Exam 4 study questions

Which antipyretic medication may cause Reye syndrome in children? 1. Aspirin 2. Naproxen 3. Ibuprofen 4. Dantrolene

1 rationale: aspirin is an anti-platelet drug that increases the risk of swelling in the brain and liver, which are the main symptoms of reye syndrome in children. Aspirin is not recommended in children

The child is prescribed fluticasone after an acute asthma attack. Which instruction would the nurse give the family about the administration of this medication? 1:fluticasone needs to be taken with food and milk 2:fluticasone is primarily used to treat acute asthma attacks 3:the child should suck on hard candy to help relieve dry mouth 4:watch for white patches in the mouth and report to the HCP

4

The nurse educator is providing information about different insulin types. Which type of insulin can be safely mixed with regular human insulin in the same syringe? 1:insulin glargine 2:insulin detemir 3:insulin lispro mix 75/25 4: isophane insulin neutral protamine hagedorn (NPH)

4

Which action by a transgender client during teach-back learning about applying an estrogen hormone patch needs review for correction? 1: applies the patch over hair 2:rotates areas of patch application 3:wipes away the previous patch residue 4: ensures good contact between the patch and skin

1

Which first line medication would the nurse anticipate administering to a client to treat anaphylactic reactions 1:epinephrine 2:norepinephrine 3:dexamethasone 4:diphenhydramine

1

school health nursing programs have which goal? 1:health promotion 2:disease management 3:chronic care management 4:environmental surveillance

1

Which response would a nurse give to a client with hypertension prescribed hydrochlorothiazide who reports hearing that furosemide is more effective and requests a prescription change? 1:HCTZ has fewer side effects 2:HCTZ does not cause dizziness 3:HCTZ is only taken when needed 4:HCTZ does not cause dehydration

1 rationale: -furosemide side effects include hypokalemia, ototoxicity -HCTZ causes minor side effects. Also causes hypokalemia -all diuretics cause dizziness, dehydration, and are taken regularly as directed

Which reason would the nurse provide to a client who asks why blood test are necessary after a HCP prescribes peak and trough levels after initiation of IV antibiotic? 1:they determine if the dosage of the medication is adequate 2:they detect if you are having an allergic reaction to the medication 3:the tests permit blood culture specimens to be obtained when the medication is at its lowest level 4:these allow comparisons of your fever to changes in the antibiotic level

1 rationale: medication dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels.

which test result would the nurse use to determine whether the daily dose is therapeutic when a client with a venous thrombosis is receiving warfarin? 1:INR 2:APTT 3:bleeding time 4:sedimentation rate

1 rationale: warfarin labs are PT, INR

Which information would the nurse provide to a student about the primary level of prevention? Select all that apply 1:known as true prevention 2:applied to clients who are considered physically and emotionally healthy 3:directed toward rehabilitative care rather than diagnosis and treatment 4:activities enable clients to return to a normal level of health as early as possible 5:includes health education programs, immunizations, and physical and nutritional fitness activities

1,2,5

Which assessment finding indicates to the nurse a client is experiencing an allergic reaction to antibiotic therapy? 1:pruritus 2:confusion 3:wheezing 4:muscle aches 5:bronchospasms

1,3,5

Which factor may help in providing excellent health care services to the client? select all that apply 1:cultural sensitivity 2:high client literacy 3:competent health care 4:one-way communication 5:interprofessional teamwork

1,3,5 rationale: -cultural sensitivity helps provide excellent health care while keeping in mind the clients cultural background and attitude -competent health care help in reaching the clients goals -interprofessional teamwork helps provide comprehensive care to the client

Which is the maximum volume of an intramuscular injection recommended for a preschool-aged child? 1: 0.5mL 2:1.0mL 3:1.5 ml 4: 2.0 mL

2 rationale: -0.5 is the max in newborns -1 is the max for preschool -2 is the max for older children if they have sufficient muscle mass

Which insulin would the nurse conclude has the fastest onset action? 1:NPH 2:Insulin lispro 3:regular insulin 4:insulin glargine

2 rationale: -Lispro/aspart: onset: 15 minutes, peak: 45-90 mins, duration: 4 hours -regular insulin: onset: 30 minutes, peak: 2-4 hours, duration: 6-8 hours -NPH/isophane: onset: 1-2 hours, peak: 4-12 hours, duration: 18-24 hours -Glargine: onset: 1 hour, NO peak, duration: 24 hours

The nurse is preparing to initiate antibiotic therapy for a client who developed an incisional infection. Which task would the nurse ensure has been completed before starting the first dose of IV antibiotics? 1:RBC count 2:wound culture 3:knee x ray 4:urinalysis

2 rationale: a wound culture is obtained to determine the organism that is growing. - a WBC count is more beneficial

Which statement by a client who had an endarterectomy that is prescribed clopidogrel would cause the nurse to conclude that teaching was effective? 1:clopidogrel will limit inflammation around my incision 2:taking this medication will help prevent further clogging of my arteries 3:i will take this medication to reduce the discomfort I feel at the surgical incision

2 rationale: clopidogrel interferes with platelet aggregation, impeding the formation of thrombi -this medicine is not an anti-inflammatory, antipyretic, or analgesic

While preparing to teach a client about self injection of insulin, which nurses action would increase the effectiveness of the teaching session? 1:wait until a family member is also present 2:assess the clients barriers to learning self injection techniques 3:begin with simple written instructions describing the technique 4: wait until the client has accepted the new diagnosis of type 1 diabetes mellitus

2 rationale: must assess factors that interfere with learning

when would the nurse have the lab obtain a blood sample to determine the peak level of an antibiotic administered by intravenous piggyback (IVPB) 1:halfway between two doses of the medication 2:between 30 and 60 minutes after a dose 3:immediately before the medication is administered

2 rationale: peak is obtained after (30-60 mins) and trough is obtained before

Which instructions would the nurse provide an individual about the role an individual plays in health and wellness and its effect? select all that apply 1: using passive strategies for health promotion enables one to benefit from the activities of others 2:lifestyle choices affect quality of life and well being 3:individuals should take responsibility for health and wellness by making proper lifestyle choices 4:individuals should understand that it is enough to make positive lifestyle choices to prevent illness

2,3,4

Which description are characteristics of the secondary level of prevention? 1: activities are aimed at health promotion 2:focuses on individuals with health problems and illnesses 3:activities are directed at diagnosis and prompt interventions 4:helps in minimizing the effects of long term disease and disability 5:includes screening techniques and treating diseases at early stages

2,3,5

After completing a week of antibiotic therapy, an infant develops oral thrush. Which medication is indicated for treatment of this condition. 1:acyclovir 2:vidarabine 3:nystatin 4:fluconazole

3 rationale: Nystatin is an antifungal agent prescribed to treat oral thrush (white patches on tongue and cheeks) in infants -acyclovir is an antiviral agent and are not used to treat this -fluconazole can treat oral thrush but its use in infants is not approved by the US food and drug administration

Which assessment finding indicates a need for the nurse to consult with the HCP before administering the prescribed metoprolol to a client with stable angina? 1:BP 142/90 2:report of chest pain when walking 3:sinus bradycardia, rate 54 on monitor 4:large Q waves on electrocardiogram

3 rationale: Because beta blockers such as metoprolol decrease HR, the nurse would discuss this with HCP before administering. -beta blockers lower BP, will also decrease chest pain by decreasing cardiac o2 and ischemia

Which client statement about ampicillin indicates that additional teaching is needed? 1:i should take this on an empty stomach with a full glass of water 2:this medicine will work best if i space the time out evenly 3:i can stop this medication after i am symptom-free for 48 hours 4:if i get worse, i will notify my primary health care provider

3 rationale: it is most important for the client to complete the full antibiotic prescription to prevent the development of antibiotic resistant bacteria

Which statement is important for the nurse to include in the teaching plan of a client with IBS who has instructions to take psyllium for constipation? 1:urine may be discolored 2:stop taking the laxative once a bowel movement occurs 3:each dose should be take with a full glass of water or juice 4:daily use may inhibit the absorption of some fat soluble vitamins

3 rationale: this bulk forming laxative works by absorbing water into the intestine, which increases bulk and distends the bowel to initiate reflex bowel activity, thus promoting a bowel movement. This laxative is recommended for long term use and should not be stopped once a movement occurs

