Quiz 4 Concepts

drop factor formula

(mL/hr x gtt/mL)/ 60 min = gtt/min

ounces to mL

1 oz = 30 mL

tablespoon to mL

1 tbsp = 15 mL

tablespoon to teaspoon

1 tbsp = 3 tsp

Androgen therapy is used to treat breast cancer to promote regression tumors by opposing activity of estrogen that "feeds" breast cancer.

True

Elevated heart rate and decrease b/p are indicative of possible bleeding. IF the postop client had received tPA close monitoring of any dressings are imperative.

True

Erythropoietin-stimulating agents such as epoetin alfa are given to stimulate RBC production in Cancer chemo clients. For those clients who have HGB near 11 or more the dose needs to be held and reevaluated. (there is such a problem as too high HGB)

True

For a patient with a suspected food allergy presents with symptoms. The nurse should assess cardiac and respiratory status to determine whether the patient is developing an anaphylactic reaction before administering meds.

True

Native American patients have a reduced response to treatment with beta blockers (the olol's)

True

Vaccines recommended for pregnant women or rather look at those considered ineffective or contraindicated.

True

calculating IV flow rates

amount of fluid/hours to administer = mL/hr

The nurse is caring for a patient who is hospitalized for an asthma exacerbation. The patient reports taking diphenhydramine at home at night to help with symptoms of allergic rhinitis and cough. The nurse will contact the patient's provider to request an order for which medication? a. Benzonatate (Tessalon Perles) b. Cetirizine (Zyrtec) c. Dextromethorphan hydrobromide (Benylin DM) d. Diphenhydramine (Benadryl)

b. Cetirizine (Zyrtec) Cetirizine is an antihistamine, which is indicated for this patient's symptoms. Diphenhydramine is also an antihistamine but, because of its anticholinergic side effects, is contraindicated in patients with acute asthma.

A patient is diagnosed with borderline hypertension and states a desire to make lifestyle changes to avoid needing to take medication. The nurse will recommend which changes? a. Changing from weight bearing exercise to yoga b. Decreased fluid intake and increased potassium intake c. Stress reduction and increased protein intake d. Weight reduction and decreased sodium intake

d. Weight reduction and decreased sodium intake Weight loss decreases the stress on the heart. Decreasing salt intake decreases vascular volume. Changing to yoga from weight-bearing exercise, limiting fluids, and increasing potassium are not indicated. Stress reduction is recommended, but increasing protein is not.

A patient with COPD who has a persistent nonproductive cough asks about a medication that will not cause sedation. The nurse will encourage the patient to discuss which medication with the provider? a. Benzonatate HCl (Tessalon Perles) b. Dextromethorphan hydrobromide (Benylin DM) c. Guaifenesin and codeine d. Promethazine with dextromethorphan

ANS: A Benzonatate HCl (Tessalon Perles) is less likely to cause sedation and is safe for patients with COPD. Dextromethorphan is contraindicated in patients with COPD. Codeine and promethazine cause sedation.

A patient with cancer is receiving aldesleukin. The patient reports black stools, which the nurse recognizes as a. a sign of cancer metastasis. b. an indication of gastrointestinal bleeding. c. caused by inadequate hydration. d. renal failure.

ANS: B Black stools suggest gastrointestinal bleeding, an absolute contraindication for aldesleukin. It is not a sign of cancer metastasis, inadequate hydration, or renal failure.

A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason? A. to increase absorption B. to decrease absorption C. to swallow D. to chew

ANS: To increase absorption Nitroglycerin is given sublingually to avoid first-pass metabolism by the liver, which would occur if the drug is swallowed.

Which is an example of acquired passive immunity? a. Administration of IgG to an unimmunized person exposed to a disease b. Administration of an antigen via an immunization c. Inherent resistance to a disease antigen d. Immune response to an attenuated virus

ANS: a. Administration of IgG to an unimmunized person exposed to a disease Acquired passive immunity is when a person is given antibodies to a disease rather than producing them through his or her own immune system. Another example is when a newborn baby acquires passive immunity from its mother through the placenta. Passive acquired immunity is a type of immunity in which a person takes the antibody from the outside. For example- Taking aspirin for the headache.

