HESI

Which assessment finding(s) should the nurse expect when caring for a child with cystic fibrosis? (Select all that apply.) A. Steatorrhea B. Obesity C. Foul-smelling stools D. Delayed growth E. Pulmonary congestion

(A, C, D, and E) are all common assessment findings in the client with cystic fibrosis. Weight loss, not weight gain, is associated with cystic fibrosis (B).

Antibiotic in 4 divided doses

1000, 1600, 2200, 0400 give around the clock

Cystic fibrosis

25% chance that a child will get this if parents are carriers

Amniotic fluid

500-1200 ml

Pa02

80-100%

A client who is HIV-positive is receiving epoetin alfa (Epogen) for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider? A. Hematocrit (HCT) of 58% B. Hemoglobin of 10.8 g/dL C. White blood cell count of 5000 mm3 D. Serum potassium level of 5 mEq/L

A (A) should be reported to the health care provider immediately because of the likelihood of a hypertensive crisis and because seizure activity increases with an increase in HCT of more than 4 points, or an HCT above 36%. Epogen stimulates erythropoiesis (production of red blood cells), thereby decreasing the need for blood transfusions. Uncontrolled hypertension can occur if erythropoietin levels are too high. (B) is the reason why the client is receiving Epogen. (C and D) are within normal limits.

The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin (Aggrenox) PO. The nurse notes that the client's carotid bruit is louder than previously assessed. Which action should the nurse implement? A. Administer the prescribed dose of Aggrenox as scheduled. B. Hold the dose of Aggrenox until the health care provider is contacted. C. Advise the client to take nothing by mouth until further assessment is completed. D. Elevate the head of the bed and apply oxygen by nasal cannula.

A A carotid bruit reflects the degree of blood vessel turbulence, which is typically the result of atherosclerosis. Aggrenox is prescribed to reduce platelet aggregation and should be administered to this client, who is at high risk for thrombus occlusion (A). (B, C, and D) are not necessary interventions at this time.

A child with cystic fibrosis is receiving ticarcillin disodium (Ticar) for Pseudomonas pneumonia. For which adverse effect should the nurse assess and report promptly to the health care provider? A. Petechiae B. Tinnitus C. Oliguria D. Hypertension

A Adverse effects of ticarcillin disodium (Ticar) include hypothrombinemia and decreased platelet adhesion, which can result in the presence of petechiae (A). (B, C, and D) are not adverse effects primarily associated with the administration of Ticar.

The nurse assigns an unlicensed assistive personnel (UAP) to provide morning care to a newly admitted child with bacterial meningitis. What is the most important instruction for the nurse to review with the UAP? A. Use designated isolation precautions. B. Keep the lighting in the room dim. C. Allow the parents to assist with care. D. Report any pain that the child experiences.

A All these are important measures to review with the UAP, but the most important is (A). Improper use of isolation precautions can place other staff and clients at risk for infection. (B, C, and D) promote client comfort and reduce anxiety but are of a lower priority than (A).

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate (Atropine), IM STAT. What is the primary purpose for administering this drug to the child at this time? A. Decrease the oral secretions. B. Reduce the child's anxiety. C. Potentiate the opioid effects. D. Prevent possible peritonitis.

A Atropine sulfate (Atropine), an anticholinergic agent, is given to decrease oral secretions during a surgical procedure (A). (B, C, and D) are not actions of anticholinergic agents.

A client with Tourette's syndrome takes haloperidol (Haldol) to control tics and vocalizations. The client has become increasingly drowsy over the past 2 days and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take? A. Assess for poor skin turgor, sunken eyeballs, and concentrated urine output. B. Recognize that a sedative effect is expected and continue monitoring the client. C. Have the caregiver hold the next two doses of the medication to reduce the drug toxicity. D. Determine whether the client's urine is pink or reddish brown, and report findings to the health care provider.

A Because haloperidol (Haldol) causes CNS effects of sedation and decreased thirst, the nurse should assess for signs of dehydration (A). Although sedation may occur with haloperidol (Haldol) administration, this side effect may signal an adverse CNS reaction; therefore, (B) is not a sufficient intervention when client safety is threatened. (C) could precipitate withdrawal-emergent dyskinesia, which is potentially life threatening. (D) is expected.

A female client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole (Flagyl). Which instruction is most important for the nurse to include this client's teaching plan? A. Avoid alcohol consumption. B. Complete the medication regimen. C. Use a barrier contraceptive method. D. Treat partner(s) concurrently.

A Clients should be instructed to avoid alcohol and products containing alcohol (A) while taking metronidazole (Flagyl) because of the possibility of a disulfiram (Antabuse)-like reaction. (B) helps prevent the development of Flagyl-resistant T. vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a barrier contraceptive (C) while taking Flagyl, and their partner(s) should be treated concurrently (D). The most important instruction for client well-being is (A).

Methylphenidate HCl (Concerta) is prescribed for daily administration to a 10-year-old child with attention deficit-hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents? A. Administer the medication in the morning before the child goes to school. B. Plan to implement periodic interruptions in the administration of the drug. C. Attempt to be consistent when setting limits on inappropriate behavior. D. Seek professional counseling if the child's behavior continues to be disruptive.

A Concerta, a central nervous system (CNS) stimulant, is an extended-release tablet. To be most effective in affecting the child's behavior, the drug should be administered in the morning before the child goes to school (A). Drug holidays (B) are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time. (C and D) are worthwhile instructions but do not have the priority of (A).

The nurse reviews the laboratory findings for a client's urine drug screen that is positive for cocaine. Which client behavior should be expected during cocaine withdrawal? A. Psychomotor impairment B. Agitation and hyperactivity C. Detachment from reality and drowsiness D. Distorted perceptions and hallucinations

A During cocaine withdrawal, the nurse should expect (A) and a pattern of withdrawal symptoms similar to those of one who uses amphetamines. (B, C, and D) are signs and symptoms of a person who is high on cocaine rather than one who is experiencing withdrawal from cocaine.

A resident in a long-term care facility is diagnosed with hepatitis B. Which intervention should the nurse implement with the staff caring for this client? A. Determine if all employees have had the hepatitis B vaccine series. B. Explain that this type of hepatitis can be transmitted when feeding the client. C. Assure the employees that they cannot contract hepatitis B when providing direct care. D. Tell the employees that wearing gloves and a gown are required when providing care.

A Hepatitis B vaccine should be administered to all health care providers (A). Hepatitis A (not hepatitis B) can be transmitted by fecal-oral contamination (B). There is a chance that staff could contract hepatitis B if exposed to the client's blood and/or body fluids; therefore, (C) is incorrect. There is no need to wear gloves and gowns except with blood or body fluid contact (D).

Which nursing intervention has the highest priority during IV administration of mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin D)? A. Assess for extravasation at the IV site during infusion. B. Premedicate with antiemetics 30 to 60 minutes before infusion. C. Monitor cardiac rate and rhythm during the IV infusion. D. Check the granulocyte count daily for the presence of neutropenia.

A Mechlorethamine HCl (nitrogen mustard) and actinomycin (Actinomycin D) are vesicants; therefore, assessment for blister formation and/or tissue sloughing that can occur with leakage of these agents into surrounding subcutaneous tissues is essential to ensure client safety during the IV infusion (A). (B, C, and D) do not have the priority of (A) during the administration of vesicants.

A client begins taking an atypical antipsychotic medication. The nurse must provide informed consent and education about common medication side effects. Which client education will be most important? A. Maintain a balanced diet and adequate exercise. B. Be sure that the diet is adequate in salt intake. C. Monitor for any changes in sleep pattern. D. Report any unusual facial movements.

A Several atypical antipsychotic medications can cause significant weight gain, so the client should be advised to maintain a balanced diet and adequate exercise (A). (B) is important with lithium, a mood stabilizer. (C and D) are less common than weight gain.

A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline (Elavil) in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline (Elavil)? A. Sodium bicarbonate B. Naloxone (Narcan) C. Phentolamine mesylate (Regitine) D. Atropine sulfate (Atropine)

A Sodium bicarbonate (A) is an effective treatment for an overdose of tricyclic antidepressants such as amitriptyline (Elavil) to reverse QRS prolongation. (B, C, and D) are not the preferred agents for treating this drug overdose.

During the initial nursing assessment history, a client tells the nurse that he is taking tetracycline hydrochloride (Sumycin) for urethritis. Which medication taken concurrently with Sumycin could interfere with its absorption? A. Sucralfate (Carafate) B. Hydrochlorothiazide (Diuril) C. Acetaminophen (Tylenol) D. Phenytoin (Dilantin)

A Sucralfate (Carafate) (A) is used to treat duodenal ulcers and will bind with tetracycline hydrochloride (Sumycin), inhibiting this antibiotic's absorption. (B, C, and D) have no drug interaction properties that prohibit concurrent use with tetracycline hydrochloride (Sumycin).

A male client with arterial peripheral vascular disease (PVD) complains of pain in his feet. Which instruction should the nurse give to the UAP to relieve the client's pain quickly? A. Help the client dangle his legs. B. Apply compression stockings. C. Assist with passive leg exercises. D. Ambulate three times a day.

A The client who has arterial PVD may benefit from dependent positioning, and this can be achieved with bedside dangling (A), which will promote gravitation of blood to the feet, improve blood flow, and relieve pain. (B) is indicated for venous insufficiency (C) and indicated for bed rest. Ambulation (D) is indicated to facilitate collateral circulation and may improve long-term complaints of pain.

The nurse is observing an unlicensed assistive personnel (UAP) performing morning care for a bedridden client with Huntington's disease. Which care measure is most important for the nurse to supervise? A. Oral care B. Bathing C. Foot care D. Catheter care

A The client with Huntington's disease experiences problems with motor skills such as swallowing and is at high risk for aspiration, so the highest priority for the nurse to observe is the UAP's ability to perform oral care safely (A). (B, C, and D) do not necessarily require registered nurse (RN) supervision because they do not ordinarily pose life-threatening consequences.

