PHARM EXAM 3 TP questions

The nurse is preparing medication for 4 clients on a respiratory medical-surgical unit. Which situation would prompt the nurse to clarify the prescribed treatment with the health care provider? a. Client with bronchospasm who is due to receive nebulized acetylcysteine b. client with chronic obstructive pulmonary disease scheduled to receive PO prednisone c. client with cystic fibrosis scheduled to received PO pancrelipase with breakfast d. client with suspected bacterial pneumonia scheduled to receive IV levofloxacin

A. Client with bronchospasm who is due to receive nebulized acetylcysteine

Which of the following principles is accurate regarding administration of packed red blood cells (PRBCs)? a. Increase of body temperature by two degrees Fahrenheit or more is expected during blood administration b. the nurse is responsible for obtaining the consent to administer blood from the patient c. the nurse would remain with the patient for the first 15 minutes of the infusion d. if a blood transfusion is expected, the nurse should stop the blood and remove the peripheral IV it was running through

c. the nurse would remain with the patient for the first 15 minutes of the infusion

A nurse is assessing a client for hypoxemia during an asthma attack. Which of the following manifestations should the nurse expect? a. Dysphasia b. Hypotension c. Nausea d. Agitation

d. Agitation

A client has a V/Q of 1/5 or 0.25. What type of condition would be consistent with this V/Q? a. Sickle cell anemia b. Deep vein thrombosis c. Pulmonary embolism d. COPD exacerbation

d. COPD exacerbation

A nurse is assessing a client who is suspected of a pneumothorax. Which of the following is most concerning? a. shifting of the trachea toward the unaffected lung b. air is able to move in and out of the pleural space on the affected side c. diminished lung sounds on the affected side d. patient reports pleuritic pain on inspiration and exhalation

A. shifting of the trachea toward the unaffected lung

RN caring of a patient experiencing hypervolemia related to right-sided heart failure. Which of the following medications do you anticipate being prescribed to address the fluid volume overload? a. metoprolol b. 0.9% normal saline c. furosemide d. epinephrine

C. Furosemide It's a great diuretic medication; to get the fluid excreted of the body

A nurse in the ED is caring who is brought from home experiencing a severe asthma attack. Which of the following interventions is the for the nurse to nurse? a. adminster an inhaled glucocorticoid b. obtain a peak flow reading c. administer a short-acting beta 2-agonist (SABA) d. determine the cause of the acute exacerbation

C. administer a short-acting beta 2-agonist (SABA)

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone. Which of the following instruction should the nursing provide? a. check pulse after medication b. taking the medication with meals c. rinse mouth with water after administration d. limit caffeine intake

C. rinse mouth with water after administration

The nurse is teaching a client who has a new prescription of clopidogrel. Which of the following instructions should the nurse include? a. "You might have to stop taking the medications 5 days before any planned surgeries" b. "Clopidogrel is monitored using INR " c. "This medication is used to prevent pulmonary embolisms and DVTs" d. "Expected to have black colored stool while taking this medication"

a. "You might have to stop taking the medications 5 days before any planned surgeries"

Which of the following FEV1/FVC ratios indicates an obstructive airway disease? a. 1/3 b. 4/5 c. 2.8/3 d. 3.7/4

a. 1/3

A client is having a COPD exacerbation, their baseline V/Q is 3/5. Which of the following would be an expected change in their V/Q during the exacerbation? a. 1/5 b. 4/5 c. 4/1 d. no change during exacerbation

a. 1/5

You are an ER nurse caring for 4 clients, who all came into the ED reporting signs and symptoms of an asthma attack. Which client is your priority to see? a. A client absent breathing sounds bilaterally b. A client who finds crackles to hears during exhalation c. A client with coarse breath sounds a productive cough d. A client with high pitch, squeaking breath sounds bilaterally

a. A client absent breathing sounds bilaterally

A V/Q ratio is a comparison of ... a. Airflow to blood flow in the lungs b. Hydrogen ions to bicarbonate ions in the body c. Carbon dioxide and oxygen exchange in the lungs d. Oxygen affinity to hemoglobin dissociation

a. Airflow to blood flow in the lungs

Which type of COPD involves hypertrophy of mucus-secreting cells? a. Chronic bronchitis b. Emphysema c. Epiglottitis d. Croup

