ARCHER - READINESS ASSESSMENT #1

The nurse is providing discharge instructions to a client with hepatitis A. Which of the following instructions should the nurse include? A. You will need to take daily showers or baths with chlorhexidine. B. It is important to clean common surfaces with warm soapy water. C. You will need to have repeat stool testing to determine if you are still infectious. D. Check with your primary healthcare provider prior to taking any medications.

Explanation Choice D is correct. While a client is being treated for hepatitis, they should consult with their primary healthcare provider, so they are not taking any medications or substances that are hepatotoxic. Exposing a client with hepatitis to a hepatotoxic medication would significantly complicate their recovery. Choices A, B, and C are incorrect. Having the client shower with chlorhexidine is not an appropriate teaching point for hepatitis A. The pathogen spreads through contaminated food, water, and surfaces. The primary mode of transmission is fecal-oral. Surfaces contaminated with hepatitis should be sanitized with a bleach solution, not warm soapy water. Repeat stool testing is not indicated for hepatitis as diagnosis of hepatitis is made through serum hepatitis-A antibodies.

The nurse reviews a client's medical history and identifies a diagnosis of presbycusis. The nurse should integrate which intervention in the care plan? A. Have educational materials in large print B. Provide an eye patch to the affected eye C. Request food be seasoned with herbs D. Move closer to the better-hearing ear

Choice D is correct. Presbycusis is a type of sensorineural hearing loss associated with aging. Sensorineural hearing loss is often permanent. Interventions for a client with this type of hearing loss include speaking in the ear less affected, speak clearly and slowly, avoid shouting, and ensure that the environment is well lit while conversing. Choices A, B, and C are incorrect. Presbycusis is a type of sensorineural hearing loss, and interventions such as scanning the room, having large print for reading materials, and seasoning food are not relevant to this condition. Scanning the room would be an intervention appropriate for visual field loss. Additional Info Hearing loss is divided into sensorineural or conductive. Conductive hearing loss is caused by obstruction. Causes of this type of hearing loss include cerumen, foreign body, water, edema, infection, or tumor. This type of hearing loss may be reversible. Impairments of the nerve fibers cause sensorineural hearing loss. Causes of this type of hearing loss include prolonged exposure to noise, ototoxic substances (aminoglycosides), diabetes mellitus, and presbycusis (age-related hearing loss). This type of hearing loss is often not reversible.

The emergency department nurse is caring for a client with sudden onset of edema of the lips and acute shortness of breath following a bee sting. The nurse knows that the first-line medication for this presentation is: A. Oral diphenhydramine B. Nebulized albuterol C. Oral prednisone D. Parenteral epinephrine

Choice D is correct. The client's presentation with angioedema(lip swelling) and dyspnea after a bee sting indicates anaphylaxis, an acute antibody-antigen reaction that can lead to life-threatening multi-system involvement. Anaphylaxis is characterized by bronchoconstriction, angioedema, abdominal cramps, urticaria, and distributive shock. The client is at risk for airway compromise from angioedema, and immediate administration of epinephrine is recommended to prevent airway closure. Intramuscular (IM) administration of epinephrine is preferred over the intravenous (IV) route because there is a higher risk of cardiac complications with IV administration. Choices A, B, and C are incorrect. Parenteral epinephrine is the immediate first-line drug for anaphylaxis. After stabilizing the client, the nurse may administer other medications to control other symptoms, such as diphenhydramine (Benadryl), nebulized albuterol (bronchodilator), and steroids like prednisone (steroids). Diphenhydramine (Benadryl) is an H1 receptor blocker that helps address rash and itching (choice A). Nebulized albuterol (bronchodilator) helps reverse bronchoconstriction (choice B). Steroids, like prednisone, may reduce late-phase reactions in anaphylaxis but are not life-saving and do not provide immediate symptom relief (choice C).

The nurse cares for a 48-hour-old newborn who has not yet passed stool since delivery. The nurse understands that the client is at highest risk for which conditions? Select all that apply. Celiac disease Cystic fibrosis Anorectal anomalies Hirschprung's disease Intussusception

Choice E is incorrect. Intussusception is often associated with abdominal pain, bilious vomiting, and rectal bleeding with "red currant jelly" stools. A "sausage-shaped" mass may be palpable on physical exam. Intussusception refers to the telescoping of a bowel segment into another bowel segment. Most often, this occurs from the telescoping of the terminal ileum into the cecum—Ischemia from constricted blood supply results in rectal bleeding and red currant stools. A lack of stool passage during the first 48 hours of life is not a common symptom associated with intussusception.

The nurse is conducting a client teaching session at the clinic. The client has been prescribed a bisphosphonate for osteoporosis treatment. What instructions should the nurse provide to this client? A. Take this medication sitting upright first thing in the morning with a full glass of water. B. Take this medication at night, just before bed. C. This medication should be taken along with a full meal. D. This medication is the best alternative if an esophageal disorder is present.

Explanation Choice A is correct. Bisphosphonates should be taken first thing in the morning with a full glass of water. Clients should also wait 30 minutes to eat any food and should remain sitting or standing during that time. This prevents esophageal damage that may occur when this medication is taken improperly. Choice B is incorrect. This medication should not be taken at night because the client needs to remain sitting or standing for 30 minutes following medication administration. Choice C is incorrect. This medication should not be taken with a full meal. Choice D is incorrect. Bisphosphonates are contraindicated in clients with esophageal disorders.

The nurse is educating a client scheduled for pulmonary function tests. It would indicate effective teaching if the client makes which statement? A. "I should not use my bronchodilator four to six hours before these tests." B. "I should not eat or drink six to eight hours prior to these tests." C. "I will need someone to drive me home after I wake up from the anesthesia." D. "My gag reflex will have to return before I resume eating and drinking."

