Exam 1

The primary care provider orders Decadron (dexamethasone sodium phosphate) to be administered at 1800. What time is 1800 on the traditional clock?

6:00 PM

The drug that will most likely be used for treatment of erectile dysfunction (ED) is

sildenafil (Viagra). Sildenafil is an agent for ED.

The nurse explains to a client who is taking oral contraceptives that these drugs can increase risk for

thrombophlebitis.

2 mg= ______ mcg XXX.0002

2000

The nurse is teaching a new mother about the reason her infant will receive vitamin K. The nurse evaluates instruction as being effective when the mother makes which statement?

"Babies do not have enough intestinal bacteria to synthesize vitamin K." The infant's gut is sterile, so there are inadequate bacteria to synthesize vitamin K, which is essential to promote blood clotting.

Choose the correct example of using a "leading zero."

0.01

The patient tells the nurse, "I thought I was just depressed, but my doctor says I have bipolar disorder. What is that?" What is the best response by the nurse?

"Bipolar disorder means you have cycles of depression as well as hyperactivity, or mania." Patients with bipolar disorder may shift from emotions of extreme depression to extreme rage and agitation. Mania may include grandiosity, decreased need for sleep, pressured speech, racing thoughts, buying sprees, and sexual indiscretions.

A patient was prescribed sertraline (Zoloft) for the treatment of depression and anxiety. The patient's spouse calls the clinic and reports the patient is increasingly moody and seems "disconnected with life." What is the best response by the nurse?

"Bring him to the clinic for assessment today." Sertraline (Zoloft) increases the risk of suicidal thinking and behavior. The patient must be assessed.

The patient has been depressed, and the physician plans to begin treatment with an antidepressant medication. In performing the initial assessment, what is the most important question for the nurse to ask?

"Have you had any thoughts about killing yourself?" The nurse should always assess for suicidal ideation in any depressed patient who is about to begin antidepressant treatment. The medication takes several weeks before the full benefit is obtained. This is a safety issue.

The patient has a potassium level of 5.9 mEq/L. The nurse is administering glucose and insulin. The patient's wife says, "He doesn't have diabetes, why is he getting insulin?" What is the best response by the nurse?

"Insulin will cause his extra potassium to go into his cells and lower the blood level." Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells.

The client receives estrogen for prostate cancer. He asks the nurse why he is receiving a female hormone. What is the best response by the nurse?

"It suppresses secretion of the androgens that make your cancer grow." Prostate cancer is usually dependent on androgens for growth; administration of estrogens will suppress androgen secretion.

The patient is diagnosed with generalized anxiety disorder. He asks the nurse, "Will I need medication for this? My coworker is very nervous and he takes medication." What is the best response by the nurse?

"Medication is necessary when anxiety interferes with your quality of life." It is more productive to identify and treat the cause of anxiety than to use medications. When anxiety becomes severe enough to significantly interfere with the patient's quality of life, pharmacotherapy is indicated.

The client receives prednisone as treatment for his inflammatory disease. He has experienced great relief and asks the nurse if he can just keep taking this medication. What is the best response by the nurse?

"No, because this medication has serious adverse effects." Systemic glucocorticoids are reserved for the short-term treatment of severe disease because of potentially serious adverse effects.

The patient tells the nurse that she has been taking phenytoin (Dilantin) for 3 years now and is still having too many side effects. She wants to stop taking it. What is the best response by the nurse?

"Please do not stop the medication abruptly, as you will have withdrawal seizures." Seizures are likely to occur with abrupt withdrawal of antiseizure medication. The medication must be withdrawn over a period of 6 to 12 weeks.

The nurse plans to teach a class on acetaminophen (Tylenol) to mothers with young children. What will the best plan by the nurse include?

"Read the labels of all over-the-counter (OTC) medications for the amount of acetaminophen (Tylenol) in them." It is very easy for parents of young children to overdose them with acetaminophen (Tylenol). All medication labels should be read.

A client has been taking low-dose oral contraceptives. She calls the clinic and reports that she is mid-cycle and has noticed some slight spotting. What information should the nurse provide?Select all that apply.

"Slight spotting may occur, especially with low-dose oral contraceptives." "Monitor the bleeding and contact us again if it becomes continuous or heavy."

The client had a liver transplant and asks the nurse if she really needs all of those medications. How should the nurse respond?"

"You need these medications because it is important to dampen your immune response so you won't reject your new liver." The client needs medication to dampen her immune response so that she will not reject the new liver.

A client calls the clinic and tells the nurse that she has missed taking several of her contraceptive pills during the current cycle. What is the best instruction for the nurse to give the client?

