x
nonpharmacological therapies to cope with anxiety
-cognitive behavioral therapy -counseling -biofeedback techniques -meditation
ipratropium (Atrovent) AE
-cough -drying of nasal mucosa -hoarseness -bitter taste
phenobarbital (Luminal) AE
-dependence -drowsiness -vitamin deficiencies -laryngospasm
dextromethorphan (Delsym) AE
-dizziness -drowsiness -GI upset
escitalopram (Lexapro) AE
-dizziness -nausea -insomnia -somnolence -confusion -seizures
lorazepam (Ativan) AE
-drowsiness -dizziness -respiratory depression
aldosterone
hormone that controls renal reabsorption of Na and K
spironolactone (Aldactone) AE
hyperkalemia is increased if patient takes K supplements or ACE inhibitors
diuretics
increase rate of urine flow
escitalopram (Lexapro) MOA
increases availability of serotonin at specific postsynaptic receptor sites located within the CNS
more then 8% burn
need fluid replacement
beclomethasone (QVAR) AE
oropharyngeal candidiasis
furosemide (Lasix) contraindications
severe fluid or electrolyte depletion
EPS treatment
short term therapy with IV diphenhydramine (Benadryl)
Causes of pressure ulcers
-Immobility -Inadequate nutrition -Fecal and Urinary Incontinence -Decreased mental status -Diminished sensation -Excessive body heat -Advanced age -Chronic Medical condition
The infants epidermis is
-Thinner than the adults
Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin) AE
-insomnia -nervousness -anorexia -weight loss
valproic acid (Depakote) AE
-limited CNS depression -visual disturbances -pancreatitis
valproic acid (Depakote) contraindications
-liver disease -bleeding dysfunction -pancreatitis -congenital metabolic disorders
zolpidem (Ambien) AE
-mild nausea -dizziness -diarrhea -daytime drowsiness -amnesia -sleepwalking -eating while sleeping
theophylline (Theolair, Theo-24) AE
-nausea -vomiting -CNS stimulation
The physician orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse would be most appropriate?
"Do you have any concerns about taking the medication?"
During the client-teaching session, which instruction should the nurse give to a client receiving alprazolam (Xanax)?
"Inform the physician if you become pregnant or intend to do so."
What is Contact Dermatitis?
-Antigentic substance exposure -Allergy to nickel, cobalt, or plants
Ineffective tissue perfusion
-Assess pulses -Elevate extremities -Assist with escharotomy and fasciotomy
Tinea Pedis
-Athletes foot
Second-generation antipsychotic
"atypical"/risperidone, ziprasidone, aripiprazole, clozapine
First-generation antipsychotic/ phenothiazines
"typical or conventional"/chlorpromazine, prochlorperazine, thioridazine.
The nurse is caring for a Vietnam War veteran with a history of explosive anger, unemployment, and depression since being discharged from the service. The client reports feeling ashamed of being "weak" and of letting past experiences control thoughts and actions in the present. What is the nurse's best response?
1. "Many people who have been in your situation experience similar emotions and behaviors."
During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction?
1. Ataxia
A client is receiving 5% dextrose in water (D5W) Which of the following statements is correct? 1. The solution may cause hypoglycemia in the client who has diabetes. 2. The solution may be used to dilute mixed intravenous drugs. 3. The solution is considered a colloid solution. 4. The solution is used to provide adequate calories for metabolic needs.
2 Rationale: 5% Dextrose in water (D5W) is often used to reconstitute (dilute) powdered forms of drugs that are intended to be given parenterally.
A client tells the nurse that she has an overwhelming fear of having a heart attack. This client is most likely suffering from which disorder?
2. Panic disorder
A patient is to receive the initial infused dose of infliximab (Remicade), 5 mg/kg. The patient weighs 198 pounds. How many milligrams will the patient receive? 1. 40 mg 2. 90 mg 3. 450 mg 4. 990 mg
3. 450 mg
A client admitted to the unit is visibly anxious. When collecting data on the client, the nurse would expect to see which cardiovascular effect produced by the sympathetic nervous system?
3. Increased heart rate
The nurse teaching an older adult taking chlorothiazide (Diuril) should include which instruction? 1. "It is all right to have a glass of wine with this medication." 2. "Avoid foods high in potassium while you are taking this medication." 3. "Be sure to include lots of salt in your diet." 4. "Take the medication early in the morning."
4. Older adults are at risk for falls that might be associated with nocturia (excessive urination at night) caused by taking diuretics in the evening.
b. Rinse his mouth with water after each use.
A client demonstrates understanding of flunisolide (AeroBid) by saying that he will do what? a. Take two puffs to treat an acute asthma attack. b. Rinse his mouth with water after each use. c. Immediately stop taking his oral prednisone when he starts using AeroBid. d. Not use his albuterol inhaler while he is taking AeroBid.
a. Monitor for heart rate >100 beats/min.
A client has taken metaproterenol. What is the nurse's priority action? a. Monitor for heart rate >100 beats/min. b. Tell the client not to drive for 2 hours. c. Monitor for sedation. d. Assess for elevated blood pressure.
a. Asthma
A client is diagnosed with a pulmonary disorder that causes COPD. Lungs tissue changes are normally reversible with this condition. The nurse understands that which is the client's most likely diagnosis? a. Asthma b. Emphysema c. Bronchiectasis d. Chronic bronchitis
b. "Take the ipratropium at least 5 minutes before the cromolyn."
A client is prescribed ipratropium and cromolyn sodium. What will the nurse teach the client? a. "Do not take these medications within 4 hours of each other." b. "Take the ipratropium at least 5 minutes before the cromolyn." c. "Administer both medications together in a metered-dose inhaler." d. "Take the ipratropium only in the mornings."
b. 10 to 20 mcg/mL
A client is prescribed theophylline to relax the smooth muscles of the bronchi. The nurse monitors the client's theophylline serum levels to maintain which therapeutic range? a. 1 to 10 mcg/mL b. 10 to 20 mcg/mL c. 20 to 30 mcg/mL d. 30 to 40 mcg/mL
a. Monitor client for potential chest pain.
A nurse reviews a client's medication history and notes that the client is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention? a. Monitor client for potential chest pain. b. Monitor blood pressure continuously. c. Assess daily for hyperkalemia. d. Assess 12-lead ECG each shift.
The nurse is caring for a 46-year-old female patient during the first 12 hours after a thermal burn injury. She weighed 71 kg on admission to the burn unit. Which outcomes if observed by the nurse would indicate adequate fluid resuscitation? (select all that apply) A. Urine output is 80 mL/hour. B. Heart rate is 86 beats/minute. C. Urine specific gravity is 1.025. D. Mean arterial pressure is 54 mm Hg. E. Systolic blood pressure is 88 mm Hg.
A, B, C A. Urine output is 80 mL/hour. B. Heart rate is 86 beats/minute. C. Urine specific gravity is 1.025. Assessment of the adequacy of fluid resuscitation is best made using either urine output or cardiac factors. Urine output should be at least 0.5 to 1 mL/kg/hr. Cardiac factors include a mean arterial pressure (MAP) > 65 mm Hg, systolic blood pressure (BP) > 90 mm Hg, heart rate < 120 beats/minute. Normal range for urine specific gravity is 1.003 to 1.030.
A child is ordered to receive naloxone intravenously STAT. The child's weight is 20 kg, and the recommended child's dosage is 0.01 mg/kg. Naloxone is available in a 400 mcg/mL solution. How much drug will the nurse plan to administer?
Answer: 0.5 mL.
Fill in the blank: Mites cause a skin disorder called __________.
Scabies
Fill in the blank: Other than keratolytic agents, two classes of drugs, and _____________ offer some protection against acne.
Antibiotics, oral contraceptives
permethrin (Acticin, Elimite, Nix) classes
T: anti parasitic P: scabicide/pediculicide
Depression Cause
Associated with imbalance of neurotransmitters that focus on cognition and emotion (norepinephrine, serotonin, and dopamine)
ADHD Drugs (CNS Stimulants)
Atomoxetine (Stratteral) Clonidine (Kapvay) Methylphenidate (Ritalin) Racemic Mixture (Adderall) Dexmethylphenidate (Focalin)
imipramine (Tofranil) MOA
Blocks reuptake of serotonin and norepinephrine
The client receives albuterol (Proventil) via inhaler. He asks the nurse why he can't just take a pill. What is the best response by the nurse? Select one: A. "Because pills would produce too many side effects; you will have very few side effects with inhaled medications." B. "When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects." C. "Because this medication cannot be absorbed from your GI tract; the acid in your stomach would destroy it." D. "Because pills cannot help your illness; you must have inhaled medications for relief of symptoms."
B. "When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects."
Which vitamin is synthesized by the skin? A. A B. D C. E D. K
B. D
Phenothizines MOA
Blocks the excitement associated with positive symptoms of schizophrenia Prevents dopamine and serotonin from occupying critical neurologic receptor sites Hallucinations and delusions diminish within days Do not cause physical or psychological dependence Wide safety margin Overdose uncommon
valsava manuever
Breath-holding upon exertion. Assists in stabilizing the torso muscles for heavy lifting, but may spike blood pressure to dangerous levels. Especially risky for persons with hypertension, pregnancy, or other medical conditions
Which finding in a patient taking oxymetazoline (Afrin) nasal spray every 2 hours would indicate that the patient has developed an adverse effect? A. Dry mouth and constipation B. Drowsiness and sedation C. Congestion and stuffiness D. Itching and skin rash
C. Oxymetazoline is an effective nasal decongestant, but overuse results in worsening, or rebound, congestion. It should not be used more often than every 4 hours for several days. Dry mouth and constipation, drowsiness and sedation, and itching and skin rash are not adverse effects of oxymetazoline.
heparin classes
T: anticoagulant (parenteral) P: indirect thrombin inhibitor
phenelzine (Nardil) classes
T: antidepressant P: monoamine oxidase inhibitor (MAOI)
Drugs to treat oily skin would most likely be used for which of the following disorders? A. Atopic dermatitis B. Contact dermatitis C. Seborrheic dermatitis D. Stasis dermatitis
C. Seborrheic dermatitis
The patient receives imipramine (Tofranil) as treatment for depression. He is admitted to the emergency department following an intentional overdose of this medication. What will the priority assessment by the nurse include? Select one: A. The patient's liver function B. The patient's renal status C. The patient's cardiac status D. The patient's neurological function
C. The patient's cardiac status
Common Phenothiazines
Chlorpromazine (Thorazine)
c. "This medication will prevent the inflammation that causes your asthma attack."
Client teaching regarding the use of antileukotriene agents such as zafirlukast (Accolate) should include which statement? a. "Take the medication as soon as you begin wheezing." b. "It will take about 3 weeks before you notice a therapeutic effect." c. "This medication will prevent the inflammation that causes your asthma attack." d. "Increase fiber and fluid in your diet to prevent the side effect of constipation."
Types of antispychotics (neuroleptics)
Conventional Atypical
Your patient has been diagnosed with heart failure. What breath sound should be assessed by the nurse?
Crackles
ipratropium (Atrovent) classes
T: bronchodilator P: anticholinergic
Fluoxetine (Prozac) is prescribed for a client with depression. The nurse recognizes that the advantage to using this drug rather than tricyclic antidepressants is that fluoxetine: Does not have cardiotoxicity as a side effect. Does not cause GI distress. Can be used for a shorter time. Does not cause sexual dysfunction.
Does not have cardiotoxicity as a side effect. Objective: Categorize drugs used for mood and emotional disorders based on their classification and drug action. Rationale: Fluoxetine (Prozac) is an SSRI. These drugs are safer than MAOI and TCAs, and they have fewer side effects. Cognitive Level: Comprehension Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Assessment
Matching: Sunburn A. Black head B. Whiteheads C. Intense itching D. Redness E. "First-degree" injury
E. "First-degree" injury
Matching: Etretinate (Tegison) A. Scabicide/pediculicide B. Sunburn/minor irritation drug C. Acne and acne-related drug D. Topical corticosteroid E. Psoriatic drug
E. Psoriatic drug
Fill in the blank: A skin disorder with symptoms resembling an allergic reation is called atopic dermatitis or __________.
Eczema
Nonphenothiazines
Efficacy is equal to Phenothiazines Created to produce fewer side effects, but they are identical Cause less sedation Fewer anticholinergic side effects Equal or greater extrapyramidal signs, specially in older adults No significant advantage
Treatment
Emergency Treatment Stop the burning ABCs *consider C-spine and internal injuries Conserve body heat- lose own body heat from fluid loss Minimize wound contamination- sterile sheets, bedding Remove jewelry/constricting garments Transport quickly Keep NPO - secondary may need surgery History of accident and medical history
Phases of burn management
Emergent (Resuscitative) Phase Acute Phase Rehabilitation Phase
Depression
Emotional Disorder characterized by a sad or despondent mood
Autograft - permanent coverage
From patient- Cultured
A 49-year-old painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician prescribes buspirone (BuSpar), 5 mg by mouth three times per day. During buspirone therapy, the client should avoid which of the following drugs?
Monoamine oxidase (MAO) inhibitors
Lithium Toxicity Symptoms
Muscle weakness Lethargy Tremors Nausea and vomiting Treatment: Dialysis
Lithium MOA
NOT clear, thought to alter dopamine, norepinephrine, and serotonin Decrease euphoria, hyperactivity without causing sedation Narrow therapeutic range (0.6 to 1.5 mEq/L) Acts like a salt in the body. Dehydration causes toxicity Too much salty food= decreases lithium levels
Atypical Antypsychotics
Not to be used for patients with dementia related pshychosis due to increased risk of death Abilify Zyprexa Seroquel Risperidal Geodon
Dextromethorphan (Delsym) classes
T: cough suppressant P: drug to increase cough threshold
Fill in the blank: The disorder usually begins one or two years before puberty and is caused by overproductive oil glands, or __________.
Seborrhea
phenobarbital (Luminal) classes
T: anitseizure drug; sedative P: barbiturate; GABAa receptor agonist
d. St. John's wort
The nurse instructs the client to avoid which over-the-counter products when taking theophylline (Theo-Dur)? a. acetaminophen (Tylenol) b. echinacea c. diphenhydramine (Benadryl) d. St. John's wort
c. Continue to assess the client's oxygenation.
The nurse is caring for a client with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? a. Increase the IV drip rate. b. Monitor the client for toxicity. c. Continue to assess the client's oxygenation. d. Stop the IV for an hour then restart at lower rate.
d. Teach the child to use a spacer.
The nurse is caring for a young child who has been prescribed an inhaler for control of her asthma. The child is having difficulty using the inhaler. What is the nurse's best action? a. Tell the parent to hold the inhaler for the child. b. Ask the health care provider to switch to oral medications. c. Tell the parent that young children should not use inhalers. d. Teach the child to use a spacer.
d. The client with atrial fibrillation with a rate of 100
The nurse is caring for clients on the pulmonary unit. Which client should not receive epinephrine if ordered? a. The client with a history of emphysema b. The client with a history of type 2 diabetes c. The client who is 16 years old d. The client with atrial fibrillation with a rate of 100
d. Salmeterol has a longer duration of action.
The nurse is instructing a client about the advantages of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil). How will the nurse explain to the client the difference in these two medications? a. Salmeterol has a shorter onset of action. b. Salmeterol does not have any side effects. c. Albuterol has a longer onset of action. d. Salmeterol has a longer duration of action.
You are the emergency department nurse caring for a patient complaining of dyspnea. You assess the patient's chest and hear wheezing throughout the lung fields. What might this indicate?
The patient is in bronchospasm. dyspnea SOB and wheezing are generally associated
Tidal volume
The volume of air inhaled and exhaled in a normal, resting breath, typically about 500 mL.
Which of the following solutions would be administered intravenously to manage a client with a serum sodium level of 130 mEq/L? a) 5% D5W b) Lactated Ringer's c) D5W with KCl d) 0.9% NaCl
d Rationale: Hyponatremia is defined as serum sodium levels < 136 mEq/L. Mild hyponatremia usually is treated with intravenous infusions of NaCl.
Conventional antipsychotic/ nonphenothiazine
haloperidol
Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin) MOA
heightens awareness, increases focus
diphenhydramine (Benadryl) MOA
histamine (H1) receptor blocker (first generation)
succinylcholine/ adverse effects
paralysis of diaphragm and intercostal muscles / risk of malignant hyperthermia in susceptible individuals
thiazide diuretics aren't effective in
patients with renal failure
corpus striatum
region of brain that controls unconscious muscle movement/ requires dopamine from neurons in the substantia nigra. Balance, posture, muscle tone, and involuntary muscle movement depends on balance of dopamine and acetylcholine in the corpus striatum
ipratropium (Atrovent) use
relief of acute bronchospasm -sometimes combined with beta agonists or glucocorticoids -also prescribed fro chronic bronchitis and symptomatic relief of nasal congestion
beclomethasone (QVAR) use
to decrease frequency of asthma attacks -allergic rhinitis -should be used to terminate asthma attacks in progress
Phenytoin (Dilantin) MOA
to desensitize sodium channels
Drug therapy for PD
to restore dopamine function and/or block acetylcholine
diphenhydramine (Benadryl) use
to treat minor symptoms of allergy and common cold
Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin) use
treat ADHA
MAO-B inhibitors for PD
prevents dopamine breakdown: selegiline, rasagiline
dopamine releaser for PD
prevents dopamine reuptake: amantadine
A client who has been diagnosed with a sexually transmitted disease (STD) asks that this information not be shared with her family members. Which of the following responses from the nurse would be appropriate?
" ""Your health information is confidential, and I can't talk to anyone about it without your permission.""
(SELECT ALL THAT APPLY) After being examined by the forensic nurse in the emergency department, a rape victim is prepared for discharge. Due to the nature of the attack, this client is at risk for posttraumatic stress disorder (PTSD). Which symptoms are associated with PTSD?
" 1. Recurrent, intrusive recollections or nightmares 3. Sleep disturbances 6. Difficulty concentrating "
funnel chest
(also known as pectus excavatum) - the sternum is depressed from the second intercostal space - more pronounced with inspiration; a congenital anomaly
(SELECT ALL THAT APPLY) A physician prescribes clomipramine (Anafranil) for a client diagnosed with obsessive-compulsive disorder (OCD). What instructions should the nurse include when teaching the client about this medication?
"1. Avoid hazardous activities that require alertness or good coordination until adverse central nervous system (CNS) effects are known. 2. Avoid alcohol and other depressants. 3. Use saliva substitutes or sugarless candy or gum to relieve dry mouth. "
The nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior?
"1. By designating times during which the client can focus on the behavior
The nurse in a psychiatric inpatient unit is caring for a client with obsessive-compulsive disorder. As part of the client's treatment, the psychiatrist orders lorazepam (Ativan), 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to:
"1. avoid caffeine.
A nurse notices that a client who came to the clinic for treatment of anxiety disorder has a strong body odor. What can the nurse do or say to help this client?
"2. Ask the client basic hygiene questions to determine how frequently he bathes.
The nurse is caring for a client with panic disorder who has difficulty sleeping. Which nursing intervention would best help the client achieve healthy long-term sleeping habits?
"2. Encouraging the use of relaxation exercises
A nurse on the psychiatric unit realizes that she typically fails to administer medications according to schedule. What's the best way for the nurse to improve her medication administration practice?
"2. Evaluate her current practice and devise an improvement plan.
The nurse is formulating a short-term goal for a client suffering from a severe obsessive-compulsive disorder (OCD). An appropriately stated short-term goal is that after 1 week, the client will:
"2. participate in a daily exercise group.
Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?
"3. Fluvoxamine (Luvox) and clomipramine (Anafranil)
A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time?
"3. Risk for injury
Which nursing intervention would be most helpful for a client experiencing a panic attack?
"3. Staying with the client and remaining calm, confident, and reassuring
A client admitted to the psychiatric unit for treatment of repeated panic attacks comes to the nurses' station in obvious distress. After observing that the client is short of breath, dizzy, trembling, and nauseated, the nurse should first:
"3. escort the client to a quiet area and suggest using a relaxation exercise that he's been taught.
A client who lost her home and dog in an earthquake tells the admitting nurse at the community health center that she finds it harder and harder to "feel anything." She says she can't concentrate on the simplest tasks, fears losing control, and thinks about the earthquake incessantly. She becomes extremely anxious whenever the earthquake is mentioned and must leave the room if people talk about it. The nurse suspects that she has:
"3. posttraumatic stress disorder (PTSD).
While being escorted to an operating room, a client is extremely anxious and says, "I really don't know what they're going to do to me today. The physician said I have a lump in my breast and that's all I know." Which action is appropriate for the nurse to take?
"4. Notify the physician upon arrival at the operating room.
While administering medications to a group of clients admitted with anxiety, a nurse hears someone call for help. The nurse should respond by:
"4. locking the medication cart and responding to the call for help.
A 59-year-old client is scheduled for cardiac catheterization the next morning. His physician prescribed secobarbital sodium (Seconal), 100 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:
"4. sedatives reduce excitement; hypnotics induce sleep.
A client, age 40, is admitted for a surgical biopsy of a suspicious lump in her left breast. When the nurse comes to take her to surgery, she is tearfully finishing a letter to her two children. She tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic?
"In case anything goes wrong? What are your thoughts and feelings right now?"
Before eating a meal, a client with obsessive-compulsive disorder (OCD) must wash his hands for 18 minutes, comb his hair 444 strokes, and switch the bathroom light on and off 44 times. What is the most appropriate goal of care for this client?
"Systematically decrease the number of repetitions of rituals and the amount of time spent performing them.
A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with:
"repetitive thoughts and recurring, irresistible impulses.
Eschar
(sloughing layer of necrotic tissue, collagen and protein exudate that coagulates into a hard crust) + edema →tight constricting band that prevents airway/chest expansion
Full thickness
-Significant damage -Epidermis, dermis, hypodermis -Extensive scarring -Significant time needed to heal
Atopic Dermatitis Therapeutic Management
-Skin hydration -Corticosteroids -Immune modulators -Antihistamines -Antibiotics
Symptoms of Smoke Inhalation
- Presence of soot around mouth and nose and in sputum (carbonaceous sputum) -Tachycardia -Stridor -Wheezing -Hoarseness -Hypoexmia -Facial burns -Difficulty swallowing -Singed nasal hairs -Intercostal/suprasternal retractions
Stage 1
-Skin intact -Area red & does not black with external pressure -Potential ulceration -May be painful, firm, soft, warmer, or cooler
Pt @ home 10 days after burn of L hand and arm, partial thickness burn what are priorities
- assessment - health teaching - assessing for infection - fever, pus, smell - pain : medication working, ADL, Sleep - wound healing: protein + Vit C ( componant of making collogen) - increased calories - hungry - nausea - stress ulcer
Rule of nine for adults perineal
-1%
In Suspected Inhalation Injury What is the Recommended % of 02 and Mode of Delivery?
-100% HUMIDIFIED O2 by NON-Rebreathing facemask or endotracheal tube.
Rule of nine for child 1-8 legs
-14% EACH -7% anterior -7% posterior
Rule of nine for infants legs
-14% EACH -7% anterior -7% posterior
Rule of nine for child 1-8 face
-18% -9% anterior -9% posterior
Rule of nine for infant face
-18% -9% anterior -9% posterior
Rule of nine for infants chest and back
-18% -9% anterior -9% posterior
Rule of nines for adults legs
-18% EACH -9% anterior -9% posterior
Rule of nines for adults back and chest
-18% each
Rule of nines for adults face
-9% -4.5% anterior -4.5% posterior
Rule of nine for infants arms
-9% EACH -4.5% anterior -4.5% posterior
Rule of nines for adults arms
-9% EACH -4.5% anterior -4.5% posterior
Acne Neonatum
-Acne in babies -Appears at 2 to 4 weeks -Usually goes away in 4 to 6 months -Could last up to 2 to 3 years
Objective Physical Findings During the Emergent Phase of Burn Injury
-Airway & Breathing (upper burns) and circulation -Pain (Lower burns) -Tachycardia -Amount of fluid coming out of the body -Mouth and nose and in sputum (inhalation) -Hoarse voice -Notice and document circumferential burns
Seborrhea Therapeutic Management
-Anti dandruff shampoo -Corticosteroid creams or lotions
Coal Tar Preparations
-Anti itching -Anti-inflammatory -For psoriasis and atopic dermatitis -Apply at bed time and wash off in the morning -May stain sheets
Corticosteroids (topical)
-Anti-Inflammatory effect in atopic dermatitis and certain kinds of contact dermatitis -DON'T USE HIGH POTENCY ON FACE OR GENITALS -DON'T cover with an occlusive dressing
Systemic corticosteroids
-Anti-inflammatory -Immunosuppressive action -SEVERE contact dermatitis -TAKE WITH FOOD
Maintain Skin Hygiene
-Assess skin daily in the hospital and weekly in the home -When bathing use minimal force and do not use products that will dry out the skin -Use lotion after bathing
Impaired Skin Integrity
-Assess skin for warmth, redness, color, drainage -Use Norton or Braden scale for risk assessment -Position the child on the opposite side of the skin impairment to avoid further skin breakdown -Proper nutrition -Wound and Ostomy care
Acne Neonatum Nursing Management
-Avoid picking or squeezing -Wash area with clear water -Avoid fragrance soap -Will go away on its own when babies hormones stabilize
Reactive Hyperemia
-Skin is bright red and flush -Extra blood flows to the area to make up for the previous impeded blood flow
Silver Sulfadiazine (Silvadene)
-Bactericidal -FOR BURNS -Apply two times a day -Cover with occlusive dressing -DON'T USE IN CHILDREN WITH SULFA ALLERGY -DON'T use on face or a child younger than two months -May cause transient neutropenia
What are Antibiotics (systemic) used for?
-Bactericidal or bacteriostatic -Acne vulgaris -Extensive impetigo -Cellulitis -Scalded skin syndrome
heparin AE
-Bleeding -Hypersensativity reactions -Heparin-induced Thrombocytopenia (HIT) -Hyperkalemia (aldosterone inhibiting effect) -Osteoporosis (long term therapy)
What are fluid resuscitation requirements?
-Body weight in kg -The % of TBSA burned -Patients age - 4mL x wt (kg) x TBSA (%)
Eschar
-Brown or black necrotic tissue
diphenhydramine (Benadryl) drug drug interactions
-CNS depressants such as alcohol or opioids will increase sedation -OTC cold preparations may increase anticholinergic SE -monoamine oxidase inhibitors (MAOIs) may cause hypertensive crisis
Phenytoin (Dilantin) AE
-CNS depression -gingival hyperplasia -skin rash -cardiac dysrhythmias -hypotension
Friction
-Can remove superficial layers of the skin -Sheets rubbing against the patient
Inadequate Nutrition
-Causes weight loss, muscle atrophy, loss of subcutaneous tissue -Reduce the amount of padding between the skin and bone
Preventing Diaper Candidasis
-Change diapers frequently -Wash area with soft cloth avoiding harsh soaps -Use fragrance free baby wipes -Allow child to go diaperless for a period of time -Blow dry rash set on warm for three to five minutes
What is Seborrhea
-Chronic inflammation may occur on the skin or scalp -Also known as cradle cap -Could be on eyes, ears, nose or diaper area
Psorasis
-Chronic inflammatory skin disease
Isotretinoin (Accutane)
-Cystic or severe acne that is resistant to treatment with oral antibiotics -PREGNANCY TESTS -Monitor for SUICIDE
What are antibiotics (topical) used for
-Decrease skin colonization with bacteria -Acne -Impetigo -Folliculitis
Benzoyl peroxide
-Decreases colonization of acne
Ischemia
-Deficincy in the blood supply to the tissue -Cause of pressure ulcers -Tissue dies as a result of the compression of the bed and bony skeleton
Chronic Medical Conditions
-Diabetes and Heart disease cause poor perfusion and cause poor delayed healing
Static low air loss
-Each level of the bed can be inflated to a different level of firmness
What is Atopic Dermatitis?
-Eczema
Superficial Burns
-Epidermal injury -Heal without scarring in 4 to 5 days
Partial Thickness
-Epidermis and dermis -Heal within two weeks with minimal scarring
Goals with patients at risk for skin integrity
-Explain to the client that they will be turned and how often -Position proper body alignment -Use speciality beds and mattresses as need -Document skin status every shift -Remove moisture -Apply protective barriers
Psorasis Nursing Management
-Exposure to sun light -UV -Tar -Anti-inflammatory -Mineral oil and warm towels
Staphlycoccal Scalded Skin Syndrome
-Flattish bullae that rupture within hours -Red weeping surface on face groin neck and axillary -Antibioitcs -IV -Fluid management
Retinoids (topical)
-For severe acne -Dryness, burning -USE SPF 15 SUNSCREEN
Antihistamines
-For: -Hypersensitivity -Atopic dermatitis -Contact dermatitis -May give three or four times daily -SEDATION EFFECTS
Shearing Force
-Friction and pressure -Caused from patient sitting up in bed -Body slides downward which moves pressure to the sacral bone and deep tissue
Stage 3
-Full thickness skin loss -Extends into the dermis and subcutaneous tissues -Necrosis -Slough may be present -Does not go through underlying fascia -Subcutaneous tissue may be visible -Undermining and tunneling may or may not be present.
Unstageable
-Full-Thickness loss -Wound bed is covered by slough and/or eschar -Unknown true depth -Stage of wound cannot be determined until debridement -Covered in slough -Could be a stage III or IV
Stage 4
-Full-Thinkness skin loss is present -Necrosis with damage to muscle, bone, tendon or joint capsule -Slough or eschar may be present -Osteomylitis and sepsis can occur -Undermining and tunneling may be develop
Antifungals (topical)
-Fungicidal used to treat -Tinea -Candidal diaper rash -apply a thin layer
Nortons Pressue Area Risk Assessment For Scale
-General physical condition -Mental state -Activity -Mobility -Incontinence
diuretics are used to treat
-HTN -HF -kidney failure -liver failure/cirrhosis -pulmonary edema
Protective devices
-Heel protector -Alternating pressure mattress -Water bed -Static low air loss bed-press
What is Urticaria
-Hives -May go away in a few days or take 6-8 weeks
Braden Scale for Predicting Pressure Sore Risk
-Sensory perception -Moisture -Activity -Mobility -Nutrition -Friction -Shear
What is the parkland formula?
-How much LR to give in the first 24 hours -4mL x wt (kg) x TBSA (%) = Volume (mL) -Half is given in the FIRST 8 hours -Ex) 2,400mL/2 = 1,200 for FIRST 8 hours - Remaining volume divided into HALF again for second and third 8 hours - Ex) 1,200 (remaining)/2 = 600 mL Second & 3rd 8 Hours (16 hours total)
Decreased mental status
-Individuals with a reduced level of awareness -unconscious, heavily sedated, have dementia -cant recognize and respond to pain
Topical immune modulators
-Inhibit T lymphocyte action at skin level -Atopic dermatitis -Or for conditions resistant to topical steroids -AVOID SUN LIGHT -Burning, itching, flu like symptoms
Pressure Ulcer
-Injury to skin and/or underlying tissue usually over a bony prominence as a result of force alone or in combination with movement -Multiple stages or un-stagable (worst)
Suspected Deep-Tissue Injury
-Ischemic subcutaneous tissue injury -Under intact skin -Appears purple or maroon colored -May be painful, firm, or boggy
Tinea Cruris
-Jock itch
Antifungals (systemic)
-Kills fungus -Binds to human keratin making it resistant to fungus -For Tinea Capitis and severe widespread fungal infections -GIVE WITH FATTY FOODS
permethrin (Acticin, Elimite, Nix) AE
-LOCAL: pruritus, rash, transient tingling, burning, stinging, erythema, edema -use with caution over inflamed skin, people with asthma, or lactating women
Advanced age
-Loss of body mass -Thinning epidermis -Decreased strenght and elasticity -Increased dryness -Diminished pain perception -Diminished venous and arterial flow
Excoriation
-Loss of superficial layers of the skin -caused by urea, gastric tube drainage, digestive enzymes in feces
HYPOproteinemia
-Low protein the blood -Can lead to edema -Edema decreases skins elasticity making it more prone to edema
Avoid Skin trauma
-Make sure bed is smooth, wrinkle free, and firm -Turn client frequently -For bed ridden clients do not elevate bed more than 30 degrees
Provide nutrition
-Make sure the client has an adequate intake of: -calories -protein -iron -vitamins -Monitor weight regularly
Ineffective airway clearance for burns
-Monitor SpO2 every hour -Assess RR -Auscultate breath sounds q4h -Cough and deep breathe every hour awake -Turn every 2 hours -Elevate HOB -Schedule activities to avoid fatigue
Risk for hypothermia for burns
-Monitor rectal/core temp every hour -Monitor for shivering -For temps less than 98.6 institute rewarming measure
Diaper Candidiasis
-NYASTIN cream
Atopic Dermatitis Nursing Interventions
-No hot baths -No fragerence soaps -Pat dry -Leave moist -Moisturize -Evening primrose oil -Chamomile -AVOID WOOL AND SYNTHETIC FABRICS -Avoid tight clothing and heat
If redness disappears
-No tissue damage has occured
Tinea Versicolor
-Oval-like scaly lesions on UPPER back and chest and arm -More common in WARM weather
Non-bullous Impetigo
-Papules professing to vessicles -Honey colored exudate when the vesicles rupture -Treat topically with Mupirocin ointment -Remove crust with cool compress two times a day
Diminished sensation
-Paralysis, stroke, or other neurologic diseases -body cant recognize hot, cold, tingling, trauma -body cant recognize and providing healing for a wound
Tinea capitis
-Patches of scaling skin on the scalp -Hair loss -No school or day care for a week after treatment
Who gets IV fluid resuscitation?
-Patients with burns over 20% of their body
What test IDENTIFIES Fungal Disorders?
-Potassium Hydroxide KOH prep
Alternating pressure mattress
-Pressure alternately increases and decreases
Preventing pressure ulcers
-Provide nutrition -Maintain skin hygiene -Avoid skin trauma -Provide supportive devices
Active low air loss
-Pulsates from side to side stimulating capillary blood flow
Bullous Impetigo
-Red macules and bullous eruptions -Good hygiene -Cephalosporins
Folliculitis
-Red raised hair follicles -WARM compresses with soap and water several times a day -Topical Mucpirocin
Immobility
-Reduction in the amount of control of body movements -ex: paralysis, extreme weakness, pain
Risk for ineffective coping
-Reinforce information frequently -Interventions to reduce pain and fatigue -Consult social workers -Group support sessions
Anticipated Therapeutic Outcome of Escharotomy/Fasciotomy
-Relieve pressure -Restore circulation
Tinea Corporis
-Ring worm
Stage 2
-Skin is not intact -Abrasion, blister, shallow crater -Some skin may be damaged beyond repair -Partial Thickness skin loss of dermis -Shallow open ulcer with red-pink wound bed -OR- as intact or open/ruptured serum-filled blister
Urticaria Nursing Management
-Stop antibiotics -Administer antihistamines, steroids, and ani-itching medications -Check respiratory and airway -Assess what they ate, drank, changes in environment, recent infection,unusual stress
tretinoin (Avita, Retin-A) contraindications
-TOPICAL: eczema, exposure to UV rays, sunburn, hypersensitivity to vitamin A, and children less than 12 -pregnancy
Deep Partial-Thickness
-Take longer to heal -May scar -Resulting in nail hair and sebaceous gland function
Air fluidized/static bed
-Tiny silicone coated beads -Uniform support to body contours -Moisture from client soaks into beads and is kept away from the client keeping them dry -Head of bed cannot be elevated
If redness does not disappear
-Tissue damage has occured
Maceration
-Tissue softened by prolonged wetting and soaking
Acute pain
-Type,location, quality -Administer meds as ordered -Medicate patient before bathing,dressing, and major procedures -Minimize open exposure of wounds -Distraction and relaxation techniques
What Physical Objective Finding Would Best Reflect Adequate Fluid Resuscitation During the Emergent Phase of Burn Injury?
-Urine output
Seborrhea Nursing Management
-Wash affected area with mild soap -Apply mineral oil then comb off crust 10 to 15 minutes later -Selenium sulfide shampoo can be used
Contact Dermatitis Nursing Interventions
-Wear long sleeves and long pants on outings in the woods -Remove offending plants in the yard -Vinyl gloves (not rubber or latex) -Wash clothing well with soap and water -If contact occurs wash vigorously within ten minutes of contact -Oatmeal baths -Wash lesions daily -Avoid hot showers -Avoid occlusion of lesion
Assessment Finding That Would Indicate a Worsening State
-Wheezing goes away (obstruction)
Excessive body heat
-When bodys temp is elevated cells need more oxygen, especially cells under pressure which are already oxygen deficienet
Heparin Contraindications
-active bleeding -bleeding disorders -severe HTN -recent trauma -intracranial hem -bacterial endocarditis `
clopidogrel (Plavix) contraindications
-active bleeding -use with anticoagulants, anti-platelets, thrombolytic agents, NSAIDs increase bleeding risk
lorazepam (Ativan) contraindications
-acute narrow angle glaucoma -closed angle glaucoma
drug classes for COPD
-antibiotics -bronchodilators -Mucolytics and expectorants -oxygen therapy -roflumilast (Daliresp)
spironolactone (Aldactone) contraindications
-anuria -impaired renal function -hyperkalemia -pregnancy
quick relief medications for asthma
-beta 2 adrenergic agonist -anticholinergics -systemic corticosteroids
diazepam (Valium) MOA
-binds with GABA receptor chloride channel molecules (intensity GABA effects) -inhibit brain impulse from passing through limbic and reticular activating systems
tretinoin (Avita, Retin-A) AE
-bone pain -fever -headache -nausea -vomiting -rash -stomatitis -pruritus -sweating -ocular disorders
escitalopram (Lexapro) contraindications
-breast feeding -younger than 12 -within 14 days of MAOI therapy
phenelzine (Nardil) contraindications
-cardiovascular disorder -cereberalvasular disease -hepatic or renal impairment
diphenhydramine (Benadryl) AE
-drowsiness (diminished with long term use) -paradoxical CNS stimulation and excitability -dry mouth -tachycardia -mild hypotension -may cause photosensitivity
clopidogrel (Plavix) AE
-flulike symptoms -headaceh -dizziness -brusing -rash or pruritus -bleeding
albuterol (ProAir H F A, Proventil H F A, Ventolin H F A) AE
-headaceh -throat irritation -nervousness -restlessness -tachycardia -chest pain -allergic reaction
montelukast (Singulair) AE
-headache -nausea -diarrhea
diphenhydramine (Benadryl) contraindications
-hypersensitivity -BPH -narrow angle glaucoma -GI obstruction -caution with asthma or hyperthyroidism
long acting medications for asthma
-inhaled corticosteroids -mast cell stabilizers -leukotriene modifiers -long-acting beta2-adrenergic agonists -methylxanthines -immunomodulators
devices used for aerosol therapy
-nebulizer -metered dose inhaler -dry powder inhaler-
phenelzine (Nardil) AE
-orthostatic hypotension -headache -insomnia -diarrhea
imipramine (Tofranil) AE
-orthostatic hypotension -sedation and anticholinergic effects -cardiac dysrhythmias
dry powder inhaler (DPI)
-patient inhales powered drug -device activated by inhalation
furosemide (Lasix) AE
-potential electrolyte imbalance -hypokalemia -ototoxicity
hydrochlorothiazide (Microzide) contraindications
-pre-eclampsia -pregnancy
phenobarbital (Luminal) contraindications
-pre-existing CNS depression -severe respiratory disease with dyspnea or obstruction -glaucoma -prostatic hypertrophy
metered dose inhaler (MDI)
-propellant delivers measured dose of drug -patient times inhalation to puffs of drugs
Phenytoin (Dilantin) contraindications
-rask -seizures due to hypoglycemia -sinus bradycardia -heart block
Warfarin (Coumadin) contraindications
-recent trauma -active internal bleeding -bleeding disorders -severe HTN -bacterial endocarditis
Benzodiazepines important indications
-seizure control -alcohol withdrawal -central muscle relaxation -induction agents in anesthesia
sertraline (Zoloft) AE
-sexual dysfunction -nausea -headache -weight gain -anxiety -insomnia -sedation (less common) -anticholinergic effects (less common) -sympathomimetic effects (less common)
diazepam (Valium) AE
-tolerance -respiratory depression -psychological and physical dependence -HIGH risk of dependence
nebulizer
-vaporizes liquid drug into fine mist -use small machine and face mask
The client's serum sodium value is 152 mEq/L. Which of the following nursing interventions is most appropriate for this client? (Select all that apply.) 1. Assess for inadequate water intake or diarrhea. 2. Administer a 0.45% NaCl IV solution. 3. Hold all doses of glucocorticoids. 4. Notify the health care provider. 5. Have the client drink as much water as possible.
1 and 4 Rationale: Hypernatremia is defined as serum sodium levels higher than 148 mEq/L. Elevated levels may be associated with inadequate fluid intake, diarrhea, fever, or after burns when fluid is lost from the burn site. Because this laboratory value is significantly increased, the health care provider should be notified.
A client uses a metered-dose inhaler (MDI) to aid in management of his asthma. Which action by the client indicates to the nurse that he needs further instruction regarding its use? Select all that apply. 1. Activation of the MDI is not coordinated with inspiration. 2. The client inspires rapidly when using the MDI. 3. The client holds his breath for 3 seconds after inhaling with the MDI. 4. The client shakes the MDI after use. 5. The client performs puffs in rapid succession.
1, 2, 3, 4, 5. Utilization of an MDI requires coordination between activation and inspiration; deep breaths to ensure that medication is distributed into the lungs, holding the breath for 10 seconds or as long as possible to disperse the medication into the lungs, shaking up the medication in the MDI before use, and a sufficient amount of time between puffs to provide an adequate amount of inhalation medication.
Which of the following is significant data to gather from a client who has been diagnosed with pneumonia? Select all that apply. 1. Quality of breath sounds. 2. Presence of bowel sounds. 3. Occurence of chest pain. 4. Amount of peripheral edema. 5. Color of nail beds.
1, 3, 5. A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can interfere with the client's ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the client with pneumonia.
The nurse administers two 325 mg aspirin every 4 hours to a client with pneumonia. The nurse should evaluate the outcome of administering the drug by assessing which of the following? Select all that apply. 1. Decreased pain when breathing. 2. Prolonged clotting time. 3. Decreased temperature. 4. Decreased respiratory rate. 5. Increased ability to expectorate secretions.
1, 3. Aspirin is administered to clients with pneumonia because it is an analgesic that helps control chest discomfort and an antipyretic that helps reduce fever. Aspirin has an anticoagulant effect, but that is not the reason for prescribing it for a client with pneumonia, and the use of the drug will be short term. Aspirin does not affect the respiratory rate, and does not facilitate expectoration of secretions.
The nurse is teaching the client how to use a metered-dose inhaler (MDI) to administer a corticosteroid. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply. 1. The inhaler is held upright. 2. The head is tilted down while inhaling the medicine. 3. The client waits 5 minutes between puffs. 4. The mouth is rinsed with water following administration. 5. The client lies supine for 15 minutes following administration.
1, 4. The client should shake the inhaler and hold it upright when administering the drug. The head should be tilted back slightly. The client should wait about 1 to 2 minutes between puffs. The mouth should be rinsed following the use of a corticosteroid MDI to decrease the likelihood of developing an oral infection. The client does not need to lie supine; instead, the client will likely to be able to breathe more freely if sitting upright.
The nurse is caring for a client who is experiencing acute renal failure. The nurse knows that this client may experience problems regulating: Select all that apply. 1. Fluid balance. 2. Electrolyte composition. 3. The pH of body fluids. 4. Heart rate. 5. Blood pressure.
1,2,3,5. The kidneys are the primary organs for regulating fluid balance through filtration and urine output.. The kidneys are the primary organs for regulating electrolyte composition through filtration and urine output. The kidneys are the primary organ for regulating the pH of body fluids through filtration and urine output. The kidneys play a role in regulating blood pressure through the secretion of renin.
Which substances enter the filtrate by active secretion? Select all that apply. 1. Hydrogen 2. Potassium 3. Phosphate 4. Chloride 5. Sodium
1,2,3. Hydrogen is pumped into filtrate by molecular pumps. Potassium is pumped into filtrate by molecular pumps. Phosphate is pumped into filtrate by molecular pumps.
A home care nurse is instructing a client with congestive heart failure on daily self-monitoring between home care visits. The nurse should instruct the client to monitor and record: Select all that apply. 1. Weight. 2. Pulse. 3. Temperature. 4. Blood pressure. 5. Respiratory rate.
1,2,4. It is essential that the client measure and record weight daily to monitor for fluid loss or retention. It is essential that the client measure and record the pulse daily to determine the effectiveness of the medication therapy. It is essential that the client measure and record daily BP to determine the effectiveness of the medication therapy.
The nurse is caring for a client admitted to the med-surg unit with hypervolemia that has resulted from renal failure. The nurse anticipates that medications that may be ordered to treat this condition would include: Select all that apply. 1. Furosemide (Lasix). 2. Hydrochlorothiazide (Microzide). 3. Epoetin alfa (Procrit). 4. Polystyrene sulfate (Kayexalate). 5. Sodium bicarbonate.
1,2. Loop diuretics are often given to treat the hypervolemia that accompanies renal failure. Thiazide diuretics are often given to treat the hypervolemia that accompanies renal failure.
The nurse is preparing to discharge a client who has been placed on a loop diuretic for the treatment of congestive heart failure. Which foods should the nurse encourage the client to consume to prevent serious adverse effects associated with the medication? Select all that apply. 1. Bananas 2. Red meat 3. Oranges 4. Dried dates 5. Green leafy vegetables
1,3,4. Bananas are a potassium-rich food. Clients on loop diuretics should eat foods rich in potassium. Citrus fruits are a good source of potassium. Clients on loop diuretics should eat foods rich in potassium. Dried dates are a good source of potassium. Clients on loop diuretics should eat foods rich in potassium.
A client has been diagnosed with chronic renal failure and is receiving hydrochlorothiazide (HCTZ). The nurse has taught the client about the importance of kidney function and evaluates that learning has occurred when the client makes which statements? Select all that apply. 1. "The kidneys help my heart by balancing potassium." 2. "The kidneys help decrease infections by excreting bacteria." 3. "The kidneys keep blood pressure from getting too low." 4. "The kidneys balance the fluid and electrolytes in my body." 5. "The kidneys help regulate the oxygen levels in my blood."
1,3,4. The kidneys are the primary organs for regulating potassium balance. The kidneys secrete renin, which helps to maintain blood pressure. The kidneys are the primary organs for regulating fluid and electrolyte balance.
During a panic attack, a client runs to the nurse and reports breathing difficulty, chest pain, and palpitations. The client is pale with his mouth wide open and eyebrows raised. What should the nurse do first?
1. Assist the client to breathe deeply into a paper bag
Which of the following findings would most likely indicate the presence of a respiratory infection in a client with asthma? 1. Cough productive of yellow sputum. 2. Bilateral expiratory wheezing. 3. Chest tightness. 4. Respiratory rate of 30 breaths/ minute.
1. A cough productive of yellow sputum is the most likely indicator of a respiratory infection. The other signs and symptoms- wheezing, chest tightness, and increased respiratory rate- are all findings associated with an asthma attack and do not necessarily mean an infection is present.
A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol? 1. Irregular heartbeat. 2. Constipation. 3. Pedal edema. 4. Decreased pulse rate.
1. Irregular heartbeats should be reported promptly to the care provider. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because of its adrenergic effect on beta-adrenergic receptors in the heart. It is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.
When developing a discharge plan to manage the care of a client with chronic obstructive pulmonary disease (COPD), the nurse should advise the the client to expect to: 1. Develop respiratory infections easily. 2. Maintain current status. 3. Require less supplemental oxygen. 4. Show permanent improvement.
1. A client with COPD is at high risk for development of respiratory infections. COPD is slowly progressive; therefore, maintaining current status and establishing a goal that the client will require less supplemental oxygen are unrealistic expectations. Treatment may slow progression of the disease, but permanent improvement is highly unlikely.
Which of the following is a priority goal for the client with chronic obstructive pulmonary disease (COPD)? 1. Maintaining functional ability. 2. Minimizing chest pain. 3. Increasing carbon dioxide levels in the blood. 4. Treating infectious agents.
1. A priority goal for the client with COPD is to manage the signs and symptoms of the disease process so as to maintain the client's functional ability. Chest pain is not a typical symptom of COPD. The carbon dioxide concentration in the blood is increased to an abnormal level in clients with COPD; it would not be a goal to increase the level further. Preventing infection would be a goal of care for the client with COPD.
The client with pneumonia develops mild constipation, and the nurse administers docusate sodium (Colace) as ordered. This drug works by: 1. Softening the stool. 2. Lubricating the stool. 3. Increasing stool bulk. 4. Stimulating peristalsis.
1. Docusate sodium (Colace) is a stool softener that allows fluid and fatty substances to enter the stool and soften it. Docusate sodium does not lubricate the stool, increase stool bulk, or stimulate peristalsis.
A client with deep vein thrombosis suddenly develops dyspnea, tachypnea, and chest discomfort. What should the nurse do first? 1. Elevate the head of the bed 30 to 45 degrees. 2. Encourage the client to cough and deep breathe. 3. Auscultate the lungs to detect abnormal breath sounds. 4. Contact the physician.
1. Elevating the head of the bed facilitates breathing because the lungs are able to expand as the diaphragm descends. Coughing and deep breathing do not alleviate the symptoms of a pulmonary embolus, nor does lung auscultation. The physician must be kept informed of changes in a client's status, but the priority in this case is alleviating the symptoms.
Bed rest is prescribed for a client with pneumonia during the acute phase of the illness. The nurse should determine the effectiveness of bed rest by assessing the client's: 1. Decreased cellular demand for oxygen. 2. Reduced episodes of coughing. 3. Diminished pain when breathing deeply. 4. Ability to expectorate secretions more easily.
1. Exudate in the alveoli interferes with ventilation and the diffusion of gases in clients with pneumonia. During the acute phase of the illness, it is essential to reduce the body's need for oxygen at the cellular level; bed rest is the most effective method for doing so. Bed rest does not decrease coughing or promote clearance of secretions, and it does not reduce pain when taking deep breaths.
Which of the following physical assessment findings are normal for a client with advanced chronic obstructive pulmonary disease (COPD)? 1. Increased anteroposterior chest diameter. 2. Underdeveloped neck muscles. 3. Collapsed neck veins. 4. Increased chest excursions with respiration.
1. Increased anteroposterior chest diameter is characteristic of advanced COPD. Air is trapped in the overextended alveoli, and the ribs are fixed in an inspiratory position. The result is the typical barrel-chested appearance. Overly developed, not underdeveloped, neck muscles are associated with COPD because of their increased use in the work of breathing. Distended, not collapsed, neck veins are associated with COPD as a symptom of the heart failure that the client may experience secondary to the increased workload on the heart to pump blood into the pulmonary vasculature. Diminished, not increased, chest excursion is associated with COPD.
Which of the following health promotion activities should the nurse include in the discharge teaching plan for a client with asthma? 1. Incorporate physical exercise as tolerated into the daily routine. 2. Monitor peak flow numbers after meals and at bedtime. 3. Eliminate stressors in the work and home environment. 4. Use sedatives to ensure uninterrupted sleep at night.
1. Physical exercise is beneficial and should be incorporated as tolerated into the client's schedule. Peak flow numbers should be monitored daily, usually in the morning (before taking medication). Peak flow does not need to be monitored after each meal. Stressors in the client's life should be modified but cannot be totally eliminated. Although adequate sleep is important, it is not recommended that sedatives be routinely taken to induce sleep.
A client experiencing a severe asthma attack has the following arterial blood gas: pH 7.33; Pco2 48; Po2 58; HCO3 26. Which of the following orders should the nurse perform first? 1. Albuterol (Proventil) nebulizer. 2. Chest x-ray. 3. Ipratropium (Atrovent) inhaler. 4. Sputum culture.
1. The arterial blood gas reveals a respiratory acidosis with hypoxia. A quick-acting bronchodilator, albuterol, should be administered via nebulizer to improve gas exchange. Ipratropium is a maintenance treatment for bronchospasm that can be used with albuterol. A chest x-ray and sputum sample can be obtained once the client is stable.
Because antianxiety agents such as lorazepam (Ativan) can potentiate the effects of other drugs, the nurse should incorporate which instruction in her teaching plan?
1. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants
A 79-year-old female client is admitted to the hospital with a diagnosis of bacterial pneumonia. While obtaining the client's health history, the nurse learns that the client has osteoarthritis, follows a vegetarian diet, and is very concerned with cleanliness. Which of the following would most likely be a predisposing factor for the diagnosis of pneumonia? 1. Age. 2. Osteoarthritis. 3. Vegetarian diet. 4. Daily bathing.
1. The client's age is a predisposing factor for pneumonia; pneumonia is more common in elderly or debilitated clients. Other predisposing factors include smoking, upper respiratory tract infections, malnutrition, immunosuppression, and the presence of a chronic illness. Osteoarthritis, a nutritionally sound vegetarian diet, and frequent bathing are not predisposing factors for pneumonia.
The nurse is planning to teach a client with chronic obstructive pulmonary disease how to cough effectively. Which of the following instructions should be included? 1. Take a deep abdominal breath, bend forward, and cough three or four times on exhalation. 2. Lie flat on the back, splint the thorax, take two deep breaths, and cough. 3. Take several rapid, shallow breaths and then cough forcefully. 4. Assume a side-lying position, extend the arm over the head, and alternate deep breathing with coughing.
1. The goal of effective coughing is to conserve energy, facilitate removal of secretions, and minimize airway collapse. The client should assume a sitting position with feet on the floor if possible. The client should bend forward slightly and, using pursed-lip breathing, exhale. After resuming an upright position, the client should use abdominal breathing to slowly and deeply inhale. After repeating this process three or four times, the client should take a deep abdominal breath, bend forward, and cough three or four times upon exhalation (" huff" cough). Lying flat does not enhance lung expansion; sitting upright promotes full expansion of the thorax. Shallow breathing does not facilitate removal of secretions, and forceful coughing promotes collapse of airways. A side-lying position does not allow for adequate chest expansion to promote deep breathing.
A client with a history of drug and alcohol abuse is concerned that the hospital will divulge her history to her employer without her knowledge. What response by the nurse would be appropriate?
1. "Your personal health information can't be disclosed to your employer without your permission."
Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply. 1. Excessive worry about items difficult to control. 2. Muscle tension. 3. Hypersomnia. 4. Excessive amounts of energy. 5. Feeling "keyed up" or "on edge."
1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control. 2. A client diagnosed with GAD would experience muscle tension. 5. A client diagnosed with GAD would experience an increased startle reflex and tension, causing feelings of being "keyed up" or being "on edge." TEST-TAKING HINT: To answer this question correctly, the test taker would need to recognize the signs and symptoms of GAD.
Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply. 1. Dissociative events. 2. Intense fear and helplessness. 3. Excessive attachment and dependence toward others. 4. Full range of affect. 5. Avoidance of activities that are associated with the trauma.
1. A client diagnosed with posttraumatic stress disorder (PTSD) may have dissociative events in which the client feels detached from the situation or feelings. 2. A client diagnosed with PTSD may have intense fear and feelings of helplessness. 5. A client diagnosed with PTSD avoids activities associated with the traumatic event. TEST-TAKING HINT: To answer this question correctly, the test taker must be aware of the different symptoms associated with the diagnosis of PTSD.
The patient is complaining of discomfort related to minor sunburn. Which of the following medications would be included in a plan of care for someone who has minor sunburn? 1. Benzocaine (Solarcaine) 2. Cortizone 3. Benzoyl peroxide 4. Doxycycline
1. Benzocaine (Solarcaine)
A nurse is caring for a newly diagnosed patient with psoriasis. The skin on her elbow is covered with red plaques and scales. She finds it very embarrassing. Even though she doesn't have much money, she wants to know what medication can help her. The nurse understands that the initial and inexpensive medication is: 1. Betamethasone 2. Doxycycline 3. Cyclosporine 4. Benzocaine
1. Betamethasone
A client leaving home for the first time in a year arrives on the psychiatric in-patient unit wearing a surgical mask and white gloves and crying, "The germs in here are going to kill me." Which nursing diagnosis addresses this client's problem? 1. Social isolation R /T fear of germs AEB continually refusing to leave the home. 2. Fear of germs R /T obsessive-compulsive disorder, resulting in dysfunctional isolation. 3. Ineffective coping AEB dysfunctional isolation R /T unrealistic fear of germs. 4. Anxiety R /T the inability to leave home, resulting in dysfunctional fear of germs.
1. According to the North American Nursing Diagnosis Association (NANDA), the nursing diagnosis format must contain three essential components: (1) identification of the health problem, (2) presentation of the etiology (or cause) of the problem, and (3) description of a cluster of signs and symptoms known as "defining characteristics." The correct answer, "1," contains all three components in the correct order: health problem/NANDA stem (social isolation); etiology/cause, or R /T (fear of germs); and signs and symptoms, or AEB (refusing to leave home for the past year). Because this client has been unable to leave home for a year as a result of fear of germs, the client's behaviors meet the defining characteristics of social isolation. TEST-TAKING HINT: To answer this question correctly, the test taker needs to know the components of a correctly stated nursing diagnosis and the order in which these components are written.
The nurse is caring for four pts on a renal failure unit and recognizes which drug as safe to administer to a client with hypokalemia? 1. Amiloride (Midamor) 2. Chlorothiazide (Diuril) 3. Bumetanide (Bumex) 4. Ethacrynic acid (Edecrin)
1. Amiloride is a potassium-sparing diuretic.
47. The nurse asks the male client with epilepsy if he has auras with his seizures. The client says, "I don't know what you mean. What are auras?" Which statement by the nurse would be the best response? 1. "Some people have a warning that the seizure is about to start." 2. "Auras occur when you are physically and psychologically exhausted." 3. "You're concerned that you do not have auras before your seizures?" 4. "Auras usually cause you to be sleepy after you have a seizure."
1. An aura is a visual, auditory, or olfactory occurrence that takes place prior to a seizure and warns the client a seizure is about to occur. The aura often allows time for the client to lie down on the floor or find a safe place to have the seizure.
A client with cancer is secreting excessive amounts of antidiuretic hormone. The nurse will monitor the client for which consequence of excess antidiuretic hormone secretion? 1. Fluid volume excess 2. Hyperkalemia 3. Hypernatremia 4. Dehydration
1. Antidiuretic hormone increases renal tubular permeability and water retention.
A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which correctly stated nursing diagnosis takes priority? 1. Anxiety R /T obsessive thoughts AEB ritualistic behaviors. 2. Powerlessness R /T ritualistic behaviors AEB statements of lack of control. 3. Fear R /T a traumatic event AEB stimulus avoidance. 4. Social isolation R /T increased levels of anxiety AEB not attending groups.
1. Anxiety is the underlying cause of the diagnosis of obsessive compulsive disorder (OCD), therefore, anxiety R/T obsessive thoughts is the priority nursing diagnosis for the client newly admitted for the treatment of this disorder. TEST-TAKING HINT: When the question is asking for a priority, the test taker should consider which client problem would need to be addressed before any other problem can be explored. When anxiety is decreased, social isolation should improve, and feelings about powerlessness can be expressed.
(SELECT AL THAT APPLY) A 54-year-old client diagnosed with generalized anxiety disorder is admitted to the facility. Which therapeutic modalities are typically used to treat this disorder?
1. Biofeedback 2. Buspirone 3. Relaxtion technique
The nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to prescribe which psychotropic drug regimen for this client?