a. Chronic bronchitis

A nurse is teaching a client who has asthma about how to use salmeterol (SABA) and budesonide inhalers. Which of the following actions by the client indicates an understanding of the teaching? a. I will use my salmeterol inhaler first, wait a few minutes, and then use my budesonide b. I will use by budesonide inhaler first, wait a few minutes, and then use my salmeterol c. I will wait 10 minutes between inhalations of these 2 medications d. I will administer both of these medications simultaneously for maximum benefit

a. I will use my salmeterol inhaler first, wait a few minutes, and then use my budesonide

In the oxygen-hemoglobin dissociation curve, the strength of oxygen binding to hemoglobin is impacted by several factors ... (SATA) a. Metabolic needs b. Elevation/altitude c. CO2 levels d. Body temperature e. pH

a. Metabolic needs b. Elevation/altitude c. CO2 levels d. Body temperature e. pH

Which of the following is NOT recommended as a mean of oxygen delivery for a patient experiencing a COPD exacerbation? a. Non-rebreather b. Nasal cannula c. Simple face mask d. Venturi mask

a. Non-rebreather

A client with a history of peripheral arterial disease is asking how to respond to episodes where they're waking up in the middle of the night and their legs feel like "they're on fire" and they are in extreme pain. Which recommendations would be most appropriate for the nurse to give this client? a. Sit at the edge of the bed and have your legs in a dependent position b. put some compression stockings c. perform leg exercises in bed d. stand up and walk around the neighborhood for two to three blocks

a. Sit at the edge of the bed and have your legs in a dependent position

The nurse should instruct a client with sickle cell anemia to do which of the following? Select all that apply a. avoid cities that have high elevations and therefore lower oxygen levels b. drink plenty of fluids went outside in hot weather c. if client develops sickle cell crisis, the only pain medications they should take are NSAIDs d. in sickle cell crisis, severe abdominal pain should be reported to the HCP immediately

a. avoid cities that have high elevations and therefore lower oxygen levels b. drink plenty of fluids went outside in hot weather d. in sickle cell crisis, severe abdominal pain should be reported to the HCP immediately

Which of the following are consistent with deep vein thrombosis? SATA a. calf pain b. leg edema c. leg pallor d. absent pedal pulses e. necrosis ulcers on the foot

a. calf pain b. leg edema

A client was admitted to the hospital for a COPD exacerbation and has been receiving high dose of Dexamethasone IV for the entire week. Which of the following is a side or adverse side affect? a. client's blood pressure have been trending upwards all week long b. client reports weight loss of 2 kg in the past week c. client's report fast blood glucose is 90 d. client reports that they are producing less and less urine every day

a. client's blood pressure have been trending upwards all week long

A client who recently experienced a myocardial infarction is being discharged home on an antiplatelet medication to prevent re-infarction. Which medication is being described? a. clopidogrel b. heparin c. desmopressin d. warfarin

a. clopidogrel

A nurse is caring for a client who has emphysema. Which of the following findings should the nurse expect to assess in this client? (SATA) a. clubbing of the fingernails b. dyspnea c. bradycardia d. barrel-chested e. frequent respiratory infections

a. clubbing of the fingernails b. dyspnea d. barrel-chested e. frequent respiratory infections

A client is on bedrest following bowel surgery for a small bowel obstruction. On the fourth post-op day, the nurse is assessing the client and finds unilateral swelling, pain, and erythema in the client's right calf. And is now prescribed heparin 80 units/kg IV bolus followed by heparin 18 units/kg/hr IV infusion. The client's lab values follows as aPPT of 195 in the following morning. Now, the client has reached therapeutic ranges for aPPT and started transitioning to Warfarin to be soon discharged to go home. Which health teaching will the nurse include as a part of discharging related to Warfarin therapy? (SATA) a. contact your HCP if you if your stool is black and tarry b. if you eat green, leafy vegetables, make sure to eat a consistent amount each day c. take ibuprofen or aspirin for mild pain d. keep your scheduled appointment at the warfarin clinic where your INR will be tested e. monitor your heart rate and blood pressure daily to assess signs of bleeding f. the goal of the INR range is between 5-6

a. contact your HCP if you if your stool is black and tarry b. if you eat green, leafy vegetables, make sure to eat a consistent amount each day d. keep your scheduled appointment at the warfarin clinic where your INR will be tested e. monitor your heart rate and blood pressure daily to assess signs of bleeding