"You should use an alternative form of birth control for the rest of this cycle." If more than one pill is missed, the medication will not be effective and conception could occur, so the client must use an alternative form of birth control for the rest of her current cycle.

A client is prescribed total parenteral nutrition (TPN). Which education should the nurse provide? "Since this is going to be a long-term treatment, your TPN will be given through a central line." "Not All of your nutrition can be supplied by TPN." "You will not be able to return home until the TPN is discontinued." XXX "Once you go home, you will come in twice a week for TPN." (TPN is administered continuously.)

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Androgen is secreted by XXXthe pituitary gland. The pituitary releases follicle-stimulating hormone. gonadotropin-releasing hormone. the testes. follicle-stimulating hormone.

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Benzodiazepines are often the drug of choice for managing anxiety and insomnia. Which statement best explains why? Benzodiazepines have the lowest risk of dependency and tolerance. Benzodiazepines are the most affordable. Benzodiazepines are most likely to be covered under insurance premiums. XXX Benzodiazepines are the most effective. (Benzodiazepines are not necessarily more effective than other drugs.)

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Estrogens are secreted by the ovarian follicles. endometrium. XXX anterior pituitary. Gonadotropin-releasing hormone is secreted by the pituitary. corpus luteum.

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Medication on hand: Heparin 25,000 units in 250 mL Order: infuse 1500 units per hr. How many mL per hour will you set the pump? XXX1.5

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Medication order: 500 mg/kg/day Patient weight: 176 pounds The patient weighs _____ kg. XXX38

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Medication order: Insulin 20 units in 500 mL, infuse at 0.04 units/min How many mL per hour do you need to infuse to deliver 0.04 units/min? XXX0.01

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Medication order: Vistaril 20 mg IM now Available: Vistaril 25 mg/mL How many mL will you administer?_______________ XXX1.25

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The BSA of a patient who is 3 years old is 0.62 m2. Medication order: Daunorubicin 25 mg/m2 weekly Available: 2 mg/mL in 25 mL vial The patient would receive a dose of _____ mg/week. (round to the nearest tenth) XXX6.1

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The nurse is evaluating the drug effects in a client who has been given interferon alfa-2b (Intron-A). For hepatitis B and C. Which of the following is a common adverse effect? Depression, and thoughts of suicide Insomnia, bradycardia,, dry cough XXX Hypertension, hepatic toxicity Edema, hypotension, and tachycardia

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The patient has been prescribed an oral immunosuppressant medication. The nurse would evaluate the teaching as effective when the patient makes which statement? XXX "I have eliminated chocolate from my diet." (There is no reason to avoid chocolate when taking immunosuppressants.) "I have a cute plastic cup I use to mix my medicine." "When I mix my medicine with grapefruit juice, it doesn't taste as bad." "I always rinse the cup and drink the rinse water."

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The patient has bipolar disorder and is in a manic phase. The physician prescribes lithium (Eskalith). The patient's current lithium level is 0.2. What will the nurse expect to assess in this patient? Signs and symptoms of depression Hyperactivity and pressured speech A return to baseline behavior, calm and rational XXX A decrease in manic behavior (There will be no decrease in manic behavior because the lithium level is not within range.)

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The physician has prescribed sertraline (Zoloft) for the patient who is anxious and depressed. The patient calls the nurse to report that he has experienced delayed ejaculation since being on this medication. What is the best response by the nurse? "I am concerned that you will become suicidal if you stop the medication." "I will let your doctor know, and he will most likely change your medication." "Keep taking the medicine, as this usually goes away after a few months." XXX "This does happen, but treating your depression is a bigger priority." (It is inappropriate to tell a patient that his depression is a higher priority; sexual functioning is important to patients.)

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The physician orders a hypertonic crystalloid solution for the patient in critical care who has cerebral edema. The nurse hangs a bag of a hypotonic solution. What will the priority assessment by the nurse include? Headache, irritability, and decreasing level of consciousness Nausea, projectile vomiting, and pinpoint pupils Hypertension, increased alertness and nausea XXX Confusion, hallucinations, and agitation (Confusion, hallucinations, and agitation are not classical signs of cerebral edema.)

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The suggested dose of tobramycin is 4 mg/kg/day to be administered every 12 hours. A baby weighing 5500 g should receive how many mg/dose? XXX114583.4

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The nurse is caring for a client with epilepsy who is being treated with Carbamazepine (Tegretol). Which laboratory value might indicate a serious side effect of this drug? Hemoglobin 13.0 gm/dL BUN 10 mg/dL WBC 4,000 /mm3 Platelets 200,000 /mm3 (wrong) Rationale: Tegretol can cause bone marrow depression, which is evident by the low WBC of 4000. It can also cause problems with the liver which would raise the BUN. Although the BUN is normal in this scenario.

