Respiratory and Anticoag Pharm Exam 1

17 The nurse is caring for a client who is experiencing excessive bleeding after receiving unfractionated heparin sodium. Which orders should the nurse anticipate from the health care provider? Select all that apply. Administer vitamin K. Obtain prothrombin time (PT)/international normalized ratio (INR). Administer protamine sulfate. Obtain activated partial thromboplastin time (aPTT). Change prescription to enoxaparin.

Obtain activated partial thromboplastin time (aPTT). Administer protamine sulfate.

990) A client with rheumatoid arthritis has been taking a corticosteroid medication for the past year. Prolonged use of corticosteroids puts this client at increased risk for which complication? Decreased white blood cells Increased C-reactive protein Increased sedimentation rate Decreased serum glucose levels

Decreased white blood cells Rationale: Prolonged use of steroids may cause leukopenia as a result of bone marrow depression. C-reactive protein and sedimentation rate are elevated in acute inflammatory diseases; steroids help decrease them. Serum glucose levels increase with steroid use.

14. The nurse is preparing to administer an albuterol nebulizer treatment to a patient with asthma. Which assessment finding should be brought to the health care provider's attention prior to administering the medication? A Temperature of 101°F (38.3°C) B Heart rate of 116 bpm C Respiratory rate of 28 D Lower extremity edema

B Heart rate of 116 bpm Rationale: One of the more common adverse effects of beta-adrenergic medications, such as albuterol, is an increase in heart rate.

753) A health care provider prescribes metaproterenol for a client. For which therapeutic effect would the nurse monitor the client? Induced sedation Relaxed bronchial spasm Decreased blood pressure Productive cough

Relaxed bronchial spasm this is a breath-terol Rationale: Metaproterenol stimulates beta receptors of the sympathetic nervous system, causing bronchodilation and an increased rate and strength of cardiac contractions. Barbiturates and hypnotics produce sedation. Antihypertensives and diuretics help decrease blood pressure. Expectorants mobilize respiratory secretions, promoting a productive cough.

644) Which complication is an adverse effect of cortisone therapy? Hypoglycemia Severe anorexia Anaphylactic shock Behavioral changes

Behavioral changes

1186) A client with systemic lupus erythematosus is taking prednisone. Which foods would the nurse encourage the client to eat while receiving treatment to prevent hypokalemia? Broccoli Oatmeal Fried rice Cooked carrots

Broccoli Rationale: Potassium is plentiful in green leafy vegetables; broccoli provides 207 mg of potassium per half cup. Oatmeal provides 73 mg of potassium per half cup. Rice provides 29 mg of potassium per half cup. Cooked fresh carrots provide 172 mg of potassium per half cup; canned carrots provide only 93 mg of potassium per half cup.

962) Which information from the client's history would the nurse identify as a risk factor for developing osteoporosis?Takes estrogen therapy Receives long-term steroid therapy Has a history of hypoparathyroidism Engages in strenuous physical activity

Receives long-term steroid therapy Rationale: Increased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization. Weight-bearing that occurs with strenuous activity promotes bone integrity by preventing bone demineralization. Estrogen promotes deposition of calcium into bone which may prevent, not cause, osteoporosis.

1119) A client is admitted to the hospital for an adrenalectomy. When teaching the client about the prescribed medications, which advice will the nurse emphasize? Medication therapy will be given in conjunction with insulin. Once regulated, the dosage will remain the same for life. Medications will need to be held for surgery or other invasive procedures. Salt intake may have to be restricted.

Salt intake may have to be restricted. Rationale: Administration of adrenocortical hormones causes sodium retention; dietary intake of salt should be limited. Because pancreatic function is unimpaired, insulin therapy is not indicated. Dosages will likely need to be adjusted over time. The dosage will need to be increased for surgery and severe infections; not doing this can cause a life-threatening

828) A client who recently started receiving oral corticosteroids for a severe allergic reaction is instructed that the dosage will be reduced gradually until all medication is stopped at the end of 2 weeks. Which reason would the nurse provide for this gradual reduction in dosage? Discontinuing the medication too fast will cause the allergic reaction to reappear. Slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed. The health care provider is attempting to determine the minimal dose that will be effective for the allergy. Sudden cessation of the medication will cause development of serious side effects, such as moon face and fluid retention.

Slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed.

610) A child undergoing prolonged steroid therapy takes on a cushingoid appearance. The nurse would expect to find which of these manifestations during further assessment? Select all that apply. One, some, or all responses may be correct. Truncal obesity Thin extremities Increased linear growth Loss of hair on the body Decreased blood pressure

Truncal obesity Thin extremities

5.The nurse is monitoring an older adult client prescribed diphenhydramine for contact dermatitis related to poison ivy exposure. Which finding should be reported to the provider as a potential drug-related side effect? A Confusion B Hypertension C Incontinence D Bradypnea

A Confusion Rationale: Diphenhydramine and other first-generation H1 receptor antagonists may cause confusion (with impaired thinking, judgment, and memory), dizziness, hypotension, sedation, syncope, unsteady gait, and paradoxical central nervous system stimulation in older adults.

