PathoPharm Exam 3
Which instruction about clopidogrel [Plavix] should the nurse include in the discharge teaching for a patient who has received a drug-eluting coronary stent? a. "Constipation is a common side effect of clopidogrel, so take a stool softener daily." b. "If you see blood in your urine or black stools, stop the clopidogrel immediately." c. "Check with your healthcare provider before taking any over-the-counter medications for gastric acidity." d. "Keep the amounts of foods containing vitamin K, such as mayonnaise, canola and soybean oil, and green, leafy vegetables, consistent in your diet."
"Check with your healthcare provider before taking any over-the-counter medications for gastric acidity."
When receiving discharge instructions, a patient with osteoporosis makes all of these statements. Which statement indicates to the nurse that the patient needs additional teaching? a. "I take my ibuprofen every morning as soon as I get up." b. "My daughter removed all of the throw rugs in my home." c. "My husband helps me every afternoon with range-of-motion exercises." d. "I rest in my reclining chair every day for at least an hour."
a. "I take my ibuprofen every morning as soon as I get up." Rationale: Ibuprofen can cause abdominal discomfort or pain and ulceration of the gastrointestinal tract. In such cases, it should be taken with meals or milk. Removal of throw rugs helps prevent falls. Range-of-motion exercises and rest are important strategies for coping with osteoporosis. Focus: Prioritization
The nurse is ready to begin a heparin infusion for a patient with an evolving stroke. The baseline activated partial thromboplastin time (aPTT) is 40 seconds. Which aPTT value indicates that a therapeutic dose has been achieved? a. 50 b. 70 c. 90 d. 110
b. 70
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (select all that apply) a. Wear a medical alert bracelet. b. Check all urine and stool for discoloration. c. Do not start any new medication without first talking to your healthcare provider. d. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. e.No laboratory or home monitoring of international normalized ratio (INR) is required after the first 6
a. Wear a medical alert bracelet. b. Check all urine and stool for discoloration. c. Do not start any new medication without first talking to your healthcare provider.
A patient admitted with deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE) requires immediate anticoagulation. What medication would be appropriate for this patient who has a history of heparin-induced thrombocytopenia (HIT)? a. Warfarin [Coumadin] b. Lepirudin [Refludan] c. Bivalirudin [Angiomax] d. Eptifibatide [Integrilin]
b. Lepirudin [Refludan]
The nurse performs a pain assessment. Charlie rates his pain as 4 of 10 on the Wong-Baker FACES® Pain Rating Scale. Which intervention should the nurse implement? a. Administer 5 mg of hydrocodone. b. Administer 100 mg of acetaminophen. c. Administer 200 mg of ibuprofen. d. Administer 10 mg of codeine.
c. Administer 200 mg of ibuprofen.
The nurse is monitoring a patient receiving a heparin infusion for the treatment of pulmonary embolism. Which assessment finding most likely relates to an adverse effect of heparin? a. Heart rate of 60 beats per minute b. Blood pressure of 160/88 mm Hg c. Discolored urine d. Inspiratory wheezing
c. Discolored urine
The nurse is working with a health care provider who prescribes opioid doses based on a specific pain intensity rating (dosing to the numbers). Which patient circumstance is cause for greatest concern? a. A 73-year-old frail female patient with a history of chronic obstructive pulmonary disease is prescribed 4 mg IV morphine for pain of 1 to 3 on a scale of 0 to 10. b. A 25-year-old postoperative male patient with a history of opioid addiction is prescribed one tablet of oxycodone and acetaminophen for pain of 4 to 5 on a scale of 0 to 10. c. A 33-year-old opioid-naïve female patient who has a severe migraine headache is prescribed 5 mg IV morphine for pain of 7 to 8 on a scale of 0 to 10. d. A 60-year-old male with a history of rheumatoid arthritis is prescribed one tablet of hydromorphone for pain of 5 to 6 on scale of 0 to 10.
a. A 73-year-old frail female patient with a history of chronic obstructive pulmonary disease is prescribed 4 mg IV morphine for pain of 1 to 3 on a scale of 0 to 10.