The nurse is preparing to care for a Native American patient who has hypertension. The nurse understands that which antihypertensive medication would be most effective in this patient? a. Acebutolol (Sectral) b. Captopril (Capoten) c. Carteolol HCl (Cartrol) d. Metoprolol (Lopressor)

ANS: b. Captopril (Capoten) Captopril is an ACE inhibitor. Native American patients have a reduced response to treatment with beta blockers. Acebutolol, carteolol, and metoprolol are all beta blockers.

The nurse is caring for an 80-year-old patient who has just begun taking a thiazide diuretic to treat hypertension. What is an important aspect of care for this patient? a. Encouraging increased fluid intake b. Increasing activity and exercise c. Initiating a fall risk protocol d. Providing a low potassium diet

ANS: c. Initiating a fall risk protocol Older patients experience a higher risk of orthostatic hypotension when taking antihypertensive medications. Fall risk also increases with a need for increased trips to the bathroom. A fall risk protocol should be implemented. Increasing fluids and activity and limiting potassium are not indicated.

A patient is prescribed raloxifene as a cancer prophylactic agent. Which type of cancer is this being used to prevent? a. Prostate cancer. b. Colon cancer. c. Multiple myeloma. d. Breast cancer.

ANS: d. Breast cancer. Selective estrogen receptor modulators (SERMs) such as tamoxifen and raloxifene have both estrogenic and antiestrogenic effects on various tissues. Tamoxifen is primarily used for breast cancer in both men and women. Raloxifene produces estrogenic effects in bone and lipids and has an antiestrogenic property in mammary tissues. It is used as a prophylactic against breast cancer in high-risk postmenopausal women with osteoporosis.

A patient who has atrial fibrillation is taking digoxin. The nurse expects which medication to be given concurrently to treat this condition? a. Hydrochlorothiazide (HydroDIURIL) b. Inamrinone (Inocor) c. Milrinone (Primacore) d. Warfarin (Coumadin)

ANS:D Digoxin is given for atrial fibrillation to restore a normal heart rhythm. To prevent thromboemboli, warfarin is given concurrently. Hydrochlorothiazide is a diuretic medication. Inamrinone and milrinone are inotropic agents that would be used instead of digoxin.

Which of the following patients, who have had chickenpox, should receive Zostavax, a vaccine against shingles? A) A 60-year-old man with non-Hodgkin lymphoma B) A 60-year old man in good health C) A 60-year-old taking immunosuppressive drugs D) A 60-year-old man with HIV

B. A 60-year-old man in good health Zostavax is given to boost the immunity to varicella-zoster virus among recipients

The nurse teaches a patient about their antihypertensive medication. Which statements by the patient indicate understanding of the teaching? (Select all that apply.) a. "I should be careful when I stand up from a chair when I start this medication." b. "I should not add extra salt to my foods." c. "If I have side effects, I should stop taking the drug immediately." d. "If my blood pressure returns to normal, I can stop taking this drug." e. "I may need to take a combination of drugs, including diuretics." f. "I will not need to make lifestyle changes since I am taking a medication."

ANS: a. "I should be careful when I stand up from a chair when I start this medication." b. "I should not add extra salt to my foods." e. "I may need to take a combination of drugs, including diuretics." The patient receiving an antihypertensive medication should be warned to rise slowly to avoid orthostatic hypotension. Patients should be counseled to continue to make lifestyle changes, including decreasing sodium. Often, more than one medication is required. Patients should not stop taking the drug abruptly to avoid rebound hypertension and will not stop the drug when blood pressure returns to normal.

The nurse is caring for an African-American patient who has been taking a beta blocker to treat hypertension for several weeks with only slight improvement in blood pressure. The nurse will contact the provider to discuss a. adding a diuretic medication. b. changing to an angiotensin-converting enzyme (ACE) inhibitor. c. decreasing the beta blocker dose. d. doubling the beta blocker dose.