54. A client is receiving methylprednisolone 40 mg IV daily. The nurse should monitor which laboratory value closely? A. Serum glucose. B. Serum calcium. C. Red blood cells. D. Serum potassium.

A. Serum glucose.

724) To prevent excessive bruising when administering subcutaneous heparin, which technique will the nurse employ? Administer the injection via the Z-track technique. Avoid massaging the injection site after the injection. Use 2 mL of sterile normal saline to dilute the heparin. Inject the medication into the vastus lateralis muscle in the thigh.

Avoid massaging the injection site after the injection. Rationale: The site of the injection should not be massaged to avoid dispersion of the heparin around the site and subsequent bleeding into the area. The Z-track technique and the intramuscular route are not used with heparin; subcutaneous injection and intravenous administration are the routes appropriate for heparin administration.

3. The nurse is teaching a client with asthma about albuterol. How should the nurse best describe the action of this medication? A "The medication is given to reduce secretions that block airways." B "The medication will help to relax smooth muscles in the airways." C "The medication will stimulate the respiratory center in the brain." D "The medication will help to prevent pneumonia.

B "The medication will help to relax smooth muscles in the airways." Rationale: Albuterol is a bronchodilator and rescue drug of choice to treat asthma. It is a short-acting beta-adrenergic agonist that is used to prevent and treat wheezing, difficulty breathing, and chest tightness. Albuterol works by relaxing and opening the airways to make breathing easier. The medication comes as a tablet, syrup, inhaler and nebulizer. Albuterol does not reduce secretions, stimulate the respiratory center in the brain or prevent pneumonia.

493) Which drink would a nurse teach a client on warfarin to avoid? Apple juice Grape juice Orange juice Cranberry juice

Cranberry juice Rationale: The antioxidants in cranberry juice may inhibit the mechanism that metabolizes warfarin, causing elevations in the international normalized ratio, resulting in hemorrhage. Apple juice, grape juice, and orange juice are fine to drink.

20. The nurse is caring for a client prescribed warfarin therapy for treatment of persistent atrial fibrillation. Which of the following may potentiate the effect of this medication? ASt. John wort B Estrogen C Vitamin K D Green tea

D Green tea Rationale: Warfarin, an anticoagulant agent used to prevent thrombosis and risk of stroke in clients with atrial fibrillation, is associated with many drug and food interactions. Careful assessment with a pharmacist/formulary is recommended to avoid potential complications. Green tea can potentiate the effect of warfarin and increase bleeding. St. John's wort, estrogen, and vitamin K may inhibit the action requiring higher doses of the anticoagulant.

16. A nurse is assessing a client receiving alteplase for a pulmonary embolism. The client suddenly becomes confused and is unable to follow commands. What action does the nurse take first? A Notify the healthcare provider B Reorient the client C Check the client pupils D Stop the infusion

D Stop the infusion

12. The nurse is preparing to administer prescribed warfarin to a client with a mechanical heart valve. Which finding should the nurse report to the healthcare provider? A The INR is 3.0. B The peripheral IV site has been oozing blood. C The aPTT is 30. D The client has cola-colored urine.

D The client has cola-colored urine.

573) The nurse is teaching the parents of a child prescribed a high dose of oral prednisone for asthma. Which information is critical for the nurse to include when teaching about this medication? It protects against infection. It should be stopped gradually. An early growth spurt may occur. A moon-shaped face will develop.

It should be stopped gradually. Rationale: Gradual weaning from prednisone is necessary to prevent adrenal insufficiency or adrenal crisis. Prednisone depresses the immune system, thereby increasing susceptibility to infection. The medication usually suppresses growth. A moon face may occur, but it is not a critical, life-threatening side effect.

664) A client is prescribed albuterol to relieve severe asthma. Which adverse effects will the nurse instruct the client to anticipate? Select all that apply. One, some, or all responses may be correct. Tremors Lethargy Palpitations Bronchoconstriction Decreased pulse rate

Palpitations Tremors Rationale: Albuterol's sympathomimetic effect causes central nervous system (CNS) stimulation, precipitating tremors, tachycardia, and palpitations. Lethargy is an adverse effect of medications that cause CNS depression, not CNS stimulation. Albuterol causes bronchodilation, not bronchoconstriction. Albuterol will cause tachycardia, not bradycardia

597) The nurse administers albuterol to a child with asthma. Which common side effect would the nurse monitor for in the child? Flushing Dyspnea Tachycardia Hypotension

Tachycardia Rationale: Albuterol produces sympathetic nervous system side effects such as tachycardia and hypertension. Pallor, not flushing, is a common side effect. Dyspnea is not a common side effect; this medication is given to decrease respiratory difficulty. Hypertension, not hypotension, is a common side effect.

