EXAM 3 ATI QUESTIONS

A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following statements should the nurse include in the teaching?

"Clients who are pregnant should not take warfarin." Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta and places the fetus at risk for bleeding.

A nurse is caring for a client who has diabetes and a new prescription for 14 units of regular insulin and 28 units of NPH insulin subcutaneously at breakfast daily. What is the total number of units of insulin that the nurse should prepare in the insulin syringe?

42 units Rationale: Each order of for units of insulin is combined in the same syringe. The nurse should withdraw the regular insulin into the syringe first.

A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective?

A decrease in urine output Rationale: The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

A nurse is preparing to administer a unit of packed red blood cells to a client. Which of the following actions should the nurse plan to take?

Remain with the client for the first 15 minutes of the transfusion. Rationale: The nurse should remain with the client for the first 15 to 30 minutes of the transfusion to monitor for a transfusion reaction, which occurs often during the first 50 mL of the transfusion.

A nurse is preparing a presentation about black cohosh to a group of clients. Which of the following information should the nurse include in the teaching?

"Black cohosh is used to alleviate menopausal symptoms." Rationale: Black cohosh may relieve menopausal symptoms, such as hot flashes, by suppressing the release of luteinizing hormone.

A nurse is administering a unit of RBC 350 mL over 3 hr to a client who has anemia. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

117 mL/hr

A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider?

Platelets 74,000/mm3 Rationale: Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts. It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. The expected reference range for platelets is 150,000-400,000/mm3.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance?

Prednisone Rationale: Corticosteroids such as prednisone can cause glucose intolerance and hyperglycemia. The client might require increased dosage of a hypoglycemic medication.

A nurse is caring for a client who is receiving a transfusion of packed red blood cells and suspects that the client is experiencing a hemolytic reaction. Which of the following interventions is the priority?

Stop the transfusion. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When suspecting a hemolytic reaction, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis.

A nurse is preparing to administer heparin 2,000 units by IV bolus. Available is heparin injection 5,000 units/mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

0.4 mL

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take?

Inject the medication into the abdomen above the level of the iliac crest. Rationale: The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.

A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. Which of the following instructions should the nurse provide regarding this type of insulin?

Insulin glargine has a duration of 18 to 24 hr. Rationale: Insulin glargine is a long duration insulin that has a duration of 18 to 24 hr. It is only dosed once a day.

A nurse is preparing to initiate a transfusion of packed RBC for a client who has anemia. Which of the following actions should the plan to nurse take?

Check the client's vital signs every hour during the transfusion. Rationale: The nurse should check the client's vital signs every 15 min at the start of the transfusion, then every 1 hr to monitor for a transfusion reaction.

A nurse is reviewing the medical record of a client who has been on levothyroxine for several months. Which of the following findings indicates a therapeutic response to the medication?

Decrease in level of thyroid stimulating hormone (TSH). Rationale: In hypothyroidism, the nonfunctioning thyroid gland is unable to respond to the TSH, and no endogenous thyroid hormones are released. This results in an elevation of the TSH level as the anterior pituitary continues to release the TSH to stimulate the thyroid gland. Administration of exogenous thyroid hormones, such as levothyroxine, turns off this feedback loop, which results in a decreased level of TSH.

A nurse is teaching a group of young women about the use of oral contraceptives. The nurse should teach that taking which of the following herbal preparations reduces the effectiveness of this birth control method?

St. John's wort Rationale: St. John's wort decreases the effectiveness of oral contraceptives and can be responsible for breakthrough bleeding and unintended pregnancies.

A nurse is assessing a client who is receiving a unit of packed RBCs. The client appears flushed and reports low-back pain. Which of the following actions is the nurse's priority?

Stop the transfusion. Rationale: The greatest risk to the client is injury due to further hemolysis; therefore, the priority action is to stop the transfusion. When a hemolytic reaction is suspected, the priority action by the nurse is to immediately stop the transfusion to prevent further hemolysis.

A nurse is teaching a client who has a new prescription for NPH insulin. Which of the following instructions should the nurse include?

"Eat a snack 8 hours after taking this medication." Rationale: NPH insulin peaks in 6 to 14 hr after dosing. The client is at risk for hypoglycemia and might require a snack at this time. Clients should check blood glucose 8 to 10 hr after administration of NPH insulin, and if hypoglycemic, consume a small snack of 15 g of carbohydrates, followed by rechecking of the blood glucose in 15 min.

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

"Heparin does not dissolve clots. It stops new clots from forming." Rationale: This statement accurately answers the client's question.

A nurse at a family practice clinic receives a call from a client who is prescribed oral contraceptives but forgot to take one dose. The client reports she is in the first week of a 28-day cycle pack. Which of the following instructions should the nurse provide?

