Exam 1 B261

What is the ratio between a drug's therapeutic effects and toxic effects called? A) Therapeutic index B) Tolerance C) Cumulative effect D) Affinity

A) Therapeutic index

Which vaccination is recommended in the prevention of a virus that is known to cause cervical cancer? a. Herpes zoster vaccine b. Papillomavirus vaccine c. Pneumococcal vaccine d. Hepatitis B virus vaccine

b. Papillomavirus vaccine

Which vaccine contains inactivated virus in its formulation? a. Polio virus vaccine b. Varicella virus vaccine c. Hepatitis B virus vaccine d. Measles-mumps-rubella (MMR) virus vaccine

c. Hepatitis B virus vaccine

Which is an active immunizing drug? a. Influenza virus vaccine b. Tetanus immunoglobulin c. Vaccinia immunoglobulin d. Antivenin Micrurus fulvius

a. Influenza virus vaccine

Which immunizing drug is harvested from a large pool of blood donors? a. Antitoxin b. Immunoglobulin c. Snake antivenin d. Spider antivenin

b. Immunoglobulin

The nurse teaches the patient that developing immunity after contracting a disease is an example of what type of immunity? a. Natural passive immunity b. Natural active immunity c. Artificial active immunity d. Artificial passive immunity

b. Natural active immunity

he nurse is teaching a pregnant patient about the effects of medication on fetal development. The nurse understands the greatest risk for medication effects on developing fetuses occurs during which time period? A) First trimester B) Third trimester C) Birthing process D) Second trimester

A) First trimester

When administering two medications that are highly protein bound, the nurse understands to monitor the patient carefully for which effect? A) Increase in the risk of drug-drug interactions B) Hypovolemic shock caused by a low albumin level C) Immediate improvement in the patient's condition D) A short duration of medication action

A) Increase in the risk of drug-drug interactions

What is the mechanism of action of nonsteroidal antiinflammatory drugs (NSAIDs)? A) Inhibiting prostaglandin production B) Increasing the supply of natural endorphins C) Increasing blood flow to painful areas D) Enhancing pain perception

A) Inhibiting prostaglandin production

he nurse understands that drugs exert their actions on the body by what process? (Select all that apply.) A) Inhibiting the action of a specific enzyme B) Making the cell perform a new function C) Altering metabolic chemical processes D) Interacting with receptors

A) Inhibiting the action of a specific enzyme C) Altering metabolic chemical processes D) Interacting with receptors

The nurse knows that which factors will affect the absorption of orally administered medications? (Select all that apply.) A) Presence of food in the stomach B) Time of daypH of the stomach C) Form of drug preparation D) Patient in high-Fowler's position

A) Presence of food in the stomach B) Time of daypH of the stomach C) Form of drug preparation

The nurse is administering probenecid (Benemid) to a client with recurrent strep throat. The nurse teaches the client that the MOST likely reason for taking this medication is for what drug effect? A) Prolong the effectiveness of penicillin therapy B) Inhibit bacterial growth and replication C) Prevent the occurrence of gout D) Increase uric acid excretion

A) Prolong the effectiveness of penicillin therapy

A nurse administers an incorrect medication to a patient. In reviewing this medication error,the nurse finds out that incorrect medication was placed in the Pyxis system. What type of error has the nurse committed? a.Latent error b.Blunt end c.Did not follow nursing process d.Latent error resulting inactive error

d.Latent error resulting inactive error The situation described is a latent error which resulted in an active error as incorrect medication was placed in the Pyxis system. Latent errors are also referred to as blunt end whereas active errors are applied as occurring at the sharp end. There is no provided information to suggest that the nurse did not follow nursing process.

The nurse is preparing to give an oral dose of acetaminophen (Tylenol) to a child who weighs 12 kg. The dose is 15 mg/ kg. How many milligrams will the nurse administer for this dose?

180 mg

Which immunization would the nurse administer to a patient with a wound that places the patient at risk for infection from Clostridium tetani? a. Tetanus immunoglobulin b. Varicella zoster immunoglobulin c. Rh0(D) immunoglobulin d. Hepatitis B immunoglobulin

a. Tetanus immunoglobulin

A 30-year-old woman is in the clinic for her yearly gynecologic exam and asks the nurse about the "new vaccine that prevents HPV." She wants to receive the papilloma virus vaccine (Gardasil). Which response by the nurse is most appropriate? a."For women, the recommended age for this vaccine is 13 to 26 years of age." b."We will need to make sure you are not pregnant first." c."There will be a total of three injections." d."I will check with your health care provider and then get the first dose of thevaccine ready."

a."For women, the recommended age for this vaccine is 13 to 26 years of age."