1. Buspirone (BuSpar), 5 mg orally three times per day "
Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply. 1. Chronic obstructive pulmonary disease. 2. Hyperthyroidism. 3. Hypertension. 4. Diverticulosis. 5. Hypoglycemia.
1. Chronic obstructive pulmonary disease causes shortness of breath. Air deprivation causes anxiety, sometimes to the point of panic. 2. Hyperthyroidism (Graves's disease) involves excess stimulation of the sympathetic nervous system and excessive levels of thyroxine. Anxiety is one of several symptoms brought on by these increases. 5. Marked irritability and anxiety are some of the many symptoms associated with hypoglycemia. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that anxiety is manifested by physiological responses.
Which of the following medications can be used to treat clients with anxiety disorders? Select all that apply. 1. Clonidine hydrochloride (Catapres). 2. Fluvoxamine maleate (Luvox). 3. Buspirone (BuSpar). 4. Alprazolam (Xanax). 5. Haloperidol (Haldol).
1. Clonidine hydrochloride (Catapres) is used in the treatment of panic disorders and generalized anxiety disorder. 2. Fluvoxamine maleate (Luvox) is used in the treatment of obsessive-compulsive disorder. 3. Buspirone (BuSpar) is used in the treatment of panic disorders and generalized anxiety disorders. 4. Alprazolam (Xanax), a benzodiazepine, is used for the short-term treatment of anxiety disorders. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that many medications are used off-label to treat anxiety disorders.
The nurse caring for a client with renal failure will question the use of a usual dose of: 1. Digoxin (Lanoxin). 2. Cholestyramine (Questran). 3. Fluvastatin (Lescol). 4. Benzylpenicillin (penicillin G)
1. Digoxin has a narrow therapeutic index and is renally excreted. The dose should be reduced.
A client on an in-patient psychiatric unit is experiencing a flashback. Which intervention takes priority? 1. Maintain and reassure the client of his or her safety and security. 2. Encourage the client to express feelings. 3. Decrease extraneous external stimuli. 4. Use a nonjudgmental and matter-of-fact approach.
1. During a flashback, the client is experiencing severe-to-panic levels of anxiety; the priority nursing intervention is to maintain and reassure the client of his or her safety and security. The client's anxiety needs to decrease before other interventions are attempted. TEST-TAKING HINT: It is important to understand time-wise interventions when dealing with individuals experiencing anxiety. When the client experiences severe-to-panic levels of anxiety during flashbacks, the nurse needs to maintain safety and security until the client's level of anxiety has decreased.
A newly admitted client diagnosed with social phobia has a nursing diagnosis of social isolation R/T fear of ridicule. Which outcome is appropriate for this client? 1. The client will participate in two group activities by day 4. 2. The client will use relaxation techniques to decrease anxiety. 3. The client will verbalize one positive attribute about self by discharge. 4. The client will request buspirone (BuSpar) PRN to attend group by day 2.
1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a timeframe. TEST-TAKING HINT: To express an appropriate outcome, the statement must be related to the stated problem, be measurable and attainable, and have a timeframe. The test taker can eliminate "2" immediately because there is no timeframe, and then "3" because it does not relate to the stated problem.
After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client?
1. Exploring the meaning of the traumatic event with the client
A 10-year-old client diagnosed with nightmare disorder is admitted to an in-patient psychiatric unit. Which of the following interventions would be appropriate for this client's problem? Select all that apply. 1. Involving the family in therapy to decrease stress within the family. 2. Using phototherapy to assist the client to adapt to changes in sleep. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both. 4. Giving central nervous system stimulants, such as amphetamines. 5. Using relaxation therapy, such as meditation and deep breathing techniques, to assist the client in falling asleep.
1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate intervention to assist in the treatment of clients diagnosed with a nightmare disorder. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both is an appropriate intervention for clients diagnosed with a parasomnia disorder, such as a nightmare disorder. 5. Relaxation therapy, such as meditation and deep breathing techniques, would be appropriate for clients diagnosed with a nightmare disorder to assist in falling back to sleep after the nightmare occurs. TEST-TAKING HINT: To answer this question correctly, the test taker must be able first to understand the manifestation of a nightmare disorder and then to choose the interventions that would address these manifestations effectively.
38. The occupational health nurse is concerned about preventing occupation-related acquired seizures. Which intervention should the nurse implement? 1. Ensure that helmets are worn in appropriate areas. 2. Implement daily exercise programs for the staff. 3. Provide healthy foods in the cafeteria. 4. Encourage employees to wear safety glasses.
1. Head injury is one of the main reasons for epilepsy that can be prevented through occupational safety precautions and highway safety programs.
Spironolactone (Aldactone) is prescribed for a client with hypertension. The nurse recognizes which information as providing the most support for the use of this drug? 1. Diagnosis of hepatic failure 2. Insufficient therapeutic response to hydrochlorothiazide 3. Insufficient therapeutic response to furosemide (Lasix) 4. Diagnosis of renal failure
1. Hepatic failure is accompanied by increased production of aldosterone, which increases reabsorption of sodium and water in the distal tubule and collecting ducts. Spironolactone (Aldactone) achieves a diuretic effect by blocking the effects of aldosterone. Found on page 351
The nurse notices that a client with obsessive-compulsive disorder dresses and undresses numerous times each day. Which comment by the nurse would be therapeutic?
1. I saw you change clothes several times today. That must be very tiring.
The nurse caring for a client in renal failure should question an order for which drug? 1. Ibuprofen (Advil) 800 mg three times daily 2. Erythromycin (E-Mycin) 500 mg four times daily 3. Aluminum hydroxide gel 30 ml every 4 hours as needed 4. Acetylsalicylic acid (aspirin) 162 mg daily
1. Ibuprofen (NSAID) is a nephrotoxic drug. Clients in renal failure have increased vulnerability to injury from nephrotoxic drugs.
Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessivecompulsive disorder? 1. Ineffective coping R /T punitive superego. 2. Ineffective coping R /T active avoidance. 3. Ineffective coping R /T alteration in serotonin. 4. Ineffective coping R /T classic conditioning.
1. Ineffective coping R /T punitive superego reflects an intrapersonal theory of the etiology of obsessive-compulsive disorder (OCD). The punitive superego is a concept contained in Freud's psychosocial theory of personality development. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the different theories of the etiology of OCD. The keyword "intrapersonal" should make the test taker look for a concept inherent in this theory, such as "punitive superego."
A hospitalized client diagnosed with posttraumatic stress disorder has a nursing diagnosis of ineffective coping R /T history of rape AEB abusing alcohol. Which is the expected short-term outcome for this client problem? 1. The client will recognize triggers that precipitate alcohol abuse by day 2. 2. The client will attend follow-up weekly therapy sessions after discharge. 3. The client will refrain from self-blame regarding the rape by day 2. 4. The client will be free from injury to self throughout the shift.
1. It is a realistic expectation for a client who copes with previous trauma by abusing alcohol to recognize the triggers that precipitate this behavior. This outcome should be developed mutually early in treatment. TEST-TAKING HINT: It is important to relate outcomes to the stated nursing diagnosis. In this question, the test taker should choose an answer that relates to the nursing diagnosis of ineffective coping. Answer "4" can be eliminated immediately because it does not assist the client in coping more effectively. Also, the test taker must note important words, such as "short-term." Answer "2" can be eliminated immediately because it is a long-term outcome.
45. The client has been newly diagnosed with epilepsy. Which discharge instructions should be taught to the client? Select all that apply. 1. Keep a record of seizure activity. 2. Take tub baths only; do not take showers. 3. Avoid over-the-counter medications. 4. Have anticonvulsant medication serum levels checked regularly. 5. Do not drive alone; have someone in the car.
1. Keeping a seizure and medication chart will be helpful when keeping follow-up appointments with the health-care provider and in identifying activities that may trigger a seizure. 3. Over-the-counter medications may contain ingredients that will interact with antiseizure medications or, in some cases, as with use of stimulants, possibly cause a seizure. 4. Most of the anticonvulsant medications have therapeutic serum levels that should be maintained, and regular checks of the serum levels help to ensure the correct level.
The patient is using topical corticosteroids. The nurse will need to monitor for which of the following systemic effects of the medication? (Select all that apply.) 1. Mood changes 2. Bone defects 3. Liver toxicity 4. Adrenal insufficiency
1. Mood changes 2. Bone defects 4. Adrenal insufficiency
40. The nurse enters the room as the client is beginning to have a tonic-clonic seizure. What action should the nurse implement first? 1. Note the first thing the client does in the seizure. 2. Assess the size of the client's pupils. 3. Determine if the client is incontinent of urine or stool. 4. Provide the client with privacy during the seizure.
1. Noticing the first thing the client does during a seizure provides information and clues as to the location of the seizure in the brain. It is important to document whether the beginning of the seizure was observed.
The nurse is managing care for a client with acute renal failure. What does the nurse recognize as the most important safety precaution with regard to medication administration? 1. Review the client's medication regimen to identify any nephrotoxic drugs. 2. Ensure that the client's fluid intake and output are measured precisely. 3. Review the client's medication regimen to identify any drugs that increase fluid retention. 4. Plan to administer less-than-average doses of all medications prescribed for the client.
1. Persons in acute renal failure are at significantly increased risk of injury from nephrotoxic drugs.
The nurse is reviewing results of a routine urinalysis that indicate the presence of protein in the urine. The nurse interprets this finding to mean that 1. The client probably has kidney damage. 2. The results are probably insignificant if the amount of protein is very small. 3. There is likely a mistake with the results, and the client should have another test done. 4. The client is in acute renal failure, and should be hospitalized.
1. Protein is always an abnormal finding on urinalysis; it indicates damage to the glomerular membrane.
When a client experiences a panic attack, which outcome takes priority? 1. The client will remain safe throughout the duration of the panic attack. 2. The client will verbalize an anxiety level less than 2/10. 3. The client will use learned coping mechanisms to decrease anxiety. 4. The client will verbalize the positive effects of exercise by day 2.
1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client. TEST-TAKING HINT: All outcomes must be appropriate for the situation described in the question. In the question, the client is experiencing a panic attack; having the client verbalize the positive effects of exercise would be inappropriate. All outcomes must be client-centered, specific, realistic, positive, and measurable, and contain a timeframe.
A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction formation?
1. The client assumes an attitude that is the opposite of an impulse that the client harbors.
While in the facility, a client with obsessive-compulsive disorder saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures from them. Which outcome would indicate successful treatment for this client?
1. The client throws away all disposable cups
A client diagnosed with generalized anxiety disorder has a nursing diagnosis of panic anxiety R/T altered perceptions. Which of the following short-term outcomes is most appropriate for this client? 1. The client will be able to intervene before reaching panic levels of anxiety by discharge. 2. The client will verbalize decreased levels of anxiety by day 2. 3. The client will take control of life situations by using problem-solving methods effectively. 4. The client will voluntarily participate in group therapy activities by discharge.
1. The client's being able to intervene before reaching panic levels of anxiety by discharge is measurable, relates to the stated nursing diagnosis, has a timeframe, and is an appropriate short-term outcome for this client. TEST-TAKING HINT: When evaluating outcomes, the test taker must make sure that the outcome is specific to the client's need, is realistic, is measurable, and contains a reasonable timeframe. If any of these components is missing, the outcome is incorrectly written and can be eliminated.
The formation of urine begins at which structure? 1. Glomerulus 2. Ureter 3. Collecting duct 4. Henle's loop
1. The glomerulus is the site where filtration and production of urine begin.
The nurse is caring for a client with chronic renal failure and is assessing the client's urine output for the shift. In calculating the expected urine output, the nurse knows that the body produces _______ mL of urine per minute.
1. The kidneys produce approximately 1 mL of urine each minute.
A client diagnosed with generalized anxiety disorder complains of feeling out of control and states, "I just can't do this anymore." Which nursing action takes priority at this time? 1. Ask the client, "Are you thinking about harming yourself?" 2. Remove all potentially harmful objects from the milieu. 3. Place the client on a one-to-one observation status. 4. Encourage the client to verbalize feelings during the next group.
1. The nurse should recognize the statement, "I can't do this anymore," as evidence of hopelessness and assess further the potential for suicidal ideations. TEST-TAKING HINT: To answer this question correctly, the test taker should apply the nursing process. Assessment is the first step of this process. The nurse initially must assess a situation before determining appropriate nursing interventions.
The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which statement by the client would indicate that the intervention has been successful? 1. "I reminded myself that the panic attack would end soon, and it helped." 2. "I paced the halls until I felt my anxiety was under control." 3. "I felt my anxiety increase, so I took lorazepam (Ativan) to decrease it." 4. "Thank you for staying with me. It helped to know staff was there."
1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand which interventions support which theories of causation. When looking for a "cognitive" intervention, the test taker must remember that the theory involves thought processes.
43. The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure disorder. Which statement indicates the client understands the discharge teaching concerning this medication? 1. "I will brush my teeth after every meal." 2. "I will check my Dilantin level daily." 3. "My urine will turn orange while on Dilantin." 4. "I won't have any seizures while on this medication."
1. Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental care are essential to prevent or control gingival hyperplasia, which is a common occurrence in clients taking Dilantin.
Lorazepam (Ativan) is often given along with a neuroleptic agent, such as haloperidol (Haldol). What is the purpose of administering the drugs together?
1. To reduce anxiety and potentiate the sedative action of the neuroleptic
A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which behavioral symptom would the nurse expect to assess? 1. The client uses excessive hand washing to relieve anxiety. 2. The client rates anxiety at 8/10. 3. The client uses breathing techniques to decrease anxiety. 4. The client exhibits diaphoresis and tachycardia.
1. Using excessive hand washing to relieve anxiety is a behavioral symptom exhibited by clients diagnosed with obsessivecompulsive disorder (OCD). TEST-TAKING HINT: To answer this question correctly, the test taker must be able to differentiate various classes of symptoms exhibited by clients diagnosed with OCD. The keyword "behavioral" determines the correct answer to this question.
The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessivecompulsive disorder? Select all that apply. 1. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 3. With the client's input, set limits on ritualistic behaviors. 4. Present the reality of the impact the compulsions have on the client's life. 5. Discuss client feelings surrounding the obsessions and compulsions.
1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the nursing process, and this information needs to be gathered to intervene effectively. 2. Allowing time for the client to complete compulsions is important for a client who is newly admitted. If compulsions are limited, anxiety levels increase. If the client had been hospitalized for a while, then, with the client's input, limits would be set on the compulsive behaviors. 5. It is important for the nurse to allow the client to express his or her feelings about the obsessions and compulsions. This assessment of feelings should begin at admission. TEST-TAKING HINT: It is important for the test taker to note the words "newly admitted" in the question. The nursing interventions implemented vary and are based on length of stay on the unit, along with client's insight into his or her disorder. For clients with obsessive-compulsive disorder, it is important to understand that the compulsions are used to decrease anxiety. If the compulsions are limited, anxiety increases. Also, the test taker must remember that during treatment it is imperative that the treatment team includes the client in decisions related to any limitation of compulsive behaviors.
A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective? 1. "I understand that the event I experienced, how I deal with it, and my support system all affect my disease process." 2. "I have learned to avoid stressful situations as a way to decrease emotional pain." 3. "So, natural opioid release during the trauma caused my body to become 'addicted.'" 4. "Because of the trauma, I have a negative perception of the world and feel hopeless."
1. When the client verbalizes understanding of how the experienced event, individual traits, and available support systems affect his or her diagnosis, the client demonstrates a good understanding of the psychosocial cause of posttraumatic stress disorder (PTSD). To answer this question correctly, the test taker should review the different theories as they relate to the causes of different anxiety disorders, including PTSD. Only "1" describes a psychosocial etiology of PTSD.
A client is admitted to the psychiatric unit with a diagnosis of conversion disorder. Since witnessing the beating of his wife at gunpoint, he has been unable to move his arms, complaining that they are paralyzed. When planning the client's care, the nurse should focus on:
1. helping the client identify and verbalize feelings about the incident.
Nursing interventions for a patient receiving enoxaparin (Lovenox) may include: (Select all that apply) 1. teaching the patient or family to give subcutaneous injections at home 2. teaching the patient or family not take any OTC drugs without first consulting with the health care provider 3. teaching the patient to observe for unexplained bleeding such as pink, red, or dark brown urine or blood gums 4. teaching the patient to monitor for the development of DVT 5. teaching the importance of drinking grapefruit juice daily
1. teaching the patient or family to give subcutaneous injections at home 2. teaching the patient or family not take any OTC drugs without first consulting with the health care provider 3. teaching the patient to observe for unexplained bleeding such as pink, red, or dark brown urine or blood gums 4. teaching the patient to monitor for the development of DVT
A client diagnosed with generalized anxiety disorder is prescribed paroxetine (Paxil) 30 mg QHS. Paroxetine is supplied as a 20-mg tablet. The nurse would administer ______tablets.
1.5 tablets
510. The nurse is preparing to care for a burn client scheduled for an escharotomy procedure being performed for a third-degree circumferential arm burn. The nurse understands that which finding is the anticipated therapeutic outcome of the escharotomy? 1.Return of distal pulses 2.Brisk bleeding from the site 3.Decreasing edema formation 4.Formation of granulation tissue
1.Return of distal pulses Rationale:Escharotomiesareperformedtorelievethecompartmentsyndromethatcanoccurwhenedemaformsundernondistensibleescharinacircumferentialthird-degreeburn.Escharotomiesareperformedthroughavasculareschartosubcutaneousfat.Althoughbleedingmayoccurfromthesite,itisconsideredacomplicationratherthanananticipatedtherapeuticoutcome.Usually,directpressurewithabulkydressingandelevationcontrolthebleeding,butoccasionallyanarteryisdamagedandmayrequireligation.Escharotomydoesnotaffecttheformationofedema.Formationofgranulationtissueisnottheintentofanescharotomy
The nurse weighs the client who is on an infusion on lactated Ringer's postoperatively and finds that there has been a weight gain of 1.5kg since the previous day. What would be the nurse's next priority? 1. Check with the client to determine whether there have been any dietary changes in the last few days. 2. Assess the client for signs of edema and BP for possible hypertension. 3. Contact dietary to change the client's diet to reduced sodium. 4. Request a diuretic from the client's provider.
2 Rationale: A weight gain of 1 kg (2 lbs) or more may indicate fluid retention. Signs of fluid retention include increased BP and edema. A complete nursing assessment is needed to determined other signs or symptoms that may be present.
Which of the following nursing interventions is most important when caring for a client receiving dextran 40 (Gentran 40)? 1. Assess the patient for deep vein thrombosis. 2. Observe for signs of fluid overload. 3. Encourage fluid intake. 4. Monitor arterial blood gases.
2 Rationale: Dextran 40 (Gentran 40) is a colloidal plasma volume expander that causes fluid to move rapidly from the tissues to vascular spaces. This places the client at risk for fluid overload.
The nurse is instructing a client with COPD how to do pursed-lip breathing. In which order should the nurse explain the steps to the client? 1. "Breathe in normally through your nose for 2 counts (while counting to yourself, one, two)." 2. "Relax your neck and shoulder muscles." 3. "Pucker your lips as if you were going to whistle." 4. "Breathe out slowly through pursed lips for 4 counts (while counting to yourself, one, two, three, four)."
2, 1, 3, 4. The nurse should instruct the client to first relax the neck and shoulders and then take several normal breaths. After taking a breath in, the client should pucker the lips, and finally breathe out through pursed lips.
512.A client is brought to the emergency department with partial thickness burns to his face, neck, arms, and chest after trying to put out a car fire. The nurse should implement which nursing actions for this client? Select all that apply. 1.Restrict fluids. 2.Assess for airway patency. 3.Administer oxygen as prescribed. 4.Place a cooling blanket on the client. 5.Elevate extremities if no fractures are present. 6.Prepare to give oral pain medication as prescribed.
2, 3, 5 2.Assess for airway patency. 3.Administer oxygen as prescribed. 5.Elevate extremities if no fractures are present. Rationale:Theprimarygoalforaburninjuryistomaintainapatentairway,administerIVfluidstopreventhypovolemicshock,andpreservevitalorganfunctioning.Thereforethepriorityactionsaretoassessforairwaypatencyandmaintainapatentairway.Thenursethenpreparestoadministeroxygen.Oxygenisnecessarytoperfusevitaltissuesandorgans.AnIVlineshouldbeobtainedandfluidresuscitationstarted.Theextremitiesareelevatedtoassistinpreventingshock.TheclientiskeptwarmandplacedonNPOstatusbecauseofthealteredgastrointestinalfunctionthatoccursasaresultofaburninjury
The nurse is assessing a client prior to the administration of a diuretic. The nurse knows it is essential to assess which vital signs at this time? Select all that apply. 1. Temperature 2. Pulse 3. Respirations 4. Blood pressure 5. Pain
2,4. The nurse must assess the client's pulse prior to administering a diuretic. The nurse must assess the client's blood pressure prior to administering a diuretic.
Which of the following is an expected outcome for an elderly client following treatment for bacterial pneumonia? 1. A respiratory rate of 25 to 30 breaths/ minute. 2. The ability to perform activities of daily living without dyspnea. 3. A maximum loss of 5 to 10 lb of body weight. 4. Chest pain that is minimized by splinting the rib cage.
2. An expected outcome for a client recovering from pneumonia would be the ability to perform activities of daily living without experiencing dyspnea. A respiratory rate of 25 to 30 breaths/ minute indicates the client is experiencing tachypnea, which would not be expected on recovery. A weight loss of 5 to 10 lb is undesirable; the expected outcome would be to maintain normal weight. A client who is recovering from pneumonia should experience decreased or no chest pain.
When performing postural drainage, which of the following factors promotes the movement of secretions from the lower to the upper respiratory tract? 1. Friction between the cilia. 2. Force of gravity. 3. Sweeping motion of cilia. 4. Involuntary muscle contractions.
2. The principle behind using postural drainage is that gravity will help move secretions from smaller to larger airways. Postural drainage is best used after percussion has loosened secretions. Coughing or suctioning is then used to remove secretions. Movement of cilia is not sufficient to move secretions. Muscle contractions do not move secretions within the lungs.
A client with bacterial pneumonia is to be started on I.V. antibiotics. Which of the following diagnostic tests must be completed before antibiotic therapy begins? 1. Urinalysis. 2. Sputum culture. 3. Chest radiograph. 4. Red blood cell count.
2. A sputum specimen is obtained for culture to determine the causative organism. After the organism is identified, an appropriate antibiotic can be prescribed. Beginning antibiotic therapy before obtaining the sputum specimen may alter the results of the test. Neither a urinalysis, a chest radiograph, nor a red blood cell count needs to be obtained before initiation of antibiotic therapy for pneumonia.
A client with chronic obstructive pulmonary disease (COPD) is experiencing dyspnea and has a low PaO2 level. The nurse plans to administer oxygen as ordered. Which of the following statements is true concerning oxygen administration to a client with COPD? 1. High oxygen concentrations will cause coughing and dyspnea. 2. High oxygen concentrations may inhibit the hypoxic stimulus to breathe. 3. Increased oxygen use will cause the client to become dependent on the oxygen. 4. Administration of oxygen is contraindicated in clients who are using bronchodilators.
2. Clients who have a long history of COPD may retain carbon dioxide (CO2). Gradually the body adjusts to the higher CO2 concentration, and the high levels of CO2 no longer stimulate the respiratory center. The major respiratory stimulant then becomes hypoxemia. Administration of high concentrations of oxygen eliminates this respiratory stimulus and leads to hypoventilation. Oxygen can be drying if it is not humidified, but it does not cause coughing and dyspnea. Increased oxygen use will not create an oxygen dependency; clients should receive oxygen as needed. Oxygen is not contraindicated with the use of bronchodilators.
The nurse reviews an arterial blood gas report for a client with chronic obstructive pulmonary disease (COPD). pH 7.35; PC02 62; PO2 70; HCO3 34 The nurse should: 1. Apply a 100% non-rebreather mask. 2. Assess the vital signs. 3. Reposition the client. 4. Prepare for intubation.
2. Clients with chronic COPD have CO2 retention and the respiratory drive is stimulated when the PO2 decreases. The heart rate, respiratory rate, and blood pressure should be evaluated to determine if the client is hemodynamically stable. Symptoms, such as dyspnea, should also be assessed. Oxygen supplementation, if indicated, should be titrated upward in small increments. There is no indication that the client is experiencing respiratory distress requiring intubation.
When teaching a client with chronic obstructive pulmonary disease to conserve energy, the nurse should teach the client to lift objects: 1. While inhaling through an open mouth. 2. While exhaling through pursed lips. 3. After exhaling but before inhaling. 4. While taking a deep breath and holding it.
2. Exhaling requires less energy than inhaling. Therefore, lifting while exhaling saves energy and reduces perceived dyspnea. Pursing the lips prolongs exhalation and provides the client with more control over breathing. Lifting after exhaling but before inhaling is similar to lifting with the breath held. This should not be recommended because it is similar to the Valsalva maneuver, which can stimulate cardiac arrhythmias.
A client's arterial blood gas values are as follows: pH, 7.31; PaO2, 80 mm Hg; PaCO2, 65 mm Hg; HCO3 −, 36 mEq/ L. The nurse should assess the client for? 1. Cyanosis. 2. Flushed skin. 3. Irritability. 4. Anxiety.
2. The high PaCO2 level causes flushing due to vasodilation. The client also becomes drowsy and lethargic because carbon dioxide has a depressant effect on the central nervous system. Cyanosis is a sign of hypoxia. Irritability and anxiety are not common with a PaCO2 level of 65 mm Hg but are associated with hypoxia.
The nurse should teach the client with asthma that which of the following is one of the most common precipitating factors of an acute asthma attack? 1. Occupational exposure to toxins. 2. Viral respiratory infections. 3. Exposure to cigarette smoke. 4. Exercising in cold temperatures.
2. The most common precipitator of asthma attacks is viral respiratory infection. Clients with asthma should avoid people who have the flu or a cold and should get yearly flu vaccinations. Environmental exposure to toxins or heavy particulate matter can trigger asthma attacks; however, far fewer asthmatics are exposed to such toxins than are exposed to viruses. Cigarette smoke can also trigger asthma attacks, but to a lesser extent than viral respiratory infections. Some asthmatic attacks are triggered by exercising in cold weather.
A client with borderline personality disorder tells the nurse, "You're the only nurse who really understands me. The others are mean." The client then asks the nurse for an extra dose of antianxiety medication because of increased anxiety. How should the nurse respond?
2. ""I'll have to discuss your request with the team. Can we talk about how you're feeling right now?""
When treating individuals with posttraumatic stress disorder, which variables are included in the recovery environment? 1. Degree of ego strength. 2. Availability of social supports. 3. Severity and duration of the stressor. 4. Amount of control over reoccurrence.
2. Availability of social supports is part of environmental variables. Others include cohesiveness and protectiveness of family and friends, attitudes of society regarding the experience, and cultural and subcultural influences. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the following three significant elements in the development of posttraumatic stress disorder: traumatic experience, individual variables, and environmental variables.
The patient receiving heparin therapy asks how the "blood thinner" works. The best response by the nurse would be: 1. "heparin makes the blood less thick" 2. "heparin does not thin the blood but prevents clots from forming as easily in the blood vessels" 3. "heparin decreases the number of platelets so that blood clots more slowly" 4. "heparin dissolves the clot"
2. "heparin does not thin the blood but prevents clots form forming as easily in the blood vessels"
Which of the following assessment data would support the disorder of acrophobia? 1. A client is fearful of basements because of encountering spiders. 2. A client refuses to go to Europe because of fear of flying. 3. A client is unable to commit to marriage after a 10-year engagement. 4. A client refuses to leave home during stormy weather.
2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be unable to fly because of this fear. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the definitions of specific commonly diagnosed phobias.
The nurse planning teaching for a client taking acetazolamide (Diamox) will include which instruction? 1. "Limit intake of foods high in potassium, such as peaches." 2. "Drink 1 to 2.5 quarts of fluids daily." 3. "Report signs of hypokalemia, such as vomiting and diarrhea." 4. "Weigh yourself daily, and report a weight gain of 1 pound or more in 24 hours."
2. An adequate fluid intake is necessary to prevent formation of renal calculi (kidney stone), which are an adverse effect of acetazolamide (Diamox).
A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? 1. Elopement precautions. 2. Suicide precautions. 3. Homicide precautions. 4. Fall precautions.
2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions. TEST-TAKING HINT: To answer this question correctly, the test taker should note the words "hopelessness" and "helplessness," which would be indications of suicidal ideations that warrant suicide precautions.
A client with chronic renal failure has been taking hydrochlorothiazide (HCTZ). He has gained 4 pounds in the past 24 hours. The nurse anticipates that he will receive which diuretic? 1. Triamterene (Dyrenium) 2. Ethacrynic acid (Edecrin) 3. Mannitol (Osmitrol) 4. Hydrochlorothiazide (HCTZ)
2. As a loop diuretic, ethacrynic acid can produce significant diuresis in the presence of renal failure.
The nurse informs a patient taking benzocaine for a minor skin irritation that benzocaine: 1. Cannot be used for sunburns 2. Should not be used on open lesions 3. Causes blisters 4. Can be used on open sores
2. Should not be used on open lesions
c. Administer a beta2 adrenergic agonist.
A client with a history of asthma is short of breath and says, "I feel like I'm having an asthmatic attack." What is the nurse's best action? a. Call a code. b. Ask the client to describe the symptoms. c. Administer a beta2 adrenergic agonist. d. Administer a long-acting glucocorticoid.
In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.
2. Benzodiazepines are prescribed for shortterm treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative sedation. TEST-TAKING HINT: The test taker needs to note the words "long-term" and "short-term" in the answers. Benzodiazepines are prescribed in the short-term because of their addictive properties. The test taker must understand that when taking a test, if one part of the answer is incorrect, the whole answer is incorrect, as in answer choice "3."
The nurse caring for a client receiving chlorothiazide (Diuril) recognizes which assessment findings as indicating that the client is experiencing side effects of this medication? 1. Ataxia and diarrhea 2. Serum potassium 3.0 mEq/L and blood pressure 88/60 mmHg 3. Serum sodium 170 mEq/L and headaches 4. Mental confusion and dependent edema
2. Chlorothiazide (Diuril) causes side effects of hypokalemia and hypotension.
A physician's order states to administer lorazepam (Ativan), 20 mg by mouth twice per day, to treat anxiety. How should the nurse proceed?
2. Clarify the order with the prescribing physician because the amount prescribed exceeds the recommended dose.
A client in a psychiatric facility is prescribed escitalopram (Lexapro) for anxiety. She tells the nurse that she has been having "weird dreams" and feelings of wanting to "end it all." What action should the nurse take?
2. Consult a pharmacist to see if these symptoms are adverse effects of the drug.
"After months of coaxing by her husband, a client comes to the mental health clinic. She reports that she suffers from an overwhelming fear of leaving her house. This overwhelming fear has caused the client to lose her job and is beginning to take a toll on her marriage. The physician diagnoses the client with agoraphobia. Which treatment options are effective in treating this disorder?
2. Desensitization 3. Alprazolam (Xanax) therapy 4. Paroxetine (Paxil) therapy
The nurse is using an intrapersonal approach to assist a client in dealing with survivor's guilt. Which intervention would be appropriate? 1. Encourage the client to attend a survivor's group. 2. Encourage expression of feelings during one-to-one interactions with the nurse. 3. Ask the client to challenge the irrational beliefs associated with the event. 4. Administer regularly scheduled paroxetine (Paxil) to deal with depressive symptoms.
2. Encouraging expressions of feelings during one-to-one interactions with the nurse is an intrapersonal approach to interventions that treat survivor's guilt associated with PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker needs to differentiate various theoretical approaches and which interventions reflect these theories.
A client diagnosed with obsessive-compulsive disorder is newly admitted to an inpatient psychiatric unit. Which cognitive symptom would the nurse expect to assess? 1. Compulsive behaviors that occupy more than 4 hours per day. 2. Excessive worrying about germs and illness. 3. Comorbid abuse of alcohol to decrease anxiety. 4. Excessive sweating and an increase in blood pressure and pulse.
2. Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD. TEST-TAKING HINT: To answer this question correctly, the test taker must note the keyword "cognitive." Only "2" is a cognitive symptom.
The nurse is preparing to administer furosemide (Lasix) 40 mg IV to a client on complete bed rest who has renal failure and pulmonary edema. Which action is most appropriate prior to administering furosemide (Lasix) to this client? 1. Measure the client's urine output. 2. Monitor apical heart rate and rhythm. 3. Auscultate bowel sounds. 4. Lower the head of the bed.
2. Furosemide (Lasix) can cause a decrease in serum potassium and precipitate cardiac dysrhythmias.
A client is diagnosed with obsessive-compulsive disorder. Which intervention should the nurse include when assisting with development of the plan of care?
2. Giving the client adequate time to perform rituals
A client is taking acetazolamide (Diamox) to treat absence seizures. Which finding indicates that the next dose of this drug should be withheld? 1. Elevated serum pH 2. Decreased serum potassium 3. Increased seizure frequency 4. Nausea and dizziness
2. Hypokalemia is a serious adverse effect of acetazolamide (Diamox).
A client diagnosed with obsessive-compulsive disorder has been hospitalized for the last 4 days. Which intervention would be a priority at this time? 1. Notify the client of the expected limitations on compulsive behaviors. 2. Reinforce the use of learned relaxation techniques. 3. Allow the client the time needed to complete the compulsive behaviors. 4. Say "stop" to the client as a thought-stopping technique.
2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that nursing interventions should be based on timeframes appropriate to the expressed symptoms and severity of the client's disorder. The length of hospitalization also must be considered in planning these interventions. The average stay on an in-patient psychiatric unit is 5 to 7 days.
During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority? 1. Teach the client relaxation techniques. 2. Ask the client, "Do you have a plan to commit suicide?" 3. Call the physician to obtain a PRN order for an anxiolytic medication. 4. Encourage the client to participate in group activities.
2. It is important for the nurse to ask the client about a potential plan for suicide to intervene in a timely manner. Clients who have developed suicide plans are at higher risk than clients who may have vague suicidal thoughts. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the importance of assessing the plan for suicide. Interventions would differ depending on the client's plan. The intervention for a plan to use a gun at home would differ from an intervention for a plan to hang oneself during hospitalization.
A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movements.
2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremor. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the signs and symptoms of serotonin syndrome and which psychotropic medications affect serotonin, potentially leading to this syndrome.
Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine need for additional buspirone (BuSpar) PRN. 4. Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.
2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that buspirone (BuSpar) has a delayed onset of action, which can affect medication compliance. If the effects of the medication are delayed, the client is likely to stop taking the medication. Teaching about delayed onset is an important nursing intervention.
Some patients with acne may need medications that promote the shedding of old skin. These medications are known as: 1. Pediculicides 2. Keratolytic agents 3. Retinoids 4. Corticosteroids
2. Keratolytic agents
A patient with rosacea is being seen at the doctor's office with concerns about her skin. She has been trying to deal with her condition by using over-the-counter medications, but they seemed to have made her condition worse. The nurse understands the patient may need: 1. Calcipotriene (Dovonex) 2. Metronidazole (Metrogel) 3. Acitretin (Soriatane) 4. Cyclosporine (Sandimmune, Neoral)
2. Metronidazole (Metrogel)
(SELECT ALL THAT APPLY) After receiving a referral from the occupational health nurse, a client comes to the mental health clinic with a suspected diagnosis of obsessive-compulsive disorder. The client explains that his compulsion to wash his hands is interfering with his job. Which interventions are appropriate when caring for a client with this disorder?
2. Support the use of appropriate defense mechanisms. 4. Explore the patterns leading to the compulsive behavior. 6. Encourage activities, such as listening to music."
A client experiencing a panic attack would display which physical symptom? 1. Fear of dying. 2. Sweating and palpitations. 3. Depersonalization. 4. Restlessness and pacing.
2. Sweating and palpitations are physical symptoms of a panic attack. TEST-TAKING HINT: The test taker must note important words in the question, such as "physical symptoms." Although all the answers are actual symptoms a client experiences during a panic attack, only "2" is a physical symptom.
42. The unlicensed assistive personnel (UAP) is attempting to put an oral airway in the mouth of a client having a tonic-clonic seizure. Which action should the primary nurse take? 1. Help the UAP to insert the oral airway in the mouth. 2. Tell the UAP to stop trying to insert anything in the mouth. 3. Take no action because the UAP is handling the situation. 4. Notify the charge nurse of the situation immediately.
2. The nurse should tell the UAP to stop trying to insert anything in the mouth of the client experiencing a seizure. Broken teeth and injury to the lips and tongue may result from trying to place anything in the clenched jaws of a client having a tonic-clonic seizure.
An older adult reports ringing in the ears while the nurse is administering a dose of ethacrynic acid (Edecrin) intravenously. The priority intervention for this client is to: 1. Schedule a hearing test. 2. Stop infusion of the drug and notify the prescriber. 3. Question the client about recent history of hearing loss. 4. Review the client's fluid intake and assess fluid status.
2. Tinnitus can be an early sign of hearing loss as an adverse effect of potassium-sparing drugs, which is more common with IV administration of ethacrynic acid (Edecrin).
A client diagnosed as having panic disorder with agoraphobia is admitted to the inpatient psychiatric unit. Until her admission, she had been a virtual prisoner in her home for 5 weeks, afraid to go outside even to buy food. When planning care for this client, what is the nurse's overall goal?
2. To help the client function effectively in her environment
The nurse is providing information at a high school health fair. Many of the students ask for information on acne treatment. The nurse tells them that ___________ is available but it is extremely important that women who are pregnant should not take this medication. 1. Hydrocortisone 2. Tretinoin 3. Benzoyl peroxide 4. Benzocaine
2. Tretinoin
The nurse administers a dose of hydrochlorothiazide (HCTZ) to a client who needs assistance walking and plans to assist the client to the bathroom in approximately: 1. 1 hour. 2. 2 hours. 3. 6 hours. 4. 30 minutes.
2. Two hours is the time following administration of the drug when the onset of action occurs, and this client will likely need assistance to the bathroom.
A nurse has been providing care to the same group of clients for 4 consecutive days. On day 5, she sees that her assignment has changed, and she is concerned about the continuity of care for these clients. What should the nurse do?
2. Voice her concerns about continuity of care with the charge nurse.
During a shift report, the nurse learns that she will be providing care for a client who's vulnerable to panic attacks. Treatment for panic attacks includes behavioral therapy, supportive psychotherapy, and medication such as
2. antianxiety drugs.
The nurse is collecting data on a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:
2. diarrhea
Initial interventions for the client with acute anxiety include:
2. encouraging the client to verbalize feelings and concerns.
A client with a conversion disorder reports blindness, and ophthalmologic examinations reveal that no physiologic disorder is causing progressive vision loss. The most likely source of this client's reported blindness is:
2. having been forced to watch a loved one's torture.
While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client may expect the resident to prescribe:
2. lorazepam (Ativan).
A client with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:
2. severe anxiety and fear.
A patient has started clopidogrel (Plavix) after experiencing a TIA (transient ischemic attack). The desired therapeutic effects of this drug will be: 1. anti-inflammatory and antipyretic effects 2. to reduce the risk of a stroke from a blood clot 3. analgesic as well as clot-dissolving effects 4. to stop clots from becoming emboli.
2. to reduce the risk of a stroke from a blood clot Rationale: Antiplatelet drugs such as clopidogerel are given to inhibit platelet aggreagtion and thus reduce the risk of thrombus formation. Antiplatelet drugs do no exert antiinflammatory, antipyretic or analgesic effects. The antiplatelet and anticoagulant drugs do not prevent emboli formation. Thrombolytics dissolve existing blood clots.
A client is taking a diuretic for the treatment of congestive heart failure. The nurse teaches the client the importance of daily weights and knows the client understands the instruction when he states, "I will report a weight gain or loss of _____ pounds in a 24-hour period."
2.2. The client should report a weight gain or loss of over 1 kg (2.2 lb) in a 24-hour period.
516.The nurse is administering fluids intravenously as prescribed to a client who sustained superficial partial-thickness burn injuries of the back and legs. In evaluating the adequacy of fluid resuscitation, the nurse understands that which assessment would provide the most reliable indicator for determining the adequacy? 1.Vital signs 2.Urine output 3.Mental status 4.Peripheral pulse
2.Urine output Rationale:Successfuloradequatefluidresuscitationintheclientissignaledbystablevitalsigns,adequateurineoutput,palpableperipheralpulses,andclearsensorium.However,themostreliableindicatorfordeterminingadequacyoffluidresuscitationistheurineoutput.Foranadult,thehourlyurinevolumeshouldbe30to50mL
A client is receiving intravenous sodium bicarbonate for treatment of metabolic acidosis. During this infusion, how will the nurse monitor for therapeutic effect? 1. Blood urea nitrogen (BUN) 2. WBC counts 3. Serum pH 4. Renal function laboratory values
3 Rationale: Sodium bicarbonate may be given in conditions of metabolic acidosis to correct the pH levels to a normal range.
A client with be sent home on diuretic therapy and has a prescription for liquid potassium chloride (KCl). What teaching will the nurse provide before the client goes home? 1. Do not dilute the solution with water or juice; drink the solution straight. 2. Increase the use of salt substitutes; they also contain potassium. 3. Report any weakness, fatigue, or lethargy immediately. 4. Take the medication immediately before bed to prevent heartburn.
3 Rationale: Weakness, fatigue, lethargy, and anorexia are symptoms or hypokalemia. Because this client is taking potassium supplements to replace potassium lost during diuresis, the dosage may need to be adjusted to ensure adequate replacement.
The nurse is caring for clients on a renal failure unit and recognizes which of the following as indications for diuretic therapy? Select all that apply. 1. Confusion and ataxia 2. Visual and auditory hallucinations 3. Blood pressure of 200/98 mm/Hg 4. Generalized edema and decreased urine output 5. Pinpoint pupils and extreme paranoia
3,4. Hypertension is an indication for diuretic therapy. These are signs of renal failure and edema, which are indications for diuretic therapy.
The nurse is instructing a client on the importance of eating foods rich in potassium while taking a diuretic that causes hypokalemia. Which diuretics do not require potassium supplements? Select all that apply. 1. Furosemide (Lasix) 2. Chlorothiazide (Diuril) 3. Amiloride (Midamor) 4. Mannitol (Osmitrol) 5. Spironolactone (Aldactone)
3,5. Amiloride (Midamor) is a potassium-sparing diuretic; therefore, clients do not need to eat foods high in potassium or take a potassium supplement while on this medication. Spironolactone (Aldactone) is a potassium-sparing diuretic. Clients on this medication are not required to eat foods high in potassium or take a potassium supplement.
Which of the following mental status changes may occur when a client with pneumonia is first experiencing hypoxia? 1. Coma. 2. Apathy. 3. Irritability. 4. Depression.
3. Clients who are experiencing hypoxia characteristically exhibit irritability, restlessness, or anxiety as initial mental status changes. As the hypoxia becomes more pronounced, the client may become confused and combative. Coma is a late clinical manifestation of hypoxia. Apathy and depression are not symptoms of hypoxia.
A client with pneumonia has a temperature of 102.6 ° F (39.2 ° C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care? 1. Position changes every 4 hours. 2. Nasotracheal suctioning to clear secretions. 3. Frequent linen changes 4. Frequent offering of a bedpan.
3. Frequent linen changes are appropriate for this client because of the diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client's productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario.
When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which of the following laboratory values? 1. Serum sodium. 2. Serum potassium. 3. Serum creatinine. 4. Serum calcium.
3. It is essential to monitor serum creatinine in the client receiving an aminoglycoside antibiotic because of the potential of this type of drug to cause acute tubular necrosis. Aminoglycoside antibiotics do not affect serum sodium, potassium, or calcium levels.
The nurse teaches a client with chronic obstructive pulmonary disease (COPD) to assess for signs and symptoms of right-sided heart failure. Which of the following signs and symptoms should be included in the teaching plan? 1. Clubbing of nail beds. 2. Hypertension. 3. Peripheral edema. 4. Increased appetite.
3. Right-sided heart failure is a complication of COPD that occurs because of pulmonary hypertension. Signs and symptoms of right-sided heart failure include peripheral edema, jugular venous distention, hepatomegaly, and weight gain due to increased fluid volume. Clubbing of nail beds is associated with conditions of chronic hypoxemia. Hypertension is associated with left-sided heart failure. Clients with heart failure have decreased appetites.
A client with pneumonia is experiencing pleuritic chest pain. The nurse should assess the client for: 1. A mild but constant aching in the chest. 2. Severe midsternal pain. 3. Moderate pain that worsens on inspiration. 4. Muscle spasm pain that accompanies coughing.
3. Chest pain in pneumonia is generally caused by friction between the pleural layers. It is more severe on inspiration than on expiration, secondary to chest wall movement. Pleuritic chest pain is usually described as sharp, not mild or aching. Pleuritic chest pain is not localized to the sternum, and it is not the result of a muscle spasm.
A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? 1. Promote bronchodilation. 2. Act as an expectorant. 3. Have an anti-inflammatory effect. 4. Prevent development of respiratory infections.
3. Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion. Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.
A nurse notes that a client has kyphosis and generalized muscle atrophy. Which of the following problems is a priority when the nurse develops a nursing plan of care? 1. Infection. 2. Confusion. 3. Ineffective coughing and deep breathing. 4. Difficulty chewing solid foods.
3. In kyphosis, the thoracic spine bends forward with convexity of the curve in a posterior direction, making effective coughing and deep breathing difficult. Although the client may develop other problems because respiratory status deteriorates when pulmonary secretions are not adequately cleared from airways, ineffective coughing and deep breathing should receive priority attention.
The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate? 1. Suppression of the client's respiratory infection. 2. Decrease in bronchial secretions. 3. Relaxation of bronchial smooth muscle. 4. Thinning of tenacious, purulent sputum.
3. Theophylline (Theo-Dur) is a bronchodilator that is administered to relax airways and decrease dyspnea. Theophylline is not used to treat infections and does not decrease or thin secretions.
A client who has been taking flunisolide (AeroBid), two inhalations a day, for treatment of asthma.has painful, white patches in his mouth. Which response by the nurse would be most appropriate? 1. "This is an anticipated adverse effect of your medication. It should go away in a couple of weeks." 2. "You are using your inhaler too much and it has irritated your mouth." 3. "You have developed a fungal infection from your medication. It will need to be treated with an antifungal agent." 4. "Be sure to brush your teeth and floss daily. Good oral hygiene will treat this problem."
3. Use of oral inhalant corticosteroids such as flunisolide (AeroBid) can lead to the development of oral thrush, a fungal infection. Once developed, thrush must be treated by antifungal therapy; it will not resolve on its own. Fungal infections can develop even without overuse of the corticosteroid inhaler. Although good oral hygiene can help prevent development of a fungal infection, it cannot be used alone to treat the problem.
A woman, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. The client asks the nurse, "Why has this happened to me?" What is the most appropriate response?
3. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."
A client is undergoing treatment for an anxiety disorder. Such a disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least:
3. 6 months
48. The nurse educator is presenting an in-service on seizures. Which disease process is the leading cause of seizures in the elderly? 1. Alzheimer's disease. 2. Parkinson's disease. 3. Cerebral vascular accident (stroke). 4. Brain atrophy due to aging.
3. A CVA (stroke) is the leading cause of seizures in the elderly; increased intracranial pressure associated with the stroke can lead to seizures.
Which client would the charge nurse assign to an agency nurse who is new to a psychiatric setting? 1. A client diagnosed with posttraumatic stress disorder currently experiencing flashbacks. 2. A newly admitted client diagnosed with generalized anxiety disorder beginning benzodiazepines for the first time. 3. A client admitted 4 days ago with the diagnosis of algophobia. 4. A newly admitted client with obsessive-compulsive disorder.
3. A client admitted 4 days ago with a diagnosis of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a nurse unfamiliar with psychiatric clients. TEST-TAKING HINT: To answer this question correctly, the test taker needs to recognize the complexity of psychiatric diagnoses and understand the ramifications of potentially inappropriate nursing interventions by inexperienced staff members.
The nurse has received evening report. Which client would the nurse need to assess first? 1. A newly admitted client with a history of panic attacks. 2. A client who slept 2 to 3 hours last night because of flashbacks. 3. A client pacing the halls and stating that his anxiety is an 8/10. 4. A client diagnosed with generalized anxiety disorder awaiting discharge.
3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others. TEST-TAKING HINT: When the nurse is prioritizing client assessments, it is important to note which client might be a safety risk. When asked to prioritize, the test taker must review all the situations presented before deciding which one to address first.
A client has severe protein malnutrition and is taking a drug that is 99% bound to albumin. What alteration in the concentration of this drug in the urinary filtrate will occur? 1. An increase in the amount of drug actively secreted across the walls of the renal tubule 2. A decrease in the amount of drug reabsorbed across the walls of the renal tubule 3. An increase in the amount of drug filtered into Bowman's capsule 4. An increase in the amount of drug passively secreted across the walls of the renal tubule
3. A decrease in albumin concentration increases the proportion of free drug in the plasma available to be filtered into Bowman's capsule.
44. The client is admitted to the intensive care department (ICD) experiencing status epilepticus. Which collaborative intervention should the nurse anticipate? 1. Assess the client's neurological status every hour. 2. Monitor the client's heart rhythm via telemetry. 3. Administer an anticonvulsant medication by intravenous push. 4. Prepare to administer a glucocorticosteroid orally.
3. Administering an anticonvulsant medication by intravenous push requires the nurse to have an order or confer with another member of the health-care team.
A patient is receiving a thrombolytic agent, alteplase (Activase), follwing an acute myocardial infraction. Which condition is most likely attributed to thrombolytic therapy with this agent? 1. Skin rash with urticaria 2. Wheezing with labored respirations 3. Brusing and epistaxis 4. Temperature elevation of 100.8F
3. Bruising and epistaxis Rationale: Thrombolytic agents dissolve existing clots rapidly and continue to have effects for 2 to 4 days. All forms of bleeding must be monitored and reported immediately. Skin rash with urticara, wheezing with labored respirations, and temperature elevation of 100.8F are not symptoms of adverse effects directly attributed to thrombolytic therapy.
A client receiving bumetanide (Bumex) asks the nurse, "What is all this about 'loops' in my medicine?" The nurse's best response is: 1. "This medication reabsorbs potassium in Henle's loop in your kidney." 2. "This medication blocks sodium reabsorption in what is known as Bowman's capsule." 3. "This is a loop diuretic, which refers to the location where it acts in your kidneys." 4. "This is a loop diuretic, which means it works in the proximal tubule of your kidney."
3. Bumetanide (Bumex) promotes sodium loss at Henle's loop, which leads to diuresis.
A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam (Klonopin) is to be used for long-term therapy in conjunction with buspirone (BuSpar). 2. The client verbalizes that buspirone (BuSpar) can cause sedation and should be taken at night. 3. The client verbalizes that clonazepam (Klonopin) is to be used short-term until the buspirone (BuSpar) takes full effect. 4. The client verbalizes that tolerance can result with long-term use of buspirone (BuSpar).
3. Clonazepam would be used for shortterm treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks. TEST-TAKING HINT: To answer this question correctly, the test taker must note appropriate teaching needs for clients prescribed different classifications of antianxiety medications.
The nurse is assessing a client receiving chlorothiazide (Diuril), and recognizes which assessment findings as indications of hypokalemia? 1. Confusion and decreased urine output 2. General irritability and increased urine output 3. Muscle weakness or cramps 4. Diarrhea and projectile vomiting
3. Confusion might accompany hypokalemia, but decreased urine output is not a sign of hypokalemia. Neither general irritability nor increased urine output is a sign of hypokalemia. Muscle weakness and cramps are indicators of hypokalemia.
A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess? 1. Recurrent, distressing flashbacks. 2. Intense fear, helplessness, and horror. 3. Diminished participation in significant activities. 4. Detachment or estrangement from others.
3. Diminished participation in significant activities is a behavioral symptom of PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker should take note of the keyword "behavioral," which determines the correct answer. All symptoms may be exhibited in PTSD, but only answer choice "3" is a behavioral symptom.
A client enters the crisis unit complaining of increased stress from her studies as a medical student. She states that she has been increasingly anxious for the past month. Her physician prescribes alprazolam (Xanax), 25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when given concomitantly with alprazolam?
3. Diphenhydramine (Benadryl)
41. The client who just had a three (3)-minute seizure has no apparent injuries and is oriented to name, place, and time but is very lethargic and just wants to sleep. Which intervention should the nurse implement? 1. Perform a complete neurological assessment. 2. Awaken the client every 30 minutes. 3. Turn the client to the side and allow the client to sleep. 4. Interview the client to find out what caused the seizure.
3. During the postictal (after-seizure) phase, the client is very tired and should be allowed to rest quietly; placing the client on the side will help prevent aspiration and maintain a patent airway.
A client diagnosed with social phobia has an outcome that states, "Client will voluntarily participate in group activities with peers by day 3." Which would be an appropriate intrapersonal intervention by the nurse to assist the client to achieve this outcome? 1. Offer PRN lorazepam (Ativan) 1 hour before group begins. 2. Attend group with client to assist in decreasing anxiety. 3. Encourage discussion about fears related to socialization. 4. Role-play scenarios that may occur in group to decrease anxiety.
3. Encouraging discussion about fears is an intrapersonal intervention. TEST-TAKING HINT: It is important to understand that interventions are based on theories of causation. In this question, the test taker needs to know that intrapersonal theory relates to feelings or developmental issues. Only "3" deals with client feelings.
A nurse observes a medical student walk into a client's room and begin questioning her about her current health status. The client appears reluctant to respond. How should the nurse intervene?
3. Explain to the client that she has the right to refuse to answer questions asked by the medical student.
Which assessment data would support a physician's diagnosis of an anxiety disorder in a client? 1. A client experiences severe levels of anxiety in one area of functioning. 2. A client experiences an increased level of anxiety in one area of functioning for a 6-month period. 3. A client experiences increased levels of anxiety that affect functioning in more than one area of life over a 6-month period. 4. A client experiences increased levels of anxiety that affect functioning in at least three areas of life.
3. For a client to be diagnosed with an anxiety disorder, the client must experience symptoms that interfere in a minimum of two areas, such as social, occupational, or other important functioning. These symptoms must be experienced for durations of 6 months or longer. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that specific symptoms must be exhibited and specific timeframes achieved for clients to be diagnosed with anxiety disorders.
The nurse is caring for a client with a brain tumor who has received mannitol (Osmitrol) IV. Which laboratory finding represents a potential adverse effect of this drug? 1. Serum cholesterol 300 mg/dL 2. Serum albumin 29 mg/dL 3. Serum sodium 104 mEq/L 4. Serum amylase 820 mg/dL
3. Hyponatremia is a common adverse effect of mannitol (Osmitrol).
The nurse has been teaching a client about spironolactone (Aldactone), and recognizes which statement as an indication that the client needs further teaching about this drug? 1. "I am really happy that I can have my cranberry juice." 2. "I am relieved that I do not have to give up my cabbage and mushrooms." 3. "Thank goodness I can still have my orange juice and bananas for breakfast." 4. "I need an apple a day to stay regular. I am glad I can still have this."
3. Orange juice and bananas are rich in potassium and should be avoided by persons taking spironolactone (Aldactone), which is a potassium-sparing diuretic.
A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct? 1. The client is exhibiting signs and symptoms of an exacerbation of generalized anxiety disorder. 2. The client's signs and symptoms are due to an underlying medical condition. 3. A physical examination is needed to determine the etiology of the client's problem. 4. The client's anxiolytic dosage needs to be increased.
3. Physical problems should be ruled out before determining a psychological cause for this client's symptoms. TEST-TAKING HINT: The test taker needs to remember that although a client may have a history of a psychiatric illness, a complete, thorough evaluation must be done before assuming exhibited symptoms are related to the psychiatric diagnosis. Many medical conditions generate anxiety as a symptom.
A client with chronic renal failure receiving hydrochlorothiazide (HCTZ) asks the nurse what the best fluid to drink to avoid dehydration is. What is the best response by the nurse? 1. "Iced tea or coffee is good." 2. "You may drink alcohol in moderation." 3. "Plain water is best." 4. "Electrolyte-replacement fluids like Gatorade are excellent."
3. Plain water is the preferred fluid for avoiding dehydration.
The health care provider has ordered hydrochlorothiazide (HCTZ) for a client in chronic renal failure. The nurse suspects the client is experiencing an ineffective response to the medication. Which adverse effect would be the most significant? 1. Hyponatremia 2. Excessive skin moisture 3. Rales 4. Hypertension
3. Rales can represent pulmonary edema, which is a life-threatening complication of chronic renal failure and fluid retention.
A client seen in an out-patient clinic for ongoing management of panic attacks states, "I have to make myself come to these appointments. It is hard because I don't know when an attack will occur." Which nursing diagnosis takes priority? 1. Ineffective breathing patterns R /T hyperventilation. 2. Impaired spontaneous ventilation R /T panic levels of anxiety. 3. Social isolation R /T fear of spontaneous panic attacks. 4. Knowledge deficit R /T triggers for panic attacks.
3. Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses anticipatory fear of unexpected attacks, which affects the client's ability to interact with others. TEST-TAKING HINT: To answer this question correctly, the test taker must link the behaviors presented in the question with the nursing diagnosis that is reflective of these behaviors. The test taker must remember the importance of time-wise interventions. Nursing interventions differ according to the degree of anxiety the client is experiencing. If the client were currently experiencing a panic attack, other interventions would be appropriate.
46. Which statement by the female client indicates that the client understands factors that may precipitate seizure activity? 1. "It is all right for me to drink coffee for breakfast." 2. "My menstrual cycle will not affect my seizure disorder." 3. "I am going to take a class in stress management." 4. "I should wear dark glasses when I am out in the sun."
3. Tension states, such as anxiety and frustration, induce seizures in some clients, so stress management may be helpful in preventing seizures.
A client diagnosed with posttraumatic stress disorder has a nursing diagnosis of disturbed sleep patterns R /T nightmares. Which evaluation would indicate that the stated nursing diagnosis was resolved? 1. The client expresses feelings about the nightmares during group. 2. The client asks for PRN trazodone (Desyrel) before bed to fall asleep. 3. The client states that the client feels rested when awakening and denies nightmares. 4. The client avoids napping during the day to help enhance sleep.
3. The client's feeling rested on awakening and denying nightmares are the evaluation data needed to support the fact that the nursing diagnosis of disturbed sleep patterns R/T nightmares has been resolved. TEST-TAKING HINT: To answer this question correctly, the test taker needs to discern evaluation data that indicate problem resolution. Answers "1," "2," and "4" all are interventions to assist in resolving the stated nursing diagnosis, not evaluation data that indicate problem resolution.
39. The client is scheduled for an electroencephalogram (EEG) to help diagnose a seizure disorder. Which preprocedure teaching should the nurse implement? 1. Tell the client to take any routine antiseizure medication prior to the EEG. 2. Tell the client not to eat anything for eight (8) hours prior to the procedure. 3. Instruct the client to stay awake for 24 hours prior to the EEG. 4. Explain to the client that there will be some discomfort during the procedure.
3. The goal is for the client to have a seizure during the EEG. Sleep deprivation, hyperventilating, or flashing lights may induce a seizure.
Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder? 1. Encourage the client to evaluate the power of distorted thinking. 2. Ask the client to include his or her family in scheduled therapy sessions. 3. Discuss the overuse of ego defense mechanisms and their impact on anxiety. 4. Teach the client about the effect of blood lactate level as it relates to the client's panic attacks.
3. The nurse discussing the overuse of ego defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder. TEST-TAKING HINT: When answering this question, the test taker must be able to differentiate among various theoretical perspectives and their related interventions.
Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism? 1. Suppression. 2. Repression. 3. Undoing. 4. Denial.
3. Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the underlying reasons for the ritualistic behaviors used by individuals diagnosed with OCD.
A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. The nurse notices that the client's hair is thinning and the skin on the forehead is irritated — possible effects of this ritual. When planning the client's care, the nurse should assign highest priority to:
3. setting consistent limits on the ritualistic behavior if it harms the client or others.
The nurse is caring for a client experiencing an anxiety attack. Appropriate nursing interventions include:
3. staying with the client and speaking in short sentences.
509. An adult client was burned in an explosion. The burn initially affected the client's entire face (anterior half of the head) and the upper half of the anterior torso, and there were circumferential burns to the lower half of both arms. The client's clothes caught on fire, and the client ran, causing subsequent burn injuries to the posterior surface of the head and the upper half of the posterior torso. Using the rule of nines, what would be the extent of the burn injury? 1.18% 2.24% 3.36% 4.48%
3.36% Rationale:Accordingtotheruleofnines,withtheinitialburn,theanteriorhalfoftheheadequals4.5%,theupperhalfoftheanteriortorsoequals9%,andthelowerhalfofbotharmsequals9%.Thesubsequentburnincludedtheposteriorhalfofhead,equaling4.5%,andtheupperhalfofposteriortorso,equaling9%.Thistotals36%
518.The nurse is caring for a client following an autograft and grafting to a burn wound on the right knee. What would the nurse anticipate to be prescribed for the client? 1.Out-of-bed activities 2.Bathroom privileges 3.Immobilization of the affected leg 4.Placing the affected leg in a dependent position
3.Immobilization of the affected leg Rationale:Autograftsplacedoverjointsoronthelowerextremitiesaftersurgeryoftenareelevatedandimmobilizedfor3to7days.Thisperiodofimmobilizationallowstheautografttimetoadheretothewoundbed.Options1,2,and4areincorrect
511. A client is undergoing fluid replacement after being burned on 20% of her body 12 hours ago. The nursing assessment reveals a blood pressure of 90/50mmHg, a pulse rate of 110 beats/minute, and a urine output of 20mL over the past hour. The nurse reports the findings to the healthcare provider (HCP) and anticipates which prescription? 1.Transfusing 1 unit of packed red blood cells 2.Administering a diuretic to increase urine output 3.Increasing the amount of intravenous (IV) lactated Ringer's solution administered per hour 4.Changing the IV lactated Ringer's solution to one that contains dextrose in water
3.Increasing the amount of intravenous (IV) lactated Ringer's solution administered per hour Rationale:Fluidmanagementduringthefirst24hoursfollowingaburninjurygenerallyincludestheinfusionof(usually)lactatedRinger'ssolution.Fluidresuscitationisdeterminedbyurineoutputandhourlyurineoutputshouldbeatleast30mL/hour.Theclient'surineoutputisindicativeofinsufficientfluidresuscitation,whichplacestheclientatriskforinadequateperfusionofthebrain,heart,kidneys,andotherbodyorgans.ThereforetheHCPwouldprescribeanincreaseintheamountofIVlactatedRinger'ssolutionadministeredperhour.Bloodreplacementisnotusedforfluidtherapyforburninjuries.Administeringadiureticwouldnotcorrecttheproblembecauseitwouldnotreplaceneededfluid.Diureticspromotetheremovalofthecirculatingvolume,therebyfurthercompromisingtheinadequatetissueperfusion.Dextroseinwaterisanisotonicsolution,andanisotonicsolutionmaintainsfluidbalance.Thistypeofsolutionmaybeadministeredafterthefirst24hoursfollowingtheburninjury,dependingontheclient's psychological needs.
Which of the following is among the first-choice drugs used for allergic rhinitis? A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Sympathomimetics C. Glucocorticoids D. Cytokines
C. Glucocorticoids
517. The nurse manager is observing a new nursing graduate caring for a burn client in protective isolation. The nurse manager intervenes if the new nursing graduate planned to implement which unsafe component of protective isolation technique? 1.Using sterile sheets and linens 2.Performing strict hand washing technique 3.Wearing gloves and a gown only when giving direct care to the client 4.Wearing protective garb, including a mask, gloves, cap, shoe covers, gowns, and plastic apron
3.Wearing gloves and a gown only when giving direct care to the client Rationale:Thoroughhandwashingshouldbedonebeforeandaftereachcontactwiththeburn-injuredclient.Sterilesheetsandlinensareusedbecauseoftheclient'shighriskforinfection.Protectivegarb,includinggloves,cap,masks,shoecovers,gowns,andplasticapron,needtobewornwhenintheclient'sroomandwhendirectlycaringfortheclient
Which diagnostic exam does the nurse know will best aid in the diagnosis of Duchenne muscular dystrophy? 1) EEG 2) CT Scan 3) MRI 4) EMG
4)
During the admission data collection, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What is the nurse's best response?
4. ""You're having a panic attack. I'll stay here with you
Which of the following is an expected outcome of pursed-lip breathing for clients with emphysema? 1. To promote oxygen intake. 2. To strengthen the diaphragm. 3. To strengthen the intercostal muscles. 4. To promote carbon dioxide elimination.
4. Pursed-lip breathing prolongs exhalation and prevents air trapping in the alveoli, thereby promoting carbon dioxide elimination. By prolonging exhalation and helping the client relax, pursed-lip breathing helps the client learn to control the rate and depth of respiration. Pursed-lip breathing does not promote the intake of oxygen, strengthen the diaphragm, or strengthen intercostal muscles.
The cyanosis that accompanies bacterial pneumonia is primarily caused by which of the following? 1. Decreased cardiac output. 2. Pleural effusion. 3. Inadequate peripheral circulation. 4. Decreased oxygenation of the blood.
4. A client with pneumonia has less lung surface available for the diffusion of gases because of the inflammatory pulmonary response that creates lung exudate and results in reduced oxygenation of the blood. The client becomes cyanotic because blood is not adequately oxygenated in the lungs before it enters the peripheral circulation. Decreased cardiac output may be a comorbid condition in some clients with pneumonia; however, it is not the cause of cyanosis. Pleural effusions are a potential complication of pneumonia but are not the primary cause of decreased oxygenation. Inadequate peripheral circulation is also not the cause of the cyanosis that develops with bacterial pneumonia.
Which of the following is an appropriate expected outcome for an adult client with well-controlled asthma? 1. Chest X-ray demonstrates minimal hyperinflation. 2. Temperature remains lower than 100 ° F (37. 8 ° C). 3. Arterial blood gas analysis demonstrates a decrease in PaO2. 4. Breath sounds are clear.
4. Between attacks, breath sounds should be clear on auscultation with good air flow present throughout lung fields. Chest X-rays should be normal. The client should remain afebrile. Arterial blood gases should be normal.
When instructing clients on how to decrease the risk of chronic obstructive pulmonary disease (COPD), the nurse should emphasize which of the following? 1. Participate regularly in aerobic exercises. 2. Maintain a high-protein diet. 3. Avoid exposure to people with known respiratory infections. 4. Abstain from cigarette smoking.
4. Cigarette smoking is the primary cause of COPD. Other risk factors include exposure to environmental pollutants and chronic asthma. Participating in an aerobic exercise program, although beneficial, will not decrease the risk of COPD. Insufficient protein intake and exposure to people with respiratory infections do not increase the risk of COPD.
The nurse assesses the respiratory status of a client who is experiencing an exacerbation of chronic obstructive pulmonary disease (COPD) secondary to an upper respiratory tract infection. Which of the following findings would be expected? 1. Normal breath sounds. 2. Prolonged inspiration. 3. Normal chest movement. 4. Coarse crackles and rhonchi.
4. Exacerbations of COPD are commonly caused by respiratory infections. Coarse crackles and rhonchi would be auscultated as air moves through airways obstructed with secretions. In COPD, breath sounds are diminished because of an enlarged anteroposterior diameter of the chest. Expiration, not inspiration, becomes prolonged. Chest movement is decreased as lungs become overdistended.
A 34-year-old female with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/ minute, nasal flaring, and use of accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Based on these findings, which action should the nurse take to initiate care of the client? 1. Initiate oxygen therapy and reassess the client in 10 minutes. 2. Draw blood for an arterial blood gas analysis and send the client for a chest X-ray. 3. Encourage the client to relax and breathe slowly through the mouth. 4. Administer bronchodilators.
4. In an acute asthma attack, diminished or absent breath sounds can be an ominous sign indicating lack of air movement in the lungs and impending respiratory failure. The client requires immediate intervention with inhaled bronchodilators, I.V. corticosteroids and, possibly, I.V. theophylline (Theo-Dur). Administering oxygen and reassessing the client 10 minutes later would delay needed medical intervention, as would drawing blood for an arterial blood gas analysis and obtaining a chest X-ray. It would be futile to encourage the client to relax and breathe slowly without providing the necessary pharmacologic intervention.
Which of the following indicates that the client with chronic obstructive pulmonary disease (COPD) who has been discharged to home understands his care plan? 1. The client promises to do pursed-lip breathing at home. 2. The client states actions to reduce pain. 3. The client says that he will use oxygen via a nasal cannula at 5 L/ minute. 4. The client agrees to call the physician if dyspnea on exertion increases.
4. Increasing dyspnea on exertion indicates that the client may be experiencing complications of COPD. Therefore, the nurse should notify the physician. Extracting promises from clients is not an outcome criterion. Pain is not a common symptom of COPD. Clients with COPD use low-flow oxygen supplementation (1 to 2 L/ minute) to avoid suppressing the respiratory drive, which, for these clients, is stimulated by hypoxia. .
Which of the following diets would be most appropriate for a client with chronic obstructive pulmonary disease (COPD)? 1. Low-fat, low-cholesterol diet. 2. Bland, soft diet. 3. Low-sodium diet. 4. High-calorie, high-protein diet.
4. The client should eat high-calorie, high-protein meals to maintain nutritional status and prevent weight loss that results from the increased work of breathing. The client should be encouraged to eat small, frequent meals. A low-fat, low-cholesterol diet is indicated for clients with coronary artery disease. The client with COPD does not necessarily need to follow a sodium-restricted diet, unless otherwise medically indicated. There is no need for the client to eat bland, soft foods.
Which of the following measures would most likely be successful in reducing pleuritic chest pain in a client with pneumonia? 1. Encourage the client to breathe shallowly. 2. Have the client practice abdominal breathing. 3. Offer the client incentive spirometry. 4. Teach the client to splint the rib cage when coughing.
4. The pleuritic pain is triggered by chest movement and is particularly severe during coughing. Splinting the chest wall will help reduce the discomfort of coughing. Deep breathing is essential to prevent further atelectasis. Abdominal breathing is not as effective in decreasing pleuritic chest pain as is splinting of the rib cage. Incentive spirometry facilitates effective deep breathing but does not decrease pleuritic chest pain.
The nurse is caring for a client with sodium retention that has resulted in hypervolemia. The nurse knows that even a 1% increase in sodium is equivalent to _____ lb of fluid weight gain.
4. A 1% increase in sodium reabsorption (retention) could potentially cause a 1.8-L net gain of water each day, which is equivalent to 4 lb of body weight.
The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which action by the client would indicate that the teaching was successful? 1. The client eliminates anxiety by using the breathing technique. 2. The client performs activities of daily living independently by discharge. 3. The client recognizes signs and symptoms of escalating anxiety. 4. The client maintains a 3/10 anxiety level without medications.
4. A client's ability to maintain an anxiety level of 3/10 without medications indicates that the client is using breathing techniques successfully to reduce anxiety. TEST-TAKING HINT: To answer this question correctly, the test taker should understand that anxiety cannot be eliminated from life. This understanding would eliminate "1" immediately.
In which situation would the nurse suspect a medical diagnosis of social phobia? 1. A client abuses marijuana daily and avoids social situations because of fear of humiliation. 2. An 8-year-old child isolates from adults because of fear of embarrassment, but has good peer relationships in school. 3. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. 4. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.
4. A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social phobia. TEST-TAKING HINT: The test taker must understand the DSM-IV-TR diagnostic criteria for social phobia to answer this question correctly.
During a panic attack, a client hyperventilates, becomes unable to speak, and reports symptoms that mimic those of a heart attack. Which nursing intervention would be best?
4. Accompany the client to his room; remain there and provide instructions in short, simple statements.
During an assessment, a client diagnosed with generalized anxiety disorder rates anxiety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority? 1. Hopelessness R /T anxiety AEB client's stating, "Nothing ever seems to work out." 2. Ineffective coping R /T rating anxiety as 9/10 AEB thoughts of suicide. 3. Anxiety R /T thoughts about work AEB rates anxiety 9/10. 4. Risk for suicide R /T expressing thoughts of suicide.
4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client problems. TEST-TAKING HINT: When looking for a priority nursing diagnosis, the test taker always must prioritize client safety. Even if other problems exist, client safety must be ensured.
A client was admitted to an in-patient psychiatric unit 4 days ago for the treatment of obsessive-compulsive disorder. Which outcome takes priority for this client at this time? 1. The client will use a thought-stopping technique to eliminate obsessive/compulsive behaviors. 2. The client will stop obsessive and/or compulsive behaviors. 3. The client will seek assistance from the staff to decrease obsessive or compulsive behaviors. 4. The client will use one relaxation technique to decrease obsessive or compulsive behaviors.
4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome. TEST-TAKING HINT: The test taker must recognize the importance of time-wise interventions when establishing outcomes. In the case of clients diagnosed with obsessive-compulsive disorder, expectations on admission vary greatly from outcomes developed closer to discharge.
From a cognitive theory perspective, which is a possible cause of panic disorder? 1. Inability of the ego to intervene when conflict occurs. 2. Abnormal elevations of blood lactate and increased lactate sensitivity. 3. Increased involvement of the neurochemical norepinephrine. 4. Distorted thinking patterns that precede maladaptive behaviors.
4. Distorted thinking patterns that precede maladaptive behaviors relate to the cognitive theory perspective of panic disorder development. TEST-TAKING HINT: The test taker should note important words in the question, such as "cognitive." Although all of the answers are potential causes of panic disorder development, the only answer that is from a cognitive perspective is "4."
Victims of sexual assault can experience posttraumatic stress reactions after the attack. Which of the following statements best describes symptoms associated with posttraumatic stress disorder (PTSD)?
4. Flashbacks, recurring dreams, and numbness
Mannitol (Osmitrol) is ordered to be administered IV to a client. The nurse will question the order for this drug if which manifestation is noted? 1. Mental confusion and elevated blood pressure 2. Fatigue and dizziness 3. Urinary output of 68 ml over 2 hours following administration of a test dose of mannitol (Osmitrol) 4. Urinary output of 45 ml over the previous 24 hours
4. Mannitol (Osmitrol) is contraindicated in the presence of anuria. Anuria is failure of the kidneys to produce urine. The normal urine output is 800-2000 ml in 24 hour period.
(SELECT ALL THAT APPLY) A registered nurse caring for a client with generalized anxiety disorder identifies a nursing diagnosis of Anxiety. The short-term goal identified is: The client will identify his physical, emotional, and behavioral responses to anxiety. Which nursing interventions will help the client achieve this goal?
4. Observe the client for overt signs of anxiety. 5. Help the client connect anxiety with uncomfortable physical, emotional, or behavioral responses. 6. Introduce the client to new strategies for coping with anxiety, such as relaxation techniques and exercise.
The nurse and a patient are discussing how to eliminate lice. The patient is given a shampoo-like medication that is applied and rinsed from the body within 10 minutes after application. This medication is: 1. Lindane 2. Crotamiton 3. Cortizone 4. Permethrin
4. Permethrin
While driving home from work, a nurse realizes that she failed to communicate to the oncoming nurse that a client asked for more information about advance directives. Which action would be appropriate for the nurse to take?
4. Phone the nurse caring for the client and inform her of the client's request.
A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? 1. Posttrauma syndrome R /T a distressing event AEB flashbacks and nightmares. 2. Social isolation R /T anxiety AEB isolating because of fear of flashbacks. 3. Ineffective coping R /T flashbacks AEB alcohol abuse and dependence. 4. Risk for injury R /T exhaustion because of sustained levels of anxiety.
4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flashbacks, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioritize the nursing diagnosis that addresses safety. TEST-TAKING HINT: When the question asks for a priority, it is important for the test taker to understand that all answer choices may be appropriate statements. Client safety always should be prioritized.
Counselors have been sent to a location that has experienced a natural disaster to assist the population to deal with the devastation. This is an example of __________________ prevention.
4. Sending counselors to a natural disaster site to assist individuals to deal with the devastation is an example of primary prevention. Primary prevention reduces the incidence of mental disorders, such as posttraumatic stress disorder, within the population by helping individuals to cope more effectively with stress early in the grieving process. Primary prevention is extremely important for individuals who experience any traumatic event, such as a rape, war, hurricane, tornado, or school shooting. TEST-TAKING HINT: To answer this question correctly, it is necessary to understand the differences between primary, secondary, and tertiary prevention.
The nurse is helping to create a teaching plan for a patient prescribed desoximetasone (Topicort) for atopic dermatitis. The nurse will include which adverse effect in that plan? 1. Localized pruritus and hives 2. Hair loss in the application area 3. Worsening of acne 4. Skin irritation and redness in the application area
4. Skin irritation and redness in the application area
Which of the following statements explains the etiology of obsessive-compulsive disorder (OCD) from a biological theory perspective? 1. Individuals diagnosed with OCD have weak and underdeveloped egos. 2. Obsessive and compulsive behaviors are a conditioned response to a traumatic event. 3. Regression to the pre-Oedipal anal sadistic phase produces the clinical symptoms of OCD. 4. Abnormalities in various regions of the brain have been implicated in the cause of OCD.
4. The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a biological theory perspective. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the different theories of OCD etiology. This question calls for a biological theory perspective, making "4" the only correct choice.
A client diagnosed with posttraumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing? 1. Denial. 2. Social isolation. 3. Anger. 4. Survivor's guilt.
4. The client in the question is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others died and the individual survived. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand common phenomena experienced by individuals diagnosed with posttraumatic stress disorder and relate this understanding to the client statement presented in the question.
37. The male client is sitting in the chair and his entire body is rigid with his arms and legs contracting and relaxing. The client is not aware of what is going on and is making guttural sounds. Which action should the nurse implement first? 1. Push aside any furniture. 2. Place the client on his side. 3. Assess the client's vital signs. 4. Ease the client to the floor. Company. Kindle Edition.
4. The client should not remain in the chair during a seizure. He should be brought safely to the floor so that he will have room to move the extremities.
The nurse's understanding of the clotting mechanism is important in administering anticoagulant drugs. the nurse understands that which of the following clotting factors are formed after injury to the vessels? 1. Fibrin, vitamin K 2. Thromboplastin, fibrinogen 3. Prothrombin, thrombin 4. Thrombin, fibrin
4. Thrombin, fibrin
The nurse receives the patient's lab values throughout warfarin drug therapy. The expected therapeutic level is: 1. aPTT of three to four times the normal control value 2. aPTT one to two times the patient's baseline level 3. aPT one to two times the patient's last result 4. aPT one and half to two and half times the control value.
4. aPT one and half to two and half times the control values. Rationale: aPT is the coagulation study that monitors oral anticoagulant use, such as warfarin. As a result of one and half to two and half times the control value indicates adquate anticoagulation. aPTT is the coagulation study that monitors heparin use. aPT level of one would indicate a less than therapeutic level of anticoagulation.
The nurse discovers that a client with obsessive-compulsive disorder (OCD) is attempting to resist the compulsion. Based on this finding, the nurse should look for signs of:
4. increased anxiety.
515.A client arrives at the emergency department following a burn injury that occurred in the basement at home, and an inhalation injury is suspected. What would the nurse anticipate to be prescribed for the client? 1.100% oxygen via an aerosol mask 2.Oxygen via nasal cannula at 6L/minute 3.Oxygen via nasal cannula at 15L/minute 4.100% oxygen via a tight-fitting, non rebreather face mask
4.100% oxygen via a tight-fitting, non rebreather face mask Rationale:Ifaninhalationinjuryissuspected,administrationof100%oxygenviaatight-fittingnonrebreatherfacemaskisprescribeduntilcarboxyhemoglobinlevelsfall(usuallybelow15%).Ininhalationinjuries,theoropharynxisinspectedforevidenceoferythema,blisters,orulcerations.Theneedforendotrachealintubationalsoisassessed.Options1,2,and3areincorrectandwouldnotprovidethenecessaryoxygensupplyneededforadequatetissueperfusion.
513.The nurse is caring for a client who sustained superficial partial-thickness burns on the anterior lower legs and anterior thorax. Which finding does the nurse expect to note during the resuscitation/emergent phase of the burn injury? 1.Decreased heart rate 2.Increased urinary output 3.Increased blood pressure 4.Elevated hematocrit levels
4.Elevated hematocrit levels Rationale:Theresuscitation/emergentphasebeginsatthetimeofinjuryandendswiththerestorationofcapillarypermeability,usuallyat48to72hoursfollowingtheinjury.Duringtheresuscitation/emergentphase,thehematocritlevelincreasestoabovenormalbecauseofhemoconcentrationfromthelargefluidshifts.Hematocritlevelsof50%to55%areexpectedduringthefirst24hoursafterinjury,withreturntonormalby36hoursafterinjury.Initially,bloodisshuntedawayfromthekidneys,andrenalperfusionandglomerularfiltrationaredecreased,resultinginlowurineoutput.Pulseratesaretypicallyhigherthannormal,andthebloodpressureisdecreasedasaresultofthelargefluidshifts
The nurse is administering furosemide (Lasix) IV to client with congestive heart failure. The nurse knows that the anticipated onset of action is within ____ minutes.
5. Furosemide is frequently used in the treatment of acute edema associated with liver cirrhosis, renal impairment, or congestive heart failure because it has the ability to remove large amounts of edema fluid from the client in a short time. When given IV, diuresis begins within 5 minutes, providing clients quick relief from their symptoms.
The nurse is instructing a client who is going home on diuretic therapy for the treatment of fluid retention caused by hypertension. The nurse instructs the client to stop the med and notify a HCP if the BP falls below 90/____ mmHg.
60. The nurse instructs the client to stop taking the medication if BP is 90/60 mmHg or below, or is below the parameters set by the health care provider, and promptly notify the provider.
Labeling of herbal products is important. Which is an appropriate claim for an herbal product? A) Prevents diabetes B) Helps increase blood flow to the extremities C) Cures Alzheimer disease D) Is safe for all
Answer: B.
A patient who was in a motor vehicle accident sustained a severe head injury and is brought into the emergency department. The provider orders intravenous mannitol [Osmitrol]. The nurse knows that this is given to: a. reduce intracranial pressure. b. reduce renal perfusion. c. reduce peripheral edema. d. restore extracellular fluid.
A Mannitol is an osmotic diuretic that is used to reduce intracranial pressure by relieving cerebral edema. The presence of mannitol in blood vessels in the brain creates an osmotic force that draws edematous fluid from the brain into the blood. Mannitol can also be used to increase renal perfusion. It can cause peripheral edema and is not used to restore extracellular fluid.
Antihistamines block the actions of histamine at the Select one: A. B2 receptor site. B. B1 receptor site. C. H1 receptor site. D. C1 receptor site.
C. H1 receptor site.
A patient is brought to the emergency department with shortness of breath, a respiratory rate of 30 breaths per minute, intercostal retractions, and frothy, pink sputum. The nurse caring for this patient will expect to administer which drug? a. Furosemide [Lasix] b. Hydrochlorothiazide [HydroDIURIL] c. Mannitol [Osmitrol] d. Spironolactone [Aldactone]
A Furosemide, a potent diuretic, is used when rapid or massive mobilization of fluids is needed. This patient shows severe signs of congestive heart failure with respiratory distress and pulmonary edema and needs immediate mobilization of fluid. Hydrochlorothiazide and spironolactone are not indicated for pulmonary edema, because their diuretic effects are less rapid. Mannitol is indicated for patients with increased intracranial pressure and must be discontinued immediately if signs of pulmonary congestion or heart failure occur.
An older adult patient with congestive heart failure develops crackles in both lungs and pitting edema of all extremities. The physician orders hydrochlorothiazide [HydroDIURIL]. Before administering this medication, the nurse reviews the patient's chart. Which laboratory value causes the nurse the most concern? a. Elevated creatinine clearance b. Elevated serum potassium level c. Normal blood glucose level d. Low levels of low-density lipoprotein (LDL) cholesterol
A Hydrochlorothiazide should not be given to patients with severe renal impairment; therefore, an elevated creatinine clearance would cause the most concern. Thiazide diuretics are potassium-wasting drugs and thus may actually improve the patient's potassium level. Thiazides may elevate the serum glucose level in diabetic patients. Thiazides increase LDL cholesterol; however, this patient's levels are low, so this is not a risk.
a. Maintenance treatment of asthma
A client with COPD is taking a leukotriene antagonist, montelukast (Singulair). The nurse is aware that this medication is given for which purpose? a. Maintenance treatment of asthma b. Treatment of an acute asthma attack c. Reversing bronchospasm associated with COPD d. Treatment of inflammation in chronic bronchitis
c. Increased heart rate
A client is taking aminophylline-theophylline ethylenediamine (Somophyllin). For what should the nurse monitor the client? a. Drowsiness b. Hypoglycemia c. Increased heart rate d. Decreased white blood cell count
b. epinephrine (Adrenalin)
A client with COPD has an acute bronchospasm. The nurse knows that which is the best medication for this emergency situation? a. zafirlukast (Accolate) b. epinephrine (Adrenalin) c. dexamethasone (Decadron) d. oxtriphylline-theophyllinate (Choledyl)
You are admitting a patient with a heart murmur. You note there is a depression in the lower portion of the sternum. What is this type of chest deformity called?
A funnel chest
Besides having diuretic effects for patients with congestive heart failure, thiazides are also used to treat what? (Select all that apply.) a. Diabetes insipidus b. Hepatic failure c. Increased intracranial pressure d. Intraocular pressure e. Postmenopausal osteoporosis
A, B, E Thiazide diuretics have the paradoxical effect of reducing urine output in patients with diabetes insipidus. They can also be used to mobilize edema associated with liver disease. They promote tubular reabsorption of calcium, which may reduce the risk of osteoporosis in postmenopausal women. Mannitol is used to treat edema that causes increased intracranial pressure and intraocular pressure.
Which medication is indicated for suppression of cough? A. Benzonatate (Tessalon) B. Guaifenesin (Mucinex) C. Acetylcysteine (Mucomyst) D. Fluticasone furoate (Flonase)
A. Benzonatate suppresses cough by reducing the sensitivity of respiratory stretch receptors (components of the cough reflex pathway). Acetylcysteine reacts directly with mucus to make it more watery and is administered by inhalation treatment. Guaifenesin is an expectorant. Fluticasone furoate is an intranasal glucocorticoid used to treat the clinical manifestations of allergic rhinitis.
The parent of a pediatric patient with nasal stuffiness and congestion asks a nurse about cold remedies. Which additional information is the priority for the nurse to obtain? A. Age B. Developmental stage C. Body weight D. Swallowing ability
A. Cold remedies should not be used for children younger than 2 years because of the risk of harm with little evidence of efficacy. In 2008, the U.S. Food and Drug Administration (FDA) recommended that over-the-counter (OTC) cold remedies no longer be given to children younger than 2 years because of the risk of life-threatening events. Safety is still being reviewed for children ages 2 to 11 years. Developmental stage, body weight, and swallowing ability are secondary considerations with dosing of cold remedies for children.
A nurse should monitor more frequently the blood pressure of a patient with a history of hypertension who takes which medication for allergic rhinitis? A. Pseudoephedrine (Sudafed) B. Montelukast (Singulair) C. Mometasone (Nasonex spray) D. Oxymetazoline (Afrin spray)
A. Pseudoephedrine is a sympathomimetic that activates alpha1 receptors and causes vasoconstriction. Only oral agents cause widespread vasoconstriction that warrants caution in patients with hypertension. Montelukast blocks leukotrienes and has no adverse effects. Oxymetazoline spray is a topical sympathomimetic that causes rebound congestion with prolonged use. Mometasone spray is a glucocorticoid intranasal spray for which systemic side effects are rare.
The nurse completes medication education for the client receiving antihistamines. The nurse evaluates that learning has occurred when the client makes which statement? Select one: A. "This medication could make me very sleepy." B. "I can still have my after-dinner drink." C. "I need to increase fluids while taking this medication." D. "This medication is safe because it is sold over-the-counter (OTC)."
A. "This medication could make me very sleepy."
The client takes diphenhydramine (Benadryl) but forgets to tell the physician about this drug when a monoamine oxidase inhibitor (MAOI) drug is prescribed for depression. What will the best assessment by the nurse reveal? Select one: A. The client may develop a hypertensive crisis. B. The client may develop seizures. C. The depression will not subside. D. The diphenhydramine (Benadryl) will not control allergies.
A. The client may develop a hypertensive crisis.
The nurse is providing emergent care for a 62-year-old man with a possible inhalation injury sustained in a house fire. The patient is anxious and disoriented, and the skin is a cherry red color. Which action should the nurse take first? A. Administer 100% humidified oxygen. B. Teach the patient deep breathing exercises. C. Encourage the patient to express his feelings. D. Assist the patient to a high Fowler's position.
A. Administer 100% humidified oxygen. Carbon monoxide (CO) poisoning may occur in house fires. CO displaces oxygen on the hemoglobin molecule resulting in hypoxia. High levels of CO in the blood result in a skin color that is described as cherry red. Hypoxia may cause anxious behaviors and altered mental status. Emergency treatment for inhalation injury and CO poisoning includes the immediate administration of 100% humidified oxygen. The other interventions are appropriate for inhalation injury but are not as urgent as oxygen administration.
The nurse works with a physician who frequently prescribes benzodiazepines. The use of benzodiazepines in which patient would cause the nurse the most concern? Select one: A. An 87-year-old patient who uses a cane for ambulation B. A 42-year-old businessman who travels internationally C. A 32-year-old mother of two preschool children D. A 9-year-old child with panic attacks
A. An 87-year-old patient who uses a cane for ambulation
Matching: Open comedones A. Black head B. Whiteheads C. Intense itching D. Redness E. "First-degree" injury
A. Black head
Which of the following medications is administered topically for psoriasis? A. Calcipotriene (Dovonex) B. Adapalene (Differin) C. Metronidazole (Metrogel, MetroCream) D. Sulfacetamide sodium (Cetamide, Klaron, others)
A. Calcipotriene (Dovonex)
Scabicides and pediculicides are contraindicated in all of the following EXCEPT: A. Children ages 2-10 B. Children less than 2 years old C. Children with seizures D. Children who have abrasions, rash or dermatitis
A. Children ages 2-10
The patient comes to the emergency department after an overdose of lorazepam (Ativan). The nurse will plan to administer which medication? Select one: A. Flumazenil (Romazicon) B. Pralidoxime (Protopam) C. Nalmefene (Revex) D. Naloxone (Narcan)
A. Flumazenil (Romazicon)
The nurse is planning to change the dressing that covers a deep partial-thickness burn of the right lower leg. Which prescribed medication should the nurse administer to the 70-year-old female patient 30 minutes before the scheduled dressing change? A. Morphine sulfate B. Sertraline (Zoloft) C. Zolpidem (Ambien) D. Enoxaparin (Lovenox)
A. Morphine sulfate Deep partial-thickness burns result in severe pain related to nerve injury. The nurse should plan to administer analgesics before the dressing change to promote patient comfort. Morphine is a common opioid used for pain control. Sedative/hypnotics and antidepressant agents also can be given with analgesics to control the anxiety, insomnia, and/or depression that patients may experience. Zolpidem promotes sleep. Sertraline is an antidepressant. Enoxaparin is an anticoagulant.
Use of retinoid compounds are contraindicated in patients with all of the following conditions EXCEPT: A. Rosacea B. Severe depression and suicidal tendencies C. Seizures treated with carbamazepine D. Diabetes treated with oral agents
A. Rosacea
Matching: Permethrin (Nix) A. Scabicide/pediculicide B. Sunburn/minor irritation drug C. Acne and acne-related drug D. Topical corticosteroid E. Psoriatic drug
A. Scabicide/pediculicide
Atypical Antipsychotics
AKA as second generation Broad action spectrum Treats positive and negative symptoms of schizophrenia Fewer side effects, especially EPS
A patient who has been taking warfarin is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? A) Vitamin E. B) Vitamin K. C) Protamine sulfate. D) Calcium gluconate.
Answer: B. Vitamin K is the antagonist for warfarin.
A patient with chronic obstructive pulmonary disease is taking the leukotriene antagonist montelukast. The nurse is aware that this medication is given for which purpose? A) Maintenance treatment of asthma B) Treatment of acute asthmatic attack C) Reversing bronchospasm associated with chronic obstructive pulmonary disease D) Treatment of inflammation in chronic bronchitis
Answer: A.
A 51-year-old woman has been reportedly taking alprazolam for a severe anxiety disorder following her mother's death. She was brought into the emergency department because she became unresponsive while at work in an insurance office. Knowing her history, what should the nurse anticipate administering? A) Mannitol B) Naloxone C) Activated charcoal D) Flumazenil
Answer: D.
The nurse has just received an order for tenecteplase [TNKase] for a patient experiencing an acute myocardial infarction. The nurse should administer this drug: a. by bolus injection. b. by infusion pump over 24 hours. c. slowly over 90 minutes. d. via monitored, prolonged infusion.
ANS: A Tenecteplase [TNKase] is given by bolus injection. Tissue plasminogen activator (tPA) must be infused over 90 minutes. Because tenecteplase [TNKase] is given by bolus injection, an infusion pump is not required. Although the patient should be monitored, tenecteplase [TNKase] does not require a prolonged infusion time.
a sun burn is what type of burn
primary - increases risk of melanoma
A patient with atrial fibrillation is receiving warfarin [Coumadin]. The nurse notes that the patient's INR is 2.7. Before giving the next dose of warfarin, the nurse will notify the provider and: a. administer the dose as ordered. b. request an order to decrease the dose. c. request an order to give vitamin K (phytonadione). d. request an order to increase the dose.
ANS: A This patient has an INR in the appropriate range, which is 2 to 3 for most patients and 2.5 to 3.5 for some, so no change in warfarin dosing is necessary. It is not correct to request an order to either decrease or increase the dose of warfarin. It is not necessary to give vitamin K, which is an antidote for warfarin toxicity.
A patient who is taking warfarin [Coumadin] has just vomited blood. The nurse notifies the provider, who orders lab work revealing a PT of 42 seconds and an INR of 3.5. The nurse will expect to administer: a. phytonadione (vitamin K1) 1 mg IV over 1 hour. b. phytonadione (vitamin K1) 2.5 mg PO. c. protamine sulfate 20 mg PO. d. protamine sulfate 20 mg slow IV push.
ANS: A Vitamin K1 is given for warfarin overdose and may be given IV in an emergency. To reduce the incidence of an anaphylactoid reaction, it should be infused slowly. In a nonemergency situation, it would be appropriate to give vitamin K1 orally. Protamine sulfate is used for heparin overdose.
A patient is admitted to the hospital with unstable angina and will undergo a percutaneous coronary intervention. Which drug regimen will the nurse expect to administer to prevent thrombosis in this patient? a. Aspirin, clopidogrel, omeprazole b. Aspirin, heparin, abciximab [ReoPro] c. Enoxaparin [Lovenox], prasugrel [Effient], warfarin [Coumadin] d. Heparin, alteplase, abciximab [ReoPro]
ANS: B Abciximab, combined with ASA and heparin, is approved for IV therapy for patients undergoing PCI.
Antidepressants MOA
Blocking the enzymatic breakdown of norepinephrine Slowing reuptake of serotonin and norepinephrine
A patient who has taken warfarin [Coumadin] for a year begins taking carbamazepine. The nurse will anticipate an order to: a. decrease the dose of carbamazepine. b. increase the dose of warfarin. c. perform more frequent aPTT monitoring. d. provide extra dietary vitamin K.
ANS: B Carbamazepine is a powerful inducer of hepatic drug-metabolizing enzymes and can accelerate warfarin degradation. The warfarin dose should be increased if the patient begins taking carbamazepine. Decreasing the dose of carbamazepine is not indicated. It is not necessary to perform more frequent aPTT monitoring or to add extra vitamin K.
A patient will begin taking dabigatran etexilate [Pradaxa] to prevent stroke. The nurse will include which statement when teaching this patient? a. Dabigatran should be taken on an empty stomach to improve absorption. b. It is important not to crush, chew, or open capsules of dabigatran. c. The risk of bleeding with dabigatran is less than that with warfarin [Coumadin]. d. To remember to take dabigatran twice daily, a pill organizer can be useful.
ANS: B Patients should be taught to swallow capsules of dabigatran intact; absorption may be increased as much as 75%, increasing the risk of bleeding, if the capsules are crushed, chewed, or opened. Dabigatran may be taken with or without food. The risk of bleeding is not less than that of warfarin. Dabigatran is unstable when exposed to moisture, so using a pill organizer is not recommended.
A postoperative patient will begin anticoagulant therapy with rivaroxaban [Xarelto] after knee replacement surgery. The nurse performs a history and learns that the patient is taking erythromycin. The patient's creatinine clearance is 50 mL/min. The nurse will: a. administer the first dose of rivaroxaban as ordered. b. notify the provider to discuss changing the patient's antibiotic. c. request an order for a different anticoagulant medication. d. request an order to increase the dose of rivaroxaban.
ANS: B Patients with impaired renal function who are taking macrolide antibiotics will experience increased levels of rivaroxaban, increasing the risk of bleeding. It is correct to discuss using a different antibiotic if possible. The nurse should not administer the dose without discussing the situation with the provider. The patient's renal impairment is minor; if it were more severe, using a different anticoagulant might be appropriate. It is not correct to increase the dose of rivaroxaban.
valproic acid (Depakote) use
wide range of seizure types, including absence seizures and missed types of seizures
A nurse caring for a patient receiving heparin therapy notes that the patient has a heart rate of 98 beats per minute and a blood pressure of 110/72 mm Hg. The patient's fingertips are purplish in color. A stat CBC shows a platelet count of less than 100,000 mm3. The nurse will: a. administer oxygen and notify the provider. b. discontinue the heparin and notify the provider. c. request an order for protamine sulfate. d. request an order for vitamin K (phytonadione).
ANS: B This patient is showing signs of heparin-induced thrombocytopenia, so the heparin should be discontinued immediately and the provider should be notified. The purplish color of the fingertips is caused by thrombosis, not hypoxia, so oxygen is not indicated. This patient may need continued anticoagulation therapy, so a request for protamine sulfate is not correct. Heparin is not a vitamin K inhibitor.
A patient is admitted to the emergency department with chest pain. An electrocardiogram shows changes consistent with an evolving myocardial infarction. The patient's cardiac enzymes are pending. The nurse caring for this patient will expect to: a. administer aspirin when cardiac enzymes are completed. b. give alteplase [Activase] within 2 hours. c. give tenecteplase [TNKase] immediately. d. obtain an order for an INR.
ANS: B When alteplase is given within 2 hours after symptom onset, the death rate for MI has been shown to be 5.4%, compared with 9.4% if given 4 to 6 hours after symptom onset. ASA may be given at the first sign of MI; it is not necessary to wait for cardiac enzyme results. Tenecteplase may be given more than 2 hours after onset of symptoms. Obtaining an order for an INR is not indicated.
A postoperative patient reports pain in the left lower extremity. The nurse notes swelling in the lower leg, which feels warm to the touch. The nurse will anticipate giving which medication? a. Aspirin b. Clopidogrel [Plavix] c. Enoxaparin [Lovenox] d. Warfarin [Coumadin]
ANS: C Enoxaparin is a low-molecular-weight heparin and is used in situations requiring rapid onset of anticoagulant effects, such as massive DVT. Aspirin, clopidogrel, and warfarin are useful for primary prevention but are not used when rapid anticoagulation is required.
A patient has been receiving heparin while in the hospital to treat deep vein thromboses and will be discharged home with a prescription for enoxaparin [Lovenox]. The nurse provides teaching for the nursing student who asks about the advantages of enoxaparin over heparin. Which statement by the student indicates a need for further teaching? a. "Enoxaparin does not require coagulation monitoring." b. "Enoxaparin has greater bioavailability than heparin." c. "Enoxaparin is more cost-effective than heparin." d. "Enoxaparin may be given using a fixed dosage."
ANS: C Low-molecular-weight (LMW) heparins have higher bioavailability and longer half-lives, so routine coagulation monitoring is not necessary and fixed dosing is possible. LMW heparins are more expensive, however, so this statement indicates a need for further teaching.
A patient who is taking clopidogrel [Plavix] calls the nurse to report black, tarry stools and coffee-ground emesis. The nurse will tell the patient to: a. ask the provider about using aspirin instead of clopidogrel. b. consume a diet high in vitamin K. c. continue taking the clopidogrel until talking to the provider. d. stop taking the clopidogrel immediately.
ANS: C Patients who experience bleeding should be warned not to stop taking the clopidogrel until the prescriber says they should, since abrupt withdrawal may precipitate a thrombotic event. Taking aspirin with an active GI bleed is contraindicated. Warfarin is a vitamin K inhibitor; consuming extra vitamin K will not reverse the effects of clopidogrel.
A nursing student who is preparing to care for a postoperative patient with deep vein thrombosis asks the nurse why the patient must take heparin rather than warfarin. Which response by the nurse is correct? a. "Heparin has a longer half-life." b. "Heparin has fewer adverse effects." c. "The onset of warfarin is delayed." d. "Warfarin prevents platelet aggregation."
ANS: C Warfarin is not useful for treating existing thromboses or for emergencies because the onset of action is delayed. Heparin has a shorter half-life and has more side effects. Warfarin does not prevent platelet aggregation.
A 50-year-old female patient asks a nurse about taking aspirin to prevent heart disease. The patient does not have a history of myocardial infarction. Her cholesterol and blood pressure are normal, and she does not smoke. What will the nurse tell the patient? a. Aspirin is useful only for preventing a second myocardial infarction. b. She should ask her provider about using a P2Y12 ADP receptor antagonist. c. She should take one 81-mg tablet per day to prevent myocardial infarction. d. There is most likely no protective benefit for patients her age.
ANS: D ASA is used for primary prevention of myocardial infarction (MI) in men and in women older than 65 years. Aspirin for primary prevention may be used in women ages 55 to 79 years when the potential benefit of a reduction in MI outweighs the potential harm of increased GI hemorrhage. This patient has no previous history of MI, so the use of ASA is not indicated. ASA is useful for primary prevention, but only when indicated by cardiovascular risk, based on age, gender, cholesterol levels, blood pressure, and smoking status. A P2Y12 ADP receptor antagonist is used as secondary prevention. This patient should not begin taking ASA unless her risk factors change, or until she is 65 years old.
A patient is receiving heparin postoperatively to prevent deep vein thrombosis. The nurse notes that the patient has a blood pressure of 90/50 mm Hg and a heart rate of 98 beats per minute. The patient's most recent aPTT is greater than 90 seconds. The patient reports lumbar pain. The nurse will request an order for: a. a repeat aPTT to be drawn immediately. b. analgesic medication. c. changing heparin to aspirin. d. protamine sulfate.
ANS: D Heparin overdose may cause hemorrhage, which can be characterized by low blood pressure, tachycardia, and lumbar pain. Protamine sulfate should be given, and the heparin should be discontinued. An aPTT may be drawn later to monitor the effectiveness of protamine sulfate. Analgesics are not indicated because the lumbar pain is likely caused by adrenal hemorrhage. Aspirin will only increase the risk of hemorrhage.
A patient's blood pressure is 130/84. The health care provider plans to suggest nonpharmacologic methods to lower blood pressure. Which should the nurse include in teaching? (Select all that apply.) A) Stress-reduction techniques B) An exercise program C) Salt restriction D) Smoking cessation E) A diet with increased protein
Answer: A, B, C, D.
beclomethasone (QVAR) MOA
acts by reducing inflammation
A patient who takes warfarin [Coumadin] is brought to the emergency department after accidentally taking too much warfarin. The patient's heart rate is 78 beats per minute and the blood pressure is 120/80 mm Hg. A dipstick urinalysis is normal. The patient does not have any obvious hematoma or petechiae and does not complain of pain. The nurse will anticipate an order for: a. vitamin K (phytonadione). b. protamine sulfate. c. a PTT. d. a PT and an INR.
ANS: D This patient does not exhibit any signs of bleeding from a warfarin overdose. The vital signs are stable, there are no hematomas or petechiae, and the patient does not have pain. A PT and INR should be drawn to evaluate the anticoagulant effects. Vitamin K may be given if laboratory values indicate overdose. Protamine sulfate is given for heparin overdose. PTT evaluation is used to monitor heparin therapy.
A patient who takes warfarin for atrial fibrillation undergoes hip replacement surgery. On the second postoperative day, the nurse assesses the patient and notes an oxygen saturation of 83%, pleuritic chest pain, shortness of breath, and hemoptysis. The nurse will contact the provider to report possible ____ and request an order for ____. a. congestive heart failure; furosemide [Lasix] b. hemorrhage; vitamin K (phytonadione) c. myocardial infarction; tissue plasminogen activator (tPA) d. pulmonary embolism; heparin
ANS: D This patient is exhibiting signs of pulmonary embolism. Heparin is used when rapid onset of anticoagulants is needed, as with pulmonary embolism. The patient would have respiratory cracks and a cough with congestive heart failure. Hemorrhage involves a decrease in blood pressure, bruising, and lumbar pain. The patient has pleuritic pain, which is not consistent with the chest pain of a myocardial infarction.
A patient has been taking warfarin [Coumadin] for atrial fibrillation. The provider has ordered dabigatran etexilate [Pradaxa] to replace the warfarin. The nurse teaches the patient about the change in drug regimen. Which statement by the patient indicates understanding of the teaching? a. "I may need to adjust the dose of dabigatran after weaning off the warfarin." b. "I should continue to take the warfarin after beginning the dabigatran until my INR is greater than 3." c. "I should stop taking the warfarin 3 days before starting the dabigatran." d. "I will stop taking the warfarin and will start taking the dabigatran when my INR is less than 2."
ANS: D When switching from warfarin to dabigatran, patients should stop taking the warfarin and begin taking the dabigatran when the INR is less than 2. It is not correct to begin taking the dabigatran before stopping the warfarin. While warfarin is stopped before beginning the dabigatran, the decision to start taking the dabigatran is based on the patient's INR and not on the amount of time that has elapsed.
dextromethorphan (Delsym) MOA
acts in medulla to inhibit cough reflex
A patient tells the nurse that he has started to take an over-the-counter antihistamine, diphenhydramine. In teaching about side effects, what is most important for the nurse to tell the patient? A) To avoid insomnia, do not to take this drug at bedtime. B) Avoid driving a motor vehicle until stabilized on the drug. C) Nightmares and nervousness are more likely in an adult. D) Medication may cause excessive secretions.
Answer: B.
A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client has been sleeping poorly, has lost 8 lb (3.6 kg), is poorly groomed, exhibits hyperactivity, and loudly denies the need for hospitalization. Which nursing intervention takes priority for this client?
Administering a sedative as prescribed
Atypical Antidepressants (Bupropion, Wellbutrin)
Affects the activity of norepinephrine and dopamine, inhibits serotonin reuptake Contraindicated in patients with seizure disorders (lowers threshold) Marketed as Zyban for smoking cessation
Temporary coverage grafting
Allograft (cadaver skin) Xenograft (biological dressing usually pigskin)
A patient with chronic obstructive pulmonary disease has an acute bronchospasm. The nurse anticipates that the health care provider will prescribe which medication? A) Zafirlukast B) Epinephrine C) Dexamethasone D) Beclomethasone
Answer: B.
A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).
An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety. 1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. TEST-TAKING HINT: The test taker first must recognize the signs and symptoms presented in the question as an indication of increased levels of anxiety. Next, the test taker must recognize the medications that address these symptoms. Also, it is common to confuse lithium carbonate (lithium) and Librium and clozapine and clonazepam. To answer this question correctly, the test taker needs to distinguish between medications that are similar in spelling.
You are caring for a patient admitted with chronic obstructive pulmonary disease. During your shift assessment, you find that your patient is experiencing a change in his respiratory and mental status. You are aware that the most accurate measurement of the concentration of oxygen in the patient's blood is what?
An arterial blood gas study
A patient is taking ezetimibe and asks the nurse how it works. The nurse should explain that ezetimibe does what? A) Inhibits absorption of dietary cholesterol in the intestines B) Binds with bile acids in the intestines to reduce low-density lipoprotein levels C) Inhibits 3-hydroxy-3-methylglutaryl-coenzyme A reductase, which is necessary for cholesterol production in the liver D) Forms insoluble complexes and reduces circulating cholesterol in the blood
Answer: A.
An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the ___________________ theory of generalized anxiety disorder development.
An overuse or ineffective use of ego defense mechanisms, which results in a maladaptiveresponse to anxiety, is an example of thepsychodynamic theory of generalized anxiety disorder development. TEST-TAKING HINT: To answer this question correctly, the test taker should review the various theories related to the development of generalized anxiety disorder.
The nurse caring for a client discusses the importance of restricting sodium in the diet. Which statement made by the client indicates that he needs further teaching? a. "I should avoid grilling hamburgers." b. "I must cut out bacon and canned foods." c. "I shouldn't put the salt shaker on the table anymore." d. "I should avoid lunch meats but may cook my own turkey."
Answer: "I should avoid grilling hamburgers." Rationale: Cutting out beef or hamburgers made at home is not necessary; however, fast food hamburgers are to be avoided owing to higher sodium content.
Which of the following actions by the nurse is the most important when caring for a client with renal disease who has an order for furosemide (Lasix)? 1. Assess urine output and renal laboratory values for signs of nephrotoxicity. 2. Check the specific gravity of the urine daily. 3. Eliminate potassium- rich foods from the diet. 4. Encourage the client to void every 4 hours.
Answer: 1 Rationale: Because the kidneys excrete most drugs, clients with renal failure may need a lower dosage of furosemide (Lasix) to prevent further damage to the kidneys. Options 2,3 and 4 are incorrect. Urine specific gravity will not adequately assess renal status and may be altered by the diuresis secondary to the furosemide. Potassium should be increased when furosemide, a potent loop diuretic, is ordered and not eliminated. If diuresis is occurring, the patient may need to void more often then every 4 hours.
39.6 The nurse teaches the client about the use of a metered-dose inhaler (MDI). The nurse evaluates that additional teaching is required when the client makes which statement? 1. "I should hear a whistling sound each time I use the metered-dose inhaler (MDI)." 2. "I need to rinse my mouth each time after using the metered-dose inhaler (MDI)." 3. "I need to drink a lot of fluids while I am using the metered-dose inhaler (MDI)." 4. "I need to follow the instructions about using the metered-dose inhaler (MDI)."
Answer: 1 "I should hear a whistling sound each time I use the metered-dose inhaler (MDI)." Rationale: A whistling sound indicates that the metered-dose inhaler (MDI) is not being used effectively and the client is not receiving the medication. Rinsing the mouth after using the metered-dose inhaler (MDI) is correct; it will help reduce oral absorption of the drug. Fluids are encouraged to liquefy pulmonary secretions when using the metered-dose inhaler (MDI). Following instructions indicates compliance with use of the metered-dose inhaler (MDI).
A patient who received heparin begins to bleed. The nurse anticipates that the health care provider will order which antidote? A) Protamine sulfate B) Phytonadione C) Aminocaproic acid D) Potassium chloride
Answer: A.
38.10 The client receives beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. He asks the nurse if this drug is safe because it is a glucocorticoid. What is the best response by the nurse? 1. "Intranasal glucocorticoids produce almost no serious adverse effects." 2. "Intranasal glucocorticoids are safe if they are not used too long." 3. "Intranasal glucocorticoids are safe if you do not swallow too much while using them." 4. "Intranasal glucocorticoids are safe only if used once a day."
Answer: 1 "Intranasal glucocorticoids produce almost no serious adverse effects." Rationale: Intranasal glucocorticoids produce almost no serious adverse effects. There is no time frame for the use of intranasal glucocorticoids, they produce almost no serious adverse effects. There is no problem with swallowing intranasal glucocorticoids, they produce almost no serious adverse effects. Intranasal glucocorticoids may be used more than once a day; they produce almost no serious adverse effects.
39.2 The nurse teaches a medication class on bronchodilators for clients with asthma. The nurse evaluates that learning has occurred when the clients make which statement? 1. "The medication widens our airways because it stimulates the fight-or-flight response of our nervous system." 2. "The medication widens our airways because it acts on the parasympathetic nervous system." 3. "The medication widens our airways because it decreases the production of mucous that narrows our airways." 4. "The medication widens our airways because it decreases the production of histamine that narrows our airways."
Answer: 1 "The medication widens our airways because it stimulates the fight-or-flight response of our nervous system." Rationale: During the fight-or-flight response, beta2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs. Bronchodilators act on the sympathetic nervous system, not the parasympathetic nervous system. Bronchodilators do not decrease the production of mucous. Bronchodilators do not decrease the production of histamine.
38.14 The client is very frustrated that pseudoephedrine is no longer stocked on pharmacy shelves. The client does not like to go the pharmacy counter to obtain the drug. What is the best response by the nurse? 1. "This is frustrating, but hopefully it will decrease the amount of methamphetamine being produced." 2. "This is frustrating, but hopefully it will decrease the amount of crack cocaine being produced." 3. "This is frustrating, but hopefully it will decrease the amount of inhaled heroin being produced." 4. "This is frustrating, but hopefully it will decrease the amount of methylphenidate being produced."
Answer: 1 "This is frustrating, but hopefully it will decrease the amount of methamphetamine being produced." Rationale: Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine. Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine, not crack cocaine. Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine, not heroin. Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine, not methylphenidate. Implementation
39.11 The client receives zafirlukast (Accolate) as treatment for asthma. The nurse has completed medication education and evaluates learning has occurred when the client makes which statement? 1. "This medication decreases the inflammation in my lungs." 2. "This medication dilates my airways so I can breathe better." 3. "This medication is good when I have an acute attack of asthma." 4. "This medication activates my fight-or-flight response."
Answer: 1 "This medication decreases the inflammation in my lungs." Rationale: Zafirlukast (Accolate) prevents airway edema and inflammation by blocking leukotriene receptors in the airways. Zafirlukast (Accolate) is not a bronchodilator. Zafirlukast (Accolate) is ineffective for acute asthma attacks. Zafirlukast (Accolate) is not a beta-adrenergic drug so it does not activate the sympathetic (fight-or-flight) nervous system.
38.3 Which assessment finding, by the nurse, is a priority concern when a client receives pseudoephedrine (Sudafed) 60 mg PO every 4 hours? 1.Blood pressure of 150/60 mmHg 2.Temperature of 100° F 3.Complaints of a dry mouth 4.Respiratory rate of 22
Answer: 1 Blood pressure of 150/60 mmHg Rationale: Psuedoephedrine (Sudafed) is a vasoconstrictor and can increase blood pressure. A temperature is possible with pseudoephedrine (Sudafed), but is not the primary concern. A dry mouth is possible with pseudoephedrine (Sudafed), but is not the primary concern. A respiratory rate of 22 is possible with pseudoephedrine (Sudafed), but is not the primary concern.
38.6 The nursing instructor teaches the nursing students about the major functions of the upper respiratory tract. What will the best plan of the nursing instructor include? Select all that apply. 1. The nasal mucosa is the first line of immunological defense. 2. The nose warms the air before it reaches the lungs. 3. Activation of the sympathetic nervous system constricts arterioles in the nose. 4. Activation of the parasympathetic nervous system constricts arterioles in the nose. 5. Inward airflow from the trachea branches off to the two bronchi.
Answer: 1, 2, 3 Rationale: The nasal mucosa is the first line of immunological defense. The nose warms the air before it reaches the lungs. Activation of the sympathetic nervous system constricts arterioles in the nose. Activation of the sympathetic nervous system, not the parasympathetic nervous system, constricts arterioles in the nose. The trachea and bronchi are part of the lower respiratory tract.
38.7 The client has allergic rhinitis and asks the nurse what causes this. What is the best response by the nurse? Select all that apply. 1. "It is caused by weeds and grasses." 2. "It is caused by tobacco smoke." 3. "You inherited the predisposition for this." 4. "It is caused by animals." 5. "It is caused by asthma."
Answer: 1, 2, 3, 4 Rationale: Allergic rhinitis is caused by weeds and grasses. Allergic rhinitis is caused by tobacco smoke. Allergic rhinitis is caused by animals. There is a strong genetic predisposition for allergic rhinitis. Although associated with asthma, allergic rhinitis is not caused by asthma.
39.7 The client receives beclomethasone (Beconase). What will the best assessment of the nurse include? Select all that apply. 1. Assess if the client alternates nares with administration of nasal spray. 2. Assess the client's blood glucose prior to administration of nasal spray. 3. Assess the client's mouth for any sign of fungal infection. 4. Assess the client for any hoarseness or change in voice. 5. Assess if the client has blown his nose prior to administration of nasal spray.
Answer: 1, 3, 4, 5 Rationale: Nares should be alternated with nasal spray. Clients may develop candidiasis so the mouth should be assessed. Clients may experience a change in voice as a local effect. The client should gently blow the nose prior to use to clear the nasal passages. There is no need to assess the client's blood glucose.
The nurse is providing teaching to a client who has been prescribed furosemide (Lasix). Which of the following should the nurse teach the client? 1. Avoid consuming large amounts of kale, cauliflower, or cabbage. 2. Rise slowly from a lying or sitting position. 3. Count the pulse for one full minute before taking this medication. 4. Restrict fluid intake to no more than 1L per 24 hour period.
Answer: 2 Rationale: Loop diuretics such as furosemide (Lasix) may dramatically reduce a client's circulating blood volume from diuresis and may cause orthostatic hypotension. To minimize the chance for syncope and falls, the client should be taught to rise slowly from a lying or sitting position to standing. Options 1,3, and 4 are incorrect. Kale, cauliflower and cabbage contain vitamin K, which does not need to be restricted during diuretic therapy. Monitoring the pulse along with blood pressure to assess for tachycardia is advised, but the pulse does not need to be taken for 1 full minute before taking the drug. Fluids should not be restricted during diuretic therapy unless ordered by the provider.
38.4 The elderly client receives diphenhydramine (Benadryl) for allergies. The nurse completes medication education and evaluates learning has occurred when the client makes which statement? 1. "If my nose begins to run, I can use a nasal spray." 2. "Constipation is common; I need to increase fiber in my diet." 3. "I need to watch my intake of sodium with this medication." 4. "I cannot take this medication with pseudoephedrine (Sudafed)."
Answer: 2 "Constipation is common; I need to increase fiber in my diet." Rationale: Constipation is a common side effect of antihistamines. Antihistamines dry, not increase, secretions. Sodium intake is not related to antihistamines. Pseudoephedrine (Sudafed) is commonly used with antihistamines.
39.10 The physician has ordered ipratropium (Atrovent) for the client. What is a priority assessment question for the nurse to ask prior to administering this medication? 1. "Do you have diabetes mellitus?" 2. "Do you have glaucoma?" 3. "Do you have seizures?" 4. "Have you ever had a heart attack?"
Answer: 2 "Do you have glaucoma?" Rationale: Anticholinergic drugs can worsen narrow angle glaucoma. Anticholinergic drugs do not impact glucose levels, so having diabetes mellitus is not a concern. Anticholinergic drugs do not affect seizure disorders, this is not a concern. Anticholinergic drugs do not affect cardiac status; a prior heart attack is not a concern.
