exam 3 case study
15. The patient's heparin is infusing at 11 mL/hr. The bag of fluid is mixed 25,000 units of heparin in 250 mL D5W. What hourly dose is the patient receiving? (Fill in the blank and record your answer.)__
1,100
CS#1: At the change of shift, the nurse reassesses Charlie. His NG tube is patent and drained 120 mL over 12 hours. His oral temperature is 99.5°F (37.5°C), heart rate is 80 beats/min, and respiratory rate is 17 breaths/min. Charlie appears groggy and confused. Charlie's muscle strength is 3 of 5 in his upper and lower extremities. Laboratory tests are ordered. Which results are most consistent with Charlie's clinical presentation? 1. K+, 3.3 mEq/L; Cl−, 95 mEq/L; pH, 7.55; HCO3= 32 2. K+, 3.3 mEq/L; Cl−, 110 mEq/L; pH, 7.45; HCO3= 22 3. K+, 5.2 mEq/L; Cl−, 110 mEq/L; pH, 7.20; HCO3= 18 4. K+, 3.3 mEq/L; Cl−, 95 mEq/L; pH, 7.22; HCO3= 24
1. K+, 3.3 mEq/L; Cl−, 95 mEq/L; pH, 7.55; HCO3= 32
32- Which medications should be used with caution in a hypertensive diabetic patient? (Select all that apply) Furosemide [Lasix] Metoprolol [Lopressor] Diltiazem [Cardizem] Hydrochlorothiazide [HCTZ] Enalapril [Vasotec]
Furosemide [Lasix] Metoprolol [Lopressor] Hydrochlorothiazide [HCTZ]
6- The nurse is caring for a patient with renal artery stenosis who has been prescribed benazepril [Lotensin]. Which laboratory result indicates an adverse effect of this drug? Potassium level of 3.2 mEq/L Blood glucose level of 180 mg/dL Uric acid level of 10 mg/dL Serum creatinine level of 2.3 mg/dL
Serum creatinine level of 2.3 mg/dL
10- The nurse is teaching a patient with essential hypertension who has a new prescription for verapamil [Calan]. Which statements by the patient indicate that the teaching was effective? (select all that apply) "I will increase my intake of fluid and foods high in fiber." "I should stay out of direct sunlight to prevent exposing my skin to the sun." "I will call my healthcare provider if I notice swelling in my ankles." "I need to avoid salt substitutes and potassium supplements." "I may notice easy bruising and bleeding with this drug."
"I will increase my intake of fluid and foods high in fiber." "I will call my healthcare provider if I notice swelling in my ankles."
34. The nurse is teaching a patient about the side effects associated with doxazosin [Cardura]. Which statement by the patient indicates an understanding of the nurse's instructions? "I may experience an increase in hair growth as a side effect." "I'll notify the healthcare provider if I develop a persistent cough." "I'll make sure I include extra sources of potassium in my diet, such as bananas and baked potatoes." "When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."
"When getting out of bed in the morning, I will sit on the side of the bed for several minutes before standing."
19. The healthcare provider prescribes heparin 2500 units subcutaneous daily. The drug is available in 10,000 units per mL. How may milliliters will the nurse give? (Fill in the blank and record your answer using one decimal place.)__
0.25 mL
2- When receiving discharge instructions, a patient with osteoporosis makes all of these statements. Which statement indicates to the nurse that the patient needs additional teaching? A) "I take my ibuprofen every morning as soon as I get up." B) "My daughter removed all of the throw rugs in my home." C) "My husband helps me every afternoon with range-of-motion exercises." D) "I rest in my reclining chair every day for at least an hour."
A) "I take my ibuprofen every morning as soon as I get up."
3- The nurse is reviewing medication lists for patients who are being treated for peptic ulcer disease (PUD). The nurse is most likely to question the use of which medication? A) Omeprazole B) Ibuprofen C) Amoxicillin D) Clarithromycin
A) Omeprazole
10. A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (select all that apply) A. Wear a medical alert bracelet. B. Check all urine and stool for discoloration. C. Do not start any new medication without first talking to your healthcare provider.
A. Wear a medical alert bracelet. B. Check all urine and stool for discoloration. C. Do not start any new medication without first talking to your healthcare provider.