The nurse is reviewing the health history of a new patient who may need immunizations.Active immunizations are usually contraindicated in which patients? (Select all thatapply.) a.Patients with a febrile illness b.Children younger than 1 year of age c.Elderly patients d.Patients who are immuno suppressed e.Those receiving cancer chemotherapy

a.Patients with a febrile illnessd.Patients who are immuno suppressed e.Those receiving cancer chemotherapy

An 18-month-oldfemale patient is diagnosed with her fifth ear infection in the past 10 months. The physician notes that the child's growth rate has decreased from the 60th percentile for height and weight to the 15th percentile over that same time period. The child has been treated for thrush consistently since the third ear infection. The nurse understands that the patient is at risk for which condition? a.Primary immunodeficiency b.Secondary immunodeficiency c.Cancer d.Auto immunity

a.Primary immunodeficiency Primary immunodeficiency is a risk for patients with two or more of the listed problems.Secondary immunodeficiency is induced by illness or treatment. Cancer is caused by abnormal cells that will trigger an immune response.Auto immune diseases are caused by hyperimmunity

A 45-year-old man has received a series of immunizing drugs in preparation for a trip to a developing country. Within hours, his wife brings him to the emergency department because he has developed edema of the face, tongue, and throat and is having trouble breathing. The nurse suspects that, based on the patient's history and symptoms, he is experiencing which condition? a.Serum sickness b.Cross-sensitivity c.Thrombocytopenic purpura d.Adenopathy

a.Serum sickness

The nurse is preparing to administer an injection to a preschool-age child. Which approaches are appropriate for this age group? (Select all that apply.) a. Explain to the child in advance about the injection. b. Provide a brief, injection. c. Encourage participation in the procedure. d. Make use of magical thinking. e. Provide comfort measures after the injection

b. Provide a brief, injection. d. Make use of magical thinking. e. Provide comfort measures after the injection

A patient is being treated with an antibiotic for an infected orthopedic injury.What explanation should the nurse give to the patient about this medication? a."Antibiotics will decrease the pain at the site." b."An antibiotic helps to kill the infection causing the inflammation." c."An antibiotic inhibits cyclooxygenase,an enzyme in the body." d."Antibiotics will reduce the patient's fever."

b."An antibiotic helps to kill the infection causing the inflammation." Antimicrobials treat the underlying cause of the infection which leads to inflammation.Analgesicsand nonsteroidal anti-inflammatory drugs(NSAIDs) help to treat pain.NSAIDs and otherantipyretics are cyclooxygenase inhibitors. Antipyretics help to reduce fever.

An 82-year-old patient is admitted to the hospital after an episode of confusion at home. The nurse is assessing the current medications he is taking at home. Which method is the best way to assess his home medications? a. Ask the patient what medications he takes at home. b. Ask the patient's wife what medications he takes at home. c. Ask the patient's wife to bring his medications to the hospital in their original containers. d. Contact the patient's pharmacy for a list of the patient's current medications.

c. Ask the patient's wife to bring his medications to the hospital in their original containers.

While teaching a 76-year-old patient about the adverse effects of his medications, the nurse encourages him to keep a journal of the adverse effects he experiences. This intervention is important for the older adult patient because of which altera-tions in pharmacokinetics? a. Increased renal excretion of protein-bound drugs b. More alkaline gastric pH, resulting in more adverse effects c. Decreased blood flow to the liver, resulting in altered metabolism d. Less adipose tissue to store fat-soluble drugs

c. Decreased blood flow to the liver, resulting in altered metabolism

The nurse is reviewing factors that influence pharmacokinetics in the neonatal patient. Which factors puts the neonatal patient at risk with regard to drug therapy? (Select all that apply.) a. Higher gastric pH b. Increased peristalsis in the GI tract c. Immature renal function d. Reduced first-pass elimination in the liver e. Decreased protein-binding of medications

c. Immature renal function d. Reduced first-pass elimination in the liver e. Decreased protein-binding of medications

Which type of immunity does a newborn obtain from the mother? a. Herd immunity b. Cell-mediated immunity c. Naturally acquired passive immunity d. Artificially acquired passive immunity

c. Naturally acquired passive immunity

Which statement most accurately describes the pharmacodynamics of vaccines? a. Vaccines provide passive immunity. b. Vaccines work by suppressing immunoglobulins. c. Vaccines work by stimulating the humoral immune system d. Vaccines prevent the formation of antibodies against a specific antigen.

