A client with a fungal infection of the toenail reports to the nurse that the client has been applying an over-the-counter (OTC) triple antibiotic ointment to the infection daily for two weeks without any improvement. Which action should the nurse take?

Instruct the client to obtain a prescription for oral terbinafine.

Advise the client to obtain a prescription-strength formulation of the ointment.

Reassure the client that treatment of fungus infected toenails often takes several months.

Suggest that the client use the ointment twice a day to be more effective.

Answer and Explanation

The Correct Answer is A

A. Instruct the client to obtain a prescription for oral terbinafine: Since the client has been using an over-the-counter triple antibiotic ointment for two weeks without improvement, it indicates that the treatment is ineffective for fungal infections. Over-the-counter ointments are typically not effective for toenail fungal infections, which often require prescription-strength antifungal treatment. Oral terbinafine is a prescription antifungal medication that is more effective for treating such infections, so advising the client to obtain a prescription is the most appropriate action.
B. Advise the client to obtain a prescription-strength formulation of the ointment: Prescription-strength topical treatments are often used for fungal infections, but toenail fungal infections usually require oral antifungal medications to penetrate the nail effectively. Advising the client to obtain a prescription-strength ointment may not address the root cause, which often involves systemic treatment.
C. Reassure the client that treatment of fungus-infected toenails often takes several months: While it is true that toenail fungal infections can take several months to treat, the lack of improvement with the current treatment suggests that a more effective treatment is needed. Reassuring the client about the duration of treatment without addressing the ineffectiveness of the current treatment does not resolve the issue.
D. Suggest that the client use the ointment twice a day to be more effective: Increasing the frequency of application of the triple antibiotic ointment is unlikely to improve its effectiveness against a fungal infection. Fungal infections typically require specific antifungal agents, and simply using the current ointment more frequently will not address the underlying issue.

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Correct Answer is D

Explanation

A. Pulse rate:
While monitoring the pulse rate is important for assessing overall cardiovascular function, it is not the most immediate concern when a client becomes lethargic after receiving an opioid. Opioids are known to potentially cause respiratory depression, which is a more critical issue to address first.
B. Blood pressure:
Blood pressure changes can occur with opioid use, but in the context of sudden lethargy, the primary concern is to check for respiratory depression. This condition can lead to significant complications and requires immediate attention.
C. Temperature:
Temperature monitoring is important for identifying infection or other issues, but it is not the most relevant vital sign to assess immediately after noticing lethargy from opioid administration. Respiratory rate is more directly affected by opioids.
D. Respiratory rate:
Opioids can cause respiratory depression, which can lead to lethargy and other serious complications. Assessing the respiratory rate first is crucial to determine if the client is experiencing slowed or irregular breathing, which may require immediate intervention such as administering naloxone or providing supplemental oxygen.

A. High density lipoprotein (HDL). B. Prothrombin time (PT). C. Creatine phosphokinase (CK). D. Low density lipoprotein (LDL)

Correct Answer is D

Explanation

A. High-density lipoprotein (HDL): While HDL levels are important for assessing cardiovascular risk, atorvastatin primarily targets the reduction of low-density lipoprotein (LDL) cholesterol. An increase in HDL is generally beneficial, but it is not the primary measure of atorvastatin's effectiveness.
B. Prothrombin time (PT): PT measures blood clotting ability and is not directly related to the effectiveness of atorvastatin. Atorvastatin’s role is to manage cholesterol levels, not to influence coagulation directly.
C. Creatine phosphokinase (CK): CK levels can be monitored to assess muscle damage or myopathy, a potential side effect of atorvastatin. However, changes in CK are not a direct measure of the medication’s effectiveness in lowering cholesterol.
D. Low-density lipoprotein (LDL): This is the most appropriate indicator of atorvastatin's effectiveness. Atorvastatin is a statin medication used to lower LDL cholesterol levels, which is a primary goal in managing and reducing the risk of coronary artery disease. A decrease in LDL cholesterol levels reflects that the medication is working as intended.

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A client with a fungal infection of the toenail reports to the nurse that the client has been applying an over-the-counter (OTC) triple antibiotic ointment to the infection daily for two weeks without any improvement. Which action should the nurse take?

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Naxlex Comprehensive Predictor Exams

The nurse observes that a client has become lethargic 30 minutes after receiving an opioid injection for pain. Which vital sign should the nurse obtain first?

Correct Answer is D

Explanation

The nurse is reviewing the client's laboratory values. Which serum laboratory value indicates to the nurse that a prescription for atorvastatin is having the desired effect for a client at risk for coronary artery disease?

Correct Answer is D

Explanation

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