38.8 The nursing instructor teaches the student nurses about histamine receptors and evaluates that further instruction is needed when the students make which statement? 1. "H1-receptors are responsible for allergic symptoms." 2. "H1-receptors are responsible for peptic ulcers." 3. "H2-receptors are responsible for peptic ulcers." 4. "H2-receptors increase mucus secretion in the stomach."
Answer: 2 "H1-receptors are responsible for peptic ulcers." Rationale: H2-receptors, not H1-receptors, are responsible for peptic ulcers. H1-receptors are responsible for allergic symptoms. H2-receptors are responsible for peptic ulcers. H2-receptors increase mucus secretion in the stomach.
38.2 The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask? 1. "Can you describe how your symptoms have gotten worse?" 2. "How long have you been using the medication?" 3. "May I take your temperature?" 4. "Are you using any other inhaled medications?"
Answer: 2 "How long have you been using the medication?" Rationale: Oxymetazoline (Afrin) can cause rebound congestion if used for too long, so length of treatment is the best assessment question. The problem is rebound congestion, asking the client to describe her symptoms is unnecessary. The problem is rebound congestion, not infection; taking the client's temperature is not necessary. The use of other inhaled medications will not cause or prevent rebound congestion, so this question is unnecessary.
38.12 The mother asks the nurse when she should give her child cough medicine. What is the best response by the nurse? 1. "When he has bronchitis." 2. "When he has a dry cough and cannot rest." 3. "When he is coughing up green secretions." 4. "When he has a temperature over 102°F."
Answer: 2 "When he has a dry cough and cannot rest." Rationale: Dry, hacking, and nonproductive cough is irritating to the membranes of the throat and deprives the client of much needed rest, so a cough medicine would be warranted in this case. It is not desirable to suppress the cough reflex in a client with bronchitis; the child should not receive cough medicine. If the client is coughing up green secretions, he needs to receive an antibiotic, not cough medicine. If a client is febrile, he needs an assessment prior to receiving cough medication.
39.15 The client receives ipratropium (Atrovent). She tells the nurse she is going to stop it because of the bitter taste in her mouth after using the medication. What is the best response of the nurse? 1. "That is a good idea; you are experiencing a serious side effect." 2. "You can decrease that side effect by rinsing your mouth after use." 3. "That is a common side effect; it will go away in time." 4. "Are you sure you are using the medication properly?"
Answer: 2 "You can decrease that side effect by rinsing your mouth after use." Rationale: Ipratropium (Atrovent) produces a bitter taste, which may be relieved by rinsing the mouth after use. The client is not experiencing a serious side effect; there is no need to stop the medication. The bitter taste will not go away in time; the client must rinse her mouth. Asking how the client uses the medication may be a good option, but not with the common side effect of bitter taste.
39.4 The nurse plans to teach an adolescent about inhalation therapy as part of the treatment plan for the client's asthma. What does the best plan of the nurse include? 1. Inhalation therapy is effective because it provides around-the-clock therapy, as opposed to oral medications. 2. Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract. 3. Inhalation therapy is effective because it provides systemic relief of symptoms as well as local relief. 4. Inhalation therapy is the preferred treatment for adolescents because it is easier for them to manage.
Answer: 2 Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract. Rationale: The major advantage of aerosol therapy is that it delivers the drugs to their direct site of action. Inhalation therapy does not provide around-the-clock therapy. Inhalation therapy does not provide systemic relief of symptoms. Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage.
For the patient taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose? A) To decrease serum potassium level B) To increase serum potassium level C) To decrease glucose level D) To increase glucose level
Answer: B.
38.15 The client takes diphenhydramine (Benadryl), but forgets to tell the physician about this drug when a monoamine oxidase inhibitor (MAOI) drug is prescribed for depression. What will the best assessment of the nurse reveal? 1. The depression will not subside. 2. The client may develop a hypertensive crisis. 3. The diphenhydramine (Benadryl) will not control allergies. 4. The client may develop seizures. Answer: 2 Rationale: The combination of diphenhydramine (Benadryl) and a monoamine oxidase inhibitor (MAOI) drug can result in a hypertensive crisis. Depression is not the concern with this combination, a hypertensive crisis is. Control of allergies is not the concern with this combination, a hypertensive crisis is. Seizures are not the concern with this combination, a hypertensive crisis is.
Answer: 2 The client may develop a hypertensive crisis. Rationale: The combination of diphenhydramine (Benadryl) and a monoamine oxidase inhibitor (MAOI) drug can result in a hypertensive crisis. Depression is not the concern with this combination, a hypertensive crisis is. Control of allergies is not the concern with this combination, a hypertensive crisis is. Seizures are not the concern with this combination, a hypertensive crisis is.
39.14 The nurse is preparing to administer beclomethasone (Beconase) to several clients. For which client would the nurse hold the drug and contact the physician? 1. The client who has diabetes mellitus. 2. The client who has methicillin resistant Staphylococcus aureus (MRSA). 3. The client who has had a myocardial infarction (MI). 4. The client who has terminal cancer.
Answer: 2 The client who has methicillin resistant Staphylococcus aureus (MRSA). Rationale: Glucocorticoids can mask the signs of infection, and are contraindicated if active infection is present. Beclomethasone (Beconase) is not contraindicated in clients who have diabetes mellitus. Beclomethasone (Beconase) is not contraindicated in clients who have had a myocardial infarction. Beclomethasone (Beconase) is not contraindicated in clients who have terminal cancer.
38.9 The client receives diphenhydramine (Benadryl) to control allergic symptoms. Which common symptom does the nurse teach the client to report to the physician? 1. Sedation 2. Urinary hesitancy 3. Diarrhea 4. Projectile vomiting
Answer: 2 Urinary hesitancy Rationale: Urinary hesitancy is an anticholinergic effect of diphenhydramine (Benadryl) and should be reported to the physician. Sedation is a common side effect, but does not need to be reported. Diarrhea is not a common side effect. Projectile vomiting is not a common side effect.
39.8 The client receives ipratropium (Atrovent) via inhalation for the treatment of chronic asthma. The nurse plans to do medication education with the client. What will the best plan of the nurse include? Select all that apply. 1. The medication may also be used for acute asthma attacks. 2. Report any changes in urinary pattern. 3. Wait 15 minutes before using any other inhaled medications. 4. Report a change in the color or amount of sputum. 5. Use the medication consistently, not occasionally.
Answer: 2, 4, 5 Rationale: Anticholinergic drugs can result in urinary retention, and the client should report any changes in urinary patterns. A side effect of anticholinergics is sinusitis and upper respiratory tract infection, so the client should report any change in the color or amount of sputum. To get the most benefit from ipratropium (Atrovent), it must be used consistently. Anticholinergic drugs will not terminate an acute asthma attack, as peak effects may take 1 to 2 hours. It is only necessary to wait 5 minutes, not 15 minutes, between inhaled medications.
Which of the following manifestations may indicate the the client taking metolazone (Zaroxolyn) is experiencing hypokalemia? 1. Hypertension 2. Polydipsia 3. Cardiac dysrhythmias 4. Skin rash
Answer: 3 Rationale: Metolazone (Zaroxolyn) is a thiazide diuretic and causes potassium loss. Signs of hypokalemia include cardiac dysrhythmias, hypotension, dizziness and fainting. Options 1,2 and 4 are incorrect. Polydipsia is not associated with hypokalemia. Hypertension is a clinical indication for the use for diuretics. Skin rashes are an adverse effect of metolazone but are not a symptom of hypokalemia.
While planning for a client's discharge from the hospital, which of the following teaching points would be included for a client going home with a prescription for chlorothiazide (Diuril)? 1. Increase fluid and salt intake to make up for the losses caused by the drug. 2. Increase intake of vitamin C- rich foods such as grapefruit and oranges. 3. Report muscle cramping or weakness to the health care provider. 4. Take the drug at night because it may cause drowsiness.
Answer: 3 Rationale: Muscle cramping or weakness may indicate hypokalemia and should be reported to the health care provider. Options 1,2, and 4 are incorrect. Clients on diuretic therapy are taught to monitor sodium (salt) and water intake to maintain adequate, but not excessive, amounts. Vitamin C -rich foods do not need to be increased while a client is taking chlorothiazide (Diuril). The drug should be taken early in the day to avoid nocturia. It does not cause drowsiness.
38.5 The nurse completes medication education for the client receiving antihistamines. The nurse evaluates learning has occurred when the client makes which statement? 1. "I can still have my after-dinner-drink." 2. "I need to increase fluids while taking this medication." 3. "This medication could make me very sleepy." 4. "This medication is safe because it is sold over-the-counter (OTC)."
Answer: 3 "This medication could make me very sleepy." Rationale: Sedation is a common side effect of antihistamines. Alcohol will increase the sedative effects of antihistamines, so the client should not drink while taking antihistamines. There is no need to increase fluids when taking antihistamines. Just because a medicine is sold over-the-counter (OTC), does not mean it is safe.
39.1 The client receives albuterol (Proventil) via inhaler. He asks the nurse why he can't just take a pill. What is the best response by the nurse? 1. "Because this medication cannot be absorbed from your GI tract; the acid in your stomach would destroy it." 2. "Because pills cannot help your illness; you must have inhaled medications for relief of symptoms." 3. "Because the surface of your lungs, and their blood supply, results in a rapid onset of action of the drug when inhaled. 4. Because pills would produce too many side effects; you will have very few side effects with inhaled medications.
Answer: 3 Because the surface of your lungs, and their blood supply, results in a rapid onset of action of the drug when inhaled. Rationale: The respiratory system offers a rapid and efficient mechanism for delivering drugs. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances. Albuterol (Proventil) can be given orally (PO), but has a faster onset of action if inhaled. Oral medications are effective with some symptoms of respiratory disorders, but inhaled medications work faster. Inhaled medications also produce side effects.
39.5 A client receives theophylline (Theo-Dur) and calls the clinic to say he has had nausea and vomiting for two days. What is the best action by the nurse? 1. Recommend that the client begin a clear liquid diet. 2. Ask the client if he has been exposed to anyone with the flu. 3. Tell the client to come to the clinic for an assessment. 4. Ask the client if he has eaten at any unclean restaurants.
Answer: 3 Tell the client to come to the clinic for an assessment. Rationale: Nausea and vomiting are symptoms of theophylline toxicity; the client needs to come to the clinic for an assessment. A clear-liquid diet might help, but the client needs to be assessed for theophylline toxicity. Flu could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity. Food poisoning could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity.
39.12 The physician has prescribed cromolyn (Intal) for the client with asthma. The nurse plans to do medication education. What will the best plan of the nurse include? 1. This medication can affect blood glucose levels. 2. This medication is indicated for acute asthma attacks. 3. This medication will help prevent asthma attacks. 4. This medication can result in hypertension.
Answer: 3 This medication will help prevent asthma attacks. Rationale: By reducing inflammation, cromolyn (Intal) is able to prevent asthma attacks. Cromolyn (Intal) does not affect blood glucose levels. Cromolyn (Intal) is ineffective for acute asthma attacks. Cromolyn (Intal) does not cause hypertension.
The client admitted for heart failure (HF) has been receiving hydrochlorothiazide (Microzide). Which of the following laboratory levels should the nurse carefully monitor? (Select all that apply) 1. Platelet count 2. WBC count 3. Potassium 4. Sodium 5. Uric acid
Answer: 3,4,5 Rationale: Thiazide diuretics such as hydrochlorothiazide (Microzide) cause loss of sodium and potassium but may cause hyperuricemia. Options 1 and 2 are incorrect. Hydrochlorothiazide does not have a direct effect on blood cells.
38.11 The nurse teaches the client about the difference between oral and nasal decongestants. The nurse evaluates learning has been effective when the client makes which statement? 1. "Oral and nasal decongestants can cause rebound congestion." 2. "Intranasal decongestants are safe to use for a month, if needed." 3. "Oral decongestants are the most effective at relieving severe congestion." 4. "Oral decongestants can cause hypertension."
Answer: 4 "Oral decongestants can cause hypertension." Rationale: One of the side effects of oral decongestants is hypertension. Oral decongestants do not cause rebound congestion, nasal decongestants can cause rebound congestion. Intranasal decongestants should not be used for longer than 3 to 5 days. Intranasal, not oral, decongestants are the most effective at relieving severe congestion.
39.13 The physician has ordered salmeterol (Serevent) for the client with asthma. The client asks the nurse how to use the medication. What is the best response by the nurse? 1. "Use it frequently because its action is very short." 2. "Use it when you have an acute asthma attack." 3. "Take it 5 to 10 minutes before you exercise." 4. "Take it 30 to 60 minutes before you exercise."
Answer: 4 "Take it 30 to 60 minutes before you exercise." Rationale: When taken 30 to 60 minutes prior to physical activity, salmeterol (Serevent) can prevent exercise-induced bronchospasm. Salmeterol (Serevent) has a 12-hour duration of action, not a short duration of action. Salmeterol (Serevent) takes 15 to 25 minutes to act so it cannot be used to terminate an acute asthma attack. Taking salmeterol (Serevent) 5 to 10 minutes prior to beginning exercise is not sufficient enough time to prevent an acute attack.
39.3 The client asks the nurse why she must continue taking her asthma medication even though she has not had an asthma attack in several months. What is the best response by the nurse? 1. "The medication needs to be taken for at least a year; then, if you have not had an acute attack, you can stop it." 2. "The medication needs to be taken or your lungs will be severely damaged and we will not be able to stop an acute attack." 3. "The medication needs to be taken indefinitely according to your doctor, so you should discuss this with him." 4. "The medication is still needed to decrease inflammation in your airways and help prevent an attack."
Answer: 4 "The medication is still needed to decrease inflammation in your airways and help prevent an attack." Rationale: Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Long-term treatment of asthma continues indefinitely, not for just one year. Telling a client that lungs will be severely damaged is nontherapeutic; the inability to prevent an acute attack in this client is not true. The nurse is able to answer the client's question; it does not need to be referred to the physician.
39.9 The client receives isoproterenol (Isuprel) via inhalation. The nurse determines that the client is experiencing a side effect of this medication when reviewing which laboratory test? 1. Creatinine of 1.0 mg/dl 2. Sodium of 160 3. AST of 20 units/L 4. Glucose of 145
Answer: 4 Glucose of 145 Rationale: A side effect of isoproterenol (Isuprel) is hyperglycemia. A creatinine of 1.0 mg/dl is a normal creatinine level, and isoproterenol (Isuprel) is not nephrotoxic. A sodium of 160 is an elevated sodium level, but isoproterenol (Isuprel) does not cause hypernatremia. An AST of 20 units/L is a normal AST, and isoproterenol (Isuprel) is not hepatotoxic.
38.13 The physician orders ipratropium bromide (Atrovent) for the client. The nurse would hold the drug and contact the physician with which assessment finding? 1. The client has hypertension. 2. The client is pregnant. 3. The client has diabetes mellitus. 4. The client has glaucoma.
Answer: 4 The client has glaucoma. Rationale: Ipratropium bromide (Atrovent) is an anticholinergic drug and should be used in caution with clients who have glaucoma. There is no contraindication with the use of ipratropium bromide (Atrovent) in clients who have hypertension. Ipratropium bromide (Atrovent) is Pregnancy Category B drug, and should be safe for use in the pregnant client. There is no contraindication with the use of ipratropium bromide (Atrovent) in a client with diabetes mellitus.
The nurse anticipates which of the following orders for the patient with Duchenne Muscular Dystrophy? Select all that apply: A) Prednisone B) Calcium supplements C) Bedrest D) Botulinum Toxin E) Chest percussion
Answer: A, B, and E. Corticosteroids are thought to help slow the progression of the disease. Calcium supplements are provided to help with the long-term effects of osteoporosis caused by the corticosteroids. Chest percussion can help remove excess secretions from the respiratory tract that the patient may be too weak to expel by themselves. Bedrest or use of botulinum toxin would not be recommended for this patient.
A child who weighs 88 pounds is ordered to receive 3 mg/kg of a drug. The drug is available in a 15 mg/mL elixir. How much drug will the patient receive?
Answer: 8 mL.
The nurse has been measuring the blood pressure of an African-American patient every 4 hours for the past 3 days in a hospital setting. The blood pressure is consistently above 140/90. The patient has been adherent to the antihypertensive drug therapy while hospitalized. The nurse will initially perform which action? A) Determine if the patient has been given high sodium foods from visitors. B) Withhold the antihypertensive drug until the physician can be notified. C) Increase blood pressure measurements to every 2 hours. D) Place the patient on a restricted fluid intake.
Answer: A
39.17 The nurse understands that one advantage of inhaled pulmonary drugs over oral drugs is that inhaled drugs: a. Allow for quick absorption. b. Increase adverse effects. c. Are delivered to systemic locations. d. Allow for convenience to the client.
Answer: A Allow for quick absorption. Rationale: A. Inhalation is the most common route of administration; it is rapid, and allows for quick absorption to direct airway. B. Inhaled drugs decrease adverse effects. C. Inhaled drugs are delivered to local sites. D. Inhaled drugs are not as convenient as oral.
39. 22. A beta-adrenergic agonist (bronchodilator) is used to: a. Cause bronchodilation. b. Reduce respiratory secretions. c. Increase the respiratory rate. d. Decrease the amount of air entering the lungs.
Answer: A Cause bronchodilation. Rationale: A. The primary action of beta-adrenergic agonists such as bronchodilators is to relax smooth muscle. B. A beta-adrenergic agonist would not reduce respiratory secretions C. this is an adverse effect, but not indication. D. This is not related to bronchodilation, and would increase the amount of air.
38.19 Which of the following over-the-counter (OTC) antihistamine combinations contains an analgesic property? a. Drixoral Allergy and Sinus Extended b. Sudafed PE Nighttime c. Tavist Allergy 12-hour d. Triaminic Cold/Allergy
Answer: A Drixoral Allergy and Sinus Extended Rationale: A. Drixoral Allergy and Sinus Extended contains acetaminophen. B. Sudafed PE Nighttime contains diphenhydramine and Phenylephrine. C. Tavist Allergy 12-hour contains clemastine. D. Triaminic Cold/Allergy contains chlorpheniramine and phenylephrine.
39.19 Leukotriene modifiers are primarily used for: a. Prophylaxis of asthma symptoms. b. Infection. c. Bronchodilation in asthma. d. Status asthmaticus.
Answer: A Prophylaxis of asthma symptoms. Rationale: A. Leukotriene modifiers are used primarily for prophylaxis and reducing inflammatory components. B. Leukotrienes do not reduce infection. C. Anticholinergics are bronchodilators. D. Leukotrienes are not used for treatment of status asthmaticus.
What provisions of the Dietary Supplement Health and Education Act of 1994 are most important for the nurse to know related to patient health teaching? (Select all that apply.) A) Clarified marketing regulations B) Reclassified herbs as dietary supplements C) Stated that herbal products can be marketed with suggested dosages D) Required that package labels give quality and strength of all contents E) Stated that herbs can be used as drugs
Answer: A, B, C
A patient is placed on heparin, and the nurse acknowledges that heparin is effective for preventing clot formation in patients who have which disorder(s)? (Select all that apply.) A) Coronary thrombosis B) Acute myocardial infarction C) Deep vein thrombosis D) Hemorrhagic stroke E) Disseminated intravascular coagulation
Answer: A, B, C, D, E
A patient is ordered furosemide to be given via intravenous push. Which interventions will the nurse perform? (Select all that apply). A) Administer at a rate no faster than 20 mg/min. B) Assess lung sounds before and after administration. C) Assess blood pressure before and after administration. D) Maintain accurate intake and output record. E) Monitor the electrocardiogram continuously. F) Insert an arterial line for continuous blood pressure monitoring.
Answer: A, B, C, D. Furosemide can be infused via intravenous push at the rate of 20 mg/min. Furosemide is a diuretic and will decrease fluid in alveoli, and assessing lung sounds can help to determine therapeutic effect. Blood pressure should decrease with the administration of a diuretic. It is appropriate to monitor before and after administration. It is appropriate to monitor intake and output for a patient receiving a diuretic. There is no need to insert an arterial line to continuously monitor the blood pressure since it should not fluctuate that dramatically. Also, there is no need to continuously monitor the electrocardiogram because the medication is not cardiotoxic.
A patient is to start disulfiram to help with alcohol use disorder. The nurse providing medication education about the drug will include which topics in the education plan? (Select all that apply.) A) Importance of taking the medication every day B) That better results are experienced when a support group helps with treatment adherence C) Common food and hygiene products that contain alcohol D) That disulfiram treatment should be stopped 1 day before alcohol consumption E) That disulfiram works by disrupting the metabolism of alcohol F) That use of alcohol with disulfiram may cause nausea and vomiting and may even be fatal
Answer: A, B, C, E, F
A patient has nine drugs prescribed to take daily. Which are common reasons for nonadherence to the drug regimen in an older adult? (Select all that apply.) A) Taking multiple drugs at one time B) Impaired memory C) Decreased dexterity D) Increased mobility E) Increased visual acuity
Answer: A, B, C.
Which of the following disorders would be considered medically appropriate for the use of anabolic-androgenic steroids (AAS)? A) Delayed puberty. B) Hypogonadism. C) Cachexia. D) Appetite suppression. E) Muscle growth.
Answer: A, B, C. Anabolic-androgenic steroids (AAS) are synthetic agents used to treat conditions caused by low levels of testosterone in the body, such as delayed puberty, hypogonadism, and cachexia related to chronic disease states.
The nurse understands that the risk for drug toxicity in the first year of life can be due to which of the following factors. (Select all that apply). A) Immaturity of the liver. B) Alterations in blood flow to tissues. C) Decreased protein and protein-binding sites. D) Increased renal perfusion. E) Increased muscle mass.
Answer: A, B, C. Neonates and infants have immature livers, decreased protein concentrations compared with adults, and they have fewer protein receptor sites with an affinity for drug binding in the first 12 months after birth; this results in higher levels of unbound drug and an increased risk of drug toxicity.
The patient is caring for the patient receiving nitroprusside. Which interventions should be included in the nurse's plan of care? A) Monitor for thiocyanate levels. B) Protect fluid bag from light. C) Provide continuous blood pressure monitoring. D) Monitor potassium levels. E) Assess chest pain level.
Answer: A, B, C. Nitroprusside is used for hypertensive emergencies as well as emergency management for heart failure. The drug can be administered over 24 h but decomposes in light, so the container must be wrapped in opaque material, such as aluminum foil. Discard drug if red, green, or blue. Measure cyanide and thiocyanate levels. May cause confusion, hypotension, bradycardia, tachycardia, dizziness, headache, palpitations, ataxia, seizures, cyanide or thiocyanate toxicity, and methemoglobinemia.
When conducting a cultural assessment of a patient, what will the nurse include in the assessment? (Select all that apply). A) Touch preferences. B) Perception of time. C) Eye contact preference. D) Sexual orientation. E) Ability to speak English.
Answer: A, B, D.
A patient who has angina is prescribed nitroglycerin. Which are appropriate nursing interventions for nitroglycerin? (Select all that apply.) A) Have the patient sit or lie down when taking a nitroglycerin sublingual tablet. B) Teach the patient who has taken a tablet to call 911 in 5 minutes if chest pain persists. C) Apply the nitroglycerin patch to a hairy area to protect skin from burning. D) Call the health care provider after taking five tablets if chest pain persists. E) Warn the patient against ingesting alcohol while taking nitroglycerin.
Answer: A, B, E.
The Principle of Atraumatic Care includes (select all that apply): A) Pain management B) Collaborative care with family members C) Restraining infants to administer drugs D) Keeping the child apart from family members when administering drugs
Answer: A, B.
What factors contribute to polypharmacy in the elderly? (Select all that apply.) A) Multiple health care providers B) Multiple chronic diseases C) Use of a single pharmacy D) Care coordination by a nurse E) Few hospitalizations
Answer: A, B.
Which symptoms are likely to be produced by abuse of cannabis? A) Relaxation. B) Heightened sensation of time. C) Euphoria. D) Lack of motivation. E) Emotional liability
Answer: A, C, D, E. Cannabis abuse is most likely to produce a slowed sensation of time rather than a heightened sensation.
A nurse caring for a child with developmental delay prepares to teach the patient about prescribed drugs. Which actions are essential to ensure patient safety? (Select all that apply.) A) Assess the child's developmental age. B) Assess for side effects the same as those experienced by adults. C) Consider the actions and uses of the drug. D) Focus on the child's chronologic age. E) Involve the family in teaching sessions.
Answer: A, C, E.
The nurse is developing teaching materials for an 82-year-old African-American man with macular degeneration, who is being discharged on two new drugs. Which strategies would be best to use to impart the information? (Select all that apply.) A) Limit distractions in the room when teaching. B) Wait until discharge to teach so information is fresh in the memory. C) Augment teaching with audio material. D) Use Honey and other terms of familiarity to promote trust. E) Use large, dark print on a light background for written material.
Answer: A, C, E.
A patient being seen at a cardiovascular clinic mentions he takes garlic, which is reported to decrease cholesterol, blood pressure, and heart disease. Which patient statement indicates a need for further teaching? (Select all that apply.) A) I can just take garlic for my heart problems. B) Garlic may provide some decrease in blood pressure. C) Garlic is very effective in preventing depression. D) Garlic will not cure impotence.
Answer: A, C.
Which of the following strategies are helpful when working with adolescent patients to promote adherence? (Select all that apply.) A) Allow flexibility in the treatment plan. B) Use future-oriented examples and consequences to support the need for drug therapy. C) Guarantee the adolescent patient privacy when obtaining history. D) Set up a mutually developed drug contract.
Answer: A, D.
A nurse observes another nurse taking oral opioids from the medication room at the hospital. Which is the best action for the nurse who observes drug diversion to take? A) Report the finding to the nursing supervisor to enable the nurse's participation in a nondisciplinary program. B) Ignore the situation to protect the nurse from dismissal and possible loss of licensure. C) Confront the nurse and demand that the drugs be returned before someone notices their absence. D) Ask the nurse to request pain medications from a physician rather than stealing them from the hospital.
Answer: A.
A patient has a low-density lipoprotein of 175 mg/dL and a high-density lipoprotein of 30 mg/dL. What teaching should the nurse implement for this patient? A) Discuss medications ordered, dietary changes, and exercise. B) No changes in lifestyle are needed; continue with the current plan. C) Discuss how to have fat intake be 40% of caloric intake. D) Begin keeping a food diary, and schedule lab work to be repeated in 6 months.
Answer: A.
A patient has developed mild hypertension. The nurse acknowledges that the first-line drug for treating this patient's blood pressure might be which drug? A) Diuretic B) Alpha blocker C) Angiotensin-converting enzyme inhibitor D) Alpha/beta blocker
Answer: A.
A patient has taken metaproterenol. What is the nurse's priority action? A) Monitoring for heart rate > 100 beats/min. B) Telling the patient not to drive for 2 h. C) Monitoring for sedation. D) Assessing for elevated blood pressure.
Answer: A.
A patient hospitalized with a fractured femur following an automobile accident develops nausea and vomiting, abdominal cramps, and restlessness. The nurse suspects that the patient is experiencing which reaction? A) Opioid withdrawal B) Alcohol toxicity C) Flashbacks from LSD use D) Nicotine withdrawal
Answer: A.
A patient is prescribed enoxaparin. The nurse knows that low-molecular-weight heparin has what kind of half-life? A) A longer half-life than heparin B) A shorter half-life than heparin C) The same half-life as heparin D) A four-times shorter half-life than heparin
Answer: A.
A patient is taking a potassium-depleting diuretic and digoxin. The nurse expects that a low potassium level (hypokalemia) could have what effect on digoxin? A) Increases serum digoxin sensitivity level B) Decreases serum digoxin sensitivity level C) No effect on serum digoxin sensitivity level D) Causes a low-average serum digoxin sensitivity level
Answer: A.
The emergency nurse practitioner orders activated charcoal for a teenage girl who took an intentional overdose of aspirin and several unknown drugs from her parents' drug cabinet. Upon preparing to administer the activated charcoal by mouth, the nurse notes that the patient has become very somnolent and opens her eyes only to a noxious stimulus. Which action by the nurse is most appropriate at this point? A) Immediately discuss the change in the patient's mental status with the nurse practitioner so that the plan of care can be reevaluated. B) Immediately insert a nasogastric tube and administer the activated charcoal. C) Immediately elevate the head of the patient's stretcher, and coax her to drink the activated charcoal while applying noxious stimuli as necessary to keep her awake. D) Give only half the dose now, and wait until her mental status improves before giving the remainder of the dose.
Answer: A.
The nurse knows that a patient's total cholesterol level should be within which range? A) 150 to 200 mg/dL B) 200 to 225 mg/dL C) 225 to 250 mg/dL D) Greater than 250 mg/dL
Answer: A.
The older adult patient has questions about oral drug metabolism. Information on what subject is most important to include in this patient's teaching plan? A) First-pass effect B) Enzyme function C) Glomerular filtration rate D) Motility
Answer: A.
The patient's serum digoxin level is 3.0 ng/mL. What does the nurse know about this serum digoxin level? A) It is in the high (elevated) range. B) It is in the low (decreased) range. C) It is within the normal range. D) It is in the low-average range.
Answer: A.
What does the nurse know to be correct concerning the use of mannitol in patients? A) It decreases intracranial pressure. B) It increases intraocular pressure. C) It causes sodium and potassium retention. D) It causes diuresis in several days.
Answer: A.
Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which adjustment to minimize the risk of toxicity? A) A decrease in the dosage of drug given B) An increase in the dosage of drug given C) A shorter time interval between doses D) Intravenous administration of the drug
Answer: A. A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. An increase in the drug dose would result in higher risk of toxicity. A shorter time interval between doses would increase the risk of toxicity. IV administration of a drug may increase the risk of toxicity due to quicker onset of action.
A patient is to be discharged with a transdermal nitroglycerin patch. Which instruction will the nurse include in the patient's teaching plan? A) "Apply the patch to a non-hairy area of the upper torso or arm." B) "Apply the patch to the same site each day." C) "If you have a headache, remove the patch for 4 hours and then reapply." D) "If you have chest pain, apply a second patch next to the first patch."
Answer: A. A nitroglycerin patch should be applied to a non-hairy area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation. The drug should be continued if headache occurs, as tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.
In the older adult, a reduction in hepatic metabolism can decrease first-pass metabolism and can prolong drug half-life, thus leading to which nursing concern? A) Drug toxicity. B) Allergic response. D) Decreased therapeutic effect. D) Increased bioavailability.
Answer: A. A reduction in hepatic metabolism can decrease first-pass metabolism and can prolong drug half-life, resulting in increased drug levels and potential drug toxicity
The patient has an international normalized ratio (INR) value of 1.5. In response to this, the nurse could anticipate the health care provider placing which order? A) Administer an additional dose of warfarin. B) Hold the next dose of warfarin. C) Increase the heparin drip rate. D) Administer protamine sulfate.
Answer: A. A therapeutic INR is 2-3. The patient needs more warfarin to reach a therapeutic level.
What effect may physiological changes due to aging in the older adult's cardiac system have on drug administration in this patient? A) Delayed transportation of drugs to the body tissues. B) Slowed absorption of oral drugs. C) Increased transportation of drugs to the body tissues. D) Increased absorption of oral drugs.
Answer: A. Administration of medication to an older adult can result in delayed transportation of the drugs to the tissues because of changes in the older adult's cardiac system. The cardiac system usually will not cause slower absorption of oral drugs.
The nurse is administering medication to an older adult. The nurse anticipates that this patient's hepatic system will have which effect on the medication? A) The medication will be excreted quicker. B) The medication will be metabolized more slowly. C) The medication will be excreted more slowly. D) The medication will be metabolized quicker.
Answer: A. Administration of medication to an older adult can result in the drug being metabolized more slowly in the body. The hepatic system will not affect the excretion of the drug.
Which nursing intervention is essential for the patient receiving alteplase? A) Assess for reperfusion dysrhythmias. B) Monitor liver enzymes. C) Administer prescribed vitamin K if bruising is observed. D) Monitor blood pressure and stop the medication if blood pressure drops below 110 systolic.
Answer: A. Alteplase can cause bleeding as well as reperfusion dysrhythmias. Alteplase does not directly affect liver enzymes. Vitamin K will not reverse the effects of alteplase. Vital sign changes can alert the nurse to complications; however, a blood pressure below 110 systolic is not, in itself, cause for alarm.
The patient arrives at the health clinic complaining of experiencing sudden onset of both flatulence and heartburn. The patient tells the nurse that he has added herbal medication to his drug regimen. Based on the symptoms being experienced, the nurse expects that the patient has been taking which herb? A) Garlic. B) Milk thistle. C) Hawthorn. D) Sage.
Answer: A. Although both sage and milk thistle can produce occasional gastrointestinal upset, of the herbs listed, only garlic is known to produce both flatulence and heartburn.
For what severe skeletal muscle adverse reaction should the nurse observe in a patient taking rosuvastatin? A) Myasthenia gravis B) Rhabdomyolysis C) Dyskinesia D) Agranulocytosis
Answer: B.
Neuroleptic Malignant Syndrome Symptoms
High fever Diaphoresis Muscle rigidity Tachycardia BP fluctuations Can progress to coma
A nurse is caring for a patient who is taking an angiotensin-converting enzyme inhibitor and develops a dry, nonproductive cough. What is the nurse's priority action? A) Call the health care provider to switch the medication. B) Assess the patient for other symptoms of upper respiratory infection. C) Instruct the patient to take antitussive medication until the symptoms subside. D) Tell the patient that the cough will subside in a few days.
Answer: A. Angiotensin-converting enzyme inhibitors prevent the breakdown of bradykinin, frequently causing a nonproductive cough. Angiotensin receptor blocking agents do not block this breakdown, thus minimizing this annoying side effect. The patient should be switched to a different medication if the side effect cannot be tolerated.
What statement indicates to the nurse that the patient needs additional instruction about antihypertensive treatment? A) "I will check my blood pressure daily and take my medication when it is over 140/90." B) "I will include rest periods during the day to help me tolerate the fatigue my medicine may cause." C) "I will change my position slowly to prevent feeling dizzy." D) "I will not mow my lawn until I see how this medication makes me feel."
Answer: A. Antihypertensive medications need to be taken routinely to maintain a normotensive state and prevent occurrence of complications. Many patients do not adhere to this regimen because hypertension itself does not cause symptoms, whereas the medication can cause some untoward effects. Patient teaching is essential. If the patient indicates that he will take rest periods and change positions slowly to avoid orthostatic hypotension, he is demonstrating compliance with the treatment regimen.
A patient is prescribed an antitussive medication. What is the most important instruction for the nurse to include in the patient teaching? A) "This medication may cause drowsiness and dizziness." B) "Watch for diarrhea and abdominal cramping." C) "This medication may cause tremors and anxiety." D) "Headache and hypertension are common side effects."
Answer: A. Antitussive medications also affect the central nervous system, thus causing drowsiness and dizziness. There is no reason to anticipate that the medication will cause diarrhea, abdominal cramping, tremors and anxiety, or headache and hypertension.
The nurse administers a medication that has a long half-life to an older adult patient. What is a priority action for the nurse? A) Assess the patient for potential drug toxicity. B) Consult with the health care provider for an alternative drug. C) Administer medications early in the day. D) Administer one-half of the medication at a time.
Answer: A. Because drug absorption is slowed in the older adult, drugs with a longer half-life may increase the potential for toxicity. The nurse should assess the patient, and the dose may need to be decreased. An alternative drug should not be needed. The time of administration will not affect the half-life. The medication should not be halved; this will not affect the half-life.
What is a priority nursing diagnosis for a patient taking an antihypertensive medication? A) Alteration in cardiac output related to effects on the sympathetic nervous system. B) Knowledge deficit related to medication regimen. C) Fatigue related to side effects of medication. D) Alteration in comfort related to nonproductive cough.
Answer: A. Circulation is always a priority over fatigue, pain, and knowledge deficit.
The nurse would question an order for colesevelam (Welchol) if the patient has which condition in the medical history? A) Impaction. B) Glaucoma. C) Hepatic disease. D) Renal disease.
Answer: A. Colesevelam binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction.
An older adult patient has been diagnosed with hypertension. A diuretic has been prescribed. Which assessment finding will most concern the nurse? A) The patient's heart rate is irregular. B) The patient is complaining of symptoms of a cold. C) The patient has a blood pressure of 140/90 mm Hg. D) The patient's temperature is 98.4°F.
Answer: A. Diuretics are frequently prescribed for the older adult. They can cause electrolyte imbalances and must be prescribed in smaller doses. An irregular heart rate could be a sign of potassium imbalance.
Which physiologic change that normally occurs in the older adult has implications for the nurse assessing drug response? A) Drug half-life is lengthened. B) Drug metabolism is faster. C) Drug elimination is faster. D) Protein binding is more efficient.
Answer: A. Drug half-life is extended secondary to diminished liver and renal function in the older adult. Metabolism is slower, not faster, in the older adult. Drug elimination is also generally slower in the older adult, and protein binding is not more efficient in the older adult.
Which assessment finding will alert the nurse to suspect early digitalis toxicity? A) Loss of appetite with slight bradycardia. B) Blood pressure of 90/60 mm Hg. C) Heart rate of 110 beats/min. D) Confusion and diarrhea.
Answer: A. Early symptoms of digitalis toxicity include anorexia, nausea and vomiting, and bradycardia.
The nurse is caring for a patient who is taking a first-generation antihistamine. What is the most important information for the nurse to teach the patient? A) "Do not drive after taking this medication." B) "Make sure you drink a lot of liquids while on this medication." C) "Take this medication on an empty stomach." D) "Do not take this medication for more than 2 days."
Answer: A. First-generation antihistamines cause drowsiness. There is no evidence to indicate that the patient should force fluids, take the medication on an empty stomach, or place the medication on hold for any period of time.
The nurse is taking a drug history of a newly admitted patient. The patient informs the nurse that one of the medications the patient is taking is garlic. For which condition would the patient be taking this medication? A) Hypertension. B) Thyroid disease. C) Infection. D) Asthma.
Answer: A. Garlic is commonly used to treat hypertension and heart disease.
Which statement indicates that the nurse understands a principle of caring for patients with drug dependency? A) "Genetics may play a role in contributing to the cause of substance abuse." B) "Patients who abuse drugs may have a brain disorder." C) "Addictive disorders are not normally treatable." D) "Patients with addictive disorders cannot take narcotics."
Answer: A. Genetics may play a role in contributing to substance abuse. Patients do not have brain disorders; however, their brains do become altered over time due to repeated ingestion of certain drugs. Addictive disorders are treatable. Patients with addictive disorders may not be addicted to narcotics and therefore can take narcotics.
The nurse is caring for a patient with a history of alcoholism who is undergoing long-term alcohol treatment. Which intervention is the highest priority? A) Ensuring the patient knows all alcohol must be avoided when taking disulfiram. B) Teaching the patient about flumazenil. C) Monitoring the patient with methadone administration. D) Administering propranolol daily
Answer: A. In addition to cognitive behavioral therapy, disulfiram may be ordered because it prevents alcohol consumption by causing an unpleasant reaction if alcohol is taken. Flumazenil is a benzodiazepine antagonist and is used to treat benzodiazepine overdose. Methadone is an opioid agonist used during opioid detoxification to decrease symptoms and is used in long-term management of opioid addiction. Propranolol is an adrenergic beta blocker and is indicated in treating elevated blood pressure and tachycardia, which may occur with amphetamine toxicity.
Which assessment indicates to the nurse a therapeutic effect of mannitol has been achieved? A) Decreased intracranial pressure. B) Decreased potassium. C) Increased urine osmolality. D) Decreased serum osmolality.
Answer: A. Mannitol is an osmotic diuretic that pulls fluid from extravascular spaces into the bloodstream to be excreted in urine. This will decrease intracranial pressure, increase excretion of medications, decrease urine osmolality, and increase serum osmolality.
Which route is most commonly used in pediatric medication administration? A) Oral. B) Fecal. C) Subcutaneous. D) Intramuscular.
Answer: A. Most pediatric drugs are administered via the oral route. This route is the least invasive and easiest to use and can be used by family members or caregivers.
The patient is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention? A) Monitoring patient for potential chest pain. B) Monitoring blood pressure continuously. C) Assessing daily for hyperkalemia. D) Assessing 12-lead electrocardiogram each shift.
Answer: A. Nonselective adrenergic agonist bronchodilators stimulate beta.
A patient is taking digoxin 0.25 mg and furosemide (Lasix) 40 mg. The patient tells the nurse, there are yellow halos around the lights. Which action will the nurse take? A) Evaluate digoxin levels. B) Withhold the furosemide. C) Administer potassium. D) Document the findings and reassess in 1 h.
Answer: A. Seeing yellow or green halos around lights is a symptom of digoxin toxicity. The nurse should evaluate the patient's digoxin levels.
Which intervention is essential before the nurse administers tenecteplase? A) Perform all necessary venipunctures. B) Administer aminocaproic acid (Amicar). C) Have the patient void. D) Assess for allergies to iodine.
Answer: A. Tenecteplase is a thrombolytic agent that can interfere with the body's clotting ability. Therefore, all invasive procedures should be completed before administering this drug.
A patient admitted with angina states, "I take Dong-quai every day, and I want to keep using it." What is the nurse's most appropriate response? A) What other medications do you currently take? B) You will not be able to take this medication anymore. C) You will have to discuss this with your health care provider. D) You do not have to stop this supplement; it will help you.
Answer: A. The nurse must first assess to determine if the patient's medications may interact with the herbal supplement.
A patient is admitted with multiple bruises over the arms and legs. What is the nurse's first action? A) To ask the patient for a list of medications and herbal supplements. B) To call the health care provider. C) To notify the police about possible abuse. D) To draw blood for coagulation studies
Answer: A. The nurse should first assess before acting. Medications as well as supplements can cause a patient to be susceptible to bruising.
A patient is admitted for elective surgery. The patient states that he regularly uses both herbs and natural remedies. What is the nurse's priority action? A) To determine what herbs the patient takes on a regular basis. B) To determine when the patient last took herbs. C) To teach the patient why natural remedies are not safe. D) To have the patient cancel the surgery.
Answer: A. The nurse should first determine what herbs the patient takes on a regular basis. It could be that the herbs will not interfere with the patient's surgery and medications. Once the nurse determines what herbs the patient takes, the nurse should ask about the last time the patient took the herbs.
Which patient assessment would assist the nurse in evaluating therapeutic effects of a calcium channel blocker? A) Absence of chest pain. B) Decreased swelling in the ankles and feet. C) Patient denies dizziness. D) Patient states that she feels stronger.
Answer: A. The workload in the heart should be decreased with the vasodilation from the calcium channel blocker. With less strain, the patient should have fewer incidences of angina as afterload is decreased.
A patient's serum digoxin level is noted to be 0.4 ng/mL. What is the nurse's priority action? A) Administer ordered dose of digoxin. B) Hold future digoxin doses. C) Administer potassium. D) Call the health care provider.
Answer: A. Therapeutic serum digoxin levels are 0.5-2 ng/mL. The patient should receive the next dose to bring the level into therapeutic range.
The charge nurse is observing the new nurse in administering medication to children on the unit. Which intervention would indicate a need for further teaching? A) The new nurse asks the parents to leave the room during medication administration. B) The new nurse checks the order regarding dosage and route prior to administration. C) The new nurse questions the parents about the existence of allergies. D) The new nurse returns 30 minutes after administration to evaluate drug effects.
Answer: A. When possible, family members or caregivers should be solicited to assist in drug administration; thus, the new nurse should allow the parents to remain in the room. To ask the parents to leave indicates a need for further teaching.
You are the nurse working at a pediatrics clinic in Miami. You are assessing four amazingly awesome patients today. Which assessment finding concerns the nurse the most? A) The patient diagnosed with Duchenne Muscular Dystrophy demonstrating Gower's sign, waddling gait, and tachycardia B) The patient with cerebral palsy with scoliosis who is need of bracing C) The patient with myelomeningocele whose urine is cloudy and smells foul D) The patient with a brachial plexus injury who has an absent Moro's reflex
Answer: A. Tachycardia in the patient with Duchenne Muscular Dystrophy is a sign of heart muscle weakening, a serious complicating of this disorder. Scoliosis often occurs in patients with cerebral palsy. Cloudy, foul-smelling is a sign of a UTI, which is a complication of neurogenic bladder. This is concerning, but not as concerning as the heart trouble with Duchenne. An absent Moro's reflex would be expected in the patient with a brachial plexus injury.
38.18. Oral decongestants differ from intranasal decongestants in that oral decongestants: a. Have high efficacy. b. Have more systemic effects. c. Can cause rebound congestion. d. Are more effective at relieving severe congestion.
Answer: B Have more systemic effects. Rationale: A. Intranasal decongestants are higher in efficacy. B. Oral decongestants can have more systemic effects. C. Intranasal decongestants can cause rebound congestion after more than 5 days of use. D. Oral decongestants are less effective at relieving severe congestion.
39. 20.Which of the following statements is true regarding asthma? a. Asthma is caused by a virus. b. It has both inflammatory and bronchoconstriction components. c. Asthma cannot be treated. d. Symptoms most often occur with rest.
Answer: B It has both inflammatory and bronchoconstriction components. Rationale: A. Asthma is not caused by a virus, although a virus can be a trigger. B. Asthma has an inflammatory and a bronchoconstriction component. C. Asthma can be treated by several drug classes. D. Symptoms occur with exposure to triggers or exertion.
38.20. Centrally acting antitussives, such as opioids, are used to: a. Break down mucus. b. Relieve severe cough. c. Relieve mild cough. d. Decrease nasal congestion.
Answer: B Relieve severe cough Rationale: A. Expectorants break down mucus. B. Opioids relieve severe cough. C. Non-opioid antitussives relieve mild cough. D. Decongestants decrease congestion.
39.23 Which of the following is an adverse effect of a beta-adrenergic agonist? a. Bradycardia b. Tachycardia c. Runny nose d. Constipation
Answer: B Tachycardia Rationale: A. Beta-adrenergic agonists cause tachycardia, not bradycardia. B. Tachycardia is common, along with restlessness. C. Dry mucous membranes can occur. D. Diarrhea can occur with some leukotrienes.
39.24 A client with asthma has been placed on salmeterol (Serevent) dry powder inhaler. The nurse will teach the client to report: a. A bitter taste in the mouth. b. Tachycardia. c. Dry mouth. d. Diarrhea.
Answer: B Tachycardia. Rationale: A. An anticholinergic can cause a bitter taste. B. Tachycardia is an adverse effect of salmeterol, and can lead to more adverse effects. C. Anticholinergics cause dry mouth. D. Leukotriene modifiers cause diarrhea.
The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide? (Select all that apply.) A) Monitor patients for signs of hypoglycemia. B) Administer ordered potassium supplements. C) Monitor serum potassium and uric acid levels. D) Assess blood pressure before administration. E) Notify the health care provider if a patient has had oliguria for 24 hours. F) Assess for decreased cholesterol and triglyceride levels.
Answer: B, C, D, E.
A patient has been prescribed nitroprusside for treatment of a hypertensive emergency. Which interventions will the nurse include when administering nitroprusside? (Select all). A) Vigorously shake the mixture before administration. B) Place the bottle in an opaque bag. C) Closely monitor the patient's blood pressure. D) Monitor the patient's thiocyanate levels. E) Administer the solution slow IV push. F) Do not mix nitroprusside with other drugs.
Answer: B, C, D, F. Nitroprusside will lower the patient's blood pressure owing to vasodilation. Thiocyanate toxicity is an adverse reaction, and levels should be monitored. To prevent drug interactions, nitroprusside should not be mixed with other drugs. The mixture should not be vigorously shaken. Nitroprusside sodium is rapidly inactivated by light; the IV bottle or bag must be wrapped with aluminum foil or another opaque material to protect the solution from degradation. The medication should not be administered IV push.
A patient is diagnosed with peripheral arterial disease. He is prescribed pentoxifylline. What does the nurse realize are the effects of pentoxifylline? (Select all that apply.) A) May lead to hypertension and bradycardia B) Improves microcirculation and tissue perfusion C) Decreases blood viscosity and improves flexibility of erythrocytes D) Alleviates intermittent claudication E) Commonly causes an adverse effect of rhabdomyolysis F) Allows vasodilation of arteries in skeletal muscles
Answer: B, C, D.
Which of the following changes in the gastrointestinal system of the older adult will directly affect absorption? (Select all that apply). A) Increase in secretion of hydrochloric acid. B) Decreased small bowel surface area. C) Slowed gastric emptying. D) Decreased gastric blood flow. E) Increased tone of the pyloric sphincter
Answer: B, C, D. Changes in the gastrointestinal system that may adversely affect absorption of medications in the older adult population include a decrease in small-bowel surface area, slowed gastric emptying, reduced gastric blood flow, and a 5 to 10% decrease in gastric acid production. Pyloric sphincter tone decreases.
During an admission assessment, a patient states that she takes amlodipine. The nurse should inquire about which signs and symptoms to determine whether the patient has any common side effects of a calcium channel blocker? (Select all that apply.) A) Insomnia B) Dizziness C) Headache D) Angioedema E) Ankle edema F) Hacking cough
Answer: B, C, E.
What changes with aging alter drug distribution? (Select all that apply.) A) An increase in muscle mass and a decrease in fat B) A decrease in muscle mass and an increase in fat C) A decrease in serum albumin levels D) An increase in total body water E) A decrease in kidney mass
Answer: B, C, E.
Which treatments will the nurse anticipate administering to a patient who has been admitted with alcohol toxicity? (Select all that apply.) A) Naloxone B) Thiamine C) Intravenous fluids D) Naltrexone E) Intravenous glucose solution F) Flumazenil
Answer: B, C, E.
Fluticasone propionate and salmeterol combination inhalation is ordered for a patient with chronic obstructive pulmonary disease. What does the nurse know about this medication? (Select all that apply.) A) It can be used to treat an acute attack. B) It is delivered as a dry-powder inhaler. C) It contains a beta1 agonist and cromolyn. D) It is taken as one puff two times a day. E) It promotes bronchodilation.
Answer: B, D, E.
When titrating intravenous nitroglycerin for a patient, what is important for the nurse to monitor? (Select all that apply). A) Continuous oxygen saturation. B) Continuous blood pressure C) Hourly electrocardiograms. D) Presence of chest pain. E) Serum nitroglycerin levels. F) Visual acuity.
Answer: B, D. Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and systolic blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin. Pulse should also be monitored.
The nurse is reviewing a patient's current medications. Which herbal products interfere with the action of anticoagulants? (Select all that apply.) A) Astragalus B) Garlic C) Ginger D) Licorice root E) Gingko
Answer: B, E.
The nurse is teaching a patient about diphenhydramine. Which instructions should the nurse include in the patient's teaching plan? (Select all that apply.) A) Take medication on an empty stomach to facilitate absorption. B) Avoid alcohol and other central nervous system depressants. C) Notify a health care provider if confusion or hypotension occurs. D) Use sugarless candy, gum, or ice chips for temporary relief of dry mouth. E) Avoid handling dangerous equipment or performing dangerous activities until stabilized on the medication.
Answer: B,C,D,E.
A dopamine infusion was started in a patient's antecubital vein during resuscitation after cardiac arrest. The electronic infusion device is now sounding an alert for an occlusion. What is the most important immediate concern for the nurse? A) Infiltration with phentolamine will be necessary if there is extravasation. B) An interruption in the infusion can produce hypotension in the patient. C) The device will need to be reported to the hospital's clinical engineering department for service. D) The patient could develop hypertension as a result of the alarm.
Answer: B.
A male nurse is caring for a young married woman who is an observant Muslim. It is important that the nurse initially perform which action? A) Delay any care that requires touching until a female nurse is available. B) Identify the patient's preference regarding touch. C) Touch the patient only when her spouse is present. D) Inform the patient that she must allow him to touch her.
Answer: B.
A patient has been prescribed guaifenesin. The nurse understands that the purpose of the drug is to accomplish what? A) Treat allergic rhinitis and prevent motion sickness B) Loosen bronchial secretions so coughing can eliminate them C) Compete with histamine for receptor sites, thus preventing a histamine response D) Stimulate alpha-adrenergic receptors, thus producing vascular constriction of capillaries in nasal mucosa
Answer: B.
A patient has heart failure, and a high dose of furosemide is ordered. What suggests a favorable response to furosemide? A) A decrease in level of consciousness occurs, and the patient sleeps more. B) Respiratory rate decreases from 28/min to 20/min, and the depth increases. C) Increased congestion is heard in breath sounds, and the patient complains of shortness of breath. D) Urine output is 50 mL/4 h, and intake is 200 mL.
Answer: B.
A patient is being changed from an injectable anticoagulant to an oral anticoagulant. Which anticoagulant does the nurse realize is administered orally? A) Enoxaparin B) Warfarin C) Bivalirudin D) Dalteparin
Answer: B.
A patient is prescribed losartan. The nurse teaches the patient that an angiotensin II-receptor blocker acts by doing what? A) Inhibiting angiotensin-converting enzyme B) Blocking angiotensin II from angiotensin I receptors C) Preventing the release of angiotensin I D) Promoting the release of aldosterone
Answer: B.
A patient is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance? A) Hypocalcemia B) Hypokalemia C) Hyperkalemia D) Hypermagnesemia
Answer: B.
A patient is taking warfarin 5 mg/day for atrial fibrillation. The patient's international normalized ratio is 3.8. The nurse would consider the international normalized ratio to be what? A) Within normal range B) Elevated range C) Low range D) Low-average range
Answer: B.
A patient is to undergo a coronary angioplasty. The nurse acknowledges that which drug is used primarily for preventing reocclusion of coronary arteries following coronary angioplasty? A) Clopidogrel B) Abciximab C) Warfarin D) Cilostazol
Answer: B.
A patient takes an initial dose of a nitrate. Which symptom(s) will the nurse expect to occur? A) Nausea and vomiting B) Headaches C) Stomach cramps D) Irregular pulse rate
Answer: B.
The health care provider is planning to discontinue a patient's beta blocker. Which instruction will the nurse give the patient regarding the beta blocker? A) The beta blocker should be abruptly stopped when another cardiac drug is prescribed. B) The beta blocker should not be abruptly stopped; the dose should be tapered down. C) The beta blocker dose should be maintained while taking another antianginal drug. D) Half the beta blocker dose should be taken for the next several weeks.
Answer: B.
The nurse discovers that a patient has recently decided to take four herbal preparations. Which action will the nurse take first? A) Discuss the cost of herbal products. B) Instruct the patient to inform the health care provider of all products taken. C) Instruct the patient to stop taking all herbal products immediately. D) Suggest that the patient taper off use of herbal products over the next 2 weeks.
Answer: B.
The nurse is administering a beta blocker to a patient. Which is the most important assessment to perform before administration? A) Urine output B) Apical pulse C) Potassium level D) Serum level of medication
Answer: B.
The nurse is administering atropine 0.3 mg IV to a 75-year-old patient with a heart rate of 45, and his heart rate decreases to 38. What is the most likely explanation? A) Atropine exerts its effects by stimulating the vagus nerve. B) The ordered dose was too low. C) Adenosine was indicated, not atropine. D) Atropine typically slows heart rate first and then increases it.
Answer: B.
The nurse is caring for a 21-year-old woman with a closed head injury. Her intracranial pressure is 35 (normal <20), and her serum osmolality is 330 mOsm/kg. The nurse should anticipate which action? A) Administration of mannitol B) Withholding mannitol at this time, but taking other measures to reduce intracranial pressure C) Administration of sodium nitroprusside D) Taking no action at this time because the patient has a serum osmolality of 330, which will offset the effects of the elevated intracranial pressure
Answer: B.
The nurse knows that which diuretic is most frequently combined with an antihypertensive drug? A) Chlorthalidone B) Hydrochlorothiazide C) Bendroflumethiazide D) A potassium-sparing diuretic
Answer: B.
The nurse practitioner orders epinephrine 0.3 mg intramuscularly for a severe allergic reaction to a bee sting in an adult patient. Which concentration of epinephrine should the nurse select to administer this particular dose? A) 1:10,000 B) 1:1000 C) 1:100 D) 1:10
Answer: B.
The patient has been receiving spironolactone 50 mg/day for heart failure. The nurse should closely monitor the patient for which condition? A) Hypokalemia B) Hyperkalemia C) Hypoglycemia D) Hypermagnesemia
Answer: B.
The patient is receiving digoxin for treatment of heart failure. Which finding would suggest to the nurse that the heart failure is improving? A) Pale and cool extremities B) Absence of peripheral edema C) Urine output of 60 mL every 4 hours D) Complaints of increasing dyspnea
Answer: B.
What is the best measure for the nurse to use to determine a patient's kidney function? A) Creatinine clearance B) Estimated glomerular filtration rate C) Serum creatinine level D) Blood urea nitrogen level
Answer: B.
What should the nurse do when a patient is taking furosemide? A) Instruct the patient to change positions quickly when getting out of bed. B) Assess blood pressure before administration. C) Administer the drug at bedtime for maximum effectiveness. D) Teach the patient to avoid fruits to prevent hyperkalemia.
Answer: B.
Which laboratory test value does the nurse realize can contribute to the development of cardiovascular disease and stroke? A) Decreased antidiuretic hormone B) Increased homocysteine level C) Decreased triglycerides D) Increased high-density lipoprotein level
Answer: B.
While getting dressed to go home after minor outpatient surgery on his leg for removal of a mole, a 62-year-old patient notifies the nurse that he has severe chest pain. He is also diaphoretic and complains of shortness of breath. The surgeon is notified and orders administration of aspirin 325 mg by mouth while quickly making arrangements to transfer the patient to the emergency department. Which is the best course of action by the nurse? A) Question the aspirin order because the patient just had a surgical procedure and might have bleeding complications. B) After checking for drug allergies, first instruct the patient to chew the aspirin tablet and then administer the aspirin. C) After checking for drug allergies, instruct the patient to swallow the aspirin tablet whole. D) Suggest to the surgeon that the enteric-coated form of aspirin might be better tolerated by the patient to avoid gastrointestinal distress.
Answer: B.
The patient asks the nurse to explain the difference between dalteparin and heparin. Which response by the nurse is accurate? A) "There is no real difference. Dalteparin is preferred because it is less expensive." B) "Dalteparin is a low-molecular-weight heparin that is more predictable in its effect and has a lower risk of bleeding." C) "I'm not sure why some health care providers choose dalteparin and some heparin. You should ask your doctor." D) "The only difference is that heparin dosing is based on the patient's weight."
Answer: B. A low-molecular-weight heparin is more predictable in its effect than regular heparin. Dalteparin is more expensive than heparin and is dosed based on the patient's weight. It is not appropriate to provide the patient with no instruction other than to simply refer to the health care provider.
What instruction should the nurse provide to the patient who needs to apply nitroglycerin ointment? A) Use the fingers to spread the ointment evenly over a 3-inch area. B) Apply the ointment to a non-hairy part of the upper torso. C) Massage the ointment into the skin. D) Cover the application paper with ointment before use.
Answer: B. Absorption is best over a non-hairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves and squeeze the ointment onto the application patch. Massaging in the ointment is not appropriate. The paper should not be covered with ointment. The ointment is measured as one straight line on the nitroglycerin paper and is then gently spread around and applied, but not rubbed, into the skin.
The health care provider orders ipratropium bromide, albuterol, and beclomethasone inhalers for a patient. What is the nurse's best action? A) Question the order; three inhalers should not be given at one time. B) Administer the albuterol, wait 5 min, administer ipratropium bromide, then beclomethasone several minutes later. C) Administer each inhaler at 30-min intervals. D) Administer beclomethasone, wait 2 min, administer ipratropium bromide, then albuterol several minutes later.