c. Vaccines work by stimulating the humoral immune system

Which immunizing drug is contraindicated with the use of salicylates? a. Measles-mumps-rubella (MMR) vaccine b. Influenza vaccine c. Varicella virus vaccine d. Papillomavirus vaccine

c. Varicella virus vaccine

Two patients arrive at the clinic; one is a young boy with sickle cell anemia, and another is a 57-year-old woman with early stages of Hodgkin's disease. The nurse notices that both patients need the same vaccine. What vaccine would that be? a.Varicella virus vaccine (Varivax) b.Herpes zoster vaccine (Zostavax) c.Hepatitis B virus vaccine, inactivated (Recombivax HB) d.Haemophilus influenzae type b (Hib) vaccine

d.Haemophilus influenzae type b (Hib) vaccine

To promote a culture of safety, the nurse manager preparing the staff schedule considers the anticipated census in planning the number and experience of staff on any given shift. Which is the human factor primarily addressed with this consideration? a.Available supplies b.Interdisciplinary communication c.Interruptions in work d.Work load fluctuations

d.Work load fluctuations Including an adequate number of staff members with experience caring for anticipatedpatients is a strategy to manage the workload and potential fluctuations. A safety culture requires organizational leadership (e.g, the nurse manager) that gives attention to human factors such as managing work load fluctuations. This strategy also applies principles of crew resource management in that it addresses workload distribution. Lack of supplies can create a challenge for safe care but could not be addressed with the schedule. Concerns with communication and coordination across disciplines, including power gradients, and excessive professional courtesy can create hazards but would not be the best answer. Strategies to minimize interruptions in work are essential but would not be the best answer in this situation.

A hospitalized patient has an order for ketorolac (Toradol). The nurse notes that the order is only for 5 days. What is the reason for this? A.The patient's pain should subside by that time. B.There are concerns about addiction to the drug. C.The drug can cause severe renal and gastrointestinal effects. D.The drug loses its effectiveness over time.

C.The drug can cause severe renal and gastrointestinal effects. Rationale: The main adverse effects of ketorolac include renal impairment, edema, gastrointestinal pain, dyspepsia, and nausea. It is important to note that the drug can only be used for 5 days because of its potential adverse effects on the kidney and gastrointestinal tract.

A patient who has a history of coronary artery disease has been instructed to take one 81-mg aspirin tablet a day. The nurse is aware that the purpose of this dose of aspirin is to A.reduce anxiety. B.reduce inflammation. C.prevent thrombus formation. D.relieve pain

C.prevent thrombus formation.

A mother of a 1-month-old infant calls the clinic and asks the nurse if the medication she is taking can be passed to her infant during breastfeeding. What is the nurse's best response to the mother's question? A) "You should not take any medication while breastfeeding." B) "Only certain medications pass to infants while breastfeeding." C) "I will leave the health care provider a message to return your call." D) "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."

D) "Drugs can cross from mother to infant in breast milk, so it will depend on the drug you are taking."

A nurse teaching a client receiving allopurinol (Zyloprim) should include which information? A) "Take the medication with an antacid to minimize GI distress." B) "This medication may cause your urine to turn orange." C) "Include salmon and organ meats in your diet on a weekly basis." D) "Increase your fluid intake to 3 L per day."

D) "Increase your fluid intake to 3 L per day."

When calculating pediatric dosages, the nurse understands which method is MOST accurate for dosing calculations? A) Calculated doses based on body weight need to be increased by 10% because of immature renal and hepatic function B) Medication dosing calculated according to body weight because it is based on maturational growth and development C) Use of drug reference recommendations based on mg/kg of body weight. D) Dosage calculation by body surface area because it takes into account the difference in size for children and neonates

D) Dosage calculation by body surface area because it takes into account the difference in size for children and neonates

The physiologic changes that normally occur in older adult patients have which implication for drug response? A) Protein binding is more efficient. B) Drug metabolism is quicker. C) Drug elimination is faster. D) Drug half-life is lengthened.

D) Drug half-life is lengthened.

Patients with renal failure would MOST likely have problems with which pharmacokinetic process? A) Absorption B) Metabolism C) Distribution D) Excretion

D) Excretion

Which nursing action will increase the absorption of a medication administered intramuscularly (IM)? A) Administer the medication via the Z-track method. B) Apply ice packs to the injection site. C) Lower the extremity below the level of the heart. D) Massage the site after injection.

