Exam 4

A nurse is providing teaching to a client who is taking raloxifene to prevent postmenopausal osteoporosis. The nurse should advise the client that which of the following are adverse effects of this medication?

-Hot flashes- Swelling or redness in calf- Shortness of breath

A nurse is transfusing a unit of packed red blood cells (PRBCs) for a client who has anemia due to chemotherapy. The client reports a sudden headache and chills. The client's temperature is 2° F higher than her baseline. In addition to notifying the provider, which of the following actions should the nurse take? (Select all that apply.) A. Stop the transfusion. B. Place the client in an upright position with feet down. C. Remove the blood bag and tubing from the IV catheter. D. Obtain a urine specimen. E. Infuse dextrose 5% in water through the IV.

A --- The nurse should stop the transfusion for a rise in temperature of 2° F and reports of chills and fever. The client can be having a hemolytic reaction to the blood or a febrile reaction. C---The nurse should avoid infusing more PRBCs into the client's vein, and should remove the blood bag and tubing from the client's IV catheter. D---Obtaining a urine specimen to check for hemolysis is standard procedure when the client has a reaction to a blood transfusion.

A nurse is explaining the mechanism of action of combination oral contraceptives to a group of clients. The nurse should tell the clients that which of the following actions occur with the use of combination oral contraceptives?

Thickening the cervical mucus. Altering the endometrial lining .Inhibiting ovulation.

A nurse is reinforcing medication instruction to a group of clients. Which of the following statements indicates a need for further clarification?

​D. "I will take aspirin for headaches like I did when I had a stroke."

A nurse is evaluating teaching for a client who has rheumatoid arthritis and new prescription for methotrexate. Which of the following statements by the client indicates understanding of the teaching?

"Ill let the doctor know if I develop sores in my mouth while taking this medication."

Why should are hot flashes, swelling or redness in calf and SOB adverse effects of raloxifene?

-Raloxifene can cause hot flashes or increase existing hot flashes -Raloxifene increases the risk for thrombophlebitis, which can cause swelling or redness in the calf -Raloxifene increases risk for pulmonary embolism, which can cause SOB

Why should the nurse provide these instructions for a client who has osteoporosis and a new prescription for alendronate?

-Take alendronate first thing in the morning before eating to increase absorption -Clients should drink at least 240mL (8oz) water with alendronate tablets -Clients should sit upright or stand for at least 30min after taking alendornate

A nurse is teaching a client who has osteoporosis and a new prescription for alendronate. Which of the following instructions should the nurse provide?

-Take the medication in the morning before eating-- Drink an 8oz glass of water with each tablet -Avoid lying down after taking this medication

A nurse is teaching a client who is about to start therapy with alendronate (Fosamax) to treat osteoporosis. Which of the following adverse effects should the nurse instruct the client to report?1. Tinnitus2. Jaw pain3. Blurred vision4. Drowsiness5. Dysphagia

2. Jaw pain 3. Blurred vision 5. Dysphagia

A nurse is caring for a client who has angina and asks about obtaining a prescription for sildenafil to treat erectile dysfunction. Which of the following medications is contraindicated with sildenafil?

Isosorbide.

Why should the client report if they develop sores in their mouth while taking methotrexate for rheumatoid arthritis?

Ulcerations in the mouth, tongue or throat are often the first signs of methotrexate toxicity and should be reported to the provider immediately

A nurse is caring for a client who has a new prescription for oxytocin to stimulate uterine contractions. Which of the following interventions should the nurse make?

Use an infusion pump for medication administrations . Obtain vital signs frequently and with every dosage change. Monitor fetal heart rate continuously.

A nurse is preparing to administer a transfusion of 300 mL of pooled platelets for a client who has severe thrombocytopenia. The nurse should plan to administer the transfusion over which of the following time frames? A. Within 30 min/unit B. Within 60 min/unit C. Within 2 hr/unit D. Within 4 hr/unit

A. Platelets are fragile and should be administered quickly to reduce the risk of clumping. The nurse should administer the platelets within 15 to 30 min/unit.

A nurse is assessing a client who has numerous bruises on his upper extremities. The client reports that he has taken warfarin (Coumadin) daily for the past 3 months. Which of the following statements by the client indicates the client needs further teaching? A. "I have started taking ginger root to treat my joint stiffness."B. "I take Tylenol whenever I have a headache."C. "I eat a green salad every night with dinner."D. "I had my INR checked three weeks ago."

