Pharm Final

The educator has reviewed the use for immunosuppressants with a nurse. Which statements made by the nurse indicate an understanding of the information? SATA 1. "Immunosuppressants prevent tissue rejection." 2. "Immunosuppressants treat severe inflammatory diseases." 3. "Immunosuppressants dampen the immune response." 4. "Immunosuppressants stimulate new immunity." 5. "Immunosuppressants eradicate the immune system."

1, 2, 3 1. Immunosuppressants prevent tissue rejection. 2. Immunosuppressants treat severe inflammatory diseases 3. Immunosuppressants dampen the immune response. 4. Immunosuppressants do not stimulate new immunity 5. Immunosuppressants do not eradicate the immune system." Learning Outcome: 34-6 Explain the need for immunosuppressant medications following organand tissue transplants.

Which information should the nurse include in the explanation of inflammation for a client? SATA 1. When cells are damaged nearby vessels get bigger. 2. The vessels in the area allow fluids to escape. 3. Inflammation produces pus. 4. Inflammation causes bleeding and inability to clot.5. Inflammation causes pain.

1, 2, 3, 5 1. Histamine and other chemical mediators are released and result in vasodilation. 2. Vessels become more permeable. 3. Pus develops from cellular infiltration and death of white cells. 4. Clots form in vessels involved in inflammation. 5. Inflammation damages tissues, stimulating nerve endings and causing pain.

A patient with cancer asks how treatment with an immunostimulant works.Which information should the nurse provide? a) "It kills cancer cells by suppressing T and B cell production and stimulating calcineurin." b) "It blocks the receptors of cancer cells to prevent further mutation and reproduction." c) "It increases the ability of the immune system to fight infection and disease." d) "It prevents cancer from growing and spreading to other organs."

"It increases the ability of the immune system to fight infection and disease."

A nurse is teaching a patient being treated for seizures with phenytoin (Dilantin) about necessary precautions that need to be taken during the course of treatment. What is the most important instruction to reduce the risk of status epilepticus in the patient?1"Refrain from driving and taking up other hazardous activities." 2"Avoid consumption of alcohol and caffeinated products like tea and coffee." 3"Never stop taking the drug abruptly; please take each dose as scheduled." 4"Consult your primary health care provider regarding the teratogenic effects of phenytoin (Dilantin)."

"Never stop taking the drug abruptly; please take each dose as scheduled." Stopping the drug therapy abruptly increases the risk of seizure rebound and status epilepticus. Therefore the patient should take each dose as scheduled in order to maintain drug therapeutic levels. During the initiation of anticonvulsant therapy, the patient should not drive or perform hazardous activities, because drowsiness may occur. This does not help to prevent status epilepticus. Alcohol and other central nervous system (CNS) depressants might lead to added depressive effects on the body if taken with anticonvulsants. Caffeinated products are CNS stimulants. If a female patient being treated with phenytoin (Dilantin) is contemplating pregnancy, she should consult the primary health care provider regarding the teratogenic effects of the drug. This instruction, however, is not relevant to preventing status epilepticus.

What do the chemical mediators histamine, leukotrienes, bradykinin, complement, and prostaglandins do when they are released during tissue damage?

*histamine: vasodilation, causes smooth muscle to contract, edema, and causes itching *leukotrienes: similar to histamine* bradykinin: vasodilation and pain *complement: neutralizes or destroys the antigen *prostaglandins: cause pain

A 24-year old client reports taking acetaminophen (Tylenol) fairly regularly for headaches. The nurse knows that a client who consumes excess acetaminophen per day or regularly consumes alcoholic beverages should be observed for what adverse effect? 1. Hepatic toxicity 2. Renal damage 3. Thrombotic effects 4. Pulmonary damage

1. Hepatic Toxicity Rationale: excessive doses of acetaminophen or regular consumption of alcohol may increase the risk of hepatic toxicity when acetaminophen is used. Options 2,3, and 4 are incorrect. Renal or pulmonary toxicity and thrombotic events are not adverse effects associated specifically with acetaminophen.

A 3-year-old child had a seizure two days ago when the child's temperature was 105 F. The child has had no previous seizures. Today, the parent and the child are in the physician's office. What should the nurse include when teaching the parent? 1. The child now has epilepsy and will need long-term care for this condition. 2. If the child develops a fever over 101°F, administer ibuprofen. 3. Make sure the child drinks plenty of water every day. 4. Call the physician's office immediately if the child develops a temperature over 100.4°F.