13- A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? Ibuprofen [Advil] Naproxen [Aleve] Aspirin [Bayer] Acetaminophen [Tylenol] Indomethacin [Indocin]
Acetaminophen [Tylenol]
1- The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising the blood pressure? Angiotensin I Angiotensin II Angiotensin III Renin
Angiotensin II
17- The nurse is caring for several patients. For which patient diagnosis would a prescription for nifedipine [Adalat] be least appropriate? Angina pectoris Essential hypertension Vasospastic angina Atrial fibrillation
Atrial fibrillation
4- The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (select all that apply) Take the medication with food. Expect a sore throat and fever. Avoid potassium salt substitutes. A persistent dry cough may occur. Report difficulty in breathing immediately.
Avoid potassium salt substitutes. A persistent dry cough may occur. Report difficulty in breathing immediately.
5- A client presents to the emergency department with chest pain. The ECG reveals ST-segment elevation. Vital signs are as follows: blood pressure 142/78 mm Hg, pulse 98 beats/min, respiratory rate 18 breaths/min, temperature 100.6°F (38.1°C), and oxygen saturation 98%. The nurse should prepare to perform which actions? (Select all that apply) A) Administer 2 L oxygen via nasal cannula. B) Obtain blood for laboratory testing. C) Administer aspirin 325 mg orally. D) Prepare to infuse diltiazem intravenously. E) Provide the client with three tablets of sublingual nitroglycerin immediately.
B) Obtain blood for laboratory testing. C) Administer aspirin 325 mg orally. E) Provide the client with three tablets of sublingual nitroglycerin immediately.
19- Which assessment finding is most important for the nurse to obtain before administering hydralazine [Apresoline]? Peripheral pulses Homans' sign Blood pressure Capillary refill
Blood pressure
CS#1: The nurse performs a pain assessment. Charlie rates his pain as 4 of 10 on the Wong-Baker FACES® Pain Rating Scale. Which intervention should the nurse implement? A) Administer 5 mg of hydrocodone. B) Administer 100 mg of acetaminophen. C) Administer 200 mg of ibuprofen. D) Administer 10 mg of codeine.
C) Administer 200 mg of ibuprofen.
2- A patient is admitted to the hospital with a diagnosis of hypertension. The nurse understands that which medication works by preventing angiotensin II from binding with its receptor sites? Quinapril [Accupril] Aliskiren [Tekturna] Eplerenone [Inspra] Candesartan [Atacand]
Candesartan [Atacand]
6- A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? (select all that apply) Routine dental cleaning Removal of a skin mole Cataract surgery Cholecystectomy Hysterectomy
Cholecystectomy Hysterectomy
3- A patient is prescribed lisinopril [Prinvil] as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug? + 2 edema of the lower extremities Potassium level of 3.5 mEq/L Crackles in the lungs are no longer heard Jugular vein distention
Crackles in the lungs are no longer heard
7- A patient is prescribed lisinopril [Prinivil] 40 mg by mouth once a day for hypertension. For which therapeutic effect will the nurse monitor? Slowing of the heart rate Decrease in blood pressure Symptoms such as dizziness and fainting Pulse oximetry oxygen saturation of 100%
Decrease in blood pressure
17. A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? Urticaria, itching, and flushing Blood pressure of 90/50 mm Hg Decreasing level of consciousness Potassium level of 5.5 mEq/L
Decreasing level of consciousness
13- Which medication is most likely to cause the side effect of constipation? Nifedipine [Adalat] Amlodipine [Norvasc] Isradipine [DynaCirc] Diltiazem [Cardizem]
Diltiazem [Cardizem]
20. The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? Heart rate of 60 beats per minute Blood pressure of 160/88 mm Hg Discolored urine Inspiratory wheezing
Discolored urine
31- The nurse is caring for a patient who has diabetes and hypertension. Which medication is most likely to be prescribed to treat this patient's hypertension? Hydrochlorothiazide [HCTZ] Enalapril [Vasotec] Propranolol [Inderal] Methyldopa [Aldomet]
Enalapril [Vasotec]
Valsartan [Diovan] 36- A client with heart failure is due for the prescribed digoxin, spironolactone, lisinopril, and furosemide. Over the past 3 days, the client has gained 2 pounds and reports worsening shortness of breath. Physical assessment reveals jugular vein distention (JVD) of 5cm, 2+ pitting edema, and heart rate of 52 beats per minute. What is the priority action by the nurse? Hold the furosemide and contact the provider. Administer all medications and document assessment findings. Hold the digoxin and administer all other medications as ordered.