The nurse is caring for a group of patients taking warfarin [Coumadin]. Which patients are at moderate to high risk for harm as a result of warfarin therapy? (select all that apply) a. A patient with variant genes that code for VKORC1 and CYP2CP A patient with a current INR of 2.2 treated for deep vein thrombosis b. A woman with a new onset of symptoms of a pulmonary embolism c. A patient on day 4 after hip replacement with a new order for warfarin d. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
a. A patient with variant genes that code for VKORC1 and CYP2CP b. A woman with a new onset of symptoms of a pulmonary embolism d. A patient with a prosthetic heart valve, for whom an interacting drug is being deleted from the regimen
After administering acetylcysteine [Mucomyst] to a patient who overdosed on acetaminophen [Tylenol], a nurse should recognize which outcome as an indicator of the therapeutic effects of acetylcysteine? a. Absence of jaundice b. Clear breath sounds c. Increased bowel sounds d. Palpable pedal pulses
a. Absence of jaundice Rationale: Acetylcysteine (Mucomyst) substitutes for depleted glutathione in the reaction that removes the toxic metabolite of acetaminophen (Tylenol) (which accumulates with acetaminophen poisoning) and thereby minimizes liver damage. Severe hepatic injury may occur with acetaminophen (Tylenol) poisoning, which is manifested by jaundiced sclera and skin. The assessment of bowel sounds, breath sounds, and pedal pulses is not used to determine the therapeutic effects of acetylcysteine (Mucomyst) for the treatment of acetaminophen overdose.
According to recent guidelines from the American Pain Society in collaboration with the American Society of Anesthesiologists, which pain management strategies are important for postsurgical patients? Select all that apply. a. Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for management of postoperative pain in adults and children without contraindications b. Surgical site-specific peripheral regional anesthetic techniques in adults and children for procedures c. Neuraxial (epidural) analgesia for major thoracic and abdominal procedures if the patient has risk for cardiac complications or prolonged ileus d. Multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies e. IV administration of opioids, rather than oral opioids, for postoperative analgesia
a. Acetaminophen and/or nonsteroidal anti-inflammatory drugs (NSAIDs) for management of postoperative pain in adults and children without contraindications b. Surgical site-specific peripheral regional anesthetic techniques in adults and children for procedures c. Neuraxial (epidural) analgesia for major thoracic and abdominal procedures if the patient has risk for cardiac complications or prolonged ileus d. Multimodal therapy that could include opioids and nonopioid therapies, regional anesthetic techniques, and nonpharmacologic therapies
A nurse provides discharge instructions for a patient who is taking acetaminophen [Tylenol] after surgery. The nurse should instruct the patient to avoid which product while taking acetaminophen? a. Alcoholic drinks b. Leafy green foods c. Bananas d. Dairy products
a. Alcoholic drinks Rationale: Through several mechanisms, regular alcohol consumption while taking acetaminophen (Tylenol) increases the risk of liver injury when dosages are excessive. Therapeutic doses of acetaminophen (Tylenol) may be safe for patients who drink alcohol; however, the U.S. Food and Drug Administration (FDA) requires that acetaminophen (Tylenol) labels state an alcohol warning for patients who consume three or more drinks a day to consult their prescriber to determine whether acetaminophen (Tylenol) can be taken safely. It is not necessary to avoid leafy green foods, bananas, or dairy products when taking acetaminophen.
Before administering celecoxib [Celebrex], it is most important for the nurse to assess the patient for a history of what? a. Allergy to sulfonamides b. History of hepatitis C c. Hypothyroidism d. Diabetes mellitus
a. Allergy to sulfonamides Rationale: Celecoxib contains a sulfur molecule and therefore can precipitate an allergic reaction in patients allergic to sulfonamides. Accordingly, the drug should be avoided by patients with a sulfa allergy. The other conditions listed should be part of the nurse's assessment but are not the most important.
A nurse teaches a patient who takes daily low-dose aspirin for protection against myocardial infarction and stroke to avoid also taking which medication? a. Ibuprofen [Motrin] b. Zolpidem [Ambien] c. Loratadine [Claritin] d. Diphenhydramine [Benadryl]
a. Ibuprofen [Motrin] Rationale: Ibuprofen (Motrin) can block the antiplatelet effects of aspirin; therefore, patients who take low-dose aspirin to protect against myocardial infarction and thrombosis should avoid taking ibuprofen (Motrin). It is not necessary to avoid taking zolpidem (Ambien), loratadine (Claritin), or diphenhydramine (Benadryl) while taking aspirin.
