The last exam
Which of the following is an example of acquired passive immunity?
A pregnant woman who transfers antibodies to her baby during breast-feeding.
Should children take aspirin?
No
Should you drink alcohol while taking your prescribed opioid?
No
A nursing student assigned to work with you asks you to explain why natural and synthetic opioids are considered "high-alert drugs?" What is your best response?
Opioids have an increased risk for causing a patient harm if given in error."
A patient who is taking a disease-modifying antirheumatic drug (DMARD) has just returned from surgery. What potential complication would you report to the RN or healthcare provider directly related to the use of DMARDs before surgery?
Redness and drainage at the incision site
A patient who has been taking aspirin several times daily for arthritis pain reports ringing in her ears. What action should you take?
Call the healthcare provider, as this is adverse reaction to the drug.
You are teaching a patient with rheumatoid arthritis about giving subcutaneous adalimumab (Humira) at home. What instructions should be included in this patient's teaching plan?
Rotate the injection site of the thighs and abdomen frequently
An adult patient who is the recipient of a kidney transplant is prescribed the antirejection drug mycophenolate. What potential problem should you monitor this patient for?
Signs and symptoms of infection
You are preparing a teaching plan for a patient prescribed the nonselective NSAID ibuprofen 800 mg orally daily. Which of the following instructions should be included in this teaching plan?
Take this drug with food to prevent GI upset.
In acquired immunity, what is the body's response to antigen exposure?
The body produces an antibody response.
A patient with a history of alcoholism is taking aspirin on a regular basis for general aches and pains. The patient reports feeling weak and dizzy, and has developed abdominal pain 7 days ago, which is increasing in severity. What adverse drug effect might this patient be experiencing?
Gastrointestinal bleeding due to the combination of aspirin and alcohol
You are preparing to give an 18-month-old child the measles, mumps, and rubella (MMR) vaccine. The child's mother informs you that a relative who is HIV-positive has just moved into the home with this family. What is your best action?
Have the HIV-positive person contact his/her healthcare provider before giving the vaccine.
An adult patient scheduled for a seasonal influenza vaccine presents to the clinic with complaints of an upper respiratory infection. He is also there for a flu shot. What is your best action?
Hold the vaccine until the infection resolves
A patient with chronic arthritis pain reports taking acetaminophen 4 to 6 g/day for arthritis pain. Which health problem should you teach this patient that can occur as a result of taking this acetaminophen therapy?
Liver toxicity can result as a result of high acetaminophen doses."
You are working at a pediatric clinic and preparing to give vaccinations to 3 children of differing ages: 1-month-old male infant, 15-month-old toddler, and a 4-year-old. The most appropriate vaccination for the 1-month-old infant is ------------ --. According to recommended vaccination schedules, the 15-month-old toddler may be due for ------ --. The 4-year-old should
hepatitis B; MMR, DTaP, and/or Varicella (VAR); IPV, MMR, DTaP, and/or VAR
A patient with a history of cardiovascular disease has been prescribed aspirin daily. What specific risk should this patient be informed of because of taking aspirin?
risk of bleeding
A patient with acute gout asks you why allopurinol cannot be used at this time. What is your best response?
"Allopurinol is used only for the prevention of gout attacks."
An adult patient has returned to the unit from an operative procedure. The healthcare provider asks you to rate a patient's postoperative pain. What is your best response?
"I will ask the patient to rate his own pain."
Which statement made by an adult patient demonstrates understanding of the recommended Tdap vaccine booster schedule?
"I will need a booster every 10 years."
A male patient taking daily aspirin for the prevention of cardiovascular complications informs you that he is planning to have a tooth extraction next week. What correct information should be provided to this patient?
"Stop taking the aspirin 7 days before the dental procedure."
A patient is beginning a prescribed disease-modifying antirheumatic drug (DMARD) for the treatment of rheumatoid arthritis. The patient asks you how these drugs work to help this condition. What is your best response?
"These drugs work by inhibiting the inflammatory mediator tumor necrosis factor."
