A community health nurse is reviewing the levels of disease prevention. Which of the following activities is an example of tertiary prevention?

Choice A reason: Administer a test dose first

Administering a test dose is not typically required for theophylline. Theophylline dosing is usually based on the patient’s weight and serum theophylline levels. A test dose is more commonly associated with medications that have a high risk of allergic reactions or require desensitization protocols, which is not the case with theophylline.

Choice B reason: Infuse the medication with an IV pump

Using an IV pump to infuse theophylline is essential to ensure accurate and controlled delivery of the medication. Theophylline has a narrow therapeutic range, and precise dosing is crucial to avoid toxicity. An IV pump allows for consistent infusion rates, reducing the risk of adverse effects. This is the most appropriate action for the nurse to take.

Choice C reason: Cover the IV container with dark paper

There is no need to cover the IV container with dark paper when administering theophylline. Theophylline is not light-sensitive, so this precaution is unnecessary. Covering IV containers is typically done for medications that degrade when exposed to light, such as certain antibiotics and chemotherapy agents.

Choice D reason: Infuse the medication at 35 mg/min

Infusing theophylline at a rate of 35 mg/min is excessively high and could lead to severe toxicity. The infusion rate for theophylline should be carefully calculated based on the patient’s weight and serum levels, and it is typically much lower than 35 mg/min. Rapid infusion can cause serious side effects, including arrhythmias and seizures.

Choice A reason:

Tremors are not typically associated with Cushing’s syndrome. Cushing’s syndrome is characterized by an excess of cortisol, which leads to various symptoms, but tremors are not commonly among them. Tremors are more often associated with conditions affecting the nervous system, such as Parkinson’s disease or essential tremor.

Choice B reason:

A buffalo hump, which is a fat deposit on the back of the neck and upper back, is a common manifestation of Cushing’s syndrome. This occurs due to the redistribution of fat caused by prolonged exposure to high levels of cortisol. The buffalo hump is a distinctive physical sign that helps in diagnosing Cushing’s syndrome.

Choice C reason:

Moon face, characterized by a rounded, puffy face, is another hallmark of Cushing’s syndrome. This symptom results from fat deposits accumulating in the facial area due to elevated cortisol levels. The moon face is often one of the first noticeable signs of Cushing’s syndrome.

Choice D reason:

Hypertension, or high blood pressure, is a common symptom of Cushing’s syndrome. Cortisol increases blood pressure by enhancing the sensitivity of blood vessels to catecholamines and by promoting sodium and water retention. This leads to an increase in blood volume and, consequently, higher blood pressure.

Choice E reason:

Purple striae, or stretch marks, are also indicative of Cushing’s syndrome. These marks typically appear on the abdomen, thighs, breasts, and arms and are caused by the thinning of the skin and weakening of connective tissue due to excessive cortisol. The striae are often wide and have a purplish hue, distinguishing them from regular stretch marks.