A client experiencing dysrhythmias is given quinidine (Quinidex), 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication? A. Diarrhea B. Hypothermia C. Seizures D. Dysphagia

A The most common side effects associated with quinidine therapy are gastrointestinal complaints, such as diarrhea (A). (B, C, and D) are not usually associated with quinidine therapy.

The nurse is preparing to administer amphotericin B (Fungizone) IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication? A. Serum potassium level B. Platelet count C. Serum creatinine level D. Hemoglobin level

A The nurse should obtain baseline potassium levels (A) prior to beginning drug therapy because amphotericin B (Fungizone) changes cellular permeability, allowing potassium to escape from the cell, which could lead to a decrease in the serum potassium level and severe hypokalemia. (B, C, and D) are helpful laboratory values, but they do not have the importance of (A) in determining if amphotericin B (Fungizone) can be administered safely via IV infusion.

A 3-month-old infant returns from surgery with elbow restraints and a Logan's bow over a cleft lip suture line. Which intervention should the nurse implement to maintain suture line integrity during the initial postoperative period? A. Place the infant upright in an infant seat position. B. Provide mittens with the use of elbow restraints. C. Use soft rubber catheters for nasal suctioning. D. Apply water-soluble lubricant to the suture line.

A The use of an infant seat simulates a supine position with the head elevated (A) and also prevents aspiration. Prone positioning should be avoided to prevent disruption of the protective Logan's bow and prevent the infant from rubbing the face on the bed surface. Mittens (B) are not necessary and decrease the ability to provide sensory comfort, such as hand holding. Nasal suctioning (C) should be avoided to prevent trauma or dislodging clots at the surgical site. Water-soluble lubricant (D) will dry the suture line and cause crusting, which predisposes the suture line to poor healing and scarring.

Which topics should the nurse include in an education program for clients with schizophrenia and their families? (Select all that apply.) A. Importance of adherence to medication regimen B. Current treatment measures for substance abuse C. Signs and symptoms of an exacerbation D. Prevention of criminal activity E. Behavior modification for aggression F. Chronic grief associated with long-term illness

A,C,F Medication adherence is an important component of successful rehabilitation (A). Clients and their families also need to know the signs and symptoms of an exacerbation or relapse of the disease (C), which is frequently associated with poor medication compliance. Acknowledging the chronic sorrow associated with severe and persistent mental illness (F) helps individuals negotiate the grieving process. (B, D, and E) are not universal problems associated with schizophrenia.

Which nursing intervention(s) should be implemented when caring for a client with bipolar disorder in the manic phase? (Select all that apply.) A. Report lithium level of 2.0 mEq/L to the primary health care provider. B. Encourage competitive physical activities as part of the client's therapy. C. Provide an environment with increased stimuli to engage the client. D. Maintain consistent salt levels in the diet when client is taking lithium. E. Assess the client's nutritional and hydration status.

A,D,E A therapeutic level for serum lithium is 0.5 to 1.5 mEq/L, and the client with 2.0 mEq/L is experiencing toxicity (A). Consistent salt levels are important when taking lithium to maintain a therapeutic level (D). Because of the client's manic state, the client is at risk for impaired nutrition and dehydration; therefore, they should be assessed (E). Noncompetitive physical activities should be encouraged because of the risk for agitation (B), and decreased environmental stimuli is therapeutic for the manic phase (C).

Beta adrenergic blockers:

Acebutolol(Monitan, Rhotral, Sectral), atenolol (Tenormin, Apo-Atenol, Nova-Atenol), esmolol (Brevibloc), metaprolol (Alupent, Metaproterenol), propanolol (Inderal)

Antivirals

Acyclovir(Zovirax),ritonavir(Norvir), saquinavir (Invirase, Fortovase), indinavir (Crixivan), abacavir (Ziagen), cidofovir (Vistide), ganciclovir (Cytovene, Vitrasert)

Addison's versus Cushing's

Addison's and Cushing's are diseases of the endocrine system involving either overproduction or inadequate production of cortisol: . Treatment for the client with Addison's: increase sodium intake; medications include cortisone preparations. . Treatment for the client with Cushing's: restrict sodium; observe for signs of infection.

Variable decelerations

Are noted as V-shaped on the monitoring strip. Variable decelerations can occur anytime during monitoring of the fetus. They are caused by cord compression. The intervention is to change the mother's position; if pitocin is infusing, stop the infusion; apply oxygen; and increase the rate of IV fluids. Contact the doctor if the problem persists.

ER nurse transferred to OB

Assign mother with infected episiotomy

Cholesterol-loweringdrugs:

Atorvastatin(Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocar), rosuvastatin (Crestor)

The health care provider performs a bone marrow aspiration from the posterior iliac crest for a client with pancytopenia. Which action should the nurse implement first? A. Inspect the dressing over the puncture site and under the client for bleeding. B. Take the vital signs to determine the client's response for a potential blood loss. C. Use caution when changing the dressing to avoid dislodging a clot at the puncture site. D. Assess the client's pain level to determine the need for analgesic medication.

B After bone marrow aspiration, pressure is applied at the aspiration site, which is critical for a client with pancytopenia because of a decrease in the platelet count. The client's baseline vital signs should be obtained first to determine changes indicating bleeding caused by the procedure (B). Although (A, C, and D) should be implemented after the procedure, the first action is to obtain a baseline assessment.

When inserting a nasogastric tube into the stomach of a 3-month-old infant, which nursing intervention is most important to implement? A. Use a blanket as a mummy restraint. B. Monitor the infant's heart rate. C. Lubricate the catheter with saline. D. Explain the procedure to the parents.

B All interventions may be implemented during nasogastric tube insertion, but the most important nursing action is to monitor the infant's heart rate (B), which may decrease because of vagal nerve stimulation and can occur when the tube is inserted. (A, C, and D) are of lower priority than (B).

An older male client comes to the outpatient clinic complaining of pain in his left calf. The nurse notices a reddened area on the calf of his right leg that is warm to the touch, and the nurse suspects that the client may have thrombophlebitis. Which additional assessment is most important for the nurse to perform? A. Measure the client's calf circumference. B. Auscultate the client's breath sounds. C. Observe for ecchymosis and petechiae. D. Obtain the client's blood pressure.

B All these techniques provide useful assessment data. The most important is to auscultate the client's breath sounds (B) because the client may have a pulmonary embolus secondary to the thrombophlebitis. (A) may provide data that support the nurse's suspicion of thrombophlebitis. (C) is the least helpful assessment because bruising is not a typical finding associated with thrombophlebitis. (D) is always useful in evaluating the client's response to a problem but is of less immediate priority than breath sound auscultation.

Which nursing diagnosis has the highest priority when planning care for an infant with eczema? A. High risk for altered parenting related to feelings of inadequacy B. Altered comfort (pruritus) related to vesicular skin eruptions C. Altered health maintenance related to knowledge deficit of treatment D. Risk for impaired skin integrity related to eczema

B Altered comfort (pruritus) (B) has the highest priority because itching will cause the infant to scratch, creating complications such as scarring or infection. (A, C, and D) are all important nursing diagnoses and should be considered when developing the infant's plan of care, but they do not have the priority of (B).

A client who is being treated with lithium carbonate for manic depression begins to develop diarrhea, vomiting, and drowsiness. Which action should the nurse take? A. Notify the health care provider immediately and force fluids. B. Prior to giving the next dose, notify the health care provider of these symptoms. C. Record the symptoms and continue with medication as prescribed. D. Hold the medication and refuse to administer additional doses.

B Although these are expected symptoms, the health care provider should be notified prior to the next administration of the drug (B). Early side effects of lithium carbonate (occurring with serum lithium levels below 2 mEq/L) generally follow a progressive pattern, beginning with diarrhea, vomiting, drowsiness, and muscular weakness (C). At higher levels, ataxia, tinnitus, blurred vision, and large dilute urine output may occur. (A) will lower the lithium level. (D) is not warranted.

A 25-year-old client was admitted yesterday after a motor vehicle collision. Neurodiagnostic studies have shown a basal skull fracture in the middle fossa. Assessment on admission revealed both halo and Battle signs. Which new symptom indicates that the client is likely to be experiencing a common life-threatening complication associated with a basal skull fracture? A. Bilateral jugular venous distention B. Oral temperature of 102° F C. Intermittent focal motor seizures D. Intractable pain in the cervical region

B Clients with basilar skull fractures are at high risk for infection of the brain, as indicated by an increased oral temperature (B), because the fracture leaves the meninges open to bacterial invasion. Clients may experience (C and D), but these findings do not pose as great a life-threatening risk as infection. Jugular distention (A) is not a typical complication of basal skull fractures.

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone (Solu-Medrol). Which nursing diagnosis reflects a problem related to this medication that should be included in the care plan? A. Ineffective airway clearance B. Risk for infection C. Deficient fluid volume D. Impaired gas exchange

B Corticosteroids depress the immune system, placing the client at risk for infection (B). Although (A, C, and D) reflect diagnostic statements that may be applicable to this client, only (B) is directly related to the administration of this medication.

A middle-aged adult was discharged from a treatment center 6 weeks ago following treatment for suicide ideation and alcohol abuse. In a follow-up visit to the mental health clinic, the client complains of lethargy, apathy, irritability, and anxiety. Which question is most important for the nurse to ask? A. "Are you taking prescribed antidepressants?" B. "How much alcohol do you consume daily?" C. "What seems to precipitate the anxious feelings?" D. "How many hours do you sleep per day?"

B First, and most importantly, the client's use of alcohol should be determined (B) because further treatment is dependent on the client's sobriety, and asking how much alcohol is being consumed is a better question than asking if the client is drinking, which is a "yes-no" answer that does not promote dialogue. (A, C, and D) provide worthwhile assessment data, but first the nurse should determine if the client is still drinking because all efforts to treat symptoms associated with depression are diminished if the client is still consuming alcohol.