A parent calls the clinic about the appropriate dosage of acetaminophen for a 16month old child. The directions on the bottle are 120mg every 4 hours when needed. However, at the 15 month visit, the health care provider prescribed 150mg. Which response by the nurse is most appropriate about the prescribed dosage? 1:the dose is close enough, and it doesnt really matter which one you give 2:from your description, the medications arent necessary. They should be avoided at this age 3:its appropriate to base dosages on age. Children typically have weights consistent for their age groups 4:the prescribed dose of the medication was based on weight, and this is a more accurate way of determining a therapeutic dose

4

Which potential adverse effect would the nurse monitor for in a client prescribed ceftriaxone for an infection? 1:dehydration 2:heart failure 3:constipation 4:allergic reaction

4

nurse teaches a patient with heart failure healthy food choices. The patient states that eating yogurt is better than eating cake. Which element represents feedback? 1: The nurse 2: The patient 3: The nurse teaching about healthy food choices 4: The patient stating that eating yogurt is better than eating cake

4

which consideration would the nurse make when preparing to give a preschooler an intramuscular injection in the vastus lateralis is used site? 1:the anterior third of the vastus lateralis is used to give an injection 2:the vastus lateralis site is used to inject volumes greater than 10mL 3:the child should keep the knee straight to receive an injection at the vastus lateralis site 4: the maximum recommended length of the needle insertion at the vastus lateralis site is 1 inch for preschoolers

4 rationale: -the middle third not the anterior third is used to give an injection -the maximum injection volume for the vastus lateralis is 1 mL -to receive an injection on the vastus lateralis site, the client should be lying flat with a flexed knee

which mechanism would a nurse recall when caring for a client prescribed bisacodyl for constipation? 1: producing bulk 2:softening feces 3:lubricating feces 4:stimulating peristalsis

4 rationale: biscodyl stimulates nerve endings in the intestinal mucosa, precipitating a bowel movement. -docusate are stool softener -psyllium are bulk forming laxatives

T/F: extra precautions should be taken with patients on anticoagulants

true

What drug am I: I am an antibiotic that is reserved for serious infections, including MRSA. I can cause ototoxicity and nephrotoxicity. Lab work has to watched carefully (peak and through).Be sure to avoid infusing too fast because it can cause red man syndrome

vancomycin

which key points need to be remembered to maintain health and wellness of a client? (select all that apply) 1:internal and external variables are considered when planning care for a client 2:the health belief model considers the relationship between a persons health beliefs and health behaviors 3:the health promotion model highlights factors that increase individual well being and self actualization 4:holistic therapies are use by nurses only for pregnancy and pregnancy related issues to help clients deal with pain 5:the ANA emphasizes identifying a clients individual needs, prioritizing the needs, and encouraging the clients self actualization

1,2,3 rationale: -holistic therapies are used for cancer, pregnancy, and for many complicated diseases

which clinical finding is commonly associated with hyperglycemia?select all that apply 1:polyuria 2:polydipsia 3:polyphagia 4:polypharsia 5:polydysplasia

1,2,3 rationale: polyuria is excessive urination associated with osmotic diuresis. polydipsia is excessive thirst. polyphagia is the catabolic state induced by insulin deficiency -polyphrasia is excessive talking associated with mental illness -polydysplasia is related to multiple developmental abnormalities

What drug am I: I am used to treat diabetes. I am available in oral form. I should be stopped before having a CT scan. Be sure to monitor blood glucose level before administering medication.

glucophage

The nurse notes an older adults admission orders include gentamicin for the treatment of osteomyelitis. Which lab report would the nurse review before beginning the medication? 1:blood urea nitrogen (BUN) and creatinine 2:electrolytes and urinalysis 3:erythrocyte count 4:blood platelet count 5:serum thyroxin level

1,2 rationale: gentamicin is an aminoglycoside (antibiotic) and it can increase the risk of nephrotoxicity. The nurse should assess the clients renal function before starting therapy. Dehydration can further increase the risk of nephrotoxicity so hydration status should be checked

Which information would the nurse provide to a child's caregivers to ensure safe, proper handling, and use of medication? select all that apply 1:medication storage 2:written instructions 3:calculation of the dosage based on symptoms 4:nature and duration of the adverse response 5:demonstration of the technique of administration

1,2,4,5 rationale: the caregiver may not know how to calculate dosage based on symptoms, and this poses a risk to the child

Which clinical indicator would the nurse monitor to determine if the clients simvastatin is effective? 1: heart rate 2:triglycerides 3:blood pressure 4:international normalized ratio

2 rationale: simvastatin is a lowering lipid agent that should only be taken in the evening (atrovastatin is taken anytime) - the therapeutic effects of simvastatin include decreased levels of serum triglycerides, low density lipoprotein, and cholesterol

Which antidote would the nurse anticipate administering to a client whose lab report establishes a warfarin overdose? 1:physostigmine 2:vitamin K 3:iron dextran 4:protamine sulfate

2 rationale: warfarin inhibits formation of vitamin K (dependent clotting factors). Its affect is overcome by increasing vitamin K -physostigmine is an antidote for anticholinergic overdose -protamine sulfate is the antidote for heparin overdose

Which response would the nurse expect a client experiencing hypoglycemia to exhibit? select all that apply 1:nausea 2:palpitations 3:tachycardia 4:nervousness 5:warm, dry skin 6:increased respirations

2,3,4 rationale: palpitations and tachycardia (heart racing) is stimulated by the decline in blood glucose. nervousness, cool and moist skin, anxiety, and shakiness also occur. There is no change in RR -nausea, vomiting, increased RR and abdominal cramps are caused by HYPERglycemia -warm, dry skin is HYPERglycemia caused by dehydration

The nurse recognizes that premature infants are at risk for increased sensitivity to medications due to which factors? select all that apply 1:body size 2:blood brain barrier 3:hepatic drug metabolism 4:renal drug excretion 5:protein binding of the drugs

2,3,4,5

Which instruction will the nurse include in a teaching plan for a client taking a calcium channel blocker such as nifedipine? select all that apply 1:reduce calcium intake 2:report peripheral edema 3:expect temporary hair loss 4:avoid drinking grapefruit juice 5:change to a standing position slowly

2,4,5 rationale: peripheral edema may occur as a result of heart failure, grapefruit juice affects the metabolism of CCB, changing positions slowly helps reduce orthostatic hypotension

Which statement by the nurse is correct regarding medication absorption in infants? 1:absorption is decreased for acid labile medications 2:absorption is increased when gastric emptying is decreased 3:absorption through the intramuscular route is rapid 4:absorption via the transdermal route is faster in infants and children

3

Which lab value would the nurse use to determine whether a client is receiving a therapeutic dose of IV heparin? 1:international normalized ration is between 2 and 3 2:PT is 2.5 times the control value 3: APTT is 70 seconds 4:ACT is the range of 70-120 seconds

3 rationale: APTT is a heparin lab and PT/INR are warfarin labs

Which effect has resulted in the avoidance of tetracycline use in children under 8 years old? 1:birth defects 2:allergic responses 3:severe nausea and vomiting 4:permanent tooth discoloration

4

A nurse is teaching a group of healthy adults about the benefits of flu immunizations. Which type of patient education is the nurse providing? 1: Health analogies 2: Restoration of health 3: Coping with impaired functions 4: Promotion of health and illness prevention

4 rationale: As a nurse, you are a visible, competent resource for patients who want to improve their physical and psychological well-being. In the school, home, clinic, or workplace, you promote health and prevent illness by providing information and skills that enable patients to assume healthier behaviors. Injured and ill patients need information and skills to help them regain or maintain their level of health; this is referred to as restoration of health. Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations; this is known as coping with impaired functions. Analogies supplement verbal instruction with familiar images that make complex information more real and understandable. For example, when explaining arterial blood pressure, use an analogy of the flow of water through a hose

Which statement by the client indicates the the nurses teaching was effective regarding intravenous gentamicin therapy? 1:i should drink lots of water if i am retaining urine 2:i should use eyeglasses if i develop vision problems 3:i should stop the medication when the symptoms have subsided 4:i should report any hearing loss to the HCP

4 rationale: Gentamicin is an aminoglycoside that is used to treat intense infections but can also cause serious side effects such as ototoxicity and nephrotoxic -gentamicin use can cause ear toxicity so the client should report any hearing issues. -gentamicin also causes urine retention, but increasing water intake can aggravate this condition

Which effect would the nurse anticipate after captopril is prescribed to a client? 1:increased urine output 2:decreased anxiety 3:improved sleep 4:decreased BP

4 rationale: captoPRIL is an ACE inhibitor antihypertensive. (-pril =ace)

Which instruction would the nurse provide a client prescribed oral extended-release ciprofloxacin for a UTI? 1: chew the medication along with food 2:take a walk in morning sunlight 3:stop the drug after symptoms subside 4:refrain from taking the tablet immediately after an antacid

4 rationale: ciprofloxacin is a fluroquinolones antibiotic used in treating UTI (and anthrax). The nurse would instruct the client to refrain from consuming ciprofloxacin within 2 hours of taking an antacid because most antacid contain magnesium or aluminum which interfere with the absorption of it.

