NCLEX Young and Middle Adults Practice Exam
A 30-year-old woman with a history of migraines is prescribed a new oral contraceptive. Which of the following is the most important teaching point?
A) Stop the medication if you develop a headache.
B) You may experience nausea, but this will subside.
C) This medication may increase the risk of blood clots.
D) You should monitor your blood pressure regularly.
A nurse is teaching a 25-year-old client about stress management. Which of the following is the most effective method to reduce stress?
A) Engaging in deep breathing exercises.
B) Watching television to relax.
C) Reducing work hours.
D) Taking medication as prescribed.
Which of the following findings should the nurse expect when assessing a 35-year-old client with hypertension?
A) Rapid pulse
B) Decreased urination
C) Headache
D) Skin pallor
A 28-year-old male client reports frequent episodes of heartburn. Which lifestyle modification should the nurse recommend first?
A) Avoid eating before bedtime.
B) Increase intake of carbonated drinks.
C) Begin a low-fat diet.
D) Avoid taking over-the-counter antacids.
A 30-year-old client asks the nurse for advice on pregnancy prevention. Which method of contraception is contraindicated in women with a history of blood clots?
A) Diaphragm
B) Intrauterine device (IUD)
C) Oral contraceptives
D) Male condoms
A nurse is educating a 25-year-old woman about the importance of regular Pap smears. At what age should women start having Pap smears according to current guidelines?
A) 18 years old
B) 21 years old
C) 25 years old
D) 30 years old
A 29-year-old client with a new diagnosis of type 2 diabetes is learning about blood glucose monitoring. Which of the following should the nurse include in the teaching plan?
A) Monitor blood glucose before and after each meal.
B) Blood glucose should be checked at least once a week.
C) Glucose should be monitored at the same time every day.
D) Use a lancet with a deep puncture to get a blood sample.
A 33-year-old woman in her second trimester of pregnancy is concerned about gaining too much weight. What is the recommended weight gain during pregnancy for women with a normal pre-pregnancy weight?
A) 15-20 pounds
B) 20-25 pounds
C) 25-35 pounds
D) 30-40 pounds
A 30-year-old male client is diagnosed with chronic stress. Which intervention is most appropriate to reduce the risk of long-term health problems associated with stress?
A) Administering anti-anxiety medications.
B) Encouraging regular exercise.
C) Suggesting alcohol consumption to manage stress.
D) Reducing sleep duration for increased productivity.
A nurse is teaching a 35-year-old client about self-breast examination. Which of the following instructions should be included?
A) Perform the exam every 6 months.
B) Examine the breasts just before your period.
C) Perform the exam at the same time each month.
D) Perform the exam immediately after a shower.
A 40-year-old woman with a history of smoking asks the nurse how often she should have a mammogram. What is the recommended screening schedule for women aged 40-49 years?
A) Every 6 months
B) Annually
C) Every 2 years
D) Every 3 years
A 32-year-old woman is diagnosed with iron-deficiency anemia. Which food should the nurse recommend to increase iron intake?
A) Chicken
B) Spinach
C) Whole wheat bread
D) Bananas
Which is an early sign of a myocardial infarction in a 45-year-old male client?
A) Sudden onset of pain in the chest radiating to the jaw.
B) Pain in the lower abdomen.
C) Increased heart rate and hypertension.
D) Severe shortness of breath only.
A nurse is assessing a 36-year-old client with a history of chronic alcohol use. Which of the following findings should the nurse anticipate?
A) Increased blood pressure
B) Increased appetite
C) Decreased blood sugar levels
D) Decreased liver function
A 28-year-old woman is concerned about osteoporosis. Which of the following should the nurse recommend to help prevent this condition?
A) High-calcium diet
B) Avoiding weight-bearing exercises
C) Increased caffeine intake
D) Decreased vitamin D intake
A 40-year-old male client has recently been diagnosed with hypertension. What is the primary goal of treatment?
A) Increase blood flow to the brain.
B) Decrease blood pressure to prevent complications.
C) Maintain normal cholesterol levels.
D) Decrease weight rapidly.
A nurse is caring for a 30-year-old male who is recovering from a knee injury. What is the best intervention to promote rehabilitation?
A) Encourage weight-bearing exercises.
B) Instruct the client to rest and avoid all movement.
C) Encourage the client to engage in cardiovascular exercises.
D) Suggest using heat therapy for the injury.
A nurse is teaching a 35-year-old male about smoking cessation. Which of the following should be the first goal in the smoking cessation process?
A) Reducing the number of cigarettes smoked each day.
B) Identifying triggers for smoking.
C) Starting an exercise program.
D) Discussing possible medications.
A nurse is educating a 32-year-old male about testicular cancer. Which statement indicates the client understands the teaching?
A) “I should perform the testicular self-exam once a year.”
B) “I should perform the testicular self-exam right after a warm bath.”
C) “I should only perform the exam if I notice pain in my testicles.”
D) “Testicular cancer is not common in young men.”
A 29-year-old female client with chronic back pain asks about the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Which of the following is an important teaching point?
A) NSAIDs can lead to gastrointestinal bleeding.
B) NSAIDs can increase the risk of kidney disease.
C) NSAIDs should be taken on an empty stomach for best absorption.
D) NSAIDs should not be used for more than 1 week.
A 34-year-old woman diagnosed with depression is prescribed an antidepressant. Which statement indicates the need for further teaching?
A) “I should avoid alcohol while taking this medication.”
B) “I can stop taking this medication once I start feeling better.”
C) “This medication may take several weeks to take effect.”
D) “I should take this medication at the same time each day.”
A 33-year-old male client is diagnosed with obesity. Which dietary change should the nurse suggest?
A) Decrease carbohydrate intake.
B) Increase the intake of high-fat foods.
C) Limit sodium intake.
D) Decrease fluid intake.
A 36-year-old client is being treated for acute bronchitis. What is the best way to promote recovery?
A) Encourage rest and adequate fluid intake.
B) Recommend over-the-counter cough syrup.
C) Suggest increasing activity levels.
D) Encourage complete bed rest and isolation.
A 38-year-old client with high cholesterol is prescribed a statin. Which of the following should the nurse monitor?
A) Liver function tests
B) Blood pressure
C) Blood glucose levels
D) Kidney function tests
A 40-year-old male client asks the nurse about preventing heart disease. Which of the following is the most important factor for the nurse to emphasize?
A) Regular exercise
B) Avoiding high-fat foods
C) Maintaining a normal weight
D) Stopping smoking
A 30-year-old woman is concerned about early menopause. Which symptom should the nurse explain as a possible early sign of menopause?
A) Hot flashes
B) Increased appetite
C) Excessive hair growth
D) Decreased fatigue
A 32-year-old female is diagnosed with iron-deficiency anemia. What is the most effective source of iron?
A) Red meat
B) Oatmeal
C) Citrus fruits
D) Low-fat yogurt
A 35-year-old client has just been diagnosed with type 2 diabetes. What should the nurse teach about diet management?
A) Focus on low-carbohydrate foods.
B) Eat small meals throughout the day.
C) Eliminate fat intake completely.
D) Drink sugary beverages to maintain energy.
A 40-year-old client asks the nurse about the risk factors for osteoporosis. Which of the following is a major risk factor?
A) Excessive alcohol consumption
B) High-protein diet
C) High intake of calcium
D) Low-fat diet
A 34-year-old woman asks the nurse about preventing cervical cancer. Which of the following should the nurse recommend?