A client diagnosed with chronic kidney disease (CKD) 2 years ago is regularly treated at a community hemodialysis facility. Before his scheduled dialysis treatment, which electrolyte imbalance should the nurse anticipate? A. Hypophosphatemia B. Hypocalcemia C. Hyponatremia D. Hypokalemia

B Hypocalcemia (B) develops in CKD because of chronic hyperphosphatemia, not (A). Increased phosphate levels cause the peripheral deposition of calcium and resistance to vitamin D absorption needed for calcium absorption. Prior to dialysis, the nurse would expect to find the client hypernatremic and hyperkalemic, not with (C or D).

The nurse is preparing a child with an intussusception for a prescribed barium enema. What is the main purpose of conducting this procedure prior to surgical intervention? A. Evacuate the bowel of impacted feces. B. Reduce the invaginated bowel segment. C. Locate the presence of diverticula. D. Identify the area of esophageal atresia.

B Intussusception, an invagination or telescoping of one portion of the intestine into another, causes intestinal obstruction in children (usually occurs between 3 months and 5 years of age). Nonsurgical treatment is attempted with hydrostatic pressure created by barium instillation, which often reduces the area of bowel intussusception (B), thereby negating the need for surgical intervention. A barium enema is likely to cause (A). A barium enema could be used to detect (C), but this is not the reason for its use with intussusception. (D) is not a use for a barium enema.

Which change in laboratory values indicates to the nurse that a client with rheumatoid arthritis may be experiencing an adverse effect of methotrexate (Mexate) therapy? A. Increase in rheumatoid factor B. Decrease in hemoglobin level C. Increase in blood glucose level D. Decrease in erythrocyte sedimentation rate (ESR; sed rate)

B Methotrexate is an immunosuppressant. A common side effect is bone marrow depression, which would be reflected by a decrease in the hemoglobin level (B). (A) indicates disease progression but is not a side effect of the medication. (C) is not related to methotrexate. (D) indicates that inflammation associated with the disease has diminished.

Which abnormal laboratory finding indicates that a client with diabetes needs further evaluation for diabetic nephropathy? A. Hypokalemia B. Microalbuminuria C. Elevated serum lipid levels D. Ketonuria

B Microalbuminuria (B) is the earliest sign of diabetic nephropathy and indicates the need for follow-up evaluation. Hyperkalemia, not (A), is associated with end-stage renal disease caused by diabetic nephropathy. (C) may be elevated in end-stage renal disease. (D) may signal the onset of diabetic ketoacidosis (DKA).

A 19-year-old male client who has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the health care provider administers pancuronium bromide (Pavulon) IV, with adjunctive opioid analgesia. What medication should the nurse maintain at the client's bedside? A. Dantrolene sodium (Dantrium) B. Neostigmine bromide (Prostigmin) C. Succinylcholine bromide (Anectine) D. Epinephrine (Adrenalin)

B Neostigmine bromide (Prostigmin) (B) and atropine sulfate (Atropine), both anticholinergic drugs, reverse the respiratory muscle paralysis caused by pancuronium bromide. (A, C, and D) are not antagonists to pancuronium bromide and would not be helpful in reversing the effects of the drug compared with the use of anticholinergics.

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, the nurse writes a nursing diagnosis of Alteration in nutrition: less than body requirements, related to inadequate digestion of nutrients. Which intervention would best meet this child's needs? A. Give aluminum hydroxide and magnesium hydroxide (Maalox) after meals. B. Give pancrelipase (Cotazym-S) capsule mixed with applesauce before each meal. C. Administer cholestyramine resin (Questran) before each meal and at bedtime. D. Administer omeprazole (Prilosec) for gastroesophageal reflux.

B Pancreatic enzyme replacement with pancrelipase (Cotazym-S) (B) is a major component of cystic fibrosis nutritional management. Aluminum hydroxide and magnesium hydroxide (A) may be given before meals with enzymes to reduce gastric acidity and prevent enzyme destruction but are ineffective when used alone to promote enzyme replacement. (C and D) are used to treat steatorrhea in cystic fibrosis.

Which physiologic mechanism explains a drug's increased metabolism that is triggered by a disease process? A. Selectivity response B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics

B Pharmacokinetics (B) describes the physiologic process of a drug's movement throughout the body and how the drug's interaction is affected by an underlying disease. Selectivity (A), or a selective drug, is defined as a drug that elicits only the response for which it is given. Pharmacodynamics (C) is the impact of drugs on the body. Pharmacotherapeutics (D) is defined as the use of drugs to diagnose, prevent, or treat disease or prevent pregnancy.

A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital (Luminal) elixir prescribed for his brother's seizure disorder. Which nursing intervention should the nurse implement first? A. Administer syrup of ipecac. B. Take the child's vital signs. C. Draw a blood specimen for a phenobarbital level. D. Teach the mother safe medication storage practices.

B Phenobarbital causes respiratory depression, so the priority intervention is assessment of vital signs (B). (A, C, and D) are actions that may all be used in the treatment of this child, but they do not have the priority of (B).

The nurse is teaching the parents of a 2-year-old child with a congenital heart defect about signs and symptoms of congestive heart failure. Which information about the child is most important for the parents to report to the health care provider? A. Sits or squats frequently when playing outdoors B. Exhibits a sudden and unexplained weight gain C. Is not completely toilet-trained and has some accidents D. Demonstrates irritation and fatigue 1 hour before bedtime

B Sudden and unexplained weight gain (B) can indicate fluid retention and is a sign of congestive heart failure. (A) is used by the child to reduce chronic hypoxia, especially during exercise. (C) is common; 2-year-olds are not expected to be toilet-trained. (D) is normal.

Which ego defense mechanism is exhibited by a client with a phobia related to refusal to leave home? A. Denial B. Symbolization C. Fantasy D. Intellectualization

B Symbolization (B) allows external objects to carry the internal emotional feeling through some act such as refusing to leave a safe harbor. (A) is the unconscious failure to acknowledge an event, thought, or feeling. (C) is pretending, usually of a more desirable situation. (D) is using reason to avoid emotional conflicts.

The nurse assesses a postoperative client whose skin is cool, pale, and moist. The client is very restless and has scant urine output. Oxygen is being administered at 2 L/min, and a saline lock is in place. Which intervention should the nurse implement first? A. Measure the urine specific gravity. B. Obtain IV fluids for infusion per protocol. C. Prepare for insertion of a central venous catheter. D. Auscultate the client's breath sounds.

B The client is at risk for hypovolemic shock because of the postoperative status and is exhibiting early signs of shock. A priority intervention is the initiation of IV fluids (B) to restore tissue perfusion. (A, C, and D) are all important interventions, but are of less priority than (B).

An adult client who lives in a residential facility is mentally retarded and has a history of bipolar disorder. During the past week, the client has refused to wear clothes and frequently exposes their body to other residents. Which intervention should the nurse implement? A. Establish a one-to-one relationship to discuss the behavior. B. Redirect the client to physically demanding activities. C. Encourage the client to verbalize thoughts when acting out. D. Restrict social interactions with other residents in the facility.

B The client is exhibiting manic behavior related to bipolar disorder, and the nurse should redirect the client to activities that are physically demanding (B) so that energy can be expended in a socially acceptable manner. Psychotic clients are not capable of (A). When exhibiting acting-out behavior, the client is distracted and (C) is difficult. (D) is likely to increase manic behaviors, such as mood swings and acting-out behaviors.

A couple expresses concern and fear prior to having an amniocentesis to determine fetal lung maturity. To assist them in coping with this situation, which intervention is best for the nurse to implement? A. Explain that harm to the fetus is highly unlikely. B. Answer all their questions regarding the procedure. C. Encourage them to verbalize their feelings. D. Show them a video about the procedure.

B The nurse should allay their concerns by providing information about the procedure and answering questions (B). This action assists the couple in coping with the situation. (A) may offer false reassurance. (C) alone does not resolve the couple's fears. Although (D) may be helpful, it is a passive activity, and the nurse's availability to answer questions is likely to be most helpful in calming their fears.

A client who is first day postoperative after a mastectomy becomes increasingly restless and agitated. Vital signs are temperature, 100° F; pulse, 98 beats/min; respirations, 24/breaths/min; and blood pressure, 120/80 mm Hg. Which intervention should the nurse implement first? A. Administer a PRN dose of a prescribed analgesic. B. Assess the incision for any drainage or redness. C. Instruct the UAP to take vital signs hourly. D. Assist the client to a more comfortable position.

B The nurse's priority is to observe for possible hemorrhage (B). The client is at high risk for hypovolemic shock and is exhibiting early symptoms of shock. Remember, in early shock the blood pressure may be stable or increase slightly as a compensatory mechanism. If there is no obvious indication of bleeding, the client should then be assessed for the need of an analgesic (A, C, and D) should be implemented.

A client on telemetry has a pattern of uncontrolled atrial fibrillation with a rapid ventricular response. Based on this finding, the nurse anticipates assisting the physician with which treatment? A. Administer lidocaine,75 mg intravenous push. B. Perform synchronized cardioversion. C. Defibrillate the client as soon as possible. D. Administer atropine, 0.4 mg intravenous push.

B With uncontrolled atrial fibrillation, the treatment of choice is synchronized cardioversion (B) to convert the cardiac rhythm back to normal sinus rhythm. (A) is a medication used for ventricular dysrhythmias. (C) is not for a client with atrial fibrillation; it is reserved for clients with life-threatening dysrhythmias, such as ventricular fibrillation and unstable ventricular tachycardia. (D) is the drug of choice in symptomatic sinus bradycardia, not atrial fibrillation.

The nurse is caring for a client who is 1 day post-acute myocardial infarction. The client is receiving oxygen at 2 L/min via nasal cannula and has a peripheral saline lock. The nurse notes that the client is having eight premature ventricular contractions (PVCs) per minute. Which intervention should the nurse implement first? A. Obtain an IV pump for antiarrhythmic infusion. B. Increase the client's oxygen flow rate. C. Prepare for immediate countershock. D. Gather equipment for endotracheal intubation.

B ncreasing the oxygen flow rate (B) provides more oxygen to the client's myocardium and may decrease myocardial irritability as manifested by the frequent PVCs. (A) can be delegated and is a lower priority action than (B). Defibrillation may eventually be necessary, but (C) is not the immediate treatment for frequent PVCs. (D) may become necessary if the client stops breathing, but is not indicated at this time.