2

A client asks the nurse about the characteristics of absence seizures. Which explanationshould the nurse provide the client? 1. "Absence seizures are basically the same kind of seizures as grand mal, but they are less frequent." 2. "This type of seizure is characterized by staring into space for a few seconds." 3. "Absence seizures are characterized by twitching of the arms and legs." 4. "This type of seizure is similar to drop attacks."

2 1. Grand mal, or tonic-clonic, seizures are different from absence or petit mal seizures;they are different forms of epilepsy. 2. Absence seizures last a few seconds and are characterized by staring into space.3. Simple partial seizures are characterized by twitching of the arms and legs.4. Drop attacks or atonic seizures last a few seconds and are characterized by stumbling orfalling for no reason.Learning Outcome: 15-3 Relate signs and symptoms to specific types of seizures.

The nurse has provided parental education on infant immunization. Which statements made by the parent indicate an understanding of the information? SATA 1. "The immunizations are more effective if they are given closer together." 2. "The baby might have a mild fever and be fussy for a few days." 3. "I will call the healthcare provider immediately if the baby develops a fever." 4. "I can give acetaminophen (Tylenol) if the baby has a mild fever." 5. "I should be concerned that a mild fever may indicate an allergic reaction has occurred."

2, 4 1. The recommended immunization schedule should be followed. There is no benefit toadministering immunizations closer together. 2. A mild fever is a typical reaction to immunizations. 3. The healthcare provider should be notified if the fever is high. 4. Acetaminophen (Tylenol) is indicted for relief of mild symptoms. 5. A mild fever does not indicate there is an allergic reaction to the immunization.Learning Outcome: 34-10 Use the nursing process to care for patients receivingpharmacotherapy for immune conditions.

The physician has prescribed phenytoin (Dilantin) for a patient with type 1 diabetes mellitus. What does the nurse include in the plan of care for this patient? 1. Plan to discuss with the physician the need to decrease the patient's insulin based on serum glucose levels. 2. Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels. 3. Plan to assess the patient for petechiae, epistaxis, and hematuria. 4. Plan to institute safety precautions, as the patient is at risk for dizziness and ataxia.

2. Plan to discuss with the physician the need to increase the patient's insulin based on serum glucose levels.

A client has been prescribed several different prescriptions for seizure control without anyimprovement. Which initial question should the nurse ask the client? 1. "Have you thought about taking a nontypical prescription?" 2. "Have you noticed any decrease in the amount of seizures you have?" 3. "Do you take your medication as prescribed? 4. "Do you drink alcohol?"

3 1. Another drug might be indicated, but compliance should be assessed first.2. There is no indication there is an improvement in seizure control.3. Compliance with the prescription should be initially assessed for a patient that has not had an improvement in seizure control after taking several different prescriptions for seizure control.4. Alcohol does not increase the risk of seizures for a patient prescribed an antileptic.Learning Outcome: 15-5 Explain the importance of patient drug compliance in thepharmacotherapy of epilepsy and seizures.

Which describes the direct action of acetaminophen (Tylenol) for fever reduction? SATA 1. Constriction of peripheral blood vessels 2. Increase activity of the sweat glands 3. Dilation of peripheral blood vessels 4. Direct action at the level of the hypothalamus 5. Decreases tissue inflammation

3, 4 1. Heat is conserved when the blood vessels are constricted.2. Acetaminophen does not affect the activity of the sweat glands.3. Acetaminophen reduces fever by direct action at the level of the hypothalamus anddilation of peripheral blood vessels, which enables sweating and dissipation of heat.4. Acetaminophen reduces fever by direct action at the level of the hypothalamus anddilation of peripheral blood vessels, which enables sweating and dissipation of heat.5. Acetaminophen does not decrease tissue inflammation.Learning Outcome: 33-7 For each of the classes listed in Drugs at a Glance, knowrepresentative drugs, and explain their mechanisms of drug action, primary actions related toinflammation and fever, and important adverse effects.

Which is a nursing priority to include in the teaching for the client prescribed an immunosuppressant? 1. Obtain adequate exercise. 2. Drink plenty of fluids. 3. Eat plenty of fruits and vegetables. 4. Avoid large crowds.

4 1. An immunosuppressant places the client at risk for infection. Adequate exercise is important but will not prevent infection. 2. An immunosuppressant places the client at risk for infection. Drinking plenty of fluids is important but will not prevent infection. 3. An immunosuppressant places the client at risk for infection. Eating plenty of fruits and vegetables is important but will not prevent infection 4. An immunosuppressant places the client at risk for infection. The client should beinstructed to avoid large crowds. Learning Outcome: 34-10 Use the nursing process to care for patients receivingpharmacotherapy for immune conditions.

