Exam 5 - NUR 2140
A young woman calls the clinic and reports that her mother had an insulin reaction and was found unconscious. The young woman gave her a glucagon injection 20 minutes ago, and her mother woke up but is still groggy and "does not make sense." What should the nurse tell the daughter?
"Give her another injection and call the paramedics"; Glucagon injections can be repeated if one dose is not effective. Hypoglycemia is a medical emergency, and because this woman has not fully recovered, medical attention is needed
A patient is taking a solution of 5% iodine and 10% potassium iodide (Lugol's solution) prior to a thyroidectomy. The patient asks why iodine solution is used since iodine is needed to make thyroid hormone.
"High levels of iodine can temporarily reduce the amount of thyroid hormone your body makes and secretes"; the high levels of iodine found in potassium iodine solution will inhibit the synthesis and release of thyroid hormone. The effectiveness decreases over time so it is only used short term before more definitive treatment can be accomplished
The nurse has received a telephone call from an anxious mother of an 18 month old. In a panicked voice, the mother states, "I just discovered that my baby has swallowed an unknown amount of household cleanser." Which instruction would be appropriate for the nurse to give?
"Call 911 to take your child immediately to the nearest emergency department or health care agency."; time is a critical factor in acute poisoning. Rescue squad should transport immediately.
A patient with chronic adrenal insufficiency taking hydrocortisone (Cortef) and fludrocortisone is planning a family vacation. What essential teaching does this patient need prior to taking this trip?
"Carry an oral and injectable form of both drugs with you on your trip"; patients receiving replacement therapy for chronic adrenal insufficiency should carry PO and parenteral forms of the drugs are prescribed in case of emergencies where the drugs may not be readily available
The nurse is making rounds at the beginning of the shift and notes that the patient's total parenteral nutrition bag is empty. Which solution should the nurse hang until the total parenteral nutrition solution can be properly prepared and delivered to the nursing unit?
10% dextrose in water (D10W); 10% dextrose in water contains the highest concentration of glucose and should be hung until the new TPN bag is available. The solution selected should minimize the risk of hypoglycemia.
How many mg of macrominerals are needed per day for normal body functioning?
100 mg; inorganic substances
How many mg of microminerals are needed per day for normal body functioning?
20 mg; inorganic substances
What are the best ways to treat peptic ulcer disease and gastroesophageal reflux disease?
A combination of pharmacotherapy and lifestyle changes
Osteoporosis
A condition in which the body's bones become weak and break easily.
A nurse should anticipate the administration of vitamin K (AquaMEPHYTON) for which of the following patients?
A newborn infant, the patient who received an overdose of certain oral anticoagulants; Vitamin K is routinely given to newborn infants to prevent bleeding postdelivery. Vitamin K decreases the anticoagulant effects of the drug warfarin.
How is obesity determined?
BMI
The patient who is taking sulfasalazine (Azulfidine) develops a sore throat, bruising, and severe fatigue. The nurse determines that the patient is most likely experiencing drug-induced:
Blood dyscrasias. One adverse effect of sulfasalazine is blood dyscrasias, which may include anemia, leukopenia, and thrombocytopenia. Fever, an increase in bruising, and sore throat are all possible symptoms in these decreased cell counts.
Which of the following measures is used to assess the presence of obesity?
Body weight, body mass index, waist circumference; all indicators to assess obesity
A health care provider orders magnesium hydroxide (Milk of Magnesia) for a patient with constipation, secondary to postoperative opioid use. Before administering the drug, the nurse would assess:
Bowel sounds. Because magnesium hydroxide will stimulate peristalsis, it is important that the nurse assess for bowel sounds before giving he drug. If blockage or an ileus is suspected, the drug should be held and the provider notified.
The patient is taking diphenoxylate with atropine (Lomotil). What does the nurse assess when monitoring for therapeutic effects?
Decrease in loose, watery stools. Diphenoxylate with atropine is given for diarrhea. The patient should report a decrease in the number of loose, watery stools after administration.
Activated charcoal is ordered for a patient who accidentally overdosed on prescription medications. The nurse would question the order for activated charcoal for the patient with which condition?