Hold the digoxin and administer all other medications as ordered.
21. The nurse knows which statement is accurate for enoxaparin [Lovenox]? E. It equally reduces the activity of thrombin and factor Xa. It has selective inhibition of factor Xa and no effect on thrombin. It has a lower bioavailability and shorter half-life than unfractionated heparin. It reduces the activity of factor Xa more than the activity of thrombin.
It reduces the activity of factor Xa more than the activity of thrombin.
14. A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? Warfarin [Coumadin] Lepirudin [Refludan] Bivalirudin [Angiomax] Eptifibatide [Integrilin]
Lepirudin [Refludan]
The nurse is caring for a patient with bipolar disorder treated with lithium [Eskalith]. The patient has a new prescription for captopril [Capoten] for hypertension. The combination of these two drugs makes which assessment particularly important? Lithium level Potassium level Creatinine level Blood pressure
Lithium level
26- The nurse is caring for a patient receiving a nitroprusside [Nipride] intravenous infusion. The patient's wife asks why furosemide [Lasix] is being prescribed along with this drug. The nurse's response is based on which concept? Furosemide will help reduce reflex tachycardia. Many vasodilators cause retention of sodium and water. Thiocyanate may accumulate in patients receiving nitroprusside. Vasodilators can cause serious orthostatic hypotension.
Many vasodilators cause retention of sodium and water.
16- What is the most appropriate nursing consideration for a patient who is prescribed verapamil [Calan] and digoxin [Lanoxin]? Restrict intake of oral fluids and high-fiber food. Take an apical pulse for 30 seconds before administration. Notify the healthcare provider of nausea, vomiting, and visual changes. Hold the medications if the heart rate is greater than 110 beats per minute.
Notify the healthcare provider of nausea, vomiting, and visual changes.
22. The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? Notify the healthcare provider to discuss the reduction or withdrawal of heparin. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.
Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
21- A patient in a hypertensive crisis is being started on a continuous sodium nitroprusside [Nipride] infusion. What interventions are essential before the nurse administers nitroprusside [Nipride]? (select all that apply) Obtain a baseline weight and weigh daily. Prepare for arterial line insertion. Discontinue the infusion when blood pressure is controlled. Observe for signs of hypertrichosis during the infusion. Cover the solution with an opaque bag.
Obtain a baseline weight and weigh daily. Prepare for arterial line insertion. Cover the solution with an opaque bag.
13. The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? Aspirin [Bayer] Omeprazole [Prilosec] Acetaminophen [Tylenol] Warfarin [Coumadin]
Omeprazole [Prilosec]
11- A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? Docusate sodium [Colace] Ascorbic acid (vitamin C) Pantoprazole [Protonix] Furosemide [Lasix]
Pantoprazole [Protonix]
12- The nurse is caring for a patient with hypertension who is receiving verapamil [Calan]. The patient has a healthy heart. What pharmacodynamic effects does the nurse expect from this drug? (select all that apply) Peripheral vasoconstriction Peripheral vasodilation Coronary vasodilation Increased heart rate Increased force of contraction
Peripheral vasodilation Coronary vasodilation
16. A patient is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? Platelets Vitamin K Prothrombin time (PT) International normalized ratio (INR) Activated partial thromboplastin time (aPTT)
Platelets Activated partial thromboplastin time (aPTT)
9. Fondaparinux [Arixtra] is not approved for use in which circumstance? Prevention of deep vein thrombosis (DVT) after knee replacement Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) Prevention of deep vein thrombosis (DVT) after abdominal surgery Prevention of ischemic complications in patients with unstable angina
Prevention of ischemic complications in patients with unstable angina
8- A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? Hypothyroidism Recent heart bypass surgery Positive tuberculin skin (PPD) test result Allergy to penicillin
Recent heart bypass surgery
10- A nurse should recognize that a patient who takes an angiotensin- converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? Congestive heart failure Liver toxicity Renal failure Hemorrhage
Renal failure
29- Which laboratory result may be a consequence of therapy with a thiazide diuretic? Serum glucose level of 58 mg/dL Serum potassium level of 5.3 mEq/L Serum sodium level of 135 mEq/L Serum uric acid level of 10.4 mg/dL
Serum uric acid level of 10.4 mg/dL
22- The nurse is preparing to administer minoxidil [Loniten] 5 mg orally. What is the only cardiovascular indication for this medication? Heart failure Myocardial infarction Angina pectoris Severe hypertension
Severe hypertension
27- The nurse is caring for a patient who has been receiving intravenous sodium nitroprusside [Nitropress] for 3 days. Which assessment data indicate the patient may be experiencing thiocyanate toxicity? Sudden confusion Difficulty breathing Erythematous rash Gastrointestinal bleeding
Sudden confusion
24- The nurse is caring for a patient receiving hydralazine [Apresoline]. The healthcare provider prescribes propranolol [Inderal]. The nurse knows that a drug such as propranolol often is combined with hydralazine for what purpose? To reduce the risk of headache To improve hypotensive effects To prevent heart failure To protect against reflex tachycardia
To protect against reflex tachycardia
5. Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? "Constipation is a common side effect of clopidogrel, so take a stool softener daily." "If you see blood in your urine or black stools, stop the clopidogrel immediately." "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." "Keep the amounts of foods containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."