A nurse is caring for a pre-school age child who has epiglottitis. Which of the following actions should the nurse take? a. monitor oxygen saturations b. implement airborne precautions c. allow the child to suck on hard candy to comfort them d. obtain a throat culture

a. monitor oxygen saturations

You are caring for a patient with a V/Q ratio of 4. what does that tell you? a. perfusion to the lungs is inadequate b. ventilation to the lungs is low c. this is known as a shunt d. both ventilation and perfusion are normal

a. perfusion to the lungs is inadequate

A client is on bedrest following bowel surgery for a small bowel obstruction. On the fourth post-op day, the nurse is assessing the client and finds unilateral swelling, pain, and erythema in the client's right calf. And is now prescribed heparin 80 units/kg IV bolus followed by heparin 18 units/kg/hr IV infusion. The client's lab values follows as aPPT of 195 in the following morning. Which action does the nurse anticipate performing next? a. place the heparin infusion on hold b. administer vitamin K IVPB c. assess vital signs d. assess urine for blood

a. place the heparin infusion on hold

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for five days. The provider prescribes warfarin PO without discontinuing the heparin. The client asked the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? a. "The Ivy heparin increases the effects of warfarin and decreases the length of your hospital stay" b. "Warfarin takes several days to work so the IV heparin will be used until the warfarin reaches a therapeutic level" c. "Both heparin and warfarin work together to dissolve the clots" d. "I will call the provider to get the prescription for discontinuing the Ivy heparin today"

b. "Warfarin takes several days to work so the IV heparin will be used until the warfarin reaches a therapeutic level"

A nurse is teaching the mother of a 5-year-old child with cystic fibrosis about pancreatic enzymes. The nurse should understand that further teaching is necessary when the mother states which of the following? (SATA) a. "the pancrelipase should be given with meals and snacks" b. "i will give my son the enzymes after meals" c. "the enzymes help him digest fats" d. "the pancrelipase will help the absorption of vitamin C"

b. "i will give my son the enzymes after meals" d. "the pancrelipase will help the absorption of vitamin C"

A client is prescribed albuterol and budesonide inhalers. How should they be administered? a. Client should monitor for Canada in the mouth related to the albuterol b. Albuterol should be taken 5 minutes before the budesonide c. Client should rinse their mouth out before taking the budesonide inhaler d. Clients are monitor blood glucose levels related to the Albuterol

b. Albuterol should be taken 5 minutes before the budesonide

The client who has a history of a myocardial infarction is prescribed aspirin 325 milligrams. The nurse recognizes that the aspirin is given due to which of the following actions of the medication? a. Antipyretic b. Antiplatelet aggregate c. Analgesic d. anti-inflammatory

b. Antiplatelet aggregate

A client is being evaluated for possible lung diseases. Pulmonary function testing is performed. Which finding is most concerning for obstructive airway disease? a. V/Q of 0.80 b. FEV1/FVC of 40% c. V/Q of 2 d. FEV1/FVC of 97%

b. FEV1/FVC of 40%

Which of the following is an accurate list of the clotting factors that the liver produces? a. Factors I, III, V b. Factors II, VII, XI and X c. Factors I, II, V, and X d. Factors XII, XI X, and IX

b. Factors II, VII, XI and X

Which of the following conditions/states makes it easier for oxygen to dissociate from hemoglobin at the tissues? a. Hypocapnia b. Hyperthermia c. Low metabolism d. Hypothermia

b. Hyperthermia

A client with chronic liver disease is deficient in clotting factor VII. Which lab value do you expect to be elevated for this client? a. aPPT b. INR c. creatinine d. potassium

b. INR

A nurse is reviewing the lab data on a client who has a new prescription of heparin for treatment for a pulmonary embolism. Which of the following data should the nurse report to the provider? a. Hemoglobin 12.9 g/dL b. Platelets 54,000/mm3 c. Activated partial thromboplastin time (aPPT) 65 sec d. White blood cells 8,000/mm3