Decreased level of consciousness; patients with decreased sensorium are at high risk for pulmonary aspiration. Activated charcoal should only be given to those patients if the airway is maintained with an endotracheal tube.
The patient is exhibiting the symptoms of Yersinia pestis exposure. Which pharmacologic therapy would most likely be used in the treatment of this patient?
Doxycycline
Before hanging a bag of total parenteral nutrition, the nurse checks the various components of the solution. Which elements would the nurse expect to see on the solution label?
Electrolytes, trace minerals, and multivitamins; in addition to the base solution, TPN contains electrolytes (sodium, potassium, chloride), trace minerals, and multivitamins.
A patient who has been taking dexamethasone for rheumatoid arthritis was unable to take the drug for several days due to an intestinal virus. The patient seeks treatment in the emergency department for complaints of severe nausea, vomiting, lethargy, fever, and hypotension. What drug does the nurse anticipate will be given to this patient?
Hydrocortisone (Solu-Cortef); the patient is experiencing symptoms of acute adrenal insufficiency related to the inability to take the prescribed drug for several days and will require immediate IV administration of hydrocortisone
A patient is prescribed lorcaserin (Belviq) for the treatment of obesity and is concerned about the risks involved with the drug. Which of the following should the nurse include when teaching this patient?
If less than a 5% weight loss has been achieved after 3 months, a different weight loss regimen may be needed; It is recommended that if a 5% weight loss is not achieved after 12 weeks of therapy with lorcaserin, the drug be discontinued and other options considered
Which of the following findings would the nurse consider to be effects of somatropin?
Increase in the length and width of long bones; organ, muscle, and connective tissue growth; increased synthesis of proteins GH increases the length and width of long bones, promotes organ, muscle, and connective tissue growth, and increases the synthesis of proteins
Which laboratory findings would the nurse monitor to determine if pharmacotherapy is helping a patient taking calcium supplementation for osteomalacia?
Increasing serum calcium and increasing phosphate levels; the patient with osteomalacia has low serum calcium and low phosphate levels. An indicator that replacement therapy is achieving therapeutic benefits would be increasing serum calcium and phosphate levels
What is the cornerstone of therapy for patients with type 1 and gestational diabetes?
Insulin
A patient was started on rosiglitazone for type 2 diabetes. He tells the nurse that he has been taking it for 5 days, but his glucose levels are unchanged. What is the nurse's best response?
It can take several weeks for rosiglitazone to provide full therapeutic effects, so the appropriate response would be to give it more time to reach effectiveness
The patient asks the nurse to explain how colchicine (Colcrys) works. The nurse would base the response on which physiological principle?
It reduces the pain associated with joint inflammation from gouty arthritis; Colchicine prevents the migration of neutrophils (WBCs) into the area of inflammation caused by uric acid crystals, reducing further inflammation and relieving the symptoms of gout and gouty arthritis
The patient has been started on orlistat (Xenical). The nurse would teach this patient to take this medication:
Just prior to each meal containing fats; Typically, orlistat is taken just prior to meals containing fats so that the drug can inhibit lipase and thus the absorption of lipids in the meal
What causes weight loss by interfering with the absorption of fats?
Lipase inhibitors
A patient will be treated with propylthiouracil (PTU) for hyperthyroidism. While the patient is taking this drug, which symptoms will the nurse teach the patient to report to the health care provider?
Low-grade fever, sore throat, an chills; symptoms of a possible infection. Because propylthiouracil may cause agranulocytosis, these symptoms should be reported to the provider.
The patient has developed severe diarrhea following 4 days of self-administered antacid preparation. The nurse suspects that the diarrhea may be caused by which type of antacid?
Magnesium compounds; especially in higher doses, often cause diarrhea
The nurse is preparing to hang a lipid (fat) solution and notes that fat globules are visible at the top of the bag. Which action should be taken?
Obtain a different container of solution; the nurse should not hang the lipids if separation of the emulsion or fat globules is visible in the solution. The solution should be returned to the pharmacy.
The patient with neurogenic diabetes insipidus is being started on an oral dose of desmopressin (DDAVP). which instruction should the nurse include in the teaching plan?
Obtain and record your weight each morning; patients on desmopressin need to obtain a daily weight and should monitor for the presence of any peripheral edema
Vitamin C (ascorbic acid) may cause a false negative result in ______ if taken within 48-72 hours of testing.