A) HPV vaccination
B) Routine blood tests
C) Regular chest X-rays
D) Screening for high blood pressure
A 29-year-old woman with a history of heavy menstrual bleeding asks the nurse about treatment options for iron-deficiency anemia. What is the most appropriate initial intervention?
A) Administering intravenous iron
B) Starting oral iron supplements
C) Blood transfusion
D) Encouraging increased dietary iron intake
A 30-year-old male client who has been smoking for 10 years is trying to quit. Which of the following methods is most effective in smoking cessation?
A) Use of nicotine replacement therapy
B) Gradually reducing the number of cigarettes smoked per day
C) Substituting cigarettes with chewing gum
D) Increased alcohol consumption
A 36-year-old male presents with sudden shortness of breath and chest pain. What is the priority action?
A) Obtain an electrocardiogram (ECG)
B) Administer oxygen
C) Obtain a chest X-ray
D) Administer nitroglycerin
A 32-year-old woman who is 6 weeks pregnant is experiencing morning sickness. Which of the following should the nurse recommend?
A) Drink a large glass of water before meals.
B) Avoid all foods and fluids until symptoms subside.
C) Eat small, frequent meals throughout the day.
D) Take a warm bath to relieve nausea.
A nurse is caring for a 40-year-old male with hyperlipidemia. Which dietary change should the nurse recommend?
A) Decreasing saturated fat intake
B) Increasing sodium intake
C) Decreasing fiber intake
D) Increasing protein intake
A 30-year-old male is being discharged after undergoing an appendectomy. Which statement by the client indicates a need for further teaching?
A) “I will eat soft foods and avoid heavy meals.”
B) “I will take pain medications as needed.”
C) “I will lift heavy objects to help strengthen my muscles.”
D) “I will monitor my incision site for signs of infection.”
A 28-year-old client is diagnosed with a sexually transmitted infection (STI). What should the nurse include in the teaching plan?
A) The client should inform all recent sexual partners.
B) The client can resume sexual activity immediately after starting antibiotics.
C) The client should only avoid sexual activity during flare-ups of symptoms.
D) The client should discontinue the prescribed medication once symptoms improve.
A 34-year-old woman with rheumatoid arthritis is prescribed methotrexate. Which of the following is an important teaching point for the nurse to include?
A) “You should take the medication with food to reduce gastrointestinal upset.”
B) “You should take a multivitamin supplement with the medication.”
C) “You should avoid alcohol while taking methotrexate.”
D) “You should take the medication only when symptoms worsen.”
A 32-year-old male is being treated for anxiety. Which of the following medications is commonly prescribed for long-term management of anxiety disorders?
A) Lorazepam
B) Diazepam
C) Sertraline
D) Alprazolam
A nurse is assessing a 33-year-old male with a history of alcohol use disorder. What is the priority assessment?
A) Blood pressure
B) Liver function tests
C) Respiratory rate
D) Neurological status
A 25-year-old female client asks the nurse about the effectiveness of birth control methods. Which of the following is the most effective long-term birth control method?
A) Oral contraceptives
B) Intrauterine device (IUD)
C) Diaphragm
D) Male condoms
A 38-year-old woman is diagnosed with depression and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following is an expected side effect of this medication?
A) Weight loss
B) Increased appetite
C) Sexual dysfunction
D) Insomnia
A 35-year-old male is diagnosed with hypertension. The nurse teaches the client about lifestyle modifications. Which statement indicates the need for further teaching?
A) “I will try to lose weight by eating smaller portions.”
B) “I will decrease my sodium intake.”
C) “I will continue drinking alcohol, but only in moderation.”
D) “I will exercise at least 30 minutes per day.”
A 32-year-old female is diagnosed with polycystic ovary syndrome (PCOS). What is a common long-term complication of PCOS?
A) Endometrial cancer
B) Diabetes mellitus
C) Ovarian cancer
D) Hypertension
A 29-year-old client is diagnosed with asthma. Which of the following medications should be prescribed for acute asthma exacerbations?
A) Fluticasone
B) Albuterol
C) Montelukast
D) Salmeterol
A 36-year-old male presents with erectile dysfunction. What should the nurse recommend as a first-line treatment?
A) Sildenafil (Viagra)
B) Vacuum erection devices
C) Hormone replacement therapy
D) Psychotherapy
A 30-year-old male client presents with chronic lower back pain. What is the most appropriate nursing intervention?
A) Encourage rest and avoidance of movement.
B) Recommend wearing a back brace for support.
C) Teach the client proper posture and body mechanics.
D) Suggest over-the-counter opioid medications.
A 34-year-old client is diagnosed with chronic migraine headaches. What should the nurse recommend to help prevent these headaches?
A) Maintain a consistent sleep schedule
B) Increase caffeine consumption
C) Take over-the-counter pain medication regularly
D) Engage in high-intensity exercise
A 37-year-old male with diabetes is experiencing blurred vision. What is the most likely cause of this symptom?
A) Hyperglycemia
B) Hypoglycemia
C) Diabetic retinopathy
D) Cataracts
A nurse is caring for a 31-year-old female with a history of recurrent urinary tract infections (UTIs). What is an appropriate nursing intervention to prevent future infections?
A) Drink plenty of fluids and empty the bladder regularly.
B) Take antibiotics only when symptoms appear.
C) Avoid drinking caffeinated beverages.
D) Use tampons rather than sanitary pads.
A 33-year-old woman with a family history of breast cancer asks about self-exams. What is the best recommendation?
A) Perform breast self-exams monthly starting at age 20.
B) Have a clinical breast exam every 6 months.
C) Begin mammograms at age 35.
D) Perform breast self-exams only if symptoms occur.
A 40-year-old male is being treated for anxiety with benzodiazepines. What is the most important teaching point for the nurse to include?
A) Avoid taking the medication with food.
B) Be aware of the risk for dependence with long-term use.
C) Alcohol may increase the effectiveness of the medication.
D) Take the medication on an as-needed basis only.
A 32-year-old woman is prescribed oral contraceptives. What should the nurse emphasize regarding the use of these contraceptives?
A) Take the pill at the same time every day.
B) Stop taking the pill if you miss one dose.
C) Use an additional form of contraception for the first 3 months.
D) It is safe to take the pill continuously without a break.
A 36-year-old woman is concerned about osteoporosis. What is the most effective way to prevent osteoporosis in her early 30s?
A) Take calcium and vitamin D supplements.
B) Engage in weight-bearing exercises.
C) Reduce alcohol consumption.
D) Maintain a low-protein diet.
A 30-year-old client is being treated for depression with antidepressants. Which of the following is the most important safety consideration?
A) Avoiding grapefruit juice.
B) Watching for signs of suicidal thoughts.
C) Increasing caffeine intake.
D) Taking the medication with high-fat meals.
A 33-year-old male client presents with jaundice. What is the priority nursing action?
A) Obtain a blood alcohol level.
B) Assess for abdominal pain.
C) Assess the color of the stool and urine.
D) Monitor vital signs for changes in blood pressure.
A 32-year-old woman with hypertension asks if she can use oral contraceptives. What is the nurse’s best response?
A) Oral contraceptives are contraindicated for individuals with hypertension.
B) Oral contraceptives are safe as long as you monitor blood pressure regularly.
C) Oral contraceptives can be used only during pregnancy.
D) Oral contraceptives are not recommended unless hypertension is severe.
A 30-year-old male client presents with a complaint of frequent urination and increased thirst. Which laboratory test should the nurse expect to order first?
A) Complete blood count (CBC)
B) Blood glucose level
C) Urinalysis
D) Renal function tests
A 34-year-old female asks the nurse about the risks of taking oral contraceptives. What is the most common risk associated with this method of birth control?
