Pharm 2 Exam 1
The nurse administers NPH insulin at 8 AM. What intervention is essential for the nurse to perform? Administer the insulin via IV pump. Monitor fingerstick at 2 PM. Make sure patient eats by 5 PM. Assess the patient for hyperglycemia by 10 AM.
Make sure patient eats by 5 PM. NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia. The patient needs to eat by 5 PM. The patient would not be at high risk for hypoglycemia at 10 AM. A fingerstick is not necessary at 2 PM. The insulin should not be routinely administered via IV.
Which organ only has beta 1-receptors? a. bladder b. pancreas c. liver d. heart
Heart
The nurse should include which statement when teaching a patient about insulin glargine? "You cannot mix this insulin with any other insulin in the same syringe." "You can mix this insulin with Lente insulin to enhance its effects." "The duration of action for this insulin is approximately 8-10 h, so you will need to take it twice a day." "You should inject this insulin just before meals because it is very fast acting."
"You cannot mix this insulin with any other insulin in the same syringe." Insulin glargine is a long-acting insulin with a duration of action up to 24 h. It should not be mixed with any other insulins. The insulin is not fast acting.
Based on the condition of the patient, an intravenous fluid that is hypotonic will be ordered. Which intravenous fluid is most likely to be ordered by the health care provider? 5% dextrose and normal saline (D5NS) 5% dextrose and lactated Ringer (D5LR) 0.33% NaCl Normal saline
0.33% NaCl Of the fluids listed, the only one that is hypotonic is 0.33% NaCl. Normal saline is isotonic; both D5NS and D5LR are considered to be hypertonic solutions.
A patient who eats meals at 8:30 a.m., noon, and 6:00 p.m. administers isophane suspension insulin (NPH) at 8 a.m. Which time is the patient at the highest risk for hypoglycemia? 10:00 a.m. 2:00 p.m. 5:00 p.m. 8:00 p.m.
5:00 p.m. Breakfast would cover the onset of isophane suspension insulin, and lunch will cover the 2:00 p.m. time frame. If the patient does not eat a midafternoon snack, however, the insulin may peak just before dinner without sufficient glucose on hand to prevent hypoglycemia.
The laboratory INR results of a client receiving warfarin have been variable. The nurse interviews the client to determine factors contributing to the problem. Which is most important for the nurse to identify? a Use of analgesics b Serum glucose level c Serum potassium levels d Adherence to the prescribed drug regimen
Adherence to the prescribed drug regimen
After surgery a client develops a DVT and a pulmonary embolus. Heparin via a continuous drip is prescribed. Several hours later, vancomycin intravenously every 12 hours is prescribed. The client has one intravenous site: a peripheral line in the left forearm. What action should the nurse take?
Start another IV line for vancomycin and continue the heparin as prescribed (These drugs are incompatible in the same IV)
A client is taking warfarin. If an antidote is needed, which agent will the nurse anticipate being prescribed?
c. vitamin K
The patient with type 1 diabetes mellitus asks, "Why can't I take a sulfonylurea like my friend who has diabetes?" What is the nurse's best response? "You are unable to store glucose, because you do not have insulin, and sulfonylurea helps with glucose storage." "Sulfonylurea will lower your blood sugar too much, and you will be hypoglycemic." "Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." "You must be mistaken. If your friend has diabetes mellitus, she is taking insulin."
"Sulfonylurea increases beta-cell stimulation to secrete insulin, and with your type of diabetes, the beta cells do not contain insulin. This medication will not work for you." Sulfonylurea agents reduce serum glucose levels by increasing beta-cell stimulation for insulin release, decreasing hepatic glucose production, and increasing insulin sensitivity. It is administered for type 2 diabetes mellitus but will not be effective in type 1 as the beta cells are not functional.
The nurse is providing patient teaching for the drug miglitol for the patient with a diagnosis of type 2 diabetes. Which group of side effects should the nurse include in the patient teaching? Dehydration, hypoglycemia, and thirst Rash, gingivitis, and hypoglycemia Flatulence, hypoglycemia, and diarrhea Hypoglycemia, diaphoresis, and hypokalemia
Flatulence, hypoglycemia, and diarrhea Side effects of miglitol include flatulence, diarrhea, and abdominal pain.
Which finding would indicate to the nurse that a medication has activated beta2 receptors? Increased saliva production Hyperglycemia Bronchiolar constriction Uterine contractions
Hyperglycemia When beta2 receptors are stimulated, the nurse will observe dilation of bronchioles; gastrointestinal and uterine relaxation; increases in blood glucose through glycogenolysis in the liver, and increases in blood flow in skeletal muscles.
Which is the highest priority nursing intervention for a patient who is starting on metoprolol? Respiratory rate Urinary retention Peripheral pulses Lung sounds
Peripheral pulses Decreased cardiac output puts the patient at highest risk. This will be evident by the assessment of peripheral pulses.
Which electrolyte is the major ion of the intracellular space? Sodium Potassium Chloride Phosphorous
Potassium The major cation of intracellular fluid is potassium.
A HCP prescribed enoxaparin 30 mg subcut daily. Which measure would the nurse take when administering this medication? a. administer in the abdomen b. remove air pocket fro the prepackaged syringe before administering c. push over 2 minutes d. rub site after administration
a. administer in the abdomen
A client is treated with lorazepam for status epilepticus. What effect of lorazepam does the nurse consider therapeutic? a. depress the CNS b. slows cardiac contractions c. dilates tracheobronchial structures d. provides amnesia for the convulsive episode
a. depress the CNS
A nurse is caring for a client who is receiving aspirin therapy. Which clinical indicator would be related to this therapy? a. premature erythrocyte destruction b. prolong bleeding time c. atrophy of the liver d. urinary calculi
b. prolonged bleeding time
After teaching a family member how to administer subcutaneous enoxaparin sodium, how should a nurse evaluate the effectiveness of the training?
observe the family administer on the client
A client with dysrhythmia is admitted to telemetry for observation. In the morning the client asks for a cup of coffee. What is the nurse's best response?
"Coffee has caffeine that can affect your heart. It should be avoided."