The nurse is counseling a mother regarding antipyretic choices for her 8-year-old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother? 1. It is not as good an antipyretic as is acetaminophen 2. It may increase fever in children under age 10. 3. It may produce nausea and vomiting. 4. It increases the risk of Reye's syndrome in children under 18 with viral infections

4. It increases the risk of Reye's syndrome in children under 18 with viral infections Rationale: aspirin and salicylates are associated with an increased risk of Reye's syndrome in children under 18, especially in the presence of viral infections. Options 1, 2, and 3 are incorrect. Acetaminophen is not significantly different than aspirin or salicylates should not increase fever although it may cause nausea or vomiting related to GI irritation; however, it is not contraindicated in children specifically for this reason.

The nurse is preparing to provide instructions on the use of an epinephrine​ auto-injector. Which information should the nurse​ include? Select all that apply. A.If you need to use this​ pen, seek medical advice as​ follow-up. B.You can dispose of a used EpiPen in your regular trash. C.Keep an extra EpiPen on hand. D.Store this device in your refrigerator. E.Carry an EpiPen in your​ car's glovebox.

A, C

A client has been prescribed phenylephrine​ (Neo-Synephrine) spray for nasal congestion. Which information about adverse effects should the nurse provide in discharge​ teaching?Select all that apply. A.​"This drug may cause some stinging or burning in your​ nose." B.​"You may notice that your nasal secretions take on a slightly orange​ tint." C.​"You may feel like your blood pressure is low for the first few times you use this​ spray." D.​"Rebound congestion may occur if the prescription is used more than a few​ days." E.​"Do not drink herbal teas while taking this​ medication."

A, D

A client has been prescribed an adrenergic nasal spray. Which information should the nurse include in the​ teaching?Select all that apply. A.​"Do not share this spray with​ anyone." B.​"Sit upright while using this​ spray." C.​"Only use this spray for 3-5 ​days." D.​"Do not shake the bottle before using this​ spray." E.​"Keep this spray​ refrigerated."

A,B,C

Which information should the nurse include when providing education for an adult female client that is beginning the series of hepatitis B​ immunizations? A. "Practice reliable birth control for 3 months after the administration of the​ vaccinations." B. "Immediately report any signs of bleeding such as​ hematuria, or bleeding from the​ gums." C. "Contact your healthcare provider if you develop pain at the injection​ site, mild​ fever, or​ soreness." D. "Avoid crowded areas where you might be exposed to an infectious​ disease."

A. "Practice reliable birth control for 3 months after the administration of the​ vaccinations."

The nurse caring for a patient who is receiving beta1 agonist drug therapy needs to be aware that these drugs cause which effect? A. Increased cardiac contractility. B. Decreased heart rate. C. Bronchoconstriction. D. Increased GI tract motility.

A. Increased cardiac contractility.

A client must eliminate caffeine intake due the contraindication with a newly prescribed medication. Which withdrawal symptoms should the nurse discuss with the​ client? A.Depression B.Insomnia C.Weight gain D.Urinary retention E.Headache

A.) Depression E.) Headache

The nurse is preparing to provide instructions on the use of an epinephrine​ auto-injector. Which information should the nurse​ include?Choose all that apply A.If you need to use this​ pen, seek medical advice as​ follow-up. B.You can dispose of a used EpiPen in your regular trash. C.Keep an extra EpiPen on hand. D.Store this device in your refrigerator.

A.If you need to use this​ pen, seek medical advice as​ follow-up. C.Keep an extra EpiPen on hand.

The nurse has provided teaching about the use of an auto injection of epinephrine. Which statement made by the client indicates further teaching is​ required? A.​"I will call 911 after I inject the​ epinephrine." B.​"I will make sure I have my​ auto-injector available at all​ times." C.​"I will use my​ auto-injector immediately if I think I am having an allergic​ reaction." D.​"I will notify my healthcare provider after I inject the​ epinephrine."

A.​"I will call 911 after I inject the​ epinephrine."

A patient has been taking an AED for several years as part of his treatment for partial seizures. His wife has called because he ran out of medication this morning and wonders if he can go without it for a week until she has a chance to go to the drugstore. What is the nurse's best response? a. "He is taking another antiepileptic drug, so he can go without the medication for a week." b. "Stopping this medication abruptly may cause withdrawal seizures. A refill is needed right away." c. "He can temporarily increase the dosage of his other antiseizure medications until you get the refill." d. "He can stop all medications because he has been treated for several years now."