A) Deep vein thrombosis
B) Weight loss
C) Decreased libido
D) Depression
A nurse is caring for a 31-year-old male who is post-op day 1 following an appendectomy. What is the most important intervention to prevent complications at this stage?
A) Encourage deep breathing and coughing.
B) Administer pain medication before meals.
C) Limit fluid intake to avoid bladder distention.
D) Encourage ambulation within 12 hours post-op.
A 30-year-old client is diagnosed with a sexually transmitted infection (STI) and has been prescribed antibiotics. What is the most important point for the nurse to include in the teaching plan?
A) The client should abstain from sexual activity until the infection is completely cleared.
B) The client should inform all recent sexual partners.
C) The client should finish the entire course of antibiotics, even if symptoms resolve.
D) The client should take the antibiotic with food to reduce stomach upset.
A 36-year-old client with type 1 diabetes is preparing to exercise. What is the priority nursing action before the client begins exercising?
A) Assess for signs of hyperglycemia.
B) Ensure that the client has an adequate carbohydrate snack.
C) Monitor blood glucose levels every 30 minutes during exercise.
D) Instruct the client to take insulin before exercise.
A 29-year-old woman presents to the clinic for a routine check-up. She reports that she has had difficulty sleeping lately due to stress at work. What is the best recommendation for improving her sleep?
A) Take over-the-counter sleep aids.
B) Limit caffeine intake, especially in the evening.
C) Exercise vigorously before bedtime.
D) Use electronic devices to relax before going to bed.
A 35-year-old man is diagnosed with hypertension. What is the first-line treatment to control his blood pressure?
A) Diuretics
B) Angiotensin-converting enzyme (ACE) inhibitors
C) Beta-blockers
D) Lifestyle changes
A 30-year-old male client is prescribed antidepressant therapy. Which of the following is an appropriate teaching point about selective serotonin reuptake inhibitors (SSRIs)?
A) “You may experience increased energy right away.”
B) “It is important to take this medication with food.”
C) “This medication may take several weeks to show full effects.”
D) “Avoid driving until you are sure how this medication affects you.”
A 32-year-old woman is concerned about the risk of developing breast cancer. What should the nurse recommend to decrease her risk?
A) Perform a breast self-exam monthly.
B) Avoid caffeine consumption.
C) Limit alcohol intake and maintain a healthy weight.
D) Use hormone replacement therapy to regulate menstrual cycles.
A 34-year-old man presents with fever, headache, and a stiff neck. Which diagnostic test should the nurse anticipate to confirm meningitis?
A) Chest X-ray
B) Urinalysis
C) Lumbar puncture
D) Blood culture
A 29-year-old woman presents with abdominal pain, bloating, and irregular periods. What condition is most likely associated with these symptoms?
A) Ovarian cyst
B) Endometriosis
C) Pelvic inflammatory disease
D) Ectopic pregnancy
A 40-year-old male presents with shortness of breath and chest pain. What is the priority action?
A) Administer aspirin.
B) Administer oxygen.
C) Place the client in a semi-Fowler’s position.
D) Obtain an electrocardiogram (ECG).
A 32-year-old client with hypertension has been prescribed an ACE inhibitor. What is the most common side effect of this medication?
A) Dry cough
B) Drowsiness
C) Increased appetite
D) Constipation
A 33-year-old client presents with fatigue, polyuria, and excessive thirst. What is the first step in assessing for diabetes?
A) Check blood pressure.
B) Measure body mass index (BMI).
C) Check blood glucose levels.
D) Perform a urine culture.
A 30-year-old woman asks the nurse about the most effective method of birth control. What is the nurse’s best response?
A) Condoms are the most effective.
B) Oral contraceptives are very reliable.
C) An intrauterine device (IUD) is the most effective.
D) The rhythm method is highly reliable.
A 28-year-old male with a history of anxiety asks for help with managing his stress. Which intervention should the nurse recommend first?
A) Engage in relaxation techniques such as deep breathing.
B) Start cognitive-behavioral therapy.
C) Begin a regular exercise program.
D) Take prescribed anti-anxiety medication daily.
A 36-year-old male presents with nausea and vomiting for the past 12 hours. He has been unable to keep fluids down. What is the priority intervention?
A) Administer antiemetics.
B) Encourage small sips of clear liquids.
C) Insert a nasogastric tube.
D) Administer IV fluids.
A 33-year-old woman who is 4 weeks pregnant is concerned about gaining weight. What is the nurse’s best response?
A) “You should restrict your calorie intake to avoid gaining weight.”
B) “It is normal to gain weight during pregnancy. The amount varies.”
C) “Only gain weight in the second and third trimesters.”
D) “It is important to lose weight during pregnancy for a healthy delivery.”
A 30-year-old woman is diagnosed with a urinary tract infection (UTI). Which of the following is the most important teaching point?
A) “Avoid drinking caffeinated beverages.”
B) “It is important to complete the full course of antibiotics.”
C) “You can stop taking the antibiotics once symptoms subside.”
D) “Only take pain medication when symptoms are severe.”
A 34-year-old male presents with shortness of breath and a cough that has persisted for several weeks. What is the priority action for the nurse?
A) Obtain a chest X-ray.
B) Administer oxygen.
C) Encourage the client to rest.
D) Take a sputum sample for culture.
A 32-year-old woman with chronic migraine headaches is prescribed sumatriptan. What is an important teaching point?
A) “You should take this medication as soon as you experience a migraine.”
B) “Take this medication only once every 12 hours.”
C) “This medication is intended for daily use.”
D) “You should avoid drinking alcohol while on this medication.”
A 35-year-old male is being treated for a peptic ulcer with proton pump inhibitors (PPIs). What is an important teaching point for the nurse to include?
A) “You may need to take this medication for several months.”
B) “Take this medication with food to reduce stomach upset.”
C) “Avoid drinking alcohol while taking this medication.”
D) “You will need periodic liver function tests while on this medication.”
A 29-year-old woman who is breastfeeding is diagnosed with mastitis. Which treatment should the nurse prioritize?
A) Antifungal therapy
B) Warm compresses and antibiotics
C) Cessation of breastfeeding
D) Referral for a mammogram
A 36-year-old male with chronic alcohol use disorder is at risk for withdrawal. Which medication should the nurse anticipate administering to manage withdrawal symptoms?
A) Disulfiram (Antabuse)
B) Lorazepam (Ativan)
C) Methadone
D) Naloxone
A 34-year-old female client with a family history of breast cancer is concerned about her risk. What is the most important recommendation?
A) Start mammograms at age 30.
B) Perform monthly breast self-exams.
C) Obtain genetic counseling for BRCA testing.
D) Engage in moderate-intensity exercise daily.
A 32-year-old male presents with a headache and blurred vision. His blood pressure is 180/110 mmHg. What is the priority intervention?
A) Administer antihypertensive medication.
B) Apply a cold compress to the forehead.
C) Encourage the client to lie down in a dark room.
D) Administer pain medication.
A 29-year-old client is diagnosed with a thyroid disorder and prescribed levothyroxine. What is an important teaching point for the nurse to include?
A) “Take the medication with food to reduce gastrointestinal upset.”
B) “Take the medication on an empty stomach, 30 minutes before breakfast.”
C) “You can stop the medication once your thyroid levels are normalized.”
D) “This medication may cause weight gain.”
A 38-year-old woman with a history of hypertension is prescribed lisinopril. What is the most important side effect for the nurse to monitor for?
