ARCHER - CAT EXAM

The nurse is teaching progressive relaxation techniques to a client. Which of the following statements by the client indicates that the teaching has been effective? Select all that apply. "I will breathe in and out in rhythm." "I expect my pulse to be faster afterwards." "I expect to require less pain medication." "I expect my muscles to feel less tense." "I will report any increased sensitivity."

Additional Info Clients who are unable to perform progressive relaxation due to advanced disease, immobility, or decreased energy can still benefit from passive relaxation or guided imagery. Passive relaxation involves slow, mindful breathing without tensing and relaxing the muscles. Imagery, or visualization, involves consciously using the mind to call forth mental images such as ocean waves along with the rhythm of the breath. These techniques can stimulate a similar relaxation response without expending additional physical energy.

Buerger's disease

(also known as thromboangiitis obliterans) affects blood vessels in the body, most commonly in the arms and legs. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene (the death or decay of body tissues)

The nurse in a community-based setting teaches clients about prostate cancer risk factors. Which of the following risk factors should the nurse share with the group? A. diet high in animal fat B. erectile dysfunction C. human immunodeficiency virus (HIV) D. human papillomavirus (HPV)

Choice A is correct. A diet high in animal fat, especially red meat, is a strong risk factor for prostate cancer. Strong risk factors for prostate cancer include - African American ethnicity Increasing age, especially after age 40 Choice B is incorrect. Erectile dysfunction is not a risk factor for prostate cancer. Erectile dysfunction may be a harbinger of cardiovascular disease. Choice C is incorrect. HIV is a risk factor for testicular cancer, not a risk factor for prostate cancer. Choice D is incorrect. HPV is a risk factor for colorectal, cervical, and head & neck cancer. It is not a risk factor for prostate cancer.

The nurse is providing discharge instructions to a client with hepatitis A. Which of the following instructions should the nurse include? A. You will need to take daily showers or baths with chlorhexidine. B. It is important to clean common surfaces with warm soapy water. C. You will need to have repeat stool testing to determine if you are still infectious. D. Check with your primary healthcare provider prior to taking any medications.

Choice D is correct. While a client is being treated for hepatitis, they should consult with their primary healthcare provider, so they are not taking any medications or substances that are hepatotoxic. Exposing a client with hepatitis to a hepatotoxic medication would significantly complicate their recovery. Choices A, B, and C are incorrect. Having the client shower with chlorhexidine is not an appropriate teaching point for hepatitis A. The pathogen spreads through contaminated food, water, and surfaces. The primary mode of transmission is fecal-oral. Surfaces contaminated with hepatitis should be sanitized with a bleach solution, not warm soapy water. Repeat stool testing is not indicated for hepatitis as diagnosis of hepatitis is made through serum hepatitis-A antibodies.

Asterixis

a clinical sign that describes the inability to maintain sustained posture with subsequent brief, shock-like, involuntary movements. This motor disorder is myoclonus characterized by muscular inhibition (whereas muscle contractions produce positive myoclonus)

The nurse performs a physical assessment on a client and observes the following finding while the client has their arms extended. The nurse understands that this finding is consistent with which of the following? A. Rheumatic fever B. End-stage renal disease C. Neuroleptic Malignant Syndrome (NMS) D. Human Immunodeficiency Virus (HIV)

Additional Info These brief shock-like movements may be associated with conditions such as hepatic encephalopathy, end-stage renal disease, and drug intoxication with phenytoin. Most asterixis is bilateral but unilateral asterixis may develop because of pathology in the brain.

The nurse is assessing a child suspected of having hemophilia A. Which of the following findings would support the diagnosis of hemophilia A? Select all that apply. prolonged activated partial thromboplastin time (aPTT) thrombocytopenia hematuria prolonged international normalized ratio (INR) increased red blood cell (RBC) count

Additional Info ✓ Hemophilia is a genetic disorder that may be mild, moderate, or severe. Severe hemophilia is highly concerning because it may cause spontaneous bleeding without any trauma. ✓ Bleeding from hemophilia is commonly found in the joints (hemarthrosis). ✓ Factor VIII and IX assays are used to diagnose hemophilia along with clinical manifestations. A prolonged aPTT supports the diagnosis of hemophilia. ✓ Treatment for hemophilia is factor VIII concentrates or desmopressin (DDAVP) for mild cases.

The nurse is caring for a 16-year-old client with cystic fibrosis. The client develops a temperature of 101.2° F (38.4° C). The nurse should obtain a prescription for A. azithromycin. B. pancrealipase. C. multivitamin. D. albuterol.

Choice A is correct. Administering azithromycin (antibiotic) is the top priority for a client with cystic fibrosis (CF) who develops a fever. Due to the excessively thick mucus that builds up in their bronchi and bronchioles, individuals with CF are incredibly susceptible to respiratory infections. A fever indicates infection and aggressive management is the top priority. Choice B is incorrect. Pancreatic enzymes, such as pancrelipase, are administered to individuals with CF within 30 minutes of any meal and snack. These are given to aid digestion since the excessive, sticky mucus clogs up the pancreatic duct in these clients. This is a standard medication given daily but is not the top priority when a client with CF develops a fever. Choice C is incorrect. A multivitamin is a standard medication for individuals with CF. Due to the buildup of excessive, sticky mucus in their bile duct, individuals with CF do not absorb fat normally. This leads to a deficiency in fat-soluble vitamins, vitamins A, D, E, and K. This is a standard medication daily but is not the top priority when this client develops a fever. Choice D is incorrect. Albuterol is a bronchodilator frequently given as a nebulizer treatment to clients with CF. Although this medication might be given top priority if the client was experiencing respiratory difficulty, the question states they have developed a fever. Due to this finding, IV antibiotics are the top priority as CF clients are susceptible to infections.

The RN is caring for a client who is recovering from carotid endarterectomy. Which assessment would the nurse recognize as a sign that the client experienced hypoglossal nerve injury? A. Tongue deviation B. Inspiratory stridor C. Tracheal deviation D. Severe headache

Choice A is correct. Carotid endarterectomy is a procedure to remove plaque build-up in the carotid artery to improve blood flow to the brain. Complications following this procedure include cranial neuropathies, hemodynamic instability, stroke, myocardial infarction, and hematoma. Hypoglossal nerve damage is one of the most common cranial neuropathies following carotid endarterectomy and would be displayed as tongue deviation. Choice B is incorrect. Inspiratory stridor or hoarseness would suggest injury to the laryngeal nerve. Choice C is incorrect. A tracheal deviation would suggest possible carotid artery hemorrhage due to blood collecting and putting pressure on the airway. Choice D is incorrect. A severe headache following this procedure would suggest cerebral hyperperfusion syndrome (CHS) due to increased blood flow to the brain and insufficient cerebrovascular autoregulation.

A 16-year-old adolescent client is brought to the emergency department following an injury at a skating rink. The client's left knee is bruised and swollen. Upon interview, the nurse finds out that the client has hemophilia A. Which medication would be most appropriate for this client? A. Codeine phosphate B. Aspirin C. Ibuprofen D. Oxycodone terephthalate and acetyl-salicylate

Choice A is correct. Codeine phosphate is an analgesic medication with no aspirin components and is used for moderate to severe pain. Choice B is incorrect. Clients with hemophilia should avoid aspirin (and all other nonsteroidal anti-inflammatory drugs (NSAIDS)), as these medications inhibit proper platelet functioning. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID). If given to this client, aspirin would aggravate the client's condition by inhibiting platelet aggregation, likely increasing this client's bleeding and worsening this client's current condition. Choice C is incorrect. As mentioned above, clients with hemophilia should avoid nonsteroidal anti-inflammatory drugs (NSAIDs), as these medications inhibit proper platelet functioning. Ibuprofen is an NSAID and should therefore be avoided in clients with hemophilia. Choice D is incorrect. Oxycodone terephthalate and acetylsalicylic acid possess aspirin. Acetylsalicylic acid (ASA) is a generic name for aspirin. Similar to Choice B, the aspirin in this medication renders this choice contraindicated for this client. Hemophilia clients should avoid all aspirin-containing medications, as these medications inhibit proper platelet functioning. If given to this client, aspirin would aggravate the client's condition by inhibiting platelet aggregation, likely increasing this client's bleeding and worsening this client's current condition.

The nurse is performing a follow-up assessment on a client who was prescribed carbidopa/levodopa. Which assessment finding would indicate a therapeutic finding from this medication? A. Decrease in tremors B. Improvement in the excessive drooling C. Reduction in seizure activity D. Improvement in muscle spasticity

Choice A is correct. In most clients with Parkinson's, resting tremor of one hand is often the first symptom. The classic sign associated with Parkinson's disease is the "pill-rolling" nature of the hand tremors. More specifically, this involves the wrist and fingers, or the thumb moving against the index finger (pill-rolling), as when an individual rolls a pill in their hand or handles a small object. Treatment is considered valid when these tremors are lessened. Choice B is incorrect. Excessive drooling (sialorrhea) is a common manifestation of Parkinson's disease. Levodopa-carbidopa helps reduce the motor symptoms of Parkinson's disease but not the sialorrhea. Medications used to help reduce this symptom include atropine sublingual. Choice C is incorrect. Seizures are also not associated with Parkinson's disease. This would be a desired effect of a medication such as topiramate for an individual with epilepsy. Choice D is incorrect. Muscle spasticity is not associated with Parkinson's disease. This is a clinical feature of multiple sclerosis. Individuals with Parkinson's disease often experience muscle stiffness.