A client with a history of pulmonary emboli is taking warfarin daily. The nurse teaches the client about foods that are appropriate to consume when taking this medication. The nurse evaluated that the client needs further teaching when the client makes which statement? 1"Eggs provide a good source of iron, which is needed to prevent anemia." 2"Yellow vegetables are high in vitamin A and should be included in the diet." 3"Milk and other high-calcium dairy products are necessary to counteract bone density loss." 4"Dark green leafy vegetables are high in vitamin K and should be eaten to prevent clotting."
"Dark green leafy vegetables are high in vitamin K and should be eaten to prevent clotting."
The nurse is working with a patient who has recently been started on a phenothiazine. The patient is also a new mother. What is the nurse's priority instruction to the patient? "Do not breastfeed while taking the medication." "Take this medication with food." "The drug should be taken with 8 ounces of water." "Take this medication on an empty stomach."
"Do not breastfeed while taking the medication." The phenothiazines are known to pass into breast milk. There are not specific requirements regarding the need to take with or without food or with specific amounts of fluid.
The nurse is teaching the patient how to administer insulin. What information is essential to include in the plan? "Inject the insulin at a 30-degree angle between the fat and muscle." "Do not mix any insulins in the same syringe." "Avoid administering the insulin into your arm." "For the most consistent absorption, inject the insulin into the abdomen."
"For the most consistent absorption, inject the insulin into the abdomen." The abdomen has the most consistent absorption because the blood flow to the subcutaneous tissue typically is not as affected by muscular movements as it could be in the arm or thigh. Insulin can be administered in the arm. The patient should be instructed to inject insulin at a 45- to 90-degree angle, not a 30-degree angle. Most insulins can be mixed.
Which statement indicates to the nurse that the patient needs additional teaching on oral hypoglycemic agents? "I will take the medication only when I need it." "I will report symptoms of fatigue and loss of appetite." "I will limit my alcohol consumption." "I will monitor my blood sugar daily."
"I will take the medication only when I need it." Oral hypoglycemic agents must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. When alcohol is ingested with certain oral hypoglycemic drugs, the hypoglycemic effect can be intensified. The patient may experience fatigue and loss of appetite as side effects of the medication, and these should be reported to the health care provider. The patient needs to closely monitor blood sugar.
The nurse is preparing to discharge a patient who is receiving acebutolol HCl. Which instruction will the nurse include in the medication teaching plan for this patient? "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." "If you become dizzy, do not take your medication for 2 days and then restart on the third day." "This medication may make you fatigued; increasing caffeine in your diet may help alleviate this problem." "Increase intake of green leafy vegetables to prevent bleeding problems that can be caused by this medication."
"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." Acebutolol HCl, a beta blocker, has negative chronotropic effects and could cause symptomatic bradycardia and/or heart block. The health care provider should be consulted before acebutolol is administered to a patient with bradycardia (heart rate less than 60 beats/min).
The nurse is teaching a patient about type 1 diabetes mellitus. Which statement made by the patient indicates effective learning? "Type 1 diabetes mellitus leads to acute hypoglycemia." "Patients with type 1 diabetes mellitus require exogenous insulin." "Type 1 diabetes mellitus accounts for about 90% of all diabetic cases." "The endogenous insulin levels are always elevated early in the disease."
"Patients with type 1 diabetes mellitus require exogenous insulin." Type 1 diabetes involves lack of insulin production. Hence, patients with type 1 diabetes require exogenous insulin to lower the blood glucose level. Type 1 diabetes results in acute hyperglycemia due to lack of insulin. The disease accounts for 10% of all cases and is usually seen in patients younger than 20 years. There is little or no endogenous insulin because the patient's body is unable to produce insulin.
A male patient 24 h post-op tells the nursing student that his nurse "gave him an extra shot of insulin and there must be some mistake." The nursing student verifies the patient received a sliding scale dose of insulin. What information should the nursing student provide to the patient? "The effects of surgery result in a decrease in your metabolic rate; this increases secretion of glucagon and increases your glucose levels." "Surgery often results in infection, and infection raises your glucose levels." "You received extra insulin today because you have not been eating." "Surgery can produce stress, which can produce stress; an additional small amount of insulin helps provide a constant glucose level."
"Surgery can produce stress, which can produce stress; an additional small amount of insulin helps provide a constant glucose level." Insulin may be administered in adjusted sliding doses that depend on individual blood glucose test results. When the diabetic patient has extreme variances in insulin requirements—such as with stress from hospitalization, surgery, illness, or infection—adjusted dosing or sliding-scale insulin coverage provides a more constant blood glucose level. Blood glucose testing is performed several times a day at specified intervals, usually before meals. A preset scale usually involves directions for the administration of rapid- or short-acting insulin.
The nurse teaches a patient about the peak action of neutral protamine Hagedorn (NPH) insulin and exercise. Which statement by the patient indicates a need for additional teaching? "I will always exercise right after I eat." "After breakfast is the best time for me to exercise." "The best time for me to exercise is every afternoon." "The best time for me to exercise is after my morning snack."
"The best time for me to exercise is every afternoon."
The patient newly diagnosed with type 2 diabetes mellitus has been ordered insulin glargine. What information is essential for the nurse to teach this patient? "This medication has a duration of action of 24 h." "This medication should be mixed with the regular insulin each morning." "This medication is very expensive, but you will be receiving it only a short time." "This medication is very short acting. You must be sure you eat after injecting it."
"This medication has a duration of action of 24 h." Insulin glargine has a duration of action of 24 h with no peaks, mimicking the natural, basal insulin secretion of the pancreas. This medication cannot be mixed with other insulins and is not a short-acting insulin. The patient may need to receive this medication for a long time.
What information will the nurse teach the patient who has been prescribed an alpha glucosidase inhibitor? "This medication will increase the sensitivity of insulin receptor sites." "This medication cannot be used in combination with other antidiabetic agents." "This medication will stimulate pancreatic insulin release." "This medication will delay the absorption of carbohydrates from the intestines."
"This medication will delay the absorption of carbohydrates from the intestines." Alpha glucosidase is an enzyme necessary for the absorption of glucose from the GI tract. Inhibiting this enzyme inhibits glucose absorption, delaying rises in postprandial serum glucose levels.