For which purpose would enoxaparin 40 mg subcutaneously daily be prescribed for a client who had abdominal surgery? 1:to control postoperative fever 2:to provide a constant source of mild analgesia 3:to limit the postsurgical inflammatory response 4:to provide prophylaxis against postoperative thrombus formation

4 rationale: enoxaprin is an anti-coagulent that prevents clot extension and formation (does not dissolve clot but helps prevent the growth)

the health care provider prescribes alprazolam 5 mg by mouth three times a day for a client with anxiety. Which intervention will the nurse take before administering this prescription? 1:assess the apical pulse 2:check the blood pressure 3:encourage the ventilation of feelings 4:clarify the prescription with the health care provider

4 rationale: the prescribed dosage is excessive, and must be questioned -therapeutic dosages of alprazolam range from 0.75 mg to 4mg daily and the max daily dose for acute anxiety is 8mg

According to the food and drug administration pregnancy risk categories, the nurse identifies which category of drugs may cause slight risks to the fetus? 1: A 2: B 3: C 4:D

B

use of which medication would the nurse identify as a potential risk for hearing impairment in a child? 1:amoxixillin 2:gentamicin 3:ciprofloxacin 4:clindamycin

2 rationale: gentamicin is an antibiotic that can be ototoxic because of its effects on the cranial nerve

identify the preferred site for the self administration of subQ injection of insulin

look at the picture first 1 2 3 4 1 because the abdoment is the preferred site for insulin injection because it is easily accessible and absorption is more even and rapid than in the extremities

What drug am I: I am used to treat upper and lower respiratory infections , Chlamydia, and gonorrhea. I may need to be taken with food to decrease the risk of GI upset. I should not be taken with antacids

Macrolides (antibiotics): -erythromycin -axithromycin

What drug am I: I can be used to treat a variety of infections, but I am not used all that often. I should not be used in pregnancy or in small children because I can cause softening of bones and teeth. I can also cause discoloring of teeth. Be careful with sun exposure because I can cause bad sunburn!

tetracyclines

T/F: delirium tremens (DTs) is an example of physical dependence

true

Which measure would the nurse take when administering enoxaparin subcutaneously? 1:push over 2 minutes 2:administer in the abdomen 3:massage site after administration 4:remove air pocket from prepackaged syringe before administration

2

Which symptom would the nurse include when teaching a client with arthritis who takes large doses of aspirin about the clinical manifestations of aspirin toxicity? 1:feelings of drowsiness 2:disturbances in hearing 3:intermittent constipation 4:metallic taste in the mouth

2

Which medication requires the nurse to monitor the client for signs of hyperkalemia? 1:furosemide 2:metolazone 3:sprinolactone 4:hydrochlorothiazide

3 rationale: furosemide, metolazone, and hydrochlorothiazide cause hypokalemia

Which adverse effect would the nurse monitor for in an infant receiving a sulfonamide? 1:kernicterus 2:gray syndrome 3:growth suppression 4:teeth discoloration

1 rationale: -gray syndrome is associated with chloramphenicol -growth suppression is associated with glucocorticoids -teeth discoloration is associated with tetracycline

Which assessment would the nurse perform before administering a dose of vancomycin to a client? select all that apply 1:creatinine 2:trough level 3:hearing ability 4:intravenous site 5:blood urea nitrogen

1,2,3,4,5 rationale: two major adverse effects of vancomycin are nephrotoxicity and ototoxicity -the nurse would assess the clients creatinine and blood urea nitrogen levels to determine renal function -the nurse would assess trough levels to determine if the clients kidneys are clearing the medication -vancomycin can cause phlebitis (vein inflammation) so the nurse would assess the IV site before initiating the infusion

The RN is teaching a nursing student about the process of medication reconciliation for a client who was admitted in a health care setting. Which statement made by the nursing student indicates the need for further teaching 1:i would check the new medication prescription against the current list of medicines 2:I would avoid asking about the clients over the counter medications 3:i would obtain a comprehensive and current list of the clients medications 4:I would avoid distractions and go slowly when reconciling the clients medications

2

Which action would the nurse take when a client reports feeling nauseated immediately after cataract surgery? 1:provide some dry crackers to eat 2:administer the prescribed antiemetic 3:explain that this is expected after surgery 4:encourage deep breathing until the nausea subsides

2

A client is to receive metoclopramide 15mg orally before meals. The concentrated solution contains 10mg/mL. How many mL of solution will the nurse administer?

15mg X 1mL/ 10mg = 1.5 mL

A pregnant client with an infection tells the nurse that they have taken tetracycline for infections in the past and prefer to take it now. Which response would the nurse give regarding the avoidance of tetracycline administration during pregnancy? 1:it affects breast feeding adversely 2:tetracycline causes fetal allergies 3:it alters the development of fetal teeth buds 4:it increases fetal tolerance to the medication

3

When preparing to administer medications to a client, which action made by the new nurse requires an intervention? 1:obtaining vital signs 2:scanning medication 3:using one client identifier 4:assessing level or orientation

3

When a client arrives in the ER and reports dyspnea, which finding by the nurse indicates that an inhaled bronchodilator may be needed for treatment? 1:oral temp of 101 2:use of accessory muscles for breathing 3:inspiratory and expiratory wheezes 4:dullness to percussion at lung bases

3 rationale: wheezing is caused by airway spasm and narrowing, and inhaled bronchodilators will relax bronchospasms and open the airways rapidly

Which areas should the nurse assess to determine the effects of external variables on a patient's illness? (Select all that apply.) 1: Patient's perception of the illness 2: Patient's coping skills 3:Socioeconomic status 4: Cultural background 5: Social support

3,4,5 rationale: External variables influencing a patient's illness behavior include the visibility of symptoms, social group, cultural background, economic variables, accessibility of the health care system, and social support. Internal variables include the patient's perceptions of symptoms and the nature of the illness, as well as the patient's coping skills and locus of control.

list the actions in the order the nurse will perform them when mixing a short acting and an intermediate acting insulin in the same syringe 1: withdraw the prescribed amount of short acting insulin 2:put air into the short acting insulin vial 3:put air into the intermediate acting insulin vial 4:withdraw the prescribed amount of intermediate acting insulin

3-2-1-4 rationale: air in cloudy, air in clear, withdraw clear, withdraw cloudy

A client with type 1 diabetes receives humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. Which intervention is appropriate? 1: administer insulin to the client 2:give the client lunch immediately 3: encourage the client to drink fluids 4:assess the clients blood glucose level

4

A RN nurse is teaching a nursing student about the nurses professional roles and responsibilities. When would the nurse play the role of an educator? 1: a client requests the nurse to pray with them for a quick recovery, and the nurse complies with the request 2:a client is unable to sleep due to back pain. The nurse provides a back massage which helps them fall asleep 3:a client with dementia refuses to take baths and loudly protests. the nurse consoles the patient and provides the bath later 4: a client is being discharged from the hospital setting with an implanted port. The nurse describes the routine care activities to prevent any complcations

4

which strategy is an example of a passive health promotion? 1:weight reduction program 2:smoking cessation program 3:drug abuse prevention strategy 4:fluoridation of municipal drinking water

