages the lining of the small intestine in individuals with this condition. *.

Choice A rationale

Chills are a systemic manifestation of an infectious process and are commonly associated with endometritis. Endometritis is an infection of the uterine lining, which can cause a systemic inflammatory response. This response often includes fever and chills, as the body's immune system fights the invading pathogens, causing a thermoregulatory cascade. A temperature of 100.4°F (38°C) or higher is typical.

Choice B rationale

Back pain can occur with various postpartum conditions, but it is not a primary or specific finding for endometritis. While uterine cramping and pelvic pain are characteristic due to the uterine inflammation, back pain is not as specific. More classic signs are fever, lower abdominal pain, uterine tenderness, and foul-smelling lochia due to the presence of bacteria.

Choice C rationale

Tachycardia, not bradycardia, is an expected finding in a client with endometritis. Tachycardia is a physiological response to fever, infection, and the systemic inflammatory process. The heart rate increases to compensate for increased metabolic demand and to circulate immune cells more efficiently. Bradycardia would be an unusual and unexpected finding.

Choice D rationale

Agitation is not a primary or typical finding of endometritis. Endometritis is a physical infection of the uterine lining. While discomfort and fever may cause irritability, agitation is not a specific expected symptom. This finding is more associated with neurological or psychiatric conditions, or severe complications like septic shock, which is a more advanced state. *.

Choice A rationale

Spironolactone is a potassium-sparing diuretic. Its mechanism of action involves blocking aldosterone receptors in the kidney's distal convoluted tubule and collecting duct, leading to increased sodium and water excretion while retaining potassium. Consequently, taking a potassium supplement concurrently would dangerously increase the risk of hyperkalemia, a condition characterized by high blood potassium levels (normal range is 3.5-5.0 mEq/L), which can cause life-threatening cardiac dysrhythmias.

Choice B rationale

Spironolactone's primary effect is on sodium and potassium balance, not calcium. Calcium supplements do not typically interact with spironolactone in a way that would cause a significant, adverse change in calcium levels. The nurse should instruct the client to avoid supplements that directly alter the electrolytes affected by the medication's mechanism of action.

Choice C rationale

Spironolactone does not significantly impact iron metabolism. Therefore, a client taking an iron supplement would not be at increased risk of an adverse interaction. Iron supplements are generally well-tolerated with spironolactone, and there is no contraindication for their concurrent use. The focus of client teaching should be on electrolytes directly affected by the medication.

Choice D rationale

Spironolactone does not have a direct or clinically significant interaction with magnesium supplements. While diuretics can sometimes affect magnesium levels, spironolactone's primary action is on potassium and sodium. Therefore, there is no major contraindication for the use of magnesium supplements, unlike the life-threatening risk associated with potassium supplementation. *.

Choice A rationale

This 12-year-old child with cystic fibrosis and difficulty clearing secretions is the priority. Cystic fibrosis causes thick mucus to accumulate in the lungs, leading to airway obstruction. Inability to clear these secretions indicates a potential acute respiratory crisis, which can rapidly progress to respiratory failure. This is a life-threatening airway and breathing emergency requiring immediate assessment and intervention to prevent respiratory compromise.

Choice B rationale

A 3-year-old with an atrial septal defect and a heart rate of 120/min is a non-acute finding. A heart rate of 120/min is within the normal range for a toddler (90-140/min) and is a common physiological response in a child with a heart defect to maintain cardiac output. This child is stable and does not present with an immediate life-threatening condition.

Choice C rationale

A 2-year-old with diarrhea and abdominal pain is a non-acute finding. While these symptoms require attention, they are common in toddlers and do not typically represent an immediate life-threatening emergency unless accompanied by signs of severe dehydration or septic shock. Other children with respiratory issues take priority due to the higher potential for rapid decompensation.

Choice D rationale

A 5-year-old with type 1 diabetes mellitus and a blood sugar of 150 mg/dL is stable. A blood sugar of 150 mg/dL is within a safe, controlled range for a child with type 1 diabetes, which is typically 80-180 mg/dL. This child does not require immediate intervention as their blood glucose is not indicative of hypo- or hyperglycemia crises. .