Which information would the nurse include when teaching a patient about the administration of metformin for treatment of type 2 diabetes mellitus? "You should take the medication with food." "If you miss a meal, you should skip the dose." "You should report any nausea immediately." "You have an increased risk for lactic acidosis."
"You should take the medication with food." Metformin acts by decreasing hepatic production of glucose from stored glycogen. Serum glucose is then decreased after a meal and blunts the degree of postprandial hyperglycemia. Metformin causes gastrointestinal disturbances; therefore the nurse would advise the patient to take the medication with food because it helps lessen the adverse effects. The nurse should not advise the patient to miss any meals or doses because it may not have therapeutic effects. It is not necessary to report nausea, because it can be lessened by taking the medication with food. Lactic acidosis is an extremely rare occurrence in patients who take metformin.
The nurse is teaching a patient who has been prescribed repaglinide. Which information should the nurse include in the teaching plan? "This medication is compatible with all of your cardiac medications." "This medication will not cause hypoglycemia." "This medication has no side effects." "You will need to be sure you eat as soon as you take this medication."
"You will need to be sure you eat as soon as you take this medication." Repaglinide is ashort-acting antidiabetic agent . The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal. Repaglinide interacts with beta-adrenergic blockers as well as other medications. Hypoglycemia is a side effect of this medication, and there are many other possible side effects of this medication.
The administration of a beta blocker and insulin may have which result? 1 Masked signs of hypoglycemia 2 Masked signs of hyperglycemia 3 Enhanced activity of the beta blocker drug 4 Decreased activity of the beta blocker drug
1 Masked signs of hypoglycemia The interaction of insulin and a beta blocker drug is known to result in masking of the signs of hypoglycemia, thus resulting in delayed recovery from the hypoglycemia, not hyperglycemia. There is not a decreased or enhanced activity of the beta blocker.
Which duration of intermediate-acting insulins supports the provision of a bedtime snack for a patient receiving neutral protamine Hagedorn (NPH) insulin at 7:30 a.m. each morning? 6 to 8 hours 9 to 13 hours 14 to 24 hours 6 to 36 hours
14 to 24 hours The knowledge that supports the provision of a bedtime snack for the patient taking NPH insulin is that onset of intermediate-acting insulin is 1 to 2 hours, peak action occurs in 4 to 12 hours, and the duration of action is 14 to 24 hours. To prevent a hypoglycemic reaction while the patient is sleeping, a bedtime snack is provided. The duration options of 6 to 8 hours and 9 to 13 hours are too short for the NPH insulin, and the duration option of 26 to 36 hours is too long for the NPH insulin.
Which medication is used in the treatment of angina? Incorrect 1 Propofol 2 Pravastatin 3 Propranolol 4 Propoxyphene
3 Propranolol Propranolol may be used to treat angina, whereas pravastatin is used for hyperlipidemia. Propofol is a central nervous system depressant that is used for inducing or maintaining anesthesia. Propoxyphene is an opioid that is used to treat mild to moderate pain.
Based on the condition of the patient, an intravenous fluid that is hypertonic will be ordered. Which intravenous fluid is most likely to be ordered by the health care provider? 0.33% NaCl 5% dextrose and normal saline Normal saline 2.5% dextrose and water
5% dextrose and normal saline Of the fluids listed, the only one that is hypertonic is 5% dextrose and normal saline. Normal saline is isotonic, and both 2.5% dextrose and water and 0.33% NaCl are considered to be hypotonic.
Which statement accurately describes the total body water (TBW) composition compared to weight? A 6 kilogram (13.2 lb) 2-month-old neonate is 75% to 80% water. A 60 kilogram 70-year-old is 75% water. A 3 kg 2-week-old is 95% water. A 70 kilogram (154 lb) 40-year-old man is 40% water.
A 6 kilogram (13.2 lb) 2-month-old neonate is 75% to 80% water. The TBW of a 70 kg (154 lb) man is approximately 60% (40 L). This percentage varies with age, sex, and percentage of body fat. Neonates are 75% to 80% water, whereas older adults are 45% to 55% water. Women tend to have less body water than men due to the effects of hormones and higher amount of adipose tissue, which contains very little water.
What is the nurse's best action when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? Administer subcutaneous regular insulin immediately. Start an insulin drip. Draw blood glucose level and send to the laboratory. Administer glucagon.
Administer glucagon. Glucagon stimulates glycogenolysis, raising serum glucose levels. The patient is showing signs of hypoglycemia.
Which intervention would the nurse implement when finding a patient with type 1 diabetes mellitus unresponsive, cold, and clammy? Start an insulin drip. Administer glucagon. Draw blood glucose level and send to the laboratory. Administer subcutaneous regular insulin immediately.
Administer glucagon. The nurse immediately administers glucagon because glucagon stimulates glycogenolysis, which raises serum glucose levels in this patient, who is showing signs of hypoglycemia. The patient is hypoglycemic, and insulin would further reduce the glucose level. Drawing blood glucose level and sending it to the laboratory takes time that is more appropriately spent administering glucagon before the patient dies. Administering subcutaneous regular insulin immediately would further reduce the glucose level in a patient who is already hypoglycemic.
What is the priority nursing intervention when administering intravenous potassium replacement to the patient? Administer the medication using an infusion device. Teach the patient and family the signs and symptoms of hypokalemia. Administer potassium as a bolus over 10 min. Apply heat to the site of intravenous administration.
Administer the medication using an infusion device. Too rapid infusion of potassium can cause cardiac dysrhythmias; an intravenous infusion device must always be used. Potassium should not be bolused or pushed. Heat will not aid the infusion. Unless the patient is prone to constant hypokalemia, teaching the signs and symptoms is not a priority.
The nurse is assessing a patient taking antipsychotics and notes that he has difficulty sitting still. The patient states that he is feeling "restless" as he paces the floor. What is the nurse's primary intervention? Administer the prescribed benzodiazepine. Stay with the patient and offer reassurance. Administer benztropine (Cogentin) as ordered. Stop the medication immediately and notify the health care provider.