4 rationale: passive strategies of health promotion help people benefit from the activities of others without direct involvement. -active strategies of health promotion require clients to adopt specific programs for improving health (1,2,3)

true

T/F: medication reconciliation is the process that is used to ensure that patients are taking only the meds that are needed

True

T/F: potency refers to the strength of the drug

true

T/F: some medications, such as nitroglycerin have to be given topically or SL in order to prevent first pass effect of liver

False it is the primary drug in excretion

T/F: the kidney is the primary organ involved in drug metabolism

Which information must be clearly described in the medication administration record (MAR) before administering a medication? select all that apply 1:dosage and route 2:clients full name 3:time to be administered 4:frequency of administration 5:full name of prescribed medication

all of these are correct

The nurse reviews the kidney function blood studies of four clients. Which client's results indicate kidney impairment? Client 1: Serum Creatinine 0.1 mg/dL; BUN 16 mg/dL Client 2: Serum Creatinine 0.8 mg/dL; BUN 18 mg/dL Client 3: Serum Creatinine 1.2 mg/dL; BUN 20 mg/dL Client 4: Serum Creatinine 1.9; BUN 22 mg/dL

client 4 rationale: elevated creatinine level signifies impaired kidney function or kidney disease. -normal range of creatinine is 0.6-1.2 -normal range of BUN is 10-20

What drug am I: I am used for dysrhythmias, especially supraventricular rhythms such as a-fib. Before administering it is important that you monitor the apical pulse for one minute (hold if less than 60). You will often notice yellow-green halos around lights if levels are getting to high. Digibind is the antidote.

digoxin

T/F: medications that are listed as a pregnancy category A are considered contraindicated during pregnancy

false pregnancy category X is contraindicated

What drug am I: I am used to treat abdominal and gynecologic infections. I am relatively safe during pregnancy. Alcohol should be avoided because of the "anabuse" types effects if combined with alcohol. I can be taken orally or in IV form.

flagyl

A nurse is teaching a patient with a risk for hypertension how to take a blood pressure. Which action by the nurse is the priority? 1: Assess laboratory results for high cholesterol and other data. 2: Identify that teaching is the same as the nursing process. 3: Perform nursing care therapies to address hypertension. 4: Focus on a patient's learning needs and objectives.

4 rationale: he teaching process focuses on the patient's learning needs, motivation, and ability to learn; writing learning objectives and goals is also included. -Nursing and teaching processes are not the same. -assessing laboratory results for high cholesterol and performing nursing care therapies are all components of the nursing process, not the teaching process.

Which response will the nurse provide when a client taking a loop diuretic asks the nurse why changing positions slowly is necessary? 1:your high BP may cause headaches with position change 2:you will experience potassium fluctuations that will affect your balance 3:you will need to rush to the bathroom while on the diuretic and we want to ensure you are safe 4:your BP may drop with position changes, leading to dizziness and risk of falling

4 rationale: loop diuretic can lead to dehydration and orthostatic hypotension, which can increase dizziness and the risk of falls

Which relationship reflects the relationship between naloxone to morphine sulfate? 1:aspirin to warfarin 2:amoxicillin to infection 3:enoaxparin to dalteparin 4:protamine sulfate to heparin

4 rationale: protamine sulfate is the antidote for heparin overdose, and naloxone will reverse the effects of opioids such as morphine

which over the counter medication would the nurse teach a client taking antihypertensive medication to avoid? 1:omeprazole 2:acetaminophen 3: docusate sodium 4: pseudophedrine

4 rationale: stimulates sympathetic nervous system and may increase blood pressure; it should be avoided by clients with hypertension

Which information about a client who has heart failure would the nurse communicate to the health care provider before administration of the prescribed digoxin? 1:apical pulse rate 96 beats/min 2:bilateral food and ankle pitting edema 3:crackles heard at the base of both lungs 4: potassium levels of 2.3

4 rationale: symptoms of digoxin toxicity, including life-threatening dysrhythmias, can occur when digoxin is administered to a client with hypokalemia -an apical pulse of 96 is at the upper end of normal and would not be a reason to hold digoxin -lower extremity edema is a sign of heart failure, which would be improved with administration of digoxin -crackles at the lung bases are common in clients with heart failure and not a reason to hold medicine

In which role is the nurse acting when verbalizing to a client ways to relieve injection-associated discomfort? 1:educator 2:advocate 3:caregiver 4:autonomy

1

The client is experiencing postoperative pain and requests a pain shot. Which health care providers are legally permitted to administer an intramuscular (IM) injection to the client? (Select all that apply) 1: registered nurse 2:licensed practical nurse 3:licensed vocational nurse 4: unit secretary 5: unlicensed assistive personnel

1,2,3

A nurse is trying to help a patient begin to accept the chronic nature of diabetes. Which teaching technique should the nurse use to enhance learning? 1: Lecture 2: Role play 3: Demonstration 4: Question and answer sessions

2 rationale: Affective learning deals with expression of feelings and acceptance of attitudes, beliefs, or values. Role play and discussion (one-on-one and group) are effective teaching methods for the affective domain. -Lecture and question and answer sessions are effective teaching methods for the cognitive domain. -Demonstration is an effective teaching method for the psychomotor domain.

the nurse would include which instruction to the parents of a child being treated with oral ampicillin for otitis media? 1:complete the entire course of antibiotic therapy 2:herbal fever remedies are highly discouraged 3:administer the medication with meals 4:stop the antibiotic therapy when the child no longer has a fever

1 rationale: once antibiotic treatment is initiated, the antibiotics start to destroy specific bacterial infections that the health care provider is trying to teat. If the caregivers start a dose and stop it before the course is complete, the remaining bacteria have a chance to grow again, become resistant to antibiotic treatment, and multiply

A pregnant client prescribed tetracycline continues the course of treatment during the first trimester. Which teratogenic effect may occur in the fetus? 1:bone anomalies 2:facial malformations 3:internal organ defects 4:CNS malformation

1 rationale: tooth and bone anomalies may occur in the fetus because of teratogenic effect of tetracyclines

Which time would the nurse schedule the blood sample to be obtained when the primary health care provider prescribes trough levels of an antibiotic? 1: just before the medication is administered 2:between 30-60 minutes after the infusion is completed 3:six hours after the dose is completely infused 4:in the morning before the client eats breakfast

1 rationale: trough levels are drawn just BEFORE a medication is give, when the medications level is at its lowest

which statement by a client with rheumatoid arthritis prescribed ibuprofen 800 mg by mouth three times a day indicates that the nurses education about the medications side effects was effective?select all that apply 1:i need to report any dark tarry stools 2:i will need to stop taking this medication before any scheduled surgery 3:i should change positions slowly 4:i will take the medication on an empty stomach 5:i need to stop takin glow dose aspirin while i take this medication

1,2

which example illustrates health promotion activities? select all apply 1: good nutrition 2:regular exercise 3:physical awareness 4:immunization against measles 5:education about stress management

1,2 rationale: -immunization against measles is an example of an illness prevention activity -education about stress management and physical awareness are examples of a wellness education activity

a child with type 1 diabetes is receiving 15 units of regular insulin and 20 units of NPH insulin at 7 am each day. Which time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur 1:before noon 2:in the afternoon 3:within 30 minutes 4:during the evening

2 rationale: NPH is an intermediate acting insulin that peak approx. 6-8 hours after administration. if it was administered at 7 am, 1-3pm is when the nurse would expect the reaction. -short acting: noon -rapid acting: within 30 minutes -long acting: nighttime evening

The nurse is preparing to administer an opthalmic medication to a client. Which steps would the nurse include for this procedure? 1:clean the eyelid and eyelashes 2:place the dropper against the eyelid 3:apply clean gloves before beginning the procedure 4: instill the solution directly onto the cornea 5:press on the nasolacrimal duct after instilling the solution

1,3,5 rationale: cleaning of the eyelids and eyelashes helps prevent contamination of the other eye and lacrimal duct. Application of gloves helps prevent direct contact of the nurse with the clients body fluids. -applying pressure to the nasolacrimal duct prevents the medication from running out of the eye -the dropper should not touch the eyelids or eyelashes to prevent contamination of the medication in the dropper -should not be instilled directly onto the cornea because the cornea has many pain fibers and is very sensitive

which topic would be included when teaching a client with heart failure who will be discharged with a new prescription for digoxin? select all that apply 1:take your radial pulse daily and write it down 2:avoid foods that are high in potassium such as bananas and potatoes 3:notify the HCP if you develop any vision changes 4:call the HCP if your pulse is irregular or less than 60b/m 5:eat at least 1 serving of green leafy veggies daily