Occult blood
A patient asks the provider about a prescription for phentermine (Adipex-P) for obesity. Which of the following would be considered a contraindication for the use of this drug?
Pregnancy; Phentermine is a pregnancy category X drug and should not be used if the patient is pregnant or there is a possibility of pregnancy
The nurse is teaching the patient about the need for adequate intake of zinc in the diet. The nurse will teach the patient to increase consumption of:
Protein foods such as beans, lentils, and nuts; Zinc is found in protein foods such as beans, lentils, nuts, meats, and dairy
What are the drugs of choice in the therapy of peptic ulcer disease and gastroesophageal reflux disease?
Proton pump inhibitors; they block gastric acid secretion. H2-receptor antagonists suppress gastric acid secretion and are also widely prescribed for treatment
To meet his nutritional goals, the patient is placed on enteral feedings vita a nasogastric (NG) tube. Which intervention should the nurse perform in order to ensure that the patient is maintaining a proper fluid balance?
Provide additional free water in addition to that used for irrigating the tube; a patient receiving enteral feedings can be at risk for dehydration caused by an inadequate intake of free water. It is important to irrigate the tube with water s ordered, or per protocol (before and after an intermittent feeding or medication, or every 4-6 hours for continuous feedings), and to include additional free water throughout the day unless contraindicated.
The patient is suspected of being exposed to ionizing radiation. Which nursing intervention would have the greatest priority?
Provide supportive care for nausea, vomiting, and diarrhea; no antidote or specific treatment exists for radiation poisoning. Supportive therapy for the associated symptoms is the only treatment available.
Enteral nutrition (EN)
Provision of nutrients through the gastrointestinal tract when the client cannot ingest, chew, or swallow food but can digest and absorb nutrients.
The patient who is receiving enteral nutrition via a PEG tube and suddenly spikes a fever of 38.6*C (101.5*F). The nurse notifies the health care provider, who orders the solution and tubing to be changed immediately. Preventative measures to limit the risk of infection from enteral feedings include which of the following?
Refrigerate unused portions of feeding, hang a feeding solution no longer than 4 hours; refrigerating unused enteral feeding solutions and limiting the length of time the solution is not refrigerated will prevent the growth of pathogens
The nurse knows that the mechanism of action for chelating therapy is:
Removal of positively charged metals; chelating agents capture the toxic metal through a bonding process. The kidneys remove both the chelator and the metal bound to it from the body.
While taking orlistat (Alli), the nurse would instruct the patient to do which of the following?
Take a daily vitamin supplement containing fat-soluble vitamins; intake of the proper amount and type of vitamins and nutrients is important in a healthy weight loss program. Because orlistat interferes with lipid absorption, the patient should be taught to supplement the diet with a product that contains all the essential fat-soluble vitamins. The supplement should be taken at least 2 hours before or after the orlistat.
What should the nurse teach the patient who is newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid)?
Take the dose in the morning before breakfast, as close to the same time each day as possible; to closely approximate the body's own hormone levels, levothyroxine should be taken in the morning, ideally at the same time each day
The patient has been discharged home on total parenteral nutrition therapy. When making the home visits, which assessments should the home care nurse closely monitor?
Temperature and weight; the patient's temperature should be monitored for signs of infection and subsequent sepsis, which are complications of TPN therapy. The weight is monitored to assess the nutritional effectiveness of the TPN and to detect signs of fluid overload.
What is the major site of water reabsorption?
The large intestine; contains host flora
A teaching plan for a parent whose child is receiving somatropin (Nutropin) should include what important information?
The medication cannot be given orally; it can be given only parenterally; GH cannot be given PO; it can only be administered subcutaneously by injections.
A nurse should question the order for pancrelipase (Pancreaze) for which patient?
The patient with allergy to pork products. The enzymes in pancrelipase come from pork. If the patient is allergic to or has religious restrictions on pork, the drug is contraindicated.
A patient with type 1 diabetes will use a combination insulin that includes NPH and regular insulins. The nurse is explaining the importance of knowing the peak times for both insulins. Why is this important information for the patient to know?