Administer the prescribed benzodiazepine. Akathisia presents with restlessness and trouble standing still. This side effect is best treated with a benzodiazepine such as lorazepam. The medication is not stopped if a patient exhibits this type of effect. Cogentin is administered for Parkinson-like side effects, which this patient is not exhibiting. The symptoms displayed are most likely not just typical nervousness. Staying with the patient will not change the symptoms.
The patient undergoing catheter placement for total parenteral nutrition experiences coughing, shortness of breath, chest pain, and cyanosis. Which complication does the nurse suspect the patient is experiencing? Infection Pneumothorax Aspiration pneumonia Air embolism
Air embolism Coughing, shortness of breath, chest pain, cyanosis, hypotension, apprehension are symptoms of air embolism.
The nurse is caring for a patient whose medication regimen includes the benzodiazepine chlordiazepoxide. The nurse recognizes that the patient is most likely experiencing which condition? Seizures Alcohol withdrawal Insomnia Depression
Alcohol withdrawal Chlordiazepoxide is the benzodiazepine that is most frequently used with patients who are experiencing alcohol withdrawal rather than the other conditions listed.
The patient has been ordered to be treated with alprazolam. The nurse recognizes that the patient is most likely experiencing which condition? Anxiety with depression Alcohol withdrawal Seizures Insomnia
Anxiety with depression Alprazolam is known to be effective in treating anxiety that is associated with depression. It is not considered a first-line treatment for alcohol withdrawal, seizures, or insomnia.
A patient taking methylphenidate is nauseous and vomiting. What is the nurse's best action? Ask the patient if he or she has been taking the medication regularly. Monitor the patient's vital signs. Assess the patient's temperature. Administer an antiemetic medication.
Ask the patient if he or she has been taking the medication regularly. Nausea, vomiting, and headache are symptoms of withdrawal. The nurse should find out if the patient has been taking the medication regularly.
The nurse would be correct in identifying which outcome as the most serious complication of tube feedings? Bowel perforation Dehydration Constipation Aspiration pneumonia
Aspiration pneumonia Aspiration pneumonitis is one of the most serious and potentially life-threatening complications of tube feedings. Bowel perforation is a complication of placement, not feeding. Dehydration and diarrhea are expected side effects.
The nurse is caring for a patient who is starting clozapine. Which nursing intervention is a priority for this patient? Assess baseline white blood cell count and absolute neutrophil count. Evaluate suicidal tendencies. Take a baseline EEG. Evaluate creatinine clearance.
Assess baseline white blood cell count and absolute neutrophil count. Patients taking clozapine must be monitored for the life-threatening side effect of agranulocytosis. A baseline white blood cell count and absolute neutrophil count must be taken. Patients started on this medication are chronically and severely ill. Evaluation of suicidal tendencies would not need to happen before the patient started the medication. Patients on this medication may have an increased risk of seizures; however, a baseline EEG will not assist in predicting or preventing this side effect. This medication is metabolized before excretion. Evaluation of creatinine clearance is not a priority for the patient starting on the medication.
The patient receiving enteral feedings has poor skin turgor, and urinary output is 40 mL/h. What is the nurse's first intervention? Assess fluid intake. Monitor hemoglobin and hematocrit. Call the health care provider. Assess blood pressure.
Assess fluid intake. Dehydration can occur if the patient does not receive a sufficient amount of fluid with or between feedings.
The nurse is caring for a patient who has been recently diagnosed with hypertension and is to receive an initial dose of atenolol. What is the nurse's primary intervention? Assess the patient's urinary output. Assess for history of any respiratory disease. Teach the change position slowly. Encourage increase in fluid intake.
Assess for history of any respiratory disease. At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs. However, the drug can lead to bronchospasm, so the assessment should focus on the lungs. It is a part of the plan to caution the patient about hypotension, but it is not the priority.
The nurse is caring for a child taking methylphenidate (Ritalin). Assessment reveals a heart rate of 110, and the child is complaining of chest pain. What is the nurse's priority action? Assess for over-the-counter medication use. Stay with the child and use relaxation techniques. Hold the next dose of the medication. Administer an antianxiety agent.
Assess for over-the-counter medication use. Methylphenidate interacts with over-the-counter cold medication. The nurse should assess for the use of over-the-counter medication use.
A patient with cardiac decompensation is receiving dobutamine as a continuous infusion. The patient's blood pressure has increased from 100/80 mm Hg to 130/90 mm Hg. What is the nurse's priority action? Assess hourly blood pressure readings. Assess I&O and decrease IV fluids. Assess ECG and slow the infusion. Assess respiratory rate and measure ABGs.
Assess hourly blood pressure readings. The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the patient's heart rate, blood pressure, and urine output. An increase in blood pressure is the expected therapeutic effect.
The nurse is administering hypertonic saline solution to treat a patient with severe hyponatremia. Which is the priority nursing intervention? Monitor temperature. Assess skin for flushing and assess increased thirst. Administer antiemetic for vomiting. Monitor urinary output.
Assess skin for flushing and assess increased thirst. Flushed skin and increased thirst are signs and symptoms of hypernatremia.
A patient has been taking metoprolol and tells the home care nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's priority action? Call the drug company to ask for assistance. Assess the patient's blood pressure. Refer the patient to the social worker. Teach the patient that abrupt medication withdrawal may lead to a rebound hypertensive crisis.
Assess the patient's blood pressure. Abrupt withdrawal of a beta blocker can cause rebound hypertension. The nurse should immediately check the patient's blood pressure and then proceed with teaching,calling the health care provider and seeking out additional resources with which to help the patient
Which is the priority intervention when the nurse is assessing a patient with a potassium level of 3.2 mEq/L? Start IV fluids. Administer Kayexalate. Apply oxygen. Attach telemetry leads for monitoring.
Attach telemetry leads for monitoring. The patient is high risk for cardiac dysrhythmias due to low potassium level. Oxygen and IV fluids are not a priority; Kayexalate is am exchange resin used to treat hyperkalemia.
A primary HCP prescribes three stool specimens for occult blood for a client who has complains of blood-streaked stools and a 1-pound weight loss in 1 month. To ensure valid test results, what instruction should the nurse give the client?
Avoid eating red meat before testing Red meat can react with reagents used in the test to cause false-positive results. Testing the specimen while it is still warm may apply for testing for ova and parasites, but not for occult blood. If the correct procedure is followed, discarding the first specimen is unnecessary. Random stool testing can be done but must be on three different bowel movements during the screening period.
