A 30-year-old female client is admitted with complaints of numbness and tingling in extremities, and double vision which has occurred 2-3 times in the past month.
Which query is important for the nurse to ask the client?
Have you noticed a rash across the bridge of your nose?
Do you get tired easily and sometimes have problems swallowing?
Are you taking birth control pills to prevent pregnancy?
Have you experienced any difficulty with your menstrual cycle?
The Correct Answer is B
Choice A rationale
A malar or butterfly rash across the bridge of the nose is a classic diagnostic sign of Systemic Lupus Erythematosus (SLE), an autoimmune connective tissue disease. While SLE can involve the nervous system, the client's symptoms of double vision and extremity paresthesia are more characteristic of demyelinating processes. Asking about a rash is specific to a different inflammatory pathology and does not address the most likely differential diagnosis of Multiple Sclerosis suggested by the neurological symptoms.
Choice B rationale
Fatigue and dysphagia combined with visual disturbances and paresthesia are hallmark indicators of Multiple Sclerosis (MS) or Myasthenia Gravis. In MS, demyelination of central nervous system axons leads to slowed nerve conduction, manifesting as muscle weakness and sensory changes. Double vision, or diplopia, often results from lesions in the brainstem affecting cranial nerves. Asking about fatigue and swallowing issues helps the nurse assess for progressive neuromuscular or neurological deficits that are scientifically consistent with the reported symptoms.
Choice C rationale
While some oral contraceptives have been investigated for their influence on autoimmune flares, they are not a primary diagnostic or assessment factor for a client presenting with acute neurological symptoms like diplopia and paresthesia. This question does not help differentiate between potential neurological conditions or help establish a timeline for the onset of demyelination. The focus of the nursing assessment must remain on the physiological manifestations of the nervous system dysfunction to ensure patient safety and care.
Choice D rationale
Changes in the menstrual cycle can occur with various hormonal imbalances or chronic illnesses, but they are not a specific or sensitive indicator for the neurological complaints presented by the client. While some women with Multiple Sclerosis report a worsening of symptoms during their menstrual period due to fluctuations in core body temperature, asking about the difficulty of the cycle itself is less diagnostic than assessing for functional impairments like fatigue, weakness, or coordination problems during a neurovascular assessment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Doxycycline is a tetracycline antibiotic commonly used to treat Chlamydia trachomatis. The standard regimen often involves 100 milligrams taken twice daily for 7 days. If the client states she followed this protocol correctly, it indicates adherence to the treatment plan and is unlikely to be the cause of a recurrence or persistent infection. Proper completion of the antibiotic course is essential for eradicating the intracellular pathogen and preventing complications like pelvic inflammatory disease.
Choice B rationale
Chlamydia is a highly communicable sexually transmitted infection. If the client did not inform her partner, it is highly probable that the partner remained untreated and asymptomatic, acting as a reservoir for the bacteria. Upon resuming sexual activity, the client likely experienced reinfection through the untreated partner. Effective management of chlamydia must include the concurrent treatment of all recent sexual contacts to break the cycle of transmission and prevent the recurrence of clinical symptoms.
Choice C rationale
While alcohol consumption is generally discouraged during any medication regimen to avoid gastric irritation or metabolic interference, moderate intake of wine does not specifically neutralize the antibacterial efficacy of doxycycline. Unlike metronidazole, which causes a disulfiram-like reaction with alcohol, doxycycline does not have a direct contraindication with 1 or 2 glasses of wine. Therefore, this behavior is unlikely to be the primary reason the treatment for the chlamydia infection failed or why symptoms returned.
Choice D rationale
Practicing abstinence during the entire course of antibiotic treatment is a critical nursing instruction. It ensures that the infected tissues have time to heal and prevents the transmission of the bacteria to others or the immediate reinfection of the client before the pathogen is fully cleared. If the client successfully practiced abstinence while taking the medication, this behavior would support the success of the treatment rather than being the cause of the yellow discharge and itchiness.
Correct Answer is ["A","D","E"]
Explanation
Choice A rationale
Ultrasound is a vital component of chorionic villus sampling (CVS) to provide real-time visualization of the placenta and the needle or catheter placement. This ensures that the clinician can safely obtain a sample of the chorionic villi without injuring the fetus or the mother. The use of ultrasound reduces the risk of procedural complications such as hemorrhage or accidental pregnancy loss. Seeing the fetus during the procedure also allows for the assessment of fetal heart tones.
Choice B rationale
This statement is incorrect because chorionic villus sampling is typically performed between 10 and 13 weeks of gestation. Performing the procedure at 18 to 20 weeks would be inappropriate, as amniocentesis is the standard diagnostic tool used during the second trimester. CVS is specifically designed for early first-trimester genetic screening. Performing CVS too early (before 10 weeks) is associated with limb reduction defects, while performing it too late loses the benefit of early diagnosis and decision-making for the parents.
Choice C rationale
This statement is incorrect because CVS involves the removal of a small piece of placental tissue (chorionic villi) rather than amniotic fluid. Amniotic fluid is obtained during an amniocentesis. While both tests provide genetic information, CVS does not evaluate for neural tube defects because it does not measure alpha-fetoprotein levels found in the amniotic fluid. The client must understand that the tissue sample is what will be analyzed for chromosomal abnormalities like Down syndrome or other genetic conditions.
Choice D rationale
Rho(D) immune globulin (RhoGAM) is required for Rh-negative clients undergoing CVS because the procedure carries a risk of fetomaternal hemorrhage. If fetal blood cells enter the maternal circulation, the mother could develop antibodies against the Rh factor, leading to hemolytic disease of the newborn in future pregnancies. Administering RhoGAM prevents this sensitization. This is a standard prophylactic measure for any invasive prenatal procedure where blood mixing might occur, regardless of whether the procedure is performed transabdominally or transcervically.
Choice E rationale
For a transabdominal CVS procedure, a full bladder is often required to help displace the uterus upward and provide a better acoustic window for the ultrasound. This improves the visualization of the placental site and allows for safer needle insertion. If the procedure is performed transcervically, the bladder requirements may vary, but a full bladder is a common preparatory step in early pregnancy imaging and procedures to optimize the view of pelvic structures and the developing gestational sac.
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