980) Enoxaparin 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given for which purpose? To control postoperative fever To provide a constant source of mild analgesia To limit the postsurgical inflammatory response To provide prophylaxis against postoperative thrombus formation

To provide prophylaxis against postoperative thrombus formation Rationale: Enoxaparin, a low-molecular-weight heparin, prevents the conversion of fibrinogen to fibrin and of prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III. Enoxaparin is not an antipyretic. Enoxaparin is not an analgesic. Enoxaparin is not an anti-inflammatory medication.

5 The nurse is providing teaching to the client prescribed albuterol for the management of asthma. The nurse is including reportable side effects in the teaching plan. Which of the following side effects is the priority? A Nervousness B Headache C Palpitations D Muscle aches

Palpitations

7) A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. Which intervention would be a priority for the nurse?Having the child rest as much as possible Checking the child's eosinophil count daily Preventing exposure of the child to infection Offering sips of water when administering the medication

Preventing exposure of the child to infection Rationale: Prednisone reduces the child's resistance to certain infectious processes and, as an anti-inflammatory medication, masks infection. The child will self-limit activity depending on respiratory status. The eosinophil count is often consistently increased in children with asthma. The child will need adequate hydration to help loosen and expel mucus.

912) When a client is receiving dexamethasone for adrenocortical insufficiency, which action would the nurse take to monitor for an adverse effect of the medication?Auscultate for bowel sounds. Assess deep tendon reflexes. Culture respiratory secretions. Measure blood glucose levels.

Measure blood glucose levels. Rationale: Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely. Assessing bowel sounds is unnecessary; corticosteroids are not known to precipitate cessation of gastrointestinal activity. Although corticosteroids may increase the risk of developing an infection, routine culturing of respiratory secretions is unnecessary. Culturing respiratory secretions becomes necessary when the client exhibits adaptations of a respiratory infection. Monitoring deep tendon reflexes is required when administering magnesium sulfate, not dexamethasone.

1180) The nurse teaches the client about appropriate foods to consume when taking warfarin. The nurse evaluates that the client needs further teaching when the client makes which statement? 'Eggs provide a good source of iron, which is needed to prevent anemia.'' Yellow vegetables are high in vitamin A and should be included in the diet.' 'Dark green leafy vegetables are high in vitamin K, so I should eat them more often.' 'Milk and other high-calcium dairy products are necessary to counteract bone density loss.'

'Dark green leafy vegetables are high in vitamin K, so I should eat them more often.' Rationale: Foods high in vitamin K should be limited to the usual amounts eaten by the client when establishing the prothrombin time/international normalized ratio because vitamin K is part of the body's blood-clotting mechanism and will counter the effects of warfarin if eaten in excess. Foods containing protein and iron are permitted because they are unrelated to blood clotting. Foods containing vitamin A are permitted because vitamin A is unrelated to blood clotting. Foods containing calcium are permitted because calcium is unrelated to blood clotting.

524) A child is prescribed fluticasone after an acute asthma attack. Which instruction would the nurse give the family about the administration of this medication? 'Fluticasone needs to be taken with food or milk.'' Fluticasone is primarily used to treat acute asthma attacks.' 'The child should suck on hard candy to help relieve dry mouth.' 'Watch for white patches in the mouth and report to the health care provider.'

'Watch for white patches in the mouth and report to the health care provider.' Rationale: Fluticasone is a steroid commonly administered by way of inhalation for long-term control of asthma symptoms. Oral thrush is a side effect that manifests as white patches. Fluticasone is administered via inhalation so food or milk is not needed before administration. Dry mouth is not a side effect of fluticasone.

19 The nurse is evaluating the plan of care for a client with benign prostatic hyperplasia (BPH). For which prescribed medication should the nurse notify the health care provider (HCP)? A Diphenhydramine B Finasteride C Terazosin D Metoprolol

A Diphenhydramine Rationale: Diphenhydramine is a first generation histamine1 receptor antagonist or antihistamine, commonly used for relief from symptoms of mild to moderate allergic disorders. H1 blockers have anticholinergic effects or atropine-like responses and can cause urinary hesitancy or retention. A client with BPH is already at risk for urinary retention and should not receive an antihistamine such as diphenhydramine without clarification from the HCP first. Metoprolol is a beta blocker, which does not affect the bladder. Finasteride and terazosin are drugs commonly used to treat BPH.

3.The nurse is reviewing the prothrombin time results for a client who is taking warfarin. The nurse notes the value is 20 seconds. What is an appropriate nursing action? A Recognize that this is a therapeutic level. B Assess for bleeding gums or IV sites. C Notify the primary health care provider immediately. D Observe the client for hematoma development.

A Recognize that this is a therapeutic level. Rationale: For the client on warfarin therapy, this prothrombin level is within the therapeutic range. Therapeutic levels for warfarin are usually one and a half to two times the normal level.