b. Platelets 54,000/mm3

A V/Q of 2/5 indicates sufficient perfusion to the lungs with inadequate ventilation, also know as ... a. Dead air space b. Shunt c. Acidosis d. Pneumothorax

b. Shunt

Oxygen dissociation from hemoglobin at the tissue is based on a. The partial pressure of carbon dioxide in the bronchioles b. The tissues need for oxygen c. the ratio of red blood cells destruction to red blood cells production in the body d. The alveoli's need for oxygen

b. The tissues need for oxygen

Which of the following is true regarding the hematologic system? a. the ideal blood pH for homeostasis is 6.35-7.0 b. a functioning liver is needed to make certain clotting factors c. the body contains approximately 6-8 liters of blood d. circulating albumin is needed to make antibodies

b. a functioning liver is needed to make certain clotting factors

A client calls telehealth nurse asking for advice. The client has a history of asthma and is currently reporting chest tightness, wheezing, and a cough. Which medications should the nurse recommend the patient take at this time? a. prednisone b. albuterol c. montelukast d. budesonide

b. albuterol

What is the reasoning behind why we use heparin and Warfarin to treat venous and arterial clots? a. Because both of these clots are made mostly of hemoglobin b. because both of these clots contain fibrin c. because both of these clouds are made mostly of platelets d. because both of these clots depend on vitamin K

b. because both of these clots contain fibrin

A patient with a COPD exacerbation is received IV systemic corticosteroids. Which of the following is an anticipated lab value or vital sign for this patient? a. WBC count of 5,500 b. blood glucose of 253 c. platelet count of 257,000 d. blood pressure of 90/50

b. blood glucose of 253

A client is on bedrest following bowel surgery for a small bowel obstruction. On the fourth post-op day, the nurse is assessing the client and finds unilateral swelling, pain, and erythema in the client's right calf. And is now prescribed heparin 80 units/kg IV bolus followed by heparin 18 units/kg/hr IV infusion. Which of the following additional actions would be indicated? (SATA) a. teach the client to avoid food that are high in vitamin K b. check platelet count for this patient in the morning c. monitor for hematuria and blood in the stool d. massage bilateral calf muscles to promote circulation e. place the client legs in the dependent position as much as possible

b. check platelet count for this patient in the morning c. monitor for hematuria and blood in the stool

A client is admitted to the hospital with sickle cell crisis after hypothermia in a cold climate. Which of the following is accurate list of interventions used to treat this condition: a. plasmapheresis to remove autoantibodies causing sickle cell crisis b. hydrate with IVF, severe pain management with opioids, supplement oxygen as needed c. immediate surgical intervention to remove the spleen, vasopressors to maintain adequate blood pressure d. draw blood cultures, administered antibiotics, assess lactic acid levels

b. hydrate with IVF, severe pain management with opioids, supplement oxygen as needed

In the oxygen-hemoglobin dissociation curve, a shift to the left means ... a. Hemoglobin releases oxygen to the tissues easily b. it is more difficult for tissues to extract oxygen from hemoglobin c. it is easier for tissues to extract oxygen from hemoglobin d. oxygen and hemoglobin have a low affinity to one another

b. it is more difficult for tissues to extract oxygen from hemoglobin

Which oxygen delivery method/dose should a nurse question for a client with a COPD exacerbation? a. simple mask with an oxygen dose of 2-3 L/min b. non-rebreather mask with an Fio2 of 90% c. nasal cannula with an oxygen dose of 1-2 L/min d. Bipap with an FiO2 setting of 24%

b. non-rebreather mask with an Fio2 of 90%

A client has an FEV1/FVC ratio of 95%. Which type of airway diease do they have? a. obstructive b. restrictive c. both obstructive and restrictive d. neither - lung function is normal

b. restrictive

FINAL A nurse is caring for a client who has streptococcal pneumonia and a prescription for penicillin G by intermittent IV bolus. 10 minutes into the infusion of the 3rd dose, the client reports the IV site itches and that he feels dizzy and short of breath. Which of the following actions should the nurse take first? a. call the client's provider b. stop the infusion c. elevate the head of the bed d. auscultate the client's breath sounds

