A patient is taking a cytokine immunomodulator to treat RA. The primary care NP caring for this patient should:
a. obtain periodic complete blood counts (CBCs) and liver function tests (LFTs).
b. perform annual tuberculosis (TB) skin testing.
c. advise the patient of an increased risk of bone cancer.
d. administer the intranasal live attenuated influenza vaccine (LAIV) each year.
A
Routine monitoring for patients taking cytokine immunomodulators should include periodic CBCs and LFTs. TB skin testing should be performed before initiating therapy but is not indicated annually. Patients taking immunomodulators do not have an increased risk of bone cancer. Providers should administer the trivalent influenza vaccine intramuscularly and not the LAIV given intranasally because the LAIV is a live virus, which is contraindicated in patients who are immunosuppressed.
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Delegation is defined as:
A. Reassigning the responsibility of performing a job from one person to another. B. Explaining how you want a job done. C. Telling other people what to do. D. Developing ways to classify people into job categories to learn what they are capable of doing.
You have recently returned from a medical missions trip to sub-Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your “routine” when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has
malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers? A) Continue asking these questions in a more selective way. B) Stop asking these questions, because they are low yield. C) Question the validity of the questions. D) Ask these questions of all your patients.
The current environment requires a concerted national effort including all levels of government to prevent, prepare for, respond to, and recover from major disasters. The National Response Plan was formed under Presidential directives
The purpose of this plan is to create: 1. A new branch of government that deals with bioterrorism 2. A way for the Red Cross to carry out its mission 3. A unified, all-discipline, all-hazards approach to domestic incident management 4. An extension of presidential power to act quickly to weapons of mass destruction
Your primary assessment of the infant reveals the following: s.B is alert and fussy and consoles with a
bottle of Pedialyte (per physician orders). His anterior fontanel is slightly depressed and posterior fontanel cannot be palpated. you auscultate regular breath sounds at a rate of 18 breaths/min. No adventitious sounds. Pulse oximetry is 98% on room air. Heart rate is 140 beats/min with regular rate and rhythm. Brachial and pedal pulses are +3 and equal. Abdomen is round and nontender to palpation. Positive bowel sounds. diaper is dry. s.B. moves all extremities and there are no rashes noted. Rectal temperature is 98.9 ° F (37.2 ° C). There is a quarter-sized flat red area on occiput that "has been there since he was born" according to the mother. slight "tenting" noted. you transport s.B. to radiology and he vomits a large amount of clear fluid. Patient returns to the room in his mother's arms, awake and alert. The mother appears anxious and states, "I don't know what's wrong with my baby! Why can't you people tell me anything?" The emergency physician orders a complete blood count, complete metabolic profile, urinalysis, blood pH, and x-rays. The physician suspects dehydration and metabolic alkalosis secondary to hypertrophic pyloric stenosis. Which of these laboratory findings would you expect with metabolic alkalosis? a. Na: 128 mEq/L, K: 2.6 mEq/L, Cl: 90 mEq/L, HCO3: 28 mEq/L b. Na: 130 mEq/L, K: 5.7 mEq/L, Cl: 94 mEq/L, HCO3: 22 mEq/L c. Na: 130 mEq/L, K: 3.9 mEq/L, Cl: 98 mEq/L, HCO3: 17 mEq/L d. Na: 148 mEq/L K: 4.1 mEq/L, Cl: 108 mEq/L, HCO3: 13 mEq/L