The nurse is performing an assessment on a client newly admitted to the medical-surgical unit. Which question would be appropriate for the nurse to ask when assessing the client's spirituality? A. "What are your sources of hope and strength?" B. "Have you considered arranging a visit from members of your church?" C. "Do you attend worship any specific day of the week?" D. "Can you tell me about your dietary preferences and any restrictions?"

Choice A is correct. Spirituality and religion are not synonymous. Spirituality refers to an interpretation of the client's beliefs regarding their own would or spirit and a connection bigger than oneself. Spirituality is fluid and often evolves. Religion is structured and may have a specific God or gods. Religion is often ritualistic and may involve readings from a well-regarded book or text. Spirituality is fluid and is purely internal to one's ability to feel connected and look inside for hope and strength. Religion often looks to an external source, such as the Bible, for guidance. This question is appropriate to ask the client to inquire about their spirituality. Choice B is incorrect. Visitors are helpful in a client's recovery. However, spirituality is not connected to a Church because spirituality is purely internal to how the person may gain hope and self-discovery. Religion often utilizes a church or formalized setting for worship. Choice C is incorrect. Attending worship on a defined day is not associated with spirituality as the source of hope, strength, and self-discovery does not come from an external source such as a Bible or church. Religion is more formalized as it may require participation in a practice, institution, or place of worship. This would be an appropriate question to ask when assessing religion. Choice D is incorrect. This question is not specific to spirituality. Both religion and spirituality may influence dietary preferences and restrictions. However, this question does not inquire directly about the client's spiritual stance on their source of hope and strength.

The nurse is caring for an infant with developmental dysplasia of the hip (DDH). Which of the following prescriptions would the nurse anticipate from the primary healthcare provider (PHCP)? A. Pavlik harness B. Compression hose C. Knee immobilizer D. Continuous passive motion

Choice A is correct. The Pavlik harness is utilized for the treatment of DDH. The goal of the therapy is to keep the hips abducted as much as possible. Choice B is incorrect. Compression hose is utilized in adults for the treatment of varicose veins and the prevention of venous thromboembolism. Choice C is incorrect. A knee immobilizer is used in adults for any injuries to the knee. The client with DDH requires stabilization of the hip and the prevention of extension and adduction. Choice D is incorrect. Continuous passive motion is used after certain orthopedic surgeries, such as a knee replacement. This is not used for DDH.

The client has been prescribed a continuous infusion of heparin for multiple venous thromboembolism. The nurse understands that the goal of this treatment is to prolong the A. partial thromboplastin time, 1.5 to 2.5 times the normal control. B. international normalized ratio, 2 to 3 C. prothrombin time, 1.5 to 2.5 times the normal control. D. international normalized ratio, 3 to 4

Choice A is correct. The goal for heparin therapy delivered by continuous infusion is to prolong the partial thromboplastin time, by 1.5 to 2.5 times the normal control value. Choices B, C, and D are incorrect. Heparin does not impact these laboratory values. PT and INR is prolonged by warfarin - not heparin. The partial thromboplastin time (PTT) assesses the intrinsic clotting cascade and the action of factors II, V, VIII, IX, XI, and XII. Because factors II, IX, and X are vitamin K dependent and are produced in the liver, liver disease can prolong the PTT. Desired therapeutic ranges for anticoagulation are usually between 1.5 and 2.5 times normal (control) values.

The nurse is setting up the room for a patient newly diagnosed with Celiac disease. She knows to place the patient on which of the following precautions? A. Droplet precautions B. Contact precautions C. Standard precautions D. Neutropenic precautions

Choice B is incorrect. Contact precautions are not indicated for the patient with Celiac disease. It is not an infectious disease and is not transmitted from person to person. Contact precautions are indicated when there is an infection that can spread by touching the patient or items in the room. Examples include MRSA and VRE. Choice D is incorrect. Neutropenic precautions are not indicated for the patient with Celiac disease. Neutropenic precautions are indicated when the patient is immunocompromised and at additional risk for infection. Examples of patients on neutropenic precautions may be those who have received a transplant, or who have a low absolute neutrophil count due to cancer or chemotherapy.

The patient with a right distal fibula fracture complains of pain and a tingling sensation in the right foot. Upon assessment, the nurse notes the right foot is cold to the touch with a weak dorsalis pedis pulse. Which potential complication should the nurse be most concerned about? A. Compartment syndrome B. Sepsis C. Peripheral neuropathy D. Pressure Injury

Choice A is correct. This patient is presenting with early signs/symptoms consistent with compartment syndrome. Later signs of compartment syndrome include paralysis and the absence of pulses in the affected extremity. If not caught and treated early, compartment syndrome can result in permanent muscle and nerve damage. Choice B is incorrect. There is no assessment data that supports a diagnosis of sepsis. Localized pain is expected in fracture patients, but would not be indicative of sepsis without additional symptoms of infection. Choice C is incorrect. Patients with nerve damage/peripheral neuropathy would experience symptoms such as pain and tingling. Still, the other assessment data of cold skin temperature and weak pulse would not support this diagnosis. Peripheral neuropathy would not be a more significant concern than compartment syndrome. Choice D is incorrect. This patient would be at risk of developing a pressure injury due to injury and immobility, but this potential complication would not be a more significant concern than compartment syndrome.

The nurse is caring for a client who is receiving prescribed enoxaparin. Which of the following findings would indicate the client is having an adverse effect? A. Thrombocytopenia B. Leukocytosis C. Polycythemia D. Neutropenia

Choice A is correct. Thrombocytopenia is an adverse effect associated with this medication. This effect is linked to Heparin-Induced Thrombocytopenia (HIT). This may occur within five to fourteen days of exposure to the drug and may be hastened by exposure to higher-than-normal doses. Choices B, C, and D are incorrect. Leukocytosis (an increase in the overall white blood cell count), polycythemia (an increase in red blood cells), and neutropenia (a decrease in neutrophils) are not adversely associated with enoxaparin

The nurse is caring for a client who was recently admitted to the cardiac floor for angina. This client states that their chest pain occurs at the same time every day at rest. The client does not believe there are any precipitating factors. Which of the following types of angina is this client most likely experiencing? A. Variant angina B. Stable angina C. Unstable angina D. Nonanginal pain

Choice A is correct. Variant angina, also known as Prinzmetal's angina, occurs at about the same time every day, usually at rest. Variant angina is treated with calcium channel blockers. Choice B is incorrect. Stable angina occurs after activity and is relieved by nitroglycerin tablets. Choice C is incorrect. Unstable angina is less predictable and may precipitate myocardial infarction. Choice D is incorrect. This type of discomfort does not describe nonanginal pain. Additional Info ✓ Prinzmetal's angina occurs when there is a temporary spasm or constriction of one or more coronary arteries, leading to a sudden decrease in blood flow to the heart muscle. These spasms can occur even in the absence of significant coronary artery blockages. ✓ During an episode of Prinzmetal's angina, transient changes may be seen on an electrocardiogram (ECG). These changes can include ST-segment elevation, often resembling a heart attack, which usually resolves once the spasm is relieved. ✓ Other types of angina include Stable angina Unstable angina Microvascular Angina Silent Angina Postprandial Angina Nocturnal Angina

The nurse has attended a staff education program about disseminated intravascular coagulation (DIC). Which of the following clients is at risk for DIC? A client A. with iron deficiency anemia receiving parenteral iron sucrose infusion. B. being treated for gram-negative sepsis with intravenous antibiotics. C. with atrial fibrillation receiving prescribed rivaroxaban to reduce their risk for stroke. D. taking a daily aspirin to reduce their risk for acute coronary syndrome.

Choice B is correct. A client with gram-negative sepsis faces an array of complications, including DIC. The release of the endotoxin by the bacteria may cause excessive activation of the clotting cascade, leading to exhaustion by the clotting factors. Clients with sepsis need to be monitored for DIC as this condition is life-threatening. The risk for DIC caused by gram-negative sepsis is even higher for those with hypothermia and acidosis because the coagulation factors' enzymatic functions are pH and temperature-dependent. Choice A is incorrect. Iron deficiency anemia and iron are not risk factors for DIC. Iron deficiency anemia is an issue with reducing red blood cells and hemoglobin. This condition does not cause a problem with clotting factor exhaustion, which practically explains DIC. Choice C is incorrect. Atrial fibrillation puts the client at risk for an ischemic stroke, and rivaroxaban is a direct thrombin inhibitor used in stroke prophylaxis. Choice D is incorrect. Aspirin is an antiplatelet which has shown benefits in reducing the risk of ACS and colon cancer. Aspirin is not implicated in DIC.

The nurse is caring for a client with a myocardial infarction experiencing tachycardia and coughing up frothy, pink-tinged sputum. Which finding would the nurse expect upon lung auscultation? A. Wheezing B. Crackles C. Rhonchi D. Diminished sounds

Choice B is correct. A massive anterior acute myocardial infarction may result in left ventricular failure and flash pulmonary edema. In pulmonary edema, fluid (transudate) fills up the alveoli. Pulmonary edema presents with shortness of breath, tachypnea, and cough with pink frothy sputum. Physical exam may reveal crackles, elevated jugular venous pressure, and peripheral edema. Crackles indicate alveoli that are collapsed by fluid (transudate or exudate). Crackles are adventitious sounds produced when these small alveoli filled with fluid snap open on inspiration. Other causes of crackles include atelectasis, COPD, pneumonia, acute respiratory distress syndrome (ARDS), bronchitis, and bronchiectasis. Choices A, C, and D are incorrect. Wheezes and rhonchi are common in cases of inflamed and narrowed airways. These adventitious sounds are caused by the air traveling through and fluttering narrowed airways. Unlike coarse crackles, wheezes are high-pitched and continuous. Asthma is associated with chronic inflammation and narrowing of the airways, and bronchial hyper-responsiveness. Wheezes can be noticed in asthma exacerbation, not in pulmonary edema. Rhonchi are low-pitched and loud. Rhonchi can be heard in bronchitis and pneumonia, not pulmonary edema. Diminished breath sounds may occur with reduced sound transmission or decreased production. In COPD, breath sounds are often diminished with a prolonged expiration phase. Breath sounds can also be diminished in pneumonia, pneumothorax, pleural effusion, and obesity.