"Take the missed dose now, then continue the medication as ordered." Rationale: The nurse should tell the client to take the missed dose immediately, then continue with the pack as ordered. The nurse should also tell the client to use an additional form of contraception for 7 days.

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?

"You might have to stop taking this medication 5 days before any planned surgeries." Rationale: Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding.

A nurse is caring for a client is who has a deep vein thrombosis and is prescribed heparin by continuous IV infusion at 1,200 units/hr. Available is heparin 25,000 units in 500 mL D5W. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest tenth/whole number. Use a leading zero if it applies. Do not use a trailing zero.)

24 mL/hr Correct Rationale: STEP 1: What is the unit of measurement the nurse should calculate? mL/hr STEP 2: What is the volume the nurse should infuse? 1200 units/hr STEP 3: What is the total infusion time? 2 hr STEP 4: Should the nurse convert the units of measurement? Yes Units/Volume (mL) = X units/mL 25000 units/500 mL = 50 units/mLX = 50 units/mL STEP 5: Set up an equation and solve for X. Volume (units)/Time (hr) = X mL/hr 1200 mL/50 units/mL = X mL/hr X = 24 mL/hr STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the provider prescribed 1200 units to infuse per hr, it makes sense to administer 24 mL/hr. The nurse should set the IV pump to deliver heparin 1200 units/hr at 24 mL/hr.

A nurse is preparing to administer 10 units of regular insulin and 20 units of NPH insulin to a client. What is the sequence of events the nurse should follow? (Move the steps of mixing insulin on the left into the box on the right, placing them in the selected order of performance. All steps must be used.)

4. Inspect vials for contaminants. 3. Roll NPH vial between palms of hands. 1. Inject air into NPH insulin vial. 5.. Inject air into regular insulin vial. 2. Withdraw short-acting insulin into syringe. 6.. Add intermediate insulin to syringe.

A nurse is obtaining a medical history from a client who is to start warfarin therapy and currently uses herbal supplements at home. The nurse should inform the client that which of the following herbal supplements can interact adversely with warfarin?

Feverfew Rationale: The nurse should instruct the client to avoid taking feverfew while taking warfarin because it will increase the anticoagulant effect.

A nurse is caring for a client who has diabetes and plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. After checking the client's morning glucose level, which of the following actions should the nurse take?

Give the insulin at 0730. Rationale: Regular insulin has an onset of 30 to 60 minutes and should be given at a specific time before meals, usually within 30 min. The nurse should always check the blood glucose levels prior to administering short-acting insulin.

A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication the client might be experiencing a hemolytic reaction?

Hypotension Rationale: A hemolytic reaction causes hypotension, headache, apprehension, chest pain, and low-back pain.

A nurse is assessing a client who is receiving liothyronine for treatment of hypothyroidism. The nurse should recognize which of the following findings is a therapeutic response to this medication?

Increase in energy Rationale: An increase in energy is a therapeutic response to liothyronine. Depression, lethargy, and fatigue are manifestations of hypothyroidism and effective treatment will improve these manifestations.

A nurse is providing teaching to a female client who has type 2 diabetes and a new prescription for pioglitazone. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Monitor weight daily. Increase calcium intake. Rationale: Monitor weight daily is correct. Pioglitazone may lead to fluid retention and worsen heart failure. Clients should monitor weight and report any rapid gains to the provider. Rationale: Increase calcium intake is correct. Pioglitazone increases the risk of fractures in women. Clients should be advised to exercise and ensure adequate intake of vitamin D and calcium to protect bone health.

A nurse is reviewing laboratory results of a client who has atrial fibrillation and is taking warfarin. For which of the following results should the nurse notify the provider?

PT 45 seconds Rationale: The expected reference range for PT is 11 to 12.5 seconds. During therapy, the nurse should expect to see the values increase 1.5 to 2.5 times the baseline. Therefore, the nurse should withhold the warfarin and notify the provider.

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose?

Protamine Rationale: Protamine reverses the effects of heparin and is used in the event of an overdose.

A nurse is preparing to transfuse one unit of packed RBC to a client who experienced a mild allergic reaction during a previous transfusion. The nurse should administer diphenhydramine prior to the transfusion for which of the following allergic responses?

Urticaria Rationale: For clients who have previously had allergic reactions to blood transfusions, administering an antihistamine such as diphenhydramine prior to the transfusion might prevent future reactions. Allergic reactions typically include urticaria (hives).

A nurse is reviewing the medication list for a client who has a new prescription for warfarin. The nurse should recognize that which of the following medications is incompatible with warfarin?

Vitamin K Rationale: These two medications are not compatible. Vitamin K antagonizes the action of warfarin and is the antidote for warfarin toxicity.