"Check with your healthcare provider before taking any over-the-counter medications for gastric acidity."
11- The nurse provides discharge instructions to a patient prescribed verapamil [Calan] SR 120 mg PO daily for essential hypertension. Which statement by the patient indicates understanding of the medication? "I will take the medication with grapefruit juice each morning." "I should expect occasional loose stools from this medication." "I'll need to reduce the amount of fiber in my diet." "I must make sure I swallow the pill whole."
"I must make sure I swallow the pill whole."
20- The nurse is teaching a patient who has just been prescribed a vasodilator. Which statement by the patient indicates that the teaching was effective? "I can take this medication in the morning to reduce nighttime urination." "I will rise slowly when changing from a sitting to a standing position." "My heart rate may slow down with this drug. I will call if my pulse is below 60." " I need to increase my intake of fluids and foods that are high in fiber."
"I will rise slowly when changing from a sitting to a standing position."
5- The nurse is evaluating the teaching done with a patient who has a new prescription for fosinopril [Monopril]. Which statement by the patient indicates a need for further teaching? "I can take this medicine with breakfast each morning." "I will call if I notice a rash or wheals on my skin." "I will use a salt substitute to lower my sodium intake." "I will call if I develop a bothersome cough."
"I will use a salt substitute to lower my sodium intake."
30- An adult male patient is taking medication for blood pressure management. The patient states to the nurse, "I'm not going to take these drugs anymore, because they are interfering with my sex life." What is the most appropriate response by the nurse? "It is unfortunate these drugs can cause erectile dysfunction but managing your blood pressure is more important than your sexual performance." "I understand how discouraging it must be to live with this adverse effect, but you could have a stroke if you do not take your blood pressure medications." "Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect." "I am glad you told me about your experience with this common side effect. Sexual performance can be a difficult subject to discuss."
"Let's discuss this effect with your prescriber. There are other drugs available to manage your blood pressure that may not have the same adverse effect."
12- The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (select all that apply) "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." "The most common side effect of treatment with the drug is kidney failure." "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." "Use of this drug can prevent heart attack and stroke."
"Notify your healthcare provider if you notice that your skin or eyes are turning yellow." "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain."
