A woman who is 4 months pregnant comes to the clinic with acute ...

[colton]

A woman who is 4 months pregnant comes to the clinic with acute diarrhea and nausea. Her husband is experiencing similar symptoms. The primary care nurse practitioner (NP) notes a temperature of 38.
 
  5 C, a heart rate of 92 beats per minute, and a blood pressure of 100/60 mm Hg. The NP should: a. prescribe attapulgite to treat her diarrhea.
  b. obtain a stool culture and start antibiotic therapy.
  c. instruct her to replace lost fluids by drinking Pedialyte.
  d. refer her to an emergency department for intravenous (IV) fluids.

Question 2

A patient is being tapered from long-term therapy with prednisolone and reports weight loss and fatigue. The primary care NP should counsel this patient to:
 
  a. consume foods high in vitamin D and calcium.
  b. begin taking dexamethasone because it has longer effects.
  c. expect these side effects to occur as the medication is tapered.
  d. increase the dose of prednisolone to the most recent amount taken.

[jennafosdick]

Answer to Question 1

D
Diarrhea in pregnant women can have serious consequences, and the patient may need to be referred. This woman is showing signs of dehydration and needs IV rehydration. Attapulgite is a category B drug for pregnancy and should be avoided if possible. Acute diarrhea is usually viral, and antibiotics are not given unless a stool culture is performed and is positive. Because the patient is pregnant and has nausea, oral rehydration would not be effective.

Answer to Question 2

D
Sudden discontinuation or rapid tapering of glucocorticoids in patients who have developed adrenal suppression can precipitate symptoms of adrenal insufficiency, including nausea, weakness, depression, anorexia, myalgia, hypotension, and hypoglycemia. When patients experience these symptoms during a drug taper, the dose should be increased to the last dose. Vitamin D deficiency is common while taking glucocorticoids, but these are not symptoms of vitamin D deficiency. Changing to another glucocorticoid is not recommended. Patients should be taught to report the side effects so that action can be taken and should not be told that they are to be expected.

[colton]

TYSM

[atrochim]

Excellent