A nurse is collecting a medication history from the parent of a preschooler who comes to the clinic for routine immunizations. For which of the following findings should the nurse withhold the varicella immunization?

A pregnant parent

Receiving treatment for leukemia

Taking acetaminophen for mild discomfort

An allergy to eggs

Answer and Explanation

The Correct Answer is B

A. A pregnant parent. A child can receive the varicella vaccine even if the parent is pregnant. While the varicella vaccine is a live attenuated vaccine, the vaccinated child does not pose a significant risk of transmission to others. The parent should avoid direct contact with the vaccinee's rash if one develops, but this is not a contraindication to immunization.

B. Receiving treatment for leukemia. Children undergoing treatment for leukemia often have weakened immune systems due to chemotherapy or radiation. The varicella vaccine is a live attenuated vaccine, meaning it contains a weakened form of the virus that could cause severe illness in immunocompromised individuals. These children should not receive live vaccines until their immune function improves and their healthcare provider approves vaccination.

C. Taking acetaminophen for mild discomfort. Acetaminophen is an over-the-counter pain reliever and fever reducer that does not interfere with the efficacy or safety of the varicella vaccine. There is no evidence that mild analgesic use before or after vaccination affects immune response, so it is not a reason to withhold the immunization.

D. An allergy to eggs. Unlike some influenza and yellow fever vaccines, the varicella vaccine is not produced using egg-based components. An egg allergy is not a contraindication to receiving the varicella vaccine, as it does not contain egg proteins.

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Correct Answer is B

Explanation

A. Tingling sensation. A mild tingling or paresthesia is a common side effect of sumatriptan due to its vasoconstrictive action. While it should be monitored, it is not typically harmful and does not require immediate medical intervention.

B. Hypertension. Sumatriptan works by constricting blood vessels to relieve migraine symptoms, but it can also cause a dangerous increase in blood pressure. Severe hypertension can lead to complications such as stroke or myocardial infarction. This is the priority finding that requires immediate reporting to prevent life-threatening cardiovascular events.

C. Dizziness. Dizziness can occur due to sumatriptan’s vasoconstrictive properties or from the migraine itself. While it can be uncomfortable, it is not an immediate threat to the client’s safety unless it is severe or associated with other neurological symptoms.

D. Flushing. Facial flushing is a known side effect of sumatriptan and is generally harmless. It occurs due to transient vasodilation in the skin and does not indicate a serious adverse reaction. Monitoring is appropriate, but it does not require urgent intervention.

A. Increased Hct B. Decreased WBC count C. Decreased heart rate D. Increased blood pressure

Correct Answer is C

Explanation

A. Increased Hct. Propylthiouracil (PTU) is an antithyroid medication that reduces excessive thyroid hormone production in Graves' disease. It does not directly affect hematocrit (Hct) levels. While anemia can occur in some clients with untreated hyperthyroidism, PTU itself is not expected to raise Hct.

B. Decreased WBC count. A serious adverse effect of PTU is agranulocytosis, which results in a dangerously low white blood cell (WBC) count, increasing the risk of infection. However, this is a potential complication rather than an expected therapeutic outcome. Clients on PTU require regular monitoring of WBC levels to detect early signs of agranulocytosis.

C. Decreased heart rate. Graves’ disease causes hyperthyroidism, which increases metabolism and leads to symptoms such as tachycardia. PTU works by inhibiting thyroid hormone synthesis, leading to a gradual reduction in heart rate as thyroid function normalizes. This is a desired outcome of treatment, helping to reduce cardiovascular strain associated with hyperthyroidism.

D. Increased blood pressure. Hyperthyroidism can cause elevated blood pressure due to increased cardiac output. As PTU lowers thyroid hormone levels, blood pressure is expected to decrease or stabilize rather than increase. An increase in blood pressure would be unexpected and may indicate another underlying issue requiring evaluation.

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A nurse is collecting a medication history from the parent of a preschooler who comes to the clinic for routine immunizations. For which of the following findings should the nurse withhold the varicella immunization?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a provider's office is collecting data from a client who continues to have a migraine headache after taking sumatriptan orally 2 hr ago. Which of the following findings is the priority for the nurse to report?

Correct Answer is B

Explanation

A nurse is caring for a client who has Graves' disease and is to start therapy with propylthiouracil. The nurse should expect which of the following outcomes?

Correct Answer is C

Explanation

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