D) Massage the site after injection.

What is the study of physiochemical properties of drugs and how they influence the body called? A) Pharmacokinetics B) Pharmacotherapeutics C) Pharmacology D) Pharmacodynamics

D) Pharmacodynamics

The nurse would question a prescription to administer misoprostol (Cytotec) to a client with which condition? A) Gastroesophageal reflux disease B) Peptic ulcer C) Chronic obstructive pulmonary disease D) Pregnancy

D) Pregnancy

A patient with gout has been treated with allopurinol (Zyloprim) for 2 months. The nurse will monitor laboratory results for which therapeutic effect? A.Increased hemoglobin and hematocrit levels B.Decrease white blood cell count C.Decreased prothrombin time D.Decreased uric acid levels

D.Decreased uric acid levels

A patient is admitted with salicylate toxicity. When assessing the patient, the nurse anticipates which manifestation associated with salicylate toxicity? A.Bradycardia B.Hypoventilation C.Constipation D.Hyperglycemia

D.Hyperglycemia Rationale: Manifestations of salicylate toxicity include increased heart rate, tinnitus, hearing loss, dimness of vision, headache, dizziness, mental confusion, lassitude, drowsiness, nausea, vomiting, diarrhea, sweating, thirst, hyperventilation, and hypoglycemia or hyperglycemia.

An 82-year-old woman is taking ibuprofen (Motrin) 3200 mg divided three times daily as treatment for arthritis. She has had no other health problems. What is the most important assessment for the nurse to monitor while the patient is on this therapy? A.Blood sugar B.Liver function studies C.Assessment of hearing D.Renal function studies

D.Renal function studies Rationale: NSAIDs disrupt the prostaglandins, which stimulate vasodilation and increase renal blood flow. This disruption may precipitate chronic or acute renal failure in some patients, and elderly patients are at greater risk for this adverse drug reaction.

Which drug does the nurse associate with the development of potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis? A.probenecid B.colchicine C.febuxostat (Uloric) D.allopurinol (Zyloprim)

D.allopurinol (Zyloprim) Rationale: If the patient is taking allopurinol, assess the integrity of the skin due to potentially life-threatening skin adverse effects of exfoliative dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis

The nurse is administering medications. One patient has an order for aspirin 325 mg by mouth daily and another patient has an order for aspirin 650 mg 4 to 6 times daily (maximum 4 g/day). The nurse understands that the indication for the 325 mg of aspirin once daily is A.pain management. B.fever reduction. C.treatment of osteoarthritis. D.thromboprevention.

D.thromboprevention. Rationale: "Low-dose" aspirin, such as 81 or 325 mg once daily, is given for thromboprevention. Dosages for pain, fever, or arthritis are much higher usually.

The nursei scaring for a patient experiencing an allergic reaction to a beesting who hasan order for diphenhydramine (BenaDRYL). The only medication in the patient's medicationbin is labeled BenaZEPRIL. The nurse contacts the pharmacy for the correct medication to avoid what type of error? a.Communication b.Diagnostic c.Preventive d.Treatment

d.Treatment The nurse avoided a treatment error, giving the wrong medication. Benazepril is an ace inhibitor used to treat blood pressure. The Institute of Medicine (IOM) report referred to Leape identification of four types of errors. Treatment errors occur in the performance of an operation, procedure, or test; in administering a treatment; in the dose or method of administering a drug; or in avoidable delay in treatment or in responding to an abnormal test. Communication errors refer to those that occur from a failure to communicate. Diagnostic errors are the result of a delay in diagnosis, failure to employ indicated tests,use of outmoded tests, or failure to act on results of monitoring or testing. Preventive errors occur when there is inadequate monitoring or failure to provide prophylactic treatment or follow-up of treatment.