Answer: B. Administering the bronchodilator albuterol first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium bromide also help the bronchodilator, but to a lesser extent. Corticosteroids such as beclomethasone do not dilate and are therefore given last.
Which nursing intervention will decrease the flushing reaction of niacin? A) Administering niacin with an antacid B) Administering aspirin 30 min before nicotinic acid. C) Administering diphenhydramine hydrochloride (Benadryl) with niacin. D) Applying cold compresses to the head and neck
Answer: B. Administration of an anti-inflammatory agent such as aspirin has been shown to decrease the flushing reaction associated with niacin. In addition, avoiding hot beverages, such as coffee, when taking niacin may also prevent flushing.
What effect may the physiological changes of aging in the older adult's gastrointestinal system have on drug administration? A) Delayed transportation of drugs to the body tissues. B) Slowed absorption of oral drugs. C) Increased transportation of drugs to the body tissues. D) Increased absorption of oral drugs.
Answer: B. Administration of medication to an older adult can result in slowed absorption of oral drugs. The gastrointestinal system changes will not usually result in a change in the transportation of drugs to the body tissues.
The patient asks the nurse how nitroglycerin should be stored while traveling. What is the nurse's best response? A) "You can protect it from heat by placing the bottle in an ice chest." B) "It's best to keep it in its original container away from heat and light." C) "You can put a few tablets in a resealable bag and carry in your pocket." D) "It's best to lock them in the glove compartment to keep them away from heat and light."
Answer: B. Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and must be kept away from light, not in a clear plastic bag.
When caring for patients with varied cultural backgrounds, the nurse will recognize that: A) cultural considerations will not be a concern if patient's health needs are significant. B) generalizations about behavior of a specific cultural group may not be accurate. C) current health standards will determine if cultural practices can be utilized. D) similar reactions to stress occur when patients have the same cultural background.
Answer: B. Any time that generalizations are made about a patient group, they will usually be inaccurate since nursing care must be individualized to the specific patient. Cultural considerations must always be a major concern for the nurse regardless of the condition of the patient.
The nurse is teaching the patient on the use of beclomethasone. Which statement by the patient indicates an understanding of the teaching? A) "I will need to taper off the medication to prevent acute adrenal crisis." B) "This medication will help prevent the inflammatory response of my allergies." C) "I will need to monitor my blood sugar more closely because it may increase." D) "I need to take this medication only when my symptoms get bad."
Answer: B. Beclomethasone is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the patient does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids. Because the medication has a localized effect, it will not produce the changes in blood sugar that would be generated by systemic steroids.
Which statement indicates the patient understands discharge instructions regarding cholestyramine? A) "I will take cholestyramine 1 h before my other medications." B) "I will increase fiber in my diet." C) "I will weigh myself weekly." D) "I will have my blood pressure checked weekly."
Answer: B. Cholestyramine can cause constipation; thus, increasing fiber in the diet is appropriate. All other drugs should be taken 1 h before or 4 h after cholestyramine to facilitate proper absorption.
Which physiological factor that exists in children leads to decreased drug concentrations? A) Increase in adipose tissue B) Increase in body fluid proportions. C) Decrease in albumin. D) Decrease in liver function.
Answer: B. Drug distribution is affected by factors such as body fluid composition, body tissue composition, protein-binding capability, and effectiveness of various barriers to drug transport. In neonates and infants, the body is about 75% water, compared with 60% in adults. This increased body fluid proportion allows for a greater volume of fluid in which to distribute drugs, which results in a lower drug concentration.
Which factor takes priority in considering drug dosage in children? A) Child's age. B) Child's weight in kilograms. C) Child's fluid intake. D) Child's birthweight.
Answer: B. Drugs for pediatric patients are ordered based on either the child's weight in kilograms (mg/kg) or on body surface area (BSA or mg/m
The patient is started on ezetimibe for elevated cholesterol. The nurse demonstrates understanding of the mechanism of action of this drug when including which statement in the patient education presentation? A) This drug inhibits cholesterol synthesis in the liver. B) This drug inhibits cholesterol absorption in the bowel. C) This drug sequesters bile acids in the small bowel. D) This drug increases pancreatic secretion facilitating lipid breakdown.
Answer: B. Ezetimibe is a cholesterol absorption inhibitor that acts on the cells in the small intestine to inhibit cholesterol absorption. It decreases cholesterol from dietary absorption, reducing serum cholesterol.
Which assessment finding in a patient taking an HMG-CoA reductase inhibitor will the nurse act on immediately? A) Decreased hemoglobin. B) Elevated liver function tests. C) Elevated HDL. D) Elevated LDL.
Answer: B. HMG-CoA reductase inhibitors (statins) can cause hepatic toxicity; thus, it is necessary to monitor liver function tests. The nurse should act on this finding immediately. Decreased hemoglobin should be addressed but not immediately. It is most likely not related to the administration of the HMG-CoA reductase inhibitor. Also, while an elevated LDL level must be addressed, it is not as high a priority as the elevated liver function test results. An elevated HDL is a positive finding and an encouraging result.
Which laboratory value will the nurse report to the health care provider as a potential adverse response to hydrochlorothiazide? A) Sodium level of 140 mEq/L B) Fasting blood glucose level of 140 mg/dL. C) Calcium level of 9 mg/dL. D) Chloride level of 100 mEq/L
Answer: B. Hydrochlorothiazide can cause hyperglycemia. Normal calcium level is approximately 8.8-10.3 mg/dL; normal sodium level is 135-147 mEq/L; normal chloride level is 95-107 mEq/L, and normal fasting blood glucose should be 60-110 mg/dL.
The nurse is caring for a patient whose cultural background places a great emphasis on respect for personal space. In order to properly care for this patient, what will the nurse do? A) Avoid touching the patient while providing care. B) Explain all nursing care delivered prior to touching the patient. C) Limit the number of visitors allowed to see the patient. D) Maintain a specific distance from the patient at all times.
Answer: B. In order to properly provide nursing care, it will be necessary to occasionally touch the patient. To respect the patient's cultural beliefs, the nurse should explain the reason for care provided and procedures completed prior to implementing them
Which statement is true regarding the drug information available concerning pediatric patients? A) Information is derived primarily from animal studies. B) Information is derived from smaller adult studies. C) Information is based on smaller studies with ill children. D) Information is the best guess due to lack of any studies on children.
Answer: B. Information regarding drug therapy in the pediatric population is most often based on smaller adult studies. Rarely, studies may be conducted on well children. Animal studies may be used initially but are not the primary source of information.
What is the most important thing for the nurse to teach a patient who is switching allergy medications from diphenhydramine to loratadine? A) Loratadine can potentially cause dysrhythmias. B) Loratadine has fewer sedative effects. C) Loratadine has increased bronchodilating effects. D) Loratadine causes less gastrointestinal upset.
Answer: B. Loratadine does not affect the central nervous system and therefore is non-sedating. There is insufficient evidence to indicate that loratadine can cause dysrhythmias, can act as a bronchodilator, or cause gastrointestinal upset than other comparable medications.
A patient diagnosed with hypercholesterolemia is prescribed lovastatin. Based on this medication order, the nurse will contact the health care provider about which reported condition in the patient's history? A) Chronic pulmonary disease. B) Hepatic disease. C) Leukemia. D) Renal disease.
Answer: B. Lovastatin can cause an increase in liver enzymes and thus should not be used in patients with preexisting liver disease.
In addition to its benefit in reducing pain and anxiety in the patient with pulmonary edema, the nurse understands morphine produces which primary effect on the pathophysiology of pulmonary edema? A) Decreasing the conduction rate at the AV node B) Morphine sulfate is also indicated for acute pulmonary edema because it produces venous vasodilation that decreases cardiac preload, the amount of blood returning to the right ventricle. The net effect is a decrease in pulmonary venous congestion. C) Morphine sulfate is also indicated for acute pulmonary edema because it produces venous vasodilation that decreases cardiac preload, the amount of blood returning to the right ventricle. The net effect is a decrease in pulmonary venous congestion. D) Morphine sulfate is also indicated for acute pulmonary edema because it produces venous vasodilation that decreases cardiac preload, the amount of blood returning to the right ventricle. The net effect is a decrease in pulmonary venous congestion.
Answer: B. Morphine sulfate is also indicated for acute pulmonary edema because it produces venous vasodilation that decreases cardiac preload, the amount of blood returning to the right ventricle. The net effect is a decrease in pulmonary venous congestion.
A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's priority action? A) Assess the patient's lung sounds. B) Decrease the intravenous nitroglycerin by 10 mcg/min. C) Stop the nitroglycerin infusion for 1 h and then restart. D) Continue the infusion and recheck the patient's vital signs in 15 min.
Answer: B. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 min while changing the rate of the intravenous nitroglycerin infusion.
A patient is prescribed a noncardioselective beta1 blocker. What nursing intervention is a priority for this patient? A) Assessment of blood glucose levels. B) Auscultation of the lungs. C) Orthostatic blood pressure assessment. D) Teaching about potential tachycardia
Answer: B. Noncardioselective beta blockers can cause bronchospasms, and a respiratory assessment is indicated to check for potential respiratory side effects. Assessment of blood glucose and teaching about tachycardia will not be priorities.
The nurse notes that the patient is receiving hydrochlorothiazide for hypertension. Which additional medication in the patient's drug regimen would cause concern on the part of the nurse? A) Maalox. B) Digoxin. C) Nitroglycerine. D) Albuterol.
Answer: B. Of the numerous thiazide drug interactions with hydrochlorothiazide, the most serious occurs with digoxin. Thiazides can cause hypokalemia, which enhances the action of digoxin, and digitalis toxicity can occur.
A patient complains of worsening nasal congestion despite the use of oxymetazoline nasal spray every 2 h. What is the nurse's most appropriate response? A) "Oxymetazoline is not an effective nasal decongestant." B) "Overuse of nasal decongestants results in rebound congestion." C) "Oxymetazoline should be administered every hour for severe congestion." D) "You are probably displaying an unexpected reaction to oxymetazoline."
Answer: B. Oxymetazoline is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 h. To avoid future rebound congestion with nasal sprays, it is recommended that they be used for no more than 3-5 days.
The nurse is completing the admission history for a patient who tells the nurse that he takes valerian. Based on the use of this herb, the nurse anticipates that the patient will most likely report experiencing which condition? A) Muscle aches. B) Headaches. C) Insomnia. D) Dry eyes.
Answer: B. Valerian has been shown to produce anxiety, headache, and gastrointestinal upset. It is not known to produce muscle aches, insomnia, or dry eyes.
The nurse is observing a nursing student giving medications to a group of patient. Which observation of the student by the nurse would suggest the need for additional cultural sensitivity on the part of the student? A) The student suggests a female nurse provide care for the patient of Muslim ethnicity. B) The student gently pats the head of a patient of East Indian ethnicity as encouragement for the patient to take all of the medications ordered. C) The student allows moments of silence when intervening with a patient of Asian American ethnicity. D) The student avoids making direct eye contact with a patient of Asian ethnicity.
Answer: B. Patients of Asian descent often avoid direct eye contact. Muslim woman will likely prefer to be cared for by a female nurse rather than a male nurse. East Asians consider a pat on the head to be offensive due to the belief that the head is sacred. Asian Americans and Native Americans may be comfortable with periods of silence, whereas persons of Latin American, African, Middle Eastern, or European descent may be uneasy during these periods.
A patient taking warfarin asks for an aspirin for a headache. What is the nurse's best action? A) Administer 650 mg of acetylsalicylic acid (ASA) and reassess pain in 30 min. B) Teach the patient of potential drug interactions with anticoagulants. C) Explain to the patient that ASA is contraindicated and administer ibuprofen as ordered. D) Explain that the headache is an expected side effect and will subside shortly.
Answer: B. Patients taking an anticoagulant should not use medications that would further increase the risk of bleeding, which includes aspirin as well as ibuprofen. Aspirin should not be administered to the patient taking other anticoagulants, unless it is ordered specifically as a low-dose daily therapy. Ibuprofen is not the best choice of medication for the patient receiving warfarin. Acetaminophen would be preferred for pain relief. Headache is not an expected side effect of warfarin therapy.
A patient has arrived at the emergency department and requires immediate surgery. He has been receiving heparin. Which intervention is essential? A) Teach the patient about the phenytoin. B) Administer protamine sulfate. C) Assess the INR before surgery. D) Administer vitamin K.
Answer: B. Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect. Allowing the patient to undergo surgery while receiving heparin would be life-threatening. The situation should be reversed immediately, without the nurse taking the time to assess the INR or administer vitamin K. It is not appropriate to teach the patient about phenytoin since it has not been ordered for the patient.
What is the best information for the nurse to provide to the patient who is receiving spironolactone and furosemide (Lasix) therapy? A) Moderate doses of two different diuretics are more effective than a large dose of one. B) This combination promotes diuresis but decreases the risk of hypokalemia. C) This combination prevents dehydration and hypovolemia. D) Using two drugs increases the osmolality of plasma and the glomerular filtration rate.
Answer: B. Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance. It is not accurate to state that the drug combination prevents dehydration and hypovolemia or that it increases the osmolality of plasma and the glomerular filtration rate. Stating that giving two different diuretics is more effective is not specific enough information for the patient
A patient is receiving an intravenous heparin drip. Which laboratory value requires immediate action by the nurse? A) Platelet count of 150,000. B) Activated partial thromboplastin time (aPTT) of 120 sec. C) INR of 1.0 D) Blood urea nitrogen (BUN) level of 12 mg/dL
Answer: B. The aPTT value of 120 sec is too prolonged. The heparin drip should be shut off for an hour. The typical aPTT normal reference range for a patient on anticoagulant therapy is 30-85 sec (range may vary slightly depending on the laboratory used). The normal range for BUN is 7-20 mg/dL, and the normal platelet range is 150,000-450,000.
The nurse is working with a health care worker who exhibits emotional lability, drowsiness, and decreased inhibitions. Which substance has the health care worker most likely been abusing? A) Stimulants. B) MDMA. C) Psychedelics. D) Inhalants.
Answer: B. The combination of emotional lability, drowsiness, decreased inhibitions, and initial relaxation is most likely to have been produced by the use of MDMA.
The nurse has been assigned to care for a patient from a cultural background that is different from that of the nurse. In order to provide appropriate care to the patient, what will the nurse do? A) Arrange for the family to provide all care so that no cultural practices are omitted. B) Identify how the patient's cultural practices and beliefs will influence his health care. C) Explain to the patient how he must adapt his practices to the hospital routine. D) Arrange for an interpreter to explain hospital practices to the patient.
Answer: B. The goal for culturally appropriate care is to identify how the patient's beliefs and practices will influence his health care, thus allowing nursing care to be properly planned for him. Having different cultural beliefs and practices does not mean that the patient speaks a different language.
The nurse is reviewing discharge medications with a patient of African American ethnicity. Which drug would the nurse question for inclusion in the medication regimen? A) A diuretic. B) An angiotensin-converting enzyme inhibitor. C) A calcium channel blocker. D) A renin inhibitor.
Answer: B. The nurse would question the inclusion of an angiotensin-converting enzyme inhibitor as African Americans respond poorly to this medication group. A diuretic, a calcium channel blocker, and a renin inhibitor can be used in this group.
The patient tells the nurse that she has a cold, is coughing, and feels like she has fluid in her lungs. What action will the nurse anticipate performing next? A) Administer dextromethorphan. B) Administer guaifenesin. C) Encourage the patient to drink fluids hourly. D) Administer fluticasone (Flonase).
Answer: B. The patient needs an expectorant. This medication will help the patient cough the fluid out of her lungs. Dextromethorphan and fluticasone will not help the patient expectorate. There is no information about the patient's fluid intake, so hourly fluids may be too much.
The patient taking methyldopa has elevated liver function tests. What is the nurse's best action? A) Document the finding and continue care. B) Notify the health care provider. C) Immediately stop the medication. D) Change the patient's diet.
Answer: B. This drug should not be used in patients with impaired liver function. The nurse should notify the health care provider so that the patient can be tapered off the medication. The nurse should not immediately stop this medication, as the patient could have a hypertensive crisis. The patient's diet is not the cause of elevated liver enzymes and should not make a difference with therapy.
A patient is started on warfarin therapy while also receiving intravenous heparin. The patient is concerned about the risk for bleeding. What will the nurse tell the patient? A) "Your concern is valid. I will call the doctor to discontinue the heparin." B) "It usually takes about 3 days to achieve a therapeutic effect for warfarin, so the heparin is continued until the warfarin is therapeutic." C) "Because of your valve replacement, it is especially important for you to be anticoagulated. The heparin and warfarin together are more effective than one alone." D) "Because you are now up and walking, you have a higher risk of blood clots and therefore need to be on both medications."
Answer: B. Warfarin works by decreasing the production of clotting factors. However, it takes approximately 3 days for the body to metabolize present clotting factors and thus achieve a therapeutic anticoagulant effect. Because of this, heparin is continued until this is achieved.
A patient is prescribed ipratropium and cromolyn sodium. What will the nurse teach the patient? A) Do not take these medications within 4 h of each other. B) Take the ipratropium at least 5 min before the cromolyn. C) Administer both medications together in a metered-dose inhaler. D) Take the ipratropium only in the mornings.
Answer: B. When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 5 min before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.
38.22 Which of the following is a common adverse effect of antihistamines? a. Nosebleed b. Bradycardia c. Dry mouth d. Rebound congestion
Answer: C Dry mouth Rationale: A. Epistaxis, or nosebleed, usually occurs with intranasal glucocorticoids. B. Tachycardia, not bradycardia, is an adverse effect of antihistamines. C. Dry mouth is an common anticholinergic effect of antihistamines. D. Rebound congestion can occur with decongestants.
39.21 The nurse would observe for fungal infection of the throat for which class of medications? a. Mast cell inhibitors b. Beta-adrenergic agonists c. Glucocorticoids d. Methylxanthines
Answer: C Glucocorticoids Rationale: A. Mast cell inhibitors do not cause fungal infection. B. Beta-adrenergic agonists can cause throat irritation, but not infection. C. Glucocorticoids weaken the immune system and cause candidiasis of the throat. D. Methylxanthines do not cause fungal infection.
38.17 Antihistamines block the actions of histamine at the: a. B1 receptor site. b. B2 receptor site. c. H1 receptor site. d. H2 receptor site.
Answer: C H1 receptor site. Rationale: A. The B1 receptor site does not play a role in blocking histamine. B. The B2 receptor site does not play a role in blocking histamine. C. The H1 receptor site is the site for blocking histamine with the use of antihistamines. D. The H2 receptor site is responsible for peptic ulcers.
39.16 Bronchoconstriction in the airways is stimulated by: a. The sympathetic nervous system. b. Ventilation. c. Parasympathetic nervous system. d. Perfusion.
Answer: C Parasympathetic nervous system. Rationale: A. The sympathetic nervous system stimulates dilation. B. Ventilation moves air in and out. C. The parasympathetic nervous system stimulates bronchoconstriction. D. Perfusion is the flow of blood in the lungs.
39.18 Which of the following is true regarding dry powder inhalers (DPI)? a. The medication is delivered by fine mist. b. The medication is delivered by tablet orally. c. The medication is activated by the inhalation. d. The medication is applied topically.
Answer: C The medication is activated by the inhalation. Rationale: A. Nebulizers deliver medications in fine mist. B. Inhalers are not oral tablets. C. The client activates the dry powder by inhaling. D. Inhalers are not applied topically.
A Native American patient is newly diagnosed with diabetes mellitus type 2 and is prescribed the antidiabetic drug metformin 500 mg per os with morning and evening meals. Which statement best indicates to the nurse that the patient will adhere to the pharmacotherapy? A) I will be healthier if I don't eat sugar anymore. B) When I feel better, I won't have to take this medicine. C) I must take the medicine as scheduled to prevent damage to my body. D) I have diabetes because of my ancestry, so there's not much I can do about it.
Answer: C.
A patient had an orthopedic surgery and is prescribed enoxaparin. What would the nurse teach the patient and/or family members about this low-molecular-weight heparin before discharge? A) How to administer the medication intramuscularly B) Prothrombin time and international normalized ratio monitoring will be done weekly. C) Avoidance of green leafy vegetables is recommended. D) Watch for bleeding or excessive bruising.
Answer: D.
A nurse is teaching a 16-year-old female patient about a newly prescribed medication. The patient is bilingual in Spanish and English. Which behavior best indicates the patient's understanding of the instructions? A) The patient frequently nods her head while listening to the nurse's instructions. B) The patient states that she understands the instructions. C) The patient repeats the nurse's instructions to her parents. D) The patient does not ask the nurse for clarification of the instructions.
Answer: C.
A parent is learning to administer drug to a school-age child. Which strategy will the nurse teach the parent to achieve cooperation in a child of this age? A) Enlisting physical restraint B) Establishing drug contracts C) Providing age-appropriate explanations D) Tolerating violent reactions
Answer: C.
A patient complains of a sore throat and has been told it is due to beta-hemolytic streptococcal infection. The nurse anticipates that the patient has which acute condition? A) Rhinitis B) Sinusitis C) Pharyngitis D) Rhinorrhea
Answer: C.
A patient has a serum cholesterol level of 265 mg/dL, a triglyceride level of 235 mg/dL, and a low-density lipoprotein of 180 mg/dL. What do these serum levels indicate? A) Hypolipidemia B) Normolipidemia C) Hyperlipidemia D) Alipidemia
Answer: C.
A patient is admitted to the emergency department with an acute myocardial infarction. Which drug does the nurse expect the health care provider to order for prevention of tissue necrosis following blood clot blockage in a coronary artery? A) Heparin sodium B) Clopidogrel C) Alteplase D) Aminocaproic acid
Answer: C.
A patient is prescribed a beta blocker. Beta blockers are as effective as antianginals because they do what? A) Increase oxygen to the systemic circulation B) Maintain heart rate and blood pressure C) Decrease heart rate and decrease myocardial contractility D) Decrease heart rate and increase myocardial contractility
Answer: C.
A patient is prescribed aminophylline-theophylline. For what adverse effect should the nurse monitor the patient? A) Drowsiness B) Hypoglycemia C) Increased heart rate D) Decreased white blood cell count
Answer: C.
A patient is receiving intravenous aminophylline. The nurse checks the patient's lab values and sees the serum theophylline level is 32 mcg/mL. What action should the nurse take? A) Assess the patient's breath sounds for improvement. B) Increase the dosage per sliding-scale directions. C) Notify the health care provider of the level. D) Have the laboratory collect another sample to verify the results.
Answer: C.
A patient on the medical-surgical unit has suffered an acute anaphylactic reaction during infusion of an IV antibiotic with hives and bronchospasm. The nurse practitioner has written a number of stat drug orders. What is the priority drug to administer first? A) Steroid dose pack B) Dopamine C) Epinephrine D) Diphenhydramine
Answer: C.
An 80-year-old woman with a hip fracture received morphine 3 mg intravenously 20 minutes ago. The patient's son runs to the nurses' station and says that his mother is no longer responding to him. What actions should the nurse take? A) Assess the patient; call for additional assistance; support breathing with a bag-valve-mask device as indicated, and prepare to administer flumazenil. B) Call the physician and report that the patient most likely suffered a stroke and now has elevated intracranial pressure; prepare to administer mannitol. C) Assess the patient; call for additional assistance; support breathing with a bag-valve-mask device as indicated, and prepare to administer naloxone. D) Explain to the patient's son that the morphine is taking effect and that unresponsiveness is the desired outcome to best manage her pain.
Answer: C.
An African American patient has developed hypertension. The nurse is aware that which group(s) of antihypertensive drugs are less effective in African American patients? A) Diuretics B) Calcium channel blockers and vasodilators C) Beta blockers and angiotensin-converting enzyme inhibitors D) Alpha blockers
Answer: C.
An older patient has just started on hydrochlorothiazide and is advised by the health care provider to eat foods rich in potassium. What is the nurse's best recommendation of foods to consume? A) Cabbage and corn B) Bread and cheese C) Avocados and mushrooms D) Brown rice and fish
Answer: C.
The beta blocker acebutolol is prescribed for dysrhythmias. What is the primary purpose of the drug? A) Increase beta1 and beta2 receptors in cardiac tissues B) Increase the flow of oxygen to cardiac tissues C) Block beta1-adrenergic receptors in cardiac tissues D) Block beta2-adrenergic receptors in cardiac tissues
Answer: C.
The nurse is assessing a patient who is taking furosemide. The patient's potassium level is 3.4 mEq/L; chloride is 90 mmol/L, and sodium is 140 mEq/L. Based on the nurse's understanding of the laboratory results, what prescribed therapy can the nurse anticipate administering? A) Mix 40 mEq of potassium in 250 mL D5W and infuse rapidly. B) Administer sodium polystyrene sulfonate. C) Administer 2 mEq potassium chloride per kilogram per day IV. D) Administer calcium acetate, two tablets three times per day.
Answer: C.
The nurse is reviewing a patient's list of drugs. The nurse understands that the older adult's slower absorption of oral drugs is primarily because of which phenomenon? A) Decreased cardiac output B) Increased gastric emptying time C) Decreased gastric blood flow D) Increased gastric acid secretion
Answer: C.
The nurse is teaching a patient about clopidogrel. Which information will the nurse include in the patient's teaching plan? A) Constipation may occur. B) Hypotension may occur. C) Bleeding may increase when taken with aspirin. D) Normal dose is 25-mg tablet per day.
Answer: C.
The nurse receives a stat order to administer 50% dextrose solution intravenously to a 1-year-old child with hypoglycemia. How should this drug best be prepared for safe administration to the child? A) Use a filter needle. B) Draw the drug into a tuberculin syringe. C) Dilute 1:1 with sterile water to produce dextrose 25%. D) Shake the solution vigorously before injection.
Answer: C.
The nurse understands the differences between drug excretion in children and that in adults. With this knowledge, what does the nurse consider when administering drugs to children? A) Most children need a higher dose of drug, so the nurse will contact the physician for an increase in the ordered dose. B) Children excrete drugs rapidly, so the nurse must assess carefully for therapeutic effects of the drug. C) The most important assessment is to evaluate for drug accumulation, because the excretion of drugs is slower in children. D) Excretion of most drugs is the same in children as in adults, but assessments are important to avoid side effects
Answer: C.
When caring for a patient recovering from an episode of opioid toxicity, the nurse determines that the patient has opioid use disorder based on which finding? A) Withdrawal symptoms B) A history of daily use C) Craving that results in drug-seeking behaviors D) Intravenous, rather than oral, use of the drug
Answer: C.
The nurse is administering nitroglycerin at 10 mcg/min. The patient continues to complain of chest pain. What is the nurse's priority action? A) Perform an electrocardiogram (ECG). B) Stop the infusion. C) Increase the infusion by 5 mcg/min. D) Call the health care provider.
Answer: C. A continuous infusion is started for the patient with chest pain at a rate of 10-20 mcg/min and increased by 5-10 mcg/min based on the patient's symptoms. The patient would have had an ECG at the beginning of the episode. Another ECG is not needed. The infusion should not be stopped. The health care provider does not need to be called because there are interventions that the nurse can do.
The nurse is caring for several patients who are all being treated for hypertension. Which patient will the nurse assess first? A) The patient who has been on beta blockers for 1 day. B) The patient who is on a beta blocker and a thiazide diuretic. C) The patient who has stopped taking a beta blocker due to cost. D) The patient who is taking a beta blocker and Lasix (furosemide).
Answer: C. Abrupt discontinuation of the antihypertensive drug may cause rebound hypertension. The patient who has just been started on an antihypertensive drug and the patients who are on combinations of antihypertensive drugs will not be as high priorities for assessment since they seem to be complying with treatment. Abruptly discontinuing the drug indicates either a failure to understand the treatment or a noncompliance with the treatment.
A nurse is caring for a patient receiving acetazolamide. Which assessment finding will require immediate nursing intervention? A) A decrease in bicarbonate level. B) An increase in urinary output. C) A decrease in arterial pH. D) An increase in PaO2.
Answer: C. Acetazolamide causes excretion of bicarbonate, which would worsen metabolic acidosis. It is used to treat metabolic alkalosis, edema, seizures, and acute glaucoma. A decrease in blood pH would indicate that the patient was becoming more acidotic.
What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine? A) Decreased cough reflex. B) Decreased nasal secretions. C) Liquefying and loosening of bronchial secretions. D) Relief of bronchospasms.
Answer: C. Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in order to enhance their expectoration.
The nurse is administering medication to an older adult. The nurse anticipates that this patient's renal system will have which effect on the medication? A) The medication will be excreted quicker. B) The medication will be metabolized more slowly. C) The medication will be excreted more slowly. D) The medication will be metabolized quicker.
Answer: C. Administration of medication to an older adult can result in the drug being excreted less completely. The renal system will not affect how the drug is metabolized in the body.
The nurse will include which information regarding the use of antileukotriene agents such as zafirlukast in the patient teaching? A) "Take the medication as soon as you begin wheezing." B) "It will take about 3 weeks before you notice a therapeutic effect." C) "This medication will prevent the inflammation that causes your asthma attack." D) "Increase fiber and fluid in your diet to prevent the side effect of constipation."
Answer: C. Antileukotriene agents block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat an acute asthma attack.
The nurse reviews the history for a patient taking atorvastatin. What will the nurse act on immediately? A) The patient takes medications with grape juice. B) The patient takes herbal therapy including kava. C) The patient is on oral contraceptives. D) The patient was started on penicillin for a respiratory infection.
Answer: C. Atorvastatin increases the estrogen levels of oral contraceptives. The patient's oral contraceptive may need to be altered.
The nurse is caring for a patient whose cultural background does not emphasize planning for the future. In order to properly provide care for this patient, what will the nurse do? A) Make clinic appointments for the patient and notify him prior to each one. B) Instruct the family to make clinic appointments for the patient. C) Give the patient a calendar with dates circled when he should call for appointments. D) Notify the facility social worker that home health care is recommended.
Answer: C. By giving the patient a calendar with dates circled to remind him to call to make his own appointments, the nurse is encouraging the patient to be autonomous and involved in his own care while simultaneously respecting his cultural beliefs.
A calcium channel blocker has been ordered for a patient. Which condition in the patient's history is a contraindication to this medication? A) Hypokalemia. B) Dysrhythmias. C) Hypotension. D) Increased intracranial pressure.
Answer: C. Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension.
The nurse is assessing a newly admitted patient who is noted to exhibit unusually low blood pressure. The patient tells the nurse that he has added herbal medication to his drug regimen. Based on the symptoms being experienced, the nurse expects that the patient has been taking which herb? A) Licorice. B) Milk thistle. C) Hawthorn. D) Sage
Answer: C. Hawthorn is known to produce hypotension. Licorice produces an increase in blood pressure, not a decrease. Milk thistle and sage are not known to lower blood pressure.
The clinic nurse is reviewing medication instructions with a patient taking nicotine replacement gum for smoking cessation. Which statement by the patient indicates a need for further teaching by the nurse? A) "I will continue to use birth control while taking this drug." B) "I will not drink or eat while chewing the gum." C) "I can continue to smoke a cigarette once in a while when taking this drug." D) "While chewing the gum, I will periodically hold the gum between my cheek and teeth."
Answer: C. Cigarette smoking while using nicotine-replacement therapy (NRT) agents such as gum may cause nicotine overdose. The patient should not smoke cigarettes while using nicotine replacement gum. NRT should not be used by pregnant or nursing women, so use of birth control is appropriate while taking NRT. Food and drink should be avoided 15 minutes before and during gum use. While the patient is chewing the gum, there should be periods of holding the gum between the cheek and teeth.
The patient who is prescribed cilostazol questions the nurse about the addition of the drug to the drugs currently prescribed. The patient states, "I already take something for my platelets." Which response by the nurse provides the best information to the patient? A) Cilostazol also lowers blood pressure to improve arterial blood flow. B) Cilostazol interferes with the last step of lipid deposit in walls of vessels. C) Cilostazol promotes vasodilation, improving blood flow to the extremities. D) Cilostazol decreases blood viscosity, improving flexibility of erythrocytes.
Answer: C. Cilostazol is an antiplatelet that has a dual purpose of inhibiting platelet aggregation as well as causing vasodilation to treat intermittent claudication.
The health care provider indicates that the patient will be ordered an opioid antitussive. Which medication does the nurse anticipate the provider will order? A) Promethazine with dextromethorphan. B) Benzonatate. C) Codeine. D) Levocetirizine.
Answer: C. Codeine is classified as an opioid antitussive. Promethazine with dextromethorphan and benzonatate are both non-opioid antitussives. Levocetirizine is an antihistamine.
Which symptom presenting in an older adult would cause the nurse to suspect drug toxicity? A) Decreased urine output. B) Bradycardia. C) Confusion. D) Constipation.
Answer: C. Confusion is one of the first signs of drug toxicity in an older adult.
A patient is receiving warfarin for a chronic condition. Which patient statement requires immediate action by the nurse? A) "I will avoid contact sports." B) "I will take my medication in the early evening each day." C) "I will increase dark-green, leafy vegetables in my diet." D) "I will contact my health care provider if I develop excessive bruising."
Answer: C. Dark-green, leafy vegetables are rich in vitamin K, which would antagonize the effects of warfarin. Rather than increase the intake of these, it is important to maintain a consistent daily intake of vitamin K. The patient should monitor his or her incidence of bruising carefully. The medication will usually be ordered for the patient to take in the morning.
Which patient will have highest priority for the nurse performing an assessment? A) The patient with a history of cardiac disease who has been taking garlic daily. B) The patient with a history of dementia who is taking Ginkgo biloba. C) The patient scheduled for surgery who is taking Dong-quai. D) The patient who is nauseous and is taking ginger.
Answer: C. Dong-quai increases the risk of bleeding and should not be taken before surgery. Garlic will reportedly decrease high cholesterol and may help a patient with a cardiac history. Ginkgo is purported to help patients diagnosed with dementia. Ginger is purported to help decrease the risk of vomiting in nausea.
The nurse is taking a drug history of a newly admitted patient. The patient informs the nurse that one of the medications the patient is taking is Echinacea. For which condition would the patient be taking this medication? A) Hypertension. B) Thyroid disease. C) Infection. D) Asthma.
Answer: C. Echinacea is commonly used for colds, flu, and infections.
A nurse is preparing to administer enoxaparin sodium to a patient for the prevention of deep vein thrombosis. Which is an essential nursing intervention? A) Draw up the medication in a syringe with a 22-gauge, 1½-inch needle. B) Utilize the Z-track method to inject the medication. C) Administer the medication into subcutaneous tissue. D) Rub the administration site after injecting.
Answer: C. Enoxaparin is a low-molecular-weight heparin that is administered subcutaneously. The site should not be rubbed after injection, and the Z-track method also should never be used to administer enoxaparin sodium. The use of 22-gauge, 1½-inch needle is more appropriate for administration of an IM injection.
The nurse is preparing to administer medication to a child. As part of the preparation, the nurse carefully considers developmental factors. To which step of the nursing process does this action most closely correspond? A) Assessment. B) Nursing diagnosis. C) Planning. D) Nursing intervention.
Answer: C. Ensuring that developmental factors are considered as part of the process of medication administration is considered to be part of the planning phase of the nursing process.
The nurse is teaching a patient about the use of an expectorant. What is the most important instruction for the nurse to include in the patient teaching? A) "Restrict your fluids in order to decrease mucus production." B) "Take the medication once a day only, at bedtime." C) "Increase your fluid intake in order to decrease viscosity of secretions." D) "Increase your fiber and fluid intake to prevent constipation."
Answer: C. Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.
A patient with acute pulmonary edema is receiving furosemide. What assessment finding indicates to the nurse that the intervention is working? A) Potassium level decreased from 4.5-3.5 mEq/L. B) Improvement in mental status. C) Lungs clear to auscultation. D) Output 30 mL/h.
Answer: C. Furosemide is a potent, rapid-acting diuretic that would be the drug of choice to treat acute pulmonary edema. Furosemide should not cause a drastic change in output or decrease in potassium level, and there is no evidence that it will create any change in mental status.
The nurse is taking a drug history of a newly admitted patient. The patient informs the nurse that one of the medications the patient is taking is ginseng. For which condition would the patient be taking this medication? A) Hypercholesteremia. B) Thyroid disease. C) Inflammation. D) Asthma.
Answer: C. Ginseng has been said to boost the immune system, increase a person's sense of well-being, and increase stamina. It has also been used to treat erectile dysfunction, hepatitis C, and menopausal symptoms and to lower glucose and blood pressure.
Which instruction will the nurse include when teaching a patient about the proper use of metered-dose inhalers? A) "After you inhale the medication once, repeat until you obtain relief." B) "Make sure that you puff out air repeatedly after you inhale the medication." C) "Hold your breath for 10 seconds if you can after you inhale the medication." D) "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."
Answer: C. Holding the breath for 10 sec allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.
A nurse is caring for a patient who has been started on ibutilide. Which assessment is a priority for this patient? A) Blood pressure measurement. B) BUN and creatinine. C) ECG and palpitations. D) Lung sounds.
Answer: C. Ibutilide is specifically indicated for treatment of recent-onset atrial fibrillation and flutter. It is important for the nurse to obtain an ECG to see if the patient has converted to sinus rhythm and to watch for palpitations.
The nurse is caring for a patient with a diagnosis of acute alcohol toxicity. Which assessment finding requires immediate action? A) Decreased reflexes. B) Headache. C) Vomiting. D) Tachycardia.
Answer: C. In acute alcohol toxicity, vomiting occurs frequently, and to the patient's semiconscious state, aspiration is a concern.
A patient with a history of asthma is short of breath and says, "I feel like I'm having an asthma attack." What is the nurse's highest priority action? A) Calling a code. B) Asking the patient to describe the symptoms. C) Administering a beta2 adrenergic agonist. D) Administering a long-acting glucocorticoid
Answer: C. In an acute asthmatic attack, the short-acting sympathomimetics are the first line of defense.
Before the nurse administers isosorbide dinitrate, what is a priority nursing assessment? A) Assess serum electrolytes. B) Measure blood urea nitrogen and creatinine. C) Assess blood pressure. D) Monitor level of consciousness.
Answer: C. Isosorbide dinitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.
Which patient would the nurse need to assess first if the patient is receiving mannitol? A) A 67-year-old patient with type 1 diabetes mellitus. B) A 21-year-old patient with a head injury. C) A 47-year-old patient with anuria. D) A 55-year-old patient receiving cisplatin to treat ovarian cancer.
Answer: C. Mannitol is not metabolized but excreted unchanged by the kidneys. Potential water intoxication could occur if mannitol is given to a patient with anuria. Mannitol is safe to use with diabetic patients and those with head injuries, and it may function as a nephroprotectant when cisplatin is being used.
A patient is being treated for short-term management of heart failure with milrinone. What is the primary nursing action? A) Administer digoxin via IV infusion with the milrinone. B) Administer furosemide (Lasix) via IV infusion after the milrinone. C) Monitor cardiac rhythm and blood pressure continuously. D) Maintain an infusion of lactated Ringer with milrinone infusion.
Answer: C. Milrinone lactate is a phosphodiesterase inhibitor administered intravenously for short-term treatment in patients with heart failure not responding adequately to digoxin, diuretics, or other vasodilators. Blood pressure and heart rate should be closely monitored. Digoxin is not administered with the milrinone but is usually tried before treatment with milrinone. Furosemide is not necessarily administered after the milrinone, although it could be. It is not, however, administered routinely via IV infusion. Lactated Ringer does not have to be administered with milrinone.
The nurse would anticipate the health care provider to prescribe which drug of choice to manage the short-term opiate side effect of respiratory depression? A) Naloxone. B) Methadone. C) Naltrexone. D) Disulfiram.
Answer: C. Naloxone is the drug of choice in the treatment of respiratory depression associated with opioid overdose.
Varenicline is prescribed for a middle-aged patient for smoking cessation. What is the priority nursing action for this patient? A) Monitoring every 4 hours for orthostatic hypotension. B) Teaching the patient to avoid sunlight while on the medication. C) Telling the patient that nausea and vomiting are likely. D) Monitoring the patient for increased temperature.
Answer: C. Nausea and vomiting are likely with this drug. Orthostatic hypotension and hyperthermia are not a concern with this drug. Avoidance of sunlight is not necessary while on this medication.
The patient tells the nurse, "I have brought along the tea that I drink every day. My family has been drinking this kind of tea for generations because it promotes good health and long life. I hope I can continue drinking this tea while I am on my new medications." What is the nurse's best response? A) "You should not use any kind of traditional remedy while you are taking this new medication." B) "If you have been drinking this tea every day, then you should continue drinking it to maintain your health." C) "Do you know what the tea is made of? We want to be sure that none of its ingredients will react poorly with your new medications." D) "Traditional remedies have no health benefits. You should stop drinking the tea; it's a waste of time and money."
Answer: C. Patients may derive both psychological and physical benefits from taking traditional remedies, but it is essential to ensure that the traditional remedies will not interfere with the action of the conventional medications the patient has been prescribed. Because patients may achieve health benefits or psychological comfort from their traditional remedies, they should not be told that the remedies are forbidden or useless; however, they should be instructed not to continue the remedies until it has been determined that the remedies will not affect the action of the patient's conventional medications.
A patient is taking pravastatin sodium. Which assessment finding requires immediate action by the nurse? A) Headache. B) Slight nausea. C) Muscle pain. D) Fatigue.
Answer: C. Patients who experience severe muscle pain while taking pravastatin sodium need to report the findings right away, as this may be indicative of rhabdomyolysis, a muscle disintegration that can become fatal.
A 4-year-old patient is discharged on an oral liquid drug suspension of 4 mL per dose. Which device will the nurse recommend to ensure the highest level of accuracy in home administration of the drug? A) Measuring spoon B) Graduated medicine cup C) Household teaspoon D) Oral syringe
Answer: D.
During assessment of a patient diagnosed with pheochromocytoma, the nurse auscultates a blood pressure of 210/110 mm Hg. What is the nurse's best action? A) Ask the patient to lie down and rest. B) Assess the patient's dietary intake of sodium and fluid. C) Administer phentolamine. D) Administer nitroprusside.
Answer: C. Phentolamine is a potent alpha-blocking agent specifically effective for treatment of hypertension associated with pheochromocytoma. The patient's blood pressure is elevated owing to tumor secretion. If the patient lies down, the blood pressure will not necessarily decrease. Increased fluid and sodium is not the cause of hypertension in this condition. Nipride is not the recommended treatment for this condition.
A patient taking spironolactone has been taught about the medication. Which menu selection indicates that the patient understands teaching related to this medication? A) Potatoes. B) Lima beans. C) Chicken. D) Strawberries.
Answer: C. Spironolactone is a potassium-sparing diuretic that could potentially cause hyperkalemia. Chicken is the only appropriate choice of the foods listed because it is lower in potassium. Potatoes, lima beans, and strawberries are all known to contain high levels of potassium.
What over-the-counter product will the nurse instruct the patient to avoid when taking montelukast? A) Acetaminophen. B) Echinacea. C) St. John's wort.
Answer: C. St. John's wort has been shown to decrease serum montelukast levels. The other substances do not interact with montelukast.
The nurse is administering PO medications to a 2-year-old child who is belligerent. What action is the best strategy for the nurse to use? A) Explain the reason for the medication to the child. B) Ask the parent's permission before the medication is administered. C) Ask the parents to assist in calming the child. D) Administer medications intravenously.
Answer: C. The child needs to cooperate in the medication process. At this age, the best strategy is to ask the parents to assist in calming the child so that the child will take the medications. The child is too young to understand reasoning. The parents have given consent for care, so the nurse does not need to ask again before administering the medication. Obtaining the parent's permission will not make the child any more cooperative. The fact that the child is being uncooperative is not a reason to change the route of administration.
The nurse is assessing a patient who has been admitted after exhibiting hallucinations and delusions at a party. Upon assessment, the nurse determines that the patient is experiencing perceptual distortions. The patient has most likely been abusing which substance? A) Stimulants. B) Depressants. C) Cannabis. D) inhalants.
Answer: C. The combination of hallucinations, delusions, perceptual distortions, as well as depersonalization is most likely to be produced by an abuse of cannabis.
A patient taking prazosin has a blood pressure of 140/90 mm Hg and is complaining of swollen feet. What is the nurse's best action? A) Hold the medication. B) Call the health care provider to change to an alternative medication. C) Determine the patient's drug history with this medication. D) Weigh the patient.
Answer: C. The desired therapeutic effect of prazosin may not fully occur for 4 weeks. The nurse does not know how long the patient has been on this medication. There is no need to hold the medication. It is more important to determine the patient's history prior to weighing the patient or calling the health care provider, since symptoms may be the result of the medication not yet achieving the full therapeutic effect.
The nurse is caring for a patient whose cultural beliefs include being cared for by a large extended family. In order to provide care while also respecting the patient's cultural beliefs, what will the nurse do? A) Limit the number of visitors allowed to see the patient. B) Give the family written instructions on how to care for the patient. C) Involve the family as much as possible in the patient's care. D) Make the health care provider aware that the family may question care.
Answer: C. The nurse should involve the family as much as possible in the patient's care; this includes explaining and demonstrating procedures. Involving rather than limiting the family's involvement will help ensure that continuity of care takes place.
A patient taking an oral theophylline drug is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110 bpm. The patient is irritable. What is the nurse's best action? A) Continue to monitor the patient. B) Call the health care provider. C) Hold the next dose of theophylline. D) Administer oxygen 2 L/min via nasal cannula.
Answer: C. The patient is displaying adverse reactions to theophylline, and her blood level should be assessed before another dose of the medication. The nurse should hold the medication.
In the case of cardiac arrest in a child, the nurse would prepare to administer intracardiac epinephrine IV or IO along which time frame? A) Every 30-60 sec. B) Every 2-3 min. C) Every 3-5 min. D) Every 10 min.
Answer: C. The pediatric dose of epinephrine is 0.01 mg/kg (1:10,000 solution) given every 3-5 min IV/IO for cardiac arrest. The ETT dose of 0.1 mg/kg should be given using the 1:1,000 solution every 3-5 min.
The nurse is caring for a patient with a theophylline level of 14 mcg/mL. What is the priority nursing intervention? A) Increase the IV drip rate. B) Monitor the patient for toxicity. C) Continue to assess the patient's oxygenation. D) Stop the IV for an hour, then restart at lower rate.
Answer: C. The therapeutic theophylline level is 10-20 mcg/mL. The nurse should continue interventions and monitor oxygenation.
What intervention will the nurse perform when monitoring a patient receiving triamterene? A) Assess urinary output every other day. B) Monitor for side effect of hypoglycemia. C) Assess potassium levels. D) Monitor for hypernatremia.
Answer: C. Triamterene is a potassium-sparing diuretic. The nurse should monitor potassium for potential hyperkalemia.
You are the nurse taking care of the infant just diagnosed with cerebral palsy. The mother of the child asks you, "What does this mean for my child?" What is the best response by the nurse? A) This means that you child will gradually lose more and more muscle mass until eventually they will be unable to sustain their respiratory function B) This is a disorder related to how your child was born. Most likely they sustained injury during the birthing process C) There really is no specific way to tell how this disease will affect your child other than it will affect the muscle tone and control in some way. D) Why are you asking me? I ain't no doctor!
Answer: C. Cerebral Palsy is a term used to describe a range of nonspecific clinical symptoms characterized by abnormal motor pattern and postures caused by nonprogressive abnormal brain function.
38.16. The upper respiratory tract (URT) consists of the nose, nasal cavity, pharynx, and paranasal sinuses. Its undergoes a process sometimes referred to as: a. Filtering. b. Absorbing. c. Warm conditioning. d. Air conditioning.
Answer: D Air conditioning. Rationale: A. Filtering does not occur in this process. B. Absorbing does not occur in this process. C. It does not warm condition in this process. D. It does undergo a process referred to as "air conditioning.
38.23 An important aspect of client teaching regarding use of intranasal glucocorticoids is: a. Do not shake the inhaler prior to spraying b. Take oral medications prior to using an intranasal glucocorticoid inhaler. c. Use the intranasal glucocorticoid prior to using the decongestant spray. d. Avoid swallowing medication.
Answer: D Avoid swallowing medication Rationale: A. The inhaler should be shaken gently prior to use. B. Oral medications should be avoided prior to use of the inhaler. C. The decongestant spray should be used prior to use of the inhaler to clear nasal passages. D. Spit out the postnasal medication residue to avoid possible fungal infection.
38.21 The main classification fora prototype drug, such as fexofenadine (Allegra), is a/n: a. Atypical first generation H1-receptor antagonist. b. Atypical second generation H2-receptor antagonist. c. Typical first-generation H1-receptor antagonist. d. Typical second-generation H2-receptor antagonist.
Answer: D Typical second-generation H2-receptor antagonist. Rationale: A. Fexofenadine (Allegra) is not an atypical H1-receptor antagonist. B. Fexofenadine (Allegra) is not an atypical H2-receptor antagonist. C. Fexofenadine (Allegra) is not a typical first-generation H1-receptor. D. Fexofenadine (Allegra) is a typical second-generation H2-receptor antagonist.
A 25-year-old woman was admitted to the emergency department after a successful prehospital resuscitation from cardiac arrest owing to an asthma attack. On arrival, her pulse oximeter reading is 85%. Given her condition, what is the most important initial drug to administer as ordered? A) Epinephrine B) Sodium bicarbonate C) Albuterol D) Oxygen
Answer: D.
A patient is prescribed a decongestant nasal spray that contains oxymetazoline. What will the nurse teach the patient? A) Take this drug at bedtime because it may cause drowsiness. B) Directly spray the medication away from the nasal septum and gently sniff. C) This drug may be used in maintenance treatment for asthma. D) Limit use of the drug to 5 to 7 days to prevent rebound nasal congestion
Answer: D.
A patient is taking lovastatin. Which serum level is most important for the nurse to monitor? A) Blood urea nitrogen B) Complete blood count C) Cardiac enzymes D) Hepatic enzymes
Answer: D.
Adenosine is ordered for a patient in the emergency department. Immediately after intravenous (IV) administration, the nurse observes a short period of asystole on the cardiac monitor that resolves spontaneously. What is the most appropriate initial action for the nurse? A) Call for the doctor. B) Prepare epinephrine and atropine for intravenous administration. C) Initiate cardiopulmonary resuscitation (CPR). D) Closely observe the patient and the cardiac monitor.
Answer: D.
Beclomethasone has been prescribed for a patient with allergic rhinitis. What should the nurse teach the patient regarding this medication? A) This may be used for an acute attack. B) An oral form is available if the patient prefers to use it. C) Avoid large amounts of caffeine intake because an increased heart rate may occur. D) With continuous use, dryness of the nasal mucosa/lining may occur.
Answer: D.
Captopril has been ordered for a patient. The nurse should teach the patient that the most commonly occurring side effect of an angiotensin-converting enzyme drug is which of the following? A) Nausea and vomiting B) Dizziness and headaches C) Upset stomach D) Constant, irritating cough
Answer: D.
Cilostazol is being prescribed for a patient with coronary artery disease. The nurse understands that which of the following is the major purpose for antiplatelet drug therapy? A) Dissolve the blood clot B) Decrease tissue necrosis C) Inhibit hepatic synthesis of vitamin K D) Suppress platelet aggregation
Answer: D.
The nurse is assessing a patient for possible evidence of digitalis toxicity. Which of these is included in the signs and symptoms for digitalis toxicity? A) Apical pulse rate of 100 beats/min B) Apical pulse of 72 beats/min with an irregular rate C) Apical pulse of 90 beats/min with an irregular rate D) Apical pulse of 48 beats/min with an irregular rate
Answer: D.
The nurse is performing a health assessment on a newly admitted patient of Asian descent. The patient looks at the floor whenever the nurse asks a question. Communication is enhanced when the nurse does which action? A) Frequently touches the patient B) Asks questions that require only "yes" or "no" answers C) Discontinues the health assessment D) Uses eye contact sparingly
Answer: D.
In discharge teaching, the nurse will emphasize to a patient receiving a beta-agonist bronchodilator the importance of reporting which side effect? A) Hypoglycemia. B) Nonproductive cough. C) Sedation. D) Tachycardia.
Answer: D. A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.
The nurse is reviewing a medication history on a patient taking an ACE inhibitor. The nurse plans to contact the health care provider if the patient is also taking which medication? A) Docusate sodium. B) Furosemide. C) Morphine sulfate. D) Spironolactone.
Answer: D. ACE inhibitors block the conversion of angiotensin I to angiotensin II, thus also blocking the stimulus for aldosterone production. Aldosterone is responsible for potassium excretion—decreased aldosterone can result in increased serum potassium levels. Spironolactone is a potassium-sparing diuretic and should not be administered with an ACE inhibitor.
A patient is prescribed chlorthalidone. What is the most important information the nurse will teach the patient? A) "Do not drink more than 10 ounces of fluid a day while on this medication." B) "Take this medication on an empty stomach." C) "Take this medication before bed each night." D) "Wear protective clothing and sunscreen while taking this medication."
Answer: D. Adverse effects associated with chlorthalidone include photosensitivity. The nurse should teach the patient to protect himself when out in the sun. There is no evidence that fluid should be restricted while taking the medication, that it should be taken on an empty stomach, or that it should only be taken at bedtime.
Which statement made by the patient indicates to the nurse that understanding about discharge instructions on antihyperlipidemic medications has occurred? A) "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol." B) "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." C) "I will stop taking the medication if it causes nausea and vomiting." D) "I will continue my exercise program to help increase my high-density lipoprotein serum levels."
Answer: D. Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen used to decrease serum cholesterol levels. The dose should never be doubled if one is missed nor stopped due to side effects.
Which patient's statement indicates a need for further medication instruction about colestipol? A) "The medication may cause constipation, so I will increase fluid and fiber in my diet." B) "I should take this medication 1 h after or 4 h before my other medications." C) "I might need to take fat-soluble vitamins to supplement my diet." D) "I should stir the powder in as small an amount of fluid as possible to maintain potency of the medication."
Answer: D. Colestipol is a powder that must be well diluted in fluids before administration to avoid esophageal irritation or obstruction and intestinal obstruction. The powder should not be stirred because it may clump; it should be left to dissolve slowly for at least 1 min.
The nurse is monitoring a patient during IV nitroglycerin infusion. Which assessment finding will cause the nurse to take action? A) Blood pressure 110/90 mm Hg. B) Flushing. C) Headache. D) Chest pain.
Answer: D. The patient should not continue to have chest pain while on IV nitroglycerin. This would prompt the nurse to intervene. Blood pressure of 110/90 mm Hg is not cause for concern and is expected with nitroglycerin. Headache and flushing are common side effects of nitroglycerin.
The nurse is providing home health care to a patient from a culturally diverse background. In order to provide the most appropriate care for this patient, what will the nurse do? A) Focus only on the patient's needs while not considering the influence of the nurse's cultural beliefs and practices. B) Only provide nursing care that has been shown to be congruent with the nursing staff's cultural beliefs. C) Thoroughly document the patient's cultural beliefs to expedite provision of care from the next nurse. D) Provide nursing care that emphasizes the patient's individual needs while also being aware of the nurse's own biases.
Answer: D. Culturally appropriate care should emphasize the patient's individual needs, while also being aware of the biases of the nurse. Ignoring the nurse's biases will prevent the nurse from being culturally aware.
The health care provider indicates that the patient will be ordered an expectorant. Which medication does the nurse anticipate the provider will order? A) Brompheniramine maleate. B) Chlorpheniramine maleate. C) Dexchlorpheniramine maleate. D) Guaifenesin.
Answer: D. Guaifenesin is classified as an expectorant. The other drugs listed are classified as first-generation antihistamines.
The nurse is caring for a child who has been prescribed an inhaler for asthma control. The child is having difficulty using the inhaler. What will the nurse do? A) Tell the parent to hold the inhaler for the child. B) Ask the health care provider to switch to oral medications. C) Tell the parent that young children should not use inhalers. D) Teach the child to use a spacer.
Answer: D. If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.
Which statement indicates to the nurse that the patient understands sublingual nitroglycerin medication instructions? A) "I will take up to five doses every 3 min for chest pain." B) "I can chew the tablet for the quickest effect." C) "I will keep the tablets locked in a safe place until I need them." D) "I should sit or lie down after I take a nitroglycerin tablet to prevent dizziness."
Answer: D. Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. Three doses can be taken 5 min apart. The tablet should be placed under the tongue to dissolve. The medication should be kept in a readily accessible location for immediate use should chest pain occur.
Which statement made by the patient demonstrates a need for further instruction regarding the use of nitroglycerin? A) "If I get a headache, I should keep taking nitroglycerin and use Tylenol for pain relief." B) "I should keep my nitroglycerin in a cool, dry place." C) "I should change positions slowly to avoid getting dizzy." D) "I can take up to five tablets at 3-minute intervals for chest pain if necessary."
Answer: D. Patients are taught to take up to three tablets every 5 min. If no relief from chest pain is obtained after one tablet, they should seek medical assistance and take up to two more tablets. All other responses demonstrate a good understanding by the patient.
A patient is receiving mannitol for treatment of cerebral edema. The nurse assesses a heart rate of 110 beats/min and rhonchi throughout the lung fields, and the patient complains of blurred vision. What will the nurse do? A) Continue to assess the patient. B) Encourage the patient to cough and deep breathe. C) Tell the patient to close her eyes and relax. D) Stop the infusion and call the health care provider.
Answer: D. Pulmonary congestion, tachycardia, and blurred vision are symptoms of adverse effects of mannitol. The nurse should stop the infusion. Coughing and deep breathing will not assist the patient.
The nurse is caring for a patient in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this patient? A) "Take the medication only when you are not driving." B) "Take a lower dose than normal when you have to drive." C) "You are correct; you should not take antihistamines." D) "You may be able to safely take a second-generation antihistamine."
Answer: D. Second-generation antihistamines are often called non-sedating antihistamines. These may be safer for the patient to take, but the patient should still monitor for signs of excessive sedation.
The nurse is updating a clinic history on a patient who reports experiencing increasingly frequent sunburns. The patient also mentions that he has started taking a specific herb on a regular basis. Based on the symptoms being experienced, the nurse expects that the patient has been taking which herb? A) Garlic. B) Milk thistle. C) Hawthorn. D) St. John's wort.
Answer: D. St. John's wort produces skin photosensitivity; garlic, milk thistle, and hawthorn are not known to cause this side effect.
The nurse is caring for a patient who arrived at the Emergency Department exhibiting slurred speech, giddiness, euphoria, and a decrease in his inhibitions. The nurse suspects that the patient has been abusing which substance? A) Stimulants. B) Depressants. C) Psychoactives. D) Inhalants.
Answer: D. The combination of slurred speech, giddiness, euphoria, and decreased inhibitions is most likely to be produced by an abuse of inhalants.
While performing an admission interview, which question would be the most appropriate for the nurse to ask the patient in regard to the use of herbal supplements? A) "Are you aware that you must stop all herbal supplements before being admitted?" B) "Is your health care provider aware of the herbal supplements you take?" C) "What is your opinion about herbal supplements?" D) "What supplements do you take, and how often do you take them?"
Answer: D. The nurse needs to assess what herbs the patient takes, as this may affect the patient's treatment or interfere with medications.
An older adult patient has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the patient? A) The older adult patient should not take sedative hypnotics. B) The older adult patient should be prescribed a drug with a short half-life. C) The older adult patient should alternate different sedatives every other day so as not to become dependent. D) The older adult patient should use alternative therapies and herbal remedies rather than sedatives.
Answer: D. The older adult patient may have difficulty with elimination of drugs, so a drug with a short half-life is preferable. If used correctly, sedative hypnotics are safe for the older adult. There is no benefit to giving two different sedatives to a patient. Alternative therapies and herbal remedies may be tried; however, there is no indication that they are better than traditional therapies.