Choice A rationale

Administering a vasoconstrictor is a potential intervention for shock but it is not the first action. The client's hypotension and tachycardia are indicative of hypovolemic shock due to profuse vomiting, leading to fluid loss. The body's initial compensatory mechanism involves vasoconstriction to maintain blood pressure, so further constriction without addressing the volume deficit can worsen tissue perfusion.

Choice B rationale

The client is exhibiting signs of hypovolemic shock, including a low blood pressure of 86/58 mmHg, a high pulse of 114/min, and a high respiratory rate of 27/min. These are physiological compensations for reduced circulating blood volume. Increasing the intravenous infusion rate directly addresses the primary problem by rapidly replacing lost fluid volume, thereby increasing preload, stroke volume, cardiac output, and ultimately, blood pressure.

Choice C rationale

Elevating the client's feet can temporarily increase venous return to the heart and improve blood pressure. However, this is a passive measure that does not address the underlying fluid deficit causing the hypovolemic shock. It is a helpful adjunctive action but is not the definitive first-line intervention required to correct the circulatory collapse in this scenario.

Choice D rationale

Initiating oxygen therapy is a supportive measure for shock because it helps improve tissue oxygenation, which is compromised due to poor perfusion. While beneficial, it does not correct the root cause of the shock, which is the lack of circulating fluid volume. The most immediate and life-saving intervention is to restore fluid volume to improve cardiac output and blood pressure

Choice A rationale

Tetracycline binds to divalent and trivalent cations such as calcium, magnesium, and aluminum. Milk and dairy products are rich in calcium, so taking tetracycline with milk significantly reduces its absorption from the gastrointestinal tract, rendering the medication less effective. The drug should be taken on an empty stomach with a full glass of water.

Choice B rationale

Taking tetracycline at bedtime is not a recommended practice for this drug. Although some medications are taken at night to avoid side effects or promote sleep, tetracycline can cause gastroesophageal reflux or esophagitis, particularly when a person lies down soon after ingestion. It is important to remain upright for at least 30 minutes after taking the medication.

Choice C rationale

Photosensitivity is a well-documented adverse effect of tetracycline. The drug sensitizes the skin to ultraviolet light, leading to an exaggerated sunburn reaction. This is due to the drug's accumulation in the skin and its ability to absorb light energy. Clients must be advised to use sunscreen, wear protective clothing, and avoid prolonged sun exposure.

Choice D rationale

Tetracycline is known to cause gastrointestinal side effects, but diarrhea is far more common than constipation. This is often due to the disruption of the normal gut flora, which can lead to opportunistic infections like Clostridium difficile. While not exclusively causing diarrhea, constipation is not a typical adverse effect and should not be the primary teaching point. *.

Choice A rationale

Varying a child's scheduled activities each day is counterproductive for a child with ADHD. Children with this condition benefit significantly from structured routines and predictable schedules. A consistent daily structure minimizes the need for the child to process new information and adapt to changes, which can be overwhelming and lead to decreased concentration and increased impulsivity.

Choice B rationale

Encouraging a child with ADHD to read a book during an outdoor school activity period is not a suitable strategy. This situation places the child in an environment filled with external stimuli, such as other children playing, sounds, and visual distractions. This highly stimulating setting is precisely the opposite of what is needed to improve focus and attention in a child with ADHD.

Choice C rationale

Children with ADHD have difficulty filtering out irrelevant stimuli from their environment. Providing a designated, quiet space with minimal distractions directly addresses this core challenge. This environment reduces the number of competing sensory inputs, allowing the child to direct their limited attention resources more effectively toward a single task, such as homework, thereby improving concentration.

Choice D rationale

The mode of completing homework, whether by hand or using a computer, is less critical than the environmental context. While a computer might offer some interactive benefits, it also presents numerous potential distractions, such as internet access, games, and notifications. Having a child write by hand in a distracting environment would not be as effective as using a computer in a distraction-free zone. *.