A nurse is teaching a patient who is to begin long-term therapy with prednisone to treat rheumatoid arthritis.
The nurse should instruct the patient to take which of the following supplements while taking this medication?
Pantothenic acid and vitamin B6.
Biotin and vitamin B2.
Folic acid and vitamin C.
Calcium and vitamin D.
The Correct Answer is D
Choice A rationale
Pantothenic acid (vitamin B5) is involved in fatty acid metabolism and coenzyme A synthesis, while vitamin B6 (pyridoxine) is crucial for amino acid metabolism and neurotransmitter synthesis. Prednisone does not typically lead to deficiencies in these vitamins.
Choice B rationale
Biotin (vitamin B7) plays a role in carbohydrate, fat, and protein metabolism, and vitamin B2 (riboflavin) is essential for cellular respiration and energy production. Prednisone therapy is not directly linked to a need for these supplements.
Choice C rationale
Folic acid (vitamin B9) is necessary for DNA synthesis and cell division, and vitamin C (ascorbic acid) is an antioxidant involved in collagen synthesis and immune function. Prednisone's effects do not primarily target these metabolic pathways to cause deficiencies.
Choice D rationale
Long-term prednisone therapy can lead to bone demineralization by increasing osteoclast activity and decreasing calcium absorption in the gut, thus increasing the risk of osteoporosis. Vitamin D is essential for calcium absorption and bone health. Supplementation with calcium and vitamin D helps to mitigate these adverse effects of prednisone. Normal serum calcium levels range from 8.5 to 10.5 mg/dL, and normal vitamin D levels are generally considered to be between 20 to 50 ng/mL, although optimal levels may vary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D"]
Explanation
Choice A rationale
A client who is ambulatory following a cardiac catheterization 4 hours ago has increased mobility, which reduces the risk of prolonged pressure on bony prominences. The short duration post-procedure and ability to ambulate make this client less susceptible to pressure ulcer development.
Choice B rationale
Postoperative delirium can lead to decreased mobility, increased agitation and friction against surfaces, and impaired ability to communicate discomfort or reposition themselves. These factors significantly increase the risk of prolonged pressure and subsequent pressure ulcer formation.
Choice C rationale
Protein-calorie malnutrition results in decreased subcutaneous tissue and muscle mass, which normally provide cushioning over bony prominences. Poor nutritional status also impairs tissue repair and increases skin fragility, making the client highly susceptible to pressure ulcer development.
Choice D rationale
Right-sided heart failure can cause fluid overload and peripheral edema, particularly in the lower extremities. This edema increases tissue fragility and reduces blood flow to the skin, making it more susceptible to breakdown and pressure ulcer formation, especially in areas with bony prominences like heels and ankles.
Choice E rationale
While hyperglycemia in type 1 diabetes mellitus can impair wound healing and increase the risk of infection if a pressure ulcer develops, it is not a direct primary risk factor for the initial development of pressure ulcers. Immobility, malnutrition, and edema are more direct contributors to skin breakdown due to pressure.
Correct Answer is A
Explanation
Choice A rationale
Basal cell carcinoma, the most common type of skin cancer, often presents as a raised, flesh-colored or pearly white papule or nodule with rolled, pearly borders and telangiectasia (visible small blood vessels). The description of the 1-cm raised, flesh-colored lesion with pearly white borders aligns with the typical appearance of basal cell carcinoma.
Choice B rationale
Malignant melanoma is characterized by its irregular shape, asymmetrical borders, uneven color (often with shades of black, brown, red, white, or blue), and diameter greater than 6 mm. It can arise from existing moles or appear as a new pigmented lesion. The described lesion does not fit this profile.
Choice C rationale
Actinic keratosis is a precancerous skin condition that appears as rough, scaly patches on sun-exposed areas. These lesions are typically flat or slightly raised and can be skin-colored, reddish-brown, or have a whitish scale. The description of a raised lesion with pearly borders is inconsistent with actinic keratosis.
Choice D rationale
Squamous cell carcinoma often presents as a firm, red nodule or a flat lesion with a scaly, crusted surface. It can also appear as a non-healing ulcer. While it can occur on the chest, the pearly white borders are more characteristic of basal cell carcinoma.
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