The acetic acid derivative indomethacin (Indocin) has which properties?Select all that apply. A) Antirheumatic B) Antiinflammatory C) Antipyretic D) Antinausea E) Anticonvulsant

A) Antirheumatic B) Antiinflammatory C) Antipyretic

An elderly patient tells the nurse that he uses aspirin for "anything that hurts." The nurse will assess for which most common signs of chronic salicylate intoxication in adults? A.Tinnitus and hearing loss B.Acute gastrointestinal bleeding and anorexia C.Hyperventilation and central nervous system (CNS) effects D.Photosensitivity and nervousness

A.Tinnitus and hearing loss

A patient calls the clinic to ask about taking a glucosamine-chondroitin supplement for arthritis. The nurse reviews the medication history and notes that there will be a concern for drug interactions if the patient is also taking medications for which disorder? A.Type 2 diabetes mellitus B.Hypertension C.Hypothyroidism D.Angina

A.Type 2 diabetes mellitus

What are two major foci of The Joint Commission(TJC) in the delivery of health care? a.Cost containment, safety b.Safety, quality c.Quality, assessment d.Assessment, evaluation

b.Safety, quality The focus of TJC is quality and safety for patient care. TJC does not address cost containment, assessment of care, or evaluation of care.

A patient asks the nurse why a lower dose of IV pain medication is being given than the previous oral dose. What is the nurse's best response to the patient? A) "A large percentage of an intravenously administered drug is metabolized into inactive metabolites in the liver." B) "Medications given intravenously are not affected by the first-pass effect." C) "Drugs administered intravenously enter the portal system before systemic distribution." D) "Medications given orally bypass the portal circulatory system."

B) "Medications given intravenously are not affected by the first-pass effect."

The client asks the nurse about the use of herbal and dietary supplements to treat arthritis pain. What is the nurse's best response? A) "Ginkgo biloba has shown tremendous benefit as an antiinflammatory drug and is used to treat the symptoms of pain." B) "There is evidence that glucosamine sulfate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider." C) "There really are no safe herbal treatments for pain. Your best action would be to take your prescription medications." D) "High doses of vitamins and minerals have been used for many years to help maintain joint health."

B) "There is evidence that glucosamine sulfate with chondroitin does decrease joint stiffness and pain. Discuss this with your health care provider."

When teaching a client about potential adverse effects of NSAID therapy, the nurse will teach the client to immediately notify the health care provider of which effect? A) Nonproductive cough B) Black tarry stools C) Diarrhea D) Mild indigestion

B) Black tarry

While conducting a health history for an older adult patient with heart failure, the patient tells the nurse, I have chronic constipation." The nurse suspects this gastrointestinal complaint is caused by which class of drugs? A) Nonsteroidal anti inflammatory drugs B) Calcium channel blockers C) Potassium-sparing diuretics D) Anticoagulants

B) Calcium channel blockers

Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates the health care provider will perform which action to minimize the risk of toxicity? A) Increase the amount of drug given. B) Decrease the amount of drug given. C) Administer the medication intravenously. D) Shorten the time interval between doses.

B) Decrease the amount of drug given.

The nurse working in a prenatal clinic recognizes that the safety or potential harm of drug therapy during pregnancy relates to which factor? A) Maternal blood type B) Drug properties C) Fetal sex D) Diet of the mother

B) Drug properties

To achieve the most rapid onset of action, the health care provider will prescribe the medication to be administered by which route? A) IM B) IV C) Subcut D) Intrathecally

B) IV

What is advantage of COX-2 inhibitors over other NSAIDs? A) Are less likely to cause hepatic toxicity B) Maintain GI mucosa C) Have a longer duration of action D) Have a more rapid onset of action

B) Maintain GI mucosa

A mother brings her toddler into the emergency department and tells the nurse that she thinks the toddler has eaten an entire bottle of chewable aspirin tablets. The nurse will assess for which most common signs of salicylate intoxication in children? A.Acute gastrointestinal bleeding B.Hyperventilation and drowsiness C.Photosensitivity and nervousness D.Tinnitus and hearing loss

B.Hyperventilation and drowsiness

A patient is taking ibuprofen 800 mg three times a day by mouth as treatment for osteoarthritis. While taking a health history, the nurse finds out that the patient has few beers on weekends. What concern would there be with the interaction of the alcohol and ibuprofen? A.Increased bleeding tendencies B.Increased chance for gastrointestinal bleeding C.Increased nephrotoxic effects D.Reduced anti inflammatory effects of the nonsteroidal anti inflammatory drug (NSAID)

B.Increased chance for gastrointestinal bleeding Rationale: NSAIDs taken with alcohol may result in increased risk of gastrointestinal bleeding.