ANS: A African Americans do not respond well to beta blockers and ACE inhibitors, but do tend to respond to diuretics and calcium channel blockers. Changing to an ACE inhibitor or altering the beta blocker dose is not indicated. Hypertension in African-American patients can be controlled by combining beta blockers with diuretics.

A 4-year-old child is receiving amoxicillin (Amoxil) to treat otitis media and is in the clinic for a well-child checkup on the last day of antibiotic therapy. The provider orders varicella (Varivax); mumps, measles, and rubella (MMR); inactivated polio (IPV); and diphtheria, tetanus, and acellular pertussis (DTaP) vaccines to be given. Which action by the nurse is correct? a. Administer the vaccines as ordered. b. Discuss giving the MMR vaccine in 4 weeks. c. Hold all vaccines until 2 weeks after antibiotic therapy. d. Recommend aspirin for fever and discomfort.

ANS: A Antibiotic therapy is not generally a contraindication to the use of vaccines. Vaccines may be given in cases of mild acute illness or during the convalescent phase of an illness.

A patient begins taking cholestyramine (Questran) to treat hyperlipidemia. The patient reports abdominal discomfort and constipation. The nurse will provide which instruction to the patient? a. Increase fluid and slowly increase fiber intake. b. Stop taking the medication immediately. c. Take an over-the-counter laxative. d. Take the medication on an empty stomach.

ANS: A Cholestyramine can cause gastrointestinal upset and constipation, and these symptoms can be reduced with increased fluids and foods high in fiber. Stopping the medication is not indicated. Over-the-counter laxatives are not recommended until other methods have been tried. Giving the medication on an empty stomach will not relieve the discomfort.

The nurse is caring for a patient who is receiving warfarin (Coumadin) and notes bruising and petechiae on the patient's extremities. The nurse will request an order for which laboratory test? a. International normalized ratio (INR) b. Platelet level c. Partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT) d. Vitamin K level

ANS: A The INR is the test used most frequently to report prothrombin time results in patients taking warfarin. Warfarin is not an antiplatelet drug, so platelet levels are not indicated. PTT and aPTT are used to monitor heparin therapy. Vitamin K is an antidote for warfarin; levels are not routinely checked.

A patient experiences a blood clot in one leg, and the provider has ordered a thrombolytic medication. The patient learns that the medication is expensive and asks the nurse if it is necessary. Which response by the nurse is correct? a. The drug will decrease the likelihood of permanent tissue damage. b. This medication also acts to prevent future blood clots from forming. c. You could take aspirin instead of this drug to achieve the same effect. d. Your body will break down the clot, so the drug is not necessary.

ANS: A Thrombolytic medications are given primarily to prevent permanent tissue damage caused by compromised blood flow to the affected area. Thrombolytics do not prevent clots from forming. Aspirin prevents, but does not dissolve, clots. Although the body will break down the clot, the drug is needed to prevent tissue damage due to active ischemia.

A patient begins taking nicotinic acid (Niacin) and reports dizziness and flushing of the skin. The nurse will perform which action? a. Recommend that the patient take a baby aspirin with their niacin dose. b. Counsel the patient to increase fluid intake. c. Request an order for renal function tests. d. Schedule the medication to be taken with meals.

ANS: A. Recommend that the patient take a baby aspirin with their niacin dose. Flushing of the skin and dizziness are common side effects of nicotinic acid, but with careful drug titration and concomitant use of aspirin, these effects can be minimized. Increasing fluid intake or taking with food does not alter these adverse effects. Nicotinic acid can affect liver enzymes not renal function

The nurse is discussing vaccines with the mother of a 4-year-old child who attends a day care center that requires the DTaP vaccine. The mother, who is pregnant, tells the nurse that she does not want her child to receive the pertussis vaccine because she has heard that the disease is "not that serious" in older children. What information will the nurse include when discussing this with the mother? a. If she gets the vaccine, both she and her 4 year-old child will be protected. b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn. c. The vaccine will not be given to her child while she is pregnant. d. Vaccinating the 4-year-old will provide passive immunity for her unborn child.

