The nurse is caring for a young adult woman taking immune modulating medications who has been advised to use barrier contraceptives but she wants to start her family. What information can the nurse provide about these drugs to help this patient with her decision-making?

Correct Answer: A

Rationale: The correct answer is A because it encourages open communication between the patient, nurse, and provider to ensure the best possible outcome for both the patient's health and desire to start a family. By discussing the desire to start a family with the provider, the risks associated with immune modulating medications can be assessed, and appropriate steps can be taken to minimize these risks. This approach allows for personalized care and decision-making based on the individual's specific situation. Choice B is incorrect because discontinuing immune modulating drugs without proper guidance can have negative consequences for the patient's health. Choice C is incorrect because while some immune modulating drugs may have teratogenic effects, not all drugs in this class are equally harmful. Choice D is incorrect as it presents a limited view that pregnancy is not an option without considering individual circumstances and medical advice.

Correct Answer: A

Rationale: The correct answer is A: At the same laboratory at approximately the same time of day whenever possible. This is important for accurate comparison of CD4+ counts over time. Different labs or varying times can lead to inconsistent results. Choice B is incorrect as fasting is not necessary for CD4+ count testing. Choice C is incorrect because CD4+ count testing should be done before taking antiretroviral medications. Choice D is incorrect as consistency in time and lab location is crucial for reliable CD4+ count monitoring.

Correct Answer: C

Rationale: Rationale: 1. Posttransplant lymphoproliferative disorder (PTLD) is linked to Epstein-Barr virus (EBV). 2. EBV infects B cells and can lead to lymphoproliferative disorders, especially in immunocompromised individuals. 3. In transplant recipients, EBV reactivation can cause PTLD due to suppressed immune function. 4. Cytomegalovirus, Herpes simplex virus, and Human immunodeficiency virus are not typically associated with PTLD. Summary: - A: Cytomegalovirus is not the correct answer as it is not primarily linked to PTLD. - B: Herpes simplex virus does not cause PTLD; it mainly causes cold sores and genital herpes. - D: Human immunodeficiency virus can lead to AIDS-related lymphomas but is not the primary virus associated with PTLD.

Correct Answer: B

Rationale: Correct Answer: B Rationale: 1. Continuing all other drugs as prescribed ensures optimal management of her underlying health condition during pregnancy. 2. Abruptly discontinuing other medications could lead to worsening of her condition or potential risks to the fetus. 3. Stopping belatacept immediately is not recommended as the patient has already made an informed decision to continue it. 4. Consulting with a genetic counselor may be beneficial but is not directly related to the immediate need of managing her medications during pregnancy.

Correct Answer: D

Rationale: The correct answer is D because administering varicella vaccine to a pregnant woman can pose serious risks to the fetus, including birth defects. This finding has the greatest implication for care as it involves the safety and well-being of both the woman and the unborn child. A: Fear of needles is a common issue that can be managed with appropriate support and techniques. B: Allergy to eggs is a contraindication for receiving the varicella vaccine, but alternative vaccines can be considered. C: Past history of leukemia as a child may affect the immune response to the vaccine, but it is not as critical as pregnancy in this scenario.