25. After abdominal surgery, a client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse the reason for the medication. Which is the best response for the nurse to provide the client? A. This medication is given to prevent blood clot formation. B. This medication enhances antibiotics to prevent infection. C. This medication dissolves clots that develop in the legs. D. This medication enhances the healing of wounds.

A. This medication is given to prevent blood clot formation.

64. A client being discharged is prescribed warfarin for the treatment following a pulmonary embolism. Which diagnostic test should the nurse instruct the client to receive once a month? A. Perfusion scan. B. Prothrombin Time (PT). C. Activated partial thromboplastin (aPTT). D. Serum Coumadin level (SCL).

B. Prothrombin Time (PT). Pt and INR for warfarin. WINR

10. A client is prescribed heparin therapy for a deep vein thrombosis (DVT). Which laboratory value should the nurse monitor closely? A D-dimer B Platelet count C Activated partial thromboplastin time D Bleeding time

C Activated partial thromboplastin time Rationale:Heparin is used to prevent further clots from being formed and to prevent the present clot from enlarging. The activated partial thromboplastin time (APTT) test measures the time it takes blood to clot and is used to monitor the effectiveness of heparin therapy. The therapeutic range is about 1 1/2 to 2 or 2 1/2 times the normal values. D-dimer is used to evaluate blood clot formation. Platelet counts are used to evaluate abnormal bleeding times. Bleeding time refers to the time it takes for a pinprick to stop bleeding (normally, about 2 1/2 minutes).

765) A beclomethasone inhaler would be prescribed for which purpose? Prevents atelectasis Decreases inflammation Relaxes smooth muscle in the airways Reduces bacteria in the respiratory tract

Decreases inflammation Rationale: Beclomethasone reduces the inflammatory response in bronchial walls by suppression of polymorphonuclear leukocytes and fibroblasts and the reversal of capillary permeability. Beclomethasone does not prevent atelectasis. Beclomethasone does not cause smooth muscle relaxation in the airways. Beclomethasone is not an antibiotic.

603) The nurse is administering hydroxyzine to a client. The nurse would monitor the client for which side effect of this medication? Ataxia Drowsiness Vertigo Slurred speech

Drowsiness Rationale: Hydroxyzine suppresses activity in key regions of the subcortical area of the central nervous system; it also has antihistaminic and anticholinergic effects. Ataxia, vertigo and slurred speech are not associated with hydroxyzine.

115) Which response to fludrocortisone will the nurse teach a client with adrenal insufficiency to report? Select all that apply. One, some, or all responses may be correct. Edema Rapid weight gain Fatigue in the afternoon Unpredictable changes in mood Increased frequency of urination

Edema Rapid weight gain Rationale: Fludrocortisone has a strong effect on sodium retention by the kidneys, which leads to fluid retention, causing edema and weight gain. Fatigue may occur with adrenal insufficiency and is not related to cortisone therapy. Unpredictable changes in mood commonly occur but are not as serious a threat as fluid retention. Fluid retention, and thus decreased urination, may occur.

526) Which action would be the most appropriate way for the nurse to evaluate a child's understanding of how to use an inhaler? Asking questions about using the inhaler Having the child demonstrate inhaler use Explaining how the inhaler will be used at home Having the child tell the nurse about the technique that was learned

Having the child demonstrate inhaler use Rationale: The nurse can best evaluate teaching by asking the learner for a return demonstration. Behavior, rather than words, more easily shows what has been learned. A child may be too young to know whether he or she has any questions. A demonstration, rather than an explanation, can be evaluated more readily. Telling the nurse about the technique that was learned is difficult for a younger child; the ability to articulate a concept is not that advanced—nor is the vocabulary.

689) Which information would the nurse include when teaching a client about warfarin? Periodic blood testing is necessary. Increase intake of green leafy vegetables. Limit the amount of daily physical activity. It should be continued for minor surgical procedures.

Periodic blood testing is necessary. Rationale: Testing is essential to determine dosing; a therapeutic prothrombin time (PT) ranges from 1.3 to 1.5 times greater than the control and is equal to an international normalized ratio (INR) of 2 to 3 times control. Green leafy vegetables are high in vitamin K, which may decrease medication effectiveness if eaten in large amounts. Physical activities do not need to be limited; however, the type (e.g., contact sports such as football) may need to be restricted. Warfarin will need to be stopped for most dental, medical, and surgical procedures; the provider should be contacted regarding the need to hold the medication.

446) Which substance does vitamin K contributes to the formation of? Bilirubin Prothrombin Thromboplastin Cholecystokinin

Prothrombin Rationale: Vitamin K is necessary in the formation of prothrombin to prevent bleeding. It is a fat-soluble vitamin and is not absorbed from the gastrointestinal (GI) tract in the absence of bile. Bilirubin is the bile pigment formed by the breakdown of erythrocytes. Thromboplastin converts prothrombin into thrombin during the process of coagulation. Cholecystokinin is the hormone that stimulates contraction of the gallbladder.