ANS: B Even though pertussis is not as serious in older children, it is important to vaccinate children to prevent the spread of the disease to infants and others who are not immunized and who are at risk for significant morbidity and mortality from this disease. Vaccinating the mother will not protect the 4-year-old from getting pertussis. The DTaP vaccine may be given to children whose mothers are pregnant. Vaccinating the child does not confer passive immunity to the unborn child.

The nurse is caring for a patient who develops marked edema and a low urine output as a result of heart failure. Which medication will the nurse expect the provider to order for this patient? a. Digoxin (Lanoxin) b. Furosemide (Lasix) c. Hydrochlorothiazide (HydroDIURIL) d. Spironolactone (Aldactone)

ANS: B Furosemide is a loop diuretic and is given when the patients condition warrants immediate removal of body fluid, as in heart failure. Digoxin improves cardiac function but does not remove fluid quickly. The other diuretics may be used when immediate fluid removal is not necessary.

A provider has ordered Gardasil to be given to a prepubertal 9-year-old female. The parent asks the nurse if this vaccine can be postponed until the child is in high school. The nurse will tell the parent that Gardasil a. is less effective in older adolescents. b. is more effective if given before sexual activity begins. c. is more effective if given prior to the hormonal changes of puberty. d. is not effective if given after the onset of menses.

ANS: B Gardasil is most effective when the client is not yet sexually active.

A patient who has a nonproductive cough will begin taking guaifenesin to help with secretions. When teaching this patient about the medication, the nurse will provide which instruction? a. "Avoid driving or using heavy machinery." b. "Drink extra water while taking the medication." c. "Monitor urine output closely." d. "Take with an oral antihistamine for better effects."

ANS: B Guaifenesin is an expectorant, and patients taking this medication should be advised to increase fluid intake to at least 8 glasses of water per day. (Remember to assess for contraindications to increasing fluid intake [e.g., heart failure, kidney failure with dialysis, etc.].) Guaifenesin does not cause drowsiness or urinary retention. Antihistamines will dry secretions, making them harder to expectorate.

A patient has been taking atorvastatin (Lipitor) for several months to treat hyperlipidemia. The patient reports muscle weakness and tenderness. The nurse will counsel the patient to a. ask the provider about switching to simvastatin. b. contact the provider to report these symptoms. c. start taking ibuprofen to combat these effects. d. stop taking the medication immediately.

ANS: B Patients taking statins should report immediately any muscle aches or weakness, which can lead to rhabdomyolysis, a muscle disintegration that can become fatal. All statins carry this risk, so changing to another statin is not indicated. Ibuprofen may be useful, but notifying the provider is essential. Patients should not abruptly discontinue statins without discussing this with the provider.

A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so she can protect her unborn child. Which vaccine(s) may be administered to this patient? a. Gardasil vaccine b. Trivalent influenza vaccine c. MMR vaccine d. Varivax vaccine

ANS: B The influenza vaccine is recommended for pregnant women and should be given. Gardasil is given to young women who are not yet sexually active. The MMR is contraindicated because rubella can cause serious teratogenic effects. Varivax is contraindicated during pregnancy.

The parent of a 12-month-old child who has received the MMR, varicella, and hepatitis A vaccines calls the clinic to report redness and swelling at the vaccine injection sites and a temperature of 100.3° F. The nurse will perform which action? a. Recommend aspirin or a nonsteroidal anti-inflammatory drug (NSAID) for pain and fever. b. Recommend acetaminophen and cold compresses. c. Report these adverse effects to the Vaccine Adverse Event Reporting System (VAERS). d. Schedule an appointment in clinic so the provider can evaluate the child.

ANS: B These are common, minor side effects of vaccines and can be treated with acetaminophen and cold compresses. Aspirin is contraindicated in children because of its association with Reye's syndrome. Since these are not serious adverse effects, they do not need to be reported to VAERS. It is not necessary to schedule a clinic visit, but the parent should be encouraged to re-contact the clinic if symptoms do not improve.