The nurse is assessing a client with leukemia. Which of the following assessment findings would be expected? A. Dyspnea, malaise, and hypotension. B. Bruising, fatigue, and bone pain. C. Bradycardia, hypotension, and palpitations. D. Paresthesia, facial rash, and abdominal pain.

Choice B is correct. Because the bone marrow is not making enough red blood cells and platelets, the patient will experience fatigue due to anemia and bruising due to decreased platelets. The stretching of the periosteum causes bone pain because of the excessive white blood cells. The CBC may show increased blasts or immature white blood cells, crowding out the healthy RBCs and platelets. Choice A is incorrect. Although dyspnea, bradycardia, and hypotension may occur as a side effect of the treatment of leukemia, they are likely not caused by leukemia itself. Choice C is incorrect. Bradycardia, hypotension, and palpitations are not findings associated with leukemia. Choice D is incorrect. Paresthesia, facial rash, and abdominal pain as a collection of symptoms are not associated with leukemia. Skin alterations with leukemia include bruising.

Which of the following medications may be prescribed to control hypertension associated with a nephroblastoma? A. Propranolol B. Enalapril C. Nitroprusside D. Digoxin

Choice B is correct. Enalapril is an ACE inhibitor used to lower blood pressure. Since clients with nephroblastoma are hypertensive due to increased renin levels, this medication is commonly prescribed to decrease their blood pressure. Any ACE inhibitor reduces blood pressure by inhibiting the formation of angiotensin II in the renin-angiotensin-aldosterone system (RAAS), so they are an excellent choice for treating hypertension caused by nephroblastoma. While ACE-I's may be nephrotoxic, this is still the recommended treatment and is therapeutic as long as the creatinine levels are monitored closely. Choices A, C, and D are incorrect. Propranolol is a beta-blocker used to slow the heart rate. While it can decrease blood pressure in specific client populations, it is not prescribed to clients with nephroblastoma to reduce their hypertension. Nitroprusside is a direct-acting vasodilator. This means it acts on the muscles of your blood vessels to dilate them, lowering the blood pressure. While this drug also lowers blood pressure, it is not the right choice for hypertension associated with nephroblastoma. It does not address the RAAS, which causes hypertension in clients with nephroblastoma. Digoxin is a cardiac glycoside. It increases the force of contraction of the muscle of the heart and is commonly prescribed to clients with heart failure. It would not be administered to clients with a nephroblastoma to lower their blood pressure.

The nurse is discharging a client following knee arthroplasty. Which of the following information should the nurse include in discharge teaching? A. "After this procedure, you will use a wheelchair to get around." B. "You will need to resume your prescribed anticoagulants." C. "Placing a pillow under your knee will help with the pain." D. "You may ice the site for one hour at a time."

Choice B is correct. Following a knee arthroplasty, the patients will not be as mobile and require crutches. This may increase their risk of developing venous thromboembolism (VTE). Thus, the nurse should reiterate that the patients resume their prescribed anticoagulants or initiate them if they are newly prescribed. Evidence-based guidelines recommend that patients undergoing total hip or knee arthroplasty receive anticoagulant prophylaxis for at least 14 days. Choices A, C, and D are incorrect. A wheelchair is not utilized following knee arthroplasty. The nurse should teach the patient to use crutches because some degree of ambulation must be initiated. A pillow underneath the knee may increase the risk of flexion contracture and must be avoided following the procedure (choice C). Finally, ice may be applied for no more than twenty minutes for the first twenty-four hours (choice D). Prolonged ice application may cause skin damage. Learning Objective Recognize that venous thromboembolism is a significant complication of relative immobility following knee arthroplasty and other major lower extremity surgical procedures. The clients should be on venous thromboembolism prophylaxis.

The nurse is developing a plan of care for a client admitted P. aeruginosa pneumonia. Which of the following should the nurse include in the client's plan of care? A. Instruct the client to wear an N95 mask when ambulating in the hall. B. Initiate a vascular access device and encourage by-mouth fluids. C. Obtain daily weights every morning using the same scale. D. Administer prescribed oseltamivir within 48 hours of symptom onset.

Choice B is correct. Initiating vascular access is essential for a client admitted with P. aeruginosa pneumonia because parenteral antibiotics are the mainstay of treatment. Dehydration is common in pneumonia, and encouraging non-caffeinated fluids is beneficial. Choice A is incorrect. The client should wear a surgical mask when ambulating around the nursing unit. Droplet precautionswill be instituted, and the essential PPE for droplet precautions includes a surgical mask. Choice C is incorrect. Daily weights are not part of care standard of care for a client with pneumonia, as fluid volume overload is unlikely. This would be recommended for a client admitted with congestive heart failure or acute kidney injury. Choice D is incorrect. Oseltamivir is indicated for influenza infections, not bacterial pneumonia. This antiviral reduces influenza symptoms if taken within 48 hours of symptom onset.

A nurse is caring for a client who has Lyme disease. The nurse should anticipate a prescription for which medication? A. Finasteride B. Doxycycline C. Valacyclovir D. Diphenhydramine

Choice B is correct. Lyme disease is a disease that is caused by the bacteria, Borrelia burgdorferi, which is carried by deer ticks. Symptoms of Lyme disease include a localized rash progressing to generalized symptoms. Doxycycline is one of the antibiotics used to treat this infection. Choice A is incorrect. Finasteride is indicated for benign prostatic hypertrophy. Choice C is incorrect. Valacyclovir is an anti-viral indicated for herpes infections Choice D is incorrect. Diphenhydramine is indicated for seasonal allergies. Additional Info ✓ Lyme disease is a tick-borne illness causing the client to have B. burgdorferi ✓ Symptoms may begin one month after a client was exposed to the bacteria via the tick ✓ The symptoms start with the classic bullseye rash progressing to lymph node enlargement, arthralgias, malaise, fatigue, and encephalopathy ✓ The mainstay treatment is antibiotics such as doxycycline ✓ The client can reduce their exposure risk by wearing long sleeve clothing, tick repellent, and avoiding high grass and wooded areas without the recommended attire

A client admitted to the medical ward for convulsions is receiving intravenous magnesium sulfate. Which of the following signs indicate an expected side effect of the drug? A. Less frequency of urination B. Frequent sleepiness C. Absence of a knee jerk reflex D. Decreased respirations

Choice B is correct. Magnesium sulfate, when administered intravenously, can lead to central nervous system depression, causing drowsiness and sedation. Clients taking magnesium sulfate may experience sleepiness and lethargy, particularly during the daytime. This effect is a known side effect of magnesium sulfate. Choice A is incorrect. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the endplate by the motor nerve impulse. Magnesium sulfate does not affect urine production. Choice C is incorrect. The absence of a knee-jerk reflex is not a typical side effect of magnesium sulfate. A decrease in deep tendon reflexes (such as the knee jerk reflex) can be a sign of magnesium toxicity, indicating that magnesium levels are too high in the body. As plasma magnesium rises above 4 mEq/L (2 mmol/L) [ 1.5-2.5 mEq/L, 0.74-1.03 mmol/L], the deep tendon reflexes are decreased. Choice D is incorrect. Magnesium sulfate can cause respiratory depression, especially at high doses. Respiratory depression is characterized by slow and shallow breathing. While it's essential to monitor respiratory status closely in clients receiving magnesium sulfate, complete cessation of breathing (apnea) is a severe side effect and is generally seen in cases of magnesium toxicity or overdose. As the plasma level approaches 10 mEq/L, respiratory paralysis may occur. A decrease in respiratory rate initially manifests this.

The nurse is caring for a client two days post-op total knee replacement with a continuous passive motion (CPM) device at the bedside. The nurse would recognize that the primarypurpose of this machine is to: A. Stabilize the knee joint during ambulation B. Promote knee flexion C. Reduce post-surgical swelling D. Prevent blood clots

Choice B is correct. Maintaining joint flexion and mobility is a high priority for the post-op total knee replacement (TKR) client. The continuous passive motion (CPM) device would be worn intermittently while the client is in bed to flex and extend the knee, reduce scar tissue formation, and help the client maintain optimal joint mobility. Choice A is incorrect. The CPM machine will assist the client in flexing and extending the knee joint through a passive range of motion while in bed. If needed, a knee brace or immobilizer would be used to support and stabilize the knee during ambulation/activity. Choice C is incorrect. The CPM machine is not intended to limit swelling after surgery. Ice packs and cold therapy may be ordered to improve post-op swelling. Choice D is incorrect. Although leg exercises would reduce the client's risk of DVT, the primary purpose of the CPM machine is to promote flexion and mobility of the joint, not to prevent blood clots.