Explanation Choice A is correct. Bronchodilators, such as inhalers, can impact the results of pulmonary function tests. It is generally recommended to withhold the use of a bronchodilator for a specific period before the tests to obtain accurate results. This period may vary depending on the specific medication and the healthcare provider's instructions, but the client's statement about withholding the bronchodilator for four to six hours before the tests is generally appropriate. Choice B is incorrect. While fasting may be required for certain medical procedures, it is not a standard requirement for pulmonary function tests. Clients are typically allowed to eat and drink before these tests. Choice C is incorrect. Pulmonary function tests do not typically involve anesthesia, so there is no need for someone to drive the client home afterward. Choice D is incorrect. The return of the gag reflex is not related to pulmonary function tests. It is typically a consideration after certain types of anesthesia or surgery but not for routine pulmonary function testing. Additional Info ✓ Pulmonary function tests (PFTs) do not require any sedation or invasive machinery and may be done at the bedside. The purpose is to assess lung function and breathing problems. ✓ These tests measure lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and ventilation distribution. The results are interpreted by comparing the client's data with expected findings for age, gender, race, height, weight, and smoking status. ✓ Some PFTs may require specific preparation, such as avoiding certain medications or fasting for a few hours before the test. Client's should follow their healthcare provider's instructions to ensure accurate and reliable test results.

The nurse is caring for a client who is receiving prescribed cilostazol. Which of the following client findings would indicate a therapeutic response? A. Absence of pain while ambulating B. Decreased total cholesterol C. Increased visual acuity D. Improved focus and attention

Explanation Choice A is correct. Cilostazol is a phosphodiesterase inhibitor approved to treat peripheral arterial disease. Its action mechanism decreases platelet aggregation and promotes vasodilation, allowing a client to ambulate distances without pain. Choices B, C, and D are incorrect. Cilostazol is not utilized to mitigate total cholesterol levels. Further, this medication does not improve visual acuity or attention. Additional Info ✓ Cilostazol is an effective treatment for a client with peripheral arterial disease (PAD). ✓ Manifestations of PAD include pain while walking (claudication), decreased peripheral pulses, and painful ulcers. ✓ Common side effects of this medication include diarrhea and headache. ✓ Under no circumstances should this medication be given to a client with heart failure as it may worsen the condition.

The nurse is caring for a client with Guillain-Barré syndrome (GBS). The nurse plans on taking which priority action? A. Assessing respiratory status frequently. B. Administering intravenous immunoglobulin (IVIG) as prescribed. C. Providing passive range of motion exercises to maintain joint mobility. D. Monitoring for autonomic dysreflexia.

Explanation Choice A is correct. Given the available options, assessing respiratory is the highest priority nursing intervention for a client with Guillain-Barré syndrome experiencing ascending paralysis. The frequency of respiratory assessment will vary from client to client. GBS is a neurological disorder characterized by progressive muscle weakness and paralysis that can start from the legs and ascend upwards. As paralysis affects the muscles responsible for breathing, clients with GBS are at risk of developing respiratory insufficiency or failure. Choice B is incorrect. Administering intravenous immunoglobulin (IVIG) as prescribed is an essential nursing intervention for clients with GBS. While IVIG is crucial for managing GBS, in the context of a client experiencing ascending paralysis, the priority is to ensure their respiratory status. Choice C is incorrect. Providing passive range of motion exercises to maintain joint mobility is an important aspect of nursing care for clients with GBS. It helps prevent complications such as contractures and maintains joint function. However, in a client with ascending paralysis, immediate attention to respiratory status is more critical to prevent life-threatening respiratory compromise. Choice D is incorrect. Monitoring for autonomic dysreflexia is a critical nursing intervention for clients with spinal cord injuries or other neurological conditions, but it is not typically associated with Guillain-Barré syndrome.

The nurse is interviewing a client who is assessed to have poor muscle coordination, stooped posture, and slow movements. Which medication on the client's daily medication list would most likely cause these findings? A. Haloperidol B. Nifedipine C. Venlafaxine D. Prazosin

Explanation Choice A is correct. Haloperidol is a typical antipsychotic which may adversely cause extrapyramidal side effects (EPS). These effects include akathisia, dystonia, pseudo parkinsonism, and/or tardive dyskinesia. Choices B, C, and D are incorrect. Nifedipine is a calcium channel blocker indicated for the treatment of hypertension. It also may be used as a tocolytic to mitigate preterm labor. Venlafaxine is a serotonergic drug used in the management of depressive and anxiety disorders. Prazosin is indicated for the treatment of hypertension as well as PTSD.

The nurse is caring for a child with nephroblastoma. The nurse plans to take which action? A. Post a sign that states, "Do not palpate abdomen" B. Recommend foods low in protein C. Insert an indwelling urinary catheter D. Initiate fluid restrictions

Explanation Choice A is correct. Nephroblastoma (Wilms tumor) is the most common childhood cancer. Common treatments include surgical removal followed by chemotherapy. Nursing care involves minimal manipulation of the abdomen (no palpation) and a posted sign. It is essential to keep the encapsulated tumor intact. Choices B, C, and D are incorrect. These are not interventions relevant to a client with nephroblastoma; instead, these may be used for acute or chronic renal disease. While nephroblastoma may impair renal function, this is not commonly seen. Additional Info ✓ Nephroblastoma is a tumor affecting the kidney(s). ✓ The average age at diagnosis is three years in children with single kidney disease. ✓ It is slightly younger for those with bilateral involvement. Nephroblastoma nursing care involves ✓ Frequent blood pressure monitoring because this tumor may induce renin-related hypertension ✓ Avoid any activities that may cause palpation of the abdomen ✓ Gastrointestinal assessment as obstruction may consequently occur (absent bowel sounds, abdominal distention should be reported) ✓ Assessment of hemorrhage (tachycardia and hypotension)

Which of the following statements by a patient who was recently placed in a cast on the right lower extremity should be the most alarming to the nurse? A. "I've been having pain in my right calf." B. "My right leg feels really itchy." C. "I didn't keep my leg elevated as the doctor asked me to." D. "When I put weight on my crutches, it makes the arthritis in my wrists ache."

Explanation Choice A is correct. Pain in the casted extremity could indicate neurovascular compromise. Patients who have been cast should be educated on safety measures and signs of complications before discharge from care. It is not uncommon for the skin inside a cast to itch. However, any signs of neurovascular compromise should be immediately reported. Any time a patient reports pain in a casted extremity, this is an alarming sign that requires immediate assessment/intervention. Patients should be instructed to report pain, tingling, and edema in the extremity that is greater than before the cast was applied, or if the cast feels too loose. Choice B is incorrect. Itching is not an immediate reason for alarm. Heat and sweat will cause the skin under the cast to itch. Patients should be instructed to keep the cast and surrounding skin fresh, clean, and dry. Choice C is incorrect. This answer does indicate a need for further education but is not a sign of immediate distress. Patients should be encouraged to keep the injured limb elevated, especially during the first 48 hours following injury and casting. Elevation helps to decrease swelling and pain at the site of injury. Choice D is incorrect. Although the patient is experiencing pain, this answer option is no reason for alarm. Instead, the patient may need to be educated on how to use crutches properly. Some discomfort is reasonable because the hands and arms were not meant to hold the weight of the entire body. However, with proper instruction on how to use crutches, the patient's discomfort may be reduced.