A patient who has cancer is about to begin chemotherapy. The patient asks the nurse why two chemotherapeutic agents are being used instead of just one. Which response by the nurse is correct? a. "The drugs may be given in less toxic doses if two drugs are used." b. "Two agents used together can have synergistic effects." c. "Use of two drugs will increase tumoricidal activity in the G0 phase of the cell." d. "Using two agents will shorten the length of time chemotherapy is needed."

ANS: B Using two or more chemotherapeutic agents can have a synergistic effect.

A patient has been receiving intravenous heparin. When laboratory tests are drawn, the nurse has difficulty stopping bleeding at the puncture site. The patient has bloody stools and is reporting abdominal pain.The nurse notes elevated partial thromboplastin time (PTT) and activated partial thromboplastin time (aPTT). Which action will the nurse perform? a. Ask for an order for oral warfarin (Coumadin). b. Obtain an order for protamine sulfate. c. Request an order for vitamin K. d. Suggest that the patient receive subcutaneous heparin.

ANS: B Protamine sulfate is given as an antidote to heparin when patient's clotting times are elevated

A patient who has seasonal allergies with a runny nose during the daytime reports increasing nighttime symptoms of coughing and sneezing that are interfering with sleep. The provider recommends diphenhydramine (Benadryl) at bedtime. What information will the nurse include when teaching the patient about this medication? a. Avoid fluids at bedtime to prevent urinary retention. b. This will help clear your daytime symptoms, too. c. You should be able to sleep better when you take this medication. d. You should take this medication on an empty stomach.

ANS: C A side effect of diphenhydramine is drowsiness. Patients whose nighttime symptoms clear should be able to sleep better, especially with drowsiness side effects. Avoiding fluids does not prevent urinary retention. The half-life of diphenhydramine is short, so drug effects will not last through the next day. There is no need to take the medication on an empty stomach.

The nurse is teaching a patient who will begin taking oral theophylline (Theo-Dur) when discharged home from the hospital. What information will the nurse include when teaching the patient about this drug? a. An extra dose should be taken when symptoms worsen. b. Anorexia and gastrointestinal upset are unexpected side effects. c. Avoid caffeine while taking this medication. d. Food will decrease the amount of drug absorbed.

ANS: C Caffeine and theophylline are both xanthine derivatives and should not be taken together because of the increased risk of toxicity and severe adverse effects. Theophylline has a narrow therapeutic range and must be dosed carefully; patients should never increase or decrease the dose without consulting their provider. Gastrointestinal symptoms are common side effects. Food slows absorption but does not prevent the full dose from being absorbed.

The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching? a. "I will apply the patch as needed when I experience anginal pain." b. "I will remove the old patch and replace it with a new one at bedtime each day." c. "I should rotate sites when changing the patch to prevent skin irritation." d. "When I am symptom-free, I may stop using the patch on a regular basis."

ANS: C Patients should be taught to rotate application sites when using the transdermal nitroglycerin. Transdermal nitroglycerin is not used as needed. Patients should remove the patch at bedtime to provide an 8- to 12-hour nitrate-free interval. Patients should use the patch even when symptom-free unless otherwise instructed by the provider.

The nurse is assessing a patient prior to administering thrombolytic therapy. Which is an important assessment for this patient? a. Determining whether the patient has a history of diabetes b. Finding out about a history of renal disease c. Assessing which medications are taken for discomfort d. Assessing whether the patient eats green, leafy vegetables

ANS: C Patients who take aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) should be monitored closely for excessive bleeding when given thrombolytics. There are no contraindications or precautions for patients with diabetes or renal disease. Foods rich in vitamin K are of concern for patients taking warfarin

A patient will begin taking simvastatin (Zocor) to decrease serum cholesterol. When teaching the patient about this medication, the nurse will counsel the patient to take which action? a. Return to the clinic annually for laboratory testing. b. Take care when rising from a sitting to standing position. c. Take the medication in the evening for best effect. d. Use ibuprofen as needed for muscle aches and pain.