1,3,5 rationale: digoxin causes hypokalemia so they are advised to eat foods high in potassium

Which statement indicates effective teaching about an automatic epinephrine injector to self treat reactions to insect stings? select all that apply 1:i will inject the medication into my thigh 2:i will call 911 before I inject the medication 3:i will store the medication into the refrigerator 4:i will keep the medication with me at all times 5:i will replace the medication when the expiration date is approaching

1,4,5

A child recovering from a severe asthma attack is given oral prednisone 15mg twice a day. Which intervention would be a priority for the nurse? 1:having the child rest as much as possible 2:checking the childs eosinophil count daily 3:preventing exposure of the child to infection 4:offering sips of water when administering the medication

3 rationale: prednisone is a type of corticosteriod which inhibits inflammatory response in the body. It reduces the child's resistance to certain infectious processes and, as an anti-inflammatory medication, masks infection -the secondary priority is to take sips of water to hydrate and help loosen/expel mucus

A client has been receiving oxycodone for moderate pain associated with multiple injuries sustained in a motor vehicle collision. Which assessment finding, in addition to the clients slurred speech, leads the nurse to suspect opioid intoxication? 1:mood lability 2:hypervigilance 3:constricted pupils 4:increased respirations

3 rationale: pupil constriction is a physical sign of opioid intoxication or overdose. -opioids cause apathy/depressed, sad mood (dysphoria); lability of mood is associated with the use of anabolic androgenic steroids -opioids cause drowsiness and psychomotor retardation -opioids depress the respiratory center of the brain causing slow shallow respirations -increase in temp, PR, RR, BP are associated with cocaine use

A client with hemiplegia becomes frustrated when preforming skills. Which nurse intervention would motivate the client toward independency? 1:establish long-range goals for the client 2:identify errors that the client can correct 3:reinforce success in tasks accomplished 4:demonstrate ways to promote self-reliance

3 rationale: success is a basic motivation for learning

While preparing a teaching plan, the nurse describes what the learner will be able to accomplish after the teaching session about healthy eating. Which action is the nurse completing? 1: Developing learning objectives 2: Providing positive reinforcement 3: Presenting facts and knowledge 4: Implementing interpersonal communication

1 rationale: Learning objectives describe what the learner will exhibit as a result of successful instruction. Positive reinforcement follows feedback and reinforces good behavior and promotes continued compliance. Interpersonal communication is necessary for the teaching/learning process, but describing what the learner will be able to do after successful instruction constitutes learning objectives. Facts and knowledge will be presented in the teaching session.

A nurse is describing a patient's perceived ability to successfully complete a task. Which term should the nurse use to describe this attribute? 1: Self-efficacy 2: Motivation 3: Attentional set 4: Active participation

1 rationale: Self-efficacy, a concept included in social learning theory, refers to a person's perceived ability to successfully complete a task. -Motivation is a force that acts on or within a person (e.g., an idea, an emotion, a physical need) to cause the person to behave in a particular way. -An attentional set is the mental state that allows the learner to focus on and comprehend a learning activity. -Learning occurs when the patient is actively involved in the educational session.

When a RN determines a new nurse is unwilling to participate in a community health literacy program for clients with diabetes mellitus, which action by the RN shows good leadership ability? 1:inspiring the new nurse to actively participate 2:leaving the new nurse to make their own decisions 3:demanding the new nurse take active participation 4:reporting the new nurse to other higher level health care professionals

1 rationale: The leader would inspire and motivate their followers to complete the task successfully. Inspiring a new nurse to participate actively in the program shows good leadership skills -leaving the new nurse on their own does not allow the new nurse to grow and reporting and demanding do not show good leadership skills

Which technique will the nurse employ to prevent excessive bruising when administering subcutaneous heparin? 1:administer the injection via the Z-track technique 2:avoid massaging the injection site after the injection 3:use 2ml of sterile normal saline to dilute the heparin 4:inject the medication into the vastus lateralis muscle in the thigh

2

A child with type 1 diabetes is receiving 155 units of regular insulin and 20 units of NPH insulin at 7 am each day. What time would the nurse anticipate a hypoglycemic reaction from the NPH insulin to occur? 1:before noon 2:in the afternoon 3:within 30 minutes 4:during the evening

2 rationale: NPH insulin is an intermediate acting insulin that peaks from 6-8 hours after administration. Afternoon would be between 1-3. -noon is when a reaction from short acting insulin is expected -within 30 minutes of administration is when a reaction of the rapid fast would be expected -evening/nighttime is when a reaction from long acting insulin is expected

Which sensation reported by the client would the nurse consider when determining that furosemide is being administered too quickly? 1: full bladder 2:buzzing ears 3:fast heartbeat 4:numb arms and legs

2 rationale: raid administration of furosemide can cause tinnitus (a perceived ringing or buzzing in the ear), loss of hearing and ear pain. - Furosemide has a diuretic effect, so a full bladder is with a need to urinate is a common sensation

Which emergency care action would the nurse consider a priority for a hospitalized client who develops an anaphylactic reaction after receiving an intravenous medication? select all that apply 1:elevate the lower extremities 2:complete a respiratory status assessment 3:contact the rapid response team 4:discontinue the IV medication 5:keep the head of bed elevated to 10 degrees

2,3,4 rationale: the clients respiratory status should immediately be assessed, including the airway and o2 saturation. The rapid response team should be called right away. Immediate discontinuation of the medicine is also important

The nurse understands which are the pharamacokinetic reasons for medication sensitivity in infants? select all that apply 1:small body size 2:medication absorption 3:renal medication excretion 4:protein binding of drugs 5:hepatic medication metabolism

2,3,4,5 rationale: pharmacokinetics is the study of how medications enter the body, reach their site of action, metabolize, and exit the body.

Which action will the nurse take when a client appears flushed and complains of palpitations ten minutes after the start of IV vancomycin scheduled to infuse over 30 minutes? 1:stop the infusion 2:continue the infusion but monitor the client 3:contact the primary health care provider to obtain a prescription to decrease the infusion rate 4:contact the HCP to obtain a prescription for and antianxiety medication

3 rationale: the rate of the infusion should be decreased. Administering vancomycin too rapidly can produce "red man syndrome" characterized by flushing, increased HR, and decreased BP. All can be elevated by slowing rate down

after obtaining vital sign data of BP 90/60, pulse 96, RR 10 breaths, for a postoperative client receiving hydromorphone by a patient-controlled analgesia pump, which priority action would the nurse take? 1:give naloxone IV per protocol 2:assess the clients pain level on a 10 point scale 3:document the VS in the client record 4:notify the hospital rapid response team

1 rationale: a RR of 10 is abnormal and indicates oversedation and the naloxone will reverse the medication

Which statement indicates to the nurse providing discharge medication education to a client prescribed warfarin that teaching was effective? 1: i will avoid taking aspirin and nonsteroidal anti-inflammatory drugs 2:i will need to develop a more sedentary routine 3:i will need to have regular complete blood counts to guide warfarin dosage 4: before going to the dentist, i will ask my health care provider for antibiotics

1 rationale: acetaminophen should be used when an analgesic is required because it does not interfere with platelet aggregation like aspirin does -A PT or IRN needs to be done not a CBC

The nurse administers albuterol to a 4 year old child. Which intervention would assist the nurse in evaluating the effectiveness of this medication> 1:auscultate breath sounds 2:collect a sputum sample 3:conduct a neurological exam 4:palpate chest excursion

1 rationale: albuterol is an example of a bronchodilator: adrenergic medication that stimulate beta receptors, leading to relaxation of smooth muscles of the airway. The lung sounds should be auscultated to evaluate effectiveness.