b. stop the infusion

The client experiencing sickle cell crisis for the first time asked you why are they feeling so much pain all over their body. You understand that the primary reason for this generalized pain is? a. Autoantibodies attacking their peripheral nerves b. vascular occlusions leading to tissue hypoxia c. neuropathic pain associated with hypotension d. because the medications used to treat sickle cell cause nociceptive pain

b. vascular occlusions leading to tissue hypoxia

A nurse is caring for a client who has a DVT and is receiving heparin by continuous IV infusion. the client asked the nurse how long will it take for the heparin to dissolve the clot. Which of the following responses should the nurse give? a. "It usually takes heparin at least two to three days to reach a therapeutic blood level." b. "The oral medication you will take after this, PO Warfarin, will dissolve the clot" c. "Heparin does not dissolve clots. It stops new clots from forming." d. "A pharmacist is the person to answer that question."

c. "Heparin does not dissolve clots. It stops new clots from forming."

A nurse is providing teaching for a client who has a new prescription for ferrous sulfate liquid. Which of the following statements by the client indicates an understanding of the teaching? a. "I will expect the color of my urine to be amber" b. "I should expect increased bruising" c. "I should expect dark, tarry stool" d. "I will not get as many infections"

c. "I should expect dark, tarry stool"

A nurse is providing discharging teaching to a client who has asthma and a new prescription for cromolyn and albuterol, both by nebulizer. Which of the following statement by the client indicated an understanding of the teaching? a. "if my breathing begins to feel tight, I will use the cromolyn immediately" b. "I will use both medications immediately after exercising." c. "I will use albuterol at the onset of an attack, and cromolyn sodium prior to exercising." d. "I will administer the medication 12 hours apart"

c. "I will use albuterol at the onset of an attack, and cromolyn sodium prior to exercising."

A nurse is caring for a child who is experiencing status asthmaticus. Which of the following interventions is the priority for the nurse to take? a. Determine the cause of the acute exacerbation b. Administer an inhaled glucocorticoid c. Administer a short-acting beta 2-agaonist (SABA) d. Obtain a peak flow reading

c. Administer a short-acting beta 2-agaonist (SABA)

You are caring for a patient experiencing asthma attack who is not responding to oxygen via nasal cannula (SpO2 is 75% ON 100% FiO2). The patient RR what's 45 in is rapidly dropping as work of breathing increasing. most recent ABGs reveal a CO2 level of 115. which intervention is the next most appropriate action? a. Prepare for intubation and mechanical ventilation b. Apply CPAP c. Apply BiPAP d. Apply a non-rebreather mask

c. Apply BiPAP

Related to ventilation and perfusion, what is the other term for a situation where an alveoli has adequate airflow, but not adequate perfusion? a. Wasted perfusion b. Shunt c. Dead air space d. Sickling

c. Dead air space

Lung compliance refers to the ability of the lungs to ... a. Exchange gases b. Recoil c. Expand d. Bronchoconstrict

c. Expand

A nurse would expect a client in status asthmaticus to exhibit which of the following sign or symptoms? a. An elevated peak expiratory flow volume b. Croup c. Paradoxical breathing d. Bradycardia

c. Paradoxical breathing

Which of the following patients is most at risk for respiratory failure? a. Patient with COPD who has a SpO2of 90% b. Patient with an arterial oxygen saturation of 98% c. Patient with an arterial CO2 level of 75 d. Patient with asthma who is experiencing wheezing with exercise

c. Patient with an arterial CO2 level of 75

Which of the following is an example of a situation that caused the extrinsic coagulation cascade to begin to form a fibrin clot? a. Venous stasis in the lakes during pregnancy b. Arteriosclerosis (from cholesterol plaque) in the coronary artery c. Trauma causing injury to skin and muscle d. excessive number of red blood cells in the bloodstream

c. Trauma causing injury to skin and muscle

A nurse is providing teaching to a client who has chronic bronchitis and a new prescription for theophylline. Which of the following instruction should the nurse provide? a. consume a high-protein diet b. administer the medication with food c. avoid caffeine while taking this medication d. increase fluids to 1L/per day.