ANS: C Simvastatin is given in the evening. Laboratory tests are performed every 3 to 6 months, not annually. Statins do not cause postural hypotension. Patients taking statins should report muscle aches and weakness immediately.

A patient is admitted to the hospital after developing pneumonia. During the admission assessment, the patient reports having used a topical nasal decongestant spray for the past few weeks but thinks the nasal congestion is getting worse. The nurse will: a. request an order for a systemic decongestant medication. b. request an order so the patient can continue to use the decongestant spray. c. tell the patient the congestion will eventually clear up after stopping the spray. d. tell the patient to increase oral fluid intake.

ANS: C Use of nasal decongestants longer than 3 days can cause rebound congestion. This will eventually clear up when the decongestant spray is discontinued for several days or weeks. A systemic decongestant is not indicated. Continuing the spray will increase the congestion. Increasing fluid intake is not recommended.

A patient with high cholesterol is ordered to take atorvastatin (Lipitor). What information will be included in the patient teaching? (Select all that apply.) a. Dietary management is not a priority with this medication. b. The medication should be taken on an empty stomach. c. The medicine should be taken with a full glass of water. d. The patient should watch for body aches or gastrointestinal upset as side effects. e. The patient should have renal function tests frequently. f. The patient should have liver function tests frequently.

ANS: C, D, F This medication is most effective with careful monitoring of diet. Atorvastatin does not affect renal function.

The nurse is teaching a patient about sublingual nitroglycerin administration. What information will the nurse include when teaching this patient? a. Call 911 if pain does not improve after three doses. b. If pain persists after one dose, administer a second dose. c. Swallow the tablet with small sips of water. d. Take the first tablet while sitting or lying down.

ANS: D Because nitroglycerin can cause hypotension, patients should be cautioned to take them while sitting or lying down. If pain is not better or has worsened 5 minutes after the first dose, patients should call 911. The tablets must dissolve under the tongue and should not be swallowed

The nurse is preparing to administer epinephrine to a patient who is experiencing an acute bronchospasm. The nurse understands that because epinephrine is a nonselective alpha- and beta-adrenergic agonist, the patient will experience which effects? a. Decreased blood pressure b. Anticholinergic effects c. A shorter duration of therapeutic effects d. Cardiac and pulmonary effects

ANS: D Nonselective sympathomimetic epinephrine is an alpha1, beta1, and beta2 agonist that is given to promote bronchodilation and elevate blood pressure. It does not have anticholinergic effects.

A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication? a. Nausea and vomiting b. Increased blood pressure c. Pruritus and skin rash d. Pounding headache

ANS: D The pounding headache is related to vasodilation of the cerebral vessels. Nitrates decrease blood pressure.

A patient who uses an inhaled glucocorticoid medication reports having a sore tongue. The nurse notes white spots on the patient's tongue and oral mucous membranes. After notifying the provider, the nurse will remind the patient to perform which action? a. Avoid using a spacer with the inhaled glucocorticoid medication. b. Clean the inhaler with hot, soapy water after each use. c. Consume yogurt daily while using this medication. d. Rinse the mouth thoroughly with water after each use.

ANS: D When using inhaled glucocorticoid medications, Candida albicans oropharyngeal infections may be prevented by rinsing the mouth and throat with water after each dose. Patients should also use a spacer to reduce deposits of the drug in the oral cavity. The inhaler should be washed with warm water daily, but not after each use. There is no indication that yogurt is effective.

The nurse performs a medication history and learns that the patient takes a loop diuretic and digoxin (Lanoxin). The nurse will question the patient to ensure that the patient is also taking which medication? a. Cortisone b. Lidocaine c. Nitroglycerin d. Potassium

ANS: Potassium If a patient is taking digoxin and a potassium-wasting diuretic such as a loop diuretic, the patient should also take a potassium supplement to prevent hypokalemia that could result in digoxin toxicity.