At the change of shift, the nurse reassesses Charlie. His NG tube is patent and drained 120 mL over 12 hours. His oral temperature is 99.5°F (37.5°C), heart rate is 80 beats/min, and respiratory rate is 17 breaths/min. Charlie appears groggy and confused. Charlie's muscle strength is 3 of 5 in his upper and lower extremities. Laboratory tests are ordered. Which results are most consistent with Charlie's clinical presentation? a. K+, 3.3 mEq/L; Cl−, 95 mEq/L; pH, 7.55; HCO3= 32 b. K+, 3.3 mEq/L; Cl−, 110 mEq/L; pH, 7.45; HCO3= 22 c. K+, 5.2 mEq/L; Cl−, 110 mEq/L; pH, 7.20; HCO3= 18 d. K+, 3.3 mEq/L; Cl−, 95 mEq/L; pH, 7.22; HCO3= 24
a. K+, 3.3 mEq/L; Cl−, 95 mEq/L; pH, 7.55; HCO3= 32
A key aspect of teaching for the patient on anticoagulant therapy includes which instructions? a. Monitor for and report any signs of bleeding. b. Do not take acetaminophen (Tylenol) for a headache. c. Decrease your dietary intake of foods containing vitamin K. d. Arrange to have blood drawn routinely to check drug levels.
a. Monitor for and report any signs of bleeding. Rationale: Patients taking anticoagulants should be taught to monitor and report any signs of bleeding, which can be a serious complication. Other important patient teaching includes maintenance of a consistent intake of foods containing vitamin K, avoidance of supplements that contain vitamin K, and routine coagulation laboratory studies if a patient is taking warfarin.
The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis. Which action by the nurse is the most appropriate? a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin. b. Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. c. Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. d. Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated.
a. Notify the healthcare provider to discuss the reduction or withdrawal of heparin.
The nurse is reviewing medication lists for patients who are being treated for peptic ulcer disease (PUD). The nurse is most likely to question the use of which medication? a. Omeprazole b. Ibuprofen c. Amoxicillin d. Clarithromycin
a. Omeprazole
A patient is receiving a continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? a. Platelets b. Vitamin K c. Prothrombin time (PT) d. International normalized ratio (INR) e. Activated partial thromboplastin time (aPTT)
a. Platelets e. Activated partial thromboplastin time (aPTT)
The nurse assesses a patient who takes ibuprofen [Advil] on a regular basis. Which finding does the nurse know is an adverse effect of ibuprofen [Advil] therapy? a. Hives b. Hematemesis (the vomiting of blood) c. Dysmenorrhea d. Jaundice
b. Hematemesis (the vomiting of blood) Rationale: Ibuprofen is a member of the nonaspirin first-generation nonsteroidal anti-inflammatory drugs (NSAIDs). Through inhibition of both cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2), ibuprofen poses a risk for gastric ulceration and bleeding, which may lead to hematemesis. Ibuprofen is used to reduce inflammation, fever, and pain and therefore is effective in reducing dysmenorrhea (painful menstrual cramping). It is not known to cause hives or jaundice, which are signs of impaired liver function
A patient with a deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? a. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. b. Heparin suppresses coagulation by helping antithrombin perform its natural functions. c. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. d. Heparin inhibits the enzyme responsible for platelet activation and aggregation within vessels.
b. Heparin suppresses coagulation by helping antithrombin perform its natural functions. Rationale: Heparin belongs to the class of anticoagulants. Anticoagulants work by suppressing coagulation by helping antithrombin perform its natural functions.
Which are probable clinical findings in a person with an acute VTE (select all that apply)? a. Pallor and coolness of foot and calf b. Mild to moderate calf pain and tenderness c. Grossly diminished or absent pedal pulses d. Unilateral edema and induration of the thigh e. Palpable cord along a superficial varicose vein
b. Mild to moderate calf pain and tenderness d. Unilateral edema and induration of the thigh Rationale:The patient with lower extremity venous thromboembolism (VTE) may or may not have unilateral leg edema, extremity pain, a sense of fullness in the thigh or calf, paresthesias, warm skin, erythema, or a systemic temperature greater than 100.4 F (38 C). If the calf is involved, it may be tender to palpation.
A client presents to the emergency department with chest pain. The ECG reveals ST-segment elevation. Vital signs are as follows: blood pressure 142/78 mm Hg, pulse 98 beats/min, respiratory rate 18 breaths/min, temperature 100.6°F (38.1°C), and oxygen saturation 98%. The nurse should prepare to perform which actions? (Select all that apply) a. Administer 2 L oxygen via nasal cannula. b. Obtain blood for laboratory testing. c. Administer aspirin 325 mg orally. d. Prepare to infuse diltiazem intravenously. e. Provide the client with three tablets of sublingual nitroglycerin immediately.
b. Obtain blood for laboratory testing. c. Administer aspirin 325 mg orally. e. Provide the client with three tablets of sublingual nitroglycerin immediately.