The nurse is teaching a client about newly prescribed isoniazid (INH) for pulmonary tuberculosis. Which of the following statements by the client would require follow up? A. "I will have to take this medication for three months." B. "I will need to have my blood drawn periodically to see if I am having an adverse effect to this medication." C. "I will not be considered infectious if I have three consecutive negative sputum samples." D. "This medication may make my hands and feet have numbness and tingling sensations."

Explanation Choice A is correct. This statement requires follow-up because it is not accurate. Antitubculin medications must be taken for six to nine months to complete treatment and prevent resistance. If the client is at risk of poor treatment adherence, they may be ordered directly observed therapywhere an individual supervises the client to take their medication. Choice B is incorrect. This statement is accurate and does not require follow-up because INH may cause hepatic injury and blood dyscrasias. The client will need periodic blood specimen collections to determine if they are experiencing anemia, transaminitis, or thrombocytopenia. Choice C is incorrect. The client will be considered noninfectious if they have three consecutive negative sputum tests for acid-fast bacilli (AFB). One of the sputum specimens must be collected in the morning. Choice D is incorrect. INH may cause a client to experience peripheral neuropathy, described as a pins and needles sensation. This is why a client is prescribed pyridoxine to attenuate these sensations. Additional Info ✓ INH is the first-line therapy for pulmonary tuberculosis. ✓ This agent is often combined with another antitubercular medication because of emerging drug resistance. ✓ Hepatotoxicity is the most common adverse effect of most antitubercular drugs. ✓ The client should immediately report signs of hepatotoxicity, such as jaundice and clay-colored stools. ✓ INH may cause a client to develop peripheral neuropathies. Pyroxidine (vitamin B6) is commonly prescribed to prevent this occurrence.

When the nurse is educating parents of young kids with congenital heart defects, it is essential to teach them about the early signs and symptoms of heart failure so that they can recognize it sooner. Which of the following should the nurse emphasize as early signs of heart failure? Select all that apply. Diaphoresis Sudden weight gain No wet diapers Hypoxia Increased appetite

Explanation Choices A and B are correct. The parents of children with congenital heart defects need to be aware of the "early" signs of heart failure, so they can report them to the healthcare provider before it is too late. Diaphoresis (Choice A), or excessive sweating is a common early sign of heart failure. Parents should be taught to look out for excessive sweating, especially at rest. Sudden weight gain (Choice B) is due to fluid retention and edema. This indicates decreased cardiac output, increased venous congestion, and is an early sign of heart failure. Choice C is incorrect. An infant or child having "no wet diapers" would mean he/she is severely oliguric. Oliguria is due to decreased kidney perfusion that occurs during untreated heart failure. This degree of damage to the kidneys takes time and is a late sign of heart failure, not an early warning. Choice D is incorrect. Hypoxia is also a late sign of heart failure, not an early warning. Hypoxia is typically secondary to pulmonary edema that develops during untreated heart failure. Choice E is incorrect. Children with early heart failure typically have poor feeding and appetites, rather than an increased appetite.

The nurse is reviewing a new prescription for amphotericin b. The nurse understands that this medication treats A. autoimmune infections. B. fungal infections. C. viral infections. D. bacterial infections.

Explanation Choice B is correct. Amphotericin B is a powerful antifungal indicated in treating systemic fungal infections. This medication requires pre-medication with isotonic saline, diphenhydramine, and acetaminophen to help decrease the symptoms of fever, chills, and rigors associated with the infusion. Choice A is incorrect. Autoimmune infections are treated with immunomodulators such as methotrexate. Choice C is incorrect. Viral infections are not treated with amphotericin B. Antiviral medications include acyclovir, tenofovir, and famicyclovir. Choice D is incorrect. Bacterial infections are not treated with amphotericin B. Antibiotics such as doxycycline and ciprofloxacin may be used.

The nurse is caring for a client hospitalized due to acute chronic obstructive pulmonary disease (COPD) exacerbation. What assessment finding would the nurse expect to find? A. ABG showing a carbon dioxide level of 31 mmHg. B. An overinflated chest on chest x-ray. C. Improving oxygen saturation upon exercise. D. A wide diaphragm on chest x-ray.

Explanation Choice B is correct. In clients with COPD, there is a loss of elastic recoil in the lungs leading to hyperinflation of the lungs, as seen on chest x-ray. Prolonged hyperinflation of the lungs causes barrel chest in COPD clients. Choice A is incorrect. A normal pCo2 level is 35 -45 mmHg. A decreased pCo2 (respiratory alkalosis) is not typical in COPD. In clients with COPD, carbon dioxide is trapped in the lungs (hypercapnia), resulting in an increased carbon dioxide level (hypercapnia) and respiratory acidosis. Choice C is incorrect. COPD exacerbations typically result in decreased exercise tolerance and worsened oxygen saturation during physical activity. Improvement in oxygen saturation upon exercise would not be expected in this context. Choice D is incorrect. While a wide diaphragm may be associated with certain conditions, such as muscle weakness or paralysis, it is not a specific assessment finding expected during a COPD exacerbation.

The nurse is assessing a client with drooping of their left eyelid. The nurse documents this finding as A. mydriasis. B. ptosis. C. presbyopia. D. hyphema.

Explanation Choice B is correct. Ptosis is drooping of the eyelid. Ptosis may be congenital or acquired and may be a clinical feature of neurological conditions such as myasthenia gravis or multiple sclerosis. Choice A is incorrect. Mydriasis is the dilation of the pupil. This is not drooping of the eyelid. Mydriasis may be caused by the fight or flight response and certain medications such as central nervous stimulants. Choice C is incorrect. Presbyopia is age-related vision loss that causes farsightedness. This is progressive and may be corrected with glasses or contact lenses. Choice D is incorrect. Hyphema is blood in the anterior chamber of the eye. This is commonly caused by blunt trauma to the eye. Additional Info ✓ Ptosis is eyelid drooping, which may be congenital or acquired. ✓ Ptosis may be a manifestation associated with neurological conditions such as multiple sclerosis, stroke, and myasthenia gravis. ✓ If ptosis is congenital, surgery may be done to correct it.