Seconal, 0.1 g PRN at bedtime, is prescribed for rest. The scored tablets are labeled grain 1.5 per tablet. How many tablets should the nurse plan to administer? A. ½ tablet B. 1 tablet C. 1½ tablets D. 2 tablets

B 15 gr = 1 g. Converting the prescribed dose of 0.1 g to grains requires multiplying 0.1 × 15 = 1.5 grains. The tablets come in 1.5 grains; therefore, the nurse should plan to administer one tablet (B). (A, C, and D) are incorrect.

Which intervention(s) should the nurse include in the teaching plan for the mother of a 6-year-old who is experiencing encopresis secondary to a fecal impaction? (Select all that apply.) A. Provide a low-fiber diet. B. Administer mineral oil daily. C. Decrease the daily fluids. D. Eliminate dairy products. E. Initiate consistent toileting routine.

B, D, E Encopresis is fecal incontinence, usually as the result of recurring fecal impaction and an enlarged rectum caused by chronic constipation. Encopresis is managed through bowel retraining with mineral oil (B), eliminating dairy products (D), and initiating a regular toileting routine (E). A high-fiber diet, not (A), and increased daily fluids, not (C), are components of care for a child with encopresis.

The nurse is planning the care for a client who is admitted with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which intervention(s) should the nurse include in this client's plan of care? (Select all that apply.) A. Salt-free diet B. Quiet environment C. Deep tendon reflex assessments D. Neurologic checks E. Daily weights

B,C,D,E Correct responses are (B, C, D, and E). SAIDH results in water retention and dilutional hyponatremia, which causes neurologic changes when serum sodium levels are less than 115 mEq/L. The nurse should maintain a quiet environment (B) to prevent overstimulation and assess deep tendon reflexes (C) and perform neurologic checks (D) to monitor for neurologic deterioration. Daily weights (E) should be monitored to assess for fluid overload. (A) would contribute to dilutional hyponatremia.

Early decelerations

Begin prior to the peak of the contraction and end by the end of the contraction. They are caused by head compression. There is no need for intervention if the variability is within normal range (that is, there is a rapid return to the baseline fetal heart rate) and the fetal heart rate is within normal range.

Angiotensin-convertingagents:

Benazepril (Lotensin), lisinopril (Zestril), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), moexipril (Univas), quinapril (Acupril), ramipril (Altace)

Antihistamines

Block the release of histamine

Pt to assess first

Bowel obstruction due to volvulus that is experiencing abdominal rigidity

CP Patho

Brain damage not progressive but will have variable course

During the change of shift report, the charge nurse reviews the infusions being received by clients on the oncology unit. The client receiving which infusion should be assessed first? A. Continuous IV infusion of magnesium B. One-time infusion of albumin C. Continuous epidural infusion of morphine D. Intermittent infusion of IV vancomycin

C All four of these clients have the potential to have significant complications. The client with the morphine epidural infusion (C) is at highest risk for respiratory depression and should be assessed first. (A) can cause hypotension. The client receiving (B) is at lowest risk for serious complications. Although (D) can cause nephrotoxicity and phlebitis, these problems are not as immediately life threatening as (C).

When caring for a postpartum client, which intervention is best for the nurse to implement to promote increased peripheral vascular activity? A. Encourage the client to turn from side to side every 2 hours. B. Elevate the foot of the client's bed at least 6 inches. C. Encourage the client to ambulate every 3 hours. D. Teach the client how to perform leg exercises while in bed.

C Ambulation is the best way to increase peripheral vascular activity (C). (A, B, and D) will increase peripheral vascular activity but are not as effective as ambulation.

A 3-month-old infant weighing 10 lb 15 oz has an axillary temperature of 98.9° F. What caloric amount does this child need? A. 400 calories/day B. 500 calories/day C. 600 calories/day D. 700 calories/day

C An infant requires 108 calories/kg/day. The first step is to change 10 lb 15 oz to 10.9 lb. Then convert pounds to kilograms by dividing pounds by 2.2, which is 10.9/2.2 = 4.954 kg, rounded to 5 kg. The second step is to multiply 108 calories/kg/day (108 × 5 = 540 calories/day). However, this infant requires 10% more calories because of the 1° F temperature elevation. Ten percent of 540 (calories/day) is 54 and 540 + 54 = 594. This infant will require approximately 600 calories/day (C). (A, B, and D) are incorrect.

A client who is receiving chlorpromazine HCl (Thorazine) to control his psychotic behavior also has a prescription for benztropine (Cogentin). When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine (Cogentin) in the treatment plan for this client? A. This medication will reduce the side effect of urinary retention. B. This drug potentiates the effect of chlorpromazine HCl (Thorazine). C. The benztropine (Cogentin) is used to control extrapyramidal symptoms. D. The combined effect of these drugs will modify psychotic behavior.

C Benztropine (Cogentin), an anticholinergic drug, is used to control extrapyramidal symptoms (C) associated with chlorpromazine HCl (Thorazine) use. (A, B, and D) are not accurate statements regarding the use of benztropine (Cogentin) for clients who are treated with Thorazine for the control of psychosis.

In assessing a client diagnosed with primary aldosteronism, the nurse expects the laboratory test results to indicate a decreased serum level of which substance? A. Sodium B. Phosphate C. Potassium D. Glucose

C Clients with primary aldosteronism exhibit a profound decline in serum levels of potassium (C); hypokalemia; hypertension is the most prominent and universal sign. The serum sodium level is normal or elevated, depending on the amount of water resorbed with the sodium (A). (B) is influenced by parathyroid hormone (PTH). (D) is not affected by primary aldosteronism.

Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl (Cerubidine) has been effective? A. "I should use an astringent mouthwash after every meal." B. "I will eat high-fiber foods and drink lots of water." C. "I expect my urine to be red for the next few days." D. "I should use sunscreen when I spend time outdoors."

C Daunorubicin HCl (Cerubidine) causes the urine to turn red in color (C). (A) is not recommended. (B and D) are interventions that promote general good health, but are not specific to treatment with Cerubidine.

A 35-year-old client admitted to the psychiatric unit of an acute care hospital tells the nurse that someone is trying to poison her. The client's delusions are most likely related to which factor? A. Authority issues in childhood B. Anger about being hospitalized C. Low self-esteem D. Phobia of food

C Delusional clients have difficulty with trust and have low self-esteem (C). Nursing care should be directed at building trust and promoting positive self-esteem. Activities with limited concentration and no competition should be encouraged to build self-esteem. (A, B, and D) are not specifically related to the development of delusions.

A client who recently retired is admitted to the psychiatric inpatient unit with a diagnosis of major depression. The initial nursing care plan includes the goal, "Assist client to express feelings of guilt." What is true about the goal statement referring to the client's depression? A. Implementation of the goal should be deferred until further data can be gathered. B. The depression will dissipate once the client becomes accustomed to retirement. C. Depressed clients may be unaware of guilt feelings and should be encouraged to increase self-awareness. D. Nursing goals should be approved by the treatment team before they are initiated.

C Depression is associated with feelings of guilt, and clients are often not aware of these feelings (C). Awareness is the first step in dealing with guilt (or any other feeling), so the nurse's efforts should be directed toward increasing the client's awareness of feelings. Although a goal may be changed based on an evaluation of interventions to meet the goal, a goal should never be ignored (A). (B) dismisses the client's symptoms as age-related. Setting goals for the nursing care plan is a function of the nurse (D), although the nurse can collaborate with the treatment team.

A client is admitted with a diagnosis of leukemia. This condition is manifested by which of the following? A. Fever, elevated white blood count, elevated platelets B. Fatigue, weight loss and anorexia, elevated red blood cells C. Hyperplasia of the gums, elevated white blood count, weakness D. Hypocellular bone marrow aspirate, fever, decreased hemoglobin level

C Hyperplastic gums, weakness, and elevated white blood count are classic signs of leukemia (C). (A, B, and D) state incorrect information for symptoms of leukemia.

A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate (Brethine) continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery? A. Hypokalemia B. Hypermagnesia C. Hypoglycemia D. Hypernatremia

C Hypoglycemia (C) may occur in the neonate because a side effect of terbutaline sulfate (Brethine) is increased maternal serum glucose levels. Although monitoring for the imbalances in (A, B, and D) are important, this does not have the priority of (C) following the maternal administration of Brethine.

A client who delivered by cesarean section 24 hours ago is using a patient-controlled analgesia (PCA) pump for pain control. Her oral intake has been ice chips only since surgery. She is now complaining of nausea and bloating, and states that because she had nothing to eat, she is too weak to breastfeed her infant. Which nursing diagnosis has the highest priority? A. Altered nutrition, less than body requirements for lactation B. Alteration in comfort related to nausea and abdominal distention C. Impaired bowel motility related to pain medication and immobility D. Fatigue related to cesarean delivery and physical care demands of infant

C Impaired bowel motility caused by surgical anesthesia, pain medication, and immobility (C) is the priority nursing diagnosis and addresses the potential problem of a paralytic ileus. (A and B) are both caused by impaired bowel motility. (D) is not as important as impaired motility.

Which data would the nurse expect to find when reviewing laboratory values of an 80-year-old man who is in good health overall? Complete blood count reveals increased white blood cell (WBC) and decreased red blood cell (RBC) counts. B. Chemistries reveal an increased serum bilirubin level with slightly increased liver enzyme levels. C. Urinalysis reveals slight protein in the urine and bacteriuria, with pyuria. D. Serum electrolytes reveal a decreased sodium level and increased potassium level.

C In older adults, the protein found in urine slightly rises, probably as a result of kidney changes or subclinical urinary tract infections, and clients frequently experience asymptomatic bacteriuria and pyuria as a result of incomplete bladder emptying (C). Laboratory findings in (A, B, and D) are not considered to be normal findings in an older adult.

