ATI Retake Study Guide
Lithium Levels
.4- 1.0 mEq/l above 1.5mEq/l toxicity
1. A nurse is caring for a client at 14 weeks of gestation who has hyperemesis gravidarum. The nurse is aware that which of the following are risk factors for the client? (Select all that apply.) A. Obesity B. Multifetal pregnancy C. Maternal age greater than 40 D.Migraine headache E. Oligohydramnios
A. CORRECT: Obesity is a risk factor for hyperemesis gravidarum. B. CORRECT: Multifetal pregnancy is a risk factor for hyperemesis gravidarum. D. CORRECT: Migraine headache is a risk factor for hyperemesis gravidarum.
3. A nurse is caring for a client who has a prescription for metformin (Glucophage). The nurse should monitor the client for which of the following adverse effects? A. Lactic acidosis B.Hypoglycemia C. Hyperlipidemia D.Respiratory alkalosis
A.CORRECT: Lactic acidosis, manifested by extreme drowsiness,hyperventilation, and muscle pain, is a rare but very serious adverse effect caused by metformin.
5. A nurse is caring for a client who has suspected hyperemesis gravidarum and is reviewing the client's laboratory reports. Which of the following findings is a clinical manifestation of this condition? A. Hgb 12.2 g/dL B. Urine ketones present C. Alanine aminotransferase (ALT) 20 IU/L D. Serum glucose 114 mg/dL
B. CORRECT: The presence of ketones in the urine is associated with the breakdown of proteins and fats that occurs in a client who has hyperemesis gravidarum
3. A nursing is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? A. Nifedipine (Adalat) B. Pyridoxine (vitamin B6) C. Ferrous sulfate D. Calcium gluconate
D. CORRECT: Calcium gluconate is the antidote for magnesium sulfate
Other medications used to treat bipolar disorders include the following
Valproic acid (Depakote), Carbamazepine (Tegretol, Equetro), Lamotrigine (Lamicta
Bipolar disorders are primarily managed with mood-stabilizing medications such as
lithium carbonate
2. A nurse is caring for a client who has a new prescription for lithium carbonate (Lithobid). When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? A. Avoid the use of acetaminophen for headaches. B. Restrict intake of foods rich in sodium. C. Decrease fluid intake to less than 1,500 mL daily D. Limit aerobic activity in hot weather.
2. A. INCORRECT: The client should use acetaminophen, rather than NSAIDs, such as ibuprofen, for headaches because NSAIDs interact with lithium and can cause increased blood levels of lithium. D. CORRECT: The client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity
1. A nurse is reviewing laboratory findings and notes that a client's plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? A. Perform immediate gastric lavage. B. Prepare the client for hemodialysis. C. Administer an additional oral dose of lithium. D. Request a stat repeat of the laboratory test
A. CORRECT: Gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma lithium level of 2.1 mEq/L. This action will lower the client's lithium level. B. INCORRECT: Hemodialysis is appropriate for a client who has a plasma lithium level greater than 2.5 mEq/L
2. A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply.) A. Respirations fewer than 12/min B. Urinary output less than 30 mL/hr C. Hyperreflexic deep-tendon reflexes D. Decreased level of consciousness E. Flushing and sweating
A. CORRECT: A respiratory rate of less than 12/min is a sign of magnesium sulfate toxicity. B. CORRECT: Urinary output of less than 30 mL/hr is a sign of magnesium sulfate toxicity. D. CORRECT: Decreased level of consciousness is a sign of magnesium sulfate toxicity.
2. A charge nurse is planning a staff education session to discuss medications appropriate for use during the care of a client experiencing alcohol detoxification. Which of the following should the charge nurse include? (Select all that apply.) A. Lorazepam (Ativan) B. Diazepam (Valium) C. Disulfiram (Antabuse) D. Naltrexone (Vivitrol) E. Acamprosate (Campral)
A. CORRECT: Lorazepam is a benzodiazepine used during alcohol detoxification to decrease anxiety and reduce the risk for seizures. B. CORRECT: Diazepam is a benzodiazepine used during alcohol detoxification to decrease anxiety and reduce the risk for seizures. C. INCORRECT: Disulfiram is administered to assist the client in maintaining abstinence from alcohol following detoxification.