A) Hypokalemia
B) Hyperkalemia
C) Tachycardia
D) Weight gain
A 30-year-old male with depression is started on fluoxetine. Which of the following is an early sign of serotonin syndrome?
A) Hyperreflexia
B) Weight loss
C) Increased energy
D) Hypotension
A 33-year-old woman with a history of gestational diabetes is at increased risk for which of the following?
A) Type 1 diabetes
B) Type 2 diabetes
C) Hypoglycemia
D) Insulin resistance
A 35-year-old male with asthma is prescribed an inhaler. What is the most important teaching point?
A) “Use this inhaler only when you have an asthma attack.”
B) “Use the inhaler before exercise to prevent symptoms.”
C) “Limit your use of this inhaler to once daily.”
D) “It is safe to use this inhaler even if you feel well.”
A 29-year-old woman is diagnosed with polycystic ovary syndrome (PCOS). What is the primary goal of treatment?
A) Increase fertility
B) Regulate menstrual cycles
C) Decrease insulin resistance
D) Prevent hair loss
A 32-year-old male with asthma asks about the side effects of his albuterol inhaler. What is the most common side effect of albuterol?
A) Increased appetite
B) Dizziness
C) Tachycardia
D) Weight gain
A 34-year-old male with a history of hypertension is prescribed a calcium channel blocker. What is the most common side effect associated with this medication?
A) Dizziness
B) Constipation
C) Dry cough
D) Insomnia
A 29-year-old woman who is 6 weeks pregnant asks the nurse about the safety of using over-the-counter medications. What should the nurse advise?
A) “It’s safe to take any over-the-counter medication during pregnancy.”
B) “You should avoid all over-the-counter medications unless prescribed by your doctor.”
C) “You can take any medication that does not contain caffeine or alcohol.”
D) “It is safe to take acetaminophen for pain relief during pregnancy.”
A 36-year-old male is diagnosed with an anxiety disorder and is prescribed a benzodiazepine. What is the nurse’s priority concern for this patient?
A) Risk for addiction
B) Increased energy levels
C) Risk for overdose
D) Weight loss
A 30-year-old female with asthma is prescribed a long-acting beta-agonist (LABA) inhaler. What should the nurse instruct her about this medication?
A) “Use this inhaler during an asthma attack for immediate relief.”
B) “This inhaler is used to prevent asthma attacks, not for acute symptoms.”
C) “Take this inhaler on an empty stomach.”
D) “This inhaler can be used every 4 hours for acute symptoms.”
A 32-year-old client is newly diagnosed with type 1 diabetes. What is the nurse’s priority teaching for managing this condition?
A) “Avoid all sugar in your diet.”
B) “Monitor your blood glucose levels regularly.”
C) “You will need to take oral medications daily.”
D) “You can stop insulin injections once your blood glucose is normal.”
A 35-year-old client with chronic alcohol use disorder is admitted for detoxification. Which medication should the nurse anticipate administering to prevent withdrawal symptoms?
A) Disulfiram (Antabuse)
B) Lorazepam (Ativan)
C) Methadone
D) Naloxone
A 29-year-old female with polycystic ovary syndrome (PCOS) is concerned about her fertility. Which statement by the nurse is appropriate?
A) “PCOS does not affect fertility, so you don’t need to worry.”
B) “PCOS can make it more difficult to conceive, but treatment options are available.”
C) “You will need surgery to improve your fertility.”
D) “Fertility is usually restored with weight loss alone.”
A 30-year-old male is prescribed clomiphene citrate for infertility. What is the most important teaching point?
A) “You should take this medication with food.”
B) “You may experience mood swings and hot flashes while on this medication.”
C) “This medication may cause nausea, so take it with antacids.”
D) “Avoid alcohol while taking clomiphene citrate.”
A 32-year-old woman asks the nurse about the risk factors for cervical cancer. Which of the following is the most significant risk factor?
A) Obesity
B) Smoking
C) Family history of ovarian cancer
D) Use of oral contraceptives
A 28-year-old client is prescribed metformin for newly diagnosed type 2 diabetes. What should the nurse advise about taking this medication?
A) “Take this medication with meals to reduce gastrointestinal side effects.”
B) “This medication should be taken only in the evening.”
C) “Take this medication on an empty stomach for maximum effectiveness.”
D) “You may stop the medication once your blood glucose is normal.”
A 30-year-old male client who is overweight is advised to lose weight. What is the nurse’s best recommendation for starting a weight loss program?
A) “Set an initial goal to lose 10 pounds in 1 month.”
B) “Make gradual changes to your eating habits and activity level.”
C) “Restrict calorie intake to below 1,000 calories per day.”
D) “Try a liquid diet to quickly lose weight.”
A 36-year-old male presents with frequent urination, excessive thirst, and unexplained weight loss. What is the nurse’s priority action?
A) Check blood glucose levels.
B) Administer insulin.
C) Encourage fluid intake.
D) Teach the patient about healthy eating.
A 30-year-old female who is 12 weeks pregnant presents with nausea and vomiting. What is the nurse’s best response?
A) “You should avoid all fluids during pregnancy to prevent nausea.”
B) “Try eating small meals frequently and drinking fluids between meals.”
C) “Take anti-nausea medications immediately after vomiting.”
D) “Nausea during pregnancy is abnormal and needs immediate intervention.”
A 34-year-old male with hypertension is prescribed an ACE inhibitor. What is the most common side effect of ACE inhibitors?
A) Dry cough
B) Weight gain
C) Hypoglycemia
D) Tachycardia
A 32-year-old female is concerned about her mental health. She reports feeling sad and withdrawn for several weeks. What is the nurse’s priority assessment?
A) Ask about thoughts of self-harm or suicide.
B) Assess for signs of mania.
C) Teach coping skills for stress management.
D) Recommend seeing a therapist immediately.
A 29-year-old male with HIV is started on antiretroviral therapy (ART). What is the nurse’s most important teaching point about this therapy?
A) “You should stop the medication when your symptoms resolve.”
B) “This medication can cure HIV.”
C) “You need to take this medication exactly as prescribed to prevent resistance.”
D) “You will no longer be contagious once you start ART.”
A 34-year-old woman with a history of asthma asks about managing her symptoms during exercise. What is the best recommendation?
A) “Use your quick-relief inhaler before exercise.”
B) “Exercise should be avoided if you have asthma.”
C) “Take an antihistamine before exercise to prevent symptoms.”
D) “It is best to exercise only in the morning.”
A 36-year-old male with diabetes presents with a foot ulcer. What is the nurse’s priority action?
A) Encourage the client to use over-the-counter antibiotic ointment.
B) Assess the wound and prepare for debridement.
C) Elevate the foot to reduce swelling.
D) Teach the client about foot care and proper hygiene.
A 31-year-old client with a history of depression is taking fluoxetine. What side effect should the nurse monitor for during the initial phase of treatment?
A) Increased energy and agitation
B) Sedation and weight loss
C) Dizziness and hypotension
D) Decreased libido and sexual dysfunction
A 30-year-old female with a family history of breast cancer is concerned about her risk. What is the most important step in her care?
A) Start mammograms at age 30.
B) Perform monthly breast self-exams.
C) Obtain genetic counseling for BRCA testing.
D) Begin hormone replacement therapy.
A 32-year-old male with depression is prescribed an antidepressant. Which statement indicates a need for further teaching?
A) “I will avoid alcohol while taking this medication.”
B) “I will feel better right away after starting this medication.”
C) “It may take several weeks for the medication to work.”
D) “I will take this medication every day at the same time.”
A 30-year-old woman is diagnosed with endometriosis. What is the most common symptom?