The nurse assesses a client who is taking indomethacin (Indocin) for arthritic pain. Which of the following is most important to report to the primary health care provider? A. Takes medication with milk B. Blood pressure, 104/64 mm Hg C. Elevated liver enzyme levels D. Hemoglobin level, 13 g/dL

C Indomethacin is an antiinflammatory drug and can cause liver damage. Elevated liver enzyme levels indicate a complication with the drug (C). This medication should be taken with food or milk to reduce gastrointestinal (GI) side effects (A). (B and D) are normal findings.

The health care provider prescribes carbamazepine (Tegretol) for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. The mother asks why so many blood tests are necessary. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D. Hepatotoxicity

C Myelosuppression (C) is the highest priority complication that can potentially affect clients managed with carbamazepine (Tegretol) therapy. The client requires close monitoring for this condition by weekly laboratory testing. Hepatic function may be altered (D), but this complication does not have as great a potential for occurrence as (C). (A and B) are not typical complications of carbamazepine (Tegretol) therapy.

A male client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? A. The phenomenon occurs when opiates are used for more than 6 months to relieve pain. B. Withdrawal occurs if the drug is not tapered slowly while being discontinued. C. Pharmacodynamic tolerance requires increased drug levels to achieve the same effect. D. A consistent dosage with around-the-clock administration is the most effective.

C Pharmacodynamic tolerance explains the client's need for an increased drug level to produce effects that formerly occurred at lower drug levels (C). Tolerance can occur with opioids (A) during shorter periods of use. Although a withdrawal syndrome can occur if the client develops a dependency (B), this does not address the client's immediate concern of drug effectiveness. Although a stable serum drug level provides effective pain management (D), the client's complaint is consistent with a tolerance to his current pain management regimen.

The nurse is caring for a client with heart failure who develops respiratory distress and coughs up pink frothy sputum. Which action should the nurse take first? A. Draw arterial blood gases. B. Notify the primary health care provider. C. Position in a high Fowler's position with the legs down. D. Obtain a chest X-ray.

C Positioning the patient in a high Fowler's position with dangling feet will decrease further venous return to the left ventricle (C). The other actions should be performed after the change in position (A, B, and D).

When assessing the laboratory findings of a 38-year-old client with tuberculosis who is taking rifampin (Rifadin), which laboratory finding would be most important to report to the primary health care provider immediately? A. Orange-colored urine B. Potassium level, 4.9 mEq/L C. Elevated liver enzyme levels D. Blood urea nitrogen (BUN) level, 12 mg/dL

C Rifampin can cause hepatoxicity, so elevated liver enzyme levels need to be closely monitored and reported to the health care provider (C). Orange discoloration of the urine is an expected side effect of this medication (A). The potassium level (B) is normal. A BUN level of 12 mg/dL is within defined parameters (D).

A 26-year-old gravida 2, para 1 client is admitted to the hospital at 28 weeks of gestation in preterm labor. She is given three doses of terbutaline sulfate (Brethine), 0.25 mg subcutaneously, to stop her labor contractions. What are the primary side effects of terbutaline sulfate? A.Drowsiness and paroxysmal bradycardia B.Depressed reflexes and increased respirations C.Tachycardia and a feeling of nervousness D.A flushed warm feeling and dry mouth

C Terbutaline sulfate (Brethine), a beta-sympathomimetic drug, stimulates beta-adrenergic receptors in the uterine muscle to stop contractions. The beta-adrenergic agonist properties of the drug may cause tachycardia, increased cardiac output, restlessness, headache, and a feeling of nervousness (C). (A) is not a side effect. (B and D) are side effects of magnesium sulfate.

The nurse is using the Silverman-Anderson index to assess an infant with respiratory distress and determines that the infant is demonstrating marked nasal flaring, an audible expiratory grunt, and just visible intercostal and xiphoid retractions. Using this scale, which score should the nurse assign? A. 3 B. 4 C. 5 D. 8

C The Silverman-Anderson index is an assessment scale that scores a newborn's respiratory status as grade 0, 1, or 2 for each component; it includes synchrony of the chest and abdomen, retractions, nasal flaring, and expiratory grunt. No respiratory distress is graded 0 and a total of 10 indicates maximum respiratory distress. This infant is demonstrating respiratory distress with maximal effort, so a grade 2 is assigned for marked nasal flaring, grade 2 for an audible expiratory grunting, plus grade 1 for just visible retractions, which is a total score of 5 (C). (A, B, and D) are not accurate.

A 45-year-old female client is receiving alprazolam (Xanax) for anxiety. Which client behaviors would indicate that the drug is effective? A. Personal hygiene is maintained by the client for the first time in a week. B. The client has an average resting heart rate of 120 beats/min. C. The staff observes the client sitting in the day room reading a book. D. The nurse records that the client lost 2 lb of body weight in the past week.

C The ability to sit and concentrate on reading (C) indicates decreased anxiety. (A, B, and D) are not related to the use of alprazolam (Xanax) for anxiety.

The nurse is caring for a critically ill client with cirrhosis of the liver who has a nasogastric tube draining bright red blood. The nurse notes that the client's serum hemoglobin and hematocrit levels are decreased. Which additional change in laboratory data should the nurse expect A. Increased serum albumin level B. Decreased serum creatinine C. Decreased serum ammonia level D. Increased liver function test results

C The breakdown of glutamine in the intestine and the increased activity of colonic bacteria from the digestion of proteins increase ammonia levels in clients with advanced liver disease, so removal of blood, a protein source, from the intestine results in a reduced level of ammonia (C). (A, B, and D) will not be significantly affected by the removal of blood.

A client with chronic renal insufficiency (CRI) is taking 25 mg of hydrochlorothiazide (HCTZ) PO and 40 mg of furosemide (Lasix) PO daily. Today, at a routine clinic visit, the client's serum potassium level is 4 mEq/L. What is the most likely cause of this client's potassium level? A. The client is noncompliant with his medications. B. The client recently consumed large quantities of pears or nuts. C. The client's renal function has affected his potassium level. D. The client needs to be started on a potassium supplement.

C The client has a normalized potassium level despite diuretic use (C). The kidney automatically secretes 90% of potassium consumed, but in chronic renal insufficiency (CRI), less potassium is excreted than normal. Therefore, the two potassium-wasting drugs, a thiazide diuretic and loop diuretic, are not likely to affect potassium levels. The normal potassium level is 3.5 to 5 mEq/L, and with a potassium level of 4 mEq/L, there is no reason to believe that the client is noncompliant with his treatment (A). Pears and nuts do not affect the serum potassium level (B). There is no need for a potassium supplement (D) because the client's potassium level is within the normal range.

Six hours after an oxytocin (Pitocin) induction was begun and 2 hours after spontaneous rupture of the membranes, the nurse notes several sudden decreases in the fetal heart rate with quick return to baseline, with and without contractions. Based on this fetal heart rate pattern, which intervention is best for the nurse to implement? A. Turn the client to her side. B. Begin oxygen by nasal cannula at 2 L/min. C. Place the client in a slight Trendelenburg position. D. Assess for cervical dilation.

C The goal is to relieve pressure on the umbilical cord, and placing the client in a slight Trendelenburg position (C) is most likely to relieve that pressure. The FHR pattern is indicative of a variable fetal heart rate deceleration, which is typically caused by cord compression and can occur with or without contractions. (A) may be helpful but is not as likely to relieve the pressure as the Trendelenburg position. (B) is not helpful with cord compression. (D) is not the priority intervention at this time. After repositioning the client, a vaginal examination is indicated to rule out cord prolapse and assess for cervical change.

Which vital sign in a pediatric client is most important to report to the primary health care provider? A. Newborn with a heart rate of 140 beats/min B. Three-year-old with a respiratory rate of 28 breaths/min C. Six-year-old with a heart rate of 130 beats/min D. Twelve-year-old with a respiratory rate of 16 breaths/min

C The normal heart rate for a 6- to 10-year-old is 70 to 110 beats/min (C). The others are all within normal range for those ages (A, B, and D).

Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 mm Hg to 90/60 mm Hg. Which action should the nurse take immediately? A. Notify the health care provider or anesthesiologist. B. Continue to assess the blood pressure every 5 minutes. C. Place the client in a lateral position. D. Turn off the continuous epidural.

C The nurse should immediately turn the client to a lateral position (C) or place a pillow or wedge under one hip to deflect the uterus. Other immediate interventions include increasing the rate of the main line IV infusion and administering oxygen by face mask. If the blood pressure remains low after these interventions or decreases further, the anesthesiologist or health care provider should be notified immediately (A). To continue to monitor blood pressure without taking further action (B) could constitute malpractice. (D) may also be warranted, but such action is based on hospital protocol.

The nurse includes frequent oral care in the plan of care for a client scheduled for an esophagogastrostomy for esophageal cancer. This intervention is included in the client's plan of care to address which nursing diagnosis? A. Fluid volume deficit B. Self-care deficit C. Risk for infection D. Impaired nutrition

C The primary reason for performing frequent mouth care preoperatively is to reduce the risk of postoperative infection (C) because these clients may be regurgitating retained food particles, blood, or pus from the tumor. Meticulous oral care should be provided several times a day before surgery. Although oral care will be of benefit to the client who may also be experiencing (A, B, or D), these problems are not the primary reason for the provision of frequent oral care.

The nurse is counseling a client who wants to become pregnant. She tells the nurse that she has a 36-day menstrual cycle and the first day of her last menstrual period was January 8. When will the client's next fertile period occur? A. January 14 to 15 B. January 22 to 23 C. January 29 to 30 D. February 6 to 7

C This client can expect her next period to begin 36 days from the first day of her last menstrual period. Her next period would begin on February 12. Ovulation occurs 14 days before the first day of the menstrual period. The client can expect ovulation to occur January 29 to 30 (C). (A, B, and D) are incorrect.

The nurse hears a series of long-duration, discontinuous, low-pitched sounds on auscultation of a client's lower lung fields. Which documentation of this finding is correct? A. Fine crackles B. Wheezes C. Course crackles D. Stridor

C This sound is caused by air passing through airways that are intermittently occluded by mucus (C). Fine crackles are a series of short-duration, discontinuous, high-pitched sounds (A). Wheezes are continuous, high-pitched, musical or squeaking-type sounds (B). Stridor is a continuous croupy sound of constant pitch and indicates partial obstruction of the airway (D).