704) A health care provider prescribes dexamethasone for a client with head trauma. The nurse recognizes that it reduces swelling in the brain by which process? Acts as a hyperosmotic diuretic Increases resistance to infection Reduces the inflammatory response of tissues Decreases the formation of cerebrospinal fluid

Reduces the inflammatory response of tissues Rationale: Corticosteroids act to decrease inflammation, which decreases edema. Dexamethasone is an anti-inflammatory agent, not a diuretic. Resistance to infection is decreased, not increased, with a corticosteroid. The client's problem is not with increased cerebrospinal fluid.

719) Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Before beginning the infusion, which assessment is the nurse's priority? Vital signs Electrocardiogram (ECG) monitoring Signs of bleeding Level of chest pain

Signs of bleeding Rationale: Assessment for bleeding is a priority because it is a contraindication for administration of thrombolytic agents; administration in the presence of bleeding can cause life-threatening hemorrhage. All the other options are important, but none pose a life-threatening contraindication to tissue plasminogen activator (t-PA) administration.

1499) Which nursing assessment is important for a school-age child undergoing long-term steroid therapy? Monitoring pulse for irregularities Testing of stools for occult blood Inspection of urine for mucous threads Check of oral mucous membranes for ulcers

Testing of stools for occult blood Rationale: Because steroids decrease production of prostaglandins that have a role in protecting the stomach, gastrointestinal bleeding may occur; stools should be checked for frank and occult blood. Steroids do not cause pulse irregularities, mucus in the urine, or ulceration of mucous membranes.

97) Which antidote would the nurse anticipate administering to a client whose laboratory report establishes a warfarin overdose? Physostigmine Vitamin K Iron dextran Protamine sulfate

Vitamin K Rationale: Warfarin inhibits formation of vitamin K-dependent clotting factors. Its effect is overcome by increasing vitamin K. Physostigmine is an antidote for anticholinergic overdose. Iron dextran is an iron supplement, not an antidote for warfarin. Protamine sulfate is the antidote for heparin overdose.

217) Which statement regarding mealtime administration by a client who has arthritis and is prescribed corticosteroid medication indicates that the teaching was effective? "This will decrease gastric irritation." "This will serve as a reminder to take the medication." "The presence of food will enhance absorption." "The medication is ineffective in an acid medium."

"This will decrease gastric irritation."

1520) An adolescent with hay fever has been taking a prescribed first-generation antihistamine every 8 hours for the past 2 days. The adolescent tells the nurse, 'This medicine is making me sleepy.' Which response by the nurse would be most appropriate? 'Take half a tablet before school.' 'Try omitting the early morning dose.' 'The drowsiness usually decreases after several days.' 'I'll write your teacher a note to explain your inability to concentrate in class while taking this medicine.'

'The drowsiness usually decreases after several days.' Rationale: Telling the adolescent that the drowsiness will likely disappear after a few days addresses the adolescent's concern; central nervous system depressant effects may diminish or spontaneously disappear after several days of therapy; however, if this does not occur, a second-generation antihistamine may be warranted. Nurses do not have the legal authority to instruct a client to alter the dosage of a prescribed medication. The side effect of drowsiness often diminishes within several days, so it would be inappropriate to write a note that addresses the duration of treatment until it is determined that this will be a problem.

10. The nurse is discharging a client who is at risk for venous thromboembolism (VTE). The client is prescribed enoxaparin. Which instruction should the nurse provide to this client? A "Notify your health care provider if your stools appear tarry or black." B "You must have your partial thromboplastin time (PTT) checked weekly." C "You should massage the injection site for better absorption." D "An intravenous (IV) catheter will be placed to administer the medication."

A "Notify your health care provider if your stools appear tarry or black." Rationale: As with any anticoagulant, enoxaparin carries the risk of bleeding. Clients should be instructed to report the presence of tarry stools, bleeding gums, hematuria, ecchymosis or petechiae to their HCP. PTT monitoring is not required for this medication. This type of heparin is administered subcutaneously, not intravenously. Massaging the site will cause bruising and decrease effectiveness of the drug.

779) The health care provider prescribes enoxaparin to be administered subcutaneously. To ensure client safety, which measure would the nurse take when administering this medication? Remove air pocket from the prepackaged syringe before administration. Rub the injection site for 30 seconds after administration. Administer the medication over 2 minutes. Administer in the abdomen area only.

Administer in the abdomen area only.