A) Irregular periods
B) Painful menstruation
C) Unexplained weight gain
D) Excessive hair growth
A 35-year-old male presents with chest pain. What is the nurse’s priority assessment?
A) Take the client’s blood pressure.
B) Administer pain medication.
C) Obtain an ECG.
D) Ask about the client’s family history of heart disease.
A 28-year-old female with a history of migraines asks about medication options. What is the nurse’s priority?
A) “I will provide you with a prescription for a muscle relaxant.”
B) “Consider using a triptan for acute migraine relief.”
C) “A daily dose of acetaminophen will prevent your migraines.”
D) “An opioid painkiller should be your first choice for treatment.”
A 33-year-old female with fibromyalgia is prescribed pregabalin. What is an important teaching point?
A) “You may experience a decrease in your energy levels.”
B) “Pregabalin is used for pain management and anxiety.”
C) “Take this medication with food to prevent nausea.”
D) “This medication will cure your condition.”
A 31-year-old male presents with symptoms of depression. What is the nurse’s priority assessment?
A) Ask about thoughts of suicide or self-harm.
B) Ask about recent weight changes.
C) Assess for the presence of hallucinations.
D) Inquire about alcohol consumption.
A 36-year-old male with hypertension is prescribed hydrochlorothiazide. What is a common side effect of this medication?
A) Hyperkalemia
B) Dehydration
C) Weight gain
D) Vision changes
A 30-year-old male with asthma is prescribed a corticosteroid inhaler. What is the most important teaching point for this medication?
A) “Use this inhaler only during an asthma attack.”
B) “Rinse your mouth after each use to prevent oral thrush.”
C) “This medication can be used every 4 hours for quick relief.”
D) “This inhaler is used to treat acute symptoms.”
A 32-year-old male with depression is prescribed an SSRI. Which side effect should the nurse educate the client about?
A) Increased risk of seizures
B) Decreased libido
C) Increased risk of bleeding
D) Sudden weight gain
A 33-year-old female with type 1 diabetes asks about exercising. What is the nurse’s most important advice before exercising?
A) “You should inject extra insulin before exercise.”
B) “You may need to eat a small snack before exercising.”
C) “Exercise should be avoided if your blood glucose is high.”
D) “Exercise will lower your insulin needs significantly.”
NCLEX Young and Middle Adults Questions and Answers for Study Guide
(1) A 30-year-old male patient is newly diagnosed with type 2 diabetes. Discuss the key steps in managing his condition, including lifestyle modifications, medication, and ongoing monitoring.
Answer:
Management of type 2 diabetes in a 30-year-old patient should focus on a holistic approach that includes both lifestyle changes and appropriate pharmacologic therapy. The primary goals are to achieve optimal glucose control, prevent complications, and maintain a healthy lifestyle.
Lifestyle Modifications:
- Diet: Encourage a balanced diet with an emphasis on low-sugar and whole-grain foods. Advise the patient to monitor carbohydrate intake and consider working with a dietitian to create a personalized meal plan.
- Exercise: Regular physical activity is crucial. Recommend at least 150 minutes of moderate-intensity exercise weekly to help improve insulin sensitivity and overall cardiovascular health.
- Weight Management: If the patient is overweight, weight loss can help improve insulin sensitivity and glucose levels.
Medication:
- The patient may require oral medications like metformin initially to help manage blood glucose levels. Metformin works by reducing glucose production in the liver and improving insulin sensitivity.
- If glucose levels remain uncontrolled or if the patient has additional risk factors (e.g., cardiovascular disease), the addition of a second oral medication or an injectable agent such as insulin might be necessary.
Ongoing Monitoring:
- Regular blood glucose checks are essential to assess the effectiveness of treatment. It’s important to monitor A1C levels to assess long-term glucose control and adjust treatment as necessary. Encourage the patient to keep a daily log of blood glucose readings and visit their healthcare provider regularly to discuss progress and make any necessary adjustments to their treatment plan.
(2) A 34-year-old female client reports feeling stressed and overwhelmed due to work and family responsibilities. Describe a comprehensive approach to help this patient manage her stress and improve her mental health.
Answer:
Managing stress in a 34-year-old female client requires a comprehensive approach that includes counseling, relaxation techniques, and lifestyle changes. Mental health is crucial for overall well-being, and addressing stress is essential to prevent more serious conditions such as anxiety or depression.
Counseling and Support: Start by providing the patient with information about available counseling services or support groups where she can discuss her feelings and receive professional guidance. Cognitive-behavioral therapy (CBT) is particularly effective in helping individuals manage stress by altering negative thought patterns and behaviors.
Relaxation Techniques: Encourage the patient to incorporate relaxation techniques into her daily routine. Practices such as deep-breathing exercises, meditation, yoga, or progressive muscle relaxation can help reduce feelings of anxiety and stress.
Lifestyle Modifications:
- Regular Exercise: Physical activity is a proven stress reducer and can help improve mood. Recommend engaging in regular physical exercise, such as jogging, swimming, or cycling, for at least 30 minutes several times a week.
- Healthy Diet: Advise the patient to maintain a balanced diet to support her mental and physical health. Proper nutrition can enhance energy levels and mood.
- Adequate Sleep: Encourage her to establish a consistent sleep schedule to ensure sufficient rest, which is vital for mental health.
Social Support: Stress management is often supported by a strong network of family and friends. Encourage the patient to spend time with loved ones, engage in hobbies, or join a group where she can socialize. Social interactions help provide a sense of belonging and reduce feelings of stress.
Medication, if Necessary: In some cases, if the stress persists and affects daily life, the healthcare provider may consider prescribing medication (such as antidepressants or anti-anxiety medications). It’s crucial to discuss the benefits and potential side effects of any medication, ensuring that it is used as part of a broader treatment plan rather than as the sole treatment option.
(3) A 29-year-old female client has been diagnosed with polycystic ovary syndrome (PCOS). Explain the symptoms of PCOS and outline a management plan to address these symptoms.
Answer:
Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. It can lead to various symptoms, including menstrual irregularities, excessive androgen levels, and the development of small cysts on the ovaries. A comprehensive management plan focuses on controlling symptoms and reducing the risk of long-term complications.
Symptoms of PCOS:
- Menstrual Irregularities: The most common symptom is irregular or absent menstrual periods, due to anovulation.
- Excess Androgens: Elevated levels of male hormones can result in symptoms such as hirsutism (excess hair growth), acne, and androgenic alopecia (hair loss).
- Cysts on Ovaries: Small cysts may be present on the ovaries, although they are typically asymptomatic.
- Weight Gain: Many patients with PCOS struggle with weight management, and obesity can exacerbate other symptoms.
Management Plan:
- Lifestyle Modifications: Encourage the patient to maintain a healthy weight through diet and exercise, as weight loss can help improve insulin resistance and menstrual regularity.
- Medications:
- Oral Contraceptives: These can help regulate the menstrual cycle and reduce androgen levels.
- Metformin: Often prescribed to improve insulin sensitivity, which can help regulate menstrual cycles and reduce androgen levels.
- Clomiphene Citrate: May be prescribed if fertility is a concern, to help induce ovulation.
- Manage Symptoms: Treat hirsutism with medications like spironolactone if severe. Acne can be treated with topical or oral medications.
- Monitor for Complications: Regular screening for diabetes and hyperlipidemia is important, as women with PCOS are at higher risk for these conditions.
(4) A 32-year-old male presents with symptoms of acute low back pain after lifting heavy boxes. Discuss the initial assessment and management plan for this patient.
