Nursing Elites

1. Why is it often necessary to draw a complete blood count and differential (CBC/differential) when a client is being treated with an antiepileptic drug (AED)?

• A. The hematocrit is adversely affected due to increased vascular volume.
• B. AEDs can lead to blood dyscrasia as a side effect.
• C. AEDs may cause aplastic anemia and megaloblastic anemia.
• D. Some AEDs induce white blood cell reduction.

Correct answer: B

Rationale: When a client is being treated with antiepileptic drugs (AEDs), it is essential to monitor for potential side effects on blood parameters. Some AEDs can lead to blood dyscrasia, which includes conditions like aplastic anemia and megaloblastic anemia. Therefore, drawing a complete blood count and differential helps in identifying these adverse effects early. Choices A, C, and D are incorrect because the primary concern when monitoring blood parameters in clients on AEDs is the risk of blood dyscrasia, not changes in hematocrit due to vascular volume, white blood cell reduction, or immune modulation.

2. The nurse is caring for a client who is 28 weeks pregnant and complains of swollen hands and feet. Which symptom below would cause the greatest concern?

• A. Nasal congestion
• B. Hiccups
• C. Blood glucose of 150
• D. Muscle spasms

Correct answer: D

Rationale: The correct answer is muscle spasms because they can be indicative of a severe condition like preeclampsia, which is a serious complication during pregnancy characterized by high blood pressure and signs of damage to another organ system, most often the liver and kidneys. Nasal congestion and hiccups are common discomforts during pregnancy and do not pose a severe risk to the client or fetus. A blood glucose level of 150, while slightly elevated, may not be alarming in a pregnant individual and can be managed through dietary modifications or medication adjustments. Muscle spasms, especially in the context of pregnancy, should be taken seriously and thoroughly assessed to rule out any underlying serious conditions.

3. When assessing a client in the Emergency Department whose membranes have ruptured, the nurse notes that the fluid is a greenish color. What is the cause of this greenish coloration?

• A. blood
• B. meconium
• C. hydramnios
• D. caput

Correct answer: B

Rationale: The correct answer is B: meconium. Greenish amniotic fluid passed when the fetus is in a cephalic (head) presentation might indicate fetal distress. A fetus in the breech presentation passes meconium due to compression on the intestinal tract. Choice A, blood, is incorrect as blood in the amniotic fluid would present as a different color. Choice C, hydramnios, refers to an excess of amniotic fluid and would not cause the greenish coloration. Choice D, caput, is swelling of a newborn's scalp and is not related to the color of the amniotic fluid.

4. Levothyroxine (Synthroid) is the drug of choice for thyroid replacement therapy in clients with hypothyroidism because:

• A. it is chemically stable, nonallergenic, and can be administered orally once a day.
• B. it is available in a wide range of concentrations to meet individual client requirements.
• C. it is a prodrug of T3.
• D. it has a long half-life.

Correct answer: A

Rationale: Levothyroxine (Synthroid) is the preferred medication for hypothyroidism due to its chemical stability, nonallergenic properties, and convenient once-daily oral administration. It is safe and effective with minimal side effects when appropriately dosed. Choice B is incorrect because while Levothyroxine is available in various concentrations, it is not the reason it is the drug of choice; the primary reason is its stability and nonallergenic nature. Choice C is wrong as Levothyroxine (T4) is not a prodrug of T3; it is converted to T3 in the body. Option D is inaccurate because Levothyroxine has a long half-life (around 7 days), enabling once-daily dosing, as opposed to a short half-life.

5. Acyclovir is the drug of choice for:

• A. HIV
• B. HSV 1 and 2 and VZV
• C. CMV
• D. influenza A viruses

Correct answer: C

Rationale: Acyclovir (Zovirax) is specifically used to treat infections caused by herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) and varicella-zoster virus (VZV). These include conditions like cold sores, genital herpes, and shingles. Acyclovir works by inhibiting viral DNA replication, leading to the formation of shorter, ineffective DNA chains. It is important to note that acyclovir is not effective against other viruses like HIV, cytomegalovirus (CMV), or influenza A viruses. Therefore, the correct answer is HSV 1 and 2 and VZV.

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