A patient is taking the nonsteroidal antiinflammatory drug indomethacin (Indocin) as treatment for pericarditis. The nurse will teach the patient to watch for which adverse effect? A.Nervousness B.Nausea and vomiting C.Tachycardia D.Dizziness

B.Nausea and vomiting

The nurse should question a prescription to administer acetylsalicylic acid (aspirin) to which client? A) A 45-year-old patient with a history of heart attack B) A 62-year-old patient with a history of stroke C) A 14-year-old patient with a history of flulike symptoms D) A 28-year-old patient with a history of sports injury

C) A 14-year-old patient with a history of flulike symptoms

The nurse knows colchicine (Colcrys) exerts its therapeutic effect by what action? A) Increases production of lactic acid B) Increases process of phagocytosis C) Decreases mobility of leukocytes D) Increases uric acid metabolism

C) Decreases mobility of leukocytes

A nurse working with older adult patients is concerned about the number of medications prescribed for each patient. Which older adult assessment should be of highest priority related to polypharmacy? A) Nonadherence to drug regimen B) Cost of medications C) Drug interactions D) Schedule of medications

C) Drug interactions

Which NSAID would the nurse anticipate administering parenterally for the treatment of acute postoperative pain? A) Indomethacin (Indocin) B) Allopurinol (Zyloprim) C) Ketorolac (Toradol) D) Diclofenac (Cataflam)

C) Ketorolac (Toradol)

What is another term for biotransformation of a drug? A) Excretion B) Absorption C) Metabolism D) Dilution

C) Metabolism

A drug given by which route is altered by the first-pass effect? A) Sublingual B) Intravenous (IV) C) Oral D) Subcutaneous (subcut)

C) Oral

Which nursing diagnosis is appropriate for a client prescribed colchicine (Colcrys)? A) Risk for injury related to adverse effect of life threatening seizures B) Constipation related to adverse effect of the medication C) Risk for fluid volume deficient related to nausea, vomiting, and diarrhea D) Risk for infection related to medication-induced leukocytosis

C) Risk for fluid volume deficient related to nausea, vomiting, and diarrhea

Which statement best describes pharmacokinetics? A) Physiologic interaction between a drug and body cells B) Adverse effects and toxic reactions to medications C) What the body does to the drug after it is administered D) Converts medication into its active chemical substance

C) What the body does to the drug after it is administered

Drug half-life is defined as the amount of time required for 50% of a drug to: A) be absorbed by the body. B) exert a response. C) be eliminated by the body. D) reach a therapeutic level.

C) be eliminated by the body.

The nurse is reviewing the therapeutic effects of nonsteroidal antiinflammatory drugs (NSAIDS), which include which effect? A.Anxiolytic B.Antimicrobial C.Antipyretic D.Sedative

C.Antipyretic

During assessment of a patient with osteoarthritis pain, the nurse knows that which condition is a contraindication to the use of nonsteroidal antiinflammatory drugs (NSAIDs)? A.Headaches B.Diabetes mellitus C.Renal disease D.Rheumatoid arthritis

C.Renal disease

Which information should be included in the teaching plan for a patient receiving tetanus toxoid? a. "Soreness at the injection site is a common reaction." b. "You will have lifetime immunity from this injection." c. "This medication must be repeated weekly for 4 weeks." d. "Increase fluid and fiber in your diet to prevent constipation."

a. "Soreness at the injection site is a common reaction."

A patient arrives at the clinic with a wound inflicted by a rusty nail. After checking the patient's history, the nurse finds that the patient last received the tetanus booster about 10 years earlier. Which nursing action is appropriate in this situation? a. Administer Tdap. b. Administer DTaP. c. Administer immunoglobulin. d. Administer polyvalent vaccine.

a. Administer Tdap.

Which medications are helpful in the treatment of serum sickness? Select all that apply. a. Analgesics b. Antibiotics c. Antihistamines d.Corticosteroids e. Antiviral medicines

a. Analgesics c. Antihistamines d.Corticosteroid

The nurse is assessing a patient with influenza. Which symptoms associated with influenza would the nurse expect to find in the patient? Select all that apply. a. Fever b. Myalgia c. Hair loss d. Sore throat f. Constipation

a. Fever b. Myalgia d. Sore throat

A staff nurse reports a medication error due to failure to administer a medication at the scheduled time. What is the charge nurse's best response? a."We'll conduct a root cause analysis." b."That means you'll have to do continuing education." c."Why did you let that happen?" d."You'll need to tell the patient and family."

a."We'll conduct a root cause analysis." In a just culture the nurse is accountable for their actions and practice, but people are not punished for flawed systems. Through a strategy such as root cause analysis the reasons for errors in medication administration can be identified and strategies developed to minimize future occurrences. Requiring continued education may be an appropriate recommendation but not until data is collected about the event.Telling the patient is part of transparency and the sharing and disclosure among stakeholders, but it is generally the role of risk management staff, not the staff nurse.