A nurse is monitoring a patient with angina for therapeutic effects of nitroglycerin. Which assessment finding indicates that the nitroglycerin has been effective? A) Blood pressure of 120/80 mm Hg B) Heart rate of 70 beats/min. C) ECG without evidence of ST changes. D) Patient stating that pain is 0 out of 10
Answer: D. The patient taking nitroglycerin should expect the therapeutic effect of absence of chest pain. It is unrealistic to expect that the patient's blood pressure, heart rate, and ECG will all be in completely normal range since variations in blood pressure and heart rate will occur as part of daily life and the patient may have some underlying cardiac disease that is producing the angina.
The nurse is caring for multiple patients on the pulmonary unit. The nurse would question the administration of prescribed epinephrine to which patient? A) The patient with a history of emphysema. B) The patient with a history of type 2 diabetes. C) The patient who is 16 years old. D)The patient with atrial fibrillation with a rate of 100
Answer: D. The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. This patient should not receive epinephrine.
The patient questions a nurse about herbal treatments for arthritic pain. What is the nurse's best response? A) "Ginkgo biloba has proven to be very useful as an anti-inflammatory agent." B) "High doses of vitamins have been used for many years to help maintain joint health." C) "There are no safe herbal treatments for pain; take your prescription medications." D) "Ginger has helped treat arthritic pain. Consult your health care provider."
Answer: D. There are demonstrated benefits for the use of some herbal supplements. However, they should always be used in consultation with the health care provider.
The nurse is caring for a patient with hypertension who is prescribed a clonidine transdermal patch. What is the correct information to teach this patient? A) Change the patch daily at the same time. B) Remove the patch before taking a shower or bath. C) Do not take other antihypertensive medications while on this patch. D) Get up slowly from a sitting to a standing position.
Answer: D. This medication can cause dizziness. Patient safety is a priority. The patch is left on for 7 days and can be left on while bathing. This medication is often prescribed with other drugs.
The nurse evaluates that the patient has understood discharge teaching regarding warfarin based on which statement? A) "I will double my dose if I forget to take it the day before." B) "I should keep taking ibuprofen for my arthritis." C) "I should decrease the dose if I start bruising easily." D) "I should use a soft toothbrush for dental hygiene."
Answer: D. This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The patient should call the health care provider if experiencing excessive bruising.
Which of the following medications acts by blocking the reabsorption of sodium and chloride in Henle's loop? a. Furosemide (Lasix) b. Chlorothiazide (Diuril) c. Spironolactone (Aldactone) d. Metolazone (Zaroxolyn)
Answer: a. Furosemide (Lasix) Rationale: Furosemide (Lasix) is a loop diuretic that blocks the reabsorption of sodium and chloride in Henle's loop.
Which of the following actions by the nurse is most important when caring for a client with renal disease? a. Identify medications that have the potential for nephrotoxicity. b. Check the specific gravity of the urine daily. c. Eliminate potassium-rich foods from the diet. d. Encourage the client to void every four hours.
Answer: a. Identify medications that have the potential for nephrotoxicity. Rationale: Since the kidneys excrete most drugs, clients with renal failure will need a significantly lower dosage in order to avoid fatal consequences.
The client admitted for congestive heart failure (CHF) is receiving digoxin (Lanoxin) and furosemide (Lasix). Which of the following laboratory findings should the nurse carefully monitor? a. Potassium b. Creatinine c. Calcium d. Sodium
Answer: a. Potassium Rationale: Potassium loss is a serious side effect of loop diuretics, and this is a serious concern to clients being treated with digoxin (Lanoxin).
Administration of potassium supplements is contraindicated in clients taking which of the following diuretics? a. Spironolactone (Aldactone) b. Furosemide (Lasix) c. Chlorothiazide (Diuril) d. Bumetanide (Bumex)
Answer: a. Spironolactone (Aldactone) Rationale: Unlike with loop and thiazide diuretics, clients taking potassium-sparing diuretics should not take potassium supplements, due to the increased risk of hyperkalemia.
Which of the following actions is dependent upon proper functioning of the kidneys or the administration of Epogen? a. Stimulates the production of RBCs. b. Inhibits the release of renin. c. Detoxifies drugs in the bloodstream. d. Secretes the hormone cortisol.
Answer: a. Stimulates the production of RBCs. Rationale: The kidney is responsible for the hormone erythropoietin, which stimulates the production of RBCs.
Client education as relates to loop diuretics should include goals of therapy and should include which of the following points? (Select all that apply.) a. Take in the morning to avoid nighttime urination that could result in increased risk of injury. b. Expect decreased urine output. c. Take potassium supplements, if ordered, and eat potassium-rich foods. d. Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours. e. Report any change in hearing (deafness).
Answer: a. Take in the morning to avoid nighttime urination that could result in increased risk of injury.; c. Take potassium supplements, if ordered, and eat potassium-rich foods.; d. Check weight daily, and report a weight gain of 2 pounds or greater in 24 hours.; e. Report any change in hearing (deafness). Rationale: Client education should include reasons for obtaining baseline data such as vital signs and tests for renal disorders, and possible side effects.
Which of the following is an important point of emphasis the nurse should include when teaching a client with diabetes regarding thiazides? a. Hypocalcemia b. Hyperglycemia c. Urinary tract infections d. Anemia
Answer: b. Hyperglycemia Rationale: Some thiazide diuretics can cause hyperglycemia and glycosuria in diabetic patients. Thiazides do not affect calcium or red blood cell levels.
For which of the following disorders should the nurse assess before administering chlorothiazide (Diuril)? a. Chronic urinary tract infections b. Low blood pressure c. Congenital malformations d. Hyperkalemia
Answer: b. Low blood pressure Rationale: Thiazide diuretics reduce circulating blood volume, which can cause orthostatic hypotension.
Which of the following is the most important baseline value prior to initiation of diuretic therapy? a. Glucose level b. Amino acids c. Blood pressure d. Sodium bicarbonate
Answer: c. Blood pressure Rationale: Although many baseline values are important, blood pressure (sitting and supine) can indicate excessive diuresis, which can result in dehydration and hypovolemia.
Which of the following clinical manifestations might indicate that the client has excessive potassium loss? a. Hypertension; angina b. Excessive thirst; urination c. Low blood pressure; cardiac arrhythmias d. Pitting edema; weight gain
Answer: c. Low blood pressure; cardiac arrhythmias Rationale: Rapid excretion of large amounts of fluid predisposes the client to potassium deficits and is manifested by hypotension, dizziness, cardiac arrhythmias, and fainting.
A client with a history of HF will be started on spironolactone (Aldactone). Which of the following drug groups should not be used, or used with extreme caution in patients taking potassium-sparing diuretics? 1. NSAIDs 2. Corticosteroids 3. Loop diuretics 4. ACE inhibitors or ARBs
Answer:4 Rationale: ACE inhibitors and ARBs taken concurrently with potassium -sparing diuretics increase the risk of hyperkalemia. Options 1,2, and 3 are incorrect. NSAIDs are used cautiously with all diuretics because they are excreted through the kidney. Corticosteroids and loop diuretics may cause hypokalemia and may be paired with a potassium -sparing diuretic to reduce the risk of hypokalemia developing if a diuretic is needed.
Phenothiazines Side Effects
Anticholinergic effects Ejaculation disorders and delay in achieving orgasm Menstrual disorders Sedation Drowsiness Dizziness Constipation Hypothermia EPS can become permanent with high doses
Valproic Acid (Depakene/Depakote)
Antiseizure drug used in the treatment of bipolar disorder Rapidly absorbed from GI tract Fewer side effects: -Sedation -Drowsiness -GI upset -Prolonged bleeding time
full thickness burn
Apperance: deep, res, black white and brown Dry surface, edema, fat exposed, tissue disrupted Sensation: little pain, anesthetic course: 2-3 wks to heal requires removal of eschar and skin grafting
Partial thickness burn
Apperance: large thick walled blisters covering extensive areas Edema: molted red base; broken epidermia, wet, shiny weeping surface Sensation: painful, sensative cold Course: heals in 10-14 deep burn takes 21-28
superficial burn
Apperance: mild to severe erythemia, skin blanches with pressure - skin dry -small, thin - walled blisters Sensation: painful, hyperesthetic, tingling, pain eased by cooling Course : discomfort last for about 48hrs
arterial oxygen tension
Arterial: - Normal is about 97 mm Hg - About 98% saturated with oxygen Venous: -pO2 of mixed venous blood (i.e. in inferior vena cava) is about 40 mm Hg - About 83% saturated Conclusion: About 15% of oxygen bound to hemoglobin is unloaded to tissue
The nurse providing discharge teaching for a client recently started on a tricyclic antidepressant (TCA) must include the importance of: Avoiding driving or operating dangerous equipment. Using sugarless gum for a dry mouth. Taking medication with meals. Increasing fluid intake.
Avoiding driving or operating dangerous equipment. Objective: Use the nursing process to care for clients receiving drug therapy for mood and emotional disorders. Rationale: Safety is always the first priority for nurses to address. Sedation is frequently reported at initiation of therapy, and safety needs are of highest priority. The other options should also be included in the teaching, but are not the most important. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Implementation
A patient with chronic congestive heart failure has repeated hospitalizations in spite of ongoing treatment with hydrochlorothiazide [HydroDIURIL] and digoxin. The prescriber has ordered spironolactone [Aldactone] to be added to this patient's drug regimen, and the nurse provides education about this medication. Which statement by the patient indicates understanding of the teaching? a. "I can expect improvement within a few hours after taking this drug." b. "I need to stop taking potassium supplements." c. "I should use salt substitutes to prevent toxic side effects." d. "I should watch closely for dehydration."
B Spironolactone is a potassium-sparing diuretic used to counter the potassium-wasting effects of hydrochlorothiazides. Patients taking potassium supplements are at risk for hyperkalemia when taking this medication, so they should be advised to stop the supplements. Spironolactone takes up to 48 hours to have effects. Salt substitutes contain high levels of potassium and are contraindicated. Spironolactone is a weak diuretic, so the risk of dehydration is not increased.
A nurse is planning care for a patient who takes fexofenadine (Allegra) for allergic rhinitis. Which outcome should the nurse anticipate? A. No complaints of dry mouth B. Relief of sneezing and itching C. Use limited to allergy season D. Absence of rebound congestion
B. Fexofenadine, a second-generation antihistamine, is prescribed as a first-line medication for allergic rhinitis to relieve sneezing, rhinorrhea, and nasal itching. Anticholinergic effects (dry mouth, constipation) are uncommon with second-generation antihistamines. Antihistamines are most effective when taken prophylactically. Rebound congestion develops in topical sympathomimetic agents.
Which statement by a patient indicates understanding of a nurse's teaching about fluticasone nasal spray (Flonase)? A. "I'll gradually stop taking this so I don't have any problems with withdrawal." B. "This drug will help prevent the inflammation and irritation from my allergies." C. "I'll have to be more careful about not falling, because my bones may break more easily." D. "I realize that I only need to take this when my symptoms are really bad."
B. Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.
Which instruction should the nurse include in the teaching for a patient prescribed cetirizine (Zyrtec) for seasonal allergic rhinitis? A. "Clean the nasal applicator after use to prevent contamination." B. "Take the medication daily throughout the allergy season." C. "Expect a decrease in your nasal congestion in a day or two." D. "Take a stool softener daily to avoid the side effect of constipation."
B. For treatment of allergic rhinitis, antihistamines such as cetirizine are most effective when taken prophylactically throughout the allergy season, even when symptoms are absent. The medication is taken orally, not intranasally. Oral antihistamines relieve sneezing, rhinorrhea, and nasal itching but not nasal congestion. Constipation is rare in patients taking second-generation agents, such as cetirizine.
Which complaint indicates that a patient is experiencing an adverse effect of beclomethasone (Beconase AQ) nasal spray? A. Sneezing B. Sore throat C. Runny nose D. Rebound congestion
B. Sore throat is an adverse effect associated with intranasal glucocorticoids, such as beclomethasone. More common adverse effects include drying of the nasal mucosa and a burning or itching sensation. Sneezing and runny nose are two of the symptoms of allergic rhinitis for which intranasal glucocorticoids are used. Rebound congestion is an adverse effect of intranasal sympathomimetics.
A nurse should recognize that recent research has shown which statement is true about the use of zinc in children with colds? A. Efficacy is seen within the first 24 hours of signs and symptoms. B. Evidence has been inconclusive, and more research is needed. C. Lozenges with the lemon-lime formula are the most effective. D. Recovery is accelerated, and symptoms resolve quickly.
B. Studies have shown that zinc can benefit adults with colds. However, the one study done in children showed no beneficial effects. The study left unanswered questions; therefore, more research is required. Conclusions about efficacy, lozenge formula, and time to recovery are open to other possible interpretations in the one study done in children.
The patient is receiving Phenobarbital (Luminal) for control of seizures. The patient tells the nurse she plans to become pregnant. What is the best response of the nurse? Select one: A. "Your medication dose will need to be increased during your pregnancy." B. "Please talk to your doctor; this drug is contraindicated in pregnancy." C. "Please talk to your doctor; you will need a safer drug like valproic acid (Depakene)." D. "Your medication dose will need to be decreased during your pregnancy."
B. "Please talk to your doctor; this drug is contraindicated in pregnancy."
Which food items should the nurse advise a patient taking a monoamine oxidase inhibitor (MAOI) to avoid? Select one: A. Orange juice, cottage cheese, and turkey B. Chocolate, wine, and fava beans C. Spring water, ice cream, and salmon D. Spinach, rice, and venison
B. Chocolate, wine, and fava beans
Exposure to perfume, cosmetics, detergents, or latex is associated with which of the following disorders? A. Atopic dermatitis B. Contact dermatitis C. Seborrheic dermatitis D. Stasis dermatitis
B. Contact dermatitis
Matching: Closed comedones A. Black head B. Whiteheads C. Intense itching D. Redness E. "First-degree" injury
B. Whiteheads
Methotrexate (Rheumatrx, Trexall) may be used to treat psoriasis. Which other condition is it used for? A. Gout and rheumatoid arthritis B. Rheumatoid arthritis and certain cancers C. Systemic fungal infections and certain cancers D. Urinary tract infections and peptic ulcers
B. Rheumatoid arthritis and certain cancers
Topical corticosteroids are a common treatment for all of the following EXCEPT: A. Psoriasis B. Rosacea C. Pruritus D. Dermatitis
B. Rosacea
The nurse is caring for a 34-year-old male patient who sustained a deep partial thickness burn to the anterior chest area during a workplace accident 6 hours ago. Which assessment findings would the nurse identify as congruent with this type of burn? A. Skin is hard with a dry, waxy white appearance. B. Skin is shiny and red with clear, fluid-filled blisters. C. Skin is red and blanches when slight pressure is applied. D. Skin is leathery with visible muscles, tendons, and bones.
B. Skin is shiny and red with clear, fluid-filled blisters. Deep partial thickness burns have fluid-filled vesicles that are red and shiny. They may appear wet (if vesicles have ruptured), and mild to moderate edema may be present. Superficial partial thickness burns are red and blanch with pressure vesicles that appear 24 hours after the burn injury. Full-thickness burns are dry, waxy white, leathery, or hard, and there may be involvement of muscles, tendons, and bones.
Matching: Benzocaine (Solarcaine) A. Scabicide/pediculicide B. Sunburn/minor irritation drug C. Acne and acne-related drug D. Topical corticosteroid E. Psoriatic drug
B. Sunburn/minor irritation drug
Which of the following medications is also used for the treatment of wrinkles? A. Benzoyl peroxide (Clearasil, Fostex, others) B. Tretinoin (Avita, Retin-A, others) C. Calcipotriene (Dovonex) D. Hydroxyurea (Hydrea)
B. Tretinoin (Avita, Retin-A, others)
Oral decongestants differ from intranasal decongestants in that oral decongestants Select one: A. can cause rebound congestion. B. have more systemic effects. C. are more effective at relieving severe congestion. D. have high efficacy.
B. have more systemic effects.
Emergent resuscitative phase
Begins with fluid loss and edema formation at time of burn *greatest threat is hypovolemic shock- BP decreases, HR increases, U/O decreased Continues until fluid mobilization and diuresis occurs ABCs are the priority Can last 48 hours to several days
Acute phase of the burn
Begins with mobilization of fluid (= diuresis) and ends when burned area is completely covered or healed Highest risk of infection in this stage Can last 48 hours, weeks or months
While assessing the patient's respiratory rate, the nurse assesses four normal breaths followed by an episode of apnea lasting 20 seconds. How will the nurse document this finding?
Biot's respiration
Breathing
Breathing pattern, ABGs, O2 sat, supplemental oxygen airway obstruction - inhalation - secondary edema
classification of burns
Burn Depth Partial thickness - superficial Partial thickness - deep- takes first layer of dermis off Full thickness Extent of Body Surface Area Injured TBSA
A patient is taking gentamicin [Garamycin] and furosemide [Lasix]. The nurse should counsel this patient to report which symptom? a. Frequent nocturia b. Headaches c. Ringing in the ears d. Urinary retention
C Patients taking furosemide should be advised that the risk of furosemide-induced hearing loss can be increased when other ototoxic drugs, such as gentamicin, are also taken. Patients should be told to report tinnitus, dizziness, or hearing loss. Nocturia may be an expected effect of furosemide. Headaches are not likely to occur with concomitant use of gentamicin and furosemide. Urinary retention is not an expected side effect.
A patient has 2+ pitting edema of the lower extremities bilaterally. Auscultation of the lungs reveals crackles bilaterally, and the serum potassium level is 6 mEq/L. Which diuretic agent ordered by the prescriber should the nurse question? a. Bumetanide [Bumex] b. Furosemide [Lasix] c. Spironolactone [Aldactone] d. Hydrochlorothiazide [HydroDIURIL]
C Spironolactone is a non-potassium-wasting diuretic; therefore, if the patient has a serum potassium level of 6 mEq/L, indicating hyperkalemia, an order for this drug should be questioned. Bumetanide, furosemide, and hydrochlorothiazide are potassium-wasting diuretics and would be appropriate to administer in a patient with hyperkalemia.
benztropine (Cogentin)
centrally acting cholinergic receptor blocker/ antiparkinson drug
A patient who is taking digoxin is admitted to the hospital for treatment of congestive heart failure. The prescriber has ordered furosemide [Lasix]. The nurse notes an irregular heart rate of 86 beats per minute, a respiratory rate of 22 breaths per minute, and a blood pressure of 130/82 mm Hg. The nurse auscultates crackles in both lungs. Which laboratory value causes the nurse the most concern? a. Blood glucose level of 120 mg/dL b. Oxygen saturation of 90% c. Potassium level of 3.5 mEq/L d. Sodium level of 140 mEq/L
C This patient has an irregular, rapid heartbeat that might be caused by a dysrhythmia. This patient's serum potassium level is low, which can trigger fatal dysrhythmias, especially in patients taking digoxin. Furosemide contributes to loss of potassium through its effects on the distal nephron. Potassium-sparing diuretics often are used in conjunction with furosemide to prevent this complication. This patient's serum glucose and sodium levels are normal and of no concern at this point, although they can be affected by furosemide. The oxygen saturation is somewhat low and needs to be monitored, although it may improve with diuresis.
Which outcome would be most appropriate for a nurse to establish for a patient with a cough who takes an antitussive with codeine? A. Warm, dry, pink skin B. Oriented to time, place, and person C. Respiratory rate of 12 to 24 breaths per minute D. Effective productive cough
C. Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Doses are small (one-tenth those needed to relieve pain), so orientation and peripheral effects are minimal.
Which instruction by the nurse should be the priority for a patient scheduled to start intranasal cromolyn (NasalCrom)? A. "It is only moderately effective." B. "There are few adverse reactions." C. "Relief may take a week or two." D. "It suppresses histamine release."
C. Cromolyn is best suited for prophylaxis and should be given before symptoms start, because responses may take a week or 2 to develop. It is important for the patient to know about cromolyn's moderate effectiveness, few adverse reactions, and suppression of histamine release, but it is more important that the patient be informed of the delay in response.
A nurse instructs a patient that which nonprescription medication requires patient identification and a signature for purchase? A. Chlorpheniramine (Chlor-Trimeton) B. Cetirizine (Zyrtec) C. Ephedrine D. Ipratropium bromide (Atrovent)
C. Ephedrine is a sympathomimetic agent associated with abuse, because it can be converted to methamphetamine. Legal availability has been reduced by having the product behind the counter, and patients must present identification and sign a log for purchase. Chlorpheniramine and cetirizine are first- and second-generation antihistamines that are available without legal constraints. Ipratropium bromide, an anticholinergic intranasal agent for allergic rhinitis, also does not require patient identification.
A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? A. "Restrict cold fluids to promote reduced mucus production." B. "Take the medication once a day only, usually at bedtime." C. "Increase your fluid intake to reduce the viscosity of secretions." D. "Increase your fiber and fluid intake to prevent constipation."
C. Expectorant drugs are used to reduce the viscosity of secretions, allowing them to be more easily expectorated. Reduction of mucus production is unrelated to an expectorant. Expectorants may be taken several times a day and do not cause constipation.
Which instruction should be included in the teaching for a patient being started on the antihistamine azelastine (Astelin)? A. "Take the pill in the morning before breakfast." B. "Headache may be a side effect of the medication." C. "You may experience an unpleasant taste in your mouth when using azelastine." D. "You will experience a decrease in nasal congestion if the medication is working."
C. With both formulations of azelastine (Astelin and Astepro), patients often complain of an unpleasant taste. Azelastine is administered as an intranasal metered spray. Headache is a side effect of the intranasal antihistamine olopatadine. Antihistamines do not reduce nasal congestion.
The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask? Select one: A. "How old is the bottle you are using?" B. "Are you using any other inhaled medications?" C. "How long have you been using the medication?" D. "May I take your temperature?"
C. "How long have you been using the medication?"
Which patient should the nurse prepare to transfer to a regional burn center? A. A 25-year-old pregnant patient with a carboxyhemoglobin level of 1.5% B. A 39-year-old patient with a partial-thickness burn to the right upper arm C. A 53-year-old patient with a chemical burn to the anterior chest and neck D. A 42-year-old patient who is scheduled for skin grafting of a burn wound
C. A 53-year-old patient with a chemical burn to the anterior chest and neck The American Burn Association (ABA) has established referral criteria to determine which burn injuries should be treated in burn centers where specialized facilities and personnel are available to handle this type of trauma (see Table 25-3). Patients with chemical burns should be referred to a burn center. A normal serum carboxyhemoglobin level for nonsmokers is 0% to 1.5% and for smokers is 4% to 9%. Skin grafting for burn wound management is not a criterion for a referral to a burn center. Partial-thickness burns greater than 10% total body surface area (TBSA) should be referred to a burn center. A burn to the right upper arm is 4% TBSA.
Matching: Azelaic acid (Azelex) A. Scabicide/pediculicide B. Sunburn/minor irritation drug C. Acne and acne-related drug D. Topical corticosteroid E. Psoriatic drug
C. Acne and acne-related drug
Matching: Benzoyl peroxide (BenzaClin) A. Scabicide/pediculicide B. Sunburn/minor irritation drug C. Acne and acne-related drug D. Topical corticosteroid E. Psoriatic drug
C. Acne and acne-related drug
Matching: Sulfacetamide sodium (AK-Sulf) A. Scabicide/pediculicide B. Sunburn/minor irritation drug C. Acne and acne-related drug D. Topical corticosteroid E. Psoriatic drug
C. Acne and acne-related drug
Topical metronidazole (Metrogel, MetroCream) is used to treat rosacea. For which of the following options is it used when given PO or IV? A. Crohn's disease B. To decrease lipid levels in the blood C. Anti-infective therapy D. Dysrhythmias
C. Anti-infective therapy
Which of the following is an over-the-counter (OTC) medication for acne? A. Adapalene (Differin) B. Azelaic acid (Azelex, Finacea, others) C. Benzoyl peroxide (Clearasil, Fostex, others) D. Sulfacetamide (Cetamide, Klaron, others)
C. Benzoyl peroxide (Clearasil, Fostex, others)
Matching: Pruritus A. Black head B. Whiteheads C. Intense itching D. Redness E. "First-degree" injury
C. Intense itching
The physician has prescribed cromolyn (Intal) for the client with asthma. The nurse plans to do medication education. What will the best plan by the nurse include? Select one: A. This medication can affect blood glucose levels. B. This medication is indicated for acute asthma attacks. C. This medication will help prevent asthma attacks. D. This medication can result in hypertension.
C. This medication will help prevent asthma attacks.
The most productive way of managing stress would be to Select one: A. use anxiolytics. B. use a combined approach (drug use and non-pharmacological strategies). C. determine the cause and address it accordingly. D. practice meditation.
C. determine the cause and address it accordingly.
Common Atypical Antipsychotics
Clozapine (Clozaril) Risperidone (Risperdal) increases prolactin levels Olanzapine (Zyprexa) Quetiapine (Seroquel) Aripripazole (Abilify)
Burn Shock
Compensation with intense peripheral vasoconstriction for 1-2 hours BP- decrease HR- increase Urine output- decrease When compensatory mechanisms fail S&S of hypovolemic shock will appear with CO ↓ 30-50%
The nurse is caring for an elderly patient in the PACU. The patient has had a bronchoscopy, and the nurse is monitoring for complications related to the administration of lidocaine. What does the nurse recognize as a complication related to the administration of large doses of lidocaine in the elderly?
Confusion and lethargy
A patient has an increased reaction to a drug following a change in her dietary habits. Which of the following changes would most likely be the cause? 1. Increased intake of grapefruit juice 2. Reduced intake of alcohol 3. Increased fiber intake 4. Reduced intake of citrus fruit
Correct Answer: 1 Grapefruit juice lowers the acidity of enzymes in the GI system that break down medications. This in turn results in higher medication absorption into the bloodstream. A reduction in citrus fruit intake would likely cause a lowered drug reaction. A reduced intake of alcohol or fiber would not likely produce an increased reaction to a drug. (p. 24)
An order for a medication to be given prn means 1. as needed. 2. every day. 3. at bedtime. 4. with food.
Correct Answer: 1 These are the letters used to designate as needed.
The pharmaceutical representative comes to the physician's office and says his company's pharmaceutical laboratory is marketing a drug that does not need approval by the Food and Drug Administration (FDA). What is the best response by the nurse? 1. "Any pharmaceutical laboratory in America must have approval from the Food and Drug Administration (FDA) before marketing a drug." 2. "Is this an over-the-counter (OTC) drug? They do not need approval by the Food and Drug Administration (FDA)." 3. "Is your pharmaceutical laboratory private? Only public pharmaceutical laboratories need approval from the Food and Drug Administration (FDA)." 4. "Your pharmaceutical laboratory must be involved in academic research because they are exempt from approval by the Food and Drug Administration (FDA)."
Correct Answer: 1 Any pharmaceutical laboratory, whether private, public, or academic, must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Private pharmaceutical laboratories must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories involved in academic research must obtain approval from the Food and Drug Administration (FDA) before marketing a drug. Pharmaceutical laboratories that manufacture over-the-counter (OTC) drugs must obtain approval from the Food and Drug Administration (FDA) before marketing these drugs.
The client says to the nurse, "My wife and I take the same drug, but we have different side effects. Are we doing something wrong?" What is the best response by the nurse? 1. "No. Differences such as your sex can result in different side effects." 2. "I'll have to check. What is the name of the drug you were using?" 3. "Possibly. This could happen if one uses generic or brand name drugs." 4. "I'm not sure. Maybe the drug is not the same; you should check it."
Correct Answer: 1 Drugs may elicit different responses depending on individual client factors such as age, sex, body mass, health status, and genetics. Asking he client to check a medication is fine, but this does not answer the client's question. There are differences between some generic and brand name drugs, but this is not the best answer. The nurse should not have to check the drug; basic knowledge should include knowing that the sex of clients can result in different side effects.
The physician has ordered ipratropium (Atrovent) for the client. What is a priority assessment question for the nurse to ask prior to administering this medication? 1. "Are you allergic to soy? 2. "Do you have diabetes mellitus?" 3. "Do you have seizures?" 4. "Do you have gout?
Correct Answer: 1 Rationale 1: Ipratropium (Atrovent) is contraindicated in patients with hypersensitivity to soy as soya lecithin is used as a propellant in the inhaler. Rationale 2: Anticholinergic drugs do not impact glucose levels, so having diabetes mellitus is not a concern. Rationale 3: Anticholinergic drugs do not affect seizure disorders; this is not a concern. Rationale 4: Anticholinergic drugs are not contraindicated in clients with gout.
A client receives theophylline (Theo-Dur) and calls the clinic to say he has had nausea and vomiting for 2 days. What is the best action by the nurse? 1. Tell the client to come to the clinic for an assessment. 2. Ask the client if he has eaten at any unclean restaurants. 3. Ask the client if he has been exposed to anyone with the flu. 4. Recommend that the client begin a clear liquid diet
Correct Answer: 1 Rationale 1: Nausea and vomiting are symptoms of theophylline toxicity; the client needs to come to the clinic for an assessment. Rationale 2: Food poisoning could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity. Rationale 3: Flu could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity. Rationale 4: A clear-liquid diet might help, but the client needs to be assessed for theophylline toxicity.
The client receives albuterol (Proventil) via inhaler. He asks the nurse why he can't just take a pill. What is the best response by the nurse? 1. "When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects." 2. "Because pills cannot help your illness; you must have inhaled medications for relief of symptoms." 3. "Because pills would produce too many side effects; you will have very few side effects with inhaled medications." 4. "Because this medication cannot be absorbed from your GI tract; the acid in your stomach would destroy it."
Correct Answer: 1 Rationale 1: The respiratory system offers a rapid and efficient mechanism for delivering drugs. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances. Rationale 2: Albuterol (Proventil) can be given orally (PO) but has a faster onset of action if inhaled. Rationale 3: Inhaled medications also produce side effects. Rationale 4: Oral medications are effective with some symptoms of respiratory disorders, but inhaled medications work faster.
The client is receiving a brand name drug and wants to change to the generic form because it is cheaper. What is the best outcome for this client? 1. Client will state two ways a brand name drug differs from a generic name drug. 2. Client will take the brand name drug after speaking with the physician. 3. Client will ask the nurse why brand name drugs are better than generic drugs. 4. Client will state two ways to obtain the medication at a reduced cost.
Correct Answer: 1 The dosage of drugs may be the same with a brand name and generic drug, but the bioavailability may be affected by the inert ingredients and tablet compression. Knowing ways to obtain medication at a reduced cost is an appropriate outcome, but the client will not learn why a brand name drug may be preferable over a generic drug. Referring the client to the physician is inappropriate because the nurse can educate the client about the difference between generic and brand name drugs. The client asking the nurse a question is not an outcome.
The nurse suspects that the patient has not been taking his prescribed antihypertensive medication because the patient's blood pressure remains elevated. What is the best therapeutic question the nurse can ask that will assess noncompliance? 1. "Taking medication is difficult for many people. What are some of your concerns about the medication?" 2. "Your blood pressure is really high; do you realize the serious consequences of not taking your medication?" 3. "I really doubt that you are taking your medication. What would you think about talking to the doctor?" 4. "You are one of my favorite patients and I want you to be safe. Are you really taking your medication?"
Correct Answer: 1 The most therapeutic question informs the patient that compliance is difficult for many people, and does not directly challenge the patient about not taking the medication. Telling the patient that the nurse doubts he is taking the medication directly challenges him, and recommending that he see the physician is threatening. Telling the patient his blood pressure is high and there are serious consequences is using the "scare tactic," and is non-therapeutic; the patient most likely is aware of the consequences. Telling the patient that he is a favorite is manipulating.
The patient is receiving a sustained-release capsule for his cardiac condition. The patient tells the nurse there is no way he can swallow such a large pill. What is the best response by the nurse? 1. "Withhold the medication and contact the physician." 2. "Place the capsule on the back of the patient's tongue, and have him drink a full glass of water." 3. "Open the capsule and sprinkle the contents over applesauce." 4. "Encourage the patient to try and swallow the capsule because it is the best medication for his heart condition."
Correct Answer: 1 The only option is to contact the physician. Several sustained-release medications cannot be opened and sprinkled on food. Placing the capsule on the back of the patient's tongue and having him drink a full glass of water may cause the patient to aspirate the capsule and/or the water. Encouraging the patient to try to swallow the capsule is coercive, and may result in the patient choking on the medication.
Which type of classification system is being used when drugs are grouped together because they help treat a particular disease or condition? 1. Therapeutic 2. Mechanism of action 3. Chemical 4. Pharmacological
Correct Answer: 1 Therapeutic classification is based on the drug's usefulness in treating a particular disease. Pharmacological classification addresses a drug's mechanism of action. (p. 5)
Placement of a tablet between the cheek and gum would be which route? 1. Buccal 2. Oral 3. Transdermal 4. Sublingual
Correct Answer: 1 This is the term used to describe a medication placed between the cheek and gum.
Which statement is true regarding asthma? 1. It has both inflammatory and bronchoconstriction components. 2. Asthma is caused by a virus. 3. Asthma cannot be treated. 4. Symptoms most often occur with rest
Correct Answer: 1 Rationale 1: Asthma has an inflammatory and a bronchoconstriction component. Rationale 2: Asthma is not caused by a virus, although a virus can be a trigger. Rationale 3: Asthma can be treated by several drug classes. Rationale 4: Symptoms occur with exposure to triggers or exertion.
The nurse is participating in the New Drug Review step for a new therapeutic agent. Which activities will the nurse most likely perform during this phase of the drug approval process? Select all that apply. 1. Attend meetings to finalize the brand name for the drug. 2. Check on the results of animal testing. 3. Survey for harmful effects in a larger population. 4. Evaluate the results of the drug on cultured cells. 5. Provide the medication to large groups of people with a particular disease.
Correct Answer: 1, 2 1: During the NDA or the third stage of the drug approval process the drug's brand name is finalized. 2: During the NDA stage of the drug approval process animal testing may continue. 3: Surveying for harmful effects in a larger population occurs during the postmarketing surveillance step of the drug approval process. 4: Evaluation of the results of the drug on cultured cells occurs during the preclinical investigation step of the drug approval process. 5: Providing the medication to large groups of people with a particular disease occurs during the clinical phase trials which is in the second stage of the drug approval process.
While reading a medication package inserts the nurse notes the information contained within the "black box." What is the significance of this information to the nurse? Select all that apply. 1. The drug can cause "special problems." 2. It identifies extreme adverse drug reactions. 3. It differentiates a prescribed medication from an over-the-counter medication. 4. It highlights the cost of the medication. 5. It signifies the medication is generic.
Correct Answer: 1, 2 1: The FDA created boxed warnings in order to regulate drugs with "special problems." 2: The black box warning is a primary alert for identifying extreme adverse drug reactions.
The nursing instructor is teaching a pharmacology class to student nurses. The current focus is pharmacology and therapeutics. The nursing instructor determines that learning has occurred when the students make which comments? Select all that apply. 1. "Pharmacology is the use of drugs to relieve suffering." 2. "Pharmacology is the study of medicines." 3. "Therapeutics is the study of the therapeutic use of drugs." 4. "Therapeutics is the study of drug interactions." 5. "Pharmacology is the study of drugs to prevent disease."
Correct Answer: 1, 2 Pharmacology is the study of medicines and the use of drugs to relieve suffering. Therapeutics is the study of disease prevention and treatment of suffering. Pharmacotherapy is the application of drugs for the purpose of disease prevention.
The nurse is categorizing a client's list of medications completing a health history. Which agents would be categorized as complementary and alternative medicine? Select all that apply. 1. Garlic 2. Vitamin C 3. Zinc 4. Aspirin 5. Benadryl
Correct Answer: 1, 2, 3 1: Garlic is considered an herb, which is considered complementary and alternative medicine therapy. 2: Vitamins are considered complementary and alternative medicine therapy. 3: Zinc is a mineral and is considered complementary and alternative medicine therapy. 4: Aspirin is an over-the-counter medication. 5: Benadryl is an over-the-counter medication.
Which statements regarding the preclinical research stage of drug development are true? Select all that apply. 1. Most drugs do not proceed past the preclinical stage because they are found to be too toxic or just ineffective. 2. At the end of the preclinical research stage, client variability is determined and potential drug-to-drug interactions are examined. 3. The preclinical stage of research involves extensive testing on animals in the laboratory to determine if the drug will cause harm to humans. 4. Preclinical research results are always inconclusive. 5. The Food and Drug Administration (FDA) is responsible for extensive testing for safety before the pharmaceutical company can begin the preclinical research stage of development.
Correct Answer: 1, 3, 4 1: Most drugs do not proceed past the preclinical research stage of development because they are found to be either too toxic or just ineffective. 2: Client variability and potential drug-to-drug interactions are examined in Phase 3 of the clinical investigation process after Food and Drug Administration (FDA) approval. 3: The preclinical stage involves extensive testing on human, microbial cells, and animals to determine drug action and to predict whether the drug will cause harm to humans. 4: Because lab tests cannot accurately predict human response to a drug, these results are always inconclusive. 5: This extensive testing is done by the pharmaceutical company in the preclinical research stage of drug development, not the FDA.
Which statements regarding the role of the U.S. Food and Drug Administration (FDA) are true? Select all that apply. 1. The FDA is responsible for ensuring the security of human drugs. 2. The FDA publishes a summary of the standards of drug purity and strength. 3. The FDA ensures the availability of effective drugs. 4. The FDA takes action against any supplement that is deemed to be unsafe. 5. The FDA facilitates the availability of safe drugs.
Correct Answer: 1, 3, 4,5 1: The FDA mission is to protect public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biologic products, medical devices, the nation's food supply, cosmetics, and products that emit radiation. 2: It is the role of the U.S. Pharmacopeia (USP) to publish a summary of drug standards (purity and strength). 3: Ensuring the availability of effective drugs is one of the FDA's roles. 4: It is the FDA's role to take action against any supplement that is deemed to be unsafe. 5: It is the role of the FDA to facilitate the availability of safe drugs.
A client says to the admitting nurse, "Why do you need to know the names of all the over-the-counter supplements I take? They aren't drugs." Which of the nurse's responses are appropriate? Select all that apply. 1. "The admitting physician needs to know everything you are taking." 2. "You're right. I'm not sure why the admitting paperwork asks for this information. Would you mind listing them anyway?" 3. "The law requires us to keep a list of over-the-counter drugs and supplements that you are taking." 4. "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs." 5. "We need to know if you are having an allergic reaction to one of them."
Correct Answer: 1, 4 1. "The admitting physician needs to know everything you are taking." 4. "It is true that supplements are not considered drugs; however, some of these products can cause adverse effects with prescribed drugs."
Chemical names are assigned for each drug. What are the major reasons that nursing usually does not use the chemical name of the drugs? Select all that apply. 1. They are usually not brief or easy to remember. 2. They are often difficult to pronounce. 3. There is no standard for assigning names. 4. They do not explain the nature of the drug. 5. There is only one chemical name for each drug.
Correct Answer: 1,2 Chemical names are usually not brief or easy to remember. Chemical names are often difficult to pronounce. While it is true each drug has only one chemical name, this is not one of the reasons nurses do not use the chemical name.
A client tells the nurse that the health care provider has prescribed a new medication that ìhas just come on the market.î The nurse has not heard of this particular medication but is able to give the client important information based on its prototype drug because of which principles? Select all that apply. 1. Knowing the prototype drug allows the nurse to predict the mechanism of action of the new medication. 2. The information regarding the prototype drug can be extended to any drug in the same class. 3. The prototype drug is the drug to which all drugs in a class are compared. 4. Knowing the prototype drug's therapeutic or pharmacologic classification can reveal important information about other drugs in the same class. 5. This is a new drug on the market. It may not have a prototype drug yet and its properties cannot be predicted.
Correct Answer: 1,2 Knowledge about the prototype drug can help the nurse predict important information such as actions, side effects, mechanism of action, and contraindications for other drugs in the same class.
The nurse is providing disease management education for a patient who has just been diagnosed with asthma. The nurse provides which information? (Select all that apply.) 1. Drink additional fluids. 2. Eat small, frequent meals. 3. Sleep in a warm room. 4. Do all activity early in the morning and rest in the afternoon. 5. Avoid foods high in protein
Correct Answer: 1,2 Rationale 1: Drinking sufficient fluids will help to liquefy and mobilize mucus. Rationale 2: Small, frequent meals of calorie and nutrient dense foods help to prevent fatigue and maintain nutrition. Rationale 3: Cooler room temperatures make breathing easier. Rationale 4: Activities and rest should be alternated and balanced. Rationale 5: There is no need to avoid foods high in protein.
A client is admitted to the emergency department with high blood pressure. The health care provider orders a diuretic and tells the client this medication will lower the blood pressure by decreasing intravascular fluid volume. What does this description address? Select all that apply. 1. The drug's mechanism of action 2. The drug's pharmacologic classification 3. How the drug produces its effects in the body 4. The drug's therapeutic classification 5. What condition is being treated by the drug
Correct Answer: 1,2,3 Mechanism of action describes how a drug produces its effects in the body. in this case, how it lowers blood pressure.
A client who is admitted to the intensive care unit for monitoring notices the arthritis medication does not look like the one used at home and asks the nurse why. What is the nurseís best response? Select all that apply. 1. "This is a different brand from the one you use at home, but it will give you the same pain relief." 2. "Your health care provider feels we can safely substitute this drug for the drug you use at home." 3. "This generic drug is the one we have on formulary in the pharmacy. It has the same ingredients as the one you use at home." 4. "This is what we have in the pharmacy. Go ahead and take it for now and let me know if it doesn't relieve the pain." 5. "The medications in the hospital often do not look like the ones you get from the pharmacy."
Correct Answer: 1,2,3 Most brand-name drugs can be safely substituted with generic drugs. The exceptions to this rule are critical care drugs and drugs with a narrow margin of safety.
The nurse is caring for a patient who has been involved in a motor vehicle crash. The health care provider has written orders for a transdermal patch for pain to be applied for steady pain control. The nurse knows that Select all that apply. 1. the transdermal patch should not be applied to areas of abrasion. 2. transdermal medications undergo the first-pass effect in the liver. 3. transdermal medications completely bypass digestive enzymes. 4. the actual dose received by the patient from this pain patch may vary. 5. transdermal patches are not considered an effective means of delivering medications because the rate of delivery and actual dose can vary.
Correct Answer: 1,3,4 1: Applying transdermal patches to skin that has abrasions may unintentionally increase the dose of the medication. 2: Transdermal medications avoid the first-pass effect. 3: Transdermal medications never come into contact with digestive enzymes but go straight into the bloodstream. 4: While transdermal patches do contain a specific amount of medication, the rate of delivery may vary for each patient. 5: It is true that the rate of delivery and actual dose received can vary, but this route is an effective means of delivering many medications such as birth control medications and nitroglycerin for angina.
A patient admitted to the hospital tells the nurse she is very nervous about getting all her medications while she is in the hospital because her health care provider has her on a very "strict" schedule. Which principles describe how medication dosing schedules are determined? Select all that apply. 1. The physical and biologic characteristics of a drug may determine dosing schedule. 2. Specific times may improve effectiveness and decrease risk of adverse effects. 3. Some drugs must be taken a certain time prior to an event or immediately after an event. 4. Dosing may be set for the convenience of patient and nurse. 5. Hospitals have routine dosing intervals so that all patients receive medications at the same time each day.
Correct Answer: 1,2,3,4 1: The properties of a medication will determine how often it must be given to keep the drug at a therapeutic level in the body. 2: Some medications are administered at certain times of day to improve effectiveness or decrease adverse effects. 3: Some medications are taken to prevent or to cause an effect. For example, insulin should be given 30 minutes prior to eating to promote glucose usage. 4: If the drug does not have a characteristic that relies on a certain event to take place, then the drug can be given at the convenience of patient and/or nurse. 5: While most hospitals do have specific times of day (agency protocol) when medications are administered, this is not a principle that determines any specific dosing schedule.
The nurse is preparing medications prior to administration. To promote patient safety, the nurse uses "rights" of drug administration. What do these "rights" include? Select all that apply. 1. The right medication 2. The right time of delivery 3. The right dose 4. The right route of administration 5. The right patient
Correct Answer: 1,2,3,4,5 The five rights of drug administration are the right patient, the right medication, the right dose, the right route of administration, and the right time of delivery.
The nurse has finished teaching a patient's husband how to administer drugs and enteral feeding through a gastrostomy tube. The nurse knows the husband understands the use of the tube when he makes which statement? Select all that apply. 1. "My wife has a gastrostomy tube instead of a nasogastric tube because she will have the tube for a long time." 2. "I will need to use liquid medications. If any of the medications are in pill form, I will use the pill crusher to crush them and mix them with water before putting them in the tube." 3. "This medication says it is enteric coated. I'm not supposed to crush this kind of medication. I will need to ask the doctor to substitute another medication that is liquid or can be crushed." 4. "There's a big difference in how the drugs work in the body when they're taken orally and when they're administered through the tube. That's why my wife has to have this tube." 5. "I have to be very careful to flush the tube after I put medication in it. If I don't, the tube could get clogged."
Correct Answer: 1,2,3,5 4: Drugs administered via gastrostomy tube are affected by the same physiological processes as those given orally.
An 8-year-old child was just diagnosed with asthma. Which assessment questions should the nurse ask the child and parents? Select all that apply. 1. "Have you eaten any new foods?" 2. "Are you exposed to anyone who smokes?" 3. "Have you had your carpet cleaned lately?" 4. "Have you grown taller since last year?" 5. "Has there been a change in laundry products recently?
Correct Answer: 1,2,3,5 Rationale 1: Recent diet changes should be investigated as a potential source of asthma. Rationale 2: Cigarette smoke can trigger asthma. Rationale 3: Recent carpet cleaning may release substances that trigger asthma. Rationale 4: Growth rate would not likely be affected in the last year for a client with newly diagnosed asthma. Weight would be more likely to be affected than height. Rationale 5: Changes in household chemicals may be related to the onset of asthma.
The nurse has provided medication education to a patient who was just diagnosed with asthma. The nurse would evaluate that additional teaching is necessary when the patient makes which statement? (Select all that apply.) 1. "My albuterol inhaler should be taken routinely to prevent asthma attacks." 2. "I should plan to take my corticosteroid for the rest of my life." 3. "My cromolyn inhaler (Intal) will help me prevent asthma attacks." 4. "I'll use my montelukast (Singulair) inhaler every day." 5. "My therapy will include both oral and inhaled drugs."
Correct Answer: 1,2,4 Rationale 1: Albuterol inhalers are used as rescue medications. Rationale 2: Corticosteroids are short-term drugs. Rationale 3: Cromolyn (Intal) is a mast cell stabilizer and will help prevent asthma attacks. Rationale 4: Montelukast (Singulair) is an oral drug. Rationale 5: Therapy will include both oral and inhaled drugs.
A nurse works in a clinic that sees both children and adults with asthma. Which assessments will the nurse routinely monitor on patients taking corticosteroids? (Select all that apply.) 1. Height measurement in children 2. Bone density test results in adults 3. IQ measurements in both adults and children 4. Weight measurements in children 5. EKGs on adults
Correct Answer: 1,2,4 Rationale 1: Corticosteroids can affect growth in children. Rationale 2: Corticosteroids can affect bone density in adults. Rationale 3: Corticosteroids do not affect IQ. Rationale 4: Corticosteroids can affect growth in children. Rationale 5: Corticosteroids do not affect EKG readings.
A patient presents to the emergency department with exacerbation of asthma that occurred while eating breakfast at a local buffet. The nurse would ask which assessment questions? (Select all that apply.) 1. "Did you eat bacon or sausage?" 2. "Did you have any dairy products?" 3. "Did you drink orange juice?" 4. "Did you have pastries with nuts?" 5. "Did you drink coffee?
Correct Answer: 1,2,4 Rationale 1: The nitrates in processed foods may trigger asthma. Rationale 2: Some people with asthma react to dairy products. Rationale 3: Orange juice is not a known trigger for asthma. Rationale 4: Nuts may trigger asthma in some people. Rationale 5: Coffee is not a known trigger for asthma.
A client diagnosed with COPD says, "I don't see why I need to stop smoking. The damage to my lungs is already done." How should the nurse respond to this statement? Select all that apply. 1. "If you stop smoking now, your COPD may not get worse as fast." 2. "If you stop smoking, your lungs will get better pretty quickly." 3. "Your symptoms might not be as bad if you aren't smoking." 4. "You are probably correct, but you should at least try." 5. "If I were you, I would enjoy what time I have left."
Correct Answer: 1,3 Rationale 1: Smoking cessation has been shown to slow the progression of COPD. Rationale 2: Depending on the extent of damage, the client's lungs may not get better at all, but may just stop getting worse. Rationale 3: Smoking cessation has been shown to result in fewer respiratory symptoms. Rationale 4: It is not therapeutic to tell the client that he is correct with this statement. Rationale 5: The nurse should encourage the client to stop smoking.
The client receives beclomethasone (Beconase). What will the best assessment by the nurse include? Select all that apply. 1. Assess the client's mouth for any sign of fungal infection. 2. Assess the client's blood glucose prior to administration of nasal spray. 3. Assess if the client has blown his nose prior to administration of nasal spray. 4. Assess if the client has had a change in taste. 5. Assess the client for any hoarseness or change in voice
Correct Answer: 1,3,4,5 Rationale 1: Clients may develop candidiasis so the mouth should be assessed. Rationale 2: There is no need to assess the client's blood glucose. Rationale 3: The client should gently blow the nose prior to use to clear the nasal passages. Rationale 4: Clients may experience a change in taste. Rationale 5: Clients may experience a change in voice as a local effect.
A nurse is explaining the process of respiration to a client. Which information should be given? Select all that apply. 1. "Moving air in and out of the lungs is really called ventilation." 2. The smooth muscle in the alveoli helps to pull air into the lungs. 3. Exchange of oxygen and carbon dioxide occurs across a thin capillary membrane. 4. Respiration is not effective without perfusion. 5. Your basic respiratory drive is determined by your brain.
Correct Answer: 1,3,4,5 Rationale 1: Ventilation is the process of moving air into and out of the lungs. Rationale 2: There is no smooth muscle in the alveoli. Rationale 3: The blood stays in capillaries. A thin membrane separates airway from capillary. Rationale 4: Perfusion is the blood flow through the lungs. Without this blood flow, the oxygen-carbon dioxide exchange does not take place. Rationale 5: The rate is determined by neurons in the brainstem and can be affected by a number of factors.
Which patients should the nurse be concerned about regarding nonadherence to prescribed medication regimens? Select all that apply. 1. A 70-year-old hypertensive male patient who has a prescription for a diuretic and is complaining that his medication is keeping him up all night 2. A 30-year-old college student who has a prescription for birth control pills and tells the nurse she has had breakthrough bleeding this past cycle 3. A 45-year-old diabetic who has a prescription for insulin and whose blood sugar is within the normal range 4. A 57-year-old day laborer who has a prescription for Lipitor for high cholesterol and a prescription card for a free health clinic 5. An 18-year-old male with a prescription for an acne medication that must be taken 4 times a day
Correct Answer: 1,5 1.This patient has been taking his diuretic in the evening instead of in the morning and is most likely experiencing increased urination at night that is disrupting his sleep. Adverse side effects are common causes for nonadherence. 2.Birth control pills often cause midcycle bleeding. This does not raise any red flags for nonadherence. 3.One of the most common reasons for nonadherence is forgetting a dose, particularly with drugs that must be taken more than twice a day.
The client has skin lesions that have not responded to prescription drugs. He tells the nurse he has heard about some research going on with a new drug and questions why he can't take it. What is the best response by the nurse? 1. "I know it is frustrating, but the Food and Drug Administration (FDA) approval process is in place to ensure that drugs are safe." 2. "The Food and Drug Administration (FDA) has very strict rules about new drugs; it is important to be patient regarding the review/approval process." 3. "Your skin lesions really aren't that bad, but maybe the new drug will be available soon." 4. "Maybe you could contact the drug company about becoming involved in a clinical trial."
Correct Answer: 1. Although the public is anxious to receive new drugs, the fundamental priority of the Food and Drug Administration (FDA) is to ensure that drugs are safe. Also, telling the client that the nurse knows he is frustrated is therapeutic because it communicates that the nurse recognizes what he is feeling. The client could contact the drug company, but this response fosters false hope as he may not be a viable candidate for this drug. Telling the client his skin lesions "aren't that bad" is a non-therapeutic response; the client's perception is his reality. Telling the client to be patient is a condescending response; the client wants relief from the skin condition.
What percentage of Americans takes at least one prescription drug per year? 1. 50% 2. 10% 3. 40% 4. 25%
Correct Answer: 1. 50%
The student nurse has completed an initial pharmacology course and tells the nursing instructor that it was difficult and she is glad it is over. What is the best response by the nursing instructor? 1. "It may be over, but now you must apply what you have learned to patient care." 2. "Learning is gradual and continuous; we never completely master all areas of pharmacology." 3. "Learning is always painful, but we must continue anyway." 4. "It really isn't over; you should take a graduate course next."
Correct Answer: 2 Learning pharmacology is a gradual, continuous process that does not end with graduation. Never does one completely master every facet of drug action and application. There is no reason for the student nurse to take a graduate level pharmacology course at this time. It is true that the student must apply what has been learned to patient care, but this response implies that learning is over. Learning is not always painful.
The physician prescribes an oral medication for the patient. What is the primary nursing assessment of the patient prior to receiving this medication? 1. The patient's understanding of the medication 2. The patient's ability to swallow 3. The patient's allergies 4. The patient's eyesight
Correct Answer: 2 The ability of the patient to swallow is a safety issue to prevent aspiration of the medication. The patient's understanding is important, but not a priority. The patient's eyesight is not significant. The patient's allergies are important, but if the patient cannot swallow the medication, then the allergies are not significant.
The nurse plans to administer heparin by drawing the heparin up in an appropriate syringe, donning gloves, prepping the patient's abdominal area, injecting the needle, aspirating for blood, and injecting the medication. Which statement best describes the nurse's plan? 1. The nurse does not need to wear gloves. 2. The nurse should not aspirate for blood. 3. The nurse does not need to prep the skin. 4. The nurse performed the injection correctly.
Correct Answer: 2 When performing heparin injections, the nurse should not aspirate for blood as this may cause bruising or bleeding. Gloves must always be worn for invasive techniques. The nurse did not perform the correct technique. The skin should be prepped with alcohol prior to administering an injection.
Which of the following statements about benzocaine is true? A. When applied to the ear, mouth, or throat, it produces minor irritation B. It is more appropriate for sunburn than for pruritus or insect bites C. Drug sensitivity is rare D. It should not be applied to an open wound
D. It should not be applied to an open wound
The nurse is providing medication education to a client with hypertension. The nurse teaches the client that the physician ordered a diuretic to decrease the amount of fluid in his body. Which statement best describes the nurse's instruction? 1. The nurse provided appropriate medication education. 2. The nurse explained the drug's mechanism of action. 3. The nurse taught the client about a prototype drug. 4. The nurse explained the consequences of not using the drug.
Correct Answer: 2 A drug's mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. The nurse is not teaching the client about a prototype drug. The education was most likely appropriate, but this response is too vague.
The client is receiving a very expensive medication. The client asks the nurse why the medicine is so expensive. What is the best response by the nurse? 1. "It is expensive, but your insurance covers it and you have a low co-pay." 2. "Drug companies are allowed to advertise medications and this adds to the cost." 3. "Drug companies must recoup the cost of developing and producing the drug." 4. "I think the drug companies should be more accountable for lowering costs."
Correct Answer: 2 Advertising by drug companies costs several billion dollars a year and this adds to the cost of the drug. Telling the client that drug companies must be allowed to recoup the cost implies that the nurse is defending the drug companies. Telling the client that his insurance covers the drug doesn't answer his question. It is non-therapeutic for the nurse to introduce her own beliefs, such as accountability of drug companies, into a conversation with the client.
The nurse uses the nursing process prior to administering any medications. Which step will assure the best patient safety? 1. Assess the patient's developmental level. 2. Assess the patient's medical history. 3. Assess the patient's disease process. 4. Assess the patient's learning needs.
Correct Answer: 2 An assessment of the patient's medical history, which includes allergies, is the most important assessment prior to administering medications. Assessing the patient's learning needs is important for medication education, but not for safely administering medications. Assessing the patient's developmental level is important for medication education, but not for safely administering medications. Assessing the patient's disease process is important in evaluating the effects of the medications, but not for safely administering medications.
The client says to the nurse, "My doctor said my drug is a controlled substance; am I considered an addict?" What is the best response by the nurse? 1. "Are you concerned about becoming an addict? We can discuss this in more detail it you would like to." 2. "You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of drugs with a high potential for abuse." 3. "Why do you ask about becoming an addict? Not many of our clients have asked this question." 4. "You are not an addict, but the Drug Enforcement Administration (DEA) will monitor you for this."
Correct Answer: 2 Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. "Why" questions are considered non-therapeutic because they put the client on the defensive.
While in the hospital, the pediatric patient has been receiving amoxicillin 10 mL orally bid, pc. The child will be going home on this medication. What is the best instruction by the nurse for the parents? 1. Give 2 teaspoons by mouth, 3 times a day, on an empty stomach. 2. Give 2 teaspoons by mouth, twice a day, after meals. 3. Give 2 teaspoons by mouth, 3 times a day, after meals. 4. Give 2 teaspoons by mouth, twice a day, with meals.
Correct Answer: 2 Giving 2 teaspoons by mouth, twice a day, after meals is correct.
The nurse is preparing to administer beclomethasone (Beconase) to several clients. For which client would the nurse hold the drug and contact the physician? 1. The client who has had a myocardial infarction (MI) 2. The client who has methicillin resistant Staphylococcus aureus (MRSA) 3. The client who has diabetes mellitus 4. The client who has terminal cancer
Correct Answer: 2 Rationale 1: Beclomethasone (Beconase) is not contraindicated in clients who have had a myocardial infarction. Rationale 2: Glucocorticoids can mask the signs of infection and are contraindicated if active infection is present. Rationale 3: Beclomethasone (Beconase) is not contraindicated in clients who have diabetes mellitus. Rationale 4: Beclomethasone (Beconase) is not contraindicated in clients who have terminal cancer.
The client asks the nurse why she must continue taking her asthma medication even though she has not had an asthma attack in several months. What is the best response by the nurse? 1. "The medication needs to be taken indefinitely according to your doctor, so you should discuss this with him." 2. "The medication is still needed to decrease inflammation in your airways and help prevent an attack." 3. "The medication needs to be taken or your lungs will be severely damaged, and we will not be able to stop an acute attack." 4. "The medication needs to be taken for at least a year; then, if you have not had an acute attack, you can stop it.
Correct Answer: 2 Rationale 1: The nurse is able to answer the client's question; it does not need to be referred to the physician. Rationale 2: Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. Rationale 3: Telling a client that his or her lungs will be severely damaged is non-therapeutic; the inability to prevent an acute attack in this client is not true. Rationale 4: Long-term treatment of asthma continues indefinitely, not for just 1 year.
The patient is 3 days postop, and the physician orders an oral pain medication. The patient asks the nurse if it wouldn't be better to get the medication in the intravenous (IV) line. What is the best response by the nurse? 1. "No, because you could not medicate yourself intravenously (IV) at home." 2. "No, because pills are more effective than intravenous (IV) medications." 3. "No, because pills are safer than intravenous (IV) medications." 4. "No, because we are going to take your intravenous (IV) line out."
Correct Answer: 3 Oral medications are safer than intravenous (IV) medications. Telling the patient that she cannot have the medication intravenously because the intravenous line is to be removed does not answer the patient's question. There is no evidence that the patient will be going home with an intravenous line, so this answer is incorrect. Oral medications are not more effective than IV medications.
