1533 Exam 3

What is an expected urinalysis finding in a patient with diabetes insipidus?

decreased urine specific gravity

A client is admitted to the neurologic intensive care unit for an intracranial hemorrhage. Which medication prescription should the nurse question for this client?

enoxaparin

An older adult client is being treated in the hospital for a stroke and is undergoing an extended stay on a rehabilitation unit. The client's spouse has been participating actively in the client's care and performs much of the feeding and hygiene needs. This evening, the client's spouse has brought in a number of healthy snacks to keep at the client's bedside. Knowing that the client's medication regimen includes simvastatin, the nurse would remove which item?

grapefruit juice

A client is prescribed metoprolol 25 mg by mouth twice per day for an atrial arrhythmia. Which should the nurse assess to determine the effectiveness of this medication?

heart rate

A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's:

intake of vitamin K

A 70-year-old man with diabetes mellitus is taking metoprolol (Lopressor) to manage his hypertension. The nurse would be sure to instruct the patient to:

understand the signs and symptoms of hypoglycemia.

An immunocompromised patient in a critical care setting has developed a respiratory infection that has been attributed to methicillin-resistant Staphylococcus aureus (MRSA). The nurse should anticipate that the patient will require treatment with

vancomycin

The nurse is monitoring a patient who is on heparin anticoagulant therapy. What should the nurse determine the therapeutic range of the international normalized ratio (INR) should be?

2-3

The nurse is caring for a client with peripheral arterial occlusive disease (PAD). What nursing intervention is most appropriate to reduce platelet aggregation and promote circulation?

Administer clopidogrel.

An older adult client is treated for pneumonia with clindamycin. One week after the completion of the medication, the client develops diarrhea. What is the most probable cause of the diarrhea?

Change in normal flora

A nurse is admitting a client who has a serum calcium level of 12.3 mg/dl and initiates cardiac monitoring. Which of the following finding should the nurse expect during initial assessment?

Confusion

A nurse is caring for a client receiving heparin therapy. Five days after the start of therapy the nurse notices a sudden decrease in the platelet count. Which complication of heparin therapy can cause platelets to decrease?

Heparin-induced thrombocytopenia

A client is receiving subcutaneous heparin 5,000 units every 8 hours. An activated thromboplastin time (aPTT) is drawn 1 hour before the 8:00 AM dose; the aPTT is at 3.5 times the control value. What is the nurse's priority action?

Hold the dose and call the result to the prescriber.

A patient has a serum osmolality of 250 mOsm/kg (range 285-295) The nurse know to assess further for:

Hyponatremia

A nurse is providing discharge education for a client with hypernatremia. Which statement by the client identifies the teaching has been effective?

I will stop taking alka-seltzer

A client is receiving lisinopril for the treatment of hypertension. The client began taking ibuprofen (Motrin) over the counter for arthritis pain. Which adverse effect is most likely to occur with this combination of medications?

Increased blood pressure

A nurse is caring for a client with COPD. The client's medication regimen has been recently change and the nurse is assessing for therapeutic effect of a new bronchodilator. Therapeutic effects of this medication include:

Increased respiratory flow rate relief of dyspnea

A client who gave birth 24 hours ago continues to experience urine retention after several catheterizations. The physician orders bethanechol, 10 mg by mouth three times per day. The client asks, "How does bethanechol act on the bladder?" How should the nurse respond?

It stimulates the smooth muscle of the bladder

Which of the following are examples of fluoroquinolones?

Levofloxacin Ciprofloxacin

A client is admitted with phosphorus level of 2.1 mg/dl. What would the nurse anticipate seeing on assessment?

Muscle weakness

A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe?

Older adults often lack the classic signs and symptoms of pneumonia.

An adult resident of an assisted living facility has not responded appreciably to bulk-forming laxatives, so the primary care provider has prescribed bisacodyl. The nurse who oversees the care at the facility should know that this drug may be administered by what route? Select all that apply.