ANS: B Abrupt discontinuation of antiepileptic drugs can lead to withdrawal seizures. The other options are incorrect. The nurse cannot change the dose or stop the medication without a prescriber's order.DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 220TOP: NURSING PROCESS: Implementation

The nurse is reviewing antiepileptic drug (AED) therapy. Which statements about AED therapy are accurate? (Select all that apply.) a. AED therapy can be stopped when seizures are stopped .b. AED therapy is usually lifelong. c. Consistent dosing is the key to controlling seizures. d. A dose may be skipped if the patient is experiencing adverse effects.e. Do not abruptly discontinue AEDs because doing so may cause rebound seizure activity.

ANS: B, C, E Patients need to know that AED therapy is usually lifelong, and compliance (with consistent dosing) is important for effective seizure control. Abruptly stopping AED therapy may cause withdrawal (or rebound) seizure activity.DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 232TOP: NURSING PROCESS: Implementation

When teaching a patient about taking a newly prescribed antiepileptic drug (AED) at home, the nurse will include which instruction? a. "Driving is allowed after 2 weeks of therapy." b. "If seizures recur, take a double dose of the medication." c. "Antacids can be taken with the AED to reduce gastrointestinal adverse effects." d. "Regular, consistent dosing is important for successful treatment."

ANS: D Consistent dosing, taken regularly at the same time of day, at the recommended dose, and with meals to reduce the common gastrointestinal adverse effects, is the key to successful management of seizures when taking AEDs. Noncompliance is the factor most likely to lead to treatment failure.DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 231TOP: NURSING PROCESS: Implementation

A nurse is caring for a patient injured in a car crash. The patient is manifesting signs of alcohol withdrawal delirium. Which does the nurse identify as signs of alcohol withdrawal delirium?

Gross tremors Visual hallucinations Seizures

When teaching a patient about beta blockers such as atenolol (Tenormin) and metoprolol (Lopressor), it is important for the nurse to instruct the patient about which drug information?

Abrupt medication withdrawal may lead to a rebound hypertension. Abrupt withdrawal of a beta-blocking drug can cause rebound hypertension. These drugs should not be withdrawn abruptly, but should be tapered over 1 to 2 weeks. Antacids should not be taken with beta blockers because they may decrease absorption.

A patient has been admitted with a diagnosis of cocaine poisoning. What does the nurse expect the patient's plan of care to include?

Administer IV diazepam. Perform a gastric lavage. Administer IV antipsychotic drugs.

Which statement made by a client prescribed acetylsalicylic acid (aspirin) indicates the client is experiencing an adverse reaction? "My stools have been dark in color." "My nose is stuffed up." "Bright lights give me a headache." "I have to get up a lot at night to urinate."

Answer: 1 Explanation: Aspirin may result in ulceration and bleeding, which is characterized by stools that aredarker than normal.There isn't any relationship between aspirin and nasal congestion.Aspirin does not cause photophobia.There isn't any relationship between aspirin and nocturnal renal output.Page Ref: 234-235

A nurse is preparing to administer a hepatitis B vaccination to a client. Which of the following would cause the nurse to withhold the vaccination and check with the health care provider? 1.) The client smokes cigarettes, one pack per day. 2.) The client is frightened by needles and injections. 3.) The client is allergic to yeast and yeast products. 4.) The client has hypertension.

Answer: 3 Rationale: An allergy to yeast or yeast products is a contraindication to the hepatitis B vaccination. Options 1, 2, and 4 are incorrect. Smoking, hypertension, and a fear of needles or injections are not contraindications for the drug. These conditions may be managed with appropriate health teaching .Cognitive Level: Applying Nursing Process: Assessment Client Need: Physiological Integrity

Shortly after admission to an acute care facility, a male client with a seizure disorder develops status epilepticus. The physician orders diazepam (Valium) 10 mg I.V. stat. How soon can the nurse administer a second dose of diazepam, if needed and prescribed? a. In 30 to 45 seconds b. In 10 to 15 minutes c. In 30 to 45 minutes d. In 1 to 2 hours

Answer: B When used to treat status epilepticus, diazepam may be given every 10 to 15 minutes, as needed, to a maximum dose of 30 mg. The nurse can repeat the regimen in 2 to 4 hours, if necessary, but the total dose shouldn't exceed 100 mg in 24 hours. The nurse must not administer I.V. diazepam faster than 5 mg/minute. Therefore, the dose can't be repeated in 30 to 45 seconds because the first dose wouldn't have been administered completely by that time. Waiting longer than 15 minutes to repeat the dose would increase the client's risk of complications associated with status epilepticus.