3. A nurse is providing teaching to a client who has a new prescription for clonidine (Catapres) to assist with maintenance of abstinence from opioids. The nurse should instruct the client to watch for which of the following adverse effects? A.Diarrhea B.Dry mouth C. Insomnia D.Hypertension
A. INCORRECT: Constipation, rather than diarrhea, is a common adverse effect associated with clonidine use. B.CORRECT: Dry mouth is a common adverse effect associated with clonidine use. C. INCORRECT: Sedation, rather than insomnia, is a common adverse effect associated with clonidine use. D. INCORRECT: Clonidine is more likely to cause hypotension than hypertension.
A nurse is providing teaching to a client who has type 2 diabetes mellitus and is starting repaglinide (Prandin). Which of the following statements made by the client indicates understanding of the administration of this medication? A."I'll take this medicine with my meals." B."I'll take this medicine 30 minutes before I eat." C."I'll take this medicine just before I go to bed." D."I'll take this medicine as soon as I wake up in the morning."
A. INCORRECT:Repaglinide should not be taken with a meal. B. CORRECT: Repaglinide causes a rapid, short-lived release of insulin. The client should take this medication within 30 min before each meal so that insulin is available when food is digested.
4. A nurse is providing teaching to a client who has a prescription for pramlintide (Symlin) for type 1 diabetes mellitus. Which of the following should the nurse include in the teaching? (Select all that apply.) A."Take oral medications 1 hr before injection." B. "Use upper arms as preferred injection sites." C. "Mix pramlintide with breakfast dose of insulin." D. "Inject pramlintide just before a meal." E. "Discard open vials after 28 days.
A.CORRECT: Pramlintide delays oral medication absorption, so oral medications should be taken 1 to 2 hr after pramlintide injection. B. INCORRECT:The thigh or abdomen, rather than the upper arms, are preferred sites for pramlintide injection. C.INCORRECT:Pramlintide should not be mixed in a syringe with any type of insulin. D. CORRECT: Pramlintide can cause hypoglycemia, especially when the client also takes insulin, so it is important to eat a meal after injecting this medication. E. CORRECT: Unused medication in the open pramlintide vial should be discarded after 28 days
4. A nurse is teaching a female client who has tobacco use disorder about nicotine replacement therapy. Which of the following statements by the client indicates understanding of the teaching? A."I should avoid eating right before I chew a piece of nicotine gum." B."I will need to stop using the nicotine gum after 1 year." C. "I know that nicotine gum is a safe alternative to smoking if I become pregnant." D. "I must chew the nicotine gum quickly for about 15 minutes.
A.CORRECT: The client should avoid eating or drinking 15 min prior to and while chewing the nicotine gum
4. A nurse is reviewing a new prescription for ferrous sulfate with a client who is at 12 weeks of gestation. Which of the following statements by the client indicates understanding of the teaching? A. "I will take this pill with my breakfast." B. "I will take this medication with a glass of milk." C. "I plan to drink more orange juice while taking this pill." D. "I plan to add more calcium-rich foods to my diet while taking this medication."
A.incorrEct: Ferrous sulfate should be taken on an empty stomach. C.CORRECT: A diet with increased vitamin C improves the absorption of ferrous sulfate
2. A nurse is teaching a client who experiences migraine headaches. Which of the following instructions should the nurse give this client? (Select all that apply.) A. Take ergotamine as a prophylaxis to prevent a migraine headache. B. Identify and avoid trigger factors. C. Lie down in a dark quiet room at the onset of a migraine. D. Avoid foods that contain tyramine. E. Avoid exercise that may increase heart rate.