Relaxin is a hormone that is released throughout a woman's pregnancy to help prepare her uterine ligaments for the growth of her fetus and uterus. A downside to relaxin is that it may: A. Cause high blood pressure in some women B. Lead to musculoskeletal injury due to loose ligaments C. Make urinating more difficult than normal D. Increase bowel motility

Explanation Choice B is correct. Relaxin can lead to clumsiness because of increased flexibility and ligament relaxation. This clumsiness increases the risk of musculoskeletal injury. Relaxin may also cause round ligament pain, indigestion, and an increase in the frequency of urination. Choice A, C, and D are incorrect. High blood pressure, difficulty urinating, and increased bowel motility are not associated with relaxin.

The client is diagnosed with acute kidney failure. Which of the following is an appropriate psychosocial problem for the nurse to include in the care plan? A. Imbalanced nutrition: less than body requirements related to altered metabolic state and dietary restrictions. B. Anxiety related to the disease process and uncertainty of prognosis. C. Excess fluid volume related to compromised regulatory mechanisms secondary to acute renal failure. D. Risk for infection related to invasive procedures and an altered immune response secondary to renal failure.

Explanation Choice B is correct. The focus of the question is the psychosocial problem. Of the options listed, anxiety is the only choice for an appropriate psychosocial issue. Choice A is incorrect. This patient would be at risk for imbalanced nutrition due to the renal failure diagnosis, but this would not be a psychosocial problem. Choice C is incorrect. This patient would be at risk for excess fluid volume due to the renal failure diagnosis, but this would not be a psychosocial problem. Choice D is incorrect. This patient would be at risk for infection due to the renal failure diagnosis. However, this is not a psychosocial issue.

The nurse is assisting the primary healthcare provider (PHCP) with a lumbar puncture to assess for meningitis. What should be the first action of the nurse? A. Lay the client on his side. B. Ask the client to void. C. Obtain an advanced directive from the client. D. Withhold food and drinks from the client prior to the procedure.

Explanation Choice B is correct. The lumbar puncture procedure may take up to 15-30 minutes. Following the procedure, the client is asked to lie flat for about one to two hours. Lying flat may reduce the intensity of post-lumbar puncture headache, although it may not prevent it. A need to urinate during or immediately after the procedure interrupts this protocol. Therefore, as an additional comfort measure, the client should be reminded to empty their bladder before the procedure begins. This should be the first action of the nurse. Choice A is incorrect. The client should be lying on his side in a "C" position. His back should be as close to the edge of the bed as possible. However, this is not the first intervention. Choice C is incorrect. The client should have an advanced directive should he be unable to decide for himself; however, this is not a necessity for this procedure. Choice D is incorrect. The procedure does not require the client to be NPO (nothing by mouth).

The nurse is performing a physical assessment. When assessing a client's eyes for accommodation, which of the following actions would the nurse perform? A. Bring a penlight from the side of the client's face and briefly shine the light on the pupil. B. Ask the client to gaze at a distant object and then at a test object. C. Obtain a tuning fork and place it in the middle of the client's forehead. D. Have the client stand twenty feet away from a Snellen chart.

Explanation Choice B is correct. To test for accommodation, the nurse should darken the room and instruct the client to first gaze at a distant object, such as the far wall, and then focus on a test object (e.g., a finger or pencil) held approximately 4 inches from the bridge of the client's nose. Normally, the pupils converge and accommodate by constricting when looking at close objects. Gazing at a distant object relaxes the ciliary muscles, dilates the pupils, and then focusing on a near test object helps assess the eyes' ability to adjust and focus on objects at different distances. Choice A is incorrect. This action is not related to assessing accommodation; instead, shining a penlight on the pupil is part of the pupillary light reflex assessment, which differs from assessing accommodation. Choice C is incorrect. This action is unrelated to assessing accommodation and is typically used to assess cranial nerve function, specifically the trigeminal nerve (CN V), for facial sensation. Choice D is incorrect. This action pertains to assessing visual acuity, not accommodation. The Snellen chart is employed to evaluate the client's capacity to see and read letters or symbols at a distance.

The nurse has just inserted an indwelling urinary catheter for a male client. The nurse plans on securing the catheter to the client's A. inner thigh. B. lower abdomen. C. outer thigh. D. medial thigh.

Explanation Choice B is correct. When securing an indwelling urinary catheter for a male, anchoring it to the lower abdomen (with the penis pointed upward) or upper thigh is appropriate. The catheter tubing should be secured to the lower abdomen or the upper thigh to prevent posterior urethral injury. Choice A is incorrect. Securing the catheter to the inner thigh may pose a risk of tension and trauma to the urethra. It is not the recommended site for securing an indwelling urinary catheter in a male. Choice C is incorrect. While the outer thigh may be a suitable site for securing certain medical devices, it is not the recommended location for securing an indwelling urinary catheter in a male. Choice D is incorrect. Securing the catheter to the medial thigh may pose a risk of tension and trauma to the urethra. It is not the recommended site for securing an indwelling urinary catheter in a male.

The nurse is caring for a client with an acute exacerbation of Bell's palsy. Which of the following prescriptions would the nurse anticipate? Select all that apply. Prednisone Donepezil Pyridostigmine Valacyclovir Topiramate

Additional Info Exacerbations of Bell's palsy usually occur abruptly with unilateral facial paralysis. This is accompanied by eyebrow sagging, diminished taste, decreased eye tearing, and drooping of the mouth on the affected side. Nursing care is aimed at mitigating symptoms by using artificial tears and ointment. A client may also use an eye patch on the affected eye at night.

The nurse reviews the function of a prescribed beta-blocker in the cardiovascular system. It would be appropriate for the nurse to state that beta-blockers Select all that apply. block catecholamines from binding to the beta receptors. reduce myocardial oxygen demand. increase cardiac contractility. increase cardiac output. prevent sodium and water resorption by inhibiting aldosterone secretion.