Oral Rectal

A 22-year-old female client has been diagnosed with trichomoniasis, and treatment with metronidazole has been prescribed. What characteristic of the client's health would lead the nurse to contact the health care provider regarding the prescription?

Pregnancy

An elderly client asks the nurse how to treat chronic constipation. What is the best recommendation the nurse can make?

Take a stool softener such as docusate sodium daily.

A client taking metronidazole for the treatment of H. pylori states that the medication is causing nausea. What teaching should the nurse provide to the client to alleviate the nausea?

Take the medication with meals to decrease the nausea.

What clinical indication of hyperphosphatemia does the nurse anticipate seeing on assessment in a patient?

Tetany

The nurse is preparing to administer digoxin to a client with heart failure. The nurse obtains an apical pulse rate for 1 minute and determines a rate of 52 beats/minute. What is the first action by the nurse?

Withhold the medication and notify the physician of the heart rate.

An older adult client has been brought to the clinic by family members who are concerned about the client's risk for developing shingles. The nurse should discuss what possible vaccination?

Zoster vaccine

A surgical client develops nonobstructive postoperative urinary retention. What drug would the nurse expect to be ordered for this client?

bethanechol

A nurse monitors a client receiving enoxaparin 30 mg subcutaneously BID after hip replacement surgery. Which adverse reaction is the client most likely to experience?

bleeding

A patient receiving neostigmine uses naproxen for relief of low back pain. The nurse would caution the patient to report:

blood in stool

The nurse understands that the client should be given human papillomavirus (HPV) vaccine per the health care provider's orders. What does this vaccine help prevent?

cervical cancer

The nurse instructs a patient to take his prescribed simvastatin at bedtime to promote:

Enhanced drug effectiveness

A 69-year-old client who is obese and has a diagnosis of angina pectoris has been prescribed clopidogrel by the primary health care provider. The client asks, "Why do I need this medication? It won't help my chest pain." Which response by the nurse is the best explanation?

Prevents the blood cells from forming a clot in your heart vessels

A client with cardiovascular disease is being treated with amlodipine, which is intended to cause what therapeutic effect?

Reducing the heart's workload by decreasing heart rate and myocardial contraction

A client with a urinary tract infection is experiencing intense burning and pain. What aspect of the client's health history would contraindicate the safe and effective use of phenazopyridine?

Renal Insufficiency

A client is to receiving levofloxacin. Which should be included in the client's teaching?

Report creamy white, lace like patches on the tongue, mouth, or throat to the prescriber. Report diarrhea to the prescriber. Report fever to the prescriber.

A client stepped on a nail at work. The emergency room physician prescribes a tetanus "booster" shot. The client asks the nurse, "If I have already been vaccinated for tetanus why do I need to have another shot?" How should the nurse respond?

"The booster shot will stimulate your immune system's memory, causing an immediate rise in antibodies to protect you from an infection."

A client is taking bisacodyl to treat constipation. The nurse suggests that the client take the drug at which time?

before going to bed

A nurse is teaching a client who will soon be discharged with a prescription for warfarin (Coumadin). Which statement should the nurse include in discharge teaching?

"Don't take aspirin while you're taking warfarin."

A nurse is caring for a client who has hypertension and has a potassium level of 6.0 mEq/L. Which of the following actions should the nurse take?

Advise the client to avoid the use of salt substitues

A client is started on trimethoprim and sulfamethoxazole for a urinary tract infection. The client reports nausea, anorexia, and abdominal pain. What intervention does the nurse discuss with the client?

Consume the medication with food.

A nurse is preparing a client for coronary bypass surgery the following week and asks the client to discontinue daily aspirin intake. Which response is best to explain the effect aspirin has on the platelets and potential bleeding problems?

The effect is not reversible for the life of the platelet.