The client is receiving methadone (Dolophine), a Schedule II drug. The client says to the nurse, "A pharmacist told me his pharmacy must register with the Drug Enforcement Administration (DEA) to give me this drug; will DEA agents be snooping around my house?" What is the best response by the nurse? 1. "It is probably unlikely that Drug Enforcement Administration (DEA) agents will be bothering you." 2. "No, the Drug Enforcement Administration (DEA) restricts drugs that have a high potential for abuse." 3. "No. I think our system should be more like Europe; they have fewer controlled drugs." 4. "That's an interesting question. Are you worried about the Drug Enforcement Administration (DEA)?"
Correct Answer: 2 The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will "probably" not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe's, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree.
The nursing instructor teaches the student nurses about the pharmacological classification of drugs. The instructor evaluates that learning has occurred when the students make which response? 1. "An anti-anginal treats angina." 2. "A calcium channel blocker blocks heart calcium channels." 3. "An antihypertensive lowers blood pressure." 4. "An anticoagulant influences blood clotting."
Correct Answer: 2 The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification.
Which of the following is accurate regarding medication administration via the intradermal route? 1. Injections should be limited to 1-2 milliliters. 2. Hairy sites should be avoided. 3. Usual administration sites include the upper and lower abdomen. 4. Medications should be injected into the epidermis skin layer.
Correct Answer: 2 Usual sites of intradermal administration include nonhairy surfaces, including the forearm, upper chest, and scapulae. Intradermal injection involves administering small amounts (0.1-0.2 milliliters) of medication into the dermis layer of skin. (p. 32)
A patient who takes albuterol (Proventil) reports to the emergency department with reports of fatigue and palpitations. The nurse would closely assess which laboratory test? 1. Amylase 2. Electrolytes 3. Hemoglobin 4. Arterial blood gases
Correct Answer: 2 Rationale 1: Albuterol does not affect amylase. Rationale 2: Albuterol can cause hypokalemia. Potassium is an electrolyte. Rationale 3: Albuterol does not cause bleeding. Rationale 4: The patient may have ABGs drawn to check asthma status, but this test is not indicated by fatigue and palpitations.
The nurse is teaching a pharmacology class to student nurses. What does the nurse include as key events in the history of pharmacology? Select all that apply. 1. Initial drugs included morphine, cocaine, and penicillin. 2. Early researchers used themselves as test subjects. 3. The initial intention of pharmacology was to relieve human suffering. 4. Modern pharmacology began in the early 1600s. 5. Pharmacologists synthesized drugs in the laboratory in the twentieth century.
Correct Answer: 2, 3, 5 The early roots of pharmacology included the application of products to relieve human suffering, and early researchers used themselves as test subjects. Initial drugs included morphine, colchicines, curare, and cocaine, but not penicillin. Modern pharmacology began in the early 1800s, not the 1600s. By the twentieth century, pharmacologists could synthesize drugs in the laboratory.
A prototype drug is a single drug in a class and can be compared with all other medications in the class. The benefit of studying the prototype drug is that the nurse would be able to predict characteristics of other drugs in the same class, including Select all that apply. 1. which drugs have the most favorable safety profile. 2. their therapeutic indications. 3. their actions and adverse effects. 4. their specific clinical use. 5. contraindications specific to any drug in that group.
Correct Answer: 2,3,4 Studying the therapeutic indications of a prototype drug may allow the nurse to predict actions and adverse effects of other drugs in the same group & same class. Contraindications may differ for specific drugs in the same class as the prototype.
A patient has been referred to an allergist for allergy testing. Which parenteral routes would the nurse not expect to be used for the tests? Select all that apply. 1. The intradermal (ID) route 2. The subcutaneous route 3. The intramuscular (IM) route 4. The intravenous (IV) route 5. The buccal route
Correct Answer: 2,3,4,5 1: The ID route is used to administer very small volumes of a drug into the intradermal layer of skin. This route is most commonly used for allergy and TB skin testing. 2: The subcutaneous route is used to deliver medication into the deepest layer of skin. Drugs that are delivered by this route include insulin, heparin, and some vaccines. 3: The IM route is used to deliver medication deep into a muscle. Antibiotics, vitamins, and some vaccines are delivered by this route. 4: The IV route delivers medication directly into the bloodstream. Fluid replacement, antibiotics, blood products, and many other drugs can be delivered via this route. 5: Medications administered by the buccal route are intended to be absorbed. This is not a route used for allergy testing.
The physician has ordered several medications for the patient. What does the nurse recognize as responsibilities regarding administration of medications? Select all that apply. 1. Knowing whether or not the medication is on the hospital formulary 2. Knowing the reason the medication was prescribed for this patient 3. Knowing how the medication is to be administered. 4. Knowing how the medication is supplied by the pharmacy 5. Knowing the name of the medication
Correct Answer: 2,3,4,5 How the medication is supplied by the pharmacy, how the medication is to be administered, the name of the medication, and the reason the medication was prescribed for the patient are the responsibilities of the nurse regarding medication administration. Whether or not a drug is on a hospital formulary list is not a primary responsibility of the nurse.
A patient at a community health center has been prescribed oral medications and tells the nurse that medications were administered intravenously when the patient was in the hospital. The nurse discusses the benefits and disadvantages of oral medications, including which facts? Select all that apply. 1. The oral route is considered the second safest route, after the intradermal route. 2. Tablets that are scored may be crushed for easier swallowing. 3. Enteric-coated drugs are designed to dissolve in the stomach, not the small intestine. 4. A major disadvantage of oral medications is that the patient must be conscious and able to swallow. 5. Enteric-coated drugs should be crushed to help facilitate dissolving by the stomach acid.
Correct Answer: 2,4 1: The oral route is considered the safest because the skin barrier is not compromised; if an overdose occurs, drugs remaining in the stomach can be evacuated with stomach contents. 2: The purpose of scoring a tablet is the greater ease of cutting the tablet in half or quarters. These same tablets may be crushed, if needed. 3: Some drugs irritate the stomach lining and are coated to prevent being dissolved in the stomach. These drugs go on to the small intestine and are dissolved in the alkaline environment. 4: This is a major disadvantage of oral medications. 5: Enteric-coated drugs are designed specifically to bypass the stomach's acidic environment and continue to the alkaline environment of the small intestine.
Modern pharmacology was introduced to the United States by the opening of the first department of pharmacology at the University of Michigan in the year 1. 1805. 2. 1890. 3. 1847. 4. 1908.
Correct Answer: 2.
The application of drugs for the purpose of disease prevention and treatment of suffering is known as 1. biologics. 2. pharmacotherapeutics. 3. alternative therapies. 4. therapeutics.
Correct Answer: 2. Pharmacotherapeutics is the application of drugs for the purpose of disease prevention and the treatment of suffering.
A drug manufacturer that is performing the effects of a drug on laboratory animals would be in which phase of the new drug development timeline? 1. Clinical Investigation 2. Preclinical Investigation 3. New Drug Application Review 4. Postmarketing Studies
Correct Answer: 2. Preclinical investigation involves laboratory research on nonhuman subjects.
The nurse administers a vaccine to a child. What is the best understanding of the nurse as it relates to the manufacture of this vaccine? 1. The vaccine is produced by natural plant extracts in the laboratory. 2. The vaccine is naturally produced in animal cells or microorganisms. 3. The vaccine is produced by a combination of animal and plant products. 4. The vaccine is most commonly synthesized in a laboratory.
Correct Answer: 2. Vaccines are naturally produced in animal cells, microorganisms, or by the body itself. Vaccines are not synthesized in a laboratory. Vaccines are not produced by natural plant extracts. Vaccines are not produced by a combination of animal and plant products.
Advil, Motrin, and Nuprin are examples of 1. chemical names. 2. combination names. 3. trade names. 4. generic names.
Correct Answer: 3 Advil, Motrin, and Nuprin are trade names for ibuprofen. (p. 6)
The patient is having chest pain. The physician orders sublingual nitroglycerine STAT. The nurse obtains the medication from the pharmacy and administers it to the patient 30 minutes later. Which statement best describes the nurse's action? 1. The medication should have been administered immediately. 2. The physician should have specified the time frame for the medication. 3. The medication should have been administered within a 5-minute time frame. 4. The nursing action was correct because the medication was not on the unit.
Correct Answer: 3 For a STAT order, the time frame between writing the order and administering the drug should be 5 minutes or less. Not having a drug on the unit is not an excuse, as commonly ordered STAT medications should be kept in stock. Although the drug does not need to be administered immediately, it should be done within 5 minutes. It is not the physician's responsibility to specify the time frame.
The physician has prescribed a brand name drug for the client. The client tells the nurse that the medication is too expensive. What is the best plan by the nurse? 1. Help the client receive free medicine through a "patient assistance" program. 2. Ask the physician if a cheaper brand name drug may be substituted. 3. Ask the physician if a generic drug may be substituted. 4. Maintain the client on samples of the brand name drug from the physician's office.
Correct Answer: 3 Generic drugs are much less costly than brand name drugs. A patient assistance program is a good idea, but since the client may not qualify for this it is not the best plan. Another brand name drug may not be what the client needs for the illness. Providing samples is an option, but the office may temporarily run out of samples and the client will not receive the medication.
Which drug has the highest dependency potential? 1. Acetaminophen 2. Codeine 3. Heroin 4. Diazepam
Correct Answer: 3 Heroin is a Schedule I drug, and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed. (p. 17)
The student nurse is taking a pharmacology course and studying about the Food and Drug Administration (FDA). What has the student learned about how the FDA has decreased the amount of time involved in bringing a new drug to the market? 1. The Food and Drug Administration (FDA) is not as strict as it once was with regard to drug approval. 2. Since consumers have demanded more drugs, the Food and Drug Administration (FDA) has streamlined the review/approval process. 3. Drug manufacturers are required to pay yearly user fees, which allow the Food and Drug Administration (FDA) to hire more employees to increase its efficiency. 4. Drug manufacturers are required by the Food and Drug Administration (FDA) to test more drugs on an annual basis.
Correct Answer: 3 In 1992, the Prescription Drug User Fee Act was passed. This required drug manufacturers to provide yearly product user fees so the Food and Drug Administration (FDA) could restructure, hire more employees, and operate more efficiently. The Food and Drug Administration (FDA) is just as strict now as it always was with regard to drug approval. The Food and Drug Administration (FDA) has not streamlined the review/approval process. The Food and Drug Administration (FDA) does not require drug manufacturers to test more drugs on an annual basis.
The nurse administers an oral preparation of liquid Tylenol 650 mg as ordered. Afterward, the patient indicates he had been receiving Tylenol 650 mg in pill form. Which of the following is accurate in regards to the five rights? 1. The nurse failed to deliver the correct dose. 2. The nurse failed to administer the right medication. 3. The nurse did not violate the five rights. 4. The nurse failed to give the medication via the correct route.
Correct Answer: 3 Nothing in the question depicts a violation of the five rights.
The physician has prescribed cromolyn (Intal) for the client with asthma. The nurse plans to do medication education. What will the best plan by the nurse include? 1. This medication is indicated for acute asthma attacks. 2. This medication can affect blood glucose levels. 3. This medication will help prevent asthma attacks. 4. This medication can result in hypertension.
Correct Answer: 3 Rationale 1: Cromolyn (Intal) is ineffective for acute asthma attacks. Rationale 2: Cromolyn (Intal) does not affect blood glucose levels. Rationale 3: By reducing inflammation, cromolyn (Intal) is able to prevent asthma attacks. Rationale 4: Cromolyn (Intal) does not cause hypertension.
The client receives ipratropium (Atrovent). She tells the nurse she is going to stop it because of the bitter taste in her mouth after using the medication. What is the best response by the nurse? 1. "That is a good idea; you are experiencing a serious side effect." 2. "That is a common side effect; it will go away in time." 3. "You can decrease that side effect by rinsing your mouth after use." 4. "Are you sure you are using the medication properly?
Correct Answer: 3 Rationale 1: The client is not experiencing a serious side effect; there is no need to stop the medication. Rationale 2: The bitter taste will not go away in time; the client must rinse her mouth. Rationale 3: Ipratropium (Atrovent) produces a bitter taste, which may be relieved by rinsing the mouth after use. Rationale 4: Asking how the client uses the medication may be a good option but not with the common side effect of bitter taste
The physician ordered a brand name drug for the client, paroxetine (Paxil). After taking this medication for a year, the client tells the nurse that it is no longer working. What is the best assessment of the nurse at this time? 1. "This sounds like your medication needs changing." 2. "Let's look for interactions with other medications you are taking." 3. "Are you taking Paxil or paroxetine?" 4. "It is time for us to do the Beck Depression assessment again."
Correct Answer: 3 The bioavailability of a generic drug may not be the same as the bioavailability of a brand name drug. Assessing for worsening of depression is appropriate, but the nurse should first assess if the patient has changed to a generic form of the drug.
The physician ordered an intravenous medication for a patient with nausea. The patient asks the nurse how it will help his nausea. What is the best response by the nurse? 1. "We have more intravenous drugs for nausea than we do oral drugs." 2. "If you take an oral medication, you will just vomit it up." 3. "This will work much faster for your nausea." 4. "You can't have anything by mouth, so will receive the medication intravenously."
Correct Answer: 3 The intravenous route provides the quickest route of medication absorption. Telling the patient that he will vomit the medication is non-therapeutic. Telling the patient that the nurse has more intravenous drugs than oral drugs does not answer the patient's question. There is no evidence that the patient cannot have anything by mouth.
The physician orders enteric-coated aspirin, 300 mg every day, for the patient with a nasogastric tube. What is the priority action by the nurse? 1. Crush the tablet, dissolve it in 30 mL of water, and administer through the tube. 2. Put the tablet in the tube, "milk" it down the tube, and then flush the tube with 60 mL of water. 3. Withhold the medication and contact the physician. 4. Substitute plain aspirin, dissolve it in 30 mL of water, and administer through the tube.
Correct Answer: 3 The only option is to withhold the medication and contact the physician. Crushing the tablet destroys the enteric coating. Putting the tablet in the tube will result in clogging of the tube. The nurse cannot substitute plain aspirin; this requires a physician's order.
The physician ordered an oral medication. The nurse incorrectly administered the medication intravenously. What does the best analysis of the nurse's action reveal? 1. An antidote cannot be given. 2. The nurse will be terminated from her job. 3. The medication cannot be retrieved. 4. A lawsuit by the patient will be impending.
Correct Answer: 3 When a medication is given intravenously, its effects cannot be reversed because it is already in the bloodstream. A lawsuit may occur, but this is not the primary concern; patient safety is the primary concern. The nurse may be terminated, but patient safety is the main concern, and the effect of the medication cannot be reversed. Antidotes may be given, but this must be done very quickly.
Which condition is an adverse effect of a beta-adrenergic agonist? 1. Bradycardia 2. Constipation 3. Tachycardia 4. Runny nose
Correct Answer: 3 Rationale 1: Beta-adrenergic agonists cause tachycardia, not bradycardia. Rationale 2: Diarrhea can occur with some leukotrienes. Rationale 3: Tachycardia is common, along with restlessness. Rationale 4: Dry mucous membranes can occur
Which statement is true regarding dry powder inhalers (DPI)? 1. The medication is delivered by tablet orally. 2. The medication is delivered by fine mist. 3. The device is activated by inhalation. 4. The medication is applied topically.
Correct Answer: 3 Rationale 1: Inhalers are not oral tablets. Rationale 2: Nebulizers deliver medications in fine mist. Rationale 3: The client activates the device by inhaling. Rationale 4: Inhalers are not applied topically.
The nurse is teaching a medication class for parents of children with attention-deficit hyperactivity disorder who are receiving stimulant medications. The nurse has reviewed reasons why the medications are restricted. The nurse determines that learning has occurred when the parents make which response(s)? Select all that apply. 1. "The use of these medications is restricted so that the pharmacies can track the rate of drug abuse in our city." 2. "The use of these medications is restricted because the physician needs to evaluate our child more often." 3. "The use of these medications is restricted because they have the potential for abuse." 4. "The use of these medications is restricted so that the drug companies can make a bigger profit." 5. "The use of these medications is restricted because this is the current law."
Correct Answer: 3, 5 The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.
What drug is used as a local anesthetic and an antidysrhythmic? A. Warfarin (Coumadin) B. Propranolol (Inderal) C. Infliximab (Remicade) D. Lidocaine (Xylocaine)
D. Lidocaine (Xylocaine)
The physician orders a brand name drug for the client. The hospital formulary substitutes the generic equivalent of the brand name drug, and the nurse administers the generic drug. Which statement(s) best represents the nurse's action? Select all that apply. 1. The nurse should have contacted the physician prior to administering the drug. 2. The nurse should have called the pharmacist to see if the drugs were bioequivalent. 3. The nurse used good judgment in administering the drug. 4. The nurse was correct; hospital policies allow for this.
Correct Answer: 3,4 The nurse used good judgment as hospital policies allow for generic substitution of certain drugs. If there is a concern, the pharmacist should contact the physician. It is not feasible for the nurse to contact the physician every time there is a generic substitution. Physicians are aware of the hospital formulary.
A client has been prescribed a leukotriene modifier. Which assessment finding would cause the nurse to question this prescription? Select all that apply. 1. The client is 54 years old. 2. The client reports frequent foot cramps. 3. The client reports drinking two or three mixed alcohol drinks each day. 4. The client has chronic hepatitis C. 5. The client has a history of a CVA 2 years ago.
Correct Answer: 3,4 Rationale 1: The concern would be for persons over age 65, who may experience increased frequency of infections. Rationale 2: There is no reason to avoid giving this medication to a client who has foot cramps. Rationale 3: Chronic alcohol users may not tolerate these medications as they are extensively metabolized by the liver. Rationale 4: Significant hepatic dysfunction is a contraindication to this medication as it is extensively metabolized by the liver. Rationale 5: There is no contraindication for the use of this medication in a client with history of CVA.
The client receives ipratropium (Atrovent) via inhalation for the treatment of chronic asthma. The nurse plans to do medication education with the client. What will the best plan by the nurse include? Select all that apply. 1. Wait 15 minutes before using any other inhaled medications. 2. The medication may also be used for acute asthma attacks. 3. Report any increased dyspnea. 4. Report any changes in urinary pattern. 5. Use the medication consistently, not occasionally.
Correct Answer: 3,4,5 Rationale 1: It is only necessary to wait 2-3 minutes, not 15 minutes, between inhaled medications. Rationale 2: Anticholinergic drugs will not terminate an acute asthma attack, as peak effects may take 1 to 2 hours. Rationale 3: The client should be advised to report any symptoms of deteriorating respiratory status such as increased dyspnea. Rationale 4: Anticholinergic drugs can result in urinary retention, and the client should report any changes in urinary patterns. Rationale 5: To get the most benefit from ipratropium (Atrovent), it must be used consistently.
A client says, "My doctor told me that I have COPD and might develop emphysema. I always thought I had chronic bronchitis." How should the nurse respond to this statement? Select all that apply. 1. "Are you certain he didn't say you have asthma?" 2. "Chronic bronchitis doesn't have anything to do with COPD." 3. "COPD is either asthma, chronic bronchitis, or emphysema, or a combination of those disorders." 4. "As COPD progresses, it becomes emphysema." 5. "Both diagnoses are correct."
Correct Answer: 3,4,5 Rationale 1: There would be no reason to ask this question. It is logical that a client with chronic bronchitis would have a COPD diagnosis. Rationale 2: The three specific COPD conditions are asthma, chronic bronchitis, and emphysema. Rationale 3: The three specific COPD conditions are asthma, chronic bronchitis, and emphysema. Rationale 4: COPD is progressive, with the terminal stage being emphysema. Rationale 5: Chronic bronchitis is a form of COPD, so both diagnoses are plausible
A client who received a refill for a medication returns to the pharmacy and says, This medication is wrong! It doesnít look anything like my usual prescription.î Which response by the pharmacist would be most appropriate? Select all that apply. 1. "Your usual prescription drug is too expensive, so I substituted it with a generic one." 2. "There is no difference between this drug and the one you usually get." 3. "Our state allows me to substitute a generic drug when the prescription calls for a brand-name drug." 4. "Don't worry. Can you see that the generic ingredients are exactly the same?" 5. "This medication is a generic form of your other medication. That is why it looks different. But it has the same ingredients and should work the same way."
Correct Answer: 3,5 Some states allow the pharmacist to routinely substitute a generic drug for a brand-name drug. Other states prohibit this substitution and the pharmacist or client must request the substitution from the health care provider.
The nurse is teaching a class for clients about over-the-counter (OTC) medications. The nurse determines that education has been effective when the clients make which statement? 1. "We should not take any over-the-counter (OTC) medicine without first calling and checking with the doctor's office." 2. "We should always ask the pharmacist about how to take the over-the-counter (OTC) medicine." 3. "We must read all the directions on the label and call the doctor's office if they are not clear." 4. "Medicines that are available over-the-counter (OTC) are really safe, or they would be prescription medicines."
Correct Answer: 3. In most cases, clients may treat themselves safely if they carefully follow instructions included with the medication. It is not realistic to expect clients to call the doctor's office before taking any over-the-counter (OTC) medicine. Most OTC medicines have a high margin of safety, but none is considered completely safe. Asking the pharmacist is a good idea, but does not replace reading the label directions. Also, the pharmacist might not always be in the store when the medicine is purchased.
How many years does it generally take to research and develop a drug before it is submitted to the FDA for review? 1. 6 years 2. 5 years 3. 11 years 4. 9 years
Correct Answer: 3. PharmFacts (p.16)
A patient with chronic back pain informs the nurse he has been receiving therapeutic touch in addition to his medications. This type of therapy is best classified as 1. pharmacotherapy. 2. drug-absence therapy. 3. complementary therapy. 4. biologic therapy.
Correct Answer: 3. The patient is using a non-conventional type of treatment (therapeutic touch) that is classified as complimentary to his conventional pharmacotherapy. Biologic therapy involves the use of naturally produced substances by microorganisms or within the body. The patient is using medications as well as an alternative therapy which is why complementary therapy is the best choice.
Matching: Fluticasone (Flonase) A. Scabicide/pediculicide B. Sunburn/minor irritation drug C. Acne and acne-related drug D. Topical corticosteroid E. Psoriatic drug
D. Topical corticosteroid
During pharmacology class, the student nurse asks the nursing instructor how students will ever learn about the individual antibiotic drugs since there are so many. What is the best response by the nursing instructor? 1. "You will learn a little trick called mnemonics." 2. "You will learn how to do a flow chart to enhance memory." 3. "You will learn how to categorize the individual drugs." 4. "You will learn a representative drug from each class."
Correct Answer: 4 A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs.
The client comes to the emergency department with a myocardial infarction. The client's husband tells the nurse that his wife has been taking calcium carbonate (Tums) for years for what she thought was indigestion. What is the best response by the nurse? 1. "Your wife should not have self-diagnosed herself. I hope she will be okay." 2. "Why did you let her do that? She should have seen a doctor." 3. "Well, I am glad she is here, as it certainly wasn't indigestion." 4. "Your wife was self-diagnosing, which is generally not a good idea."
Correct Answer: 4 Clients take over-the-counter (OTC) drugs for many reasons. Self-treatment is sometimes ineffective, and the potential for harm may increase if the disease is allowed to progress. Asking the husband why he let his wife take Tums is non-therapeutic and too accusatory; do not ask "why" questions. Telling the husband that "it certainly wasn't indigestion" is judgmental and will alienate the client and husband. Telling the husband "I hope she will be okay" is a very frightening response that implies she might die, and this is non-therapeutic.
The nurse is employed by the Food and Drug Administration (FDA), and is involved in clinical investigation. What is the primary role of the nurse in this phase of the review and approval process by the FDA? 1. To perform tests on the population-at-large 2. To perform tests on various species of animals 3. To perform tests on human cells cultured in the laboratory 4. To perform tests on human clients
Correct Answer: 4 Clinical investigation includes performing tests on healthy volunteers, and later, on selected clients with a particular disease. Performing tests on human cells cultured in the laboratory is the preclinical investigation stage. Performing tests on the population-at-large is the stage of post-marketing surveillance. Performing tests on various species of animals is the preclinical investigation stage.
Five milliliters is equivalent to 1. 2 tablespoons. 2. 1 fluid ounce. 3. 15 drops. 4. 1 teaspoon.
Correct Answer: 4 Conversion from the metric system (p. 25)
An overwhelmed nursing student asks the instructor whether there are any tips that will make learning pharmacology easier. The instructor gives an example of the anticoagulant heparin. The instructor indicates that knowing heparin and comparing other drugs to it will facilitate learning the many anticoagulants. Which approach is the instructor using? 1. Mechanism of action approach 2. Generic name approach 3. Trade name approach 4. Prototype drug approach
Correct Answer: 4 Heparin is the generic name, but comparing one well-understood drug with others in the same class is known as the prototype approach. (p.6)
The student nurse asks the nursing instructor why he needs to take anatomy and physiology, as well as microbiology, when he only wants to learn about pharmacology. What is the best response by the instructor? 1. "Because pharmacology is an outgrowth of those subjects." 2. "You must learn all, since those subjects, as well as pharmacology, are part of the curriculum." 3. "Knowledge of all those subjects will prepare you to provide the best patient care, including the administration of medications." 4. "Because an understanding of those subjects is essential to understanding pharmacology."
Correct Answer: 4 It is essential for the nurse to have a broad knowledge base of many sciences in order to learn pharmacology. The nurse must learn anatomy, physiology, and microbiology to understand pharmacology, not because they are part of the curriculum. Pharmacology is an outgrowth of anatomy, physiology, and microbiology, but this is not the reason for the nurse to learn them. Knowledge of anatomy, physiology, and microbiology prepares the nurse to understand pharmacology, not to provide care such as administration of medications.
A patient who recently returned from surgery is experiencing nausea. Which statement best explains why this patient would benefit from IV medication administration? 1. The IV is already in place following the surgery. 2. IV medication administration should be avoided in patients with nausea. 3. Medications are more effective when given IV. 4. IV medications bypass the need for GI absorption.
Correct Answer: 4 Nauseated patients might find medications that need to be absorbed through the GI system irritating, worsening their nausea. The presence of an existing IV line is not a reason to administer medications through it. Some medications are more effective when given IV, but bypassing the need for GI absorption is the better answer.
What is the best plan as the nurse prepares to administer a topical medication? 1. Check the medication for interactions with other medications. 2. Take the patient's vital signs. 3. Educate the patient to not disturb the patch. 4. Assess the patient's skin where the medication will be applied.
Correct Answer: 4 Planning to assess the patient's skin is imperative; if it is cracked, dry, or irritated, the medication may not be properly absorbed. Patient education is important, but is not the priority. Vital signs are not always indicated; it depends on the medication. Checking for drug interactions is important, but it is not the priority.
The nurse teaches a medication class on bronchodilators for clients with asthma. The nurse evaluates that learning has occurred when the clients make which statement? 1. "The medication widens the airways because it decreases the production of mucus that narrows them." 2. "The medication widens the airways because it decreases the production of histamine that narrows them." 3. "The medication widens the airways because it acts on the parasympathetic nervous system." 4. "The medication widens the airways because it stimulates the fight-or-flight response of the nervous system."
Correct Answer: 4 Rationale 1: Bronchodilators do not decrease the production of mucus. Rationale 2: Bronchodilators do not decrease the production of histamine. Rationale 3: Bronchodilators act on the sympathetic nervous system, not the parasympathetic nervous system. Rationale 4: During the fight-or-flight response, beta 2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs.
The nurse teaches the client about the use of a metered-dose inhaler (MDI) and spacer. The nurse evaluates that additional teaching is required when the client makes which statement? 1. "I need to follow the instructions about using the metered-dose inhaler (MDI)." 2. "I need to rinse my mouth each time after using the metered-dose inhaler (MDI)." 3. "I need to drink a lot of fluids while I am using the metered-dose inhaler (MDI)." 4. "I should keep the spacer moist between uses by storing it in a plastic zip bag.
Correct Answer: 4 Rationale 1: Following instructions indicates compliance with use of the metered-dose inhaler (MDI). Rationale 2: Rinsing the mouth after using the metered-dose inhaler (MDI) is correct; it will help reduce oral absorption of the drug. Rationale 3: Fluids are encouraged to liquefy pulmonary secretions when using the metered-dose inhaler (MDI). Rationale 4: The spacer and inhaler should be rinsed with water and allowed to air-dry.
The nurse plans to teach an adolescent about inhalation therapy as part of the treatment plan for the client's asthma. What does the best plan by the nurse include? 1. Inhalation therapy is effective because it provides around-the-clock therapy, as opposed to oral medications. 2. Inhalation therapy is the preferred treatment for adolescents because it is easier for them to manage. 3. Inhalation therapy is effective because it provides systemic relief of symptoms as well as local relief. 4. Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract.
Correct Answer: 4 Rationale 1: Inhalation therapy does not provide around-the-clock therapy. Rationale 2: Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage. Rationale 3: Inhalation therapy does not provide systemic relief of symptoms. Rationale 4: The major advantage of aerosol therapy is that it delivers the drugs to their direct site of action.
The nurse understands that one advantage of inhaled pulmonary drugs over oral drugs is that inhaled drugs 1. increase adverse effects. 2. allow for convenience to the client. 3. are delivered to systemic locations. 4. allow for quick absorption
Correct Answer: 4 Rationale 1: Inhaled drugs decrease adverse effects. Rationale 2: Inhaled drugs are not as convenient as oral. Rationale 3: Inhaled drugs are delivered to local sites. Rationale 4: Inhalation is the most common route of administration; it is rapid and allows for quick absorption to direct airway.
Bronchoconstriction in the airways is stimulated by 1. perfusion. 2. ventilation. 3. the sympathetic nervous system. 4. parasympathetic nervous system.
Correct Answer: 4 Rationale 1: Perfusion is the flow of blood in the lungs. Rationale 2: Ventilation moves air in and out. Rationale 3: The sympathetic nervous system stimulates dilation. Rationale 4: The parasympathetic nervous system stimulates bronchoconstriction
A physician may telephone in an order for which of the following? 1. Morphine 2. Marijuana 3. Cocaine 4. Codeine
Correct Answer: 4 Schedule I and II drugs cannot be ordered via the telephone. Marijuana is a Schedule I drug, and cocaine and morphine are Schedule II drugs, while codeine is a Schedule III drug. (p. 17)
The nurse provides medication education to a client with terminal cancer. The physician has ordered morphine (MS Contin), a Schedule II drug, for the client. The nurse determines that learning has occurred when the client makes which statement? 1. "I need to call the office for a refill before my medication runs out." 2. "This drug is addictive so I should only take it when my pain becomes severe." 3. "Maybe my doctor could change me to a Schedule IV drug." 4. "I need to see my doctor before my prescription runs out so I can get a refill."
Correct Answer: 4 Schedule II drugs cannot be refilled without the client seeing the physician. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a patient with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client's pain.
The mother of an adolescent receiving methylphenidate (Concerta) for attention-deficit hyperactivity disorder tells the nurse that her son is better and asks why she can't just get refills on the prescription. What is the best response by the nurse? 1. "Just drop by and I will get a prescription for you without seeing your son." 2. "We can't do that; maybe you can find another doctor's office that will do it." 3. "The law does not allow us to give you refills on this medication." 4. "The medication can be addictive so your son needs a monthly medical evaluation."
Correct Answer: 4 Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother's question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.
While discussing antihypertensives, the instructor states that a particular agent causes a reduction in blood pressure by blocking receptor sites. The instructor is describing which of the following? 1. Drug-drug interaction 2. Adverse effects 3. Indication 4. Mechanism of action
Correct Answer: 4 The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drug-drug interactions refer to the effects of multiple drug use. (p. 5)
During the admission assessment, the client tells the nurse "Sure I smoke a little weed (marijuana) to manage my stress. Doesn't everyone?" What is the best assessment question for the nurse to ask? 1. "What other ways do you think you might use to help you to manage your stress?" 2. "That is a Schedule I drug; aren't you afraid of going to jail for a long time?" 3. "Do you really believe that everyone smokes marijuana to manage stress?" 4. "How often do you smoke marijuana, and how much each time?"
Correct Answer: 4 The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question, and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question, and is not the issue during the admission assessment.
The presence of muscle tremors following drug cessation would most accurately be associated with which of the following? 1. Adverse effect 2. Psychological dependence 3. Therapeutic effect 4. Physical dependence
Correct Answer: 4 The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed. (p. 16)
Leukotriene modifiers are primarily used for 1. status asthmaticus. 2. infection. 3. bronchodilation in asthma. 4. prophylaxis of asthma symptoms.
Correct Answer: 4 Rationale 1: Leukotrienes are not used for treatment of status asthmaticus. Rationale 2: Leukotrienes do not reduce infection. Rationale 3: Anticholinergics are bronchodilators. Rationale 4: Leukotriene modifiers are used primarily for prophylaxis and reducing inflammatory components.
The nurse would observe for fungal infection of the throat with which class of medications? 1. Methylxanthines 2. Beta-adrenergic agonists 3. Mast cell inhibitors 4. Glucocorticoids
Correct Answer: 4 Rationale 1: Methylxanthines do not cause fungal infection. Rationale 2: Beta-adrenergic agonists can cause throat irritation, but not infection. Rationale 3: Mast cell inhibitors do not cause fungal infection. Rationale 4: Glucocorticoids weaken the immune system and cause candidiasis of the throat.
The client receives zafirlukast (Accolate) as treatment for asthma. The nurse has completed medication education and evaluates that learning has occurred when the client makes which statement? 1. "This medication activates my fight-or-flight response." 2. "This medication is good when I have an acute attack of asthma." 3. "This medication dilates my airways so I can breathe better." 4. "This medication decreases the inflammation in my lungs.
Correct Answer: 4 Rationale 1: Zafirlukast (Accolate) does not stimulate the sympathetic nervous system. Rationale 2: Zafirlukast (Accolate) is ineffective for acute asthma attacks. Rationale 3: Zafirlukast (Accolate) is not a bronchodilator. Rationale 4: Zafirlukast (Accolate) prevents airway edema and inflammation by blocking leukotriene receptors in the airways.
The elderly client has gastrointestinal bleeding. The client says to the nurse "I don't understand this. All I did was take ibuprofen (Advil) for my arthritis." Which plan would be best as it relates to the nurse's education of this client? 1. A plan to teach the client to use drugs that bypass the gastrointestinal system, like topical drugs 2. A plan to teach the client to substitute safer drugs like acetaminophen (Tylenol) 3. A plan to teach the client to obtain physician approval prior to the use of over-the-counter (OTC) medications 4. A plan to teach the advantages and disadvantages of ibuprofen (Advil)
Correct Answer: 4. Since elderly clients account for the use of about 40% of all over-the-counter (OTC) medications, it is essential for the nurse to teach clients about the advantages, and the disadvantages, of these medications. Substitution of other drugs may be beneficial, but this cannot be done in all situations. The use of topical drugs may be an option, but the drug a client needs may not be available in this form. It is not a realistic plan to expect clients to contact their physician prior to taking any over-the-counter (OTC) medication.
A patient with hypertension is taking furosemide [Lasix] for congestive heart failure. The prescriber orders digoxin to help increase cardiac output. What other medication will the nurse expect to be ordered for this patient? a. Bumetanide [Bumex] b. Chlorothiazide [Diuril] c. Hydrochlorothiazide [HydroDIURIL] d. Spironolactone [Aldactone]
D Spironolactone is used in conjunction with furosemide because of its potassium-sparing effects. Furosemide can contribute to hypokalemia, which can increase the risk of fatal dysrhythmias, especially with digoxin administration. The other diuretics listed are all potassium-wasting diuretics.
A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone [Aldactone]. The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropriate? a. Administer the medications as ordered. b. Ask the patient about the use of salt substitutes. c. Contact the provider to request an order for serum electrolytes. d. Request an order for furosemide [Lasix].
D Spironolactone takes up to 48 hours for its effects to develop, so it should not be used when the patient needs immediate diuresis. This patient has shortness of breath, crackles, and edema and needs a short-acting diuretic, such as furosemide. Asking the patient about the use of salt substitutes is not indicated. The patient does not need assessment of serum electrolytes.
Which class of drugs is most effective in preventing and treating seasonal and perennial rhinitis? A. Antitussives B. Oral antihistamines C. Oral sympathomimetics D. Intranasal glucocorticoids
D. Intranasal glucocorticoids are the most effective drugs for preventing and treating seasonal and perennial rhinitis. They reduce nasal congestion, rhinorrhea, sneezing, nasal itching, and erythema. Antihistamines are less effective than glucocorticoids, because histamine is only one of several mediators of allergic rhinitis. Sympathomimetics relieve only nasal congestion. Antitussives are used to suppress cough.
The client receives beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. He asks the nurse if this drug is safe because it is a glucocorticoid. What is the best response by the nurse? Select one: A. "Intranasal glucocorticoids are safe if they are not used too long." B. "Intranasal glucocorticoids are safe only if used once a day." C. "Intranasal glucocorticoids are safe if you do not swallow any while using them." D. "Intranasal glucocorticoids produce almost no serious adverse effects."
D. "Intranasal glucocorticoids produce almost no serious adverse effects."
d. Tachycardia
Discharge teaching to a client receiving a beta-agonist bronchodilator should emphasize reporting which side effect? a. Hypoglycemia b. Nonproductive cough c. Sedation d. Tachycardia
The patient has generalized anxiety disorder. He asks the nurse, "Will I need medication for this? My neighbor is very nervous and he takes medication." What is the best response by the nurse? Select one: A. "Medications are a way of life for patients with anxiety disorders." B. "Medication is necessary initially; later we will try therapy." C. "Probably not, but you shouldn't compare yourself to your neighbor." D. "Medication is necessary when anxiety interferes with your quality of life."
D. "Medication is necessary when anxiety interferes with your quality of life."
Which of the following treatments would NOT be used to promote the shedding of old skin? A. Resorcinol B. Salicylic acid C. Sulfur D. Benzoyl peroxide
D. Benzoyl peroxide
Which of the following is contraindicated in conjunction with phototherapy for the treatment of psoriasis? A. Tar and anthralin B. Keratolytic pastes C. Psoralens D. Cyclosporine
D. Cyclosporine
The nurse would observe for fungal infection of the throat with which class of medications? Select one: A. Methylxanthines B. Beta-adrenergic agonists C. Mast cell inhibitors D. Glucocorticoids
D. Glucocorticoids
Which of the following medications would NOT be useful for minor insect bites? A. Benzocaine (Solarcaine, others) B. Dibucaine (Nupercainal) C. Tetracaine (Pontocaine) D. Isotretinoin (Accutance)
D. Isotretinoin (Accutance)
permethrin (Acticin, Elimite, Nix) MOA
kills head and crab lice and mites and eradicate their ova
The physician has ordered intravenous (IV) phenytoin (Dilantin). The nurse does not read the drug label and administers the medication intramuscularly (IM). What is the most likely response in the patient? Select one: A. A marked decrease in serum glucose levels will most likely occur. B. Nothing adverse, the medication may be administered intravenously (IV) or intramuscularly (IM). C. A phenomenon known as purple gluteus syndrome will most likely occur. D. Local tissue damage following extravasation will most likely occur.
D. Local tissue damage following extravasation will most likely occur.
Matching: Erythema A. Black head B. Whiteheads C. Intense itching D. Redness E. "First-degree" injury
D. Redness
Which condition is an adverse effect of a beta-adrenergic agonist? Select one: A. Bradycardia B. Constipation C. Runny nose D. Tachycardia
D. Tachycardia
The patient has been receiving escitalopram (Lexapro) for treatment of obsessive-compulsive disorder. Unknown to the nurse, the patient has also been self-medicating with St. John's wort. The patient comes to the office with symptoms of hyperthermia and diaphoresis. Which statement best describes the result of the nurse's assessment? Select one: A. The patient is experiencing symptoms of St. John's wort toxicity, as the medication was most likely outdated. B. The patient has not been taking escitalopram (Lexapro) and is experiencing withdrawal. C. The patient has contracted a viral infection. Escitalopram (Lexapro) and St. John's wort are safe to take together. D. The patient has combined two antidepressant medications and is experiencing serotonin syndrome.
D. The patient has combined two antidepressant medications and is experiencing serotonin syndrome.
An individual who has difficulty sleeping due to two final examinations scheduled for the same day later in the week most likely would be suffering from Select one: A. social anxiety. B. performance anxiety. C. obsessive-compulsive disorder. D. situational anxiety.
D. situational anxiety.
The parents of a client receiving methylphenidate (Ritalin) express concern that the health care provider has suggested that the child have a "holiday" from the drug. The nurse explains that the drug-free holiday is designed to: Reduce the risk of drug toxicity. Decrease drug dependence and assess status. Prevent hypertensive crisis. Allow the child's "normal" behavior to return.
Decrease drug dependence and assess status. Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: Methylphenidate (Ritalin) is a Schedule II drug with the potential to cause drug dependence when used over an extended period of time. The drug holiday is to decrease the risk of dependence and to evaluate behavior. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Implementation
Bipolar Disorder
Depression alternating with mania episodes Mania= Emotional state characterized by high psychomotor activity and irritability: Inflated self-esteem flight of ideas Distractibility Excessive involvement in pleasurable activities Non compliance is a serious problem
Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.
Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. 1. Insomnia is correct. 2. Tremor is correct. 3. Delirium is correct. 4. Dry mouth is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. 5. Lethargy is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. TEST-TAKING HINT: The test taker must distinguish between benzodiazepine side effectsand symptoms of withdrawal to answer this question correctly.
Fill in the blank: Drugs used to soothe and soften the skin, as in the case of psoriasis, are called ___________.
Emollients
The client asks the nurse how antidepressants work. The best response by the nurse would be that they work by: Increasing serotonin uptake. Increasing the ability to cope. Breaking down neurotransmitters in the brain. Enhancing mood.
Enhancing mood. Objective: Identify the symptoms of attention-deficit hyperactivity disorder. Rationale: Antidepressants enhance neurotransmitter action by blocking breakdown of norepinephrine and slowing reuptake of serotonin. This leads to a more balanced chemical state in the brain. The client needs to learn how to develop effective means of coping. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Implementation
Antipsychotics (Neuroleptics) MOA
Enter dopaminergic synapses and compete with the binding of dopamine to receptors
A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the plan of care?
Exercising the client's arms regularly
Antipsychotics side effects
Extrapyramidal Symptoms (EPS) Acute dystonia Akathisia Parkinsonism Tardive Dyskinesia
True or False: Adverse effects of retinol (vitamin A) are relatively minor and should not be a problem for the patient who is pregnant?
False
True or False: All skin disorders are caused by stresses in the environment?
False
True or False: Pediculicides are pharmacologic agents that kill mites; scabicides kill lice?
False
The nurse reviews the client's lithium serum drug level, noting that it is 0.95 mEq/L. The appropriate nursing action is to: Notify the physician immediately. Hold the next dose of the drug. File the lab result in the medical record. Observe the client for signs of toxicity.
File the lab result in the medical record. Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: The therapeutic dose range of lithium is 0.6-1.5 mEq/L. 0.95 mEq is within normal limits. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Implementation
Fluid Resuscitation
First 24 hours Ringer's Lactate is used Eg. Parkland formula: 4ml/kg/%TBSA ½ of the calculated amount is given over the first 8 hours since injury The rest is given over the next 16 hours Eg. Pt. weighs 50 kg., has 50% TBSA burns. Injury was @ 0900h. And the IV was started at 1000h. Calculate the total volume for the 24 hours At what time should the first 5000 ml be finished? 1st 8 hours 0900-1700 4X50X50 =10,000ml -1/2 in first 8hr = 5,000ml - 7 hours left run @ 714 ml/hr - 1700-0900 16 hrs run @ 312 ml/hr
Common Nonphenothiazine
Haloperidol (Haldol)
The client admitted with symptoms of depression would require additional evaluation if the nurse collected which of the following data during the history and physical exam? History of hypothyroidism History of diabetes mellitus Vitamin K deficiency Asthma
History of hypothyroidism Objective: Explain the etiology of clinical depression. Rationale: The symptoms of depression may be attributed to medical and neurological disorders such as hypothyroidism. Diabetes, vitamin K deficiency, and asthma are not typical causes of depression, although chronic illness can contribute to depression. Cognitive Level: Assessment Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Evaluation
Nutrition
Hypermetabolic state Caloric needs Protein requirement is high for healing If caloric needs are not met a state of negative nitrogen balance exists leading to Delayed healing Infection Wasting of body mass Death Oral or enteral feeds, TPN if GI tract not functional Transient ↑ blood sugar
Major complications
Hypertrophic scarring Occurs 2° to ↑ vascularity, ↑ fibroblasts, collagen deposits, edema Scar formation occurs over ~ 2 years Melanocytes do not regenerate well...in deep burns skin color usually does not return Contracture formation PT, OT, NUTRITION
propofol (Diprivan)
IV anesthetic. for use with induction and maintenance of general anesthesia. Onset 40-60 sec; Peak 3-5 minutes; Duration 10-15 minutes.
Integument tx
Initial cleansing with tepid (cool/cold) N/S removes debris and removes surface bacteria Open method: topical antibiotic applied without a dressing Closed method: sterile dressing (wounds heal best in a moist environment) Flamazine (broad spectrum) Polysporin Tetanus toxoid
A nurse admits a patient to her unit with a presumptive diagnosis of pneumonia. When a sputum specimen is obtained, the nurse notes that the sputum is greenish and copious. The nurse notifies the patient's physician because these symptoms are indicative of what?
Infection
Laryngotracheitis
Inflammation of the larynx and trachea
antiplatelets
Inhibit platelet action, prevent thrombi growth
TCA's MOA
Inhibit presynaptic reuptake of serotonin and norepinephrine
SSRI MOA
Inhibit serotonin reabsorption and norepinephrine, elevate mood
Synthetic & Biosynthetic grafting
Integra synthetic skin Alloderm product
A nurse should teach a patient receiving oral pseudoephedrine (Sudafed) to observe for which adverse effects? (Select all that apply.) Sedation Irritability Paranoia Anxiety Weight loss
Irritability & Anxiety. Oral pseudoephedrine activates alpha1 receptors on nasal and systemic blood vessels, causing vasoconstriction and central nervous system (CNS) excitation. This results in restlessness, irritability, anxiety, and insomnia. Sedation, paranoia, and weight loss are not adverse effects associated with pseudoephedrine.
Fill in the blank: Drugs used to promote the shedding of old skin are called _________ agents.
Keratolytic
kyphoscoliosis
Kyphosis (hunchback-appearance) Scoliosis (lateral curvature deformity), spinal deformity seen often in the elderly -may move the cardiac apex downward so palpation of apical impulse is obscured
Depression Symptoms
Lack of energy Sleep Disturbance Abnormal eating Habits Feelings of despair Guilt Hopelessness
Other antiseizure drugs used for bipolar disorder
Lamotrigene (Lamictal) Carbamazepine (Tegretol)
You are assessing a newly admitted patient. During the assessment, the patient demonstrates an irritated, high-pitched cough. What does the nurse suspect that the patient has?
Laryngotracheitis (associated with an irritated, high-pitched cough. A cough with sputum production is indicative of bronchitis)
MAOI's MOA
Limits the breakdown of norepinephrine, dopamine, and serotonin in the CNS, this increases the level of the neurotransmitter available to alleviate symptoms of depression
You suspect your patient has a pleural effusion. Which of the following respiratory findings would you expect to find upon assessment of your patient?
Lung fields dull to percussion, absent breath sounds, and a pleural friction rub.
Circulation after burn
MONITOR TISSUE PERFUSION CLOSELY Additional fluid: FFP, colloids once capillary permeability is restored By 48 hours capillaries begin to seal and fluid will return from third spaces to the vascular space→ watch for fluid volume overload
Forms of depression
Major depressive disorder Situational Depression Postpartum Depression Seasonal Affective Disorder
Circulation
Massive fluid shift from plasma to interstitium- interstitium exposed to air- wheep Sodium and protein move out of the vascular bed- lost serum Potassium increases due to damaged cells- K is intracellular end up in pt blood Wound allows evaporation to occur 4-15x normal rate → BURN SHOCK
Serotonin Syndrome Sings and Symptoms
Mental Status Change HTN Tremors Sweating Hyperpyrexia Ataxia Treatment= Discontinue SSRI
mild, moderate and major burn TSBA
Minor burn <15% partial thickness/<2% full thickness Moderate burn 15-25% partial thickness/ < 10% full thickness Major burn > 25% partial thickness/ > 10% full thickness
bronchoscopy
NPO after midnight looking for cancer NPO till they gag 48 - 72 hours till have results of the test, fiberoptic or rigid endoscope inserted into the bronchial tubes for diagnosis, biopsy, or collection of specimens
Hypertensive Crisis Symptoms
Occipital headache Stiff neck Flushing Palpitations Diaphoresis Nausea Antidote= Ca+ channel blockers
TCA's Side Effects
Orthostatic Hypotension Anticholinergic effects: - Dry mouth - Constipation -Urinary retention -Excessive perspiration - Blurred vision Tachycardia
MAOI's Side Effects
Orthostatic Hypotension Headache Insomnia Diarrhea Hypertensive Crisis when used with other antidepressants or foods containing tyramine
Psychosocial implications
Pain Depression- milieu therapy Self-image Self-worth Risk for suicide Role in the family / at work Coping Distrust Getting on with life...
Fill in the blank: Small, inflammatory bumps without pus are called __________.
Papules
Your patient is concerned about his inability to speak clearly due to an infection in the upper respiratory system. Which structure serves as the patient's resonating chamber in speech?
Paranasal sinuses
Attention Deficit Disorder/ ADHD
Poor attention span Behavior control issues Between ages 3 and 7, mostly boys
Neuroleptic Malignant Syndrome
Potencially fatal adverse reaction from antipsychotic drugs Occurs after initiation of therapy or dose adjustment
You are caring for a patient who has returned to the unit following a bronchoscopy. The patient is asking for something to drink. Which criteriion will determine when you willow the patient to drink fluids?
Presence of a cough and gag reflex
When planning the care for a client with COPD, the nurse should include which intervention?
Provide a diet that is high in calories and protein. Clients with COPD have difficulty obtaining enough calories and protein due to fatigue and early satiety.
You need to assess arterial oxygen saturation (SaO2) in your patient. What is the best procedure accomplish this?
Pulse oximetry
EXTENT OF BODY SURFACE AREA INJURED
Rule of Nines - add 9 for each area of burn Lund and Browder- % of burn Palm Method Approx. 1-3% per "palm"
Which of the following would be a priority component of the teaching plan for a client prescribed phenelzine (Nardil) for treatment of depression? Headache can occur frequently when first started. Read labels of food and over-the-counter (OTC) drugs. Monitor blood pressure for hypotension. Hyperglycemia can occur.
Read labels of food and over-the-counter (OTC) drugs. Objective: For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary actions, and important adverse effects. Rationale: Nardil is an MAOI. This class of drugs has many drug and food interactions that can cause serious reactions, especially with foods containing tyramine. They can lead to a hypertensive crisis. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Planning
wound debridement
Removes devitalized and contaminated tissue Exposes granulation tissue Promotes healing and decreases infection although debrided wounds are at greater risk of infection Natural (dead tissue separates spontaneously) Mechanical (surgical scissors, wet-to-dry dressings, topical enzymes) Surgical (early and aggressive surgical wound closure has lowered incidence of septic shock)
Fill in the blank: Vitamin A-like compounds providing resistance to bacterial infection by reducing oil production and the occurrence of clogged pores are called ________.
Retinoids
CNS Stimulants
Reverse ADHD symptoms and helps patients focus on tasks May create paradoxical hyperactivity Schedule II controlled substances, high risk for abuse Administer after morning meal Take before 4 pm to avoid insomnia Monitor height and weight weekly Monitor HR and BP (palpitations have been reported)
Psychosis
Serious mental disorder where there is loss of contact with reality. Characterized by: Delusions Hallucinations Illusions Disorganized behavior Difficulty relating to others Paranoia
Selective Serotonin Reuptake Inhibitors (SSRI)
Serotonin is found in high concentration in hypothalamus, limbic system, medulla, and spinal cord. They are very safe Less sympathomimetic and anticholinergic effects Sexual Dysfunction is a common side effect
Immune system
Skin barrier is destroyed Decreased effectiveness of immune system 70% of those with burns die if they develop sepsis
Airway
Smoke Inhalation (check for soot on skin/clothes and carbonaceous sputum) Assess for respiratory distress, ↓pO2, altered LOC Treated with oxygen, bronchodilators CO poisoning Oxygen is displaced from HGB- CO2 higher afinity for HGB Cherry red lips and skin may not be present Treated with 100% oxygen, positioning, DB&C - bright red skin to much CO2 Airway Obstruction 2°edema, circumferential burns Pneumonia ARDS ( acute respiratory distress syndrome) (2-5 days post burn with 50% mortality)
fluticasone (Flonase) class
T: drug for allergic rhinitis P: intranasal corticosteroids
Diphenhydramine (Benadryl) classes
T: drug to treat allergies P: H1 receptor antagonisti, antihistamine
oxymetazoline (Afrin) classes
T: nasal decongestant P: sympathomimetic
zolpidem (Ambien) classes
T: sedative-hypnotic P: nonbenzodiaepine receptor agonist; nonbenzodiazephine, nonbarbiturate CNS depressant
lorazepam (Ativan) classes
T: sedative-hypnotic; anxiolytic; anesthetic adjunct P: benzodiazepine; GABAa receptor agonist
Severity of burn determined by:
TBSA injured Burn depth Location of burns Age Concommitant(another injury on top of burn) injury Past health history
The nurse closely monitors the client beginning SSRI therapy for: Contraceptive use. Weight gain. Excessive exercise. Suicidal ideation.
Suicidal ideation. Objective: Use the nursing process to care for clients receiving drug therapy for mood and emotional disorders. Rationale: SSRIs take several weeks for full therapeutic benefit. Clients should be monitored closely for suicidal intent until SSRIs reach their maximum therapeutic effect. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Assessment
Tretinoin (Retin-A) classes
T: anti acne P: retinoid
Sprinolactone (Aldactone) classes
T: anti hypertensive, drug to reduce edema P: K sparing diuretic, aldosterone antagonist
Phenytoin (Dilantin) classes
T: anti seizure drug; antidysrhythmic P: hydantion; sodium influx-suppressing drug
beclomethasone (QVAR) classes
T: anti-inflammatory drug for asthma and allergic rhinitis P: inhaled corticosteroid
montelukast (Singular) classes
T: anti-inflammatory for asthma prophylaxis P: leukotriene modifier
Clopidogrel (Plavix) classes
T: anti-platelet P: ADP receptor blocker
Warfarin (Coumadin) classes
T: anticoagulant (oral) P: vitamin K antagonist
sertraline (Zoloft) classes
T: antidepressant P: selective serotonin reuptake inhibitor (SSRI)
escitalopram (Lexapro) classes
T: antidepressant; anxiolytic P: selective serotonin reuptake inhibitor (SSRI)
imipramine (Tofranil) classes
T: antidepressant; treatment of nocturnal enuresis in children P: tricyclic antidepressant
valproic acid (Depakote) classes
T: antiseizure drug P: valproate
diazepam (Valium) classes
T: antiseizure drug P: benzodiazepine, GABAa receptor agonist
Methylphenidate (Ritalin, Concerta, Daytrana, Metadate, Methylin) classes
T: attention deficit-hyperactivity disorder drug P: CNS stimulant
albuterol (Proventil, Ventolin) classes
T: bronchodilator P: beta 2 adrenergic agonist
animocaproic acid (Amicar) classes
T: clot stabilizer P: hemostatic/antifibrinolytic
Furosemide (Lasix) classes
T: drug for HTN and HF P: loop diuretic
Hydrochlorothiazide (Microzide) classes
T: drug for HTN and edema P: thiazide diuretic
A client is prescribed alprazolam (Xanax) 2 mg bid and 1.5 mg q6h PRN for agitation. The maximum daily dose of alprazolam is 10 mg/d. The client can receive _____ PRN doses of alprazolam within a 24-hour period.
The client can receive 4 PRN doses. Medications are given four times in a 24-hour period when the order reads q6h: 1.5 mg x 4 = 6 mg. The test taker must factor in 2 mg bid = 4 mg. These two dosages together add up to 10 mg, the maximum daily dose of alprazolam (Xanax), and so the client can receive all 4 PRN doses. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that the timing of standing medication may affect the decision- making process related to administration of PRN medications. In this case, the client would be able to receive all possible doses of PRN medication because the standing and PRN ordered medications together do not exceed the maximum daily dose.
b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later.
The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action? a. Question the order; three inhalers should not be given at one time. b. Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later. c. Administer each inhaler at 30-minute intervals. d. Administer beclomethasone first, wait 2 minutes, and administer ipratropium bromide, followed by the albuterol several minutes later.
Your patient has multiple sclerosis. Neuromuscular disorders such as multiple sclerosis may lead to a decreased vital capacity. What does vital capacity measure?
The maximum volume of air exhaled from the point of maximum inspiration.
causes of burns
Thermal - heat Chemical- laundry detergent, alkaline burn worse then acid Electrical- lightning strike- coterizes bld flow
A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maximum daily dose of lorazepam should not exceed 4 mg QD. This client would be able to receive ______ PRN doses as the maximum number of PRN lorazepam doses.
This client should receive 2 PRN doses. The test taker must recognize that medications are given three times in a 24-hour period when the order reads q8h: 1 mg x 3 = 3 mg. The test taker must factor in the 0.5 mg qid = 2 mg. These two dosages together add up to 5 mg, 1 mg above the maximum daily dose of lorazepam (Ativan). The client would be able to receive only two of the three PRN doses of lorazepam. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that the timing of standing medication may affect the decision-making process related to administration of PRN medications. In this case, although the PRN medication is ordered q8h, and could be given three times, the standing medication dosage limits the PRN to two doses, each at least 8 hours apart.
Atypical Antipsychotics MOA
Thought to block dopamine, serotonin, and alpha adrenergic receptors
What is the phrase that defines the volume of air inspired and expired with a normal breath?
Tidal volume
Mood Stabilizers
Treat bipolar depression Traditional treatment is Lithium (Eskalith) Treatment is highly individualized Antidepressants worsen mania
True or False: An important component of therapy for lice involves removing nits?
True
True or False: Most acne drugs act by slowing down the turnover of skin cells, especially those surrounding pore openings?
True
True or False: Numerous drugs are employed to soothe the patient with psoriasis, including emollients, topical corticosteroids, and immunosuppressant medications?
True
True or False: The predominant form of drug therapy for lice involves removing nits?
True
True or False: The principal action of tretinoin (Avita, Retin-A, others) is the regulation of skin growth and turnover?
True
True or False: Topical corticosteroids are the most effective treatment for symptoms of dermatitis?
True
The patient is positioned in a recumbent position. Which approach should the nurse take to assess the patient's lung fields for a patient in this position?
Turn the patient to assess all lung fields so that dependent areas can be assessed for breath sounds.
Schizophrenia
Type of psychosis characterized by abnormal thoughts and thought process, disordered communication and withdrawal from other people and the outside environment High risk for suicide Symptoms appear in early adulthood May have a genetic component Cause by neurotransmitter imbalance in specific brain regions Positive Symptoms= Adds to abnormal behavior, makes it colorful Negative Symptoms= Subtracts from symptom, lack of pleasure, interest Symptoms connected to dopamine type 2 receptors
Atypical Antipsychotics Side Effects
Weight gain Diabetes Hypertriglyceremia Increased risk of CVA Menstrual disorders Decreased libido Agranulocytosis
The nurse encourages the client to remain compliant with TCA therapy in spite of the common side effect of: Urinary frequency. Hyperglycemia. Excessive thirst. Weight gain.