The nurse is caring for a patient who is prescribed propranolol. Which assessment finding if identified by the nurse will reveal if the medication is having a therapeutic effect? Sinus rhythm noted Lungs sounds are clear Blood pressure is 130/75 mm Hg Strong peripheral pulses noted
Blood pressure is 130/75 mm Hg. Propranolol is nonselective—it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The patient's blood pressure is within normal limits, which indicates therapeutic effect.
The nurse expects that a newborn who is experiencing apnea is most likely to be ordered treatment with which medication? Caffeine citrate Benzphetamine HCl Diphenhydramine Diethylpropion HCl
Caffeine citrate Caffeine citrate can be used as a respiratory stimulant for newborns experiencing apnea.
The nurse is caring for a patient diagnosed with heart failure and chronic obstructive pulmonary disease (COPD). The patient is ordered a nonselective beta blocker. What is the nurse's primary intervention? Call the health care provider to request a different medication. Maintain the patient on intake and output. Assess the heart rate before administration. Make sure the patient is on telemetry monitoring.
Call the health care provider to request a different medication. Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure and COPD. The patient could receive a selective beta blocker instead. The nurse should make the health care provider aware of the patient's history of respiratory disease.
Which of the following actions if taken by a nursing student should alert the nurse that additional instruction is needed with regard to enteral feeding administration? Perform patient identification prior to starting therapy. Head of bed is elevated between 30 to 45 degrees based on patient's comfort position. Check gastric residual immediately following feeding. Auscultated bowel sounds prior to starting therapy.
Check gastric residual immediately following feeding. To promote enteral safety, the nurse (or nursing student) should properly identigfy the patient, elevate the head of the bed between 30 to 45 degrees, and auscultate bowel sounds by performing a GI assessment and check tube placement prior to administering a tube feeding. Checking for gastric residual immediately following the tube feeding is contraindicated. Checking for residual should be done prior to tube feedings and then 3 to 6 hours following a feeding.
The patient has been ordered to receive a unit of packed red blood cells. What is the priority nursing action prior to initiating the infusion of the blood product? Verify that a large bore IV is in place. Verify that the permit for infusion was witnessed. Collect the blood product from the blood bank. Confirm the identity of the patient.
Confirm the identity of the patient. Although all of the actions listed are important, the highest priority is confirmation of the identity of the patient. Failure to do this is a major safety violation.
The health care provider has written an order for a critically ill patient to receive enteral feedings. The nurse anticipates that the provider will order which administration mode? Intermittent infusion Continous feeding Bolus Cyclic
Continous feeding For critically ill patients, the healthcare provider will order continous feedings by infusion pump. The other feeding modes would not provide sufficient nutritional benefit to the patient.
The patient asks the nurse if there is anything that the physician could order that would function as an appetite suppressant. The nurse anticipates that the physician may order which medications? (Select all that apply.) Diethylpropion HCl Phentermine-topiramate Armodafinil Benzphetamine HCl Caffeine citrate
Diethylpropion HCl Phentermine-topiramate Benzphetamine HCl
A patient receiving a unit of red blood cells suddenly develops shortness of breath, chills, and fever. What will the nurse do first? Reassure the patient that this is an expected reaction. Notify the health care provider while a peer monitors the blood transfusion. Decrease the infusion rate and reassess the patient in 15 min. Discontinue the infusion.
Discontinue the infusion. These are signs and symptoms of a blood transfusion reaction that could escalate to anaphylaxis; therefore, the blood transfusion should be stopped immediately.
The patient is suspected of having overdosed on a benzodiazepine medication. The nurse expects that the health care provider will prescribe which medication? Oxazepam Buspirone HCl Lorazepam Flumazenil
Flumazenil
Which intervention is a priority for the nurse to take when providing care for a patient with type 2 diabetes who reports a headache, jitteriness, and nervousness after the administration of glyburide? Give the patient a glass of orange juice. Check the patient's serum blood glucose level. Assess the patient's blood pressure and apical pulse. Determine when the last antidiabetic medication was administered.
Give the patient a glass of orange juice. The patient is experiencing signs of a hypoglycemic reaction; therefore the nurse must first immediately administer some type of simple-acting glucose such as orange juice. The nurse would next check the patient's serum blood glucose level by drawing a venipuncture blood sample and sending it to the laboratory. The nurse should assess the patient's vital signs in any abnormal situation, but the symptoms described address diabetes. Determining when the last oral hypoglycemic medication was administered is the nurse's third appropriate intervention.
The nurse is working with a patient who is receiving haloperidol. Which finding in the patient's history should cause the nurse to question the use of this drug? Irritable bowel disease Prostatic hypertrophy Glaucoma Hypertension
Glaucoma A contraindication for the use of haloperidol is glaucoma. The other findings would not affect the use of this drug.
A nurse is preparing to administer a beta blocker to a patient. The nurse recognizes that beta blockers are used to treat which conditions? (Select all that apply.) Sinus bradycardia Hypertension Chronic obstructive pulmonary disease (COPD) Cardiogenic shock Angina pectoris Congestive heart failure (CHF)
Hypertension Angina pectoris CHF
Which finding would indicate to the nurse that a medication has activated alpha1 receptors? Increase in blood pressure Increased saliva production Pupillary constriction Bradycardia
Increase in blood pressure When alpha1 receptors are stimulated, the nurse will see increases in force of heart contraction; vasoconstriction increases blood pressure; mydriasis (dilation of pupils) occurs; secretion in salivary glands decreases; urinary bladder relaxation and urinary sphincter contraction increases.
Which is the most appropriate action for the nurse who is told that a patient typically takes his glipizide with food? Inform the patient that the medication must be taken 15 min after a meal. Immediately check the patient's blood glucose level. Immediately call the health care provider. Inform the patient that it is better to take the medication 30 min before a meal.
Inform the patient that it is better to take the medication 30 min before a meal. Food inhibits the absorption of glipizide, the only sulfonylurea agent that should be given 30 min before a meal. The blood glucose level does not have to be taken right away. The medication is not to be taken after a meal. The health care provider does not have to be called; the nurse should intervene.
