A client is taking the immunosuppressant medication, azathioprine (Imuran), for the treatment of Crohn's disease. What statement made by the client demonstrates an understanding of the side effects of this medication?

"I will drink at least 3 L of fluid per day."

"I will stop taking my medication if I notice any side effects and then notify the doctor."

"I will notify the doctor if I am not having a bowel movement daily."

"I will notify the doctor if I have a fever or any other signs of infection."

Answer and Explanation

The Correct Answer is D

A. "I will drink at least 3 L of fluid per day.": While staying hydrated is beneficial, fluid intake is not directly related to the side effects or safety concerns of azathioprine. Some medications can affect the kidneys, making hydration crucial, but it's not the primary concern related to immune suppression.
B. "I will stop taking my medication if I notice any side effects and then notify the doctor.": Abruptly discontinuing azathioprine without physician approval may worsen Crohn's disease or cause withdrawal issues. Medication changes should always be guided by the healthcare provider to ensure safety and continuity of care.
C. "I will notify the doctor if I am not having a bowel movement daily.": Constipation is not a primary concern with azathioprine therapy, and bowel patterns may vary with Crohn’s flares. Monitoring for signs of infection or bone marrow suppression is far more critical with this drug.
D. "I will notify the doctor if I have a fever or any other signs of infection.":
Azathioprine suppresses immune function, increasing the risk for potentially serious infections. Prompt reporting of fever allows for early intervention to prevent sepsis or other complications in immunocompromised individuals.

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Correct Answer is D

Explanation

A. Congenital neural tube defect: This condition affects the central nervous system and is unrelated to the structure or function of the heart valves. It does not contribute to the development of mitral regurgitation.
B. Pacemaker inserted 2 years ago: While a pacemaker reflects a history of cardiac rhythm issues, it does not directly affect the mitral valve. It provides less diagnostic value for assessing structural valve disorders.
C. One-pack-a-day smoker for 20 years: Smoking is a major risk factor for coronary artery disease and other cardiovascular problems like hypertension. While these can indirectly affect the heart, smoking is not a primary cause of mitral valve damage leading to regurgitation.
D. Rheumatic fever: Rheumatic fever is a leading cause of mitral valve damage, often resulting in regurgitation due to scarring and deformation of the valve as a complication of untreated or poorly treated strep throat infection. This history is highly relevant and provides strong diagnostic value.

A. Left lateral B. Right lateral C. Prone D. Supine

Correct Answer is A

Explanation

A. Left lateral: Placing the client in the left lateral decubitus position brings the heart closer to the chest wall, especially the mitral valve. This position enhances the nurse’s ability to hear low-pitched diastolic murmurs like those associated with mitral stenosis.
B. Right lateral: This position does not improve the ability to hear mitral valve sounds. It moves the heart further from the chest wall and is not used for cardiac auscultation purposes.
C. Prone: A prone position is not used for heart assessments and may interfere with effective auscultation. It compresses the chest and limits access to key valve areas.
D. Supine: While commonly used for initial heart assessments, it may not be ideal for detecting low-frequency murmurs. Certain murmurs become more audible when the client is in a specific position, such as the left lateral for mitral stenosis.

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A client is taking the immunosuppressant medication, azathioprine (Imuran), for the treatment of Crohn's disease. What statement made by the client demonstrates an understanding of the side effects of this medication?

Nursing Test Bank

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