Unit Test 2- NUR 275S

A client who is receiving dioxin daily has a serum potassium level of 3 mEq/L and reports anorexia. The health care provider prescribed a serum digoxin level to be done. The nurse checks the results and should recognize which level that is outside of the therapeutic range?

2.2 ng/mL

A nurse is performing dietary needs assessments for a group of clients. A blenderized liquid diet is appropriate for which of the following clients?

A client who has a wire draw due to a motor vehicle crash, A client who is 24 hours postop following temporomandibular joint repair, A client who has difficulty chewing due to oral surgery.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The note determines that the client is receiving that therapeutic effect based on which results?

APTT of 60 seconds

A client has an As needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication?

And episode of diarrhea.

A nurse is reviewing the effect of culture on nutrition during a staff in service. Which of the following groups prescribes eating specific foods to balance forces in the body during illness?

Asian, Hispanic/Latinx

A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take first?

Auscultate apical pulse and blood pressure.

A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate & contractions have stopped. If the client's labor can be inhibited for the next 48 hours, what medication does the nurse anticipate will be prescribed?

Betamethasone

The nurse should report which assessment finding to the primary health care provider before initiating thrombolytic therapy in a client with pulmonary embolism?

Blood pressure 198/110

A school nurse is teaching a group of adolescents about healthy snack food choices. Which of the following food choices should the nurse include?

Carrot sticks with low fat dip, cheese and crackers, unbuttered popcorn

A client has been started on long term therapy with rifampin .The nurse should provide which information to the client about the medication?

Causes orange discoloration of sweat, tears, urine, and feces

A client with chrome's disease is scheduled to receive an infusion of infliximab. What intervention by the nurse will determine the effectiveness of treatment?

Checking the frequency and consistency of bowel movements

A client with valvular heart disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin sodium 7.5mg at 5pm daily. The morning laboratory results are as follows: APTT 32 seconds, INR 1.3. The nurse should take which action based on the client's laboratory results?

Collaborate with the phcp to obtain a prescription to increase the heparin infusion and continue the warfarin sodium as prescribed.

An older client recently has been taking cI medicine. The nurse monitors the client for which most frequent central nervous system side effect of this medication?

Confusion

The nurse is monitoring a client with hypertension who is taking propranolol. Which assessment finding indicates a potential adverse complication associated with this medication?

Development of expiratory wheezes.

Terbutaline is prescribed for a client with bronchitis. Which disorder in the client's medical history requires caution by the nurse?

Diabetes Mellitus

The nurse has given a client taking ethambutol information about the medication. The nurse determines the client understands the instructions if the client states that they will immediately report which finding?

Difficulty in discriminating the color red from green.

A nurse is preparing to administer intermittent enteral feedings to a client. Which of the following are appropriate nursing interventions?

Discard feeding equipment after 24 hours, Place any unused formula in open cans in the fridge, flush the feeding tube every 4 hours

The nurse is teaching a client who is beginning antiviral therapy for influenza. Which statement by the client indicates an understanding of the instructions?

I must take the medication exactly as prescribed.

The nurse provides discharging instructions to apply with a trial fibrillation who is taking warfarin sodium. Which statement by the client reflects the need for further teaching?

I will take coated aspirin for my headaches because it will coat my stomach.

The nurse determines the client needs further instruction on cimetidine if which statements were made?

I will take the cimetidine with my meals. I'll know the medication is working if my diarrhea stops. Taking the cimetidine with an antacid will increase its effectiveness.

The nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction at the client makes which statement?

I will take the medication on an empty stomach.

The home health care nurse is visiting a client with coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine and the nurse teaches the cclient about the medication. Which statement by the client indicates the need for further teaching?

I'll continue the nicotinic acid from the health food store.

The nurse provides instructions to the client about nicotinic acid prescribed for hyperlipidemia. Which statement by the client indicates understanding of the instructions?

Ibuprofen taken 30 minutes before the nicotinic acid may decrease the flushing.

The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route?

Intratracheal

A client with tuberculosis is starting anti tuberculosis therapy with isoniazid. Before giving the client the first dose, the nurse shouldn't sure that which baseline study has been completed?

Liver enzyme levels.

A nurse educator is teaching a class on culture and food to a group of newly hired nurses.Which of the following statements by a nurse indicates an understanding of the teaching?

Most clients who practice orthodox Judaism do not eat meat with dairy products.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times?

One hour before meals and at bedtime

Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse should contact the obstetrician who prescribed the medication if which condition is documented in the client's medical history?

Peripheral vascular disease

A nurse is assisting a client with selecting food choices on a menu. Which of the following actions by the nurse demonstrates ethnocentrism?

Recommending ones own favorite foods

A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having optimal intended benefit if which effect is observed?

Reduction of steatorrhea

A client who uses nonsteroidal anti-inflammatory drugs has been taking misoprostal. The nurse determines that the misoprostal is having the intended therapeutic effect if which finding is noted?

Relief of epigastric pain

A client is to begin a six month course of therapy with isoniazid. The nurse should plan to teach the client to take which action?

Report yellow eyes are skin immediately.

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication of which findings are noted on assessment?

Respiration of 10/min, urine output of 20 mL/hr

The nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which support of medical equipment should the nurse plan to have a client's bedside?

Resuscitation equipment

A nurse is instructing a client on how to administer cyclic enteral feedings at home. Which of the following information should the nurse include?