A nurse is caring for a client who has developed agranulocytosis as a result of taking propylthiouracil to treat hyperthyroidism. The nurse should understand that this client is at increased risk for which of the following conditions?

Infection Rationale: Agranulocytosis is a failure of the bone marrow to make enough white blood cells, causing neutropenia and lowering the body defenses against infection.

A nurse is assessing a client who is taking levothyroxine. The nurse should recognize that which of the following findings is a manifestation of levothyroxine overdose?

Insomnia Rationale: Levothyroxine overdose will result in manifestations of hyperthyroidism, which include insomnia, tachycardia, and hyperthermia.

A nurse in a provider's clinic is caring for a client who reports erectile dysfunction and requests a prescription for sildenafil. Which of the following medications currently prescribed for the client is a contraindication to taking sildenafil?

Isosorbide Rationale: Clients who are on nitrates including isosorbide and nitroglycerin preparations cannot take sildenafil, because of the serious medication interaction. There is the possibility of sudden death due to hypotension.

A nurse is teaching a client who has a new prescription for regular insulin and NPH insulin. Which of the following instructions should the nurse include in the teaching?

Keep the open vial of insulin at room temperature. Rationale: The client should keep the vial in use at room temperature to minimize tissue injury and to reduce the risk for lipodystrophy.

A nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for this client?

Leuprolide Rationale: Leuprolide treats cancer of the prostate hormonally. It antagonizes the androgens that androgen-dependent neoplasms require.

A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. On which of the following medications should the nurse prepare to instruct the client?

Levothyroxine Rationale: Levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine (T4). It is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on the use of this medication.

A nurse is caring for a client who is experiencing Cushing's Triad following a subdural hematoma. Which of the following medications should the nurse plan to administer?

Mannitol 25% Rationale: Cushing's Triad is an indication that the client is experiencing increased intracranial pressure. The nurse should administer mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema.

A nurse is caring for a client who has a traumatic head injury and is exhibiting signs of increasing intracranial pressure. Which of the following medications should the nurse plan to administer?

Mannitol 25% Rationale: The nurse should plan to administer mannitol 25%, an osmotic diuretic that lowers intracranial pressure by promoting diuresis.

A nurse is providing teaching for a client who is newly diagnosed with type 2 diabetes mellitus and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide?

"Glipizide stimulates your pancreas to release insulin." Rationale: Glipizide is an oral antidiabetic medication in the pharmacological classification of sulfonylurea agents. These medications help to lower blood glucose levels in clients who have type 2 diabetes mellitus using several methods, including reducing glucose output by the liver, increasing peripheral sensitivity to insulin, and stimulating the release of insulin from the functioning beta cells of the pancreas.

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?

"I have started taking ginger root to treat my joint stiffness." Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

A nurse is evaluating teaching with a client who is receiving continuous subcutaneous insulin via an external insulin pump. Which of the following statements by the client indicates a need for further teaching?

"I will use insulin glargine in my insulin pump." Rationale: The client should use a short-acting insulin in the insulin pump. The insulin pump is designed to administer rapid-acting or short-acting insulin 24 hr a day. Insulin glargine is classified as a long-acting insulin and is administered at the same time each day to maintain stable blood glucose concentration for a 24-hr period.

A nurse is providing discharge teaching to a client who has a new prescription for warfarin. Which of the following statements by the client indicates an understanding of the teaching?

"I'll use my electric razor for shaving." Rationale: Because this medication prolongs clotting times, the client should avoid situations that put him at high risk for bleeding, such as shaving with a straight razor or a razor blade.

A nurse is providing teaching to a client who is taking warfarin about monitoring its therapeutic effects. Which of the following explanations should the nurse provide about the international normalized ratio (INR) test?

"The INR is a standardized test that eliminates the variations between laboratories reports in prothrombin times." Rationale: The INR is a standardized test, which means that the result will be the same, no matter which laboratory performs it.

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make?

"Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Rationale: Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

A nurse is providing education to a client who is in labor and has a prescription for a continuous IV infusion of oxytocin. Which of the information should the nurse include?

"Your contractions will become stronger and more frequent." Rationale: Oxytocin is diluted with sodium chloride and administered IV via an infusion pump device to induce or strengthen uterine contractions during labor. The client who is receiving an oxytocin drip is closely monitored to promote a safe delivery and prevent maternal and/or fetal complications. The desired concentration of oxytocin medication is determined by the desired labor contraction pattern that should increase in frequency, duration, and intensity. The nurse closely monitors risks of continuous IV infusion of oxytocin to determine when to discontinue the medication. Risks include fetal distress (fetal bradycardia) caused by hyper-stimulation of the uterus compromising blood flow to the fetus. Uterine contractions lasting longer than 90 seconds should prompt the nurse to discontinue the medication.

