A nurse is assessing a patient who is presented with flu-like symptoms. Assessment reveals the presence of fever, sore throat, enlarged neck lymphatic nodes. What assessment question addresses the possible etiology of human immunodeficiency virus?
Has anyone in your family ever experienced symptoms similar to yours?"
"How many alcoholic drinks do you typically consume in a weak?"
To the best of your knowledge, are your immunizations up to date?"
"Have you recently had unprotected Intercourse with a new partner?"
The Correct Answer is D
A. "Has anyone in your family ever experienced symptoms similar to yours?":
This question aims to gather information about potential familial illnesses or infections but does not specifically address the possible etiology of human immunodeficiency virus (HIV). While HIV can be transmitted vertically from mother to child, asking about family members' symptoms is less directly relevant to the assessment of HIV exposure.
B. "How many alcoholic drinks do you typically consume in a week?":
This question assesses the patient's alcohol consumption habits and is important for evaluating overall health and potential risk factors for various conditions. However, it does not directly address the possible etiology of human immunodeficiency virus (HIV). Alcohol consumption may affect immune function but is not a primary indicator of HIV exposure.
C. "To the best of your knowledge, are your immunizations up to date?":
This question is aimed at assessing the patient's immunization status and is essential for preventive healthcare. However, it does not directly address the possible etiology of human immunodeficiency virus (HIV). Immunizations primarily protect against infectious diseases caused by bacteria or viruses other than HIV.
D. "Have you recently had unprotected intercourse with a new partner?":
This question directly addresses behaviors that could lead to HIV transmission. Unprotected sexual intercourse with a new partner is a significant risk factor for acquiring HIV, as the virus can be transmitted through sexual contact with an infected individual. Asking about recent sexual activity helps identify potential exposure to HIV and informs appropriate testing and counseling.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The partial thromboplastin time is 30 seconds:
The partial thromboplastin time (PTT) measures the clotting time of blood and is typically used to monitor patients on heparin therapy, not warfarin. A PTT of 30 seconds is within the normal range and does not directly relate to warfarin therapy. Therefore, it does not require immediate follow-up in the context of warfarin administration.
B. The International normalized ratio is 6.0:
The International Normalized Ratio (INR) is a standard measure used to monitor the effectiveness of warfarin therapy. For most indications, the therapeutic range for INR is typically between 2.0 and 3.0. A value of 6.0 indicates that the patient's blood is taking six times longer to clot than normal, suggesting a significantly increased risk of bleeding. Therefore, this result requires immediate follow-up by the nurse to assess the patient's condition and potentially adjust warfarin dosage to reduce the risk of bleeding.
C. Creatinine is 12:
Creatinine is a waste product generated by muscle metabolism and is filtered out of the blood by the kidneys. Elevated levels of creatinine may indicate impaired kidney function, but this result does not directly relate to warfarin therapy. While an elevated creatinine level may require follow-up for other reasons, it does not necessitate immediate action related to warfarin therapy.
D. The patient's hematocrit level is 43%:
Hematocrit is a measure of the proportion of red blood cells in the blood. A hematocrit level of 43% is within the normal range for both men and women and does not directly relate to warfarin therapy. While changes in hematocrit may occur in some patients taking warfarin, this result alone does not require immediate follow-up in the context of warfarin administration.
Correct Answer is ["42"]
Explanation
To calculate the infusion rate in mL/hr for total parenteral nutrition (TPN) to be infused over 24 hours, you would divide the total volume (1000 mL) by the total time (24 hours):
1000 mL ÷ 24 hr = approximately 41.67 mL/hr
Rounded to the nearest whole number, the IV pump should be set to deliver 42 mL/hr.
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