A. "I have started taking ginger root to treat my joint stiffness."

A nurse is caring for a client who is hospitalized with deep vein thrombosis and has been on IV heparin for 5 days. The provider prescribes oral warfarin (Coumadin) without discontinuing the heparin. The client asks that nurse why both anticoagulants are necessary. Which of the following is an appropriate nursing response?

A. "The Coumadin takes several days to work, so the IV heparin will be used until the Coumadin reaches a therapeutic level."

A nurse is teaching a patient who has rheumatoid arthritis about taking methotrexate (Rheumatrex). The nurse should tell the patient to A. Take it with food to reduce gastric irritationB. Drink 2 to 3 L of water per day to promotes its excretion.C. Take an NSAID to help reduce toxicity.D. Take it in the morning to prevent insomnia.

B. Drink 2 to 3 L of water per day to promotes its excretion.

4. A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse? A. Whole blood B. Platelets C. Fresh frozen plasma D. Packed red blood cells

C Fresh frozen plasma is indicated for a client who has an elevated aPTT because it replaces coagulation factors and can help prevent bleeding.

A nurse in a regional oncology is recording the dose of doxorubicin (Adriamycin) that a client receives with each visit. The nurse should know that this medication has a maximum lifetime cumulative dose range due to the risk for irreversible A. urticariaB. feverC. fluid overloadD. hemolysis

A. urticaria

A nurse is monitoring a client who is receiving epoetin alfa for adverse effects. The nurse should identify which of the following findings as an adverse effect of this medication? (Select all that apply) A. Leukocytosis B. Hypertension C. Edema D. Blurred vision E. Headache

B. Hypertension is an adverse effect of epoetin alfa that the nurse should monitor for throughout treatment. E. Headache is an adverse effect of epoetin alfa.

A nurse is preparing to transfuse a unit of packed red blood cells (PRBCs) for a client who has severe anemia. Which of the following interventions will prevent an acute hemolytic reaction? A. Ensure that the client has a patent IV line before obtaining blood product from the refrigerator. B. Obtain help from another nurse to confirm the correct client and blood product. C. Take a complete set of vital signs before beginning transfusion and periodically during the transfusion. D. Stay with the client for the first 15 to 30 min of the transfusion.

B. Identifying and matching the correct blood product with the correct client will prevent an acute hemolytic reaction from occurring because this reaction is caused by ABO or Rh incompatibility.

A nurse is planning to administer subcutaneous enoxaparin 40 mg using a prefilled syringe of enoxaparin 40 mg/0.4 mL to an adult client following hip arthroplasty. Which of the following actions should the nurse plan to take? A. Expel the air bubble from the prefilled syringe before injecting. B. Insert the needle completely into the client's tissue. C. Administer the injection in the client's thigh. D. Aspirate carefully after inserting the needle into the client's skin.

B. The nurse should inject the needle on the prefilled syringe completely when administering enoxaparin in order to administer the medication by deep subcutaneous injection.

3. A nurse is planning to administer IV alteplase to a client who is demonstrating manifestations of a massive pulmonary embolism. Which of the following interventions should the nurse plan to take? A. Administer IM enoxaparin along with the alteplase dose. B. Hold direct pressure on puncture sites for up to 30 min. C. Administer aminocaproic acid IV prior to alteplase infusion. D. Prepare to administer alteplase within 8 hr of manifestation onset.

B. The nurse should plan to hold direct pressure on puncture sites for 10 to 30 min or until oozing of blood stops.

A nurse is monitoring a client who takes aspirin 81 mg PO daily. The nurse should identify which of the following manifestations as adverse effects of daily aspirin therapy? (Select all that apply.) A. Hypertension B. Coffee-ground emesis C. Tinnitus D. Paresthesias of the extremities E. Nausea

B. CORRECT: GI bleeding with dark stools or coffee-ground emesis can be an adverse effect of aspirin therapy. C. CORRECT: Tinnitus and hearing loss can occur as an adverse effect of aspirin therapy D. Paresthesias of the extremities are not adverse effects of aspirin therapy. E. CORRECT: Nausea, vomiting, and abdominal pain can occur as a result of aspirin therapy.

A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A. Epinephrine B. Lorazepam C. Furosemide D. Diphenhydramine

C. Furosemide, a loop diuretic, may be prescribed to relieve manifestations of circulatory overload.

5. A nurse is caring for a client who has atrial fibrillation and a new prescription for dabigatran to prevent development of thrombosis. Which of the following medications is prescribed concurrently to treat an adverse effect of dabigatran? A. Vitamin K1 B. Protamine C. Omeprazole D. Probenecid

C. Omeprazole or another proton pump inhibitor is prescribed for a client who is taking dabigatran and has abdominal pain and other GI findings that can occur as adverse effects of dabigatran. The nurse should advise the client who has GI effects to take dabigatran with food.