A nurse is preparing to administer 1 mg vitamin K to a newborn. The medication is available in 1 mg/0.5 mL. How much should the nurse administer? (Round to the nearest tenth. Use a leading zero when applicable. Do not use a trailing zero.)

0.5 mL

A nurse is teaching a client who is in her first trimester of pregnancy about over-the-counter medications that are a pregnancy risk category B. Which of the following medications should the nurse include?

Acetaminophen Rationale: Acetaminophen is a pregnancy risk category B. Animal studies do not show fetal risk or controlled studies in women do not show a fetal risk.

A nurse is teaching a client who has diabetes mellitus and a new prescription for glimepiride. The nurse should teach the client to avoid which of the following drinks while taking this medication?

Alcohol Rationale: The nurse should teach the client to avoid alcohol while taking this medication to prevent a disulfiram reaction, such as nausea, headache, and hypoglycemia.

A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning the infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary?

An excess amount of doxorubicin can lead to cardiomyopathy. Rationale: Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m2 or 450 mg/m2 with a history of radiation to the mediastinum.

A nurse is teaching a client who reports taking gingko biloba to improve his memory. Which of the following adverse effects should the nurse include?

Bleeding gums Rationale: Gingko biloba is an herbal medication used by clients to improve age-related memory loss as well as to decrease leg pain in clients with peripheral arterial disease (PAD). Although gingko biloba is generally well-tolerated, it may suppress coagulation. There have been reports of spontaneous bleeding in clients taking this herbal medication. Clients should be instructed to discontinue use and report increased bleeding, such as nosebleeds, bleeding gums, any cuts that do not stop bleeding, to their provider.

A nurse is teaching a client how to draw up regular insulin and NPH insulin into the same syringe. Which of the following instructions should the nurse include?

Discard regular insulin that appears cloudy. Rationale: The nurse should teach the client to discard any regular insulin that appears cloudy, as regular insulin should be clear. NPH insulin has a cloudy appearance.

A nurse is monitoring a client who is receiving a unit of packed RBCs following surgery. Which of the following assessments is an indication that the client might be experiencing circulatory overload?

Dyspnea Rationale: Circulatory overload causes dyspnea, cough, rales, tachycardia, and jugular vein distention.

A nurse is caring for a client who is receiving a continuous IV infusion of heparin. Which of the following actions should the nurse take?

Check the activated partial thromboplastin time (aPTT) every 4 hr. Rationale: Heparin is an anticoagulant. The activated partial thromboplastin time (aPTT) should be monitored every 4 hr and the infusion rate should be adjusted accordingly until the effective dose has been determined.

A nurse is assessing a client who is receiving a unit of packed red blood cells. Which of the following findings is a manifestation of acute hemolytic reaction?

Client report of low back pain Rationale: Manifestations of an acute hemolytic reaction include apprehension, tachypnea, hypotension, chest pain, and lower back pain.

A nurse is teaching a client who has diabetes mellitus and receives 25 units of NPH insulin every morning if her blood glucose level is above 200 mg/dL. Which of the following information should the nurse include?

Expect the NPH insulin to peak in 6 to 14 hr. Rationale: NPH insulin is an intermediate-acting insulin. Its onset of action is 1 to 2 hr, peaking at 6 to 14 hr. Its duration of action is 16 to 24 hr. The client is at risk for hypoglycemia during the peak time.

A nurse is caring 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?

Protamine sulfate Rationale: Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties.

A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?

Prothrombin time (PT) Rationale: This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.

A nurse is preparing to administer enoxaparin to a client. Which of the following actions should the nurse plan to take?

The nurse should not expel the air bubble in the prefilled syringe. Rationale: The nurse should not expel the air bubble that is in the pre-filled syringe prior to administering the medication.

A charge nurse is supervising a newly licensed nurse care for a client who is receiving a transfusion of packed RBC. The nurse suspects a possible hemolytic reaction. After stopping the blood transfusion, which of the following actions by the new nurse requires intervention by the charge nurse?

The nurse starts the transfusion of another unit of blood product. Rationale: When suspecting a hemolytic reaction, the nurse should immediately stop the transfusion of all blood products. The transfusion of additional products can increase the client's risk for further complication.

A nurse is providing discharge teaching for a client who has a new prescription for warfarin. Which of the following instructions should the nurse include in the teaching?

Use an electric razor while on this medication. Rationale: Warfarin, an anticoagulant, increases the client's risk for bleeding. The nurse should teach the client safety measures, such as using an electric razor, to decrease the risk for injury and bleeding.