The nurse is working with a patient who has recently been started on temazepam. The nurse recognizes that the patient is most likely experiencing which condition? Depression Anxiety Seizures Insomnia
Insomnia Temazepam is used to treat insomnia. It is not recommended for treatment of anxiety, seizures, or depression.
Which hormone plays a role in regulation of glucose homeostasis? Select all that apply. One, some, or all responses may be correct. Insulin Glucagon Glycogen Dextrose Ketone
Insulin Glucagon Insulin and glucagon are the hormones produced by the pancreas that play an important role in the regulation of glucose homeostasis. They are responsible for the use, mobilization, and storage of glucose by the body.
After a DVT developed in a postpartum client, an IV infusion of heparin therapy was instituted 2 days ago. The client's aPTT is now 98 seconds. What should the nurse do next?
Interrupt the infusion and notify the primary healthcare provider of the aPTT result. The heparin should be withheld, because 98 seconds is almost three times the normal time it takes a fibrin clot to form (25 to 36 seconds), and prolonged bleeding may result; the therapeutic range for heparin is one-and-a-half to two times the normal range. The primary healthcare provider should be notified. The dosage of heparin must not be increased, because the client already has received too much. Documenting the result on the medical record and rechecking the aPTT in 4 hours is an unsafe option. Continuing the infusion could result in hemorrhage. The medication does not have to be changed; it should be stopped temporarily until the aPTT is within the therapeutic range.
A patient with type 1 diabetes mellitus has been ordered insulin aspart 10 units at 7:00 AM. What nursing intervention should the nurse perform after administering this medication? Make sure the patient eats breakfast immediately. Perform a fingerstick blood sugar test. Flush the IV. Have the patient void and dipstick the urine.
Make sure the patient eats breakfast immediately. Insulin aspart is a rapid-acting insulin that acts in 15 min or less. It is imperative that the patient eats as it starts to work. The patient should have had a fingerstick blood sugar test done before receiving the medication. There is no need to check the urine. This medication is given subcutaneously.
The nurse is caring for a patient who describes symptoms indicative of narcolepsy. The nurse recognizes that the physician is most likely to order which medication for the patient? Phentermine-topiramate Diethylpropion HCl Benzphetamine HCl Modafinil
Modafinil Modafinil (Provigil) is indicated for treatment of narcolepsy.
What is a priority nursing action when taking care of a patient who is prescribed a central nervous system (CNS) stimulant? Continuously monitor the patient's pulse rate. Keep the patient on bed rest. Obtain a bedside commode for the patient. Monitor the patient for seizure activity.
Monitor the patient for seizure activity. Central nervous system (CNS) stimulation occurs when the amount and duration of action of excitatory neurotransmitters are increased. This can lead to the development of seizure activity in the patient who has received a central nervous system stimulant.
The patient is ordered an isotonic intravenous fluid. Which intravenous fluid is most likely to be ordered by the health care provider? 5% dextrose and lactated Ringer (D5LR) 0.33% NaCl Normal saline 5% dextrose and normal saline (D5NS)
Normal saline Of the fluids listed, the only one that is isotonic is normal saline. Both D5NS and D5LR are considered to be hypertonic solutions; 0.33% NaCl is considered to be hypotonic.
The nurse is preparing to administer a transfusion of a blood product. What is the most appropriate intravenous fluid to hang as a maintenance infusion? Lactated Ringer 5% dextrose and water Ringer solution Normal saline
Normal saline Of the intravenous solutions listed, the only one that is compatible with blood products is normal saline.
Which is a priority nursing action when assessing for side effects expected in a patient taking analeptics? Observing patient for nervousness Checking blood pressure for hypotension Assessing for decreased mental alertness Ausculating heart rate for bradycardia
Observing patient for nervousness Analeptics are CNS stimulants, which cause nervousness as a side effect. The stimulation effect can result in increased heart rate, increased mental alertness, and hypertension as well.
The nurse is assessing a patient receiving enteral feedings. Which finding should alert the nurse to a potential complication? Persistent coughing by the patient Residual checks for the past 24 hours have been within normal range. Bowel sounds slightly hypoactive in all 4 quadrants. Patient prefers to sit up in bed.
Persistent coughing by the patient. A potential complication of tube feedings is that of aspiration pneumonia. The fact that patient has persistent coughing is of concern. Residual checks within range is a normal finding. Patient's preference to sit up is noted with out signficance. Bowel sounds being slightly hypoactive would need to be monitored but it at this time it is not significant.
The health care provider has indicated that the patient requires an elemental enteral feeding preparation. The nurse understands that elemental feedings are used in treating which type of patient? Patient with renal disease. Patient who is hypertensive. Post gastrointestinal surgical intervention Diabetic patient with a hemoglobin A1c level of 10%
Post gastrointestinal surgical intervention Elemental feedings contain macronutrients that are hydrolized to increase absorption and are available in different energy and protein densities. They are typically used in the treatment of patients with impaired gastronintestinal or pancreatic dysfunction. Specialty formulas would be indicated for patients who are diabetic or who have renal disease. There is no specific formula type seletion for patients who have hypertension.
Which of the following conditions would meet the medically approved criteria for use of CNS stimulants? (Select all that apply.) Promotion of wakefulness in narcolepsy Reversal of respiratory distress Severe depressive states. Weight loss in the morbidly obese Attention-deficit/hyperactivity disorder in children
Promotion of wakefulness in narcolepsy Reversal of respiratory distress Attention-deficit/hyperactivity disorder in children Medically approved use of CNS stimulants is limited to the treatment of attention-deficit/hyperactivity disorder in children, narcolepsy, and the reversal of respiratory distress. Although the drug has anorexiant properties, this is not its medically approved indication. It is not indicated for depression.
The nurse is caring for a patient receiving total parenteral nutrition (TPN). Which interventions will the nurse include in the patient's plan of care? (Select all that apply.) Protect the solution from exposure to light at all times. Monitor blood glucose levels per protocol. Keep TPN solution that is not in use at room temperature. Accelerate the rate of infusion to keep the infusion on time as needed. Monitor the patient for changes in temperature. Monitor intake and output.