Additional Info ✓ Beta-adrenergic blockers, more commonly referred to as beta blockers ✓ Beta-blockers block catecholamines from binding to the receptors found in the heart and lungs ✓ These medications block the beta receptors, the rate at which the pacemaker (sinoatrial [SA] node) fires decreases, and the time it takes for the node to recover increases ✓ Some beta-blockers are more cardioselective (metoprolol and atenolol) compared to nonselective beta-blockers (propranolol) ✓ Underlying restrictive and obstructive respiratory illness may worsen when beta-blockers are given because the medication causes bronchoconstriction ✓ The nurse needs to assess the client's pulse (P) and blood pressure (BP) before administration ✓ These medications may raise the client's risk for falls because they may cause orthostatic hypotension ✓ Beta-blockers should not be administered if the client is experiencing any atrioventricular (AV) block or bradyarrhythmia ✓ Examples of beta-blockers include propranolol, metoprolol, and carvedilol

The nurse is caring for a client prescribed a monoamine oxidase inhibitor (MAOI). During the therapy, the nurse recommends that the client monitor their A. blood pressure. B. pulse. C. capillary blood glucose. D. daily weight.

Choice A is correct. Monitoring the client's blood pressure is key while a client is taking an MAOI. These medications can cause both hypertension and hypotension. Hypertension may be severe if the client takes a contraindicated medication or consumes excessive dietary tyramine. The client should be instructed to monitor and log their blood pressure a few times weekly. Choice A is incorrect. Pulse does not need to be monitored during therapy while a client is taking an MAOI. It is the blood pressure that should be closely monitored as the client is at risk for orthostatic hypotension and hypertension. Choice C is incorrect. Capillary blood glucose is not a monitoring parameter for an MAOI. Choice D is incorrect. While these medications may increase weight, the client having to obtain a daily weight is unnecessary. This would be a teaching point for a client prescribed a diuretic or has congestive heart failure.

A 52-year-old client with a 20-year history of alcohol abuse is hospitalized with mild ascites, jaundice, and bruising. Imaging demonstrates the presence of esophageal varices, while the client's elevated serum ammonia level indicates hepatic encephalopathy. The nurse is concerned the client's esophageal varices may rupture and proceeds to educate the client accordingly. Which item should the nurse include in the client's education session? A. "Do not lift heavy objects." B. "Avoid walking briskly." C. "Avoid taking barbiturates." D. "Avoid ingesting antacids."

Choice A is correct. Primary prophylaxis to prevent the initial variceal bleeding episode is one of the most important strategies for reducing mortality in cirrhotic clients. As such, client education plays a significant role in managing esophageal varices. Lifting heavy objects, straining during defecation, stretching, and the Valsalva maneuver may cause a marked increase in variceal pressure and should, therefore, be avoided by clients with esophageal varices, cirrhotic clients, and those with portal hypertension. Choice B is incorrect. Brisk walking is not contraindicated in clients with esophageal varices. Choice C is incorrect. The use of barbiturates is not contraindicated in clients with esophageal varices. Choice D is incorrect. The use of antacids is not contraindicated in clients with esophageal varices.

A client with a peptic ulcer is prescribed sucralfate. Which statement by the client indicates an understanding of the medication? A. "I should take sucralfate at least 1 hour before meals and at bedtime." B. "I will avoid taking antacids completely while I'm on sucralfate." C. "I should take sucralfate right before meals and at bedtime." D. "I can expect immediate relief of my ulcer symptoms after taking sucralfate."

Choice A is correct. Sucralfate is a locally acting agent that combines with hydrochloric acid in the stomach in an acidic environment (pH less than 4) to make a cross-linking, thick compound that forms a barrier over the ulcer. Sucralfate is most effective when taken on an empty stomach to enhance its adherence to the ulcer site. It should be taken at least an hour before meals and at bedtime. Choice B is incorrect. This statement is not specific to sucralfate. If a client is also taking an antacid, it should be taken more than one half-hour before or after sucralfate oral liquid. Choice C is incorrect. Sucralfate should be taken on an empty stomach to enhance its adherence to the ulcer site. It should be taken at least an hour before meals and at bedtime. Choice D is incorrect. Sucralfate does not provide immediate relief; it acts by forming a protective coating over the ulcer. This helps the ulcer heal, and the onset of symptomatic relief may take several days or weeks.

The nurse manager reviews staff feedback which requests better engagement from the manager and involvement in unit-based decisions. Based on the feedback, the nurse manager plans to adjust their management style to A. democratic. B. transactional. C. lasiez-faire. D. authoritative.

Choice A is correct. The crux of the democratic leadership style encourages subordinate participation in decision-making. This process can help staff feel that their opinions matter and increase staff engagement. The downside to the democratic leadership style is that it may take time for decisions to be made because the group of individuals voting on change will need to establish cohesion. Choice B is incorrect. A transactional leadership style is not warranted because the transactional leadership style motivates individuals based on rewards. This leadership style focuses on day-to-day operations and uses a reward/consequence system to motivate employees to achieve success or discourage them from failure. This would be inappropriate because transactional does not encourage others to be involved except if some compensation (or other incentive) is offered. Choice C is incorrect. Lasiez-faire is a hands-off approach and enables individuals to have complete decision-making power. The leader takes an apathetic approach and watches as staff make decisions. While this leadership style can allow the staff to make decisions, it would not lead to increased engagement because the manager takes a back-seat approach and does not interfere. Choice D is incorrect. Authoritative leadership is when the manager makes all of the decisions for the unit and issues directives to subordinates. This would not promote staff engagement, as authoritative leadership does not encourage the staff to participate actively in decision-making.

The nurse is preparing a 3-year-old child for an incision and drainage of a large left leg abscess. The nurse understands which of the following types of anesthesia will be administered to the child? A. Peripheral nerve block B. Spinal anesthesia C. General Anesthesia D. Local Anesthesia

Explanation Choice C is correct. A large leg abscess will need significant time for incision and drainage (I&D). Children who are not yet adolescents are not mature enough to cooperate adequately during such surgical procedures. Children undergoing most surgeries require general anesthesia because this minimizes their fears of intrusive or mutilating procedures. General anesthesia provides necessary sedation so the surgery can be safely performed. Choice A is incorrect. A peripheral nerve block will not be able to provide adequate anesthesia to proceed with the I&D procedure of a large leg abscess. For the child to cooperate with such surgery, sedation is necessary. General anesthesia provides necessary analgesia and sedation to the child. Choice B is incorrect. Although spinal anesthesia may achieve an analgesic effect, the child still may not cooperate with the surgical procedure because spinal anesthesia does not provide sedation. Choice D is incorrect. Local anesthesia is helpful while addressing small abscesses. A large abscess requires more time and requires the child to cooperate. Children undergoing such procedures require general anesthesia to provide necessary sedation as well because this minimizes their fears of intrusive or mutilating procedures.

