The nurse administers an oral antiviral to a client with shingles. Which finding is most important for the nurse to report to the healthcare provide?

Elevated liver function tests.

Vomiting and diarrhea.

Decreased white blood cell count.

Pruritus and muscle aches.

Answer and Explanation

The Correct Answer is A

Rationale:
A. Elevated liver function tests: Oral antivirals such as acyclovir or valacyclovir are metabolized by the liver, and elevated liver enzymes may indicate hepatotoxicity. This finding is critical and may necessitate discontinuation or dose adjustment to prevent liver damage.

B. Vomiting and diarrhea: These are common side effects of oral antivirals and are usually self-limiting. They typically do not require discontinuation unless they lead to dehydration or are severe and persistent.

C. Decreased white blood cell count: A decreased white blood cell can be a side effect of some antiviral medications, and while it increases the risk of infection, it is usually monitored during long-term therapy. However, in the context of acute shingles treatment with an oral antiviral, elevated liver function tests often represent a more immediate concern.

D. Pruritus and muscle aches: These symptoms may occur with antiviral use but are usually mild and nonspecific. They should be monitored but are not as immediately concerning as signs of liver dysfunction.

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Correct Answer is {"A":{"answers":"C"},"B":{"answers":"B"},"C":{"answers":"C"},"D":{"answers":"B,C"},"E":{"answers":"B"},"F":{"answers":"A,B,C"}}

Explanation

Rationale:

Avoidance: Avoidance of reminders of the trauma, including people, places, or conversations related to the event, is a core diagnostic criterion for PTSD. The client avoids visiting fellow platoon members, suggesting avoidance behavior linked to her combat trauma.
Suicidal ideation: Thoughts of death or suicide are hallmark symptoms of MDD. The client was found writing a suicide note and planning to shoot herself, which strongly supports the diagnosis of MDD.
Nightmares: Recurrent distressing dreams or nightmares related to the traumatic event are common in PTSD. The client reports frequent nightmares linked to her war experience.
Feelings of guilt: Excessive guilt is common in MDD, often irrational and self-deprecating. In PTSD, survivors’ guilt is prevalent, especially when others died in the traumatic event, as expressed by the client lamenting that her life was spared over her comrades'.
Lack of interest: Markedly diminished interest or pleasure in previously enjoyed activities is a core symptom of MDD. The client’s withdrawal from social connections reflects this loss of interest.
Sleep disturbance: Insomnia is prevalent in GAD due to excessive worry, in MDD due to mood dysregulation, and in PTSD due to nightmares and hyperarousal. The client’s reported insomnia applies to all three conditions.

A. Provide support on the unaffected side. B. Hook an arm under the client's left arm. C. Use a gait belt standing on affected side. D. Hold the gait belt with palms facing down.

Correct Answer is C

Explanation

Rationale:
A. Provide support on the unaffected side: Supporting from the unaffected side gives less control if the weak side gives out. Assistance should be on the affected side to better prevent falls and provide stabilization.

B. Hook an arm under the client's left arm: This is unsafe and risks injury to both the client and nurse. It provides poor leverage, may dislocate the shoulder, and does not allow controlled support during ambulation.

C. Use a gait belt standing on affected side: This is the safest technique. Standing on the affected side offers direct support and balance while the gait belt allows secure, ergonomic assistance during movement.

D. Hold the gait belt with palms facing down: Gait belts should be held with palms facing up, which provides a more secure grip and better control if the client loses balance during ambulation.

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The nurse administers an oral antiviral to a client with shingles. Which finding is most important for the nurse to report to the healthcare provide?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits The nurse reviews the clinical findings. For each of the findings listed, click to indicate which are consistent with the disease process of major depressive disorder, generalized anxiety disorder, or posttraumatic stress disorder. Each column must have at least one response selected.

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"B"},"C":{"answers":"C"},"D":{"answers":"B,C"},"E":{"answers":"B"},"F":{"answers":"A,B,C"}}

Explanation

The nurse is caring for a client with left-sided hemiparesis after a stroke. Which action should the nurse take to safely assist the client with ambulation?

Correct Answer is C

Explanation

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