774) A client with myasthenia gravis is to receive immunosuppressive therapy with corticosteroids. Which mechanism of action assures the nurse that this therapy will be effective? Inhibits the breakdown of acetylcholine at the neuromuscular junction Stimulates the production of acetylcholine at the neuromuscular junction Decreases the production of autoantibodies that attack acetylcholine receptors Promotes the removal of autoantibodies that impair the transmission of impulses

Decreases the production of autoantibodies that attack acetylcholine receptors Rationale: Steroids decrease the body's immune response, limiting the production of antibodies that attack acetylcholine receptors at the neuromuscular junction. Inhibiting the breakdown of acetylcholine at the neuromuscular junction is the action of anticholinergic medications. Stimulating the production of acetylcholine at the neuromuscular junction is not the action of immunosuppressives. Promoting the removal of autoantibodies that impair the transmission of impulses is the rationale for plasmapheresis.

345) Which intervention would the nurse implement for a client admitted for an exacerbation of asthma? Determine the client's emotional state. Give prescribed medications to promote bronchiolar dilation. Provide education about the effect of a family history. Encourage the client to use an incentive spirometer routinely.

Give prescribed medications to promote bronchiolar dilation. Rationale: Asthma involves spasms of the bronchi and bronchioles as well as increased production of mucus; this decreases the size of the lumina, interfering with inhalation and exhalation. Bronchiolar dilation will reduce airway resistance and improve the client's breathing. Although identifying and addressing a client's emotional state is important, maintaining airway and breathing are the priority. In addition, emotional stress is only one of many precipitating factors, such as allergens, temperature changes, odors, and chemicals. Although recent studies indicate a genetic correlation along with other factors that may predispose a person to the development of asthma, exploring this issue is not the priority. The use of an incentive spirometer is not helpful because of mucosal edema, bronchoconstriction, and secretions, all of which cause airway obstruction.

77) A client is scheduled for a craniotomy to remove a brain tumor. To prevent the development of cerebral edema after surgery, the nurse anticipates the use of medications from which class?Glucocorticoids Anticholinergics Anticonvulsants Antihypertensives

Glucocorticoids

1221) A client develops a deep vein thrombophlebitis in her leg 3 weeks after giving birth and is admitted for anticoagulant therapy. The nurse would anticipate developing a teaching plan for which anticoagulant? Heparin Warfarin Clopidogrel Enoxaparin

Heparin Rationale: Heparin is the medication of choice during the acute phase of a deep vein thrombosis; it prevents conversion of fibrinogen to fibrin and of prothrombin to thrombin. Warfarin, a long-acting oral anticoagulant, is started after the acute stage has subsided; it is continued for 2 to 3 months. Clopidogrel is a platelet aggregate inhibitor andis used to reduce the risk of a brain attack. A low-molecular-weight heparin (e.g., enoxaparin) is not administered during the acute stage; it may be administered later to prevent future deep vein thromboses.

717) The nurse provides discharge medication education to a client who has a prescription for warfarin. Which client statement indicates to the nurse that teaching was effective?' I will avoid taking aspirin and nonsteroidal anti-inflammatory drugs [NSAIDs].' 'I will need to develop a more sedentary routine.' 'I will need to have regular complete blood counts to guide warfarin dosage.' 'Before going to the dentist, I will ask my health care provider for antibiotics.'

I will avoid taking aspirin and nonsteroidal anti-inflammatory drugs [NSAIDs].' Rationale: Acetaminophen should be used when an analgesic is required because it does not interfere with platelet aggregation. Acetylsalicylic acid (aspirin) should be avoided because it interferes with platelet aggregation. Immobility causes venous pooling and can predispose the client to deep vein thrombosis. Antibiotics are not necessary when going to the dentist; this is done when clients have cardiac problems, such as rheumatic fever or cardiac surgery. A prothrombin time (PT) or international normalized ratio (INR), not a complete blood count, needs to be done periodically.

576) A child with nephrotic syndrome has been receiving prednisone for 1 week. Which information in the child's record indicates to the nurse that the medication has been effective? Select all that apply. One, some, or all responses may be correct. Weight loss Lower blood pH Decreased lethargy Increased urine output Decreased blood pressure

Weight loss Decreased lethargy Increased urine output Rationale: Children with nephrotic syndrome are grossly edematous. Those who have the steroid-sensitive form of nephrotic syndrome respond to corticosteroids with diuresis within 7 to 21 days after therapy is started, and the edematous weight is lost. Once the child feels better, lethargy decreases, and the activity level increases. Steroid therapy does not affect the blood pH. There is no increase in the blood pressure of a child with nephrotic syndrome and no change in blood pressure when the child improves.

10. A nurse notes an abrupt onset of confusion in an 85-year-old client. Which newly prescribed medication most likely caused this change in the client's mental status? A Warfarin B Metoprolol C Pantoprazole D Diphenhydramine

Diphenhydramine Rationale: Older adults are susceptible to the side effect of anticholinergic medications, such as antihistamines. Diphenhydramine is a first-generation histamine blocker. Older antihistamines often cause confusion, especially at higher doses. In fact, first-generation antihistamines are included in the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Metoprolol (a beta blocker), pantoprazole (a proton pump inhibitor) and warfarin (an anticoagulant) are not known to cause mental status changes.

