NCLEX Daily Practical Exercise 34

6. You are conducting a comprehensive assessment of a 38-year-old female patient in the outpatient psychiatric clinic. She mentions that she has been struggling with both depression and an anxiety disorder for several years. She hints at being on medication but doesn’t remember the name. As you review her medication list, you notice a drug that is commonly prescribed for such conditions. Based on her described symptoms, which of the following medications on her list would she most likely be taking for her depression and anxiety?

Correct Answer: A

Answer Explanation:

Amitriptyline (Elavil) is a tricyclic antidepressant and used to treat symptoms of depression.

Option B: Calcitonin is used to treat osteoporosis in women who have been in menopause. Calcitonin is a hormone that is produced in humans by the parafollicular cells (commonly known as C-cells) of the thyroid gland. Calcitonin is involved in helping to regulate levels of calcium and phosphate in the blood, opposing the action of the parathyroid hormone.
Option C: Permax (pergolide mesylate) is indicated as adjunctive treatment to levodopa/carbidopa in the management of the signs and symptoms of Parkinson†s disease.
Option D: Verapamil is used to treat high blood pressure and to control angina (chest pain). The immediate-release tablets are also used alone or with other medications to prevent and treat irregular heartbeats. Verapamil is in a class of medications called calcium-channel blockers. It works by relaxing the blood vessels so the heart does not have to pump as hard. It also increases the supply of blood and oxygen to the heart and slows electrical activity in the heart to control the heart rate.

Advertisement

7. A nurse is reviewing the medication list of a 45-year-old male patient admitted to the medical unit. The patient has a complex medical history, including a recent diagnosis of a bacterial respiratory infection, a past episode of Legionnaires disease, a family history of Campylobacteriosis infection, and a long-standing diagnosis of Multiple Sclerosis. The physician has ordered erythromycin as part of the patient’s treatment plan. For which of the patient’s conditions would the nurse question the administration of erythromycin?

Correct Answer: D

Answer Explanation:

Erythromycin is an antibiotic used to treat various bacterial infections, including Campylobacteriosis infection, Legionnaires disease, and certain types of pneumonia. It is not used to treat Multiple Sclerosis, which is an autoimmune disease affecting the central nervous system.

Advertisement

8. A 58-year-old male patient has been admitted to the cardiology unit following complaints of palpitations and fatigue. Upon reviewing his medical chart, the nurse notes a history of chronic kidney disease and a recent episode of hyperkalemia. The patient describes a variety of symptoms he has been experiencing over the past week. Based on his history of hyperkalemia, which of the following symptoms reported by the patient would the nurse consider unrelated to an acute episode of hyperkalemia?

Correct Answer: D

Answer Explanation:

Hyperkalemia, or elevated potassium levels in the blood, can manifest with various symptoms, including cardiac disturbances (like decreased heart rate), paresthesias (tingling sensations), and muscle weakness. Migraines or severe headaches are not typically associated with hyperkalemia.

Advertisement

9. A 42-year-old female patient with a known history of type 1 diabetes presents to the emergency department with complaints of fatigue, increased urination, and difficulty breathing. The nurse suspects an acute episode of ketoacidosis based on her medical history and current symptoms. As the nurse continues the assessment, the patient describes various symptoms she has been experiencing over the past few days. Based on her potential acute ketoacidosis, which of the following symptoms reported by the patient would the nurse consider atypical for this condition?

Correct Answer: C

Answer Explanation:

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that occurs when the body produces high levels of blood acids called ketones. Common symptoms of DKA include nausea and vomiting, extreme thirst, frequent urination, and a fruity-scented breath. Weight gain is not typically associated with acute DKA; in fact, weight loss might be more common due to the body’s inability to use glucose for energy and the subsequent breakdown of fat stores.

Advertisement

10. A 28-year-old male patient presents to the emergency department with a sudden onset of severe headache, neck stiffness, and confusion. His roommate mentions that the patient had been complaining of flu-like symptoms for the past few days. Given the patient’s presentation and the information provided, the nurse suspects acute meningitis. As the nurse continues the assessment, the patient, though disoriented, tries to describe some of the symptoms he has been experiencing. Based on the suspicion of acute meningitis, which of the following symptoms reported by the patient would the nurse consider not expected for this condition?

Correct Answer: A

Answer Explanation:

Loss of appetite would be expected, not increase in appetite. Most cases of meningitis are caused by an infectious agent that has colonized or established a localized infection elsewhere in the host. Potential sites of colonization or infection include the skin, the nasopharynx, the respiratory tract, the gastrointestinal (GI) tract, and the genitourinary tract. The organism invades the submucosa at these sites by circumventing host defenses (eg, physical barriers, local immunity, and phagocytes or macrophages).
Vomiting occurs in 35% of patients with meningitis. The brain is naturally protected from the body’s immune system by the barrier that the meninges create between the bloodstream and the brain. Normally, this protection is an advantage because the barrier prevents the immune system from attacking the brain. However, in meningitis, the blood-brain barrier can become disrupted; once bacteria or other organisms have found their way to the brain, they are somewhat isolated from the immune system and can spread.

The classic triad of meningitis consists of fever, nuchal rigidity, and altered mental status. When the body tries to fight the infection, the problem can worsen; blood vessels become leaky and allow fluid, WBCs, and other infection-fighting particles to enter the meninges and brain. This process, in turn, causes brain swelling and can eventually result in decreasing blood flow to parts of the brain, worsening the symptoms of infection.
Other symptoms include photalgia (photophobia): discomfort when the patient looks into bright lights. Depending on the severity of bacterial meningitis, the inflammatory process may remain confined to the subarachnoid space. In less severe forms, the pial barrier is not penetrated, and the underlying parenchyma remains intact. However, in more severe forms of bacterial meningitis, the pial barrier is breached, and the underlying parenchyma is invaded by the inflammatory process. Thus, bacterial meningitis may lead to widespread cortical destruction, particularly when left untreated.

Advertisement