Answer:
Acute low back pain is a common complaint, often associated with improper lifting techniques, muscle strain, or injury to the spine. The management of low back pain begins with an appropriate assessment and a comprehensive care plan to relieve pain, promote healing, and prevent further injury.
Initial Assessment:
- History: Ask the patient about the onset, duration, and intensity of the pain. Inquire about any history of trauma, prior episodes of back pain, or previous surgeries. It’s also important to assess for red flags such as numbness, tingling, weakness, or bowel and bladder changes, which could indicate more serious conditions like herniated disks or spinal cord compression.
- Physical Examination: Inspect the patient’s posture, gait, and range of motion. Palpate for tenderness or muscle spasms. Perform neurological checks to assess for any deficits in sensation, strength, or reflexes.
- Diagnostic Tests: If needed, consider imaging studies like X-rays or MRI if the pain persists or there are signs of neurological involvement.
Management Plan:
- Pain Relief: Recommend over-the-counter pain relievers such as ibuprofen or acetaminophen. If the pain is severe, a short course of muscle relaxants or prescription analgesics may be considered.
- Activity Modification: Advise the patient to avoid activities that could worsen the pain. However, prolonged bed rest should be avoided as it can worsen symptoms. Instead, encourage gentle movement and low-impact activities like walking or swimming.
- Physical Therapy: If the patient continues to experience pain or has recurring episodes of low back pain, referral to physical therapy may be beneficial. A physical therapist can teach proper posture, stretching exercises, and strengthening routines to prevent future injuries.
- Education: Provide education on proper lifting techniques and ergonomic adjustments at work and home to reduce the risk of future injuries. Educating the patient on maintaining a healthy weight and regular exercise can also help prevent further back issues.
(5) A 33-year-old female presents with a recent diagnosis of generalized anxiety disorder (GAD). Discuss the appropriate interventions and management strategies for this patient.
Answer:
Generalized anxiety disorder (GAD) is characterized by excessive, uncontrollable worry and anxiety that impacts daily functioning. Management of GAD typically includes a combination of pharmacologic treatment, psychotherapy, and lifestyle modifications to improve the patient’s quality of life.
Pharmacologic Treatment:
- Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), such as sertraline or escitalopram, are often first-line treatment for GAD. These medications help regulate serotonin levels in the brain, reducing symptoms of anxiety.
- Benzodiazepines: In the short term, medications like lorazepam or alprazolam may be prescribed to manage acute anxiety symptoms, but they should be used cautiously due to the potential for dependence.
- Buspirone: This medication can be used for long-term management of GAD, especially for patients who are not candidates for benzodiazepines.
Psychotherapy:
- Cognitive Behavioral Therapy (CBT): CBT is considered the most effective therapy for GAD. It focuses on identifying and modifying negative thought patterns and behaviors that contribute to anxiety. The therapist helps the patient develop coping strategies to manage stress and anxiety.
- Relaxation Techniques: Encourage the patient to practice relaxation methods, such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation, to help alleviate anxiety.
Lifestyle Modifications:
- Exercise: Physical activity is a natural anxiety reducer. Regular exercise, such as walking, swimming, or yoga, can help reduce muscle tension and improve mood.
- Dietary Changes: Advise the patient to avoid excessive caffeine, nicotine, and alcohol, as these can exacerbate anxiety symptoms.
- Sleep Hygiene: Encourage the patient to maintain a regular sleep schedule and create a calming bedtime routine to improve the quality of their sleep, as poor sleep can worsen anxiety.
Support Systems:
- Encourage the patient to seek social support from friends, family, or support groups. Having a network of people to talk to can significantly reduce feelings of isolation and anxiety.
(6) A 28-year-old female is diagnosed with hypertension and prescribed an ACE inhibitor. Describe the common side effects of this medication, the monitoring required, and patient education.
Answer:
Angiotensin-converting enzyme (ACE) inhibitors are commonly prescribed to manage hypertension by relaxing blood vessels and improving blood flow. While they are effective for controlling blood pressure, they can have side effects that require monitoring and patient education.
Common Side Effects:
- Cough: A persistent dry cough is a well-known side effect of ACE inhibitors, occurring in up to 20% of patients. If the cough is bothersome, the healthcare provider may switch the patient to an angiotensin II receptor blocker (ARB).
- Hyperkalemia: ACE inhibitors can increase potassium levels in the blood, which may lead to dangerous heart arrhythmias. Patients should be monitored for elevated potassium levels.
- Dizziness or Lightheadedness: Due to the blood pressure-lowering effect, patients may experience dizziness, especially when standing up quickly. This is a common side effect, particularly during the initial phase of treatment.
- Angioedema: This rare but serious side effect involves swelling of the face, lips, or throat and requires immediate medical attention.
Monitoring Requirements:
- Blood Pressure: Regular monitoring of blood pressure is essential to assess the effectiveness of the ACE inhibitor and ensure the patient is not developing hypotension.
- Potassium Levels: Blood tests should be performed to monitor potassium levels, as hyperkalemia is a potential risk.
- Kidney Function: ACE inhibitors can impact kidney function, so renal function should be checked regularly, especially in patients with preexisting kidney disease.
Patient Education:
- Medication Adherence: Educate the patient on the importance of taking the medication as prescribed, even if they feel well. Missing doses can lead to uncontrolled blood pressure.
- Dietary Changes: Encourage the patient to follow a low-sodium diet and avoid potassium-rich foods, as high potassium levels can be dangerous.
- Signs of Complications: Teach the patient to recognize symptoms of complications such as swelling of the lips, tongue, or face (angioedema), and advise them to seek immediate medical attention if this occurs.
- Lifestyle Modifications: Discuss the importance of maintaining a healthy diet, regular exercise, and weight management to further control blood pressure.
(7) A 34-year-old male with asthma presents to the clinic for a routine follow-up. Discuss the management strategies for asthma control, including pharmacologic and non-pharmacologic interventions.
Answer:
Asthma management involves both acute and long-term control strategies to prevent symptoms and improve the patient’s quality of life. Pharmacologic and non-pharmacologic interventions are key components of effective asthma management.
Pharmacologic Interventions:
- Short-Acting Beta-Agonists (SABA): These medications, such as albuterol, provide quick relief of acute asthma symptoms by relaxing bronchial muscles and dilating airways. They are used as rescue inhalers for sudden exacerbations.
- Inhaled Corticosteroids (ICS): ICS medications, such as fluticasone, are used for long-term control by reducing inflammation in the airways. These should be used daily, even when the patient is asymptomatic, to prevent asthma exacerbations.
- Long-Acting Beta-Agonists (LABA): Medications like salmeterol can be combined with ICS for patients with more severe asthma to provide sustained bronchodilation.
- Leukotriene Modifiers: These oral medications, such as montelukast, help reduce inflammation and prevent asthma symptoms, especially for patients with allergic asthma.
Non-Pharmacologic Interventions:
- Trigger Identification and Avoidance: Educate the patient on identifying and avoiding asthma triggers, such as allergens (e.g., pollen, dust mites), smoking, or environmental pollutants. Implementing an asthma action plan that includes avoiding these triggers is crucial.
- Breathing Techniques: Teach the patient breathing exercises like pursed-lip breathing to help control symptoms and reduce breathlessness.
- Regular Exercise: Encourage the patient to engage in regular physical activity, as it can improve lung function and overall health. It’s important to ensure the exercise regimen is safe and does not trigger asthma symptoms.
- Monitor Peak Flow: Teach the patient to use a peak flow meter to monitor their asthma and identify early signs of worsening symptoms, so they can take appropriate action before an exacerbation occurs.