Which type of nutrition does the nurse anticipate initiating for an infant with gastroenteritis and dehydration?

oral rehydration fluids

The nurse should advise clients taking phenazopyridine (Pyridium) that they may notice a change in urine color. Which color would the nurse identify?

orange

The nurse is preparing to administer clindamycin intravenously (IV) to a client. How should the nurse set the infusion to run?

over 10-20 mins

A nurse is assessing a client who is receiving vancomycin intravenously. While the drug is being administered, the client reports a throbbing sensation in the neck and back and paresthesias. The client's blood pressure has dropped and the neck and back are erythematous. The nurse suspects which adverse finding?

red man syndrome

A nurse will conduct an influenza vaccination campaign at an extended care facility. The nurse will be administering intramuscular (IM) doses of the vaccine. Of what age-related change should the nurse be aware when planning the appropriate administration of this drug?

An older client has less subcutaneous tissue and less muscle mass than a younger client.

A parent at an educational session on sexually transmitted infections (STIs) asks the nurse if there are vaccines available to prevent STIs. How should the nurse respond?

"A vaccine has been approved to prevent the human papillomavirus."

A nurse is caring for a client with metastatic breast cancer who is extremely lethargic and very slow to respond to stimuli. The lab report indicates a serum calcium level of 12 mg/dl, a serum potassium level of 3.9 meq/l, and a serum sodium level of 140 meq/l. Which IV fluid should the nurse anticipate for the client?

0.9% Normal Saline

The nurse understands that the drug docusate sodium (Colace) would be most appropriate for what client?

A 66-year-old client who is recovering from a heart attack

A nurse is caring for a client who has hypernatremia and requires IV fluid therapy due to his NPO status. Which of the following solutions should the nurse prepare to infuse for this client?

5% dextrose in water (D5W)

A nurse is caring for a client who was admitted yesterday with myocarditis. The client takes insulin, digoxin, and metformin at home and continues these medications during hospitalization. During the morning assessment, the client reports anorexia, nausea, vomiting, headache, and disturbed color vision. An ECG strip shows a prolonged PR interval. What should the nurse suspect?

DIGOXIN TOXICITY

The nurse is caring for a client with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis?

Depressed respirations

An older adult client asks the nurse to explain the recommended schedule for influenza vaccination. Which statement should the nurse include in the response?

Each year a new vaccine is developed based on the strains most prevalent.

A patient receiving amlodipine for angina reports dizziness. Which intervention should the nurse implement to help alleviate the condition?

Instruct the patient to lie down.

A nurse is providing wound care to a patient who arrived at the emergency department after being hit by flying glass from a broken window. The nurse asks the patient about his last tetanus shot. Which statement would indicate to the nurse that the patient needs a tetanus booster?

It must be at least 6 or 7 years since I had one."

A client diagnosed with myasthenia gravis is administered a cholinergic drug named neostigmine. How does this drug produce its therapeutic effect?

It stimulates the parasympathetic nervous system.

A nurse is preparing to administer an antihypertensive drug that lowers the blood pressure primarily via suppression of the renin-angiotensin-aldosterone system. Which drug might this be?

Lisinopril

The nurse is providing discharge teaching to a client who had hypophosphatemia during his time in the hospital. The client has a diet prescribed that is high in phosphate. What foods should you teach this client to include in his diet?

Milk products Poultry Liver

A client with a urinary tract infection has been prescribed Bactrim, a medication that is a combination of sulfamethoxazole and trimethoprim. What is the most likely rationale for the use of a combination antibiotic?

The drugs' combined effect exceeds the sum of their individual effects.

A client with a newborn infant is also the caregiver for her 75-year-old mother, who lives with them and who has diabetes. The client requests pneumonia vaccinations for her entire household. Which vaccine is most likely to be effective for the baby?

There is no effective vaccine for newborn infants.

The nurse teaches the client who demonstrates herpes zoster (shingles) that

the infection results from reactivation of the chickenpox virus.