The nurse is teaching a client about newly prescribed metoclopramide for nausea and vomiting. It is a priority for the nurse to discuss which potential adverse reaction? A. dystonia B. fever C. drowsiness D. diarrhea

Choice B is correct. Metoclopramide is a dopaminergic medication indicated in the treatment of nausea and vomiting. An adverse effect of this medication is neuroleptic malignant syndrome (NMS). Classic NMS features include muscle rigidity, tachycardia, and fever. This idiosyncratic reaction is commonly associated with antipsychotics (haloperidol, aripiprazole, olanzapine, etc.). However, this may be seen in other dopaminergic medications such as metoclopramide. Choice A is incorrect. Dystonia may occur with metoclopramide. To reduce the risk of dystonia, the client should be prescribed the lowest possible dose, and if it is given an intravenous push, it should be pushed very slowly. Commonly, prescribers may write for diphenhydramine to be co-administered with this medication to reduce the risk of dystonia. Unlike NMS, this is not the priority adverse reaction because dystonia cannot be lethal. Choice C is incorrect. Drowsiness is an expected effect of metoclopramide. To mitigate this risk, the client should be prescribed the lowest possible dose and for the shortest duration. Unlike NMS, this is not the priority adverse reaction because drowsiness cannot be lethal. Choice D is incorrect. Diarrhea is an expected finding with metoclopramide. This medication stimulates peristalsis, thereby increasing bowel motility and, as a result, may cause a client to have diarrhea. Unlike NMS, this is not the priority because diarrhea is expected.

The nurse is caring for a client with a paralytic ileus following an appendectomy. Which intervention would be appropriate for the nurse to take? A. Assess the client for hyperkalemia B. Prepare for the insertion of a nasogastric tube C. Assess the surgical wound for approximation D. Instruct the client to chew their food more slowly

Choice B is correct. Paralytic ileus is a possible complication from the anesthesia used during abdominal surgery. An NG tube is placed to decompress the bowel until surgical interventions are implemented or until spontaneous bowel function returns. Choices A, C, and D are incorrect. Assessing the client for hyperkalemia is not a cause of paralytic ileus. Normal to high potassium levels maintain or increase bowel motility. Hypokalemia contributes to the development of an ileus because it slows gastrointestinal motility. The surgical wound has no relevance to the development of a paralytic ileus which is a gastrointestinal complication. Having the client chew their food more slowly would not assist in mitigating a current ileus. If paralytic ileus is suspected, the client is placed on a nothing-by-mouth (NPO) status.

The nurse is caring for a client who sustained an ischemic cerebrovascular accident (CVA) three hours ago. The client's most recent blood pressure was 168/101 mm Hg. The nurse should take which action? A. Place the client supine B. Continue to monitor C. Obtain orthostatic blood pressure D. Request a prescription for an antihypertensive

Choice B is correct. Permissive hypertension during an ischemic stroke allows the blood pressure to go up to 185/110 mm Hg. This enables perfusion around the stroke to distal tissue. Thus, the nurse will continue to monitor because the blood pressure of 168/101 mmHg does not meet the threshold to notify the PCP. A blood pressure of 150/100 mm Hg is needed to maintain cerebral perfusion after an acute ischemic stroke. Choice A, C, and D are incorrect. Placing the client supine during a stroke is contraindicated because of its increase in intracranial pressure. Orthostatic blood pressure is not indicated and is usually performed if hypovolemia could cause hypotension, not hypertension. An antihypertensive is not necessary based on this blood pressure.

The nurse is caring for a client with Bell's palsy. Which of the following prescriptions should the nurse anticipate administering to the client? Select all that apply. modafinil prednisone doxycycline acyclovir sumatriptan

Choice B is correct. Prednisone or another corticosteroid is likely to be prescribed. The anti-inflammatory action of these medications may help to reduce the swelling of the facial nerve and lessen the impingement that is causing the facial drooping Choice D is correct. Acyclovir or valacyclovir are controversial, but some studies show that combining antivirals with corticosteroids may be helpful in clients with severe facial drooping. Both medications should be given as soon as possible after the symptoms start. A theory is that the herpes simplex virus may trigger Bell's palsy. Thus, antivirals may be helpful. Choice A is incorrect. Modafinil is a non-amphetamine stimulant indicated to treat narcolepsy. Choice C is incorrect. Doxycycline, a tetracycline antibiotic, would not provide any relief for this condition since it is not caused by bacteria. Choice E is incorrect. Sumatriptan is a medication approved to treat migraine headaches (MH). This medication does not have any role in treating Bell's palsy.

The nurse is providing discharge instructions to a client prescribed phenazopyridine. Which of the following instructions should the nurse include? A. The amount of urine you void will increase B. Your urine will turn orange in color C. You may notice that your urine is malodorous D. Concentrated urine is an expected finding

Choice B is correct. The use of phenazopyridine produces a harmless orange (to red) color in the client's urine. Choices A, C, and D are incorrect. Phenazopyridine use does not increase a client's urine volume. Phenazopyridine use will not result in a pungent odor of the urine. Phenazopyridine use will not result in the client's urine appearing more concentrated.

The nurse in the pediatric clinic is speaking to a parent of an 18-month-old toddler when the parent asks about their child's protruding abdomen. The most appropriate response by the nurse is: A. "Your baby overate, resulting in a larger abdomen today." B. "Your toddler does not yet have developed abdominal muscles." C. "Your toddler has a bow-legged posture which accounts for your child's protruding abdomen." D. "Your child may have too much gas in their stomach."

Choice B is correct. Underdeveloped abdominal musculature gives the toddler a characteristically protruding abdomen. Choice A is incorrect. Although rare instances of overeating may occur, the overall growth rate during toddlerhood slows, thus decreasing the toddler's need for calories, protein, and fluid compared to prior needs during infancy. Choice C is incorrect. A toddler's slightly bowed or curved appearance is considered normal and has no bearing on the abdominal circumference of the toddler. Choice D is incorrect. The toddler having "too much gas in their abdomen" would potentially be alluding that the toddler has colic. However, based on the question, the toddler is not displaying any colic symptoms. Additionally, colic typically occurs in infants, not toddlers. Learning Objective The nurse in the pediatric clinic is speaking to a parent of an 18-month-old toddler when the parent asks about their child's protruding abdomen. The most appropriate response by the nurse is, "[y]our toddler does not yet have developed abdominal muscles."

Following a persistent cough, chills, and fever, a client was admitted for a possible respiratory infection. The admission orders include a regular diet, vital signs every 4 hours, ampicillin 250 mg PO every 6 hours, and sputum culture. Before beginning antibiotic therapy, the nurse should perform which of the following? A. Provide the client a full meal B. Collect the sputum sample C. Assess the client's vital signs D. Assess the client's oxygen saturation

Choice B is correct. When caring for a client requiring a sputum culture, the sputum sample should be obtained beforeinitiating antibiotic therapy. Obtaining the sputum sample prior to initiating antibiotic therapy allows for accurate detection of the organism(s) causing the infection through the sputum culture. Choice A is incorrect. Ampicillin should be given on an empty stomach (at least 30 minutes before or two hours after a meal). Choice C is incorrect. Overall, the assessment of a client's vital signs are an essential nursing action. Conversely, although obtaining new vital signs for any client prior to administering medication is always a sound practice, there is no specific indication or need to do so before administering oral ampicillin. Choice D is incorrect. Overall, assessing a client's oxygen saturation is an essential nursing action. Conversely, although obtaining a new oxygen saturation for any client before administering medication is always a sound practice, there is no specific indication or need to do so before administering oral ampicillin. Learning Objective In a client with admission orders for both a sputum culture and antibiotic therapy, recognize the need to obtain the sputum culture prior to initiating the antibiotic therapy.

The nurse is caring for a client in labor who is positive for the human immunodeficiency virus (HIV). The nurse should obtain a prescription for which medication? A. valacyclovir B. zidovudine C. amphotericin b D. metronidazole

Choice B is correct. Zidovudine (ZDV) is an antiretroviral medication that may be administered intrapartum to further reduce vertical transmission of HIV. This medication is commonly indicated for women who have a scheduled cesarean delivery or, in the rare instance of a vaginal delivery. This medication is preferred because it may be administered intravenously and can provide pre-exposure prophylaxis to the fetus. Whether this medication is prescribed and administered intrapartum depends on the mother's viral load. The lower the viral load, the less likely of transmission to the fetus. Additional Info ✓ Women should continue taking their antiretroviral therapy (ART) regimen as much as possible during labor and delivery or scheduled cesarean delivery ✓ Zidovudine is an intravenous antiretroviral that is administered intrapartum to reduce vertical transmission further ✓ To further reduce HIV transmission during labor and delivery, avoid fetal scalp electrode monitoring when possible ✓ To identify HIV infection in infants and young children (less than 18 months), HIV viral load (VL) testing must be performed using assays that detect HIV deoxyribonucleic acid (DNA) or ribonucleic acid (RNA) ✓ Antibody tests are not accurate because the infant acquires maternal antibodies, which may cause a false positive ✓ Cord blood should not be used for testing because of the possibility of contamination of the sample with maternal blood

The nurse is assessing a client who is newly diagnosed with irritable bowel syndrome (IBS). Which of the following findings is consistent with this diagnosis? A. Unexplained weight loss B. Epigastric pain and nausea C. Alternating constipation and diarrhea D. Low-grade fever and fatigue

Choice C is correct. Alternating constipation and diarrhea are the hallmark manifestations associated with irritable bowel syndrome (IBS). Choices A, B, and D are incorrect. Unexplained weight loss is a finding associated with multiple diseases, including colon cancer. This is not a finding relevant to IBS. Epigastric pain and nausea may be a symptom associated with pancreatitis. Finally, IBS is not an infectious process, and a fever is not an accurate clinical finding. Additional Info IBS is a disorder that manifests with alternating periods of constipation and diarrhea. While some clients may have one symptom over another, the disorder is associated with pain with defection (or after defecation), excessive flatulence, and abdominal bloating. The symptoms may relapse and remit and can be triggered by stress or food. Treatment is symptomatic with an emphasis on preventing the occurrence of triggers.