Education on Medication Use: Ensure the patient knows how to properly use inhalers and spacers to ensure effective medication delivery.
(8) A 29-year-old female presents with complaints of fatigue, weight gain, and cold intolerance. She has a history of hypothyroidism and is not currently on any medication. Discuss the management plan for this patient.
Answer:
Hypothyroidism occurs when the thyroid gland produces insufficient thyroid hormones, leading to symptoms like fatigue, weight gain, cold intolerance, and other metabolic disturbances. Management focuses on correcting hormone imbalances and providing symptomatic relief.
Initial Assessment:
- History: Ask the patient about the duration and progression of symptoms. Inquire about any previous history of thyroid disease, family history of thyroid disorders, and any medications or treatments that may have been previously used.
- Physical Examination: Check for signs such as dry skin, brittle hair, bradycardia, and delayed reflexes, which may indicate hypothyroidism.
- Diagnostic Tests: Measure thyroid function with blood tests, specifically serum levels of thyroid-stimulating hormone (TSH) and free thyroxine (T4). An elevated TSH and low T4 would indicate hypothyroidism.
Management Plan:
- Levothyroxine: The first-line treatment for hypothyroidism is levothyroxine, a synthetic form of the thyroid hormone T4. Start the patient on an appropriate dose, typically adjusted based on follow-up thyroid function tests.
- Monitoring: Regular follow-up visits are required to monitor the patient’s TSH and T4 levels, adjusting the dosage of levothyroxine as needed. It’s important to check thyroid function every 6-8 weeks until the thyroid levels stabilize, and then every 6-12 months thereafter.
- Symptom Management: Educate the patient that symptoms such as fatigue and cold intolerance should improve within a few weeks of starting therapy, but it may take several months to fully resolve. Ensure that the patient understands the importance of adhering to the prescribed medication regimen.
- Lifestyle Modifications: Encourage the patient to maintain a balanced diet and engage in regular exercise. Weight loss may be difficult during the early stages of treatment, but it should become easier once thyroid hormone levels stabilize.
Patient Education:
- Medication Adherence: Stress the importance of taking levothyroxine daily, preferably on an empty stomach, and at the same time every day. Advise against taking the medication with calcium, iron, or antacids, as these can interfere with absorption.
- Signs of Overdose: Educate the patient on signs of overdose, such as palpitations, irritability, and excessive sweating, and the need to seek medical attention if these occur.
- Long-Term Monitoring: Emphasize the need for regular follow-up to monitor thyroid function and adjust the medication dosage accordingly.
(9) A 32-year-old male with a history of chronic alcohol use presents with confusion, tremors, and diaphoresis. He is diagnosed with alcohol withdrawal syndrome (AWS). Discuss the management and treatment for this patient.
Answer:
Alcohol withdrawal syndrome (AWS) occurs when a person with chronic alcohol use suddenly reduces or stops alcohol intake. It can be life-threatening and requires immediate management to prevent complications such as seizures or delirium tremens.
Initial Assessment:
- History: Obtain a detailed history of the patient’s alcohol use, including the amount and duration of drinking. Assess for any previous withdrawal episodes, as well as any other medical conditions that may complicate treatment.
- Physical Examination: Look for signs of withdrawal, including tremors, diaphoresis, agitation, tachycardia, and elevated blood pressure. Assess for more severe symptoms, such as confusion, hallucinations, and seizures.
- Diagnostic Tests: Blood tests to check liver function, electrolytes, and a complete blood count (CBC) are necessary to assess the patient’s overall health. Additionally, consider an alcohol level test to determine the amount of alcohol in the bloodstream if the patient is still drinking.
Management Plan:
- Benzodiazepines: The cornerstone of treatment for alcohol withdrawal is benzodiazepines (e.g., lorazepam, diazepam), which help manage symptoms such as anxiety, tremors, and agitation, as well as reduce the risk of seizures. Dosing is often titrated based on the severity of withdrawal symptoms.
- Thiamine: Administer thiamine (Vitamin B1) to prevent Wernicke-Korsakoff syndrome, a serious complication of alcohol withdrawal due to thiamine deficiency.
- Electrolyte Replacement: Correct any electrolyte imbalances, particularly low magnesium, potassium, and sodium levels, which are common in alcohol withdrawal.
- Monitoring: Frequent monitoring of vital signs, particularly blood pressure, heart rate, and respiratory status, is essential. Continuous assessment of the patient’s symptoms using the Clinical Institute Withdrawal Assessment (CIWA) scale can guide medication titration.
Complications to Watch For:
- Delirium Tremens (DTs): This severe form of alcohol withdrawal presents with confusion, agitation, hallucinations, and cardiovascular instability. It can be fatal without appropriate treatment, so monitoring for signs of DTs is critical.
- Seizures: Seizures typically occur within 6-48 hours after the last drink. Benzodiazepines are effective in preventing and managing withdrawal seizures.
Patient Education:
- Substance Use Education: Once the acute withdrawal phase has passed, provide education on the risks of chronic alcohol use and refer the patient to addiction services for further counseling and support.
- Long-Term Management: Discuss options for long-term management, including medications like disulfiram, acamprosate, or naltrexone to help prevent relapse. Encourage participation in support groups such as Alcoholics Anonymous.
(10) A 30-year-old female presents with an episode of palpitations, shortness of breath, and chest discomfort. She is diagnosed with an episode of panic disorder. Discuss the acute management and long-term treatment options for this patient.
Answer:
Panic disorder is characterized by recurrent, unexpected panic attacks, which are sudden periods of intense fear or discomfort. The management of panic disorder includes both acute interventions to manage symptoms during an attack and long-term strategies to prevent recurrence.
Acute Management:
- Symptomatic Relief: During a panic attack, it is important to help the patient manage their acute symptoms. Guide the patient to practice slow, deep breathing to reduce hyperventilation and anxiety. Reassure the patient that the symptoms are not life-threatening, but they should seek medical attention if chest pain or other severe symptoms occur.
- Benzodiazepines: For immediate relief of anxiety during an acute episode, a short-acting benzodiazepine such as lorazepam may be prescribed. However, these medications are generally used on a short-term basis due to the risk of dependence.
Long-Term Treatment:
- Cognitive Behavioral Therapy (CBT): CBT is the most effective form of psychotherapy for panic disorder. It focuses on identifying and challenging irrational thoughts and beliefs that contribute to panic attacks. Gradual exposure to feared situations in a controlled environment can help reduce anxiety over time.
- Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs such as sertraline or fluoxetine are commonly prescribed for the long-term management of panic disorder. These medications work by increasing the availability of serotonin in the brain, which helps regulate mood and reduce anxiety.
- Lifestyle Modifications: Encourage the patient to adopt relaxation techniques such as yoga or meditation to manage stress. Regular exercise can also help reduce anxiety levels and improve overall well-being.
- Panic Disorder Education: Educate the patient about the nature of panic disorder, the importance of medication adherence, and how to manage symptoms during attacks. Help the patient identify potential triggers and develop coping strategies.
Follow-Up:
- Ongoing Monitoring: Regular follow-up appointments are necessary to monitor the effectiveness of treatment and make adjustments as needed. Encourage the patient to stay engaged in therapy and continue medication management for long-term symptom relief.
- Supportive Resources: Provide information on support groups or online resources where the patient can connect with others who are managing panic disorder.
(11) A 28-year-old male presents to the emergency department with severe right lower quadrant abdominal pain, fever, and nausea. He is diagnosed with acute appendicitis. Discuss the management and preoperative care for this patient.