359) Which action will a nurse take when a male client receiving prolonged steroid therapy complains of always being thirsty and urinating frequently? Have the client assessed for an enlarged prostate. Obtain a urine specimen from the client to test for ketonuria. Perform a finger stick to test the client's blood glucose level. Assess the client's lower extremities for the presence of pitting edema.

Perform a finger stick to test the client's blood glucose level. Rationale: The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention but of hyperglycemia.

Which information would the nurse provide when administering the first dose of prednisone prescribed to a client with an exacerbation of colitis? "Prednisone protects you from getting an infection." "The medication may cause weight loss by decreasing your appetite." "Prednisone is not curative but does cause a suppression of the inflammatory process." "The medication is relatively slow in precipitating a response but is effective in reducing symptoms."

"Prednisone is not curative but does cause a suppression of the inflammatory process." Rationale: Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. Prednisone suppresses the immune response, which increases the potential for infection. The appetite is increased with prednisone; weight gain may result from the increased appetite or from fluid retention. Generally, the response to prednisone is rapid.

178) Which instruction will the nurse include when performing discharge teaching to a client now receiving hydrocortisone by mouth after stabilization of an acute adrenal insufficiency? "Eat a diet high in sodium." "Take the medication with food." "Maintain the same dose indefinitely." "Eliminate a dose if side effects occur."

"Take the medication with food." Rationale: Taking the medication with food minimizes the side effect of gastrointestinal irritation; the health care provider should be notified immediately if abdominal pain or tarry stools occur. The diet should be low in sodium because cortisone can cause fluid retention. The dose may have to be adjusted with health care provider supervision when the client is under physical or emotional stress. Cortisone levels must be maintained; changes in dosage must be supervised by the health care provider.

511) The nurse teaches a client about cortisone therapy. Which statements made by the client indicate the need for further teaching? Select all that apply. One, some, or all responses may be correct. 'I should take 3 tablets at a time.' 'I should take the tablet with water.' 'I should take the tablet twice a week.' 'I should take the tablet on an empty stomach.' 'I should take the tablet with a meal.'

'I should take 3 tablets at a time.' 'I should take the tablet twice a week.' 'I should take the tablet on an empty stomach.' Rationale: The client should take the medication as prescribed. The client should not take 3 tablets at a time because this action may lead to drug toxicity. Cortisone therapy involves the administration of 25 to 50 mg of cortisone on a daily basis. Cortisone should be taken with a meal or a snack; taking the medication on an empty stomach would cause gastric irritation. Tablets can be taken with any fluid such as water or fruit juice.

527) A 6-year-old child with asthma is prescribed an inhaled corticosteroid. The nurse would conclude the mother understands teaching about the medication side effects when the mother makes which statement? 'I'll watch for frequent urination.' 'I'll check for white patches in the mouth.' 'I'll be alert for short episodes of not breathing.' 'I'll monitor for an increased blood glucose level.'

'I'll check for white patches in the mouth.' Rationale: Oral candidiasis is a potential side effect of inhaled steroids because of steroids' anti-inflammatory effect; the child should be taught to rinse the mouth after each inhalation. Frequent urination is not a side effect of steroid therapy. Apneic episodes are not a side effect of steroid therapy. Hyperglycemia is not a side effect of inhaled steroid therapy; it may occur when steroids are administered for a systemic effect.

12. The nurse is educating a client on self-administration of a fluticasone inhaler. What statement indicates an understanding of the teaching? A I will rinse my mouth with water after using the inhaler B Disinfectant wipes can be used to clean the spacer C I need to wait 15 minutes between puffs D This inhaler should be used before the others

A I will rinse my mouth with water after using the inhaler Rationale: To prevent thrush, the client should rinse his or her mouth with water and spit it out. The spacer should be washed with warm water and dish detergent. The client may need two puffs but does not have to wait 15 minutes between. Bronchodilators should be used before corticosteroids.

536) The nurse administers albuterol to a 4-year-old child. Which intervention would assist the nurse in evaluating the effectiveness of this medication? Auscultate breath sounds Collect a sputum sample. Conduct a neurological examination. Palpate chest excursion.

Auscultate breath sounds Rationale: Albuterol is an adrenergic medication that stimulates beta-receptors, leading to relaxation of the smooth muscles of the airway. The lungs should be auscultated to evaluate the effectiveness of this medication. Albuterol does not affect the consistency of pulmonary secretions. Albuterol will not cause central nervous system stimulation. Albuterol does not affect intercostal contractility; chest excursion is not the appropriate assessment.