Aspects of safety culture that contribute to a culture of safety in a health care organization include which component? a.Communication b.Fear of punishment c.Malpractice implications d.Team nursing

a.Communication Aspects that contribute to a culture of safety include leadership, teamwork, an evidence base,communication,learning,a just culture,and patient-centered care. Fear of professional or personal punishment and concern about malpractice implications are considered barriers to a culture of safety. No model of nursing care has been related to a culture of safety.

What are the major attributes of health-care quality? (Select all that apply.) a.Conforms to standards b.Sound decision making c.High acuity patients d.Low health-care costs e.Identifies adverse events

a.Conforms to standards b.Sound decision making e.Identifies adverse events Major attributes of health-care quality include conformation to standards set by regulatory agencies, sound decision making regarding care, and identifying potential adverse events.High acuity of patients does not contribute to quality health care, because the care demand is increased, and low health-care costs mean fewer services maybe available.

On admission to the clinic,the nurse notes a moderate amount of serous exudate leaking from the patient's wound. The nurse realizes what information about this fluid? a.Contains the materials used by the body in the initial inflammatory response b.Indicates that the patient has an infection at the site of the wound c.Is destroying healthy tissue d.Results from in effective cleansing of the wound area

a.Contains the materials used by the body in the initial inflammatory response Exudate is fluid moved from the vascular spaces to the area around a wound. It contains the proteins, fluid, and white blood cells (WBCs) needed to contain possible pathogens at the site of injury. Exudate appears as part of all inflammatory responses and does not mean an infection is present.Exudate is part of normal inflammatory responses which contain self-monitoring mechanisms to help prevent damage to healthy tissue.Exudate appears at wound sites regardless of cleaning done to the area of injury.

The focus of quality health care should be on which of the following items? (Select all thatapply.) a.Excellent services b.Comprehensive communication c.Private hospital rooms d.Health team collaboration e.Culturally competent care

a.Excellent services b.Comprehensive communication d.Health team collaboration e.Culturally competent care Excellent services, communication, collaboration, and culturally competent care bring quality to the health care delivered to the patient. Private hospital rooms may be a preference by some patients, but they do not add to the quality of care

The nurse is caring for a postoperative patient who had an open appendectomy. The nurse understands that this patient should have some erythema and edema at the incision site 12-24 hours post operation dependent on which condition? a.His immune system is functioning properly. b.Heb is properly vaccinated. c.He has an infection. d.The suppressor T-cells in his body are activated.

a.His immune system is functioning properly. Tissue integrity is closely associated with immunity. Openings in the integumentary system allow for the entrance of pathogens. If the immune response is functioning optimally, the body responds to the insult to the tissue by protecting the area from invasion of microorganisms and pathogens with inflammation.Routine vaccinations have no bearing on the body's response to intentional tissue impairment. The redness and swelling at the incision site in the first 12-24 hours is part of optimal immune functioning. A patient with erythema and edema that persistor worsen should be evaluated for infection. Suppressor T-cells help to control the immune response in the body.

The nurse is reviewing the information about the herpes zoster vaccine (Zostavax) before administering the dose. Which statements about the vaccine are true? (Select all thatapply.) a.It is a one-time vaccine. b.The vaccine is recommended for patients 50 years of age and older. c.The vaccine is given to children to prevent chickenpox. d.It is used to prevent postherpetic neuralgia. e.It is contraindicated in patients who have already had shingles. f.The vaccine is used to prevent reactivation of the zoster virus that causes shingles.

a.It is a one-time vaccine b.The vaccine is recommended for patients 50 years of age and older. f.The vaccine is used to prevent reactivation of the zoster virus that causes shingles.

The nurse reviews the patient and notes all of the following. Which of the findings indicates systemic manifestations of inflammation? (Select all that apply.) a.Oral temperature 38.6 degree C/101.5 degree F b.Thick, green nasal discharge c.Patient complaint of pain at 6 on a 0-10 scale on palpation of frontal and maxillary sinuses d.WBC 20 cells/McL x 10^9/L e.Patient reports,"I'm tired all the time. I haven't felt like myself in days."

a.Oral temperature 38.6 degree C/101.5 degree F d.WBC 20 cells/McL x 10^9/L e.Patient reports,"I'm tired all the time. I haven't felt like myself in days." Systemic manifestations of inflammatory response include elevated temperature, leukocytosis,and malaise and fatigue. Purulent exudates and pain are both considered local manifestations of inflammation.