The nurse is planning care for a client with a newly diagnosed fractured pelvis. Which action would lessen the risk of fat embolism syndrome (FES)? A. Request a prescription for enoxaparin. B. Alternate with the application of ice and heat. C. Educate the client on pelvic immobilization. D. Encourage passive range of motion of the lower legs.

Explanation Choice C is correct. Aggressive immobilization is the most effective way to prevent fat embolism syndrome (FES). This also reduces the risk of internal injuries, as pelvic fractures may cause significant internal bleeding. Choice A is incorrect. Enoxaparin is an effective prescription for preventing venous thromboembolism (VTE) - but not a fat embolism. This medication is given subcutaneously with a distinct advantage over heparin because it does not require aPTT monitoring. Choice B is incorrect. Ice and heat to the pelvis would be contraindicated until internal injuries have been ruled out, and the nurse obtains a prescription for such therapy. Choice D is incorrect. The client should be encouraged to have pelvic immobilization. Passive range of motion exercises during an acute injury would be contraindicated, raising the risk for FES.

The nurse is caring for a client with Buerger's disease. The nurse plans on suggesting that the client receive a referral for A. occupational therapy. B. speech therapy. C. smoking cessation. D. group psychotherapy.

Explanation Choice C is correct. Arterial and venous blood flow impediments characterize Buerger's disease. This impediment is caused by inflammation and is significantly worsened by smoking. The nicotine causes vasoconstriction and worsens blood flow. A critical intervention for a client with this condition is discussing smoking cessation with this client. Choices A, B, and D are incorrect. These types of therapies are not pertinent to Buerger's disease. The mainstay treatment is smoking cessation and prescribed vasodilators such as calcium channel blockers. Additional Info Buerger's disease is characterized by arterial and venous inflammation worsened by smoking. The nurse should advocate for smoking cessation to minimize symptoms. Prescriptive treatments include calcium channel blockers (verapamil) or phosphodiesterase inhibitors (cilostazol).

The nurse is educating a client about newly prescribed aspart insulin. The nurse should instruct the client to self-administer this insulin A. 30-45 minutes before a meal B. one hour after a meal C. 20-30 minutes before a meal D. 5-10 minutes before a meal

Explanation Choice D is correct. Aspart insulin is a rapid-acting insulin that should be administered to the client no greater than 5-10 minutes prior to the meal or while the client is actively eating. Before administering this insulin, the client's blood glucose should be obtained. Choices A, B, and C are incorrect. These are inappropriate times to administer aspart insulin. Rapid onset insulins (lispro, aspart, glulisine) are given 5-10 minutes before a meal or while the client is actively eating.

Following a detailed conversation between a nurse and a client regarding autologous blood donations, which of the following statements, if made by the client, would indicate the need for additional education on the topic? A. "Autologous donations require a health care provider's (HCP) order." B. "There is no age limitation for autologous blood donations." C. "I can begin autologous blood donations five weeks before my surgery date and continue up until 72 hours before surgery." D. "My autologous blood donation will be screened for infectious diseases."

Explanation Choice D is correct. Autologous donations are not screened for infectious diseases. According to the Food and Drug Administration (FDA), autologous donations are not screened because autologous donors are not exposed to new transfusion-transmitted infections in receiving their own blood. Choice A is incorrect. Each autologous donation requires an order or prescription by a health care provider (HCP). Choice B is incorrect. Although certain ages are preferable to others, there is no age limit for autologous donations. Active infections, specific cardiac conditions, and decreased hemoglobin levels are the primary methods of disqualification from autologous blood donation. Choice C is incorrect. Unless the client's health care provider (HCP) specifies otherwise, the traditional window for autologous blood donation begins five weeks before the scheduled surgery date, with the donation cutoff occurring 72 hours before the surgery. Learning Objective Recognize that autologous donors are not screened for infections because they are not exposed to new transfusion-related diseases in receiving their own blood.

The nurse performs a physical assessment on a client and observes that the client has reddened gums with bleeding. The nurse is correct in documenting this finding as A. glossitis. B. caries. C. cheilosis. D. gingivitis.

Explanation Choice D is correct. Gingivitis is inflammation of the gums that causes bleeding while brushing or flossing. Gingivitis is caused by poor oral hygiene and can be prevented with regular brushing and flossing. Choices A, B, and C are incorrect. Glossitis is inflammation of the tongue which may be a manifestation of pernicious anemia. Caries refer to the presence of tooth decay caused by poor oral hygiene. Cheilosis is the ulceration of the lips. Additional Info ✓ Adequate oral hygiene is an effective way to prevent gingivitis and dental caries ✓ Brushing is recommended twice a day ✓ The toothbrush bristles should be held at a 45-degree angle to the gum line ✓ Oral hygiene for a client that is hospitalized is an effective way to prevent pneumonia

The nurse is assessing a client who is newly diagnosed with rheumatoid arthritis (RA). Which of the following findings is consistent with this diagnosis? A. Janeway lesions B. Tophi C. Unilateral joint pain D. Low-grade fever

Explanation Choice D is correct. Rheumatoid arthritis (RA) is characterized by symmetrical joint involvement, which means it typically affects joints on both sides of the body. Symptoms of RA include bilateral joint pain, joint swelling, fatigue, low-grade fever, and weight loss. A low-grade fever can occur in RA due to the inflammatory nature of the disease. Choice A is incorrect. Janeway lesions are painless, small, red, or hemorrhagic macules or nodules on the palms or soles. They are typically seen in conditions like infective endocarditis, not in rheumatoid arthritis. Choice B is incorrect. Tophi are deposits of uric acid crystals that can develop in individuals with gout, not in rheumatoid arthritis. Choice C is incorrect. Rheumatoid arthritis is characterized by symmetrical joint involvement, meaning that it typically affects joints on both sides of the body, not just unilaterally. Unilateral joint pain is less likely to be associated with RA.