The nurse is caring for a client with Buerger's disease. The nurse plans on suggesting that the client receive a referral for A. occupational therapy. B. speech therapy. C. smoking cessation. D. group psychotherapy.

Choice C is correct. Arterial and venous blood flow impediments characterize Buerger's disease. This impediment is caused by inflammation and is significantly worsened by smoking. The nicotine causes vasoconstriction and worsens blood flow. A critical intervention for a client with this condition is discussing smoking cessation with this client. Choices A, B, and D are incorrect. These types of therapies are not pertinent to Buerger's disease. The mainstay treatment is smoking cessation and prescribed vasodilators such as calcium channel blockers. Additional Info Buerger's disease is characterized by arterial and venous inflammation worsened by smoking. The nurse should advocate for smoking cessation to minimize symptoms. Prescriptive treatments include calcium channel blockers (verapamil) or phosphodiesterase inhibitors (cilostazol).

The nurse has provided medication instruction to a client who has been prescribed formoterol. Which of the following statements would indicate a correct understanding of the teaching? A. "I will take this medication if I experience shortness of breath." B. "I will need to rinse my mouth out after using this medication." C. "This medication may make it hard for me to fall asleep." D. "I should take this medication two hours before I go exercise."

Choice C is correct. Beta-adrenergic agonists may cause a client to develop insomnia because the medication has the propensity to activate the client and their adrenergic receptors. Drugs in this class (albuterol, salmeterol) share the same effect, insomnia. Choices A, B, and D are incorrect. Formoterol is a long-acting beta-agonist and is indicated in the management of chronic respiratory illnesses. This medication should not be used in acute dyspnea. The client is not required to rinse their mouth out following the use of this medication. This is appropriate instruction for inhaled corticosteroids such as fluticasone. This medication is given on a scheduled basis, and a medication such as montelukast is given two hours prior to exercise to prevent exercise-induced asthma. Additional Info ✓ Long-acting beta-agonists (LABAs) are indicated in the maintenance treatment of asthma. ✓ The client should be taught that this medication is not indicated for acute exacerbations. ✓ Adverse reactions of LABAs include tachycardia, palpitations, and angina. ✓ Fometerol is an example of a LABA, whereas albuterol is an example of a SABA used in acute exacerbations.

The nurse is caring for a client following cervical spinal surgery. Which of the following assessments would require follow-up? A. Active range of motion in both arms B. Scant drainage on the dressing C. Difficulty swallowing liquids D. Soreness at the operative site

Choice C is correct. Difficulty swallowing liquids indicates nerve damage that requires immediate follow-up. Following cervical spinal surgery, the client is likely placed in a cervical collar for a prescribed period. Manifestations that need to be reported following cervical spinal surgery include numbness and tingling in the upper extremities, difficulty swallowing, decreased motor strength, and respiratory depression. Choices A, B, and D are incorrect. These findings after this procedure are normal and do not require follow-up. The nurse would be concerned if active range of motion would be reduced, and scant drainage on the dressing does not concern for any hemorrhage. Following this procedure, it is likely that the client would experience soreness at the operative site.

The process by which drugs are reabsorbed before elimination after being excreted into bile and delivered to the intestines is known as: A. Hepatic clearance B. Total clearance C. Enterohepatic cycling D. First-pass effect

Choice C is correct. Drugs and drug metabolites with molecular weights higher than 300 may be excreted via the bile, stored in the gallbladder, delivered to the intestines by the bile duct, and then reabsorbed into the circulation. This process reduces the elimination of drugs and prolongs their half-life and duration of action in the body. Before drugs can be clinically useful, they must be absorbed. Absorption is the process of a drug moving from its site of delivery into the bloodstream. The chemical composition of a drug, as well as the environment into which a drug is placed, work together to determine the rate and extent of drug absorption. Absorption can be accomplished by administering the drug in a variety of different ways (orally, rectally, intramuscularly, subcutaneously, inhalation, topically, etc.). If a drug is administered intravenously, the need for absorption is bypassed entirely. For drug absorption to be most efficient, the properties of the drug itself and the pH of the environment where the drug is located must be considered. Most drugs are either weak acids or weak bases. Drugs that are weak acids will pick up a proton when placed in an acidic environment and will be un-ionized. Other factors that also impact drug absorption include the following:

The nurse is caring for a client scheduled for electroconvulsive therapy (ECT). Which medication should the nurse question? A. citalopram B. pantoprazole C. phenytoin D. risperidone

Choice C is correct. ECT is a safe therapy that induces seizures theorized to release monoamines, which may assist in treating psychiatric illnesses such as major depressive disorder. If a client takes an anticonvulsant, like phenytoin, this will increase the seizure threshold and may attenuate the efficacy of ECT. Benzodiazepines and anticonvulsants should therefore be avoided in clients receiving ECT. Choices A, B, and D are incorrect. Antidepressant medications (such as sertraline, fluoxetine, and citalopram) and antipsychotics (such as risperidone) may be given concurrently with ECT. These medications may enhance the efficacy of the treatment. Proton pump inhibitors (such as pantoprazole) are typically given on the day of treatment to prevent gastric reflux and aspiration.

The nurse is caring for a client who sustained a fractured tibia and fibula and has a cast applied to the extremity. Which of the following findings would indicate the client has developed compartment syndrome? A. The development of petechiae over the chest B. A new onset of dyspnea and chest pain C. Severe pain that is unrelieved by an opioid analgesic D. Localized bone pain with a fever

Choice C is correct. Early manifestations associated with compartment syndrome, including paresthesia of the affected extremity and pain unrelieved by a prescribed opioid analgesic. Choices A, B, and D are incorrect. Dyspnea, chest pain and petechiae over the chest are consistent with fat embolism syndrome (FES). Localized bone pain with fever is the cardinal sign associated with osteomyelitis.

The nurse is teaching a client about the newly prescribed medication, epoetin alfa. Which of the following should the nurse include in the teaching? A. This medication will decrease your risk for infection. B. You may notice black tarry stools while on this medication. C. This medication may raise your blood pressure. D. Take this medication with food rich in Vitamin C.

Choice C is correct. Epoetin alfa is an erythropoietic growth factor indicated to increase red blood cell production for those with chronic kidney disease. This medication expands blood plasma with the therapeutic effect of increasing hemoglobin and hematocrit. It is essential to monitor the client's blood pressure while taking this medication, as an increase in blood pressure may be seen secondary to the increased blood volume. Uncontrolled hypertension is a contraindication of this medication. Choices A, B, and D are incorrect. This medication aims to increase the production of red blood cells - not white blood cells. Thus, its impact on mitigating infection is negligible. This would be appropriate for filgrastim, which assists in the production of neutrophils. Black tarry stools and taking the medication with food rich in Vitamin C is appropriate teaching for a client taking iron. Additional Info Epoetin alfa is an effective treatment for anemia secondary to chronic kidney disease. ➢ This medication is given parenterally, and the nurse should expect a therapeutic response of an increase in hemoglobin and hematocrit. ➢ Once the hemoglobin reaches 11 g/dl, the nurse should question further administration as higher hemoglobin levels have been implicated in causing myocardial infarction or stroke. ➢ The priority vital sign to monitor during the course of therapy is blood pressure.

A client with benign prostatic hyperplasia (BPH) is post-operative following transurethral resection of the prostate and is now on continuous bladder irrigation. Upon assessment, the nurse notes that the drainage from the urinary catheter has stopped. Which nursing intervention is most appropriate? A. Reinsert a new catheter B. Increase the infusion rate of the irrigation C. Attempt to dislodge a clot D. Contact the health care provider (HCP)

Choice C is correct. Following a transurethral resection of the prostate (TURP), clients often receive continuous bladder irrigation (CBI) to prevent clot retention, bladder spasms, and post-operative hemorrhage. If the continuous infusion or drainage of the sterile fluid ceases, the nurse should inspect the CBI set for the presence of a clot. If a clot is present, the most appropriate intervention would be for the nurse to attempt to dislodge any existing clot by gently aspiration the lump or irrigation through the out-port with the goal of allowing the continuous bladder irrigation to resume. Following this intervention, the nurse should document all relevant details of the intervention, including, but not limited to, a description of the clot removed. Choice A is incorrect. Although the insertion of a new catheter may be needed in the future, this is not the most appropriate intervention at this point. In a post-operative transurethral resection of the prostate (TURP) client, nursing interventions should initially focus on the least invasive interventions when possible. The nurse should use caution in inserting catheters in post-operative TURP clients, as these clients may continue to have internal swelling present from the surgery and/or the insertion of a catheter may damage the internal post-operative tissues. Therefore, if a new catheter is needed, the nurse should refer to the health care provider's (HCP) orders or speak with the HCP directly.

The nurse is counseling a client with congestive heart failure (CHF) about newly prescribed torsemide. The nurse determines that the teaching has been effective when the client plans to A. decreases their dietary potassium. B. record their daily urinary output. C. measure their weight daily. D. take their blood pressure and pulse daily.