After teaching the parents of a child with febrile seizures about methods to lower temperature other than medication, which of the following statements indicates successful teaching? A) We'll add extra blankets when he complains of being cold B) We'll wrap him in a blanket if he starts shivering C) We'll make the bath water cold enough to make him shiver D) We'll use a solution of half alcohol and half water when sponging him

B

Which lab finding would alert the nurse to hold the administration of phenytoin and notify the health care provider? A. White blood cell count of 7000 per mcL B. Albumin level of 2.9 g/dL C. Respiration rate of 14 D. Pulse rate of 92

B

Which statement should the nurse include in the parental teaching for the administration of acetaminophen (Tylenol) to a child? A. "Acetaminophen (Tylenol) should be administered with a​ high-carbohydrate meal."B. "Read the labels of all​ over-the-counter medications for the amount of acetaminophen​ (Tylenol)." C. "Due to the lasting​ effects, acetaminophen​ (Tylenol) should only be given to children once a​ day." D. "Baby aspirin can be substituted for acetaminophen​ (Tylenol)."

B. "Read the labels of all​ over-the-counter medications for the amount of acetaminophen​ (Tylenol)."

Which factor in the patient's history would cause the nurse to question a medication order for atropine?A. A 32-year old man with a history of drug abuseB. A 65-year old man with benign prostatic hyperplasiaC. An 8-year old boy with chronic tonsillitisD. A 22-year old woman on the second day of her menstrual cycle

B. A 65-year old man with benign prostatic hyperplasiaAtropine causes urinary retention to worsen, and is, therefore, contraindicated, in patients with benign prostatic hyperplasia.

A family member of a deceased client that overdosed on cocaine asks the nurse how he or she died. Which should the nurse recognize is the most likely caused the death of the​ client?A.Rhabdomyolysis B.Cardiac arrest C.Aneurysm D.Drug impurity

B. Cardiac arrest

A nurse administers a drug that activates beta 1 receptors. Which effect(s) would the nurse expect? (Select all that apply )A. Slowed heart rate B. Increased pulse rate C. Increased force of contraction D. Respiratory distress E. Decreased urinary output

B. Increased pulse rate C. Increased force of contraction

A client receives a direct cholinergic agonist. In which way should the nurse expect this medication to​ act? (Select all that​ apply.)A.Binds to acetylcholinesterase​ (AChE) receptors, preventing ACh from being destroyedB.Binds to acetylcholine​ (ACh) receptors, enhancing the action potential on the postsynaptic neuronC.Activates cholinergic receptors located at the neuroeffector junctions in the sympathetic nervous systemD.Causes more acetylcholine​ (ACh) to be released into the synaptic cleftE.Affects acetylcholine​ (ACh) synapses located at the autonomic​ ganglia, muscarinic​ receptors, neuromuscular​ junctions, and synapses in the central nervous system

B.Binds to acetylcholine​ (ACh) receptors, enhancing the action potential on the postsynaptic neuron D.Causes more acetylcholine​ (ACh) to be released into the synaptic cleftA direct cholinergic agonist causes more ACh to be released into the synaptic cleft and binds to ACh​ receptors, enhancing the action potential on the postsynaptic neuron. Indirect cholinergic agonists bind to AChE​ receptors, preventing ACh from being destroyed. Muscarinic agonists activate cholinergic receptors located at the neuroeffector junctions in the parasympathetic nervous system. Acetylcholinesterase​ (AChE) inhibitors affect ACh synapses located at the autonomic​ ganglia, muscarinic​ receptors, neuromuscular​ junctions, and synapses in the central nervous system.

A client has been prescribed prazosin​ (Minipress). Which information should the nurse​ provide? Choose all that apply A.​"Stay out of the sun until you determine if you become​ sun-sensitive." B.​"Take this medication just before you go to​ bed." C.​"This medication may make you​ dizzy." D.​"This medication may slow your heart rate​ noticeably."E.

B.​"Take this medication just before you go to​ bed." C.​"This medication may make you​ dizzy."

A patient with arthritis is on NSAID therapy. What should be evaluated by the nurse to determine the effectiveness of NSAID therapy?

Better mobility

A client who has used an adrenergic nasal spray for 2 weeks states to the​ nurse, "I am more stuffed up now than I was when I was​ sick." Which information should the nurse provide the​ patient?Select all that apply. A.​"You are having an allergic reaction to the nasal spray. Stop using it​ immediately." B.​"You are having an allergic reaction to the nasal spray. Stop using it​ immediately." C.​"Try increasing the amount of fluids you are​ drinking." D.​"Switch to a​ saline-based nasal​ spray." E.​"Continue to use your current nasal spray until the congestion goes​ away."