The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse implement to reduce the risk of systemic absorption? A. Apply the anesthetic to mucous membranes. B. Limit the area of application to inflamed areas. C. Avoid abraded skin areas when applying the anesthetic. D. Spread the topical agent over a large surface area.

C To minimize systemic absorption of topical anesthetics, the anesthetic agent should be applied to the smallest surface area of intact skin (C). Application to the mucous membranes poses the greatest risk (A) of systemic absorption because absorption occurs more readily through mucous membranes than through the skin. Inflamed areas generally have an increased blood supply, which increases the risk of systemic absorption, so (B) should be avoided. A large surface area increases the amount of topical drug that is available for transdermal absorption, so the smallest area should be covered, not (D).

Two days after swallowing 30 tablets of alprazolam (Xanax), a client with a history of depression is hemodynamically stable but wants to leave the hospital against medical advice. Which nursing action(s) is(are) most likely to maintain client safety? (Select all that apply.) Direct the client to sign a liability release form. B. Restrict the client's ability to leave the unit. C. Explain the benefits of remaining in the hospital. D. Instruct the client to take medications as prescribed. E. Provide the client with names of local support groups. F. Notify the health care provider of the client's intention.

C, D, F Correct responses are (C, D, and F). To maintain safety and to provide information, the nurse should explain the potential benefits of continuing treatment in the hospital (C) and the need to take prescribed medications (D). This client, who is very likely self-destructive, should remain on the unit and the health care provider should be notified (F). Signing a release form (A) before leaving the hospital does not contribute to safety. The nurse may ask the client not to leave the hospital (B), but pressuring clients is unethical behavior. (E) may be helpful at a later time in this client's treatment program.

For which client(s) should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.) A. A middle-aged adult with a history of tinnitus while taking aspirin B. A middle-aged adult with a history of polycystic ovarian disease C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin E. An older adult with a history of gastrointestinal upset while taking naproxen sodium (Naprosyn) F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema

C,D,F COX-2 inhibitors are contraindicated for those who are allergic to sulfa drugs (C), aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Drug safety for adolescents (D and F) is not yet established, and COX-2 inhibitors, as well as NSAIDs, are contraindicated during the third trimester of pregnancy (F) because they can cause a premature closure of the patent ductus arteriosus. Tinnitus, an adverse reaction of aspirin (A), and ovarian disease (B) are not contraindications for the use of COX-2 inhibitors. Gastrointestinal upset is a common adverse reaction of NSAIDs (E) but is not a contraindication for the use of a COX-2 inhibitor.

Electrolytes

Calcium 8.5- 10.9 Chloride 95-105 Magnesium 1.5-2.5 Phosphorus 2.5- 4.5

Cox 2 enzyme blocker drugs:

Celecoxib (Celebrex), valdecoxib (Bextra)

Phenothiazinedrugs

Chlopromazine(Thorazine), prochlorperazine (Compazine), trifluoperazine (Stelazine), promethazine (Phenergan), hydroxyzine (Vistaril), fluphenazine (Prolixin)

Histamine 2 antagonist drugs:

Cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), rantidine (Zantac)

Benzodiazepinedrugs

Clonazepam(Klonopin), diazepam (Valium), chlordiazepoxide (Librium), lorazepam (Ativan), flurazepam (Dalmane)

Miotics

Constrict the pupils

Minocycline (Minocin), 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A. Report vaginal itching or discharge. B. Take the medication at 0800, 1500, and 2200 hours. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. E. Take with an antacid tablet to prevent nausea. F. Use a nonhormonal method of contraception if sexually active.

Correct selections are (A, C, D, and F). Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge (A), protect the skin from ultraviolet light (C), and use a nonhormonal method of contraception (F) while on the medication. Minocycline (Minocin) is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving (D) should be avoided. Tetracyclines should be taken around the clock (B) but exhibit decreased absorption when taken with antacids, so (E) is contraindicated.

Anticoagulant therapy and monitoring

Coumadin (sodium warfarin) PT: 10-12 sec. (control). . Antidote:The antidote for Coumadin is vitaminK. . Heparin/Lovenox/Dalteparin PTT:30-45sec.(control). . Antidote:The antidote for Heparin is protamine sulfate. . Therapeutic level: It is important to maintain a bleeding time that is slightly prolonged so that clotting will not occur; therefore, the bleeding time with mediication should be 1 1/2-2 times the control. *The control is the premedication bleeding time.

Dopamine (Intropin), 5 mcg/kg/min, is prescribed for a client who weighs 105 kg. The nurse mixes 400 mg of dopamine in 250 mL D5W for IV administration via an infusion pump. What is the hourly rate that the nurse should set on the pump? A. 5 mL/hr B. 10 mL/hr C. 15 mL/hr D. 20 mL/hr

D 400 mg/250 mL equals 1.6 mg/mL, or 1600 mcg/mL. The prescription for 5 mcg/kg/min would result in 31,500 mcg/hr. Delivery of that dose would be achieved by administering 20 mL/hr (D), which would deliver 5.07 mcg/kg/min. (A, B, and C) are not accurate hourly rates for this infusion.

The nurse assesses a client who has been prescribed furosemide (Lasix) for cardiac disease. Which electrocardiographic change would be a concern for a client taking a diuretic? A.Tall, spiked T waves B.A prolonged QT interval C.A widening QRS complex D.Presence of a U wave

D A U wave (D) is a positive deflection following the T wave and is often present with hypokalemia (low potassium level). (A, B, and C) are all signs of hyperkalemia.

A client is being discharged with a prescription for sulfasalazine (Azulfidine) to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink eight glasses of fluid a day.

D Adequate hydration is important for all sulfa drugs because they can crystallize in the urine (D). If possible, the drug should be taken after eating to provide longer intestinal transit time (B). (A) is important for other medications, such as phenytoin (Dilantin), because of the incidence of gingival hyperplasia, and (C) is important for steroid administration, but (D) is most important to stress with this client.

A client comes to the obstetric clinic for her first prenatal visit and complains of feeling nauseated every morning. The client tells the nurse, "I'm having second thoughts about wanting to have this baby." Which response is best for the nurse to make? A. "It's normal to feel ambivalent about a pregnancy when you are not feeling well." B. "I think you should discuss these feelings with your health care provider." C. "How does the father of your child feel about your having this baby?" D. "Tell me about these second thoughts you are having about this pregnancy."

D Although ambivalence is normal during the first trimester, (D) is the best nursing response at this time. It is reflective and keeps the lines of communication open. (A) is not the best response because it offers false reassurance. (B) dismisses the client's feelings. The nurse should use communication skills that encourage this type of discussion, not shift responsibility to the care provider. (C) may eventually be discussed, but it is not the most important information to obtain at this time.

The nurse admits a child to the intensive care unit with a diagnosis of acquired aplastic anemia. What is the most common cause of this type of anemia? A. Bacterial infections B. A diet deficient in iron C. Heart-lung congenital defects D. Exposure to certain drugs

D Aplastic anemia often follows exposure to certain drugs (D) such as chloramphenicol, sulfonamides, and phenylbutazone (Butazolidin), insecticides such as DDT, and chemicals, especially, benzene. (A and C) are not related to the development of anemia. (B) is related to iron deficiency anemia.

The nurse administers atropine sulfate ophthalmic drops preoperatively to the right eye of a client scheduled for cataract surgery. Which response by the client indicates that the drug was effective? A. The pupils become equal and reactive to light. B. The right pupil constricts within 30 minutes. C. Bilateral visual accommodation is restored. D. The right pupil dilates after drop installation.

D Atropine (Isopto Atropine) is a mydriatic drug, which causes pupil dilation and paralysis in preparation for surgery or examination (D). (A, B, and C) do not describe the therapeutic effects of atropine sulfate ophthalmic drops prior to cataract surgery.

A 4-year-old child has cystic fibrosis. Which stage of Erikson's theory of psychosocial development is the nurse addressing when teaching inhalation therapy? A. Autonomy B. Industry C. Trust D. Initiative

D Children 4 to 5 years of age are in the "Initiative vs. Guilt" stage of Erikson's theory of psychosocial development (D). They enjoy being active and participating in role playing. "Autonomy vs. Shame and Doubt" occurs at 1 to 3 years of age (A). "Industry vs. Inferiority" occurs at 6 to 11 years (B); "Trust vs. Mistrust" (C) occurs from birth to 1 year of age.

A 27-year-old client is admitted to the psychiatric hospital with a diagnosis of bipolar disorder, manic phase. The client is demanding and active. Which intervention should the nurse include in this client's plan of care? A. Schedule the client to attend various group activities. B. Reinforce the client's ability to make decisions. C. Encourage the client to identify feelings of anger. D. Provide a structured environment with little stimuli.

D Clients in the manic phase of a bipolar disorder require decreased stimuli and a structured environment (D). Noncompetitive activities that can be carried out alone should be planned for these clients. (A) is contraindicated because stimuli should be reduced as much as possible. Impulsive decision making is characteristic of clients with bipolar disorder. To prevent future complications, the nurse should monitor these clients' decisions and assist them in the decision making process (B). (C) is more often associated with depression than with bipolar disorder.

The nurse is caring for a client with chronic renal failure (CRF) who is receiving dialysis therapy. Which nursing intervention has the greatest priority when planning this client's care? A. Palpate for pitting edema. B. Provide meticulous skin care. C. Administer phosphate binders. D. Monitor serum potassium levels.

D Clients with CRF are at risk for electrolyte imbalances, and imbalances in potassium can be life threatening (D). One sign of fluid retention is pitting edema (A), but it is an expected symptom of renal failure and is not as high a priority as (D). (B and C) are common nursing interventions for CRF but not as high a priority as (D).