Choice C is correct. For a client with congestive heart failure prescribed torsemide, a loop diuretic, the client should verbalize the importance of weighing themselves daily. Their daily weight should be obtained in the morning after the first void. Choices A, B, and D are incorrect. Decreasing dietary potassium would require follow-up because It is potassium that should be increased. After all, torsemide is a potassium-wasting diuretic. Recording the client's urinary output is not necessary, nor is it an accurate way to determine the client's fluid status. Intake and output are crude ways of determining a client's fluid status. Blood pressure should be monitored while a client takes this medication - but not daily. Additionally, this medication does not impact the pulse and thus is irrelevant.

The nurse is taking vital signs on a client with a diagnosis of acute lymphoblastic leukemia (ALL). The client's temperature is 38.7 degrees C. Which of the following actions should the nurse prioritize next? A. Place cool washcloths on the client's head. B. Continue the assessment. C. Obtain intravenous access on the client. D. Assess the client's perfusion.

Choice C is correct. It is the priority action to establish intravenous access for this client. This client has a diagnosis of ALL, so the nurse knows that the client is immunocompromised. The client is very susceptible to infections and with a fever of 38.7 degrees C, there is a high index of suspicion for disease. Broad-spectrum IV antibiotics will need to be started right away. Therefore it is the priority of the nurse to start an IV. Choice A is incorrect. Placing cold washcloths on the client's head is not the priority. This would only need to be done if the client was at risk for seizures due to incredibly high body temperature. The temperature of 38.7 degrees C does not warrant cooling measures and the nurse has another immediate priority given the client's immunosuppression along with the suspicion of an infection. Choice B is incorrect. It is inappropriate for the nurse to simply continue with the assessment since the nurse suspects an infection in an immunocompromised client. Choice D is incorrect. Assessing the client's perfusion has nothing to do with the nurse's suspicion of an infection. The nurse should immediately establish IV access for the administration of antibiotics.

The nurse is caring for a client experiencing an episode of vertigo. The nurse should plan to take which essential action? A. Avoid sudden movement changes B. Provide additional pillows to support the client's head C. Raise the upper side rails of the bed D. Instruct the client to move the head slowly

Choice C is correct. Many actions should be taken for a client experiencing vertigo, but protecting the client's safety is essential. If a client is experiencing vertigo, this raises the risk of a fall. Interventions to prioritize include adequate lighting in the bathroom, raising the upper side rails on the bed, and providing the client with the call bell, coupled with instructing the client to use it before getting out of bed. Choices A, B, and D are incorrect. These are appropriate actions for a client experiencing vertigo; however, they do not prioritize their safety. The client experiencing vertigo is likely to fall; thus, the nurse should maintain a safe environment.

The nurse is teaching a group of students the causes of hypokalemia. It would indicate a correct understanding of the student if they stated which condition causes this electrolyte imbalance? Select all that apply. Diabetic ketoacidosis Addison's disease Metabolic alkalosis Chronic renal failure Cushing's syndrome

Choice C is correct. Metabolic alkalosis causes an increase in the serum pH, forcing the potassium into the cells, and potassium levels decrease. Conditions causing metabolic alkalosis include a hyperglycemic-hyperosmolar state (HHS). Choice E is correct. Cushing's syndrome results in increased aldosterone production, leading to potassium elimination and sodium retention in the kidneys. The excess aldosterone activity causes hypokalemia due to increased urinary excretion of potassium. Choice A is incorrect. A client in DKA is dehydrated; they are in an acidotic state. Metabolic acidosis (e.g., untreated DKA) increases serum potassium levels by causing the intracellular potassium to shift extracellular, thus raising the potassium level. Choice B is incorrect. Addison's disease, characterized by adrenal insufficiency, leads to deficient aldosterone production. Aldosterone helps retain sodium and eliminate potassium in the kidneys. Deficiency of aldosterone can cause hyperkalemia due to impaired renal potassium excretion. Choice D is incorrect. Chronic renal failure causes hyperkalemia by decreased excretion of potassium. Chronic renal failure increases the total body potassium. Potassium binding agents (sodium polystyrene sulfonate, patiromer) bind potassium in the gastrointestinal tract and decrease total body potassium in chronic renal failure-associated hyperkalemia.

A nurse is taking care of a client that is status-post hand arthroplasty. When creating the care plan, which of the following nursing interventions should be avoided to prevent complications? A. Encourage the client to perform finger and wrist exercises ten times per hour, using a full range of flexion and extension. B. Place the client's personal items within reach of the client's non-operative arm. C. Place the client's operative arm on a pillow to rest and keep it elevated. D. Encourage the client to use the non-operative arm as much as possible.

Choice C is correct. Placing the client's operative arm on a pillow produces pressure on the ulnar nerve. Before the client's surgery, this nerve was already vulnerable to stress, trauma, and/or overuse. Upon compression of this nerve, immediate medical attention is required, especially in a post-operative client. One of the ways this nerve can become compressed is through prolonged pressure on the elbow (i.e., through a combination of post-operative fluid buildup resulting in swelling and by placing the client's operative arm on a pillow to rest and keeping it elevated). These factors place the client at risk of ulnar nerve compression. Therefore, when creating the care plan for this client, putting the client's operative arm on a pillow to rest and keep it elevated is a nursing intervention that should be avoided in order to prevent post-operative complications. Choice A is incorrect. In the sagittal plane, movements are flexion and extension (e.g., fingers and elbows). Finger exercises, especially full range of motion exercises (as tolerated) in the postoperative period, serve to reduce the client's edema and pain. Therefore, this intervention should be included in the client's care plan. Choice B is incorrect. Placing the client's items within reach of the client's non-operative arm fosters a sense of independence for the client while promoting safety. Therefore, this intervention should be included in the client's care plan. Choice D is incorrect. Encouraging the client's use of the non-operative arm will help foster a sense of independence and self-care while concurrently promoting a safe environment. Therefore, this intervention should be included in the client's care plan.

The nurse is caring for a client who is receiving newly prescribed salmeterol. Which of the following prescribed medications requires notification to the primary healthcare provider (PHCP)? A. lithium B. captopril C. labetalol D. clonidine

Choice C is correct. Salmeterol is a long-acting beta-agonist indicated in the maintenance treatment of chronic respiratory illnesses. This medication causes bronchodilation by stimulating the beta-adrenergic receptors. Blocking these receptors by beta-adrenergic blockers is contraindicated because it may lead to bronchospasm. Labetalol is a combined alpha and beta-adrenergic receptor blocker, therefore antagonizing salmeterol's therapeutic effect. Thus, labetalol would be contraindicated because of this adverse action. Choices A, B, and D are incorrect. Lithium s a mood stabilizer and is used in bipolar disorder. Captopril, an ACE inhibitor, is used in heart failure. Clonidine, an alpha-2 receptor agonist, is used in hypertension. None of these have beta-adrenergic receptor blocking action, and therefore, these medications are not contraindicated while a client receives salmeterol. Learning Objective Avoid nonselective beta-adrenergic receptor blockers in clients with asthma and those on treatment with beta-2 agonists. Understand that beta-blockers decrease the therapeutic response to beta-agonist drugs.

The nurse is caring for a client with suspected bowel perforation. Which of the following would be contraindicated? A. Administering gastrografin for an upper GI x-ray. B. An exploratory laparotomy procedure. C. Administering milk of magnesia following an upper GI study. D. An abdominal CT scan.

Choice C is correct. The client should not be given milk of magnesia (MOM). MOM is a cathartic agent used to promote the excretion of barium sulfate following an upper GI study. Barium sulfate is a liquid suspension that makes intestines visible on the X-rays. Following the procedure, patients are instructed to take plenty of fluids and a mild laxative such as MOM to clear barium from the intestines. However, the client has bowel perforation, so barium sulfate would not be appropriate. Instead, a water-soluble contrast, such asgastrografin, would be used in patients with bowel perforation. Gastrografin has a laxative effect and may cause diarrhea, which would be exacerbated by giving this patient milk of magnesia. Choice A is incorrect. Water-soluble gastrografin is an osmotic cathartic indicated for patients with bowel perforation requiring upper GI x-ray studies. Gastrografin is used instead of barium sulfate in patients with bowel perforation because any barium leaked through the perforated bowel may cause dreadful barium peritonitis and fibrotic adhesions. Choice B is incorrect. Surgical intervention (i.e., exploratory laparotomy) is commonly used to diagnose and determine the cause of bowel perforation. This procedure would be indicated for this patient unless other issues are present that would prevent the patient from tolerating surgery, such as severe congestive heart failure or multiorgan failure.

A 12-year-old child is scheduled for an appendectomy. The child's mother has already signed the consent form and the child is about to be wheeled by the nurse to the operating room when her father arrives. It is made known to the nurse that the child's parents are divorced and have joint legal custody. Which action by the nurse is most appropriate? A. Have the father sign a new consent form. B. Cancel the operation. C. Proceed with the child's operation. D. Notify the physician.

Choice C is correct. The signature of the child's mother is enough to provide consent. Choice A is incorrect. The signature of the child's mother is enough to provide consent. It is unnecessary to ask the father sign a new consent form. Choice B is incorrect. The signature of the child's mother is enough to provide consent. The surgery can proceed and there is no reason to cancel it. Choice D is incorrect. There is no need to contact the physician.

