128) ANSWER

d.	TIG and tetanus-diphtheria toxoid and pertussis vaccine (Tdap).

RATIONALE

For an adult with no previous tetanus immunizations, TIG and Tdap are recommended. The other immunizations are not sufficient for this patient.

127) Answers

A. Lower back or flank pain that worsens with activity
B. Hematuria

Rationale

•Common clinical manifestations of PKD include flank or lower back pain, frequent UTIs, hematuria, proteinuria, calculi, and hypertension.

•PKD does not cause an adrenal crisis.

•Nausea is not commonly associated with PKD.

126) Answer

B. A systolic murmur heard over the left sternal border

Rationale

•A typical systolic ejection murmur heard loudest at the upper left strenal border is indicative of pulmonic stenosis. A thrill may be present in the upper left sternal area or at the suprasternal notch.

•Pulmonary stenosis is the narrowing of the pulmonary valve or the pulmonary artery just distal to the valve. Inability of the right ventricle to evacuate blood may lead to right ventricular hypertrophy.

•Most patients with pulmonary stenosis are asymptomatic. Severe stenosis can cause exertional angina, syncope, or sudden death.

•Exertional dyspnea is more often associated with severe aortic stenosis or tetralogy of Fallot.

•Thrills are felt, not heard.

•Cyanosis does not usually occur with only pulmonic stenosis.

125) ANSWER

C)Liver

RATIONALE

Amebic infection can be carried via the blood to other organs, with the liver as the most common site, causing liver abscess. Recall that the liver is structurally close to the GI tract.

124) ANSWER

C) Hydroxyzine (Atarax)

RATIONALE

Hydroxyzine hydrochloride is an antihistamine that is a competitive inhibitor of the H₁ receptor. It is used to treat various reactions that are mediated by histamine. It will decrease the pruritus produced by the release of histamine. Cimetidine is an H₂ histamine antagonist and these agents are not effective against hypersensitivity reactions. Lorazepam is a short-acting benzodiazepine that is indicated for anxiety. Bupivacaine is a local anesthetic for nerve blocks. The core issue of the question is knowledge of which drug relieves itching. Use specific drug knowledge and the process of elimination to make a selection.

123) ANSWER

B) Excessive rubbing of the eyes

RATIONALE

Symptoms of decreased visual acuity are squinting to focus, excessive tearing of the eyes, and rubbing of the eye. Language would not be affected by diminished vision. To distinguish among the other options, recall signs of visual impairment at various ages.

122) ANSWER

B) Father of client who has had urinary stones twice.

RATIONALE

The greatest risk factor for stone formation is a prior personal or family history of urinary calculi. The other answers are important information to know but do not contribute greatly as risk factors. Recall that there is thought to be a genetic link to incidence of renal stones.