12. The nurse is teaching a pediatric client and family about prescribed albuterol sulfate extended-release tablets. Which statement should be included? A If you cannot swallow the tablet, it is ok to chew it B This medication can cause restlessness C Rinse your mouth after taking this medication D Oral albuterol can cause an increase in urination

B This medication can cause restlessness

7 A client who is 34 weeks gestation is diagnosed with a pulmonary embolism. Which of these medications should the nurse plan to administer? A Oral low-dose aspirin B Oral warfarin C Intravenous Heparin D Subcutaneous enoxaparin

C Intravenous Heparin Rationale: Clients diagnosed with pulmonary embolism (PE), whether pregnant or not, are initially treated with intravenous unfractionated heparin. Alternatively, low molecular weight heparin such as enoxaparin can be used to treat women who are pregnant. Warfarin should never be given during pregnancy due to its teratogenic effects. Although aspirin has anticoagulant properties, low-dose aspirin therapy (81 mg) is more often used prophylactically, not for the treatment of a PE.

41. A client prescribed albuterol tablets reports nausea every evening with the 9:00 p.m. dose. Which action should the nurse perform to alleviate this side effect? A. Change the time of the dose. B. Hold the 9 p.m. dose. C. Administer the dose with a snack. D. Offer an antiemetic with the dose.

C. Administer the dose with a snack.

8. The nurse is caring for a client who is receiving a continuous intravenous heparin infusion. The client's most recent activated partial thromboplastin time (aPTT) is 120 seconds. Which medication should the nurse plan to administer? A Protamine B Naloxone C Vitamin K D Enoxaparin

A Protamine Rationale: The client's aPTT is much higher than the typical desired therapeutic range of 1.5-2.5 the control value and places the client at great risk for uncontrolled bleeding. Protamine sulfate is the medication used to reverse the effects of heparin; it is a heparin antagonist. Neutralization of heparin occurs immediately and lasts for 2 hours, after which additional protamine may be needed. Protamine is administered by slow IV injection (no faster than 20 mg/ min or 50 mg in 10 minutes). Dosage is based on the fact that 1 mg of protamine will inactivate approx. 100 units of heparin. Vitamin K is used to reverse the effects of warfarin. Naloxone is used to reverse the effects of opioids. Enoxaparin is another anticoagulant (low molecular weight heparin).

146) Which explanation would the nurse provide for administering prednisone to a client with an exacerbation of colitis? The client will be protected from getting an infection. Symptoms associated with the colitis will decrease slowly over time. Although the medication causes anorexia, weight loss may not occur. Although the medication decreases intestinal inflammation, it will not cure the colitis.

Although the medication decreases intestinal inflammation, it will not cure the colitis. Rationale: Prednisone inhibits phagocytosis and suppresses other clinical phenomena of inflammation; this is a symptomatic treatment that is not curative. The medication suppresses the immune response and increases the potential for infection. The response usually is rapid. Appetite is increased; weight gain may result from this or from fluid retention.

1542) Which action would the nurse perform when administering fluticasone propionate to a client with asthma? Select all that apply. One, some, or all responses may be correct. Assessing heart rate and rhythm Monitoring liver function blood tests Rinsing the oral cavity with water after use Obtaining blood glucose levels before meals Giving stool softeners to prevent constipation

Assessing heart rate and rhythm Rinsing the oral cavity with water after use Rationale: Clients using inhaled glucocorticoids are at an increased risk for oral candidiasis. The nurse would instruct the client to rinse the mouth with water after using the inhaler. The nurse would monitor heart rate and pattern in clients taking beta 2 agonists such as albuterol, which can lead to tachydysrhythmias. Liver function is monitored in clients taking leukotrienes such as zileuton. Blood glucose monitoring is necessary for clients taking oral and intravenous glucocorticoids. Stool softeners are given to clients taking tiotropium because of the medication's anticholinergic side effect of constipation.

13. The nurse admits a client with tumor-induced spinal cord compression. Which medication should the nurse anticipate to be prescribed to offer the best palliative treatment for this client? A. Morphine sulfate. B. Ibuprofen. C. Amitriptyline. D. Dexamethasone.

D. Dexamethasone. Rationale: Dexamethasone is a palliative treatment modality to manage symptoms related to compression due to tumor growth. Morphine sulphate is an opioid analgesic used in oncology to manage severe or intractable pain. Ibuprofen, a nonsteroidal antiinflammatory drug (NSAID), provides relief for mild to moderate pain, suppression of inflammation, and reduction of fever. Amitriptyline, a tricyclic antidepressant, is often prescribed for pain related to neuropathic origin and provides a reduction in opioid dosage.

209) Which symptom would the nurse expect to decrease in response to corticosteroid therapy prescribed for a client with multiple sclerosis?Emotional lability Muscular contractions Pain in the extremities Visual impairment

Visual impairment Rationale: Corticosteroids decrease the inflammatory process around the optic nerve, thus improving vision; visual impairment is the most common physiological manifestation of multiple sclerosis. Steroids are associated with increased emotional lability. Steroids are not effective in easing muscle contractions. Pain in the extremities is not common unless spasms are present; steroids do not relieve spasms.