The nurse is performing a medication reconciliation for a client taking prescribed phenytoin. Which medication should the nurse question with the physician while the client is taking phenytoin? A. thiamine B. Hypericum perforatum (St. John's wort) C. warfarin D. acyclovir

Choice C is correct. Warfarin and phenytoin are two highly protein-bound drugs that may cause the displacement of each other. Warfarin is an anticoagulant, and if given to a client receiving phenytoin, it should be questioned by the nurse because it may cause the potentiation of the anticoagulant effects of the warfarin. Choice A is incorrect. Thiamine is a B vitamin and is commonly prescribed for individuals who are malnourished or consume excessive alcohol because this will prevent (or treat) Wernecke's encephalopathy. This has no known interaction with phenytoin. Choice B is incorrect. Hypericum perforatum (St. John's wort) should not be administered with serotonergic medications (certain antidepressants) because it may increase the client's risk for serotonin syndrome. This has no known interaction with phenytoin. Choice D is incorrect. Acyclovir is an antiviral medication indicated in preventing and treating herpes infections. This has no known interaction with phenytoin.

A client recently diagnosed with peptic ulcer disease is being discharged. While the nurse provides discharge teaching, which of the following over-the-counter medications should the client be instructed to avoid? A. Calcium B. Magnesium C. Sodium D. Aspirin

Choice D is correct. Aspirin disrupts the normal mucosal defense and repair, making the mucosa more susceptible to acid. The nurse should instruct this client on the importance of avoiding aspirin and all other nonsteroidal anti-inflammatories (NSAIDs) now and in the future.

The nurse cares for a client who has just been admitted with heparin-induced thrombocytopenia (HIT). Which of the following medications may have caused this condition? A. Epoetin alfa B. Clopidogrel C. Iron dextran D. Enoxaparin

Choice D is correct. HIT is a severe complication to a client taking heparinoids. Enoxaparin is low-molecular weight-based heparin (LMWH). Although it is not likely to cause HIT when compared to unfractionated heparin, the client still runs the risk of developing HIT. Choices A, B, and C are incorrect. Epoetin alfa is a colony-stimulating factor indicated for anemia secondary to renal disease. This medication would not cause HIT. Clopidogrel is an antiplatelet medication that is not implicated in HIT. Iron dextran is utilized in treating anemia and would not be involved in HIT.

Minimizing and challenging the client's report of pain and pain intensity is: A. Often necessary if the client has a history of substance abuse. B. Often necessary if the client has a history of drug seeking behavior. C. Contrary to and in violation of the Nightingale oath. D. Contrary to and in violation of the American Nurses Association's standard of care.

Choice D is correct. Minimizing and challenging the client's report of pain/pain intensity is in violation of the American Nurses Association's standards of care about pain/pain management. Specifically, the American Nurses Association's Standards of Professional Performance for Pain Management Nursing. For example, nurses are mandated to document pain as expressed by the client regardless of what the nurse believes to be true and accurate. Choice A is incorrect. Minimizing and challenging the client's report of pain/pain intensity is not often necessary if the client has a history of substance abuse; this expression and reporting of pain must be considered valid and accurate. Nurses are mandated to document pain as expressed by the client regardless of what the nurse believes to be accurate. Choice B is incorrect. Minimizing and challenging the client's report of pain/pain intensity is not often necessary if the client has a history of drug-seeking behavior; this expression and reporting of pain must be considered valid and accurate. Nurses are mandated to document pain as expressed by the client regardless of what the nurse believes to be accurate. Choice C is incorrect. Minimizing and challenging the client's report of pain/pain intensity is not in violation of the Nightingale oath. There is no mention of pain management in the Nightingale oath.

A client experiencing an acute exacerbation of ulcerative colitis underwent diagnostic testing and was found to have elevated serum osmolality and urine specific gravity. Which of the following is related to these findings? A. Renal insufficiency B. Diabetes insipidus D. Deficient fluid volume

Choice D is correct. Ulcerative colitis is a chronic inflammatory bowel disease in which the large intestine becomes inflamed and ulcerated, leading to flare-ups of water or bloody diarrhea, abdominal cramping, and fever. During severe ulcerative colitis flare-ups, clients may experience ten or more episodes of diarrhea per day. During these events, the client loses a large volume of fluid, resulting in a deficient fluid volume. When assessing this client, one would anticipate a finding of an elevated serum osmolality and elevated urine specific gravity due to the client's deficient fluid volume status.

The nurse is providing discharge education regarding a newly prescribed medication, apixaban. Which of the following statements by the client would require follow-up? A. "I should take apixaban exactly as prescribed by my healthcare provider, at the same time every day." B. "I will notify my healthcare provider if I notice any unusual bleeding, such as blood in my urine or stools." C. "If I miss a dose of apixaban, I will take it as soon as I remember, and I will not take more than one dose at the same time." D. "I should maintain a balanced diet and avoid excessive intake of foods high in vitamin K, like leafy greens."

Choice D is the correct answer. Choice D Indicates that the client does not understand the education provided regarding apixaban. Aside from alcohol there are no specific foods that are recommended to avoid while taking apixaban. Choice A is incorrect. Taking Apixaban as prescribed ensures consistent therapeutic levels of the medication in the body, which helps prevent blood clots and reduces the risk of complications. Choice B is incorrect. Apixaban is an anticoagulant that reduces blood clotting, which can increase the risk of bleeding. Notifying the healthcare provider about any unusual bleeding is important to ensure appropriate evaluation and management of potential complications. Choice C is incorrect. The client should not take double dose if a dose is missed but should continue to take it as prescribed. Additional Info ✓ Apixaban works by inhibiting a specific clotting factor called Factor Xa, thereby reducing the formation of blood clots. ✓ Oral anticoagulants, such as apixaban, are classified as high-alert medications ✓ Baseline laboratory tests, a coagulation profile, and renal function should be obtained whenever an oral anticoagulant is prescribed. ✓ During admission or whenever there is a change in a clients medications, reconcile the use of apixaban with other medications to identify potential drug interactions or contraindications.

The nurse is caring for a client who was prescribed carbidopa and levodopa for Parkinson's disease. The nurse should instruct the client that this medication may cause Select all that apply urine to appear darker. hallucinations. dizziness upon standing. dry, non-productive cough. painful rash that spreads and blisters.

Choices A, B, and C are correct. Levodopa-carbidopa is the mainstay treatment for Parkinson's disease. The medication helps with the movement symptoms but has an array of adverse effects, including psychiatric symptoms that may cause the client to experience nightmares, paranoia, sleep disturbances, and bouts of psychosis. This is because the medication increases dopamine levels causing these psychiatric symptoms. Orthostatic hypotension is a significant concern with this medication because of alterations in the baroreceptors. This effect is intensified if the client is on anti-hypertensives. Choices D and E are incorrect. A dry, non-productive cough is not associated with this medication. Instead, this would be found in clients prescribed an ACE inhibitor. Steven-Johnson syndrome is not related to this medication which is described as a painful rash that spreads and blisters

The nurse is caring for a 14-year-old scheduled for an appendectomy. What is the nurse's role in obtaining informed consent before surgery? Select all that apply. Informing the parents that only the surgeon may withdraw the surgical consent Review the risks and benefits of the surgery with the parents Validate that the parents are competent to provide consent for the client Witness the signature on the informed consent Make sure that the consent is witnessed by two healthcare professionals

Choices C and D are correct. Since the client is 14, they are a minor, and their parents will be responsible for signing informed consent. The nurse is accountable for validating that the parents are competent to provide consent for the client (Choice C). The nurse will serve as the witness for the informed consent. This is one of the primary responsibilities of the nurse when a client is getting a procedure and signing a consent. The other primary responsibility will be to serve as the client's advocate and ensure that the parents have received sufficient information to make an informed decision. If they have not, the nurse must call the surgeon to return and speak further with the parents (Choice D). Additional Info ✓ Informed consent is obtained by the physician and witnessed by the nurse ✓ Informed consent should be voluntary and not coerced from a coerced ✓ The consent should be witnessed and obtained when the client is not under the influence of any medications that may cause neurological impairment ✓ The client may withdraw their consent at any time ✓ The consent process required and ethically supports client autonomy

The nurse is caring for a client who is prescribed enoxaparin. Which laboratory value should the nurse monitor? A. Platelet count B. Activated Partial Thromboplastin Time (aPTT) C. International Normalized Ratio (INR) D. Troponin

Explanation Choice A is correct. Enoxaparin is a low molecular weight-based heparin (LMWH). One of the adverse events of enoxaparin is heparin-induced thrombocytopenia (HIT). This severe condition results in a 50% or more decrease in the platelet count while also causing thrombosis. Therefore, it is reasonable to monitor the platelet count after initiating enoxaparin. Choices B, C, and D are incorrect. Unlike unfractionated heparin, enoxaparin does not require aPTT monitoring (choice B). aPTT is appropriate to monitor a client receiving unfractionated heparin. An unfractionated heparin dose is titrated for an aPTT of 1.5 to 2.5 times the control (baseline) value to achieve the treatment effect. The INR (choice C) is a monitoring parameter for warfarin. Finally, troponin is a lab test for individuals with suspected myocardial infarction(choice D). The nurse should be concerned if the troponin was elevated, indicative of injury to the myocardium. None of these labs require monitoring during enoxaparin therapy. Learning Objective Recognize that low molecular weight heparin (enoxaparin, LMWH) does not require aPTT monitoring, whereas unfractionated heparin does.

Select an appropriate nursing diagnosis for your client who is affected with hyperalgesia. A. At risk for inadvertent narcotic overdoses related to hyperalgesia. B. At risk for abnormal and irreversible pain related to hyperalgesia. C. At risk for somatic pain related to hyperalgesia. D. At risk for visceral pain related to hyperalgesia.