Which statement indicates effective teaching after the nurse teaches a client on the usage of antibiotics? 1:i should not take antibiotics to treat the flu 2:i should take an antibiotic to prevent illness 3:i should stop an antibiotic when I am feeling better 4:i should borrow an antibiotic from a family member or a friend in an emergency

1 rationale: antibiotics are effective against bacterial infections; therefore, the nurse instructs the client to avoid antibiotic use for viral infections such as flu and cold -antibiotics should not be taken for preventing diseases because they may lead to resistance

which action describes a therapeutic effect of atenolol? 1: heart rate decreases 2:blood pressure increases 3:bronchospasm is relieved 4:pulse oximetry improves

1 rationale: atenolol, a beta blocker, slows the rate of SA node discharge AV node conduction, thus decreasing the heart rate; it prevents angina by decreasing the cardiac workload and myocardial o2 consumption -blood pressure may be decreased -may promote bronchospasm, not relieve it

Which substance would a client taking acetaminophen routinely be advised to avoid? 1:alcohol 2:caffeine 3:diphenhydramine 4:ibuprofen

1 rationale: both acetaminophen and alcohol are both hepatotoxic substances that can cause irreversible liver damage -caffeine stimulates the cardiovascular system, not the liver -ibuprofen and diphenhydramine can be taken with this

Which instruction would the nurse include when preparing discharge instructions for a client who will take enalapril for hypertension? 1: change to a standing position slowly 2:this may color your urine green 3:the medication may cause a sore throat for the first few days 4:schedule blood tests weekly for the first 2 months

1 rationale: enalapril is classified as an ACE inhibitor. like many antihypertensives, it can cause orthostatic hypotension. Clients should be advised to change positions slowly to minimize this effect.

in which way is public health nursing different from community health nursing? 1:public health nursing focuses on a population 2:public health nursing focuses on health promotion 3:public health nursing is part of a primary health care delivery system 4:public health nursing requires nurses to hold a graduate degree

1 rationale: focuses on a population or a collection of individuals who have one or more personal or environmental characteristics in common, whereas community health nursing has a primary focus on the health care of individuals, families, and groups in a community

which adverse effect of heparin would the nurse assess a client for during pregnancy? 1:osetoporosis 2:pelvic inflammatory disease 3:abnormal uterine contraction 4:suppression of uterine contraction

1 rationale: heparin is safe for the fetus because it does not cross the placenta but may cause osteoporosis in the woman

which clinical finding in a client receiving morphine warrants immediate follow up by the nurse? select all that apply 1:polyuria 2:unconsciousness 3:bradycardia 4:dilated pupils 5:bradypnea

2,3,5 rationale: morphine is a CNS depressant which if severe can cause unconsciousness, bradycardia and bradypnea

A nurse attends a seminar on teaching/learning. Which statement indicates the nurse has a good understanding of teaching/learning? 1: "Teaching and learning can be separated. 2: "Learning is an interactive process that promotes teaching." 3: "Teaching is most effective when it responds to the learner's needs." 4: "Learning consists of a conscious, deliberate set of actions designed to help the teacher."

3 rationale: Teaching is most effective when it responds to the learner's needs. It is impossible to separate teaching from learning. Teaching is an interactive process that promotes learning. Teaching consists of a conscious, deliberate set of actions that help individuals gain new knowledge, change attitudes, adopt new behaviors, or perform new skills.

planning to provide self care health information for several clients, which client would the nurse anticipate will be most motivated to learn? 1:a 55 year old client who had a mastectomy and is very anxious about her body image 2:an 18 year old client who smoke cigarettes and is in denial about the dangers of smoking 3:a 56 year old client who had a heart attack last week and is requesting information about exercise 4:a 47 year old client who has had a long-leg cast after sustaining a broken leg and is still experiencing severe pain

3 rationale: a client who is requesting information is indicating a readiness to learn. -when the nurse is caring for a person who is coping with the diagnosis of cancer and a change in body image, the nurse would encourage the expression of feelings, not engage in teaching

Which assessment finding indicates a need for the nurse to consult with the health care provider before administering the prescribed metoprolol to a client with stable angina? 1: blood pressure 142/90mmHg 2:report of chest pain when walking 3:sinus bradycardia, rate 54 on monitor 4:large Q waves on the electrocardiogram

3 rationale: beta blockers such as metoprolol decreases heart rate and lowers BP

Which action would the nurse perform when administering fluticasone propionate to a client with asthma? 1:assessing heart right and rhythm 2:monitoring liver function blood tests 3:rinsing the oral cavity with water after use 4:obtaining blood glucose levels before meals

3 rationale: clients using inhaled corticosteroids are at an increased risk for oral candidiasis. -nurse would monitor heart rate and pattern in clients taking beta 2 agonist such as albuterol, which can lead to tachydysrythmias -blood glucose is taken when clients are taking oral and IV corticosteroids (prednisone=PO, methylpredisolone=IV)

Which instruction will the nurse teach the client who had a femoropopliteal bypass graft and is receiving clopidogrel postoperatively? 1:eliminate starches and red meats from diet 2:eat more roughage if constipation occurs 3:report any occurrence of multiple bruises 4:take the medication on an empty stomach

3 rationale: clopidogrel is a platelet aggregation inhibitor that decreases the probability of clots forming where the graft was place. It increases bleeding tendencies when the dosage is excessive. -diarrhea, not constipation is more likely to occur and it should be take with food to decrease side effects of gastric discomfort, diarrhea, and GI bleeding

The medication prescribed for an infant is to be given intramuscularly. Which site will the nurse select for administration of the medication? 1:vastus lateralis 2:ventrogluteal 3:dorsogluteal 4:deltoid

1 rationale: intramuscular injections are given in the vastus lateralis muscle of the thigh in infants. -the ventrogluteal site is not used until children have been walking -the dorsogluteal site considered high risk for damage to the sciatic nerve or a major blood vessel -deltoid site in the arm has a small muscle mass that limits the amount of medication that can be injected

An adolescent prescribed loratadine 10 mg daily for hay fever is concerned the medication will cause drowsiness during the school day. What action would the school nurse take? 1:explain this medication rarely causes drowsiness 2:advise to take half a tablet in the morning before school 3:suggest skipping the next days dose if hay fever is better 4:recommend contacting the allergist for a prescription containing a stimulant

1 rationale: loratadine causes little to no drowsiness or anticholinergic side effects. Even if the medication caused drowsiness, the school nurse does not have legal authority to alter the medicine

Which instruction from the primary health care provider would the nurse anticipate reinforcing with a client who is on metformin therapy and is scheduled to undergo renal computed tomography (CT) with contrast dye? 1:discontinue metformin 1 day before the procedure 2:discontinue metformin 1 week before the procedure 3:discontinue metformin 3 days after the procedure 4:discontinue metformin 7 days after the procedure

1 rationale: metformin can react with the iodinated contrast dye that is given for a renal CT and cause lactic acidosis.

Which medication is indicated for management of clinical manifestations associated with an opioid overdose? 1:naloxone 2:methadone 3:epinephrine 4:amphetamine

1 rationale: naloxone is a narcotic antagonist that displaces opioids from receptors in the brain, thereby reversing respiratory depression. -methadone: synthetic opioid that causes CNS depression and will add to the problem of overdose

Which priority nursing action would the nurse implement first when caring for a client receiving nitroglycerin for the treatment of angina? 1:instruct the client to sit or stand slowly 2:monitor the clients urine output frequently 3:advise the client to report when experiencing a headache 4:instruct client to notify the HCP if pain does not subside after 5 minutes

1 rationale: nitroglycerin is a potent antihypertensive medication. Instruct pt. to stand and sit slowly prevents orthostatic hypotension. secondary task is checking patients urine output

The nurse understands incorporating which interventions would prevent medication errors? (select all that apply) 1: avoid using abbreviations and acronyms 2:minimize the use of vernal and telephone orders 3:try to guess what the client is saying if the language is not understood 4:document each dose of the medication using trailing zeros when recording the dose 5:check three times before giving medication by comparing the medication prescription and medication profile

1,2,5 rationale: -the use of abbreviation is avoided because this action may cause confusion and errors -the use of verbal and telephone orders should be minimized to avoid confusion over drugs that have similar names -triple check medication before administering

Which adverse effect will the nurse instruct the client to anticipate when prescribed albuterol to relieve severe asthma? 1:tremors 2:lethargy 3:palpations 4:bronchoconstriction 5:decreased pulse rate