A nurse is caring for a hospitalized client who is receiving IV heparin for a deep-vein thrombosis. The client begins vomiting blood. After the heparin has been stopped, which of the following medications should the nurse prepare to administer? A. Vitamin K1 B. Atropine C. Protamine D. Calcium gluconate

C. Protamine reverses the anticoagulant effect of heparin.

A nurse is caring for a client who is taking ferrous sulfate (Feosol) tablets twice daily for iron-deficiency anemia. The client asks the nurse why the provider suggested that she take the ferrous sulfate with orange juice. Which of the following is an appropriate response by the nurse? A. "The orange juice will help you avoid becoming constipated. "B. "The medication has an unpleasant taste, and the orange juice will help to disguise it ."C. "The orange juice will help you absorb the medication more efficiently. "D. "The medication can cause nausea, and the orange juice will prevent this."

C. "The orange juice will help you absorb the medication more efficiently."

A nurse is caring for a client who is HIV positive is started on zidovudine (AZT). The nurse should monitor the client for which of the following life-threatening side effects of this medication? A. Cardiac dysrhythmia B. Fever C. Renal failure D. Aplastic anemia

D. Aplastic anemia

A nurse is caring for a client who reports occasionally self-medicating with an over-the-counter calcium carbonate antacid. To avoid the adverse effects of calcium carbonate, the nurse should recommend that the client take this medication with A. orange juice. B. milk. C. a carbonated beverage .D. water.

D. water.

A nurse is teaching a client who is about to start therapy with methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which of the following instructions should the nurse include? (Select all that apply.)1. ​Expect to feel the medication's effects immediately.​2. Do not drink alcoholic beverages.​3. Report unexplained bruising to the provider.​4. Avoid people who have infections.​5. Take ascorbic acid to help minimize side effects.

​2. Do not drink alcoholic beverages .​3. Report unexplained bruising to the provider.​ 4. Avoid people who have infections.

A nurse is caring for a client who is receiving a unit of packed RBC. The nurse notices the client's face is flushing and he begins to report low back pain. Which of the following actions is the nurses's priority?

​A. Stop the transfusion.

A nurse is talking with a client who is about to start taking allopurinal (Zyloprim) to treat gout. Which of the following statements indicated that the client understands how to take this medication?

​B. "I need to drink at least 3 quarts of water a day."

A nurse is providing discharge teaching for a client who has a new prescription for warfarin sodium (Coumadin). Which of the following should the nurse include in the teaching? A. ​Mild nosebleeds are common during initial treatment.​ B. He should use an electric razor while on this medication.​ C. If he misses a dose, he should double the dose at the next scheduled time.​ D. Coumadin increases the risk for deep vein thrombosis.

​B. He should use an electric razor while on this medication.

A female client who has rheumatoid arthritis asks the nurse if it is safe for her to take aspirin. Which of the following is a contraindication to this medication? ​A. Report of recent migraine headaches. ​B. History of gastric ulcers. ​C. Current diagnosis of glaucoma.​ D. Prior reports of amenorrhea.

​B. History of gastric ulcers.

A nurse is educating a group of clients about contrainindications of warfarin (Coumadin) therapy. Which of the following statements is appropriate to include in the teaching? ​A. Clients who have diabetes mellitus type 1 should not take Coumadin ."​B. Clients who have rheumatoid arthritis should not take Coumadin."​ C. Clients who are pregnant should not take Coumadin."​ D. Clients who have chronic alcoholism should not take Coumadin."

​C. Clients who are pregnant should not take Coumadin."

A client who is postoperative following a transurethral resection of the prostate (TURP) has a new prescription for bethanechol (Urecholine) PRN. The nurse should administer this medication if the client reports? ​A. bladder spasms. ​B. severe pain.​ C. an inability to void.​ D. frequent episodes of painful urination.

​C. an inability to void.

The nurse is providing discharge teaching for a client who will be taking warfarin (Coumadin) at home. Which of the following statements indicates that the client understands the effects of this medication? ​A. "It's okay to have a couple of glasses of wine with dinner."​ B. "I'll be sure to eat foods with lots of vitamin K." ​C. "I'll take aspirin for my headaches."​ D. "I'll use my electric razor for shaving."

​D. "I'll use my electric razor for shaving."

Whenever a nurse is caring for clients who are receiving warfarin (Coumadin), which of the following medications should the nurse have on hand in the event of an overdose? ​A. Epinephrine​ B. Atropine ​C. Protamine​ D. Vitamin K

​D. Vitamin K