Explanation Choice B is correct. "At risk for abnormal and irreversible pain related to hyperalgesia" is an appropriate nursing diagnosis for a client who is affected with hyperalgesia. Hyperalgesia, which is synonymous with hyperpathia, is abnormal pain processing that can lead to the appearance of neuropathic pain that is irreversible if left untreated. Choice A is incorrect. "At risk for inadvertent narcotic overdoses related to hyperalgesia" is not an appropriate nursing diagnosis for a client who is affected with hyperalgesia. Hyperalgesia is abnormal pain processing that is not associated with inadvertent narcotic overdosages. Choice C is incorrect. "At risk for somatic pain related to hyperalgesia" is not an appropriate nursing diagnosis for a client who is affected with hyperalgesia. Hyperalgesia can lead to neuropathic pain, but not somatic nociceptive pain. Choice D is incorrect. "At risk for visceral pain related to hyperalgesia" is not an appropriate nursing diagnosis for a client who is affected with hyperalgesia. Hyperalgesia can lead to neuropathic pain, but not visceral nociceptive pain.

Which of the following would the nurse expect to be administered to treat a newborn with Respiratory Distress Syndrome (RDS) ? A. Theophylline B. Colfosceril C. Dexamethasone D. Albuterol

Explanation Choice B is correct. Colfosceril palmitate is a medication used as a pulmonary surfactant to treat and prevent respiratory distress syndrome (RDS). A fetus's lungs start making surfactants during the third trimester of pregnancy, or around 26 weeks gestation through labor and delivery. Surfactant coats the insides of the alveoli reducing the surface tension of fluid in the lungs, which helps make the alveoli more stable. This keeps the lungs from collapsing when the newborn exhales. Respiratory distress syndrome (RDS) is a type of neonatal respiratory disease that is most often caused by a lack of surfactant in the lungs. Prevention of RDS is generally desired in babies born at a gestational age less than 32 weeks. In an infant with RDS, colfosceril palmitate may be given via endotracheal tube in two to four doses during the first 24-48 hours after birth. Research shows that these surfactant medications improve respiratory status and decrease the incidence of pneumothorax. Choice A is incorrect. Theophylline is used to treat the symptoms of asthma or other lung conditions that block the airways, such as emphysema or chronic bronchitis.

The nurse is caring for a client with episodes of vertigo who has a fractured leg and has been ordered crutches and not to bear weight on the affected extremity. The most appropriate crutch-walking gait the nurse should teach the client is the A. Two-point gait B. Three-point gait C. Four-point gait D. Swing-through gait

Explanation Choice B is correct. The three-point gait is most appropriate because the client is of non-weight-bearing status on the affected leg. In a three-point gait, the client bears weight on both crutches and then the unaffected leg. This gait is also appropriate because it is slower than the swing-through gait, which requires more balance and is faster. Choice A is incorrect. The two-point gait requires at least partial weight bearing on each foot. This gait would be inappropriate because the client is instructed to have a non-weight-bearing status on the affected leg. Choice C is incorrect. The four-point, gait gives stability to the client but requires weight-bearing on both legs. This gait would be inappropriate because the client has a non-weight-bearing status ordered to the affected extremity. Choice D is incorrect. If the client has complete paralysis of the hips and legs, the swing-to-gait or swing-through gait is utilized. While a swing-to-gait may be utilized if the client has a non-weight-bearing status of an extremity, this would not be recommended because the client has a history of vertigo. The swing-through gait requires the client to swing forward as a pendulum, which may increase their risk of falling. Additional Info ✓ The basic crutch stance is the tripod position, formed when the crutches are placed 6 inches in front of and 6 inches to the side of each foot. This position maintains a client's balance by providing a wider support base.

The nurse is caring for a child with nephroblastoma. To prevent complications from this tumor, the nurse should closely monitor the client's A. liver function tests. B. capillary blood glucose. C. blood pressure. D. visual acuity.

Explanation Choice C is correct. Nephroblastoma, also known as Wilms tumor, is a kidney tumor that primarily affects children. Hypertension may occur because of the surge in renin triggered by the tumor. Choice A is incorrect. While nephroblastoma can metastasize to other organs, including the liver, monitoring liver function tests is not the primary focus in the prevention of complications from the tumor. Choice B is incorrect. Nephroblastoma is not typically associated with alterations in blood glucose levels. Choice D is incorrect. Visual acuity is not directly impacted by nephroblastoma. Monitoring visual acuity is more relevant to conditions affecting the eyes and optic nerve, which are not primary concerns in nephroblastoma. Additional Info ✓ Nephroblastoma is a tumor affecting the kidney(s). The average age at diagnosis is three years in children with single kidney disease. It is slightly younger for those with bilateral involvement. ✓ Nephroblastoma nursing care involves Frequent blood pressure monitoring because this tumor may induce renin-related hypertension Avoiding any activities that may cause palpation of the abdomen Gastrointestinal monitoring as obstruction may consequently occur (absent bowel sounds, abdominal distention should be reported) Managing pain effectively. Nephroblastoma can cause discomfort or pain, and nurses play a crucial role in providing pain relief through appropriate interventions. ✓ Provide emotional support to both the child and the family. A diagnosis of nephroblastoma can be challenging for families, and offering psychological support is an integral part of nursing care.

The nurse has received a prescription for an oral bisphosphonate for a client with osteoporosis. Which finding in the client's medical history would contraindicate the administration of this medication? A. diabetes mellitus. B. hypercalcemia. C. lactose intolerance. D. Roux-en-Y gastric bypass

Explanation Choice D is correct. Roux-en-Y gastric bypass is a surgery that contraindicates the client taking oral bisphosphonates. The risk for significant esophageal ulceration is higher in those who have had this surgery because of the higher risk of reflux. Choice A is incorrect. Diabetes mellitus is not a contraindication for a client taking bisphosphonates. Diabetes mellitus is a risk factor for osteoporosis. Choice B is incorrect. Hypercalcemia is not a contraindication for bisphosphonates. Hypocalcemia is a contraindication because bisphosphonates low serum calcium levels to put it into the bones via osteoblastic activity. Choice C is incorrect. Lactose intolerance is not a contraindication for bisphosphonates. This problem with metabolism may lead to hypocalcemia if the client does not get non-dairy sources of calcium.

The nurse is caring for a client who is in Buck traction. Which of the following actions should the nurse take? A. Ensure that weight is between 15 to 30 lb (6.8 to 13.6 kg) B. Turn the client using a foam wedge every two hours C. Ensure that a client's heels are supported with a pillow D. Elevate the foot of the bed to provide counter traction

Explanation Choice D is correct. The nurse should slightly elevate the foot of the bed to provide counter traction and prevent the client from being pulled downward. Choice A is incorrect. Buck traction is skin traction, and to prevent injury to the skin, the applied weight should not be more than 5 to 10 lb (2.3 and 4.5 kg). Skeletal traction can handle more weight, usually about 15 to 30 lb (6.8 to 13.6 kg), than skin traction. Choice B is incorrect. The client should not be turned from side to side while in traction, as this could move and further injure the affected extremity. The client's extremity should remain in a neutral position. The client should be placed on a mattress with air loss to prevent pressure ulcers. Choice C is incorrect. The nurse should not support the client's heel with a pillow because the pillow can contribute to pressure ulcers. The nurse should ensure that the heel hangs freely off the pillow's edge.

The nurse is caring for a client diagnosed with epilepsy. The nurse should anticipate a prescription for which of the following medications? Select all that apply. Topiramate Risperidone Prazosin Hydroxyzine Lorazepam

Explanation Choices A and E are correct. Epilepsy is an idiopathic condition that requires maintenance treatment by using anticonvulsants. Topiramate is an anticonvulsant that may be used in the prevention of seizures. Lorazepam is also indicated in epilepsy in the event of a patient experiencing an acute seizure. The topiramate should be used for maintenance purposes, and the lorazepam would be indicated for an acute seizure. Choices B, C, and D are incorrect. Risperidone is indicated for psychotic disorders such as schizophrenia. Prazosin is an antihypertensive that may be used for high blood pressure. This medication also may be indicated for psychiatric illnesses such as PTSD. Hydroxyzine is indicated for anxiety disorders as well as allergic rhinitis.

The nurse is planning care for a client with decreased cardiac output. Which interventions would be appropriate? Select all that apply. Apply compression stockings Obtain a prescription for nitroglycerin via transdermal patch Elevate the client's legs Implement fall precautions Educate the client about not straining when defecating

Explanation Choices A, C, D, and E are correct. A client with decreased cardiac output is at risk for hemodynamic instability. Having the client wear compression stockings is helpful because it promotes venous return to the heart. Increasing venous return will increase blood volume (preload). Either compression hose or intermittent sequential pneumatic compression devices may be helpful. Elevating the legs of a supine client redistributes blood to central organs and promotes the venous return to the heart, thereby increasing cardiac output. The client with decreased cardiac output is at greater risk for falls because of orthostatic hypotension. Implementing fall precautions and educating clients to change positions slowly will be beneficial. If a client strains during defecation, the preload will decrease due to a baroreflex. Therefore, the client should be educated not to strain during defecation, and the nurse may need to obtain a prescription for stool softeners (or a laxative). Choice B is incorrect. Nitroglycerin (NTG) would decrease cardiac output because NTG reduces preload by causing a greater blood volume to remain in the peripheral circulation. A prescription for NTG for a client with decreased cardiac output would be unhelpful, if not detrimental.