. The nurse is caring for a patient receiving clopidogrel [Plavix] to prevent blockage of coronary artery stents. Which other drug on the patient's medication administration record may reduce the antiplatelet effects of clopidogrel? a. Aspirin [Bayer] b. Omeprazole [Prilosec] c. Acetaminophen [Tylenol] d. Warfarin [Coumadin]
b. Omeprazole [Prilosec]
A patient who has rheumatoid arthritis is scheduled to start taking celecoxib [Celebrex]. A nurse should recognize which factor from the patient's history as a contraindication to taking this medication? a. Hypothyroidism b. Recent heart bypass surgery c. Positive tuberculin skin (PPD) test result d. Allergy to penicillin
b. Recent heart bypass surgery Rationale: Celecoxib (Celebrex) should be avoided in patients who have undergone recent heart bypass surgery. Because it does not inhibit COX-1, platelet aggregation is not suppressed. It does inhibit COX-2 in blood vessels, which results in increased vasoconstriction. Unimpeded platelet aggregation and increased vasoconstriction pose a higher risk of thrombotic events in patients with certain cardiovascular risk factors. Hypothyroidism, a penicillin allergy, and a positive tuberculin skin test result are not contraindications to taking celecoxib (Celebrex).
The patient at highest risk for venous thromboembolism (VTE) is a. a 62-year-old man with spider veins who is having arthroscopic knee surgery. b. a 32-year-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe. c. a 26-year-old woman who is 3 days postpartum and received maintenance IV fluids for 12 hours during her labor. b. an active 72-year-old man at home recovering from transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH).
b. a 32-year-old woman who smokes, takes oral contraceptives, and is planning a trip to Europe. Rationale: The 32-year-old woman has the highest risk: long trips without adequate exercise (venous stasis), tobacco use, and use of oral contraceptives. Note: The likelihood of hypercoagulability of blood is increased in women older than 35 years who use tobacco.
The nurse will include which statements when teaching a patient about the use of acetaminophen [Tylenol]? (select all that apply) a. "Acetaminophen is a useful drug for the treatment of inflammation, such as a rheumatoid arthritis." b. "The most common side effect of treatment with the drug is kidney failure." c. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." d. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." e. "Use of this drug can prevent heart attack and stroke."
c. "Notify your healthcare provider if you notice that your skin or eyes are turning yellow." d. "Do not routinely use acetaminophen to prevent vaccine-associated fever and pain." Rationale: Acetaminophen (Tylenol) is used to treat fever and pain. It is not an anti-inflammatory drug. The most serious side effect of acetaminophen therapy is liver failure; therefore, the healthcare provider should be notified if indications of jaundice are seen, such as yellowing of the skin or sclera. Acetaminophen therapy has no antiplatelet activity; therefore, it is not used to prevent heart attack or stroke. Routine use of acetaminophen may blunt the immune response to vaccines; therefore, it should be avoided as routine treatment for vaccine-associated fever and pain.
Which statements about the care of a patient with aspirin poisoning does the nurse identify as true? (select all that apply) a. Warming blankets are routinely used to raise the patient's temperature. b. Diuretics and fluid restrictions are needed to correct the fluid overload commonly seen with aspirin poisoning. c. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. d. Activated charcoal is contraindicated in the treatment of aspirin poisoning. e. Hemodialysis or peritoneal dialysis can accelerate salicylate removal.
c. Bicarbonate infusions are used to reverse acidosis and promote renal excretion of salicylates. e. Hemodialysis or peritoneal dialysis can accelerate salicylate removal. Rationale: Aspirin poisoning is an acute medical emergency that requires hospitalization. Treatment is largely supportive and consists of external cooling (e.g., sponging with tepid water), infusion of fluids (to correct dehydration and electrolyte loss), infusion of bicarbonate (to reverse acidosis and promote renal excretion of salicylates), and mechanical ventilation (if respiration is severely depressed). Absorption of aspirin can be reduced by gastric lavage and by giving activated charcoal. If necessary, hemodialysis or peritoneal dialysis can accelerate salicylate removal.
A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? a. Urticaria, itching, and flushing b. Blood pressure of 90/50 mm Hg c. Decreasing level of consciousness d. Potassium level of 5.5 mEq/L
c. Decreasing level of consciousness
For a postoperative patient, the health care provider (HCP) prescribed multimodal therapy, which includes acetaminophen, nonsteroidal anti-inflammatory drugs, as-needed (PRN) opioids, and nonpharmaceutical interventions. The patient continuously asks for the PRN opioid, and the nurse suspects that the patient may have a drug abuse problem. Which action by the nurse is best? a. Administer acetaminophen and spend extra time with the patient. b. Explain that opioid medication is reserved for moderate to severe pain. c. Give the opioid because the patient deserves relief and drug abuse is unconfirmed. d. Ask the HCP to validate suspicions of drug abuse and alter the opioid prescription.
c. Give the opioid because the patient deserves relief and drug abuse is unconfirmed.