Answer:
Acute appendicitis is a common surgical emergency characterized by inflammation of the appendix. It requires prompt intervention to prevent rupture and peritonitis.
Initial Assessment:
- History: The patient typically reports a history of periumbilical pain that later localizes to the right lower quadrant. Associated symptoms include nausea, vomiting, fever, and anorexia.
- Physical Examination: Palpation of the right lower quadrant will likely elicit tenderness and rebound tenderness. The Rovsing sign (pain in the right lower quadrant with palpation of the left lower quadrant) may also be positive. Check for signs of peritoneal irritation, such as guarding.
- Diagnostic Tests: A complete blood count (CBC) often shows an elevated white blood cell count. An abdominal ultrasound or CT scan is the most definitive diagnostic tool for confirming appendicitis.
Management Plan:
- Fluid Resuscitation: Administer IV fluids to correct any dehydration caused by vomiting and fever. Electrolyte imbalances should be addressed, particularly if the patient has been unable to eat or drink.
- Pain Management: Administer analgesics, typically opioids such as morphine, to control pain while monitoring for any signs of worsening condition.
- Antibiotics: Start broad-spectrum IV antibiotics, such as ceftriaxone or piperacillin-tazobactam, to prevent infection after surgery.
- Surgical Intervention: Appendectomy is the definitive treatment for appendicitis. The patient will likely undergo a laparoscopic or open appendectomy, depending on the severity of the appendicitis and the surgeon’s assessment.
Preoperative Care:
- Patient Education: Educate the patient about the need for surgery and the expected recovery time. Inform the patient about the signs of complications such as wound infection or bowel obstruction.
- NPO Status: Ensure the patient is kept NPO (nothing by mouth) in preparation for surgery to reduce the risk of aspiration during anesthesia.
- IV Access: Secure an IV line for fluid administration and medication administration during surgery. Blood work and preoperative imaging should be reviewed.
Postoperative Care:
- Monitoring: Monitor the patient for signs of complications, such as infection, bleeding, or ileus. Observe the surgical site for signs of infection or dehiscence.
- Pain Control: Continue to manage pain postoperatively with oral analgesics and adjust based on the patient’s condition.
Patient Education:
- Postoperative Instructions: Teach the patient how to care for the incision site and what signs of infection to watch for. Encourage early ambulation to reduce the risk of complications like deep vein thrombosis (DVT).
(12) A 35-year-old woman with a history of hypertension presents with a complaint of persistent headaches, blurry vision, and swelling in her ankles. Discuss the management and treatment of this patient with hypertensive urgency.
Answer:
Hypertensive urgency is characterized by severely elevated blood pressure (typically >180/110 mmHg) without evidence of end-organ damage. If left untreated, it can lead to complications such as stroke, myocardial infarction, or kidney failure.
Initial Assessment:
- History: Assess the patient’s compliance with antihypertensive medications and recent lifestyle changes. Ask about any triggers for her symptoms, such as stress or a change in diet.
- Physical Examination: Take multiple blood pressure readings to confirm hypertension. Examine the eyes for signs of retinopathy (e.g., papilledema or hemorrhages) and assess the lungs for crackles (indicating heart failure).
- Diagnostic Tests: Check laboratory tests, including renal function tests, electrolyte levels, and a urinalysis to assess for possible organ damage. An ECG and echocardiogram may be warranted to assess cardiac function.
Management Plan:
- Immediate Blood Pressure Reduction: The goal is to lower the blood pressure gradually over a 24-48 hour period using oral antihypertensive medications. Options include ACE inhibitors (e.g., lisinopril), beta-blockers (e.g., metoprolol), or calcium channel blockers (e.g., amlodipine). Rapid reduction of blood pressure can result in ischemia and organ injury, so the target is to reduce BP by no more than 25% in the first 2 hours.
- Fluid Management: Ensure adequate fluid intake, especially if the patient is presenting with symptoms of fluid retention, such as swelling in the ankles.
- Monitoring: Continuous monitoring of blood pressure, renal function, and other vital signs is necessary to assess the effectiveness of the treatment and detect any potential complications.
Long-Term Treatment and Education:
- Antihypertensive Medication: Consider a long-term regimen of antihypertensive therapy, such as ACE inhibitors, angiotensin II receptor blockers (ARBs), or diuretics to control blood pressure. Adjust medications based on the patient’s individual needs and tolerance.
- Lifestyle Modifications: Encourage weight loss, a low-sodium diet, regular exercise, and stress management. Limit alcohol consumption and advise cessation of smoking.
- Follow-Up Care: Arrange for regular follow-up visits to monitor blood pressure and adjust medications as needed. Blood pressure checks should be done regularly to prevent future episodes of hypertensive urgency.
Patient Education:
- Medication Adherence: Stress the importance of adhering to the prescribed antihypertensive regimen and not stopping medications without consulting a healthcare provider.
- Warning Signs: Educate the patient about warning signs of a hypertensive emergency, such as chest pain, difficulty breathing, or severe headaches, which require immediate medical attention.
- Long-Term Management: Discuss the importance of lifestyle changes to manage hypertension and prevent complications like stroke or heart disease.
(13) A 33-year-old woman presents with complaints of joint pain, fatigue, and a butterfly-shaped rash across her cheeks and nose. She has a family history of autoimmune diseases. Discuss the diagnosis and management of this patient with systemic lupus erythematosus (SLE).
Answer:
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that affects multiple organ systems, including the skin, joints, kidneys, and heart. The diagnosis is clinical and supported by laboratory findings.
Initial Assessment:
- History: Obtain a detailed history of symptoms, including the duration and progression of joint pain, fatigue, and the characteristic butterfly-shaped rash. Ask about any known family history of autoimmune diseases, such as lupus or rheumatoid arthritis.
- Physical Examination: Examine the skin for characteristic rashes (especially the malar rash) and mucosal ulcers. Assess for signs of systemic involvement such as joint swelling, pericarditis, or pleuritis.
- Diagnostic Tests: Laboratory tests should include antinuclear antibody (ANA) testing, which is positive in most patients with lupus. Additional tests such as anti-double-stranded DNA (anti-dsDNA) antibodies, complement levels (C3, C4), and urinalysis to check for proteinuria may also help confirm the diagnosis.
Management Plan:
- Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for joint pain and inflammation. However, use cautiously in patients with kidney involvement.
- Hydroxychloroquine: This antimalarial medication is commonly prescribed to control skin and joint manifestations and to prevent disease flare-ups. It can also help with reducing the frequency of lupus flares.
- Corticosteroids: In more severe cases, oral or intravenous corticosteroids may be used to control inflammation and reduce disease activity.
- Immunosuppressive Agents: If the disease involves major organs, such as the kidneys (lupus nephritis), drugs such as azathioprine, cyclophosphamide, or mycophenolate mofetil may be used to suppress the immune system and prevent organ damage.
Long-Term Management:
- Monitoring: Regular monitoring of kidney function, liver enzymes, and hematologic parameters is essential, as lupus and its treatments can affect these systems. Periodic screenings for lupus nephritis should also be conducted.
- Lifestyle Modifications: Advise the patient to avoid sun exposure and use sun protection, as UV light can trigger lupus flares. Encourage regular physical activity to help manage fatigue and improve joint mobility.
Patient Education:
- Medication Adherence: Emphasize the importance of adhering to prescribed medications, especially hydroxychloroquine, which helps control lupus symptoms and prevent flare-ups.
- Signs of Flare-Ups: Educate the patient on recognizing signs of a lupus flare, such as increased fatigue, new or worsening joint pain, and a recurrence of the characteristic rash, which require prompt medical attention.