c. avoid caffeine while taking this medication

Which order would be appropriate for a hospitalized patient receiving albuterol frequently (QID) for a cystic fibrosis exacerbation a. assess the patient for excessive lethargy b. check a serum hemoglobin level this AM c. check a serum potassium level this AM d. assess the patient's deep tendon reflexes

c. check a serum potassium level this AM

A client is on bedrest following bowel surgery for a small bowel obstruction. On the fourth post-op day, the nurse is assessing the client and finds unilateral swelling, pain, and erythema in the client's right calf. Which does the nurse suspects? a. peripheral arterial occlusion b. compartment syndrome c. deep vein thrombosis d. peripheral neuropathy

c. deep vein thrombosis

You are taking care of a patient who is having repeated episodes of hematemesis. Which of the following diagnostic procedures do you anticipate to perform to make a diagnosis of this patient's condition? a. venous ultrasound on the legs b. colonoscopy c. esophagogastroduodenoscopy d. CT scan of the chest

c. esophagogastroduodenoscopy

A client with chronic kidney disease is receiving Epoetin injections. What lab values in should increase as a result of administering this medication? a. potassium level b. prothrombin time (PT) c. hemoglobin count d. international normalized ration (INR)

c. hemoglobin count

Which of the following are examples of venous clots? SATA a. Ischemic stroke b. Myocardial infarction c. pulmonary embolism d. DVT e. peripheral arterial occlusion

c. pulmonary embolism d. DVT

A nurse is providing teaching for a client who has anemia and a new prescription for ferrous sulfate liquid. Which of the following instructions should the nurse provide? a. take the medication with antacids to promote absorption b. take the medication on an empty-stomach to decrease GI irritation c. take the medication with OJ to enhance absorption d. take the medication with milk

c. take the medication with OJ to enhance absorption

You are caring for 4 patients all experiencing respiratory conditions. Which patient is your priority to assess? a. the pediatric patient who is afebrile and has a barky, seal-like cough b. the patient with COPD who is barrel-chested and has clubbed fingers c. the pediatric patient who has been admitted for a bacterial upper respiratory infection and has stridor d. the patient admitted with a pulmonary embolism who is being treated with Heparin IV infusion

c. the pediatric patient who has been admitted for a bacterial upper respiratory infection and has stridor

A client comes to their primary HCP reporting numerous hospitalizations in the past 6 months for asthma attack. The HCP identifies that which of the following contributing to these repeated exacerbations? a. Client uses acetaminophen daily b. Client uses an albuterol inhaler QID PRN c. Client uses ondansetron daily PRN d. Client uses naproxen Q6H

d. Client uses naproxen Q6H

What is the trigger that promotes respirations in a patient with COPD? a. Acidosis b. Hypokalemia c. Hypercapnia d. Hypoxemia

d. Hypoxemia

Which of the following occurs early in the blood clot formation process in the case of a blood vessel wall that has been cut/damaged a. clotting factor X is activated b. clotting factor VII is inhibited c. Fibrinogen is converted to fibrin forming a "net" over the injured site d. Platelets begin to group together at the site of vessel injury

d. Platelets begin to group together at the site of vessel injury

A nurse is clearing for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects? a. Vitamin K b. Acetylcysteine c. Naloxone d. Protamine sulfate

d. Protamine sulfate

1. HCP wants to send a patient home with a self-administered SQ anticoagulant that does not require frequent aPPT lab monitoring. Which medications should be described? a. Warfarin b. Clopidogrel c. aspirin d. enoxaparin

d. enoxaparin

A patient with COPD asks you, the nurse, why their HCP prescribe inhaled corticosteroids for COPD management instead of PO corticosteroids. Your answer should relate to which of the following facts: a. inhaled corticosteroids are cheaper than PO corticosteroids b. inhaled corticosteroids are better terminating COPD exacerbations c. inhaled corticosteroids have the same number of systemic effects as PO d. inhaled corticosteroids have fewer systemic effects than PO

d. inhaled corticosteroids have fewer systemic effects than PO

Which of the following patient would most benefit from use of a BiPAP machine? a. patient with a pulmonary embolism b. patient with who overdose on oxycodone and is breathing at a rate of 4 resp/min c. patient with a history of obstructive sleep apnea d. patient with a CO2 level of 78 mmHg

d. patient with a CO2 level of 78 mmHg