C,D

A client with Alzheimer disease is prescribed an indirect cholinergic agonist. In which way should the nurse expect this medication to​ act?A.Acts by the same mechanism as acetylcholine​ (ACh) when releasedB.Inhibits acetylcholinesterase which destroys acetylcholineC.Binds the enzyme​ acetylcholinesterase, preventing destruction of acetylcholine​ (ACh)D.Increases the release of acetylcholine​ (ACh) from the synaptic cleft

C.Binds the enzyme​ acetylcholinesterase, preventing destruction of acetylcholine​ (ACh)An indirect cholinergic agonist binds the enzyme​ acetylcholinesterase, preventing destruction of ACh. Direct cholinergic agonists increase the release of ACh into the synaptic cleft and act by the same mechanism as ACh. Direct cholinergic agonists are inactivated with acetylcholinesterase.

A client who has used an adrenergic nasal spray for 2 weeks states to the​ nurse, "I am more stuffed up now than I was when I was​ sick." Which information should the nurse provide the​ patient? Choose all that apply A.​"You are having an allergic reaction to the nasal spray. Stop using it​ immediately." B.​"You are having an allergic reaction to the nasal spray. Stop using it​ immediately." C.​"Try increasing the amount of fluids you are​ drinking."

C.​"Try increasing the amount of fluids you are​ drinking." D.​"Switch to a​ saline-based nasal​ spray."

The nurse is providing education to a client that has smoked 1 pack of cigarettes daily for the past few years and is currently prescribed oral contraceptives. Which statement should the nurse include in the​ teaching? A.​"You are at a higher risk for developing diabetes than smokers who do not use birth control​ pills."B.​"The nicotine will decrease the effectiveness of your birth control​ pills." C.​"You are at a higher risk for a heart attack than​ nonsmokers." D.​"You are at a higher risk for emphysema than general​ smokers."

C.​"You are at a higher risk for a heart attack than​ nonsmokers."

A patient with cortical focal seizures has been prescribed phenobarbital. What adverse reaction should the nurse monitor for in the patient?Gingival hyperplasia Ataxia Urticaria CNS depression

CNS depression

The patient receiving phenytoin (Dilantin) has a serum drug level of 12 mcg/mL. What is the nurse's best action? Perform a neurological assessment. Assess the patient's gums and mouth. Call the health care provider. Continue to monitor the patient.

Continue to monitor the patient. Therapeutic serum drug level for phenytoin (Dilantin) is 10 to 20 mcg/mL. The nurse should continue to monitor. Since the drug is at the therapeutic level, there is no need to intervene further by calling the health care provider or performing a more in-depth assessment.

A client asks if convulsions and seizures are the same. The nurse's response is based on the knowledge that: Seizures involve muscle spasms on one side only. The terms can be used interchangeably .Seizure activity is more harmful than are convulsions. Convulsions always involve violent skeletal muscle activity.

Convulsions always involve violent skeletal muscle activity. Objective: Compare and contrast the terms epilepsy, seizures, and convulsions.Rationale: Convulsions specifically refer to involuntary, violent spasms of the large muscles of the face, neck, arms, and legs. Seizure activity does not always involve these characteristics.Cognitive Level: ComprehensionClient Need: Physiological Integrity: Physiological AdaptationNursing Process: Implementation

The home hospice nurse is completing the initial assessment of a patient who is has terminal congestive heart failure. The patient frequently has pain with breathing. What questions should the nurse ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply. 1. How much pain are you willing to tolerate? 2. What do you like to do throughout the day? 3. Have you ever been addicted to a pain medication? 4. Are there any pain medications you would like to avoid? 5. What things besides drugs help with your pain?

Correct Answer: 1,2,4,5 Rationale 1: It is sometimes impossible to eliminate all pain and all adverse medication effects. The nurse needs to know how much pain and how many of the effects the patient is willing to tolerate. Rationale 2: Knowing what the patient likes to do and when it is important for the patient to be most awake and alert helps the nurse create a pain management plan. Rationale 3: Addiction is not a concern at the end of life. Many patients are already concerned about becoming addicted and the nurse should not reinforce this myth. Rationale 4: Some patients cannot tolerate the side effects of some medications. It is important for the nurse to assess for these preferences. Rationale 5: Nonpharmacologic pain relief strategies should also be investigated.