Protect the solution from exposure to light at all times. Monitor blood glucose levels per protocol. Monitor the patient for changes in temperature. Monitor intake and output.
The nurse administers insulin to a patient at 8:30 a.m. and knows it will peak about 2.5 hours after administration. Which insulin did the nurse administer? Aspart Lispro Regular Glulisine
Regular insulin Regular insulin peaks about 2.5 hours after the drug's administration. If the drug is given at 8:30 a.m., it will have its peak effects at 11:00 a.m., and at that time the nurse would observe for signs of hypoglycemia. Insulin lispro, insulin aspart, and insulin glulisine are all considered rapid-action insulin. The onset of action for these drugs is about 15 minutes, and the effects do not last as long as other classes of insulin.
The patient has been ordered a medication regimen that includes Loxitane. During instructional sessions regarding the medication, the nurse should emphasize which information? (Select all that apply.) Extrapyramidal symptoms can occur. Sedation can occur. Nausea reduction will occur. Hypotension is likely.
Sedation can occur. Hypotension is likely. Loxitane is known to cause sedation, hypotension, and extrapyramidal symptoms. Nausea may result as a side effect of Loxitane.
The patient is receiving a bolus feeding through a gastrostomy tube and develops diarrhea. What is a priority nursing intervention? Slow the bolus feedings. Call the health care provider. Finish the bolus and continue to monitor the patient. Stop the feeding and administer an antispasmodic.
Slow the bolus feedings. Diarrhea can be caused by rapid administration of feeding, high caloric solutions, malnutrition, gastrointestinal bacteria, and drugs. Diarrhea can usually be managed or corrected by decreasing the feeding flow rate, and as diarrhea lessens, the feeding flow rate can be gradually increased.
Which electrolyte is the major cation of extracellular fluid? Sodium Chloride Potassium Phosphorous
Sodium The major cation of extracellular fluid is sodium.
The patient is receiving enteral feedings through a gastrostomy tube at a rate of 100 mL/h. The nurse assesses residual volume as 80 mL. What is the nurse's priorty intervention? Assess the patient's bowel sounds. Discard the residual volume and continue to monitor the feeding. Decrease the feeding to 80 mL/h for the next hour. Stop the feeding for 1 h and reassess.
Stop the feeding for 1 h and reassess. The residual volume should not be greater than 50% of the hourly rate. This indicates that the feeding is not absorbing. The feeding should be stopped for an hour, and then the residual volume should be reassessed.
The nurse finds that the patient's enteral feeding is infusing at 150 mL/h instead of the ordered rate of 50 mL/h. What is the nurse's priority action? Stop the infusion and check the patient. Notify the health care provider of the error. Call the pharmacy to stop the next bag. Complete an incident report.
Stop the infusion and check the patient. Although all of the actions should be completed at some point, the highest priority is the patient's safety. Thus, the infusion should be stopped, the patient's condition assessed, and the rate then clarified.
The nurse assesses the peripheral intravenous infusion site of a patient receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action? Stop the infusion. Elevate the patient's extremity. Apply a cold pad to the site. Pull the IV immediately.
Stop the infusion. The nurse's first action is to stop the infusion, followed by infusing phentolamine into the area to counteract vasoconstrictive effects of the dopamine.
The health care provider has ordered 5% dextrose in water as a maintenance fluid for the patient. The nurse is assessing the patient at the beginning of the shift and observes the fluid hanging to be 50% dextrose in water (D50W). Which is the priority nursing action? Notify the health care provider of the error. Stop the infusion. Complete an incident report. Find out which nurse hung the D50W.
Stop the infusion. The patient's safety is always the primary concern; the fluid should be stopped and the correct fluid hung before other measures are taken such as notifying the health care provider.
Which suggestion should the nurse provide to the parents of a child taking methylphenidate for attention-deficit/hyperactivity disorder to offset anticipated side effects? Take the medication with grapefruit juice. Suck on hard candy. Decrease fluid intake prior to bedtime. Increase vitamin C in the diet.
Suck on hard candy. Side effects of amphetamines include dry mouth. Sucking on hard candy can help eliminate this effect. Vitamin loss does not accompany the use of amphetamines. Dehydration is not a common side effect, and grapefruit juice could alter the metabolism of the drug.
A nurse is assessing an adolescent after the administration of epinephrine. What side effect is most important for the nurse to identify? a. hypoglycemia b. constricted pupils c. tachycardia d. decreased blood pressure
Tachycardia Epinephrine is a sympathetic nervous system stimulant that causes tachycardia.Hyperglycemia, not hypoglycemia, may result.The pupils will be dilated, not constricted.Epinephrine is more likely to cause hypertension than hypotension.
The nurse will hold the next dose of antipsychotic medication for which patients? (Select all that apply.) The patient with a sitting blood pressure of 130/90 mm Hg and 100/80 mm Hg when standing. The patient who has pill-rolling motions of the hand. The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips. The patient who has a sudden high fever.
The patient who presents with protrusion and rolling of the tongue and smacking movements of the lips. The patient who has a sudden high fever. The patient with protrusion and rolling of the tongue and smacking movements of the lips most likely is displaying symptoms of tardive dyskinesia. The medication should be stopped in any patient displaying these symptoms. A patient with a sudden high fever may be experiencing neuroleptic malignant syndrome; immediate withdrawal of the medication is needed. Orthostatic hypotension is a common occurrence with many antipsychotic medications and is not a reason to stop the medication. Pill-rolling motions of the hand may indicate Parkinson-like extrapyramidal side effects. This is not a reason to stop the medication. Treatment is aimed at controlling the side effects.
Which early symptom of hypoglycemia would the nurse instruct the patient's family to treat with a fast-acting carbohydrate source? Select all that apply. One, some, or all responses may be correct. Coma Tremor Sweating Confusion Nervousness
Tremor Sweating Confusion Nervousness Early symptoms of hypoglycemia involve the central nervous system because the brain needs a constant supply of glucose to function. Hence tremors, sweating, confusion, and nervousness are symptoms seen in patients. When these symptoms occur, the family should have the patient immediately ingest a fast-acting carbohydrate source such as glucagon, milk, or juice. Coma occurs if the patient's glucose levels are not restored.