B.CORRECT:Identifying and avoiding trigger factors is an important action that can help to prevent some migraines. C. CORRECT: Lying down in a dark, quiet room at the onset of a migraine may prevent the onset of more severe manifestations. D. CORRECT:Foods that contain tyramine may be a trigger for some migraines and should be avoided
5. A nurse is teaching a client who has a new prescription for ergotamine (Ergomar) to treat migraine headaches. For which of the following should the nurse instruct the client to stop taking the medication and notify the provider? (Select all that apply.) A. Nausea B. Visual disturbances C. Positive home pregnancy test D. Numbness and tingling in fingers E. Muscle pain
C. CORRECT: A client who has a positive home pregnancy test should stop taking ergotamine and notify the provider. Ergotamine is classified as Pregnancy Risk Category X and may cause fetal abortion. D. CORRECT: Numbness and tingling in fingers or toes can be a finding in ergotamine overdose. The medication should be stopped and the provider notified. E. CORRECT: Unexplained muscle pain may be a finding in ergotamine overdose. The medication should be stopped and the provider notified
1. A nurse is providing teaching for a client who is withdrawing from alcohol and has a new prescription for propranolol (Inderal). Which of the following is appropriate for the nurse to include in the teaching? A. Increases the risk for seizure activity B. Provides a form of aversion therapy C. Decreases cravings D.Results in mild hypertension
C. CORRECT: Propranolol is an adjunct medication used during detoxification to decrease the client's craving for alcohol
5. A nurse is teaching a female client who has bipolar disorder about her new prescription for lithium carbonate (Lithobid). Which of the following is appropriate for the nurse to include in the teaching? (Select all that apply.) A. An adverse effect of this medication is amenorrhea. B. An antidepressant is combined with lithium therapy during phases of mania. C. Take this medication with food or a glass of milk. D. Avoid pregnancy while taking this medication. E. Thyroid function is assessed prior to lithium therapy.
C. CORRECT: Taking lithium with food or a glass of milk can help reduce gastrointestinal distress. D. CORRECT: Lithium is a Pregnancy Risk Category D medication that is teratogenic, especially during the first trimester. Therefore, the client should avoid pregnancy while taking this medication. E. CORRECT: Because lithium can cause goiter and hypothyroidism, the client's thyroid function is assessed prior to lithium therapy.
5. A nurse in an acute mental health facility is caring for a client who is experiencing withdrawal from opiod use and has a new prescription for clonidine (Catapres). Which of the following is the priority nursing action? A. Administer the clonidine as prescribed schedule. B. Provide ice chips at the client's bedside. C. Educate the client on the effects of clonidine. D. Obtain the client's baseline vital signs.
D.CORRECT: Assessment is the initial step of the nursing process. Therefore, obtaining the client's baseline vital signs is the priority nursing action.
Lithium Side Effects
Fine hand tremors Polyuria Mild thirst Weight gain Renal toxicity Goiter and hypothyroidism Bradydysrhythmias Hypotension
Nicotine Replacement Therapy
Nicotine gum (Nicorette) » Use of chewing gum is not recommended for longer than 6 months. » Advise clients to chew gum slowly and intermittently over 30 min. » Advise clients to avoid eating or drinking 15 min prior to and while chewing the gum. › Nicotine patch (Nicotrol) » Advise clients to stop using patches and to notify the provider if local skin reactions occur. » Remove the patch prior to MRI scan, and replace when the scan is completed. › Nicotine nasal spray (Nicotrol NS) »Provides pleasurable effects of smoking due to rapid rise of nicotine in the client's blood level. » One spray in each nostril delivers the amount of nicotine in one cigarette.
Bupropion
decreases nicotine craving and manifestations of withdrawal To treat dry mouth, encourage clients to chew sugarless gum or suck on hard candy and to sip small amounts of water or suck on ice chips. Advise clients to avoid caffeine and other CNS stimulants to control insomnia.
Lithium
treatment of bipolar disorders. Lithium controls episodes of acute mania, helps prevent the return of mania or depression, and decreases the incidence of suicide
Naltrexone
• Naltrexone is a pure opioid antagonist that suppresses the craving and pleasurable effects of alcohol (also used for opioid withdrawal). • Advise clients to take the medication with meals to decrease gastrointestinal distress. • Suggest monthly IM injections for clients who have difficulty adhering to regimen.
Nursing Consideration w/Lithium
•Administer medication with meals or milk. •Advise clients to report an increase in tremors. •Assess baseline kidney function, and monitor kidney function periodically. •Obtain the client's baseline T3,T4, and TSH levels prior to starting treatment, and then annually. •Encourage clients to maintain a diet adequate in sodium, and to drink 2,000mL to 3,000mL of water each day from food beverage sources. • Avoid use of NSAIDs. • Avoid in pregnancy
Benzodiazepines Chlordiazepoxide , diazepam, lorazepam Intended effects
•Decrease in the risk of seizures •Decrease in the intensity of withdrawal manifestations •Maintenance of the client's vital signs within normal limits
Disulfiram
•a type of aversion ( behavioral) therapy •Advise clients to avoid any products that contain alcohol (cough syrups, mouthwash, aftershave lotion). • Monitor frequent liver function tests to detect hepatotoxicity.