Type: MCMA The nursing instructor teaches the student nurses about the nervous system. The instructor determines that learning has occurred when the students make which statement(s)? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The central nervous system includes the brain and spinal cord." 2. "The peripheral nervous system has mainly sensory functions." 3. "The somatic nervous system gives us voluntary control over our gastrointestinal (GI) tract." 4. "The nervous system helps us react to environmental changes." 5. "The somatic nervous system gives us voluntary control over moving."

Correct Answer: 1,4,5 Rationale 1: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.Rationale 2: The central nervous system includes the brain and spinal cord. The somatic nervous system provides voluntary control over moving. The nervous system provides reaction to environmental changes. The peripheral nervous system has both sensory and motor divisions. The somatic nervous system gives voluntary control over skeletal muscles.Rationale 3: The central nervous system includes the brain and spinal cord.

Type: MCMA The nursing instructor teaches the student nurses about the autonomic nervous system. The instructor determines that learning has occurred when the students make which statement(s)?Note: Credit will be given only if all correct choices and no incorrect choices are selected.Standard Text: Select all that apply. 1. "The sympathetic and parasympathetic systems are not always opposite in their effects." 2. "The parasympathetic nervous system is the "fight-or-flight" response." 3. "Sympathetic stimulation causes dilation of arterioles." 4. "The parasympathetic nervous system causes bronchial constrictio.

Correct Answer: 1,4,5 Rationale 1: The parasympathetic nervous system causes bronchial constriction. The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.Rationale 2: The parasympathetic nervous system causes bronchial constriction The sympathetic and parasympathetic systems are not always opposite in their effects. The sympathetic nervous system is activated under stress. The parasympathetic nervous system is the rest-and-digest response. Sympathetic stimulation causes constriction of arterioles.Rationale 3: The parasympathetic nervous system causes bronchial

Which statement is accurate concerning the use of aspirin (ASA) to treat pain? 1. High doses are necessary (1 gram) to achieve anticoagulant effects. 2. Enteric-coated capsules are available to reduce GI side effects. 3. Increase consumption of herbs such as garlic and ginger to potentiate the anti-inflammatory effects. 4. In low doses (325 mg), it significantly reduces inflammation.

Correct Answer: 2 Rationale 1: Aspirin can cause bleeding in low doses. Enteric-coated capsules can help prevent bleeding, and avoiding certain herbs such as ginger and garlic should be advised. The anti-inflammatory effects of aspirin occur in high doses.

The nurse has provided teaching about the use of an auto injection of epinephrine. Which statement made by the client indicates further teaching is​ required? A.​"I will make sure I have my​ auto-injector available at all​ times." B.​"I will notify my healthcare provider after I inject the​ epinephrine. "C.​"I will use my​ auto-injector immediately if I think I am having an allergic​ reaction." D.​"I will call 911 after I inject the​ epinephrine."

D

A client taking phenobarbital​ (Luminal) for seizure control asks the nurse how the prescription can control seizures. Which response should the nurse provide the​ client? A.​"Phenobarbital (Luminal) stops seizures by increasing a chemical called glutamate that calms down the excitability in the​ brain." B.​"Phenobarbital (Luminal) stops seizures by decreasing the sodium in​ brain, which is responsible for the​ seizures." C.​"Phenobarbital (Luminal) stops seizures by decreasing the calcium in the​ brain, which is responsible for the​ seizures." D.​"Phenobarbital (Luminal) stops seizures by increasing a chemical called GABA that calms down the excitability in the​ brain."

D Rationale: Phenobarbital​ (Luminal) acts biochemically in the brain by enhancing the action of the neurotransmitter​ GABA, which is responsible for suppressing abnormal neuronal discharges that can cause epilepsy. Glutamate is the primary excitatory neurotransmitter in the​ brain; enhancing this neurotransmitter will increase the likelihood of seizures. Hydantoins and​ phenytoin-like drugs, not phenobarbital​ (Luminal), suppress sodium influx.​ Succinimides, not phenobarbital​ (Luminal), suppress calcium influx.

The nurse has administered intravenous​ (IV) diazepam​ (Valium) for the client in status epilepticus. Which initial assessment should the nurse​ perform? A.Level of consciousness B.Blood pressure C.Heart rate D.Respirations

D ​Rationale: Respiratory depression is common when diazepam is given intravenously​ (IV). Assessing the respirations is the most important. Assessing the level of​ consciousness, heart​ rate, and blood pressure are​ important, but not the most important. Although tachycardia is an effect of intravenous diazepam​ (Valium), it is not the most important assessment. Although hypotension is an effect of intravenous diazepam​ (Valium), it is not the most important assessment.