The nurse supervises a graduate nurse caring for a child with cerebral palsy. Which action by the graduate nurse requires intervention? The graduate nurse Incorrect Correct Answer(s): D A. initiates gentle range-of-motion exercises for the client. [8%] B. lowers the bed to its lowest position. [13%] C. wheels the client to the playroom via a wheelchair. [11%] D. feeds the client with the head of the bed elevated at 30 degrees.

Explanation Choice D is correct. Strategies to prevent aspiration are important to care and overall clinical outcome. For clients at risk of aspiration, elevating the head of the bed to > 30 degrees may help decrease the risk of aspiration. Here, when caring for a school-aged client with cerebral palsy, the nurse should position the client with the head of the bed elevated at 60 - 90 degrees to prevent aspiration. Feeding the client with the head of the bed at 30 degrees places the pediatric cerebral palsy client at an increased risk of aspiration, therefore warranting intervention by the charge nurse.

As you bathe your client and provide foot care, the client's toenails appear as shown in the exhibit. Which condition would you suspect? View Exhibit A. Onychomycosis B. Onychomadesis C. Onychorrhexis D. Onychia

Explanation Choice D is correct. The exhibit shows inflammation of the nail folds. This disorder is referred to as onychia. Onychia is characterized by inflammation of the nail bed and matrix resulting from either injury or infection. Choice A is incorrect. Onychomycosis is a fungal infection of the nail plate, nail bed, or both. The client's nails typically appear deformed with a white or yellow discoloration. Choice B is incorrect. Onychomadesis is the spontaneous separation of the nail plate from the matrix. Drug exposure to various local or systemic medications, including, but not limited to, some chemotherapeutic agents, antibiotics, anti-epileptic agents, etc., may cause this condition. Choice C is incorrect. Onychorrhexis refers to brittle nails that tend to break easily and not the appearance of the affected nail in the exhibit.

You are caring for an 80-year-old woman with a long-standing history of asthma. You are preparing to give a dose of theophylline to the patient. You know that the most critical sign to assess before giving this dose is: A. Temperature B. Blood Pressure C. Urinary Output D. Pulse

Explanation Choice D is correct. The nurse should evaluate the character of the pulse since one of the toxic effects of theophylline is cardiac arrhythmias. If the pulse rate is significantly increased or erratic, it may alert the nurse regarding a potential arrhythmia from theophylline drug toxicity. Severe adverse events, including arrhythmias, seizures/ status epilepticus, nausea with vomiting, and hypotension, usually occur when the theophylline is at a toxic level in the body (drug toxicity). If such signs are detected, the nurse should hold the next dose of theophylline and immediately notify the healthcare provider. Choices A, B, and C are incorrect. Theophylline does not typically change the patient's temperature (choice A). Theophylline can affect the patient's blood pressure and urinary output, but these effects are less common. The pulse should be assessed first because arrhythmias are more common with theophylline toxicity than hypotension (choice B).

Your 75-year-old female client complains of pain due to post-herpetic neuralgia. She is taking Naproxen. Which of the following analgesics should additionally be added to her pain management regimen? A. Oxycodone B. Acetaminophen C. Ibuprofen D. Topical lidocaine

Explanation Choice D is correct. Topical lidocaine is a co-analgesic. Co-analgesics are also referred to as adjuvant analgesics. It is crucial to use adjuvant analgesics for adequate pain control before moving to initiate opioid analgesics ( according to the World Health Organization's pain ladder). Topical lidocaine is very useful in local control of post-herpetic neuralgia pain. The lidocaine patch provides analgesia by reducing the abnormal firing of sodium channels on injured pain nerve fibers directly under the patch. Topical patches are considered relatively safe because only less than 5% of the topically applied lidocaine is absorbed. Choice A is incorrect. Oxycodone is not a co-analgesic. It is an opioid analgesic. Choice B is incorrect. Acetaminophen is not a co-analgesic. It is classified under non-opioid analgesics. Choice C is incorrect. Ibuprofen is not a co-analgesic. It's a non-opioid analgesic and an NSAID (non-steroidal anti-inflammatory agent), like Naproxen.

The nurse is caring for a client with herpes simplex virus who is experiencing an outbreak. Which medication does the nurse anticipate that the primary healthcare provider (PHCP) will prescribe? A. Metronidazole B. Acyclovir C. Imiquimod D. Fluconazole

Choice B is correct. Acyclovir is an antiviral and is effective in the management (and prevention) of outbreaks associated with herpes simplex virus (HSV). A client will either take this during an outbreak or daily to prevent an outbreak (called suppressive therapy). It is highly recommended that the client start this medication at the earliest sign of an outbreak which is the prodromal symptoms of headache, fever, malaise, itching, and burning in the affected area. Choices A, C, and D are incorrect. Metronidazole is an antibiotic and is ineffective for HSV. Metronidazole is effective for some sexually transmitted infections and anaerobic bacteria. Imiquimod is indicated in the treatment of genital warts and certain skin cancers. Fluconazole is an antifungal agent indicated in a variety of fungal infections. Additional Info Herpes simplex virus (HSV) is both sexually and non-sexually transmitted. The client often experiences the worst symptoms during the initial outbreak, which include headache, malaise, fever, and localized lymphadenopathy. Following these prodromal symptoms, painful skin eruptions occur, putting the client at higher risk of transmitting the infection. The client should be educated that even when an outbreak is not present, they risk infecting others with the virus. Medications to manage outbreaks are best taken early and include acyclovir.

The nurse is caring for a client with akathisia. The nurse should anticipate a prescription for which medication? A. Modafinil B. Propranolol C. Venlafaxine D. Duloxetine

Choice B is correct. Akathisia is the most common extrapyramidal side effect (EPS) associated with antipsychotic medications. Propranolol is an effective treatment for akathisia as this helps with treating the internal sense of restlessness characterized by this effect. Choices A, C, and D are incorrect. Modafinil is a psychostimulant used in the treatment of narcolepsy. This would likely make akathisia worse and would not be indicated. Venlafaxine and duloxetine are serotonin-norepinephrine reuptake inhibitors (SNRIs) and are not used to manage akathisia. Additional Info Akathisia is a sense of motor restlessness and is one of the most common EPS. The individual feels a compelling urge to move and could be mistaken as an individual being aggressive or agitated. Medications that can cause EPS include: antipsychotics (haloperidol, fluphenazine) and other dopamine-modulating medications such as metoclopramide. Prior to administering propranolol, the nurse must obtain the client's blood pressure and pulse. Hypotension and bradycardia would be contraindicated to administering this medication.