A pregnant woman presents for her regular obstetric appointment and requests to have the seasonal influenza vaccine. What is your best response?
"This vaccine can be given safely anytime during your pregnancy."
A patient with chronic pain asks you to explain how tramadol works to help control pain. What is your best response?
"Tramadol acts by blocking neurotransmitters in the spinal cord and brain."
A patient who has been prescribed a topical corticosteroid cream for the treatment of a rash tells you that he now has a small, reddened, open wound located on the anterior aspect of the right foot. He asks you if he can apply this same cream to this new wound to reduce the redness. What is your best response?
"You should not apply topical steroids to open wounds."
The LPN/LVN is taking care of a 65-year-old patient who just had a major surgery. The patient is experiencing severe pain that he rates a 9/10. The LPN/LVN plans to give his prescribed opioid. List the nursing action for the patient. (Select all that apply.)
A.The LPN/LVN should reassess the patient's level of pain within an hour after giving an opioid to determine its effectiveness. B. The patient should be given a stool softener or laxative because all opioids cause constipation. C. The LPN/LVN should assess the patient's respiratory rate and pulse oximetry because opioids can cause respiratory depression.
A mother brings her febrile infant to the pediatric clinic for evaluation. The infant has a temperature of 102 degrees. The mother tells you that she wishes she had given the baby a dose of liquid aspirin before leaving the house to bring down the baby's temperature. What is your best response?
Aspirin should not be given to infants with acute illness."
When assessing the blood pressure of a patient receiving pentazocine (Talwin) 30 mg orally for pain control two days after surgery, the reading is 166/100, which is much higher than the patient's presurgical blood pressure. What is your best action?
Assess the patient for other cardiac changes
The RN has given 2 mg of hydromorphone intravenously to a patient for severe pain. When you assess the patient's pain level an hour after receiving the drug you find the patient asleep with a respiratory rate of 10 breaths/min. What is your best first action?
Assess the patient's oxygen saturation with pulse oximetry.
A patient with gout requires dietary teaching to help control flare ups of the illness. What instructions should you give to this patient regarding a diet plan?
Avoid foods that are high in purine, such as tuna.
The parent of an infant you are caring for asks you for the correct schedule for the diphtheria, tetanus, and pertussis (DTaP) vaccine schedule. What is your best response?
DTaP is given at 2, 4, and 6 months of age.
You are caring for a female patient who is paralyzed from the waist down and has a large open wound on her right heel. When asked about her pain in that foot, she tells you it is a 0 on a 0 to 10 pain rating scale. What does this response indicate?
The patient's paralysis prevents the patient's brain from perceiving the pain.
A patient presents to the clinic and is newly diagnosed with gout. The LPN/LVN is teaching the patient about lifestyle changes that can potentially control gout symptoms. One of these changes is eliminating or eating less foods that produce uric acid. List the foods that the patient should avoid. (Select all that apply.)
a. Beer and wine c. Shellfish e. Red meat f. Pork h. Whole grains
Which of the following are examples of a toxoid that has been modified to be used as a vaccine? (Select all that apply.)
a. Human papilloma virus b. Hepatitis B c. Pertussis d. Tetanus
You are preparing to teach a patient and family member about long-term corticosteroid therapy. Which instructions should be included in the patient's teaching plan? (Select all that apply.)
b. Consult your healthcare provider before getting any vaccinations. d. Take your dose of this drug early in the morning. e. Take this drug with food to prevent GI upset.
When caring for a patient who is taking anti-inflammatory drugs, what should be included in the patient's teaching plan? (Select all that apply.)
b. Take this drug with a full glass of water." d. "This drug may interact with anticoagulants." e. "Contact your healthcare provider if you develop dark stools."
Which of the following assessments is most important to perform on a patient newly prescribed to take cyclobenzaprine for severe muscle pain?
blood pressure and heart rate
A patient with a chronic inflammatory condition has been taking corticosteroids for several months. Which of the following side effects should you monitor this patient for?
fat redistribution
Which laboratory value is most likely to be elevated in a patient presenting with acute gout?
uric acid