A patient is scheduled to start taking aspirin for the treatment of rheumatoid arthritis. The nurse anticipates that which medication most likely will be prescribed? a. Docusate sodium [Colace] b. Ascorbic acid (vitamin C) c. Pantoprazole [Protonix] d. Furosemide [Lasix]
c. Pantoprazole [Protonix] Rationale: Aspirin inhibits COX-2 and thus suppresses inflammation and reduces moderate pain and fever. It also suppresses COX-1, which increases the risk for gastric ulceration and bleeding. This risk can be reduced through administration of a proton pump inhibitor, such as pantoprazole (Protonix). It is not necessary for a patient to take vitamin C or docusate sodium while taking aspirin. Although aspirin may cause sodium and water retention in patients who have pre-existing renal dysfunction, it is not necessary for all patients to take furosemide (Lasix) with aspirin.
A nurse should recognize that a patient who takes an angiotensin- converting enzyme (ACE) inhibitor while also taking high-dose aspirin is at risk of developing what complication? a. Congestive heart failure b. Liver toxicity c. Renal failure d. Hemorrhage
c. Renal failure Rationale: High-dose aspirin therapy should be avoided in patients taking ACE inhibitors. In susceptible patients, these medications can impair renal function when they are combined with aspirin. Liver toxicity, congestive heart failure, and hemorrhage are not effects of ACE inhibitor and aspirin interactions.
A nurse instructs the parent of a child with influenza that which medication or medications may be used safely to reduce fever? a. Ibuprofen [Advil] b. Naproxen [Aleve] c. Aspirin [Bayer] d. Acetaminophen [Tylenol] e. Indomethacin [Indocin]
d. Acetaminophen [Tylenol]
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? a. Administer intravenous (IV) push protamine sulfate. b. Continue with the current prescription. c. Prepare to administer vitamin K. d. Call the healthcare provider to increase the dose.
d. Call the healthcare provider to increase the dose.
A nurse instructs a patient to discontinue the scheduled use of high-dose aspirin before undergoing which procedures? (select all that apply) a. Routine dental cleaning b. Removal of a skin mole c. Cataract surgery d. Cholecystectomy e. Hysterectomy
d. Cholecystectomy e. Hysterectomy Rationale: Aspirin promotes bleeding by causing irreversible suppression of platelet aggregation. High-dose aspirin should be discontinued 1 week before elective surgery (cholecystectomy, hysterectomy). There is no need to stop aspirin before procedures with a low risk of bleeding, such as dental cleaning or dermatologic or cataract surgery.
The nurse knows which statement is accurate for enoxaparin [Lovenox]? a. It equally reduces the activity of thrombin and factor Xa. b. It has selective inhibition of factor Xa and no effect on thrombin. c. It has a lower bioavailability and shorter half-life than unfractionated heparin. d. It reduces the activity of factor Xa more than the activity of thrombin.
d. It reduces the activity of factor Xa more than the activity of thrombin.
Fondaparinux [Arixtra] is not approved for use in which circumstance? a. Prevention of deep vein thrombosis (DVT) after knee replacement b. Treatment of acute pulmonary embolism (PE) (in conjunction with warfarin) c. Prevention of deep vein thrombosis (DVT) after abdominal surgery d. Prevention of ischemic complications in patients with unstable angina
d. Prevention of ischemic complications in patients with unstable angina.
The recommended treatment for an initial VTE in an otherwise healthy person with no significant co- morbidities would include a. IV argatroban (Acova) as an inpatient. b. IV unfractionated heparin as an inpatient. c. Subcutaneous unfractionated heparin as an outpatient. d. Subcutaneous low-molecular-weight heparin as an outpatient.
d. Subcutaneous low-molecular-weight heparin as an outpatient. Rationale: Rationale: Patients with confirmed VTE should receive initial treatment with low-molecular-weight heparin (LMWH), unfractionated heparin (UH), fondaparinux, or rivaroxaban, followed by warfarin for 3 months to maintain the international normalized ratio (INR) between 2.0 and 3.0 for 24 hours. Patients with multiple comorbid conditions, complex medical issues, or a very large VTE usually are hospitalized for treatment and typically receive intravenous UH. LMWH only for 3 months is another option for patients with acute VTE. Depending on the clinical presentation, patients often can be managed safely and effectively as outpatients.