The nurse assesses a patient receiving an adrenergic (sympathomimetic) agent. Which finding will be of greatest concern to the nurse? Heart rate of 95 beats per minute and strong peripheral pulses. Increased peripheral pulses and increased heart rate. Weak peripheral pulses and decreased heart rate. Stable blood pressure and increased cardiac output.
Weak peripheral pulses and decreased heart rate. Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug, as the therapeutic effect is not being achieved.
A client is on antipsychotic therapy for schizophrenia. During a follow-up visit, the nurse suspects acute akathisia. Which symptoms in the client support the nurses suspicion? Select all that apply. a. restless movement b. agitation c. stooped posture d. anxiety e. rigidity
a. restless movement b. agitation d. anxiety
The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the healthcare provider has prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse will teach the client to take the medication on which schedule? a. with a meal b. at a specific time prescribed c. until symptoms are gone d. only at bedtime
b. at a specific time prescribed
A client presents to the emergency department with weakness and dizziness. The blood pressure is 90/60 mm Hg, pulse is 92 and weak, and body weight reflects a 3-pound (1.4 kg) loss in two days. The weather has been hot. Which condition should the nurse conclude is the priority for this client? a. inadequate nutritional intake b. deficient fluid volume c. impaired skin integrity d. decreased participation in activities
b. deficient fluid volume
What medication does the nurse expect to administer to actively reverse the overdose sedative effects of benzodiazepines? a. chlorpromazine b. flumazenil c. lithium d. methadone
b. flumazenil
During the administration of TPN, an assessment of the client reveals a bounding pulse, distended jugular veins, dyspnea, and cough. What is the priority nursing intervention? a. restart the client's infusion at another site b. interrupt the client's infusion and notify the HCP c. slow the rate of the client's infusion of the TPN d. obtain the vital signs and continue monitoring the client's status
b. interrupt the client's infusion and notify the HCP The client is experiencing pulmonary edema because of fluid volume excess. The high concentration of TPN precipitates a fluid shift from the interstitial compartment into the intravascular compartment. Fluid will continue to be infused, which will continue to increase the intravascular volume.
A client is admitted to the hospital with a diagnosis of DVT, and IV heparin sodium is prescribed. If the client experiences excessive bleeding, what should the nurse prepare to administer? a. oprelevkin b. protamine sulfate c. vitamin K d. warfarin sodium
b. protamine sulfate
A client who had a femoropopliteal bypass graft is receiving clopidogrel postoperatively. What should the nurse teach the client related to the medication? a. take the medication on an empty stomach b. report any occurrence of multiple bruises c. eat more roughage if constipation occurs d. eliminate grapefruit from the diet
b. report any occurrence of multiple bruises
A client receiving the medication buspirone is admitted to the hospital with the diagnosis of possible hepatitis. The nurse identifies that the clients sclera look yellow. What will be the nurses initial action? a. ensure that the medication an be given parenterally b. withhold the medication c. reduce the dosage fo the medication d. give the buspirone with milk
b. withhold the medication
To prevent excessive bruising when administering subcutaneous heparin, what technique will the nurse employ? a. use 2 mL of sterile NS to dilute the heparin b. inject the drug into the vastus lateralis muscle in the thigh c. avoid massaging the injection site after the injection d. administer the injection via the Z-track technique
c. avoid massaging the injection site after the injection
A nurse administers sodium polystyrene sulfonate to a client with chronic renal failure. Which finding provides evidence that the intervention is effective? a. frequent loose stools b. sodium increases to 137 mEq c. potassium decreases to 4.3 mEq d. improved mental status
c. potassium decreases to 4.3 mEq
The registered nurse is teaching the nursing student about the interventions the be followed while caring for a client undergoing treatment with anxiolytic drugs. Which statement made by the nursing student indicated the need for further teaching? a. "I should monitor vital signs of the client." b. "I should check the client's oral cavities for cheeking of drugs." c. "I should encourage the client to use compression stockings." d. "I should encourage the client to change positions quickly."
d. "I should encourage the client to change positions quickly."
A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effects may be irreversible? a. akathisia b. acute dystonic reaction c. parkinsonian syndrome d. tardive dyskinesia
d. Tardive dyskinesia Tardive dyskinesia occurs as a late and persistent extrapyramidal complication of long-term antipsychotic therapy. It is most often manifested by abnormal movements of the lips, tongue, and mouth. The other side effects are reversible with administration of an anticholinergic (e.g., benztropine [Cogentin]) or an antihistamine (e.g., diphenhydramine [Benadryl]) or cessation of the medication.
An older adult with cerebral arteriosclerosis is admitted with afib and is started on a continuous heparin infusion. What clinical finding enables the nurse to conclude that the anticoagulant therapy is effective? a. an absence of ecchymotic areas b. a decreased viscosity of the blood c. a reduction of confusion d. an activated partial thromboplastin twice the usual value
d. an activated partial thromboplastin (APTT) twice the usual value
Haloperidol 100 mg IM stat has been prescribed for a client who is battered and agitated after a street brawl. What does the nurse conclude after reviewing the prescription? a. the route of administration is incorrect b. the medication is appropriate and should be given as prescribed c. the medication is inappropriate because it take one week for antidepressants to be effective d. the dose is more than recommended
d. the dose is more than recommended
The nurse rotates the general injection site every _____ to prevent lipodystrophy.
every week Lipodystrophy is damage to the adipose tissue due to continued insulin injections to a specific area.
Warfarin is prescribed for a client who has been receiving intravenous heparin for a partial occlusion of the left common carotid artery. The client expresses concern about why both drugs are needed at the same time. What rationale does the nurse include to address the client's concern?
heparin provides anticoagulant effects until warfarin reaches therapeutic levels
A client develops thrombophelbitis in the right calf. Bed rest is prescribed, and an IV of heparin is initiated. What drug action will the nurse include when describing the purpose of this drug to the client?
prevents extension of the clot
Before a cholecystectomy, vitamin K is prescribed. The nurse recognized that this is ordered because vitamin K contribute to the formation of which substance? thromboplastin prothrombin cholecystokinin bilirubin
prothrombin Vitamin K is necessary in the formation of prothrombin to prevent bleeding.