Set the feeding up before you go to bed, weigh yourself daily

A nurse is teaching a client who is starting continuous feeding about the various types of enteral nutrition formulas. Which of the following should the nurse include in the teaching?

Standard formula contains whole protein.

A nurse is discussing the use of a low profile gastrostomy device with the guardian of a child who is receiving an enteral feeding. Which of the following is an appropriate statement by the nurse?

The device is usually comfortable for children.

A client with a peptic ulcer is diagnosed with helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen?

The medications will kill the bacteria and stop the acid production

A nurse at a community center is providing nutrition counseling for a group of older adult clients. Which of the following information should the nurse include?

The need for vitamins and minerals can increase, Up to 35% of daily calories should come from fat, At least 45% of daily calories should come from carbohydrates

The nurse is teaching about food safety and food borne illness to a group of adults at a local community center. Which of the following information should the nurse include?

Unpasteurized fruit juice is a common cause of foodborne illness

The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediately discontinue the oxytocin infusion?

Uterine hyperstimulation, Late decelerations of FHR

A nurse is assessing a 6 month old infant who has a lactose intolerance. Which of the following findings should the nurse expect?

abdominal distention, flatus, occasional diarrhea

A nurse is teaching a group of clients who are pregnant about iron rich foods. Which of the following foods should the nurse include?

beans, fish, lean red meats

Rh (D) immune globulin is prescribed for a client after delivery, and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition?

being affected by Rh incompatibility

Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of Methylergonovine, what is the priority assessment?

blood pressure

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication?

bronchospasm

A nurse is caring for a client following an appendectomy who has a postoperative prescription that reads "discontinue NPO status; advance diet as tolerated". Which of the following are appropriate for the nurse to offer the client initially?

chicken broth, cranberry juice

A client begins therapy with theophylline. The nurse plans to teach the client to limit the intake of which items while taking this medication?

coffee, cola, and chocolate

The nurse is monitoring a client with heart failure who is taking digoxin. Which findings are characteristic of digoxin toxicity?

diarrhea, blurred vision, nausea and vomiting

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication?

flushing, decreased respirations, extreme muscle weakness

A nurse is assisting a client who has a prescription for a mechanical soft diet with food selections. Which of the following are appropriate selections by the client?

ground turkey, mashed carrots, cottage cheese

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom?

heartburn

Zafirlukast Is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication?

liver function tests

A client is diagnosed with an STEMI and is receiving a TPA, alteplase. Which action is a priority nursing intervention?

monitor for signs of bleeding

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client alerts the nurse of a life-threatening effect?

my lips and tongue are swollen

An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily accessible should respiratory depression occur?

naloxone

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesia's, and tingling in the extremities. The nurse interprets that the client is experiencing which problem?

peripheral neuritis

Prior to administering a client's daily dose of digoxin to treat heart failure, the nurse reviews the clients laboratory data and notes the following results: serum calcium 9.8, serum magnesium 1.0, serum potassium 4.1, serum creatinine 0.9. Which result should alert the nurse that the client is at risk for digoxin toxicity?

serum magnesium level

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease with TB. The nurse should monitor for which side/adverse effects of the medication?

signs of hepatitis, flu- like syndrome, low neutrophil count, ocular pain or blurred vision

A nurse is providing teaching to a client who is to begin taking phenelzine. Consuming which of the following foods while taking this medication could cause a hypertensive crisis?

smoked fish

A nurse is providing teaching about food allergies to a group of new parents. Infants who react to which of the following foods typically outgrow the sensitivity?

soy, cows milk

A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and reports itching. The nurse hears strider and notes generalized urticaria and hypotension. Which interventions should the nurse anticipate?

stop the infusion, administer diphenhydramine, call for rapid response team

The nurse is monitoring a client for adverse effects of medications. Which findings are characteristic of adverse effects of hydrochlorothiazide

sulfa allergy, hypokalemia, hyperglycemia. hyperglycemia

A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication at the client states that she or he will perform which action?

take the tablet with a full glass of water

The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further teaching?

this medication should only be taken with water.

A nurse is administering bolus enteral feedings to a client who has malnutrition. Which of the following are appropriate nursing interventions?

verify the presence of bowel sounds, flush feeding tube with warm water, administer feeding at room temperature

A nurse is caring for a client who has multiple sclerosis and requires liquids with honeylike thickness. Which of the following foods can the client consume without adding a thickening agent?

yogurt

A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition?

Vomiting following cancer chemotherapy

A nurse is caring for a client who is to receive a level 2 dysphagia diet due to a recent stroke. Which of the following dietary selections is most appropriate?

poached eggs

Intravenous heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available on the nursing unit?

protamine sulfate

A nurse is educating the parents of a toddler about appropriate snack foods. Which of the following foods should the nurse include?

Graham cracker's, apple slices, cheesecakes

A nurse is caring for a client who has hypertension. Which of the dietary patterns is sometimes followed by Asian clients and places clients at risk for this condition?

Preparation of foods using sodium.

The nurse administered Intravenous bumetanide to a client being treated with heart failure. Which outcome indicates that the medication has achieved the expected effect?

Urine output has increased from 10 mL/hr to greater than 50 mL hourly

The nurse asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further treatment is needed about administration of the eye medication?

"I will flush the eyes after instilling the ointment"

The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication?

I feel like my heart is racing.

A client has an as needed prescription for ondansetron. For which condition should the nurse administer this medication?

Nausea and vomiting

The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered dose inhaler. The nurse should administer the medication using which procedure?

salmeterol first and then beclomethasone