A nurse is admitting a 68-year-old male client in the accident and emergency unit.
For each potential provider's prescription, click to specify if the prescription is anticipated or contraindicated.
Initiate IV fluids.
Administer aspirin for abdominal pain.
Insert a nasogastric tube, attach to low suction.
Initiate continuous ECG monitoring.
Test stools for occult blood.
The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"A"}}
· Initiate IV fluids – Contraindicated: While IV fluids might be helpful in some cases, excessive fluid administration could exacerbate certain conditions like heart failure or fluid overload. It would depend on the underlying cause of his symptoms.
· Administer aspirin for abdominal pain – Contraindicated: Aspirin can worsen gastrointestinal conditions, especially in someone with GERD. It can increase the risk of gastric irritation or even bleeding.
· Insert a nasogastric tube, attach to low suction – Contraindicated: While NG tube placement can be used for gastric decompression, it is generally not the first step in managing GERD or non-obstructive epigastric pain. This should only be considered if there is suspicion of an obstructive process.
· Initiate continuous ECG monitoring – Anticipated: Given his tachycardia, elevated blood pressure, and history of anxiety, monitoring his cardiac status would be appropriate to rule out cardiac involvement.
· Test stools for occult blood – Anticipated: Considering his long history of smoking and GERD, there is a risk of gastrointestinal bleeding, so checking for occult blood would be a reasonable precaution.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Checking blood glucose levels for hypoglycemia once yearly is insufficient for a patient taking high doses of oral glucocorticoids for an extended period. Glucocorticoids can cause hyperglycemia by increasing gluconeogenesis and insulin resistance. Therefore, blood glucose monitoring should be more frequent, especially when initiating or adjusting the dosage. Normal fasting blood glucose levels are typically 70-99 mg/dL.
Choice B rationale
Limiting the intake of calcium-rich foods is incorrect advice for a patient on long-term glucocorticoid therapy. Glucocorticoids can decrease calcium absorption from the gut and increase bone resorption, leading to osteoporosis. Therefore, patients on these medications should be encouraged to maintain an adequate intake of calcium and vitamin D to help preserve bone density. Normal total serum calcium levels range from 8.6 to 10.2 mg/dL.
Choice C rationale
Monitoring for fractures over the next several months is an important instruction for a patient taking high doses of oral glucocorticoids long-term. Glucocorticoids increase the risk of osteoporosis and subsequent fractures, particularly vertebral compression fractures and hip fractures, due to their effects on bone metabolism. Regular monitoring and preventive measures are crucial.
Choice D rationale
Glucocorticoids do not boost immunity; instead, they suppress the immune system by inhibiting the production and function of various immune cells and inflammatory mediators. This immunosuppressive effect is why they are used to treat autoimmune diseases like rheumatoid arthritis, but it also increases the risk of infections.
Correct Answer is A
Explanation
Choice A rationale
Basal cell carcinoma is the most common type of skin cancer and often presents as a raised, flesh-colored or pearly white lesion with rolled borders and sometimes visible blood vessels (telangiectasia). Its slow growth and characteristic appearance align with the description provided.
Choice B rationale
Malignant melanoma is a more aggressive form of skin cancer that typically appears as an asymmetrical mole with irregular borders, uneven color (often shades of black, brown, red, white, or blue), and a diameter greater than 6 mm. It is less likely to present as a raised, flesh-colored lesion with pearly borders.
Choice C rationale
Actinic keratosis is a precancerous skin condition characterized by rough, scaly patches that develop on sun-exposed areas. These lesions are typically flat or slightly raised and can be red, tan, or flesh-colored. The description of pearly white borders does not typically fit actinic keratosis.
Choice D rationale
Squamous cell carcinoma is the second most common type of skin cancer and can appear as a firm, red nodule or a flat lesion with a scaly or crusted surface. While it can vary in appearance, the description of pearly white borders is more characteristic of basal cell carcinoma.
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