The charge nurse is planning client care assignments for a registered nurse (RN) and licensed practical/vocational nurse (LPN/VN). Which of the following clients would be most appropriate to assign to the LPN? A. A client requiring assistance picking out low potassium foods. B. A client requesting to leave the facility against medical advice (AMA). C. A client needing several prescriptions called into the local pharmacy. D. A client requesting breakthrough intravenous push (IV) pain medicine.

Choice C is correct. A client requiring prescriptions called into a pharmacy is appropriate for an LPN. The rest of the options require the RN. An LPN may receive telephone orders from a primary healthcare provider (PHCP) and call in the appropriate prescriptions, when necessary. Choices A, B, and D are incorrect. Picking out low potassium foods from a menu would require the RN to perform this task since selecting these items involves teaching. The client leaving AMA would require the RN to intervene as the client would need to be educated on this consequential decision. IV pain medication would require an RN as it is not within the scope of the LPN to assess the client for pain and administer the pain medication IV push.

The nurse is providing discharge instructions to a client prescribed nasal cannula oxygen. Which of the following instructions should the nurse include? Select all that apply. Keep a pulse oximetry device readily available. Pad the tubing in areas that put pressure on the skin. Have a sign on your door indicating the presence of oxygen. Use the oven and not the stovetop to cook. You may apply petroleum jelly to your nares to prevent drying.

Explanation Choices A, B, and C are correct. A pulse oximetry device should be provided to the client, and they should be encouraged to log their oxygen saturations as directed. If the client experiences dyspnea or tachypnea, the client should be instructed to seek medical attention for a level less than 95% (unless otherwise directed). Padding the tubing around pressure ears (back of the ears) is recommended to avoid injury. A sign posted on the door should be visible to alert visitors of the oxygen and extinguish and open flames. Choices D and E are incorrect. Stovetop and oven cooking is highly discouraged as the presence of oxygen may accelerate any fire that may ignite. Rather, if cooking is to be done using heat or flames, another individual should do the cooking, and the oxygen should be greater than six feet away from the flame source. Petroleum jelly should not lubricate the nares as it may be aspirated. Water-soluble jelly is recommended.

The nurse is calculating intake for a client. The client received 0.9% saline at 70 mL/hr for four hours, two eight-ounce cups of ice chips, one eight-ounce cup of coffee, and three eight-ounce cups of water. The nurse should calculate the client's total intake as how many mL? Fill in the blank.

Explanation To calculate the client's total intake, the nurse must recall that one cup is eight ounces, equating to approximately 240 mL. The client received 0.9% saline infusion at 70 mL/hr for four hours → 280 mL total Two cups of ice chips → 240 mL total When determining the total mL for a cup of ice, the nurse should divide the volume by 1/2 since the ice melts One cup of ice is 240 mL, and it would be divided by half to account for the melt = 120 mL 120 mL x 2 (number of cups the client consumed) One cup of coffee → 240 mL Three cups of water → 720 mL When added up, the total intake was 1480 mL Additional Info When calculating intake for a client, the nurse should include - ✓ Oral liquids (anything that is liquid at room temperature) ✓ Oral liquids that should be tracked include ice cream, gelatin, water, juice, cola ✓ For ice chips, half of the total volume should be documented as fluid - 1 cup of ice chips (240 mL) = 1/2 cup of water (120 mL) ✓ Pureed foods are not considered liquid intake ✓ Additional intake that should be counted includes intravenous (IV) fluids, tube feeding, tube feeding irrigations, and blood products ✓ Intake is calculated as milliliters (mL) ✓ One ounce (oz) is equivalent to 30 mL

The primary healthcare provider (PHCP) prescribes 250 mL of 0.9% saline to infuse over 75 minutes. How many mL per hour will be administered to the client? Fill in the blank.

Explanation To solve this problem, the formula of volume / time (hours) will be used. First, convert the minutes to hours 75 minutes / 60 minutes = 1.25 hrs Next, divide the prescribed total volume by the infusion time 250 mL / 1.25 hours = 200 mL/hr

The RN is the only RN in the assisted care facility on a busy evening shift. Of the following tasks, which ones can be safely delegated to an experienced LPN/LVN? Select all that apply. Completing an admission assessment on a new patient Administering routine oral medications to stable patients. Removal of a urinary catheter Completing a dressing change Administering an initial dose of a new medication to a patient.

It's crucial for LPNs/LVNs and their employers to familiarize themselves with the specific nursing practice act and regulations in their state. State Boards of Nursing are typically the best resource for this information. The scope of practice for Licensed Practical Nurses (LPNs) or Licensed Vocational Nurses (LVNs) can vary by state, but commonly includes the following: ✓Providing basic patient care, including monitoring vital signs, bathing, and dressing. ✓Administering injections and medications (excluding certain high-risk medications or routes). ✓Performing routine laboratory tests and sample collections. ✓Assisting with wound care and dressing changes. ✓Assisting patients with activities of daily living (ADLs). ✓Reporting changes in patient status to RNs or physicians. ✓Providing patient and family education under the supervision of an RN. However, some tasks are usually outside the LPN/LVN scope of practice: ✓Initial patient assessments, which are usually done by RNs. ✓Administering certain types of medications, such as those given intravenously (although this can vary by state). ✓Developing and modifying nursing care plans. ✓Performing certain complex procedures. ✓Working independently without supervision from an RN or physician.

Onychomycosis

a fungal infection of the nail plate, nail bed, or both. The client's nails typically appear deformed with a white or yellow discoloration

Hyphema

blood in the anterior chamber of the eye. This is commonly caused by blunt trauma to the eye.

Mydriasis

dilation of the pupil. This is not drooping of the eyelid. Mydriasis may be caused by the fight or flight response and certain medications such as central nervous stimulants.

Presbyopia

is age-related vision loss that causes farsightedness. This is progressive and may be corrected with glasses or contact lenses.

Onychorrhexis

refers to brittle nails that tend to break easily and not the appearance of the affected nail in the exhibit.

Onychomadesis

the spontaneous separation of the nail plate from the matrix. Drug exposure to various local or systemic medications, including, but not limited to, some chemotherapeutic agents, antibiotics, anti-epileptic agents, etc., may cause this condition.