... Rationale: Tegretol can cause bone marrow depression, which is evident by the low WBC of 4000. It can also cause problems with the liver which would raise the BUN. Although the BUN is normal in this scenario.

The nurse is reviewing the tonicity of the different intravenous fluids on the medical-surgical unit in preparation for an educational presentation. Which fluids are considered to be isotonic and appropriate in the treatment of fluid loss due to a surgical procedure?

0.9% sodium chloride (NS) 0.9% sodium chloride (NS) is an isotonic solution and is appropriate for the treatment of fluid loss due to a surgical procedure.

You have an IV infusing at 120 mL/hr. How many hours will it take for 1200 mL to infuse?

10

The client is receiving total parenteral nutrition (TPN). What does the best plan by the nurse include to prevent complications from total parenteral nutrition?

Assess the client's blood glucose levels. Hyperglycemia may occur, as total parenteral nutrition (TPN) solutions contain concentrated amounts of glucose.

Which of the following adverse effects would most likely be associated with the use of phenytoin (Dilantin)?

Bleeding Dilantin affects the metabolism of vitamin K, which can lead to blood dyscrasias.

The nurse is assessing the laboratory results of a client scheduled to receive Phenytoin sodium (Dilantin). The Dilantin level, drawn two hours ago, is 30 mcg/mL. What is the appropriate nursing action?

Hold the scheduled dose and notify the physician. Rationale: The normal Dilantin level is 10-20 mcg/mL; a level of 30 exceeds the normal. The appropriate action is to notify the provider for orders.

A patient who has been treated with antipsychotic agents for schizophrenia has an elevated blood pressure, dyspnea, and an extremely high temperature. The nurse prepares to treat which disorder?

Neuroleptic malignant syndrome The condition that causes an elevated blood pressure, dyspnea, and high temperature is neuroleptic malignant syndrome.

The patient has been outside gardening all day on a very warm day. The patient complains of dizziness and nausea and is taken to the hospital where she becomes lethargic. The serum sodium level is 120 mEq/L. What will be the best plan of the nurse?

Prepare to administer normal saline intravenous (IV). Hyponatremia is a serum sodium level less the 135 mEq/L. Hyponatremia caused by sodium loss may be treated with intravenous (IV) fluids containing salt, such as normal saline.

Which finding is a sign or symptom of inflammation?

Redness Redness occurs from antigen reaction.

The nurse is planning care for a client who receives total parenteral nutrition. What will the best plan by the nurse include?

Remove the solution from the refrigerator 30 minutes prior to hanging. A cold infusion could cause irritation to the intravenous (IV) site.

Which drug category can be used for treating anxiety?

Seizure drugs In addition to antidepressants, several other drug classes are used to treat anxiety, including seizure drugs.

The client receives an immunosuppressant medication. What is the priority information for the nurse to teach the client about this medication?

The client should avoid crowds. Avoiding crowds is important to avoid exposure to infection.

The client plans to use an estrogen/progestin oral contraceptive for birth control. Which client behavior would the nurse be most concerned about?

The client smokes one-half pack of cigarettes per day. Cigarette smoking increases the client's risk for a thrombolytic disorder.

The nurse plans care for an older adult receiving nonsteroidal anti-inflammatory drug (NSAID) therapy. What is the best outcome for this client as it relates to side effects of nonsteroidal anti-inflammatory drugs (NSAIDs)?

The client will report any bleeding or bruising while taking the nonsteroidal anti-inflammatory drug (NSAID). Older adults are at risk for increased bleeding with nonsteroidal anti-inflammatory drug (NSAID) therapy.

The physician has prescribed haloperidol (Haldol) for the patient with schizophrenia. What is the priority patient outcome?

The patient will be compliant with taking the medication as prescribed. Medication compliance is a priority for patients with schizophrenia. Relapse of symptoms will occur without the medications.

A client has been prescribed Haloperidol (Haldol). What clinical manifestations suggests that the client is experiencing side effects from this medication?

Tremors Rationale: Tremors are extrapyramidal side effects that can occur when taking Haldol.

The most productive way of managing stress would be to

determine the cause and address it accordingly. Stress is generally a symptom of an underlying disorder. It is more productive to uncover and address the cause than to treat the symptoms.