The peak of hypoglycemic reaction is greatest around the peak of insulin activity
The nurse is scheduling the patient's daily medication. When would be the most appropriate time for the patient to receive proton pump inhibitors?
The proton pump is activated by food intake. Thus, administering it about 20-30 minutes before the first major meal of the day allows peak serum levels to coincide with when the maximum levels of pumps are activated, allowing maximum efficiency of the PPI.
What is the primary organ for absorption?
The small intestine; it is the longest portion of the alimentary canal
What is responsible for mechanical and chemical digestion?
The upper gastrointestinal tract
Lead poisoning treatment
Treatment include: Chelation therapy, to remove lead from the body, Chelating agents bind with lead and are then excreted in urine. Oral therapy include succumer or Chemet, used with lead levels between 20-44mcg/dL. IM therapy include edetate calcium disodium or CaeEDTA, used for lead levels between 45-69mcg/dL. This effectively removes lead from soft tissue and bone. Dimercaprol BAL, is used only for lead levels over 70mcg/dL because of its toxicity. This also removes lead from blood cells. penicillamine-Cuprimine, orally given after the above chelation therapy.
What's the difference between type 1 diabetes and type 2 diabetes?
Type 1 diabetes is characterized by insufficient insulin synthesis by the pancreas, whereas type 2 diabetes is characterized by insulin resistance in the target cells
Which of the preadministration assessment parameters would the nurse consider before administering edetate calcium disodium (Calcium EDTA) to a patient?
Urinary output; edetate calcium disodium may produce renal damage that may be reduced by ensuring adequate diuresis before therapy begins.
Cushing's syndrome
a condition caused by prolonged exposure to high levels of cortisol
Which assessment finding would cause the nurse to withhold the regularly scheduled dose of levothyroxine?
a heart rate of 110bpm would cause the nurse to hold the scheduled dose of levothyroxine, because it could indicate too high a level of thyroid hormone
radiation sickness
an illness caused by excess radiation exposure, marked by low white blood cell counts and nausea; possibly fatal
A patient has been taking a thiazide diuretic for treatment of hypertension and has been prescribed hydrocortisone (Cortef) for a significant allergic reaction to shellfish. Which symptom should be immediately reported to the provider?
an irregular heart rate and rhythm; a symptom of hypokalemia. Hydrocortisone given concurrently with diuretics such as thiazides, which cause loss of potassium, increase the risk of hypokalemia
gastroesophageal reflux disease (GERD)
backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus
What does the basic total parenteral nutrition solution consist of?
carbohydrates, lipids, amino acids, electrolytes, minerals, and vitamins
A patient with metastatic colon cancer is experiencing bowel-related complications of the cancer and treatment. Octreotide (Sandostatin) has been ordered. The nurse will anticipate which therapeutic effect from this drug?
decrease in the number of diarrheal stools per day; Octreotide prolongs intestinal transit time and stimulates reabsorption of fluids and electrolytes from the GI tract. These effects would have the therapeutic action of decreasing diarrhea related to the cancer or treatment.
Which of the following assessment findings would the nurse expect to observe in an adult patient experiencing therapeutic effects of levothyroxine (Synthroid)?
decreased reports of fatigue, decreased blood cholesterol levels, and pulse rate between 60-100bpm; a euthyroid (normal) state is indicated by a return to normal performance of ADLs without fatigue, normalizing cholesterol levels, and vital signs within normal limits with a pulse rate between 60-100bpm.
Which of the following assessment findings would indicate that therapeutic goals have been achieved for a patient with diabetes insipidus being treated with desmopressin (DDAVP)?
decreasing signs of dehydration; a patient with diabetes insipidus (DI) who is responding to therapy with desmopressin would have decreasing signs of dehydration
What are acute complications of diabetes?
diabetic ketoacidosis, hyperosmolar hyperglycemic state, hypoglycemia
IBS is treated with
dietary management, symptomatic therapy, and drugs that regulate intestinal motility
Omeprazole (Prilosec) is prescribed for a patient with gastroesophageal reflux disease. The nurse would monitor a reduction in which symptom to determine if the drug therapy is effective?
dysphagia, dyspepsia, nausea, belching Symptoms of GERD include dysphagia, dyspepsia, nausea, belching, heartburn, and chest pain.