7. The patient's heparin is infusing at 28 mL/hr. The bag of fluid is mixed 20,000 units of heparin in 500 mL D5W. What hourly dose is the patient receiving? (Fill in the blank and record your answer.)_
1120 units
11. The healthcare provider prescribes heparin 900 units/hr. The label on the IV bag reads Heparin 10,000 units in 500 mL D5W. How many mL/hr will deliver the correct dose? (Fill in the blank and record your answer.)__
45 ml/hr
6. The nurse is ready to begin a heparin infusion for a patient with evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? 50 70 90 110
70
18. The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (select all that apply) A patient with variant genes that code for VKORC1 and CYP2CP A patient with a current INR of 2.2 treated for deep vein thrombosis A woman with a new onset of symptoms of a pulmonary embolus A patient on day 4 after hip replacement with a new order for warfarin A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
A patient with variant genes that code for VKORC1 and CYP2CP A woman with a new onset of symptoms of a pulmonary embolus A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
17- The nurse is working with a health care provider who prescribes opioid doses based on a specific pain intensity rating (dosing to the numbers). Which patient circumstance is cause for greatest concern? A) A 73-year-old frail female patient with a history of chronic obstructive pulmonary disease is prescribed 4 mg IV morphine for pain of 1 to 3 on a scale of 0 to 10. B) A 25-year-old postoperative male patient with a history of opioid addiction is prescribed one tablet of oxycodone and acetaminophen for pain of 4 to 5 on a scale of 0 to 10. C) A 33-year-old opioid-naïve female patient who has a severe migraine headache is prescribed 5 mg IV morphine for pain of 7 to 8 on a scale of 0 to 10. D) A 60-year-old male with a history of rheumatoid arthritis is prescribed one tablet of hydromorphone for pain of 5 to 6 on scale of 0 to 10.
A) A 73-year-old frail female patient with a history of chronic obstructive pulmonary disease is prescribed 4 mg IV morphine for pain of 1 to 3 on a scale of 0 to 10.
16- According to recent guidelines from the American Pain Society in collaboration with the American Society of Anesthesiologists, which pain management strategies are important for postsurgical patients? Select all that apply. A) Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for management of postoperative pain in adults and children without contraindications B) Surgical site-specific peripheral regional anesthetic techniques in adults and children for procedures C) Neuraxial (epidural) analgesia for major thoracic and abdominal procedures if the patient has risk for cardiac complications or prolonged ileus D) Multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies E) IV administration of opioids, rather than oral opioids, for postoperative analgesia F) Pain specialists to manage the postoperative pain for all surgical patients
A) Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for management of postoperative pain in adults and children without contraindications B) Surgical site-specific peripheral regional anesthetic techniques in adults and children for procedures C) Neuraxial (epidural) analgesia for major thoracic and abdominal procedures if the patient has risk for cardiac complications or prolonged ileus D) Multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies
1. A key aspect of teaching for the patient on anticoagulant therapy includes which instructions? A. Monitor for and report any signs of bleeding. B. Do not take acetaminophen (Tylenol) for a headache. C. Decrease your dietary intake of foods containing vitamin K. D. Arrange to have blood drawn routinely to check drug levels.
A. Monitor for and report any signs of bleeding.
15- After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? Absence of jaundice Clear breath sounds Increased bowel sounds Palpable pedal pulses
Absence of jaundice
25- The patient is admitted for the management of a hypertensive emergency. The healthcare provider prescribes sodium nitroprusside [Nipride] drug therapy. What is the priority nursing action during this treatment? Observe for respiratory depression. Monitor the electrocardiogram for tachycardia. Initiate oxygen therapy via nasal cannula at 2 L/min. Adjust the intravenous infusion rate to the blood pressure response.
Adjust the intravenous infusion rate to the blood pressure response.
14- A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? Alcoholic drinks Leafy green foods Bananas Dairy products
Alcoholic drinks
9- Before administering celecoxib [Celebrex], it is most important for the nurse to assess the patient for a history of what? Allergy to sulfonamides History of hepatitis C Hypothyroidism Diabetes mellitus
Allergy to sulfonamides
true? (select all that apply) Warming blankets are routinely used to raise the patient's temperature. Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. Activated charcoal is contraindicated in the treatment of aspirin poisoning. Hemodialysis or peritoneal dialysis can accelerate salicylate removal.
Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. Hemodialysis or peritoneal dialysis can accelerate salicylate removal.
which includes acetaminophen, nonsteroidal anti-inflammatory drugs, as-needed (PRN) opioids, and nonpharmaceutical interventions. The patient continuously asks for the PRN opioid, and the nurse suspects that the patient may have a drug abuse problem. Which action by the nurse is best? A) Administer acetaminophen and spend extra time with the patient. B) Explain that opioid medication is reserved for moderate to severe pain. C) Give the opioid because the patient deserves relief and drug abuse is unconfirmed. D) Ask the HCP to validate suspicions of drug abuse and alter the opioid prescription.
C) Give the opioid because the patient deserves relief and drug abuse is unconfirmed.
12. The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? Administer intravenous (IV) push protamine sulfate. Continue with the current prescription. Prepare to administer vitamin K. Call the healthcare provider to increase the dose.