Weight gain. Objective: Explain the etiology of clinical depression. Rationale: Weight gain is a common side effect and frequently leads to noncompliance with the drug regimen. Excessive thirst, urinary frequency, and hyperglycemia are not common side effects of TCAs. Cognitive Level: Application Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies Nursing Process: Implementation
c. Monitor blood glucose levels every 4 hours when taking albuterol.
What is the most important thing for the nurse to teach the client with a history of diabetes and asthma who has started on albuterol PRN? a. Take Tylenol for headaches when taking albuterol. b. Monitor for orthostatic hypotension every 2 hours when taking albuterol. c. Monitor blood glucose levels every 4 hours when taking albuterol. d. An antianxiety agent may be prescribed to help with nervousness.
c. Liquefying and loosening of bronchial secretions
What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine (Mucomyst)? a. Decreased cough reflex b. Decreased nasal secretions c. Liquefying and loosening of bronchial secretions d. Relief of bronchospasms
After being diagnosed with pyrophobia, the client states, "I believe this started at the age of 7 when I was trapped in a house fire." When examining theories of phobia etiology, this situation would be reflective of ____________ theory.
When examining theories of phobia etiology, this situation would be reflective of learning theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of phobias, when the individual avoids the phobic object, he or she escapes fear, which is a powerful reward. This client has learned that avoiding the stimulus of fire eliminates fear. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the different theories of the causation of specific phobias.
Serotonin Syndrome
When pts take medicines that affect serotonin metabolism, synthesis, and reuptake Symptoms can begin in 2 hrs after taking medication
c. "Hold your breath for 10 seconds if you can after you inhale the medication."
Which instruction will the nurse include when teaching a client about the proper use of metered-dose inhalers? a. "After you inhale the medication once, repeat until you obtain relief." b. "Make sure that you puff out air repeatedly after you inhale the medication." c. "Hold your breath for 10 seconds if you can after you inhale the medication." d. "Hold the inhaler in your mouth, take a deep breath, and then compress the inhaler."
The client complains of muscle cramping in the calves, paresthesias of the toes, and the sensation of the heart skipping a beat. These symptoms can be symptoms of which of the following imbalances? a) hyperkalemia b) hypernatremia c) hypercalcemia d) hypoglycemia
a Rationale: Hyperkalemia, serum potassium level > 5 mEq/L, predisposes the client to cardiac and muscle irregularities.
Which of the following mechanisms is the most important regulator of fluid intake? a) thirst b) kidneys c) electrolytes d) renin-angiotensin
a Rationale: Thirst is the most important regulator of fluid intake.
*****The client's arterial blood gases (ABG) reveal respiratory acidosis. Which of the following are causes? (Select all that apply.) a) Airway obstruction. b) Excess alcohol ingestion. c) Hypoventilation or shallow breathing. d) Damage to the Medulla e) Starvation.
a, c, and d Rationale: Origins of acidosis related to respiratory involve conditions that affect airway and breathing.
NMS
after exposure to drugs that alter levels of dopamine in the brain/ or after the withdrawal of agents that increase CNS dopamine levels
A patient who has a viral upper respiratory infection reports having a runny nose and a cough that prevents sleep and asks the nurse to recommend an over-the-counter medication. Which medication will the nurse recommend? a. Diphenhydramine [Benadryl] b. Fexofenadine/pseudoephedrine [Allegra-D] c. Guaifenesin [Mucinex] d. Phenylephrine drops
a. Diphenhydramine [Benadryl]
A patient with allergic rhinitis is taking a compound product of loratadine/pseudoephedrine [Claritin-D] every 12 hours. The patient complains of insomnia. The nurse notes that the patient is restless and anxious. The patient's heart rate is 90 beats per minute, and the blood pressure is 130/85 mm Hg. The nurse will contact the provider to: a. discuss using an intranasal glucocorticoid and loratadine [Claritin]. b. report acute toxicity caused by pseudoephedrine. c. suggest using an agent with a sympathomimetic drug only. d. suggest using a topical decongestant to minimize systemic symptoms.
a. discuss using an intranasal glucocorticoid and loratadine [Claritin].
Warfarin (Coumadin) AE
abnormal bleeding
succinylcholine (Anectine)/depolarizing blocker
acetylcholine receptor blocking drug/ blocks receptor sites at neuromuscular junctions/ drug broken down by cholinesterase when the infusion is stopped allowing acetylcholine to recover at the receptors
physostigmine (Antilirium)
acetylcholinesterase inhibitor/ indirect-acting parasympathomimetic/ reverses symptoms of anticholinergic intoxication
clopidogrel (Plavix) MOA
alters plasma membrane of platelets so they can't aggregate -prolongs bleeding time by interfering with aggregation of platelets
malignant hyperthermia
anesthetic-related disorder/ rapidly progressive hypermetabolic reaction involving sustained muscle contraction. Signs include muscle rigidity, rapid heart rate, high body temperature, muscle breakdown, and increased acid content. Tx dantrolene.
lorazepam (Ativan) use
anxiety disorder and insomnia
Hippocampus
area of brain responsible for learning and memory, and other parts of cerebral cortex
dextromethorphan (Delsym) use
as component in OTC severe cold and flu preparations
Which of the following nursing interventions is most important when caring for a client receiving a plasma volume expander? a) monitor arterial blood gases b) Observe for signs of hypersensitivity. c) Assess the client for a deep vein thrombosis. d) Encourage fluid intake.
b Rationale: Dextran 40, a plasma volume expander, can cause a hypersensitivity reaction in some clients. Also, the nurse should understand that fluid moves rapidly from the tissues to vascular spaces, which places the client at risk for fluid overload.
The client's arterial blood gases (ABG) reveal metabolic acidosis. Which of the following medications is indicated? a) sodium chloride b) sodium bicarbonate c) potassium chloride d) ammonium chloride
b Rationale: Sodium bicarbonate acts by directly raising the pH of body fluids. It is the drug of choice to restore the pH of the plasma to normal limits.
Which of the following solutes is the greatest contributor to the osmolality of a fluid? a) calcium b) sodium c) potassium d) water
b Rationale: Solutes found in the osmolality of a fluid include sodium, glucose, and urea. Sodium comprises the major part of the osmolality of a fluid.
A nurse provides teaching to a patient with allergic rhinitis who will begin using an intranasal glucocorticoid. Which statement by the patient indicates understanding of the teaching? a. "If the glucocorticoid causes burning or itching, I should use it every other day." b. "I should use a decongestant if necessary before using the glucocorticoid." c. "I should use the glucocorticoid whenever I have symptoms." d. "I will probably develop systemic effects from the topical glucocorticoid."
b. "I should use a decongestant if necessary before using the glucocorticoid."
A 7-year-old child has a cough, runny nose, congestion, and fever, and the parents ask the nurse to recommend an over-the-counter product. Which response by the nurse is correct? a. "Any product will be effective when combined with vitamin C and zinc." b. "It is best to use single-agent medications to treat individual symptoms." c. "The fever indicates that your child may need an antibiotic; you should call your provider." d. "You should ask your provider to prescribe a combination product that will treat multiple symptoms."
b. "It is best to use single-agent medications to treat individual symptoms."
A child who has perennial allergic rhinitis has been using an intranasal glucocorticoid. The provider has ordered montelukast [Singulair] to replace the glucocorticoid, because the child has frequent nosebleeds. When teaching this child's parents about montelukast, the nurse will include which statement? a. "Montelukast is also effective for treating infectious rhinitis." b. "Montelukast may cause behavior changes in your child." c. "Montelukast will treat both congestion and rhinitis." d. "Montelukast works best when combined with a topical decongestant."
b. "Montelukast may cause behavior changes in your child."
dopamine agonists; examples
bromocriptine (Parlodel), pramipexole (Mirapex), ropinirole (Requip)
What is ipratropium bromide [Atrovent]? a. A cholinergic agent used for perennial rhinitis b. An anticholinergic used for allergic rhinitis and colds c. A medication that is used only in patients with asthma d. A drug that is inappropriate for use in patients with allergic rhinitis
b. An anticholinergic used for allergic rhinitis and colds
A patient asks the nurse what type of medications would be most effective for treating seasonal and perennial rhinitis. Which response by the nurse is correct? a. Pseudoephedrine [Sudafed] b. Fluticasone propionate [Fluticasone] c. Loratadine [Claritin] d. Intranasal cromolyn sodium [Atrovent]
b. Fluticasone propionate [Fluticasone]
A child with seasonal rhinitis has used budesonide [Rhinocort Aqua] for several years. The parents are concerned that the child's rate of growth has slowed. What will the nurse do? a. Reassure the parents that this is an expected side effect. b. Suggest that the parents discuss using fluticasone [Flonase] with the provider. c. Tell the parents to administer the drug only when symptoms are severe. d. Tell the parents that antihistamines work as well as intranasal glucocorticoids.
b. Suggest that the parents discuss using fluticasone [Flonase] with the provider.
A patient admitted to the hospital has been using phenylephrine nasal spray [Neo-Synephrine], 2 sprays every 4 hours, for a week. The patient complains that the medication is not working, because the nasal congestion has increased. What will the nurse do? a. Request an order for an oral decongestant to replace the intranasal phenylephrine. b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn. c. Tell the patient to increase the dose of phenylephrine to 4 sprays every 4 hours. d. Tell the patient to stop using the phenylephrine and begin using an intranasal antihistamine.
b. Request an order for an intranasal glucocorticoid to be used while the phenylephrine is withdrawn.
Warfarin (Coumadin) use
prevent stoke, MI, DVT, pulmonary embolism
A patient with a cough has been advised to use guaifenesin. The patient asks the nurse to explain the purpose of the drug. The nurse will explain that guaifenesin: a. dries secretions to help suppress coughing so patients can rest. b. helps stimulate the flow of secretions to increase cough productivity. c. helps to relieve chest pain associated with a cough. d. stimulates the body's natural immune responses.
b. helps stimulate the flow of secretions to increase cough productivity.
Dietary sources B6
bananas, green vegetables, grains, legumes, meat
zolpidem (Ambien) MOA
bind to GABA receptor
lorazepam (Ativan) MOA
bind to GABA receptor-chloride channel molecule -intensifies GABA effects
hydrochlorothiazide (Microzide) MOA
block Na reabsorption and increases K and water excretion
risperidone (Risperdal)
blockade of dopamine type 2, serotonin, and alpha2-adrenergic receptors located within the CNS. Atypical an tipsychotic
spironolactone (Aldactone) MOA
blocking Na or blocking aldosterone
anticholinergic medications for PD
blocks muscarinic receptors, maintaining balance between dopamine and acetylcholine receptors in the brain (CNS)
furosemide (Lasix) MOA
blocks reabsorption of Na and chloride in loop of Henley
carbidopa
boosts effectiveness of levodopa/ makes more dopamine available to enter CNS
clopidogrel (Plavix) use
prevent thrombi formation after stroke or MI
Which of the following solutions is used to correct hypovolemic shock secondary to severe burns? a) albumin b) plasma proteins c) dextran 40 d) lactated ringers
c Rationale: Dextran, a synthetic polysaccharide, doubles the plasma volume within hours and acts as a volume expander.
A client's serum sodium value is 149 mEq/L. Which of the following nursing interventions is most appropriate for this client? a) Administer a 0.45% NaCl intravenous solution. b) Hold all doses of glucocorticoids. c) Encourage the client to eat a low-salt diet. d) Advise that the sodium values are within normal limits.
c Rationale: Hypernatremia is defined as serum sodium levels > 148 mEq/L. A slight increase in sodium can be managed by diet.
Which of the following solutions has a greater concentration of solutes than blood has? a) Isotonic b) Hypotonic c) Hypertonic d) Hyposmolar
c Rationale: Normal plasma is isotonic. Hypertonic solutions have a greater concentration of solutes than plasma does.
A parent asks a nurse to recommend an intranasal decongestant for a 6-year-old child. Which response by the nurse is correct? a. "Decongestants are too sedating for children and should not be used." b. "Decongestants should not be given to children under 7 years old." c. "Decongestant drops are recommended instead of decongestant sprays." d. "Decongestant sprays should be used no longer than 5 to 10 days."
c. "Decongestant drops are recommended instead of decongestant sprays."
phenobarbital (Luminal) MOA
changing action of GABA
Propofol infusion syndrome
characterized by severe metabolic acidosis, hyperkalemia, lipidemia, rhabdomyolysis, hepatomegaly, cardiac failure
ipratropium (Atrovent) MOA
cause bronchodilation by blocking cholinergic receptor in bronchial smooth muscle
dantrolene (Dantrium)
calcium release blocker/ acts directly on skeletal muscle to reduce force of reflex muscle contraction/ prevents calcium release from skeletal muscle cells
pigeon chest
congenital deformity is characterized by forward displacement of the sternum with depression of the adjacent costal cartilage; condition generally requires no treatment
phenobarbital (Luminal) use
controlling seizures
A parent asks a nurse about giving diphenhydramine [Benadryl] to a child to relieve cold symptoms. Which response by the nurse is correct? a. "Benadryl must be given in higher doses to provide relief for cold symptoms." b. "Intranasal glucocorticoids are more effective for treating cold symptoms." c. "Nasal antihistamines are more effective for treating cold symptoms." d. "Because histamine doesn't cause cold symptoms, Benadryl would not be effective."
d. "Because histamine doesn't cause cold symptoms, Benadryl would not be effective."
A patient who has seasonal allergies in the spring and fall asks the nurse about oral antihistamines. Which response by the nurse is correct? a. "Anticholinergic effects are more common with second-generation antihistamines." b. "First-generation antihistamines, such as diphenhydramine [Benadryl], are more effective." c. "Make sure you take antihistamines only when you have symptoms to minimize side effects." d. "You should take oral antihistamines daily during each allergy season to get maximum effects."
d. "You should take oral antihistamines daily during each allergy season to get maximum effects."
Parkinson's disease (PD)
degenerative disorder of CNS caused by death of neurons that produce neurotransmitter dopamine
Which medication used for asthma has off-label uses to treat allergic rhinitis? a. Diphenhydramine [Benadryl] b. Fexofenadine/pseudoephedrine [Allegra-D] c. Guaifenesin [Mucinex] d. Omalizumab [Xolair]
d. Omalizumab [Xolair]
Multiple sclerosis
demyelination of neurons in CNS, resulting in progressive weakness, visual disturbance, mood alterations, and cognitive deficits/ chronic, inflammatory, autoimmune disorder
phenelzine (Nardil) use
depression
sertraline (Zoloft) use
depression
phenelzine (Nardil) MOA
decrease effectiveness of monoamine oxidase
tretinoin (Avita, Retin-A) MOA
decreases comedones formation and increase extrusion of comedones
fluticasone (Flonase) MOA
decreases local nasal passage inflammation, reducing nasal stuffiness
valproic acid (Depakote) MOA
desensitize sodium channels
dopamine agonists
directly activate/stimulate dopamine receptors
thrombolytics
dissolve existing thrombi
Dietary concerns with PD drugs
do not take with high-protein meals or snacks/absorption
Third-generation antipsychotic
dopamine-serotonin system stabililzers (CNS)
DSSs
dopamine-serotonin system stabilizers. Dopamine partial agonist. Control positive and negative symptoms of schizophrenia. Ex aripiprazole.
Stalevo
early signs of toxicity: muscle twitching and spasmodic winking
tretinoin (Avita, Retin-A) use
early treatment and control of mild to moderate acne vulgaris
COMT inhibitors for PD
enhances effect of levodopa by blocking its breakdown: entacapone, tolcapone
AE of diuretics
fluid and electrolyte disturbances -dehydration -orthostatic hypotension -K and Na imbalances
lorazepam (Ativan) OD treatment
flumazenil (Romazicon) -benzodiazepine receptor antagonist
imipramine (Tofranil) use
for major depression
escitalopram (Lexapro) use
generalized anxiety and depression
heparin use
prevent thromboembolic events or treat conditions where immediate anticoagulation is needed
NMS symptoms
hyperthermia, rigidity, altered mental status, profuse sweating, possible rhabdomyolysis, renal failure, seizures, potentially fatal
zolpidem (Ambien) use
hypnotic
AchE inhibitors
improves function in three domains: ADLs, behavior, cognition
escitalopram (Lexapro) black box warning
increases the risk of suicidal thinking and behavior in children, adolescence and young adults with major depressive disorder and other psychiatric disorders
anticoagulants
inhibit clotting factor -prevent thrombi growth
hemostats
inhibit fibrinolysis, promote clot stability
Dopamine
inhibitory neurotransmitter in corpus striatum
Warfarin (Coumadin) MOA
inhibits action of Vitamin K
sertraline (Zoloft) MOA
inhibits reuptake of serotonin in the brain
hemolysis of RBC
initially Hct may be elevated (hemoconcentration); once fluid balance is restored anemia may be apparent Myoglobin in urine is released which can cause Rhabdomylosis and ATN ( acute tubular necrosis) (Acute renal failure)
Cholinesterase inhibitors (AchE) for AD
intensifying effect of acetylcholine at cholinergic receptor (CNS)
zolpidem (Ambien) contraindications
lactating women
thiazide diuretics are
less effective than loop diuretics
theophylline (Theolair, Theo-24) USE
long term prophylaxis of asthma that is unresponsive to beta agonists or corticosteroids
AD
loss of ability to perform tasks that require acetylcholine as the neurotransmitter. Inability to remember and to recall information.
haloperidol (Haldol)
management of acute and chronic psychotic disorders/ nonphenothiazine/ available in LA preparation.
permethrin (Acticin, Elimite, Nix) use
marketed as a cream or lotion
Parkinsonisms
may result from therapy with antipsychotic drugs that compete with binding of D2 (dopamine)receptors
hydrochlorothiazide (Microzide) use
mild to moderate HTN -reduce edema associated with heart, hepatic and renal failure
theophylline (Theolair, Theo-24) has a
narrow margin of safety
levodopa/carbidopa adeverse effects
nausea, drowsiness, dyskinesia, orthostatic hypotension, CV, psychosis, discoloration of sweat and urine
Pulse oximetry
noninvasive method of estimating the percentage of oxygen saturation in the blood using an oximeter with a specialized probe attached to the skin at a site of arterial pulsation, commonly the finger; used to monitor hypoxemia
A client has been taking furosemide (Lasix) for the past 3 years. This morning, the hospital laboratory notifies the nurse that the client's serum potassium level is 2.9 mEq/L. What is the nurse's best action at this time? a. Notify the health care provider. b. Ask the lab to retest the potassium level. c. Give potassium as an IV infusion. d. Withhold this morning's Lasix dose.
p. 752, Physiological Integrity Answer: Ask the lab to retest the potassium level Rationale: This potassium value is at a critical level. The nurse should request that the lab confirm that this value is accurate since the client has been taking furosemide for 3 years. The lab value should be confirmed prior to contacting the health care provider for orders.
hydrochlorothiazide (Microzide) AE
potential electrolyte imbalance due to loss of excessive K and Na
levodopa
precursor of dopamine synthesis/ crosses blood-brain barrier; dopamine does not
montelukast (Singulair) MOA
prevent airway edema and inflammation by blocking leukotriene receptors in airways
Alzheimer's disease (AD)
progressive loss of brain function characterized by memory loss, confusion, and dementia
montelukast (Singulair) use
prophylaxis of persistence chronic asthma
The client exhibits symptoms of depression after an extended period of financial difficulty. The nurse recognizes that this type of depression is classified as _____________________.
reactive Objective: Identify the two major categories of mood disorders, and their symptoms. Rationale: Reactive or situational depression results from challenging circumstances, such as illness, job difficulties, loss of loved ones, divorce, or financial difficulties. Cognitive Level: Comprehension Client Need: Psychosocial Integrity Nursing Process: Assessment
oxymetazoline (Afrin) AE
rebound congestion when used longer than 3-5 days -minor stinging and dryness in nasal mucosa may be experienced
A client with obsessive-compulsive disorder tells the nurse that he must check the lock on his apartment door 25 times before leaving for an appointment. The nurse knows that this behavior represents the client's attempt to:
reduce anxiety.
furosemide (Lasix) use
reduce edema associated with HF, hepatic cirrhosis, or renal failure
leukotriene modifers
reduce inflammatory component of asthma
memantine (Namenda)
reduces abnormally high levels of glutamate/excitatory/ too much glutamate may be responsible for brain cell death. Protective when reducing neuronal calcium overload
fasciotomy
remove pressure form eschar ( compartment syndrome) decrease pressure
Pyridoxine (B6)
reverses antiparkinson effects of Stalevo. Speeds up conversion of levodopa to dopamine before it can cross the blood-brain barrier.
donepezil (Aricept)
reversible holinesterase inhibitor/ enhances effects of acetylcholine in neurons in cerebral cortex, slowing neuronal degradation/ maximal benefit may take up to 6 months to achieve/ half-life 70 hours
diazepam (Valium) use
sedative and hypnotic
albuterol (ProAir H F A, Proventil H F A, Ventolin H F A) MOA
selectively binds to beta 2 adrenergic receptors in bronchial smooth muscle to cause bronchodilation
A client comes to the emergency department while experiencing a panic attack. The nurse should respond to a client having a panic attack by:
staying with the client until the attack subsides
oxymetazoline (Afrin) MOA
stimulate alpha adrenergic receptors in SNS -cause arterioles in nasal passages to constrict -dries mucous membranes
Acetylcholine
stimulatory neurotransmitter in corpus striatum
chlorpromazine (Thorazine)
symptomatic relief of positive symptoms./weak blockade of cholinergic receptors/ strong blockade of alpha-adrenergic receptors
albuterol (ProAir H F A, Proventil H F A, Ventolin H F A) use
termination of acute bronchospasm
Phenytoin (Dilantin) use
treat all types of epilepsy except absence seizures
oxymetazoline (Afrin) use
treat nasal congestion
fluticasone (Flonase) use
treat seasonal allergic rhinitis
dextromethorphan (Delsym) contraindications
treatment of chronic cough due to excessive bronchial secretions (asthma, smoking, emphysema)
Symptoms of PD
tremor, muscle rigidity, bradykinesia, postural instability, affective flattening
phenelzine (Nardil) drug-food
tyramine containing food can result in hypertensive cris
incidence of burns
~ 200,000 burns/year reported in Canada 5% require hospitalization In Ontario burns account for 1000 hospitalizations/year and 10,800 hospital days Mortality rate ~90% if >60 years of age, TBSA>40%, and inhalation injury
GI symptoms from acute phase
↓blood flow → ↓peristalsis → paralytic ileus Stress response → ↑ catecholamines → ↓ mucus and ↑ gastric acid = Curling's Ulcer (a form of stress ulcer with diffuse lesions) Assessment ______________ Treatment: NGT to suction (decompression), Zantac (Ranitidine)
A nurse enters a patient's room who has a suspected diagnosis of spinal muscular atrophy (SMA). Which finding by the nurse is most concerning? 1) The child's chest is visibly sunken inward. 2) The child appears to have an S-shaped sign. 3) The child has absent tendon reflexes. 4) The child has trouble initiating spontaneous movement.
1) Pectus excavatum can occur when the child breathes using the diaphragm without intercostal muscle support (paradoxical breathing). This causes the chest to funnel and the xiphoid process retracts, which further restricts respiratory development. Scoliosis, absent or diminished tendon reflexes, and diminished ability to initiate spontaneous movement are all expected in this patient. Page 816.
The nurse is caring for a child diagnosed with pectus excavatum post-op day 1 from a steel bar placement. Which finding by the nurse is most concerning? 1) Breath sounds are absent on the right side 2) The child is crying and says his chest hurts 3) The child is lying supine. 4) The child's mother is asking the child to roll to his right side and finish his homework.
1) This indicates a pneumothorax may have occurred as a post-operative complication, and this needs to be addressed immediately. The child should not roll to EITHER side for 4 weeks after surgery. However, we can encourage aerobic activity. Pain is expected after surgery.
The nurse has provided teaching to a family regarding clean intermittent catheterization for their 4 year-old daughter with myelomeningocele. Which statement, if made by the family, indicates that further teaching is required by the nurse? Select all that apply: 1) "When the catheter becomes stiff, we will soak it in warm water to soften it." 2) "We will store our catheter in a zip-top plastic bag." 3) "We will insert the catheter about 4-6 inches, or until we see urine flow." 4) "We will lubricate the catheter with a petroleum-based jelly before usage." 5) "We will clean our daughter's genitalia with a washcloth before catheterization."
1, 3, 4 When catheters become stiff, cloudy, rough, cracked, or damaged in general, they need to be thrown away. Catheters should be inserted approximately 2-3 inches for females and 4-6 inches for males, or until urine flow is noted. A water-based lubricator needs to be used. See page 809.
To prevent rupture of the sac in a patient born with myelomeningocele, which of the following treatments does the nurse anticipate? 1) Ultrasound 2) Surgical closure 3) Banding to form necrotic tissue 4) Insertion of drain to collect CSF leakage
2) Page 807.
A nurse admits a child who has a history cerebral palsy. Which assessment finding by the nurse is most concerning? 1) The mother reports the child had a seizure 5 hours ago. 2) The child has a fever of 100.3. 3) The child is standing on his toes. 4) The mother reports the child's twisting movements seem to have worsened since arriving at the clinic.
2) This fever could indicate aspiration pneumonia, and this needs to be investigated further immediately with questioning of coughing, respiratory difficulty, or sputum production. Seizures are common with cerebral palsy. The child's symptoms have likely worsened because of the stress due to a clinic visit. Standing on the toes or scooting on the back (instead of crawling on the abdomen) are both commonly seen in a patient with cerebral palsy.
The nurse is caring for a patient diagnosed with a meningocele. The nurse should perform all of the following actions except: 1) Documenting the presence of a sac protruding from the lower spinal column. 2) Documenting the presence of clear fluid draining from the meningocele. 3) Encouraging fluids hourly. 4) Measuring head circumference every shift.
2) This may indicate a CSF leak and should be reported
When assessing a child for developmental dysplasia of the hip, the nurse feels a "clunk" when the child's hip is abducted and relocated. Which of the following did the nurse perform? 1) Braxton's maneuver 2) Ortolani's sign 3) Trendelenburg's sign 4) Barlow's test
2) Barlow's is when the hip is adducted and dislocated.
While caring for a patient with a myelomeningocele, which of the following actions, if made by the pediatric nurse, is incorrect? Select all that apply: 1) The nurse reports the presence of clear fluid from the lesion. 2) The nurse places the child in supine position to prevent skin breakdown. 3) The nurse encourages that light-weight blankets be used in place of heavy blankets or coverings. 4) The nurse places a piece of plastic wrap below the meningocele. 5) The nurse moistens the sac with a saline-soaked piece of gauze.
2, 3 A warmer or isolette should be used in place of blankets, which may place too much pressure on the sac. Supine positioning should be avoided in patients with myelomeningocele, as this places excessive pressure on the spinal cord sac. Prone positioning is preferred.
A nurse prepares to care for a patient diagnosed with athetoid, or dyskinetic, cerebral palsy. Which of the following does the nurse expect to see? Select all that apply: 1) Hypertonicity of affected extremities 2) Drooling 3) Worsening of symptoms when the child gets stressed 4) Worm-like writhing 5) Exaggerated deep tendon reflexes
2, 3, 4 Others are characteristic of spastic cerebral palsy. The infant may also appear limp or flaccid with the face, neck, and tongue possibly affected.
The pediatric nurse knows that which of the following medications are commonly used for patients with cerebral palsy? Select all that apply: 1) Docusate sodium 2) Diazepam 3) Dantrolene sodium 4) Baclofen 5) Atropine
2, 3, 4, 5 Can also use botulinum toxin, but this is administered by a nurse practitioner or physician.
A nurse has just finished providing discharge teaching to the family of a child going home with a cast that was applied 30 minutes prior. Which statement by the family indicates that further teaching is necessary? Select all that apply: 1) "For the next couple of days, we should keep the casted arm above the level of the heart and apply ice." 2) "If my child's arm starts to itch, we can apply lotion if we can reach into the cast." 3) "We will tape a plastic bag around his cast before he takes a bath." 4) "If my child gets his cast wet, we'll blow dry it with the lowest heat setting on our blow dryer." 5) "We will make sure we regularly press the skin back around the edge of the cast." 6) "We will make sure our child does not eat anything messy while he has this cast on."
2, 4, 6 Nothing should be inserted into the cast, and lotions and powders should not be used. If the cast gets wet, a blow dryer with COLD air should be used. There is no need to adjust the child's diet, but the cast should be covered while the child eats or drinks. See page 844
While caring for a 9-year-old female in Buck's traction, which of the following actions by the nurse is correct? 1) The nurse encourages the child's 3 year-old sibling to sit on the bed and visit with the child. 2) The nurse helps the child learn how to raise and lower the head of her bed so she can complete her homework. 3) The nurse checks the capillary refill on the child's extremities every 4 hours. 4) The nurse teaches the child's mother to place the weights on the bedside table before the child uses the bedpan.
3) Extra visitors should not be invited on the bed- especially a toddler who may think the weights at the end of the bed are toys. The head of the bed should only be raised or lowered with physician's orders, and this should be done minimally. The weights should ALWAYS be hanging freely.
The day shift pediatric nurse receives report on the following 4 patients. After receiving report, which patient should the nurse assess first? 1) The 4-year-old female with cerebral palsy who admits with difficulty swallowing and a fever of 101.9. 2) The 9-month-old male with myelomeningocele who has absent deep tendon reflexes in bilateral lower extremities. 3) The 6-year-old male with Duchenne muscular dystrophy who appears sad and withdrawn. 4) The 7-year-old female with a spinal cord injury who reports numbness and tingling in her feet.
4) Spinal cord injury is a medical emergency that requires immediate assessment. A fever and difficulty swallowing in a child with cerebral palsy may indicate aspiration pneumonia, so this child should be seen next. Absent deep tendon reflexes are expected in a child with myelomeningocele, related to the paralysis seen below the sac. A child with Duchenne muscular dystrophy may be sad or withdrawn due to corticosteroid medication side effects or chronicity of the disease.
A concerned mother calls the and tells you the following pieces of information about her 2-year-old son. Which statement by the mother most concerns you? 1) "I noticed that when my son is standing, his knees touch but his feet seem really far apart." 2) "My son's feet are so flat, even though he's been waking for 9 months now." 3) "My baby really hates it when I try to feed him broccoli and keeps spitting it out onto his plate." 4) "This morning when I was trying to dress him, my son cried nonstop when I tried to put his shirt on."
4) This could indicate a sprain or fracture, and nursemaid's elbow is common in toddlers and preschoolers. This statement should be further investigated since it indicates pain/discomfort. It is not uncommon for infants to have flat feet, although the arch of the foot should begin to form after walking begins. However, some infants never develop an arch and have flat feet as adults. Genu valgum, or "knock knees", are commonly seen around the ages 2-3, and this will often resolve by ages 7-8. It is not uncommon for a toddler to dislike broccoli. Who does like broccoli.
The mother of a 3 month old infant calls the clinic and says "why can't my baby hold his head up? Is he developmentally delayed?" Which response by the nurse is best? 1) "Your child is unlikely to be developmentally delayed, but we would like you to come to the clinic for a well-baby check-up." 2) "Infants do not typically hold their heads up on their own before age 6 months, so you have nothing to worry about." 3) "You sound very concerned. This may indicate a developmental delay, but we would like you to come to the clinic for a well-baby check-up and testing." 4) "Your infant may not hold his head up for a couple more months. This is nothing to be concerned about."
4) This isn't an ideal answer, and could be worded more therapeutically, but out of the four options, this is the BEST answer. Infants lose head lag around 4-5 months.
The nurse is providing discharge teaching to the client with heart failure, focusing on when to seek medical attention. Which statement by the client indicates understanding of the teaching? a. "I will call the provider if I have a cough lasting 3 or more days." b. "I will report to the provider weight loss of 2 to 3 pounds in a day." c. "I will try walking for 1 hour each day." d. "I should expect occasional chest pain."
Answer: "I will call the provider if I have a cough lasting 3 or more days." Rationale: Cough, a symptom of heart failure, is indicative of intra-alveolar edema; the provider should be notified.
The client, a college athlete who has collapsed during soccer practice, has been diagnosed with hypertrophic cardiomyopathy. The client says, "This can't be. I am in great shape. I eat right and exercise." What is the nurse's best response? a. "How does this make you feel?" b. "This can be caused by taking performance-enhancing drugs." c. "This may be caused by a genetic trait." d. "Just imagine how bad it would be if you weren't in good shape."
Answer: "This may be caused by a genetic trait." Rationale: Hypertrophic cardiomyopathy is often transmitted as a single-gene autosomal dominant trait.
Which of the following does the nurse understand places the child with myelomeningocele at high risk for infection? A) Neurogenic bladder B) Bowel incontinence C) Latex allergy D) Exposure of sac E) Corticosteroid use
Answer: A and D. Neurogenic bladder is the failure of the bladder to either store urine properly or empty itself of urine. Because of this urinary stasis occurs in the bladder placing the child at risk for infection. In myelomeningocele, the spinal cord is exposed, placing the child at high risk for infection. Immediate surgery is needed to help prevent infection from occurring. Bowel incontinence often occurs in children with myelomeningocele, but does not pose the same health risks as urinary incontinence. Latex allergy, although common, would not promote risk for infection alone. Corticosteroid use is not common in children with myelomeningocele.
Which of these clients is best to assign to an LPN/LVN working on the telemetry unit? a. A client with heart failure who is receiving dobutamine (Dobutrex) b. A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea c. A client with pericarditis who has a paradoxical pulse and distended jugular veins d. A client with rheumatic fever who has a new systolic murmur
Answer: A client with restrictive cardiomyopathy who uses oxygen for exertional dyspnea Rationale: This client, who needs oxygen only with exertion, is the most stable; administration of oxygen to a stable client is within the scope of LPN/LVN practice.
The 7 year old patient has had a cast on to heal his fracture of his arm. After the expected time period, the nurse is teaching a child about what to expect when removing his cast. Which of the following teaching points should the nurse include? Select All that Apply: A) "The cast could begin to feel really warm as the striker saw is taking the cast off" B) "The striker saw will be very loud" C) "Look, see, the saw won't be able to cut your skin" D) "Once the cast is removed we will soak your leg in warm water" E) "you will still need to keep your leg very still even after the cast is removed"
Answer: A, B, C, and D. The cast/extremity under the cast could begin to feel warm during the cast removal process. The saw could be loud, but the nurse should demonstrate on him/herself that the saw can't won't cut the child. Once the cast is removed, it will be soaked and washed in warm soapy water, and it should be soaked in warm water daily. All of these need to be communicated to the child on the level of their understanding. The child should be told to start increasing activity the limb to regain strength and range of motion.
Which of the following could the nurse do to assess for hypotonia of the 4 month-old infant? SATA: A) Pick up the child and see if the child feels like it is slipping out of the nurse's grasp B) Assess to see if the child can momentarily support his own weight when placed in a standing position C) Hold the child up and ask them to walk forward for a few steps D) Move the infant from the supine position to the sitting position and see if the child can hold up his own neck E) Move the infants muscles and note any muscle spasms not associated with the muscle movement
Answer: A, B, and D. Hypotonia is often an indicator that the child has some form of neuromuscular disorder. The feeling that the child is slipping out of the examiners hands is often as sign of hypotonia. By four months the child is often able to support their own neck and to stand momentarily when their feet are placed on a flat surface and their body is in the vertical position. The child would not be able to walk on command at this age. Assessing for extraneous muscle spasms would indicate the presence of hypertonia, not hypotonia.
The nurse is caring for the patient with Russel's traction. Which of the following should the nurse include in this patients plan of care? SATA: A) Weight should remain off of the floor at all times B) Place a foot support to prevent foot drop C) Release traction for 5 minutes of every hour to provide skin care D) Ensure heel is resting on bed at all times E) Assess neurovascular status q 4 hours
Answer: A, B, and E. With all traction, the weights should remain off of the floor at all times and should not be released periodically or stopped for any reason unless emergent. A foot support will be needed for this patient because foot drop could develop related to the heel being elevated without support. The heel should be off of the bed at all times, not resting on it. Neurovascular status should be assessed often on this patient (as often as vitals are done).
Which of the following symptoms would the nurse expect to possibly see in the child with Duchenne muscular dystrophy? Select all that apply a) Protuberant belly b) Diminished intelligence c) Walking on the toes or balls of feet d) Gower's sign e) Spinal curvatures
Answer: A, C, D, and E. To protect balance, which is impaired in this disorder, the child may often have their belly sticking out with their shoulders pulled back. They often have a waddling gait and walk on the toes or on the balls of the feet. Gower's sign is the use of a special technique in order to rise off of the floor. Spinal curvatures often occur as the muscles in the body atrophy (including lordosis, kyphosis, and scoliosis). Intelligence is rarely affected by this disorder.
The nurse is providing discharge instructions to the family and the 5 year old child who has received a cast for his broken lower leg. Which statement, if made by the legal guardian would indicate the need for further teaching? A) I can place ice on the affected leg for the first 2 days for an hour at a time B) I should make sure that the leg is elevated C) We can use a blow dryer to help relieve the itching inside the cast D) We should call in if my kid complains of severe, unrelieved pain in his leg
Answer: A. Ice should only be used for periods of 20-30 minutes. All other pieces of information are correct (page 844).
A client with heart failure has furosemide (Lasix). Which finding would concern the nurse with this new prescription? a. Serum sodium level of 135 mEq/L b. Serum potassium level of 2.8 mEq/L c. Serum creatinine of 1.0 mg/dL d. Serum magnesium level of 1.9 mEq/L
Answer: Serum potassium level of 2.8 mEq/L Rationale: Clients taking loop diuretics should be monitored for potassium deficiency from diuretic therapy
The nurse is especially concerned to assess for adequate respiratory function in which of the following disease processes? Select all that apply: a) Spina bifida occulta b) Duchene muscular dystrophy c) Spinal Muscular Atrophy d) Brachial plexus injury e) Cerebral Palsy
Answer: B, C, and E.
The nurse is providing discharge instructions to the family and the 9 year old child who has received a Gore-tex cast for his broken lower leg. The mother states to the nurse, "how do I know if something is going wrong with the cast?" The nurse should teach the mother to call the physician if: A) The cast gets wet B) The toes become cold to the touch C) The child has a fever of 100 degrees for a couple hours D) The "petals" on the edge of the cast fall off E) The child feels extreme itchiness inside the cast
Answer: B, C, and E. Page 844. Because this is a Gore-tex cast, it is allowed to get wet and would not be a cause for concern. Any decrease in the neurovascular status of the limb should be reported including coolness of the toes. A temperature of 101.5 degrees or higher for 24 hours or longer should be reported. Because this is a gore-tex cast, no petals should be placed around the edges of the cast (page 843). Extreme itchiness within the cast would be reason to call.
In monitoring the diagnostic test of a client admitted with heart failure (HF), which finding is consistent with this diagnosis? a. Serum potassium level of 3.2 mEq/L b. Ejection fraction of 60% c. B-type natriuretic peptide (BNP) of 760 ng/dL d. Chest x-ray report showing right middle lobe consolidation
Answer: B-type natriuretic peptide (BNP) of 760 ng/dL Rationale: BNP is produced and released by the ventricles when the client has fluid overload as a result of HF; a normal value is less than 100 pg/mL
A nurse is assessing a 3 year old child in the pediatrics wellness clinic, which of the following would be least concerning to the nurse? a) The child is holding his right arm close to his chest and refusing to use it b) When the child stands with his knees together, his ankles are far apart c) The child's pelvis drops slightly whenever he walks d) The child is in the shortest percentile for his age group
Answer: B. This condition, known as genu valgum or knock-knees, a common finding in children aged 2-3 and would not be concerning to the nurse. Refusal to use a limb could be a sign of damage or fracture to that limb. Trendelenberg's sign, or the drop of the pelvis when walking, could be a sign of hip dysplasia. Being in the shortest percentile for his age group could be a sign of a growth delay possibly caused by an underlying condition.
You, the awesome sauce nurse, are working at the new equally amazing pediatric clinic that opened literally five minutes from your house (nice commute!) your first patient is a child with marked pectus excavatum. What is the top nursing diagnosis for this patient? A) Impaired mobility B) Ineffective breathing pattern C) Disturbed body image D) Chronic pain
Answer: B. children with marked pectus excavatum should have a thorough assessment of their cardiac and pulmonary function, because the funnel chest can place pressure on both of these symptoms impairing proper expansion of the lungs. Page 849.
Little baby joe was born with an outer sac on his spine. Which of the following would correlate with a diagnosis of myelomeningocele? SATA: A) Accompanying hydrocephalus B) Leakage of the CSF C) Absence of deep tendon reflexes D) Constant dribbling of urine E) Meninges of the spine in the sac
Answer: C and D. Hydrocephalus could be present with either meningocele or myelomeningocele. Leakage of CSF would indicate a serious complication, not a common finding. The absence of deep tendon reflexes or the constant dribbling of urine indicates some neural involvement, differentiating it from meningocele. Meninges in the sac occurs in both myelomeningocele and meningocele. In myelomeningocele, the cord itself also protrudes into the sac
The nurse caring for the client with heart failure is concerned that digoxin toxicity has developed. For which signs and symptoms of digoxin toxicity does the nurse notify the provider? Select all that apply. a. Hypokalemia b. Sinus bradycardia c. Fatigue d. Serum digoxin level of 1.5 e. Anorexia
Answer: Sinus bradycardia; Fatigue; Anorexia
The nursing student is helping to take care of the infant with myelomeningocele. Which of the following actions, if made by the student nurse, should the nurse intervene? a) The nursing student uses and overhead radiant heater to warm the baby b) The student keeps the perineum clean and dry c) The student puts an absorbent diaper on the baby to keep it dry d) The nursing student turns props the baby slightly to the side with a towel under the abdomen
Answer: C. Diapering is not done for infants with myelomeningocele in order to prevent putting pressure on the sac. An overhead warmer should be used with this baby for temperature control. It is important to keep the perineum clean and dry. The child can be propped onto the side with a towel slightly to prevent skin breakdown from being in the prone position for long periods of time.
The nurse is assessing a young infant who comes in after being involved in a serious MVA. The nurse's priority would be? a) Assess for the presence of hypotonia or hypertonia of the neck b) Listen to respiratory sounds c) Brace the child's back to immobilize the child's spine d) Obtain a set of vital signs
Answer: C. It would be important to immobilize this child's spine.
The nurse is caring for the older child who has just undergone surgical correction of pectus excavatum. Which of the following order should the nurse anticipate doing all of the following except: a) Assessing and teaching correct use of PCA pump b) Assessing for symmetry of breath movement c) Keeping the patient on bedrest with bedside commode d) Teaching the child to avoid lying on her side
Answer: C. The child will be on strict bedrest for until the physician clears the child for activity. It is important that during this time the child keep from rolling on either side in order to keep the newly inserted bar in place. A PCA pump may be used in the older child to provide adequate pain relief. Assessing symmetry of breath movements would be important as pneumothorax is a complication of this surgery.
Tommy is a young child who is started walking early in life and usually is very active and happy. His mother tells you of a slow change that has happened to her son, and that he is less active than he has been. He now seems tired a lot and has difficulty doing things he used to do, such as running and playing. Which of the following would the nurse want to assess first? a) Check the child's back for dimpling or a tuft of hair at the base of the spine b) Assess the child's pain level and level of consciousness c) The child's ability to stand up and walk d) The presence of infantile reflexes
Answer: C. This child is presenting signs that most line up with a form of progressive muscular dystrophy, and it would be important for the nurse to follow up on the mother's claims that the child has difficulty ambulating and playing.
The nurse recognizes that which medication when given in heart failure may improve morbidity and mortality? a. Dobutamine (Dobutrex) b. Carvedilol (Coreg) c. Digoxin (Lanoxin) d. Bumetamide (Bumex)
Answer: Carvedilol (Coreg) Rationale: Beta-adrenergic blockers reverse consequences of sympathetic stimulation and catecholamine release that worsen heart failure; they improve morbidity, mortality, and quality of life
The nurse is caring for a client with heart failure. For which symptoms should the nurse assess? Select all that apply. a. Chest discomfort or pain b. Tachycardia c. Expectorates thick, yellow sputum d. Sleeps on back without a pillow e. Shortness of breath with exertion
Answer: Chest discomfort or pain; Tachycardia; Shortness of breath with exertion
How does the nurse in the cardiac clinic recognize that the client with heart failure has demonstrated a positive outcome related to the addition of metoprolol (Lopressor) to the medication regimen? a. Ejection fraction is 25%. b. Client states that she is able to sleep on one pillow. c. Client was hospitalized five times last year with pulmonary edema. d. Client reports that she experiences palpitations.
Answer: Client states that she is able to sleep on one pillow Rationale: Improvement in activity tolerance, less orthopnea, and improved symptoms represent a positive response to beta blockers.
The client who has been admitted for the third time this year for cardiac failure says, "This isn't worth it anymore. I just want it all to end." What is the nurse's best response? a. Calls the family to lift the client's spirits b. Considers further assessment for depression c. Sedates the client to decrease myocardial oxygen demand d. Tells the client that things will get better
Answer: Considers further assessment for depression Rationale: This client is at risk for depression because of the diagnosis of heart failure, and further assessment should be done.
Which of the following actions of the pregnant woman would be most likely to affect the neuromuscular development of her unborn child in utero? A) The mother who says, "I drank a few alcoholic beverages in my second trimester, I just couldn't help it!" B) The 22 year old mother who started taking folic acid before she ever got pregnant C) The 27 year old mother who was involved in a car accident which caused her to go into labor D) The 19 year old who says, "I did drugs pretty bad, but I stopped as soon as I knew I was pregnant,"
Answer: D. Early in gestation, during 3-4 weeks of pregnancy, the neural tubes of the embryo begin to develop and differentiate. This is a critical time for the unborn child, and things like drug or alcohol use are most likely to cause developmental disorders during this time period.
When assessing children at the pediatric clinic, which of the following would the nurse want to investigate further? A) The two year old who gained control of his head and neck muscles before he was able to walk B) The infant who has very brisk deep tendon reflexes C) The young child who trips and falls while running around D) The infant who demonstrates hypertonia soon after birth.
Answer: D. Hypertonia of muscles or hypotonia (high or low muscle tone) would be considered abnormal findings in children and could be indicative of an underlying problem. Myelination proceeds in a cephalocaudal and proximodistal fashion, so the child would be expected to gain head control before being able to walk. Brisk deep tendon reflexes, while abnormal in older children, is normal in young infants. Tripping and falling could cause injury in the child, but would overall be considered a normal finding as children are still gaining control of their muscle function.
The nurse expects to see all of the following when assessing the newborn infant except: a) Flexible Metatarsus adductus b) Pes Planus c) Internal tibial torsion d) Polydactyly
Answer: D. Polydactyly, or the presence of an extra digit, would be considered abnormal in a newborn child. Flexible metatarsus adductus, also known as in-toeing, would be expected in the newborn infant, and would resolve as the infant matures (page 833). Internal tibial torsion, or the slight bowing of the legs, would also be expected r/t in-utero positioning. Pes Planus, or flat-footedness also occurs in infants and disappears as the child matures.
Although the client with cardiac failure is asymptomatic, the nurse suspects noncompliance with prescribed home therapy. Which laboratory test confirms the nurse's suspicions? a. B-type natriuretic peptide (BNP) 90 pg/mL b. Serum electrolytes c. Hemoglobin and hematocrit d. Digoxin level of 0.2 ng/dL
Answer: Digoxin level of 0.2 ng/dL Rationale: A therapeutic digoxin level is 0.8 to 2.0 ng/dL. A level of 0.2 ng/dL indicates that the client has not been taking his digoxin as prescribed.
The nurse prepares to administer digoxin to a client with heart failure and notes the following information: Temperature: 99.8 Pulse: 48 and irregular Respirations: 20 Potassium level: 3.2 mEq/L What action does the nurse take? a. Give digoxin; reassess the heart rate in 30 minutes. b. Give the digoxin; document assessment findings in the medical record. c. Hold the digoxin, and obtain a prescription for an additional dose of furosemide. d. Hold the digoxin, and obtain a prescription for a potassium supplement.
Answer: Hold the digoxin, and obtain a prescription for a potassium supplement Rationale: Digoxin causes bradycardia; hypokalemia potentiates digitalis. The nurse seeks to correct this situation through collaboration with the provider.
The nurse is caring for an 82-year-old client admitted for exacerbation of heart failure. The nurse questions the client about the use of which medication because it raises an index of suspicion as to the cause of heart failure? a. Ibuprofen (Motrin) b. Hydrochlorothiazide (HydroDIURIL) c. NPH Insulin d. Levothyroxine (Synthroid)
Answer: Ibuprofen (Motrin) Rationale: Long-term use of NSAIDs, such as ibuprofen (Motrin), causes fluid and sodium retention
Which priority problems may be considered for the client with heart failure? Select all that apply. a. Decreased fluid volume related to compromised regulatory mechanism b. Impaired Physical Mobility related to limited cardiovascular endurance c. Impaired Gas Exchange related to ventilation-perfusion imbalance d. Potential for pulmonary edema e. Risk for Ineffective renal Perfusion related to hypervolemia
Answer: Impaired Physical Mobility related to limited cardiovascular endurance; Impaired Gas Exchange related to ventilation-perfusion imbalance; Potential for pulmonary edema; Risk for Ineffective renal Perfusion related to hypervolemia
The home health nurse visits a client with heart failure who has gained 5 pounds in the past 3 days. The client states, "I feel so tired and short of breath." Which action should the nurse take first? a. Assess the client for peripheral edema. b. Listen to the client's posterior breath sounds. c. Notify the physician about the client's weight gain. d. Remind the client about dietary sodium restrictions.
Answer: Listen to the client's posterior breath sounds. Rationale: Because the client is at risk for pulmonary edema and hypoxemia, the first action should be to assess breath sounds.
When caring for a client who has undergone a partial left ventriculectomy, which of these new-onset clinical manifestations indicates the need for immediate action by the nurse? a. Chest pain with movement b. Fatigue after ambulation c. Muffled heart sounds d. Bi-basilar fine crackles
Answer: Muffled heart sounds Rationale: Muffled heart sounds may be a clinical manifestation of bleeding into the pericardial space; the nurse should assess the client for possible decreased cardiac output and should notify the surgeon.
Which of these nursing actions should the nurse delegate to a nursing assistant working on the medical unit? a. Determine the usual alcohol intake for a client with cardiomyopathy. b. Monitor the pain level for a client with acute pericarditis. c. Obtain daily weights for several clients with class IV heart failure. d. Check for peripheral edema in a client with endocarditis.
Answer: Obtain daily weights for several clients with class IV heart failure. Rationale: Daily weight assessment is included in the role of the nursing assistant, who will report the weights to the RN.
Which intervention will best assist the client with acute pulmonary edema in reducing anxiety and dyspnea? a. Monitor pulse oximetry and cardiac rate and rhythm. b. Reassure the client that his distress can be relieved with proper intervention. c. Place the client in high Fowler's position with the legs down. d. Ask a family member to remain with the client.
Answer: Place the client in high Fowler's position with the legs down Rationale: High Fowler's position and placing the legs in a dependent position will decrease venous return to the heart, thus decreasing pulmonary venous congestion.
The nurse is caring for the client with congestive heart failure (CHF) in the coronary care unit (CCU). The client is now exhibiting signs of air hunger and anxiety. Which nursing intervention does the nurse perform first for this client? a. Determines the client's physical limitations b. Encourages alternate rest and activity periods c. Monitors and documents heart rate, rhythm, and pulses d. Positions the client to alleviate dyspnea
Answer: Positions the client to alleviate dyspnea Rationale: Positioning the client to alleviate dyspnea will help ease air hunger and anxiety.
The nurse is assessing the client with a cardiac infection. Which symptoms support the diagnosis of infective endocarditis instead of pericarditis or rheumatic carditis? a. Friction rub auscultated at the left lower sternal border b. Pain aggravated by breathing, coughing, and swallowing c. Splinter hemorrhages d. Thickening of the endocardium
Answer: Splinter hemorrhages Rationale: Splinter hemorrhages are indicative of infective endocarditis.
After receiving change-of-shift report about these four clients, which client should the nurse assess first? a. The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes b. The 55-year-old admitted with pulmonary edema who received furosemide (Lasix) and whose current O2 saturation is 94% c. The 68-year-old with pericarditis who is reporting sharp, stabbing chest pain when taking deep breaths d. The 79-year-old admitted for possible rejection of a heart transplant who has sinus tachycardia, rate 104
Answer: The 46-year-old with aortic stenosis who takes digoxin (Lanoxin) and has new-onset, frequent premature ventricular complexes Rationale: This client's premature ventricular complexes may be indicative of digoxin toxicity. Further assessment for clinical manifestations of digoxin toxicity should be done and the physician notified about the dysrhythmia.
A client admitted for heart failure has a priority problem of Excess Fluid Volume related to compromised regulatory mechanisms. Which of these assessment data obtained the day after admission is the best indicator that the treatment has been effective? a. The client has a diuresis of 400 mL in 24 hours. b. The client's blood pressure is 122/84 mm Hg. c. The client has an apical pulse of 82 beats/min. d. The client's weight decreases by 2.5 kg.
Answer: The client's weight decreases by 2.5 kg. Rationale: The best indicator of fluid volume loss is daily weight; because each kilogram represents approximately 1 L, this client has lost approximately 2500 mL of fluid.
Which nursing intervention for a client admitted today with heart failure will assist the client to conserve energy? a. Client ambulates around the nursing unit with a walker. b. The nurse monitors the client's pulse and blood pressure frequently. c. The nurse obtains a bedside commode before administering furosemide. d. The nurse returns the client to bed when he becomes tachycardic.
Answer: The nurse obtains a bedside commode before administering furosemide. Rationale: Limiting the need for ambulation on the first day of admission to sitting in a chair or performing basic leg exercises promotes physical rest and reduced oxygen demand.
The client begins therapy with lisinopril (Prinivil, Zestril). What should the nurse consider at the start of therapy with this medication? a. The client's ability to understand medication teaching b. The risk for hypotension c. The potential for bradycardia d. Liver function tests (LFTs)
Answer: The risk for hypotension Rationale: Angiotensin-converting enzyme (ACE) inhibitors are associated with first-dose hypotension and orthostatic hypotension, which are more likely in those older than 75 years.
When following up in the clinic with a client with heart failure, how does the nurse recognize that the client has been compliant with fluid restrictions? a. Auscultation of crackles b. Pedal edema c. Weight loss of 6 pounds since the last visit d. Reports sucking on ice chips all day for dry mouth
Answer: Weight loss of 6 pounds since the last visit Rationale: Weight loss in this client indicates effective fluid restriction and diuretic drug therapy
Which of the following problems is most often associated with myelomeningocele? A. Biliary atresia B. Hydrocephalus C. Craniosynostosis D. Tracheoesophageal fistula
Answer: b. Hydrocephalus is a frequently associated anomaly in 80% to 90% of children.
Which of the following clinical manifestations of developmental dysplasia of the hip would be seen in the newborn? A. Lordosis B. Ortolani sign C. Trendelenburg sign D. Telescoping of the affected limb
Answer: b. In the newborn period, the dysplasia usually appears as hip joint laxity. During the Ortolani test, the examiner places forward pressure and then backward pressure on the trochanter. If the femoral head is felt to slip, dysplasia may be present. This test is most reliable from birth to 2 to 3 months.
A newborn with congenital clubfoot is being treated with successive casts. The parents ask why so many casts are required. The nurse should explain that: A. casts are needed for the traction. B. each cast is good for only 6 weeks. C. surgical intervention will not be necessary. D. They allow for gradual stretching of tight structures.
Answer: d. Serial casting is begun shortly after birth and before discharge from nursery. Successive casts allow for gradual stretching of skin and tight structures on the medial side of the foot. Manipulation and casting of the leg are repeated frequently (every week) to accommodate the rapid growth of early infancy.
While assessing the newborn infant, the nurse notices a dimple with a tuft of hair at the bottom of the spine. What is the nurse's priority action? a) Place the child in the prone position to protect the area b) Soak a sterile dressing and place it over the area c) Notify the physician d) Educate the family on what this means for the child
Answer: d. it would be important to educate the family on the presence of spina bifida occulta, a neural tube defect that typically is benign and is often considered a normal defect. It would be important to differentiate this form of spina bifida from the highly stigmatized forms of spina bifida such as myelomingocele.
wheezing
Difficult breathing with a high-pitched, whistling or signing sound during expiration; caused by narrowing of the bronchioles
You are doing rounds at the beginning of your shift when you notice a sputum specimen sitting on the bedside table in a patient's room. You ask the patient when he produced the sputum specimen. You learn the specimen is about 4 hours old. Knowing this information, what action would you take?
Discard the specimen and assist the patient in obtaining another specimen
You are the nurse working on the respiratory intensive care unit. You are aware that several respiratory conditions can affect the compliance of the lung tissue. Which condition leads to an increase in lung compliance?
Emphysema
The nurse is caaring for a patient who has just returned to the unit after a colon resection. The patient is showing signs of hypoxia. The nurse knows that is probably caused by what?
Shunting (Imbalance causes shunting of blood, resulting in hypoxia - low level of cellular oxygen. Shunting appears to the main cause of hypoxia after thoracis or abdominal surgery and most types of respiratory failure.)
A patient is having her tonsils removed. The patient ask the nurse what function the tonsils serve. Which of the following would be the most accurate response?
The tonsils help to guard the body from invasion of organism. (The tonsils, adnoids and other lymphoid tissue encircle the throat. These structures are important links in the chain of lympph nodes guarding the body from invasion of organisms entering the nose and throat.)
When removing a chest tube what does the patient need to do?
VALSAVA MANUEVER (take a deep and bear down)
barrel chest
a condition characterized by increased anterior-posterior chest diameter caused by increased functional residual capacity due to air trapping from small airway collapse. A barrel chest is frequently seen in patients with chronic obstructive diseases, such as chronic bronchitis and emphysema.
Emphysema
a long-term, progressive disease of the lungs that primarily causes shortness of breath.
A client is diagnosed with right-sided heart failure. Which assessment findings will the nurse expect the client to have? Select all that apply. a. Peripheral edema b. Crackles in both lungs c. Breathlessness d. Ascites e. Lung congestion
p. 749, Physiological Integrity Answer: Peripheral edema; Crackles in both lungs; Eng congestion Rationale: Clients diagnosed with right-sided heart failure generally retain fluid. Assessment findings are often related to the fluid gain and include increased weight gain, peripheral edema, crackles in the lungs (indicative of fluid in the lung tissues), and shortness of breath from the fluid accumulation.
An older adult taking digoxin and furosemide (Lasix) for chronic heart failure is admitted to the emergency department (ED) with an apical pulse of 52. A family member states that the client has fallen four times this week. What is the nurse's first action? a. Call the ED physician immediately. b. Draw a serum digoxin level. c. Assess for signs of hypokalemia. d. Establish the client's airway.
p. 753, Physiological Integrity Answer: Draw a serum digoxin level Rationale: The client has signs and symptoms of digoxin toxicity and needs to be placed on a monitor immediately to determine the extent of effects on the heart and conduction system. Symptoms of digoxin toxicity include blurred vision or yellow or green halos around visual images, confusion, muscle weakness, and vertigo. Toxicity may be increased from furosemide-induced hypokalemia. This can lead to premature ventricular contractions (PVCs) that may lead to other life-threatening dysrhythmias and death. Clients need to be cautioned not to store both digoxin and furosemide in the same container. The most common dose of each medication is available in a small white pill (similar in appearance), increasing the chances of error.
