An 18-year-old college student with an exacerbation of systemic lupus erythematosus (SLE) has been receiving prednisone (Deltacone) 20 mg daily for 4 days. Which of these medical orders should you question?

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Administer first dose of varicella vaccine. This answer should be questioned because the patient is currently on prednisone, a corticosteroid that can suppress the immune system's response. Administering a live attenuated vaccine like the varicella vaccine can pose a risk of causing an infection in an immunocompromised individual like the patient with SLE. Option A) Discontinuing prednisone abruptly can lead to adrenal insufficiency and exacerbation of the lupus symptoms. It is important to taper corticosteroid doses gradually. Option C) Checking the patient's C-reactive protein (CRP) is a valid monitoring parameter to assess inflammation levels in SLE and response to treatment. Option D) Giving ibuprofen is not contraindicated in this scenario as it can help with managing inflammation and pain in SLE, although long-term use should be monitored due to potential side effects on the gastrointestinal system and kidneys. Educationally, this question highlights the importance of understanding drug interactions and contraindications, especially in patients with autoimmune conditions like SLE who are on immunosuppressive therapy. It emphasizes the need for healthcare providers to be vigilant in assessing medication orders to prevent potential harm to patients.

Correct Answer: C

Rationale: The primary difference between healing by primary intention and healing by secondary intention lies in the amount of granulation tissue formed during the healing process. In primary intention healing, the wound edges are brought together and sutured, resulting in minimal granulation tissue formation and less scarring. On the other hand, in secondary intention healing, the wound is left open to heal, leading to the formation of more granulation tissue, which in turn causes more scarring. Option A is incorrect because surgical debridement is not a requirement for healing by secondary intention. Debridement may be necessary in certain cases to remove necrotic tissue, but it is not a defining factor of secondary intention healing. Option B is incorrect because primary intention healing involves the approximation of wound edges and the formation of a minimal amount of granulation tissue, rather than suturing two layers of granulation tissue together. Option D is incorrect because healing by secondary intention takes longer primarily due to the increased formation of granulation tissue, which is a necessary step in the natural healing process for wounds left open to heal. Understanding the differences between primary and secondary intention healing is crucial in clinical practice as it informs healthcare professionals about the expected outcomes, healing timelines, and potential complications associated with each type of wound healing. This knowledge allows for appropriate wound management decisions to be made based on the specific characteristics of the wound and the patient's overall health status.

Correct Answer: C

Rationale: In pharmacology, understanding the importance of preventing pressure ulcers is crucial for nurses. The most important nursing intervention for the prevention and treatment of pressure ulcers is repositioning the patient a minimum of every 2 hours (Option C). This is because pressure ulcers, also known as bedsores, develop due to prolonged pressure on the skin, leading to tissue damage. Repositioning helps redistribute pressure, relieving stress on vulnerable areas and promoting better blood flow. Option A, using pressure-reduction devices, is a helpful intervention but may not be as effective if the patient is not repositioned regularly. Massaging pressure areas with lotion (Option B) can actually be harmful as it can further damage fragile skin tissues. Using lift sheets and trapeze bars (Option D) may aid in patient movement but does not directly address the root cause of pressure ulcers, which is prolonged pressure on specific areas of the skin. Educationally, nurses need to understand the pathophysiology of pressure ulcers and the importance of preventive measures like regular repositioning. By implementing proper repositioning techniques, nurses can significantly reduce the risk of pressure ulcers in patients, promoting better overall outcomes and quality of care.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) She will get the disease. A positive result in presymptomatic genetic testing for Huntington’s disease indicates that the individual carries the genetic mutation responsible for the disease. Huntington’s disease is an autosomal dominant disorder, meaning that if an individual inherits the mutated gene from one parent, they will eventually develop the disease. Option B) She is a carrier of Huntington’s disease is incorrect because being a carrier implies that the individual carries the gene but may not necessarily develop the disease themselves. Option C) She will be at increased risk for developing the disease is incorrect because a positive result in this case indicates a definitive presence of the disease-causing mutation, not just an increased risk. Option D) She should change her diet, exercise, and environment to prevent the disease is incorrect because Huntington’s disease is a genetic disorder and cannot be prevented by lifestyle changes. Educationally, understanding the implications of genetic testing results is crucial for individuals and their families in making informed decisions about their healthcare. Knowing the significance of a positive result in presymptomatic testing for Huntington’s disease can help individuals plan for the future and consider available options for managing the condition.

Correct Answer: D

Rationale: In the context of pharmacology and the lymphatic immune system, the correct answer to the question is D) T cytotoxic (CD8) cells. These cells are primarily responsible for directly attacking and destroying foreign pathogens. T cytotoxic cells recognize infected cells by binding to specific antigens presented on the surface of these cells. Once activated, they release cytotoxic substances that induce apoptosis in the target cells, effectively eliminating the pathogens. Option A) Dendritic cells are antigen-presenting cells that play a crucial role in initiating the immune response by presenting antigens to T cells. They are not directly involved in the destruction of pathogens but rather in activating other immune cells. Option B) Natural killer cells are a type of cytotoxic lymphocyte that can directly kill infected or cancerous cells without prior sensitization. However, they are not T lymphocytes and are not as specific in their targeting as T cytotoxic cells. Option C) T helper (CD4) cells are essential for coordinating the immune response by releasing cytokines that activate other immune cells. They do not directly attack pathogens but rather assist in the immune response. Understanding the functions of different T lymphocytes is crucial in pharmacology as it helps in designing targeted therapies that modulate specific aspects of the immune response. By grasping the roles of T cytotoxic cells, students can appreciate their significance in combating infections and developing immune memory for future protection.