The nurse has completed diabetic teaching for a client who has been newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A. "Regular insulin can be stored at room temperature for 30 days." B. "My legs, arms, and abdomen are all good sites to inject my insulin." C. "I will always carry hard candies to treat hypoglycemic reactions." D. "When I exercise, I should plan to increase my insulin dosage."

D Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction (D). (A, B, and C) reflect accurate statements about the use of insulin and management of hypoglycemic reactions.

Which preoperative nursing intervention should be included in the plan of care for an infant with pyloric stenosis? A. Monitor for signs of metabolic acidosis. B. Estimate the quantity of diarrhea stools. C. Place in a supine position after feeding. D. Observe for projectile vomiting.

D Projectile vomiting (D), the classic sign of pyloric stenosis, contributes to metabolic alkalosis. Metabolic acidosis (A) is the opposite imbalance from alkalosis and is not an expected finding. An antidiarrheal agent is not indicated (B). (C) is dangerous because of the potential for aspiration with frequent vomiting.

A client with small cell carcinoma of the lung has also developed syndrome of inappropriate antidiuretic hormone (SIADH). Which outcome finding is the priority for this client? A. Reduced peripheral edema B. Urinary output of at least 70 mL/hr C. Decrease in urine osmolarity D. Serum sodium level of 137 mEq/L

D Syndrome of inappropriate antidiuretic hormone (SIADH) results from an abnormal production or sustained secretion of antidiuretic hormone, causing fluid retention, hyponatremia, and central nervous system (CNS) fluid shifts. The client's normalization of the serum sodium level (normal is 135 to 145 mEq/L) (D) is the most important outcome because sudden and severe hyponatremia caused by fluid overload can result in heart failure. Fluid retention of SIADH contributes to daily weight gain, which can predispose to peripheral edema (A), but the higher priority outcome is the effect on serum electrolyte levels. Although (B and C) are findings associated with resolving SIADH, they do not have the priority of (D).

A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine (Colcrys) USP, 1 mg PO daily. Which information is most important for the nurse to provide the client? A. Take the medication with meals. B. Limit fluid intake until the attack subsides. C. Stop the medication when the pain resolves. D. Report any vomiting to the clinic.

D The client should be instructed to report signs of colchicine toxicity, such as nausea, diarrhea, vomiting (D), and/or abdominal pain, to the health care provider. Food inhibits the absorption of colchicine when ingested concurrently (A). Limited fluid intake (B) decreases the excretion of the uric acid crystals, which contributes to painful attacks. Typically, a client should remain on a daily dose of colchicine to decrease the number and severity of acute attacks, so stopping the medication after the pain resolves (C) is not indicated.

Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect? A. Beneficial response or cure for disease B. Behavioral or psychotropic responses C. Malingering or drug-seeking behaviors D. Psychological response to inert medication

D The placebo effect is a response in the client that is caused by the psychological impact (D) of taking an inert drug that has no biochemical properties. A placebo effect can be therapeutic, negative, or ineffective but provides no cure or benefit (A) to the client's progress. The placebo effect may evoke behavioral changes but does not affect neurochemical psychotropic changes (B). Malingering and drug seeking (C) are behaviors that a client exhibits to obtain treatment for nonexistent disorders or obtain prescription medications.

The nurse expects a clinical finding of cyanosis in an infant with which condition(s)? (Select all that apply.) A. Ventricular septal defect (VSD) B. Patent ductus arteriosis (PDA) C. Coarctation of the aorta D. Tetralogy of Fallot E. Transposition of the great vessels

D,E Both tetralogy of Fallot and transposition of the great vessels are classified as cyanotic heart disease, in which unoxygenated blood is pumped into the systemic circulation, causing cyanosis (D and E). The others are all abnormal cardiac conditions, but are classified as acyanotic and involve left-to-right shunts, increased pulmonary blood flow, or obstructive defects. (A, B, and C).

antidiarrheals

Decrease gastric motility and reduce water in bowel

HHNS

Decrease in serum potassium

Anticholenergics

Decrease oral secretions

Diuretics

Decrease water/sodium from the Loop of Henle

Histamine 2 receptor

Decreases amount of HCL secretions by the parietal cells in the stomach

VFib- first action

Defib with 1 shock

Management and delegation

Delegate sterile skills such as dressing changes to the RN or LPN. Where nonskilled care is required, you can delegate the stable client to the nursing assistant. Choose the most critical client to assign to the RN, such as the client who has recently returned from chest surgery. Clients who are being discharged should have final assessments done by the RN. . ThePN,liketheRN,canmonitorclientswithIV therapy, insert urinary catheters and feeding tubes, apply restraints, discontinue IVs, drains, and sutures. . For room assignments, do not coassign the post-operative client with clients who have vomiting, diarrhea, open wounds, or chest tube drainage. Remember the A, B, Cs (airway, breathing, circulation) when answering questions choices that ask who would you see first. For hospital triage, care for the client with a life-threatening illness or injury first. For disaster triage, choose to triage first those clients who can be saved with the least use of resources.

Bronchodilators

Dilate large air passages in asthma/lung disease

Mydriatics

Dilate the pupils

Proton pump inhibitors

Esomeprazole(Nexium), lansoprazole (Prevacid), pantoprazole (Protonix), rabeprazole (AciPhex)

Profile of gallbladder disease

Fair,fat,forty,five pregnancies, flatulent (actually gallbladder disease can occur in all ages and both sexes).

Arab American cultural attributes

Females avoid eye contact with males; touch is accepted if done by same-sex healthcare providers; most decisions are made by males; Muslims (Sunni) , refuse organ donation; most Arabs do not eat pork; they avoid icy drinks when sick or hot/cold drinks together; colostrum is considered harmful to the newborn.

Anti-infectivedrugs

Gentamicin(Garamycin, Alcomicin, Genoptic), kanamycin (Kantrex), neomycin (Mycifradin), streptomycin (Streptomycin), tobramycin (Tobrex, Nebcin), amikacin (Amikin)

Chemistry

Glucose 70-110 specific gravity 1.010-1.030 BUN 7-22 Creatinine 0.6-1.35 cholesterol 130-200 bilirubin less than 1 protein 6.2-8.1

Treatment for sickle cell crises

HHOP (heat, hydration, oxygen, pain medications)

Primary IV line

Hangs lower than secondary line

Anticoagulant drugs

Heparinsodium(Hepalean), enoxaparin sodium (Lovenox), dalteparin sodium (Fragmin)

Hip fractures

Hip fractures commonly hemorrhage, whereas femur fractures are at risk for fat emboli.

Religions beliefs

Jehovah's Witness—No blood products should be used . Hindu—No beef or items containing gelatin . Jewish—Special dietary restrictions, use of kosher foods

Antihypertensives

Lower blood pressure and increase blood flow

Salin lock- sodium is 150 with distended neck veins

Monitor for bilateral lung sounds

Contractions

Normal frequency 2-5 minutes apart normal duration less than 90 seconds

Late decelerations

Occur after the peak of the contraction and mirror the contraction in length and intensity. These are caused by uteroplacental insuffiency. The intervention is to change the mother's position; if pitocin is infusing, stop the infusion; apply oxygen;, and increase the rate of IV fluids. Contact the doctor if the problem persists.

Blood

Only compatible fluid in NS

Native American

Participates activly in treatment regimen

Glucocorticoiddrugs

Prednisolone(Delta-Cortef, Prednisol, Prednisolone), prednisone (Apo-Prednisone, Deltasone, Meticorten, Orasone, Panasol-S), betamethasone (Celestone, Selestoject, Betnesol), dexamethasone (Decadron, Deronil, Dexon, Mymethasone, Dalalone), cortisone (Cortone), hydrocortisone (Cortef, Hydrocortone Phosphate, Cortifoam), methylprednisolone (Solu-cortef, Depo- Medrol, Depopred, Medrol, Rep-Pred), triamcinolone (Amcort, Aristocort, Atolone, Kenalog, Triamolone)

Chest tube detached

Prepare a new water seal system and reattach chest tube

Laxatives

Promote the passage of stool

Postmenopausal- assess thyroid function

Pt will have cold sensitivity

Hematology

RBC 4.5-5 WBC 5000-10,000 Platelets 200,000-400,000 HBG 12-16 women 14-18 men

Treatment for spider bites/bleeding

RICE (rest, ice, compression, and elevate extremity)

Acid/base balance

ROME (respiratory opposite/metabolic equal) is a quick way of remembering that in respiratory acid/base disorders the pH is opposite to the other components. For example, in respiratory acidosis, the pH is below normal and the CO2 is elevated, as is the HCO3 (respiratory opposite). In metabolic disorders, the components of the lab values are the same. An example of this is metabolic acidosis. In metabolic acidosis, the pH is below normal and the CO2 is decreased, as is the HCO3. This is true in a compensated situation. . pH down, CO2 up, and HCO3 up = respiratory acidosis . pH down, CO2 down, and HCO3 down = metabolic acidosis pH up, CO2 down, and HCO3 down = respiratory alkalosis . pH up, CO2 up, and HCO3 up = metabolic alkalosis

Antacids

Reduce hydrochloric acid in the stomach

Narcotics/analgesics

Relieve moderate to severe pain

Therapeutic diets

Renal diet—High calorie,high carbohydrate, low protein, low potassium, low sodium, and fluid restricted to intake = output + 500 ml . Gout diet—Low purine; omit poultry ("cold chicken") medication for acute episodes: Colchicine; maintenance medication: Zyloprim . Heart healthy diet—Low fat (less than 30% of calories should be from fat)

Drug schedules

Schedule I—Research use only (example LSD) . Schedule II—Requires a written prescription (example Ritalin) . Schedule III—Requires a new prescription after six months or five refills (example codeine) . Schedule IV—Requires a new prescription after six months (example Darvon) . Schedule V—Dispensed as any other prescription or without prescription if state law allows (example antitussives)

STOP—This is the treatment for maternal hypotension afteranepiduralanesthesia:

Stop pitocin if infusing. Turn the client on the left side. Administer oxygen. If hypovolemiais present,pushIVfluids.

