A nurse is caring for a 16-year-old female adolescent in an urgent care clinic.
Which of the following instructions should the nurse provide to the adolescent with infectious mononucleosis?
Take amoxicillin 500 mg orally twice daily for 10 days.
Avoid contact sports for at least 4 to 6 weeks.
Apply a warm compress to the throat to reduce soreness.
Increase fluid intake to 3 liters per day to prevent dehydration
The Correct Answer is B
Choice A rationale: Amoxicillin is contraindicated in infectious mononucleosis due to the frequent occurrence of a morbilliform rash when administered during Epstein-Barr virus infection. This non-allergic rash results from immune activation and not true penicillin allergy, but its appearance can complicate diagnosis and treatment. Antibiotic therapy is unnecessary unless there is secondary bacterial infection. The rapid strep test is negative, and the Monospot confirms viral etiology, so antibiotics offer no therapeutic benefit.
Choice B rationale: Contact sports must be avoided in infectious mononucleosis due to risk of splenic rupture, a rare but serious complication. The Epstein-Barr virus causes splenomegaly through lymphoid tissue proliferation, and even minor abdominal trauma may lead to organ rupture. The spleen often remains enlarged for several weeks post-infection, so abstaining from impact sports (e.g., football, gymnastics) for 4–6 weeks post-diagnosis reduces this life-threatening risk. Ultrasound may guide readiness, but strict caution is required.
Choice C rationale: Warm compresses are typically soothing for muscular discomfort or localized inflammation but do not provide meaningful relief in viral pharyngitis linked to mononucleosis. Sore throat in this case is caused by lymphoid hyperplasia and tonsillar inflammation due to viral replication, for which systemic symptom control (e.g., analgesics, rest) is more effective. Warm compress use is not standard for throat pain management and offers negligible clinical utility.
Choice D rationale: While hydration is important, prescribing an arbitrary intake of 3 liters/day may be excessive for an adolescent female and could increase discomfort. Standard hydration guidance supports regular fluid intake based on thirst and activity level. Infectious mononucleosis causes fatigue and pharyngitis, making hydration a supportive measure, but overprescribing fluid intake is not evidence-based and could be misinterpreted. Monitoring signs of adequate hydration is more appropriate than rigid volume mandates
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Related Questions
Correct Answer is C
Explanation
Choice A rationale
Passive range-of-motion exercises are contraindicated during an acute hemarthrosis episode. Movement can exacerbate bleeding within the joint and cause further pain and damage to the synovial tissue and cartilage. The scientific rationale is to immobilize the affected joint to stop the bleeding and allow the clotting factors to work effectively. Gentle range of motion is only introduced later, during the rehabilitation phase.
Choice B rationale
Administering aspirin is a dangerous and contraindicated choice for a child with hemophilia. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) that inhibits platelet aggregation by irreversibly blocking cyclooxygenase-1 (COX-1) and COX-2 enzymes, thereby increasing the risk of bleeding. This can worsen the hemarthrosis. Acetaminophen or non-aspirin NSAIDs like ibuprofen are preferred for pain management in these patients.
Choice C rationale
Placing ice packs on the affected joints is the correct scientific intervention. Cold application, or cryotherapy, causes vasoconstriction, which helps to slow or stop the bleeding into the joint space. This reduces swelling, inflammation, and pain associated with hemarthrosis. The RICE acronym (rest, ice, compression, elevation) is a scientifically validated acute management strategy for joint bleeds in hemophilia.
Choice D rationale
Positioning the lower extremities below the level of the heart is scientifically incorrect. The affected extremity should be elevated above the level of the heart. Elevation uses gravity to reduce blood flow to the joint, which helps to decrease swelling, pain, and bleeding. Placing the extremity below the heart would increase blood flow and exacerbate the hemarthrosis, increasing intra-articular pressure and pain.
Correct Answer is D
Explanation
Choice A rationale
Dry mouth, or xerostomia, is not a common or expected adverse effect of cefazolin, which is a first-generation cephalosporin antibiotic. Adverse effects of cephalosporins are more commonly gastrointestinal, such as nausea and diarrhea, or hypersensitivity reactions. Dry mouth is more frequently associated with anticholinergic drugs or certain other medication classes.
Choice B rationale
Constipation is not a typical adverse effect associated with cefazolin. Cephalosporin antibiotics, like many other antibiotics, can disrupt the normal gut flora (microbiome), which more often leads to diarrhea. Diarrhea, sometimes severe and caused by Clostridioides difficile, is a known gastrointestinal side effect, but constipation is generally not a recognized concern.
Choice C rationale
Back pain is not a known or common adverse effect of cefazolin. Adverse effects of this antibiotic are typically related to the gastrointestinal system, the hematological system (e.g., leukopenia), or hypersensitivity reactions. Back pain is a non-specific symptom that is not directly attributable to the pharmacological action or known side effect profile of cefazolin.
Choice D rationale
Cefazolin is a beta-lactam antibiotic, a class of drugs that can cause hypersensitivity reactions. Urticaria, also known as hives, is a common manifestation of a type I hypersensitivity reaction, which involves the release of histamine from mast cells and basophils. This is a potentially serious adverse effect that the adolescent should monitor for and report immediately to the healthcare provider.
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