6. Which action by the nurse indicates understanding of herpes zoster?
Correct Answer: B
Herpes zoster is shingles. Clients with shingles should be placed in contact precautions. Wearing gloves during care will prevent transmission of the virus. Use universal precautions in caring for the client to prevent transmission of disease to self or other clients. VZV can be transmitted to others and cause chickenpox in the person who has not previously had the disease.
Option A: Covering the lesions with a sterile gauze is not necessary. Suggest the use of gauze to separate the lesions in skin folds. This reduces irritation, itching, and cross-contamination. Teach contact isolation. VZV is spread by contact with fluid from lesions containing viruses.
Option C: Antibiotics are not prescribed for herpes zoster. Instruct the client in the use of antiviral medications, as prescribed. Antiviral agents are most effective during the first 72 hours of an outbreak when viruses are proliferating. Drugs of choice are acyclovir, famciclovir, or valacyclovir.
Option D: Oxygen is not necessary for shingles. Instruct the client to avoid contact with pregnant women and immunocompromised individuals. Active lesions can be infectious, and immunosuppressed individuals are more susceptible.
7. The client has an order for a trough to be drawn on the client receiving Vancomycin. The nurse is aware that the nurse should contact the lab for them to collect the blood:
Correct Answer: B
A trough level should be drawn 30 minutes before the third or fourth dose. Draw trough specimens immediately before (?30 min) the next dose. Do not draw specimens until a steady state is achieved (ie, before the fourth dose). Draw peak specimens 1-2 hours after completion of intravenous dosage.
Option A: Vancomycin is a glycopeptide antibiotic first isolated in 1953. It is a naturally occurring antimicrobial synthesized by soil bacterium Amycolatopsis Orientalis. Generic vancomycin became available and approved for use in 1958 and quickly became a common antibiotic in treating rapidly growing penicillin-resistant Staphylococcus species.
Option C: The emergence of pseudomembranous enterocolitis, coupled with the spread of methicillin-resistant Staphylococcus aureus (MRSA), led to a resurgence in the use of vancomycin. It is used to treat serious, life-threatening infections by gram-positive bacteria that are resistant to less-toxic agents.
Option D: General indications for measuring vancomycin trough levels include risk of nephrotoxicity and inadequate therapeutic response. Monitor at regular intervals. Specifically, trough levels should be measured in patients at risk for nephrotoxicity.
8. The client using a diaphragm should be instructed to:
Correct Answer: B
The client using a diaphragm should keep the diaphragm in a cool location. The diaphragm is a birth control (contraceptive) device that prevents sperm from entering the uterus. The diaphragm is a small, reusable rubber or silicone cup with a flexible rim that covers the cervix. Before sex, the diaphragm is inserted deep into the vagina so that part of the rim fits snugly behind the pubic bone.
Option A: She should refrain from leaving the diaphragm in longer than 8 hours, not 4 hours. Always use the diaphragm with spermicidal cream, foam or gel. Avoid use of body lotions near the vagina and vaginal medications when using the diaphragm. If using a diaphragm and douche, wait until at least six hours after sex to avoid washing away spermicide.
Option C: The traditional dome-shaped diaphragm comes in different sizes, and the woman needs to be fitted for one by her healthcare provider. A newer diaphragm option — the Caya diaphragm — comes in one size. To get either type of diaphragm, the woman needs a prescription from her healthcare provider.
Option D: She should have the diaphragm resized when she gains or loses 10 pounds or has abdominal surgery. The woman will require an internal examination to assess what size of diaphragm will be suitable for her. A diaphragm should be replaced at least every 2 years. It should be examined regularly for holes or weak spots, and replaced as needed. She will need to be ‘resized’ for a diaphragm if she lost or gained more than 7 pounds in weight or have had a pregnancy.
9. The nurse is providing postpartum teaching for a mother planning to breastfeed her infant. Which of the client’s statements indicates the need for additional teaching?
Correct Answer: C
Mothers who plan to breastfeed should drink plenty of liquids, and four glasses are not enough in a 24-hour period. Women need extra support, encouragement, and reassurance while breastfeeding. Although we view breastfeeding as a natural process, it is still a skill that has to be learned. Initially, breastfeeding can seem demanding, as the baby may have a desire to feed/suck frequently. Babies, however, begin to establish their own pattern over time, and the mother will begin to feel more comfortable and at ease.
Option A: Wearing a support bra is a good practice for the mother who is breastfeeding as well as the mother who plans to bottle-feed. A comfortable, soft, cotton nursing bra is a good choice for both day and night, and a sports bra style may also make a comfortable bra for nighttime use.
Option B: Expressing milk from the breast will stimulate milk production. If it is necessary to express breast milk, show the mother how to do this and show her how to feed expressed breast milk by the cup. You may need to refer her to a trained infant feeding counselor for this.
Option D: Allowing the water to run over the breast will also facilitate “letdown,” when the milk begins to be produced; thus, answer D is incorrect. Some women also find that the initial ‘let down’ reflex is very strong which causes them pain or they get strong after-pains as their wombs contract. Reassure them that this will pass. The ‘let down’ reflex may also cause them to leak milk when they have sexual intercourse. Reassure them that this is normal and that they may need to tell their husband or partner that this is normal.
10. Damage to the VII cranial nerve results in:
Correct Answer: A
The facial nerve is cranial nerve VII. If damage occurs, the client will experience facial pain. The sensory portion, or intermediate nerve, has the following components: (1) taste to the anterior two-thirds of the tongue; (2) secretory and vasomotor fibers to the lacrimal gland, the mucous membranes of the nose and mouth, and the submandibular and sublingual salivary glands; (3) cutaneous sensory impulses from the external auditory meatus and region back of the ear.
Option B: Olfactory nerve controls smell, and it is cranial nerve I. The olfactory nerve is the first cranial nerve and is instrumental in our sense of smell. The olfactory nerve contains only afferent sensory nerve fibers and, like all cranial nerves, is paired. The olfactory nerve is the shortest cranial nerve, and along with the optic nerve is one of the only two cranial nerves that do not converge with the brainstem.
Option C: Eye movement is controlled by the Trochlear or C IV. The trochlear nerve is the fourth cranial nerve (CN IV) and one of the ocular motor nerves that controls eye movement. The trochlear nerve, while the smallest of the cranial nerves, has the longest intracranial course as it is the only nerve to have a dorsal exit from the brainstem. It originates in the midbrain and extends laterally and anteriorly to the superior oblique muscle.
Option D: The vestibulocochlear nerve or CN VIII is responsible for hearing loss and tinnitus. The vestibulocochlear nerve, also known as cranial nerve eight (CN VIII), consists of the vestibular and cochlear nerves. Each nerve has distinct nuclei within the brainstem. The vestibular nerve is primarily responsible for maintaining body balance and eye movements, while the cochlear nerve is responsible for hearing.