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Nursing - Intake Form

88 years old female, presenting with cough x3 days and subjective fever. Patient is alert and responsive. She is answering questions and does not is appear confused. She is taking her home medications as prescribed. She was sent by nursing home staff for evaluation.

Upon discharge, of the listed immunizations, select the vaccines to be recommended for this older adult client. Select all that apply.

Pneumococcal vaccine

Influenza vaccine

COVID - 19 vaccine

HIB vaccine

-Rotavirus vaccine

Answer and Explanation

Correct Answer : A,B,C

A. Pneumococcal vaccine:

The pneumococcal vaccine is recommended for older adults to protect against Streptococcus pneumoniae, a common cause of pneumonia and other invasive diseases. Individuals over 65 years of age are at increased risk for pneumococcal infections, making this vaccine essential for their health.

B. Influenza vaccine:

The influenza vaccine is recommended annually for older adults, as they are at high risk for severe complications from influenza due to age-related immune system decline. Preventing influenza reduces the risk of secondary infections, such as pneumonia.

C. COVID-19 vaccine:

COVID-19 vaccines are strongly recommended for older adults because they are at higher risk for severe illness and complications from COVID-19. Staying up to date with booster doses further reduces the risk of hospitalization and death.

D. HIB vaccine:

The Haemophilus influenzae type b (HIB) vaccine is not routinely recommended for adults unless they have specific medical conditions, such as asplenia or immunodeficiencies. This vaccine is primarily targeted for infants and young children.

E. Rotavirus vaccine:

The rotavirus vaccine is not recommended for adults. It is specifically designed to prevent rotavirus gastroenteritis in infants and young children. There is no clinical indication for its use in the older adult population.

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Correct Answer is B

Explanation

A. 250 mg:

This represents the amount of levodopa in the tablet, not carbidopa. Sinemet contains two active ingredients: carbidopa (25 mg) and levodopa (250 mg), as shown on the label.

B. 25 mg:

This is the correct answer, as the label indicates that each tablet contains 25 mg of carbidopa. Carbidopa is combined with levodopa to improve its effectiveness and reduce side effects like nausea.

C. 5 mg:

This is not accurate; the label clearly states that the carbidopa dose is 25 mg per tablet.

D. 200 mg:

This does not correspond to the dose of carbidopa or levodopa in this medication. The label specifies 25 mg of carbidopa and 250 mg of levodopa.

A. Prepare the client for mechanical ventilation. B. Instruct the client to perform the pursed lip breathing. C. Prepare to administer IVIG. D. Administration of an immunosuppressant.

Correct Answer is A

Explanation

A) Prepare the client for mechanical ventilation:
A myasthenic crisis is a medical emergency characterized by severe weakness of the respiratory muscles, leading to respiratory failure. This can result from insufficient levels of acetylcholine due to insufficient medication (e.g., pyridostigmine) or from an infection. In such cases, airway support is the priority. The nurse should first prepare the client for potential mechanical ventilation to ensure they can breathe properly and to prevent respiratory arrest.

B) Instruct the client to perform pursed-lip breathing:
While pursed-lip breathing is a useful technique to help with shortness of breath and improve ventilation in certain respiratory conditions (like COPD), it is not the first action in managing a myasthenic crisis. The immediate priority is to ensure the client can breathe and maintain oxygenation, which may require mechanical ventilation if the respiratory muscles are too weak to support breathing effectively.

C) Prepare to administer IVIG:
IV immunoglobulin (IVIG) can be used in the treatment of myasthenic crisis by suppressing the immune response and increasing acetylcholine receptor activity. However, IVIG is not typically the first intervention. Respiratory support and stabilization should take precedence, especially if there is significant respiratory distress.

D) Administration of an immunosuppressant:
Immunosuppressive therapy, such as corticosteroids or azathioprine, may be used to manage myasthenia gravis over the long term, but it is not an acute intervention for a myasthenic crisis. The immediate priority in a crisis situation is to manage respiratory distress and ensure airway protection.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

How many milligrams of carbidopa is this patient taking per dose/tablet?

Correct Answer is B

Explanation

A nurse suspects a client who has myasthenia gravis is experiencing a myasthenic crisis. Which of the following interventions should the nurse prepare to take first?

Correct Answer is A

Explanation

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