1,3 rationale: albuterols sympathomimetic effect causes central nervous system stimulation, resulting in tremors, tachycardia, and palpitations -lethargy is a result of cns depression -albuterol causes bronchodilation not bronchoconstriction

The nurse is advised to join a community health care center that mainly caters to latino clients. Which skill would the nurse develop to help reduce health disparities? 1:learning to speak basic medical Spanish 2:updating paper supplies at the health care facility 3:learning about the health literacy rate of the community 4:incorporating the health beliefs of the community in any nursing care plans 5:learning about and respecting unique beliefs and values prevalent among the group

1,3,4,5,

which action would the nurse take before administering each dose in a client who takes oxycodone every 3 hours for pain after surgery? select all apply 1:count the clients RR 2:examine the client for petechiae 3:observe the client for movement disorders 4:ask the client to rate the level of pain 5:assess the clients level consciousness

1,4,5

Which criterion is an indicator that the nitrogylcerin sublingual tablets have lost their potency? 1:sublingual tinging is experienced 2:the tablets are more than three months old 3:the headache is less severe 4:onset of relief is delayed

2

Which reason would the nurse provide for the gradual reduction in dosage to a client who recently started receving oral corticosteroids for a severe allergic reaction and is instructed that the dosage will be reduced gradually until all medication is stopped at the end of 2 weeks? 1:discontinuing the medication too fast will cause the allergic reaction to disappear 2:slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed 3:the health care provider is attempting to determine the minimal dose that will be effective for the allergy 4:sudden cessation of the medication will cause development of serious side effects, such as moon face and fluid retention

2 rationale: The body's natural corticosteroid production has been suppressed during treatment; avoiding abrupt cessation of the medication will give the body time to adjust to less and less of the exogenous source and to resume secretion of endogenous corticosteroid. -not completing the course of therapy, rather than stopping it quickly, may cause signs and symptoms of the allergy to recur -the health care provider has already determined the correct dosage, and it has been prescribed. -moon face and fluid retention are associated with long-term steroid use, not with the cessation of therapy.

A patient learns that a normal adult heartbeat is 60 to 100 beats/min after a teaching session with a nurse. In which domain did learning take place? 1:kinesthetic 2:cognitive 3:affective 4:psychomotor

2 rationale: The patient acquired knowledge, which is cognitive. Cognitive learning includes all intellectual skills and requires thinking. In the hierarchy of cognitive behaviors, the simplest behavior is acquiring knowledge. -Kinesthetic is a type of learner who learns best with a hands-on approach. -Affective learning deals with expression of feelings and development of attitudes, beliefs, or values. -Psychomotor learning involves acquiring skills that require integration of mental and physical activities, such as the ability to walk or use an eating utensil.

which result would the nurse monitor in a client with acetaminophen overdose? 1: blood gas level 2:liver function tests 3:complete blood count 4:glycosylated hemoglobin

2 rationale: acetaminophen is a non-opioid analgesic that is metabolized by the liver, and an excess may result in increased renal/hepatic toxicity -blood gas results are not priority until there is a result of hepatic failure or respiratory distress develops

The nurse completes medication reconciliation in preparation for discharge of a client recovering from osteomyelitis and ruptured achilles tendon. For which medication would the nurse contact the HCP? 1:gentamicin 2:levofloxacin 3:acetaminophen 4:cyclobenzaprine

2 rationale: achilles tendon rupture can occur with the use of fluoroquinolones (ciprofloxin, levofloxacin) -gentamin is an aminoglycoside that cause ototoxicity and nephrotoxic

A client requests information about the primary health care providers prescribed medications. Which is the correct response by the nurse? 1:give a computer printout about the medication 2:ask the client to state what the client already knows about the medications 3:advise talking to the primary health care provider to seek information about the medicaitons 4:delegate the task of sharing information about the medications to the LPN

2 rationale: assessing the clients knowledge to delineate baseline information should be done before planning appropriate health teaching. Providing written material without knowing the clients ability to read is inappropriate; also it limits the nurses personal involvement in the teaching process.

Which condition is the most common major stressor that diminishes teaching effort effectiveness? 1: extent of informed consumerism 2:limited time to engage in teaching 3:variety of cultural beliefs that exist 4:deficient motivation of adult learners

2 rationale: because of the variety of factors competing for the nurses time, efficient use of the time available for teaching is essential to meet the standards of care and legal responsibilities of the nurse.

which adverse effect would a nurse monitor for when caring for a client with hypertension who is prescribed metoprolol 1:hirsutism 2:bradycardia 3:restlessness 4:angina

2 rationale: beta blockers block stimulation of beta 1 (myocardial) receptors, which decreases the heart rate and BP. -side effect of this medication is fatigue not restlessness. -metoprolol is indicated for treatment of angina, so this will be decreased

which measure would the nurse take when administering enoxaparin subcutaneously? 1: push over two minutes 2: administer in the abdomen 3:massage site after administration 4:remove air pocket from prepackaged syringe before administration

2 rationale: enoxaparin specifically targets blood clots throughout the body and carries a lower risk of hemorrhage than that associated with the medications heparin and warfarin. Enoxaparin is administered once a day through subQ injection site around the naval. -Avoid administering in the muscle. Enoxaparin should be injected into the fatty tissue only, which is why the abdomen is recommended -there are no recommendations to push the medication over 2 minutes -rubbing the site can cause bruising

Which medication would the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines? 1:lithium 2:flumazenil 3:methadone 4:chlorpromazine

2 rationale: flumazenil is the medication of choice in the management of overdose when a benzodiazepine is the only agent ingested by a client not at risk for seizure activity. It competitively inhibits activity at benzodiazepine recognition sites -lithium is used to treat mood disorders -methadone is used for narcotic addiction withdrawal -chlorpromazine is contraindicated in presence of central nervous system depressants

which statement made by the student nurse indicates the need for further education about medication administration? 1:i should set up and prepare medication in distraction free areas 2:I should advise the certified medical assistant to administer IV medications 3:I should be vigilant during the entire process of medication administration 4:i should identify each client using at least two identifiers before administering medications

2 rationale: medical assistants are only aloud to administer PO meds

Which client statement indicates a need for further education when the nurse is reviewing statin therapy for hyperlipidemia in a female of childbearing age? 1: i will report muscle aches to my primary health care provider 2: i will take my medication with grapefruit 3: i will avoid getting pregnant while taking this medication 4: i will need regular bloodwork to ensure my liver is ok

2 rationale: medicine shouldnt be taken with grapefruit juice

The nurse is preparing discharge instructions for a client who has begun to demonstrate signs of early alzheimer dementia and lives alone, with adult children living nearby. According to the prescribed medication regimen, the client is to take medication 6 times throughout the day. Which nursing intervention is correct to assist the client with taking the medication? 1:contact the client's children and ask them to hire a private-duty aide who will provide round the clock care 2:develop a chart for the client, listing the times the medication should be taken 3:contact the primary health care provider and discuss the possibility of simplifying the medication regimen 4:instruct the client and clients children to put medications in a weekly pill organizer

3 rationale: contacting the primary health care provider first leads to using a weekly pill organizer

Which medication of action explains how diuretics reduce blood pressure? 1:they facilitate vasodilation 2:they promote smooth muscle relaxation 3:they reduce the circulating blood volume 4:they block the sympathetic nervous system

3 rationale: diuretics decrease blood volume by blocking sodium reabsorption in the renal tubules, thus promoting fluid loss and reducing arterial pressure. -direct relaxation of arteriolar smooth muscle is accomplished by vasodilator

Which nursing action is important when a health care provider prescribes enalapril for a client? 1:assess the client for hypokalemia 2:monitor for adverse effects on renal function 3:monitor the clients blood pressure during therapy 4:assess the client for hypoglycemia

3 rationale: enalapril is an antihypertensive. A lowering of the clients BP reflects a therapeutic response and needs to be monitored regularly. -the client is at risk for hyperkalemia, not hypokalemia -enalapril has renal protective effects rather than adverse renal effects -does not affect glucose levels

Which adverse effect would a nurse monitor for when caring for a client receiving furosemide to relieve edema? 1:hypernatremia 2:elevated blood urea nitrogen 3:hypokalemia 4:increase in the urine specific gravity