A patient has been ordered methylpredinosolone (Medrol Dosepak) for treatment of a significant poison ivy rash. The nurse will teach the patient to report which adverse effects to the health care provider:
edema, eye pain or vision changes, and abdominal pain are symptoms of possible adverse effects from the methylprednisolone.
Which of the following symptoms would alert the nurse to the possibility of the development of toxicity to methotrexate (Rheumatrex, Trexall)?
headache, dizziness, and blurred vision; all symptoms of toxicity
gastrin
hormone secreted in the stomach that stimulates secretion of HCl and increases gastric motility
What is used to treat inflammatory bowel disease?
immunosuppressants and anti-inflammatory drugs
Disease-modifying antirheumatic drugs (DMARDs) are prescribed for patients with rheumatoid arthritis. Which statement related to this therapy is correct? DMARDs:
include gold salts, antimalarial drugs, and medications that modify the immune response; enhance the quality of life in patients with rheumatoid arthritis; often take several months to achieve maximum therapeutic effects
The nurse explains the benefit of using the long-acting insulin glargine (Lantus) over other insulins. What will the nurse tell the patient about this insulin?
insulin glargine has no definite peak, so there is a minimal risk for hypoglycemic reaction.
The nurse would consider which of the following assessment findings as adverse effects to metformin therapy?
lactic acidosis; a serious adverse effect of metformin is the risk for developing lactic acidosis. Renal insufficiency and failure, excess alcohol use, and IV contrast agents increase the risk for lactic acidosis and are contraindicates to the use of metformin.
Parenteral Nutrition (PN)
method of supplying nutrients to the body by an intravenous route
What are serious complications of chronic diabetes?
neuropathy, nephropathy, retinopathy, and vascular disease
What enzymes break down proteins and polypeptides?
pepsin (gastric glands) trypsin, chymotrypsin, and carboxypeptidase (pancreatic juice) aminopeptidase (small intestine)
What are the classic signs of diabetes?
polyuria, polydipsia, polyphagia
What enzymes break down carbohydrates and starches?
salivary amylase (saliva) pancreatic amylase (pancreatic juice) maltase, sucrose, and lactase (small intestine)
What miscellaneous drugs are beneficial in treating peptic ulcer disease?
sucralfate, bismuth subsalicylate, and misoprostol
The patient on replacement therapy with levothyroxine (Synthroid) reports feeling nervous and is having occasional palpitations and tremors. The nurse recognizes that these symptoms may indicate what effect is occurring?
the patient is experiencing symptoms of hyperthyroidism and the drug dosage may need to be decreased; the administration of too much levothyroxine may cause hyperthyroidism, characterized by nervousness, palpitations, weight loss, diarrhea, and muscle tremors. Before altering the dosage, thyroid function studies will be performed to verify this condition.
A patient with adrenocortical insufficiency has started therapy with fludrocortisone (Florinef). What important intervention related to this drug therapy should the nurse teach the patient?
the patient should obtain a daily weight, ideally at the same time each day to assess for excessive fluid retention. Fludrocortisone is a mineralocortidoid and may cause fluid retention, edema, and HTN
Which vitamins are fat-soluble?
vitamins A, D, E, and K
An older adult patient with chronic bronchitis has been receiving low-dose therapy with dexamethasone for several months to reduce the inflammation occurring secondary to the bronchitis. What teaching should this patient receive to reduce the risk of osteoporosis related to dexamethasone use?
weight-bearing exercise three to four times weekly and increased dietary intake of calcium and vitamin D may help to prevent bone loss and osteoporosis.
The patient who has been prescribed alendronate (Fosamax) demonstrates an understanding of how to correctly take the medication when stating:
"I will take my medication with a full glass of water 30 minutes before breakfast."; Alendronate may cause severe GI adverse effects. To decrease this risk, particularly for esophageal irritation, and to promote the absorption of the medication, alendronate should be taken with a full glass of water after rising in the morning. The patient should not eat or drink anything or lie down for 30 minutes after administration.