The nurse suspects that a patient is experiencing alcohol-withdrawal delirium based on what assessment findings?

Disorientation Visual hallucinations Increased hyperactivity without seizures

the nurse recalls that which cardiovascular effects are observed during cocaine toxicity?

Dysrhythmia Hypertension Myocardial infarction

A patient's acetaminophen (Tylenol) dose is increased from 325 mg every 6 hours to 650 mg every 4 hours. For which effect should the nurse monitor? Cardiotoxicity Blood clots Reye's syndrome Hepatotoxicity

Hepatotoxicity

The nurse is asked to explain the purpose of vaccinations.Which should the nurse include about long-term disease protection? Do not produce illness in healthy individuals Stimulates production of B cells and T cells Are stable for storage and administration Are economical to develop

Stimulates production of B cells and T cells To provide long-term protection, vaccines must be able to stimulate the production of memory B cells and T cells. Although it is important for vaccines to be economical to produce, be stable for storage and administration, and not produce illness in healthy individuals, these actions do not guarantee long-term disease protection.

The emergency department nurse is caring for a patient with a migraine. Which drug would the nurse anticipate administering to abort the patient's migraine attack?

Sumatriptan (Imitrex) Rationale: Triptans such as sumatriptan (Imitrex) are used to abort a migraine attack.

A patient with a history of chronic alcohol use is hospitalized. The nurse should monitor the patient for what withdrawal symptoms?

Tachycardia Hyperreflexia Gross tremors

A parent asks why booster immunization injections are important for children to receive.Which response should the nurse provide? a) "Booster doses are given when immunizations are given outside of the guideline schedule." b) "When inactivated vaccines are used, booster doses are needed to maintain immunity." c) "Boosters are given after expected exposure to certain germs." d) "The first vaccination shot provides only 25% immunity, so booster doses are needed to ensure 100% immunity."

When inactivated vaccines are used, booster doses are needed to maintain immunity. "Booster doses of vaccinations are needed to maintain immunity when inactivated or killed vaccines are used. Each dose of the vaccination will contain 100% of the dose needed, but boosters are required to maintain immunity. Boosters are given before times of expected exposure to the pathogen. The fact that immunizations are given outside of the guideline schedule does not impact the need for boosters; they are given to maintain immunity.

While educating the client about glucocorticoids, the nurse would instruct the client to contact the physician immediately if: (Select all that apply.) a. There is an increase of two pounds in weight in a day. b. There is any swelling in the ankles. c. There is any diarrhea. d. There is any bloody vomit or stools.

a. There is an increase of two pounds in weight in a day., b. There is any swelling in the ankles., d. There is any bloody vomit or stools. Rationale: Side effects that need to be reported immediately include difficulty breathing; heartburn; chest, abdomen, or joint/bone pain; nosebleed; blood in coughing; vomitus, urine, or stools; fever, chills, or signs of infection; increase in thirst or urination; fruity breath odor; any falls; and mood swings.

A nurse is preparing to administer an opioid agonist to a client who has acute pain. Which of the following complications should the nurse monitor?a. urinary retention b. tachypnea c. hypertension d. irritating cough

a. urinary retention ATI

Which describes the mechanism of action for ibuprofen (Advil)? a. Blocks pain impulses sent to the brain b. Directly acts on the hypothalamus c. Inhibition of prostaglandin synthesis d. Decreases stimulation of sensory nerve fibers

c. Inhibition of prostaglandin synthesis

The nurse would question an order for immunostimulant therapy if the patient had which of the following conditions? a. Infection b. Immunodeficiency disease c. Pregnancy d. Cancer

c. Pregnancy Rationale: Pregnancy, and renal or liver disease, are contraindications to the use of immunostimulant drugs. Infection, immunodeficiency disease, and cancer are indications for use of these drugs.

The nurse is admitting a client with rheumatoid arthritis. The client has been taking glucocorticoids for an extended period of time. During the assessment, the nurse observes that the client has a very round, moon-shaped face; bruising; and an abnormal contour of the shoulders. The nurse concludes that: a. These are normal reactions with the illness. b. These probably are birth defects .c. These are symptoms of myasthenia gravis. d. These are symptoms of Cushing's disease.

d. These are symptoms of Cushing's disease. Rationale: Monitor for development of Cushing's disease (adrenocortical excess) with signs and symptoms of bruising, characteristic pattern of fat deposits in the cheeks (moon face) or shoulders (buffalo hump), and pendulous abdomen.