Five Ps of fractures and compartment syndrome

These are symptoms of fractures and compartment syndrome: . Pain . Pallor . Pulselessness . Paresthesia . Polar (cold)

Asian American cultural attributes

They avoid direct eye contact; feet are considered dirty (the feet should be touched last during assessment); males make most of the decisions; they usually refuse organ donation; they generally do not prefer cold drinks, believe in the "hot-cold" theory of illness.

Mexican American cultural attributes

They might avoid direct eye contact with authorities; they might refuse organ donation; most are very emotional during bereavement; believe in the "hot-cold" theory of illness.

Anticonvulsants

Used for management of seizures/bipolar disorder

Anti-infectives

Used for the treatment of infections

Angiotensin receptor blocker drugs

Valsartan (Diovan), candesartan (Altacand), losartan (Cozaar), telmisartan (Micardis)

Methylphenidate HCl (Concerta) is prescribed for daily administration to a 10-year-old child with attention deficit-hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents? A. Administer the medication in the morning before the child goes to school. B. Plan to implement periodic interruptions in the administration of the drug. C. Attempt to be consistent when setting limits on inappropriate behavior. D. Seek professional counseling if the child's behavior continues to be disruptive.

a Concerta, a central nervous system (CNS) stimulant, is an extended-release tablet. To be most effective in affecting the child's behavior, the drug should be administered in the morning before the child goes to school (A). Drug holidays (B) are often prescribed to assess the child's degree of recovery; however, such interruptions are not conducted in the early phase of treatment and are usually implemented when side effects occur over a period of time. (C and D) are worthwhile instructions but do not have the priority of (A).

The nurse is administering the early morning dose of insulin aspart (NovoLog), 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart (NovoLog), when should the nurse ensure that the client's breakfast be given? A. 5 minutes after subcutaneous administration B. 30 minutes after subcutaneous administration C. 1 to 2 hours after administration D. Any time because of a flat peak of action

a Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart (NovoLog) should be administered when the client's tray is available (A). Insulin aspart (NovoLog) peaks in 45 minutes to 1½ hours (B and C) and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine (Lantus) has a flat peak of action (D) and is usually given at bedtime.

In addition to nitrate therapy, a client is receiving nifedipine (Procardia), 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A. Hypotension B. Hyperkalemia C. Hypokalemia D. Seizures

a Nifedipine (Procardia) reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents (A). (B, C, and D) are not side effects of this treatment regimen.

A client who is hypertensive receives a prescription for hydrochlorothiazide (HCTZ). When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations C. Abdominal cramping and diarrhea D. Confusion and personality changes

a Thiazide diuretics, such as HCTZ, cause potassium wasting in the urine, so the client should be instructed to report fatigue and muscle weakness (A), which are characteristic of hypokalemia. Although (B, C, and D) should be reported, they are not indicative of hypokalemia, which is a side effect of HCTZ that can cause cardiac dysrhythmias.

Pt needing kidney transplant says he found one online

advise pt that it is a criminal offense to buy organs online

Schizo pt talking to self in corner

approach pt and ask if they are hearing voices

Prominent U waves

assess for ST depression get 12 lead check potassium

Pylenophritis

assess for increased temp

A primigravida, when returning for the results of her multiple marker screening (triple screen), asks the nurse how problems with her baby can be detected by the test. What information will the nurse give to the client to describe best how the test is interpreted? A. If MSAFP (maternal serum alpha-fetoprotein) and estriol levels are high and the human chorionic gonadotropin (hCG) level is low, results are positive for a possible chromosomal defect. B. If MSAFP and estriol levels are low and the hCG level is high, results are positive for a possible chromosomal defect. C. If MSAFP are within normal limits, there is a guarantee that the baby is free of all structural anomalies. D. If MSAFP, estriol, and hCG are absent in the blood, the results are interpreted as normal findings.

b Low levels of MSAFP and estriol and elevated levels of hCG found in the maternal blood sample are indications of possible chromosomal defects (B). High levels of MSAFP and estriol in the blood sample after 15 weeks of gestation can indicate a neural tube defect, such as spina bifida and anencephaly, not chromosomal defects (A). One of the limitations of the multiple marker screening is that any defects covered by skin will not be evident in the blood sampling (C). After 15 weeks of gestation, there will be traces of MSAFP, estriol, and hCG in the blood sample (D).

low sodium diet

baked chicken

When educating a client after a total laryngectomy, which instruction would be most important for the nurse to include in the discharge teaching? A.Recommend that the client carry suction equipment at all times. B.Instruct the client to have writing materials with him at all times. C.Tell the client to carry a medical alert card that explains his condition. D.Caution the client not to travel outside the United States alone.

c Neck breathers carry a medical alert card (C) that notifies health care personnel of the need to use mouth to stoma breathing in the event of a cardiac arrest in this client. Mouth to mouth resuscitation will not establish a patent airway. (A and D) are not necessary. There are many alternative means of communication for clients who have had a laryngectomy; dependence on writing messages (B) is probably the least effective.

pt that can transfer to medical unit

chronic liver failure with hub of 10

flea bite rash in newborn

common newborn rash, will disappear after several days

When providing client teaching about the administration of methylphenidate (Ritalin) to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan? A. The doses should be given exactly 12 hours apart to sustain a therapeutic serum level. B. Doses should be scheduled at midmorning and midafternoon to achieve optimal benefit. C. Give the medication only on school days and when the child appears to be anxious. D. Offer the child the medication before the child eats breakfast and after the child eats lunch.

d Administering the medication at breakfast and after lunch (D) provides the correct spacing of the doses to maximize the child's attention span. Doses should be spaced at 8-hour intervals, not (A). (B) is likely to increase insomnia. (C) disrupts the normal dosing schedule, resulting in ineffective treatment. Doses should be discontinued only for brief intervals (with the health care provider's approval) when the client's condition is being evaluated or if the client is being weaned from the medication entirely.

The health care provider prescribes ipratropium (Atrovent) for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for Atrovent? A. Albuterol (Proventil) B. Theophylline (Theo-24) C. Metaproterenol (Alupent) D. Atropine sulfate (Atropine)

d Clients who have experienced allergic reactions to atropine sulfate (Atropine) (D) and belladonna alkaloids may also be allergic to ipratropium (Atrovent), so the prescription for Atrovent should be questioned. Allergies to (A, B, and C) would not cause the nurse to question a prescription for ipratropium (Atrovent).

Osteoarthritis- patho

destruction of joint cartilidge

Primary screening

diabetic screening for patients who are not at risk

Chrons disease

diarrhea, abdominal pain, wt loss

Therapeutic drug levels

digoxin .5-2 lithium .8-1.5 dilantin 10-20 theophylline 10-20

dialysis pt

do not give BP meds

Pt with enlarged pancreas

dont palpate

Diabetes self management program

enables clients to become more active participants in controlling the disease process

depressed pt who won't communicate

encourage in non-threatening conversations

hospitalized adolescents- demands mom stays

explain to mom pt is probably feeling insecure

dorsal plantar flexion

foot goes up and down while the pt is lying down. heel does not lift from the bed, just the foot bending up and down

Radiation therapy- breast cancer

gently pat the skin dry after rinsing with water

Antisocial personality disorder

history of multiple convictions for misdemeanors and class b felonies

Risk for cervical cancer

history of unprotected sex with multiple partners

tube feeding 2 month old

hold baby with head slightly elevated and supported

Guillian barre syndrome

important to monitor 2-3 weeks after pt experiences an infection

Hyperparathyroidism

increase calcium levels

Antianemics

increase red blood cell production

Increased laxative use in elderly

increased magnesium

Mental health pt who is suicidal

intervention- no harm contract

Mitral stenosis at 28 wks gestation

investigate if pt had a persistent cough

BP contraindication

lymphedema in both arms

Evaluation of gestational trophoblastic disease

make sure pt stays on contraceptive for 1 year

PCA pump- morphine

make sure to initiate the dosage lockout mechanism

Vasopressin

monitor for chest pain and dysrythmia

TB pt

move into an isolated room, if occupied, move the pt out of that room

Celiac disease

no gluten

Newborn gagging

normal

Aluminum hydroxide

notify health care provider if pt is also taking allopurinol (zyloprim)

PICC line- what to assess

observe antecubital fossa for inflammation

heparin therapy

observe urine for hematuria

Improper inhaler use

patient states "after i squeeze the inhaler and swallow, i always feel a slight wave of nausea

Anxiety expected outcome

patient will use coping mechanisms effectively

septic shock

periphereal vasodilation

ER room- coughing with fever in last 24 hrs

place a face mask on pt first

gastric endoscopy

post procedure complaint- most common is sore throat

Anticoagulants

prevent clot formation

HIV- readiness for medication- asymptomatic pt

pt is willing to comply with complex drug schedules

Acute pancreatitis history

pt wil state that they drink alcohol until intoxicated

Hypoparathyroidism

pt will have increased levels of calcium

LPN

pt with lap chole the previous day

IV site tenderness- needs intervention if

red streaking tracking the vein

psoriasis

show acceptance by shaking the pts hand- not contagious

tetracyclines

take on empty stomach or 2 hours after meals

Pt with saline lock that wants to shower

tape a plastic bag over IV site

DKA with increased thirst

tell pt to give themselves a dose of reg insulin

CVA pt- needs speech therapy referral if

they have persistent coughing while drinking

native American cultural attributes

they sustain eye contact; blood and organ donation is generally refused; they might refuse circumcision; may prefer care from the tribal shaman rather than using western medicine.

TORCHS syndrome in the neonate

this is a combination of diseases. These include toxoplasmosis, rubella (German measles), cytomegalovirus, herpes, and syphyllis. Pregnant nurses should not be assigned to care for the client with toxoplasmosis or cytomegalovirus.

antihistamines

treat allergic rhinitis and contact dermatitis

high protein diet

tuna fish with chips annd ice cream

Trazodone

used to improve sleep

positive fern test

water is broken and pt is in labor

Last opportunity for a near miss medication error

when determining patient identity at bedside

LPN

wound care for pt with stage 4 pressure ulcer