3 rationale: furosemide is a potent diuretic used to provide rapid diuresis; it acts in the loop of the henle and causes depletion of electrolytes, such as potassium and sodium -furosemide inhibits the reabsorption, not retention, of sodium -furosemide increases water excretion relative to solutes, resulting in low specific gravity of fluid

Which insulin will the nurse prepare for the emergency treatment of ketoacidosis? 1:glargine 2:NPH insulin 3:insulin aspart 4:insulin detemir

3 rationale: insulin aspart is a rapid acting insulin (10-20 mins) and is used to meet a clients immediate insulin needs. -Glargine is a long acting insulin -NPH insulin is an intermediate acting insulin which has an onset of 1-2 hours -insulin detemir is a long acting insulin

before beginning administration of morphine via patient controlled analgesia, which assessment would the nurse perform first? 1:temp 2:BP 3:respirations 4:urine output

3 rationale: morphine is a respiratory depressor and is the primary VS

The nurse is providing discharge education for a parent whose child will be receiving a prescription at home. Which statement by the parent requires correction? 1:i will be the only person administering the prescription 2:i am going to create a medication administration chart 3: the full dose needs to be readministered if my child spits some out 4:i will have you watch me administer this prescription before we leave

3 rationale: parents will be instructed to estimate the amount of medication lost and readminister that amount

Which condition would the nurse identify as the likely cause of profound weakness and nervousness in a client that became confused shortly after self administering the morning dose of 10 units of regular insulin and 25 units of NPH insulin after a light breakfast with no additional intake in the 3 hours since that time? 1:hyperglycemia 2:hyperinsulinemia 3:hypoglycemia 4:hypoinsulinemia

3 rationale: severe hypoglycemia is a finding in a diabetic client who takes insulin and missed a meal. signs are nervousness, weakness, confusion, and disoriented. -hyperglycemia is rare in clients who are on insulin therapy

When a client is seen in the ER with sudden onset severe dyspnea, coughing, and wheezing, which prescribed treatment would the nurse administer first? 1:inhaled corticosteriod 2:normal saline infusion 3:albuterol via nebulizer 4:IV methylprednisolone

3 rationale: the clients symptoms suggest acute asthma attack or anaphylaxis. inhaled bronchodilators like albuterol act within a few minutes to relax bronchospasms, decrease bronchiolar inflammation, and dilate bronchioles. -inhaled corticosteroids are not rapidly acting and can be given after inhaled bronchodilators -normal saline would be needed, but the nurse would not wait to give the bronchodilator while infusing saline -IV corticosteroids take several hours to be effective and would not be the priority treatment

An intravenous injection of morphine sulfate, 2mg, is prescribed for an 8 month old infant weighing 15 lb. The recommended dose for an infant is 0.1 mg. The nurse would question the prescription for what reason? 1:the amount of the opioid would be ineffective 2:the information needed to calculate the opioid dosage is incomplete 3:this amount of morphine sulfate is unsafe for an infant of this weight 4:administration of morphine sulfate is contraindicated in infants younger than 1 year

3 rationale: the infant should not receive more than 0.7 mg of morphine per dose. A 2mg dose is excessive, and the prescription should be questioned -first convert to pounds to kilograms using this conversion factor: 2.2lb=1kg

Which antihypertensive medication class would the nurse identify as the likely cause of the cough in a client taking multiple medications for hypertension who develops a persistent, hacking cough? 1:thiazide diuretic 2:calcium channel blockers 3:direct renin inhibitors 4: angiotensin-converting enzyme inhibitors

4 rationale: The ACE break down kinins and when ACE is inhibited, the increase of kinins in the lung can cause bronchial irritation, leading to sometimes referred to as an ACE cough -ACE drugs end in "PRIL"

The nurse is planning an evening snack for a child receiving NPH insulin. The nurse offers a snack for which reason? 1: it encourages the child to stay on the diet 2:energy is needed for immediate utilization 3:extra calories will help the child gain weight 4:nourishment helps counteract late insulin activity

4 rationale: a bedtime snack is needed for the evening. NPH insulin is intermediate-acting insulin, which peaks 4-12 hours later and last for 18-24 hours. Protein and carbohydrate ingestion before sleep prevents hypoglycemia during the night when the NPH is still active

which statement by a client about sulfonamide use for a UTI would the nurse review for correction? 1:i will avoid the sunlight 2:i will increase my fluid intake 3:i will let my doctor know if I develop a rash 4:i will stop taking the medication when my symptoms subside

4 rationale: dont stop medication until the entire course of treatment is done

Which concern when caring for a client prescribed furosemide 40 mg everyday in conjunction with digoxin would prompt the nurse to ask the health care provider about potassium supplements? 1:digoxin causes significant potassium depletion 2:the liver destroys potassium as digoxin is detoxified 3:lasix requires adequate serum potassium to promote diuresis 4:digoxin toxicity occurs rapidly in the presence of hypokalemia

4 rationale: furosemide promotes potassium excretion, and low potassium increases cardiac excitability. Digoxin is more likely to cause dysrhythmias when potassium is low. -digoxin does not affect potassium excretion, furosemide causes potassium excretion -potassium is excreted by the kidneys, not destroyed by the liver -furosemide causes diuresis and potassium loss regardless of the serum potassium level

Which symptoms in a client receiving hydrochlorothiazide would cause the nurse to notify the HCP? 1:insomnia 2:nasal congestion 3:increased thirst 4:generalized weakness

4 rationale: generalized weakness is a symptom of significant hypokalemia

Which type of health service would the nurse offer in a health promotion of primary care program? 1:home care 2:immunization 3:sports medicine 4:nutrition counseling

4 rationale: health promotion and primary care focuses on improved health outcomes for the entire population. It includes nutrition counseling and health education

Which response would the nurse give to a client taking ibuprofen for rheumatoid arthritis who asks the nurse if acetaminophen can be substituted? 1:yes, both are antipyretics and have the same effect 2:acetaminophen irritates the stomach more than ibuprofen does 3:acetaminophen is the preferred treatment for rheumatoid arthritis 4:ibuprofen has anti-inflammatory properties, and acetaminophen does not

4 rationale: ibuprofen has anti-inflammatory action that relieves the inflammation and pain associated with arthritis. Ibuprofen is not an antipyretic. -acetaminophen does not cause gastritis; that is an effect of aspirin. Acetaminophen is not a nonsteroidal anti-inflammatory drug (NSAIDs). NSAIDS are preferred for the treatment of rheumatoid arthritis

The nurse is caring for a pregnant client who has contracted a trichomonal infection. For which oral medication would the nurse anticipate preparing to provide education? 1:penicillin G 2:acyclovir 3:nystatin 4:metronidazole

4 rationale: metronidazole is an antibiotic that is effective against protozoa (trichomonal) and safe for pregnancy. -penicillin is affective against bacteria -acylcovir is an antiviral -nystatin is an antifungal for infection caused by candida albicans

which action is responsible for the therapeutic effect of docusate sodium? 1:lubricates the feces 2:creates and osmotic effect 3:stimulates motor activity 4:softens the feces

4 rationale: the action of docusate sodium is to promote the drawing of fluid into the stool which softens the feces -osmotic effects is magnesium hydroxide and lactulose -stimulating motor activity of the GI tract is the action of peristaltic stimulants such as cascara

Which angle would an obese client be taught to self administer an insulin injection at? 1:30-degree angle 2:60-degree angle 3:45-degree angle 4:90-degree angle

4 rationale: when teaching a client how to give insulin, the client would be taught to push the needle straight into the skin at 90 degree angle. -IF you are thin, muscular, or using an 8-12mm needle, you may need to pinch the skin and use a 45 degree angle.

which client statement indicates that teaching about furosemide is understood? select all that apply 1:it may take 2 or 3 days for this medication to take effect 2:i should wear dark glasses when outdoors during the day 3:I should avoid lying flat in bed 4:i need to change my position slowly 5:i should eat more food that is high in potassium

4,5 rationale: furosemide may cause hypovolemia, which can result in orthostatic hypotension with sudden changes in position. There is also an increase in potassium excretion, so increased potassium intake is needed -the response to furosemide is rapid with diuresis beginning within an hour of administration