Glucocorticoids (cortisol)
Adrenal cortex stimulates gluconeogenesis anti-inflammatory immunosuppression increases blood sugar levels
The prescriber orders sucralfate (Carafate) for a patient with peptic ulcer disease. The nurse should question the order if the patient is currently taking:
Aluminum salt antacids; Concurrent use of aluminum salts and sucralfate poses a risk for aluminum toxicity.
Prior to starting a patient on vasopressin for control of esophageal varices, the nurses will obtain the patient's past health history. If present, what condition might indicate the need to verify the order with the prescriber?
Angina; Vasopressin is a potent vasoconstrictor and may precipitate angina or myocardial infarction
What drugs are used to lose weight by suppressing appetite and hunger?
Anorexiants
What alkaline substances neutralize stomach acid to treat symptoms of heartburn?
Antacids
The nurse who is caring for a patient with gastroesophageal reflux disease should question the order for which drug?
Antibiotics; antibiotics have no role in the treatment of GERD although certain antibiotics are used in treating PUD to eradicate the H. pylori organism.
Pyridoxine (vitamin B6) may cause antagonistic drug effects for the patient taking:
Antiparkinsonism drugs; Pyridoxine (vitamin B6) may reverse or antagonize the effects of anti-Parkinson's drugs
Which vitamins are water soluble?
B-complex vitamins and vitamin C
Ondansetron (Zofran) has been ordered prior to chemotherapy for a patient receiving treatment for lymphoma. Prior to administering this drug, the nurse will review the patient's past medical history for what condition?
Cardiac dysrhythmias. Ondansetron is known to prolong the QT interval and may cause cardiac dysrhythmias.
A patient asks the nurse about giving an over-the-counter drug, bismuth subsalicylate (Pepto-Bismol), to treat a daughter's diarrhea. On which of the following will the nurse base the recommendation?
Cause of diarrhea and age. The nurse should explore possible causes for the diarrhea with the mother before making a recommendation because if diarrhea is caused by infections, slowing motility may allow the infection to increase. Salicylates, including bismuth subsalicylate, are contraindicated in children under the age of 19 because of an increased risk for Reye's syndrome.
Before administering a morning lispro insulin (Humalog) injection, which activity should the nurse perform?
Check the patient's finger-stick glucose level; ensure that breakfast trays are present on the unit and the patient may eat; assess for symptoms of hypoglycemia the blood glucose level should be checked prior to administering any type of insulin. Because lispro is a rapid-acting insulin, the nurse should ensure that a meal is available and that the patient will be able to eat shortly after receiving a dose. If signs of hypoglycemia are present, the insulin dose should be held and the patient treated for hypoglycemia. The provider should be notified.
A nurse is instructing a patient taking orlistat (Xenical) about adverse effects of the medication. Which symptoms indicate the presence of an expected adverse effect?
Flatus with discharge and oily stool; flatus and oily stools are adverse effects that are often troubling to the patient. The nurse should inform the patient that these often occur when taking orlistat.
What gram-negative bacterium is associated with approximately 70% of patients with peptic ulcer disease?
H. pylori
The nurse would suspect a calcium deficiency in the patient exhibiting:
Muscle cramping and spasms; muscle cramping an spasms may be early signs of hypocalcemia
Which assessment findings in a patient who is receiving calcitriol (Rocaltrol) should the nurse immediately report to the prescriber?
Muscle weakness, nausea, and vomiting; Vitamin D toxicity may occur in the patient receiving calcitriol. Symptoms to assess include muscle weakness, fatigue, nausea, vomiting, and changes in the color or amount of urine.
A patient who has duodenal ulcers is receiving long-term therapy with ranitidine (Zantac). The nurse includes the care plan that the patient should be monitored for which adverse effects?
Neutropenia and thrombocytopenia; Blood dyscrasias have been reported, especially neutropenia and thrombocytopenia, with long-term use. Periodic blood counts should be performed.
What are the most effective drugs for controlling severe diarrhea?
Opioids
A health care provider has ordered oral vitamin A (Aquasol A) supplements for a patient. The serum level of vitamin A may be increased if the patient is also taking:
Oral contraceptives; may increase the serum levels of vitamin A
What are administered as replacement therapy for patients with chronic pancreatitis?
Pancreatic enzymes
What enzymes break down lipids?
Pancreative lipase (pancreatic juice)