Call the healthcare provider to increase the dose.
15- A patient with angina pectoris has been prescribed nifedipine [Procardia].Which possible adverse effects should the nurse expect with this medication? (select all that apply) Headache Constipation Nausea and vomiting Edema of ankles and feet Overgrowth of gum tissue
Headache Edema of ankles and feet Overgrowth of gum tissue
1- The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? Hives Hematemesis Dysmenorrhea Jaundice
Hematemesis
8. A patient with a deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. Heparin suppresses coagulation by helping antithrombin perform its natural functions. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.
Heparin suppresses coagulation by helping antithrombin perform its natural functions.
4. The recommended treatment for an initial VTE in an otherwise healthy person with no significant co- morbidities would include IV argatroban (Acova) as an inpatient. IV unfractionated heparin as an inpatient. Subcutaneous unfractionated heparin as an outpatient. Subcutaneous low-molecular-weight heparin as an outpatient.
IV unfractionated heparin as an inpatient.
7- A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? Ibuprofen [Motrin] Zolpidem [Ambien] Loratadine [Claritin] Diphenhydramine [Benadryl]
Ibuprofen [Motrin]
33. Which classes of medications are prescribed as initial therapy for hypertension after a myocardial infarction (MI)? J) Beta blocker and ACE inhibitor K) Diuretic and beta blocker L) ACE inhibitor and calcium channel blocker M) Diuretic and calcium channel blocker
J) Beta blocker and ACE inhibitor
35- The nurse is caring for a pregnant patient experiencing a new episode of hypertension. Which medication does the nurse anticipate will be prescribed for this patient? Methyldopa [Aldomet] Propranolol [Inderal] Captopril [Capoten] Valsartan [Diovan]
Methyldopa [Aldomet]
3. Which are probable clinical findings in a person with an acute VTE (select all that apply)? Pallor and coolness of foot and calf Mild to moderate calf pain and tenderness Grossly diminished or absent pedal pulses Unilateral edema and induration of the thigh Palpable cord along a superficial varicose vein
Mild to moderate calf pain and tenderness Unilateral edema and induration of the thigh
9- The nurse has just administered the initial dose of enalapril [Vasotec] to a newly admitted patient with hypertension. What is the priority nursing intervention over the next several hours? Monitor blood pressure. Check the heart rate. Auscultate lung sounds. Draw a potassium level.
Monitor blood pressure.
14- The healthcare provider prescribes an intravenous dose of diltiazem [Cardizem] for treatment of a patient with atrial fibrillation. What is the priority nursing intervention? Assist with cardioversion. Monitor electrocardiogram. Obtain baseline coagulation studies. Assess for increased urinary output.
Monitor electrocardiogram.
23- A patient with hypertensive emergency is admitted to the hospital. Which medication should the nurse be prepared to administer to this patient? Minoxidil [Loniten] Hydralazine [Apresoline] Sodium nitroprusside [Nipride] Hydralazine and isosorbide dinitrate [BiDil]
Sodium nitroprusside [Nipride]
28- A patient is admitted to the unit in a hypertensive emergency and examination reveals papilledema. The nurse should expect which IV medications to be administered to achieve rapid, controlled reduction of the patient's blood pressure? Furosemide [Lasix] Sodium nitroprusside [Nitropress] Metoprolol [Lopressor] Diltiazem [Cardizem]
Sodium nitroprusside [Nitropress]
18- Which instructions should the nurse include when developing a teaching plan for a patient prescribed diltiazem [Cardizem] for atrial fibrillation? (select all that apply) Weigh yourself daily at the same time each day. The medication will not cause dizziness or headache. Notify the healthcare provider if a skin rash develops. Do not take daily oral calcium supplements. Rise slowly from a lying to a sitting position.
Weigh yourself daily at the same time each day. Notify the healthcare provider if a skin rash develops. Rise slowly from a lying to a sitting position.
2. The patient at highest risk for venous thromboembolism (VTE) is a 62-year-old man with spider veins who is having arthroscopic knee surgery. a 32-year-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe. a 26-year-old woman who is 3 days postpartum and received maintenance IV fluids for 12 hours during her labor. an active 72-year-old man at home recovering from transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).
a 32-year-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe.