Which statement is true regarding the patient's perception of his or her care? a.Patent perception is just as important as the outcome of care. b.Patient perception is in significant compared to the outcome of care. c.Patient satisfaction has no relation to quality of care. d.Patient satisfaction is in significant compared to the outcome of care.

a.Patent perception is just as important as the outcome of care. The patient's perception of his or her care is just as important as the outcome of the care.If the patient perceives the care as meeting the aspects of quality, then patient satisfaction increases.

A patient comes to the clinic with a complaint of painful, itchy feet. On interview, the patient tells the nurse that he is a college student living in a dormitory apartment that he shares with five other students.What teaching should the nurse provide for this patient? a."Don't eat with the other students." b."Avoid sharing razors and other personal items." c."Have a complete blood count(CBC) checked monthly." d."Disinfect showers and bathroom floors weekly after use."

b."Avoid sharing razors and other personal items." Avoidance of sharing personal items like razors and hairbrushes can decrease the spread of pathogens that cause inflammation and infection. Not eating with the others in his college apartment won't relieve or prevent the spread of infection. ACBC monthly will not treat or prevent inflammation. Showers should be disinfected before and after each use.

A patient is diagnosed with a sprain to her right ankle after a fall.The patient asks the nurse about using ice on her injured ankle.What is the nurse's best response? a."Use ice only when the ankle hurts." b."Ice should be applied for 15-20 minutes every 2-3 hours over the next 1-2 days." c."Wrap an ice pack around the injured ankle for the next 24-48 hours." d."Ice is not recommended for use on the sprain because it would inhibit the inflammatory response."

b."Ice should be applied for 15-20 minutes every 2-3 hours over the next 1-2 days." Ice is used on areas of injury during the first 24-48 hours after the injury occurs to prevent damage to surrounding tissues from excessive inflammation. Ice should be used for a maximum of 20 minutes at a time every 2-3 hours. Ice must be used according to a schedule for it to be effective and not be overused. Using ice more often or for longer periods of time can cause additional tissue damage. Ice is recommended to inhibit the inflammatory process from damaging surrounding tissue.

A student nurse is talking with his instructor. The student ask show quality of care is evaluated.What is the best response by the instructor? a."By the patient getting well." b."On the basis of process and outcomes." c."By the physician's assessment." d."By the patient's satisfaction."

b."On the basis of process and outcomes." Quality of care is evaluated by process and outcomes. If the outcomes are achieved, then the care has achieved what is was designed to do. The patient getting well may be an action of the body doing what it is supposed to do and not quality of care; the same can be said of the physician's assessment. The patient's satisfaction is subjective according to his or her perceptions and not the quality of care.

A nurse is working in an immunization clinic. A new colleague asks, "When is the first dose of the diphtheria, tetanus, and a cellular pertussis (DtaP, Daptacel) given?" The nurse knows that this series is started at what age? a.At birth b.6 weeks c.3 months d.1 year

b.6 weeks

A patient is in the urgent care center after experiencing a black widow spider bite. The nurse prepares to give which product to treat this injury? a.Live vaccine b.Antivenins or antisera c.Tetanus immune globulin d.Active immunizing drug

b.Antivenins or antisera

A 12-month-old infant has received an MMR II (measles, mumps, and rubella virus vaccine), and her mother calls the clinic that afternoon to ask about helping her fussy infant to "feel better." What will the nurse suggest? a.Apply an ice pack to the injection site. b.Apply warm compresses to the injection site. c.Observe the site for further swelling and redness. d.Bring the infant in to the emergency department for an immediate examination

b.Apply warm compresses to the injection site.

A sanitation worker has experienced a needle stick by a contaminated needle that was placed in a trash can. The employee health nurse expects that which drug will be used to provide passive immunity to hepatitis B infection? a.Haemophilus influenzae type b (Hib) b.Varicella virus vaccine (Varivax) c.Hepatitis B immunoglobulin (BayHep B) d.Hepatitis B virus vaccine (inactivated) (Recombivax HB)

b.Apply warm compresses to the injection site.

The parents of a new born question the nurse about the need for vaccinations:"Why does our baby need all those shots? He's so small, and they have to cause him pain." The nurse can explain to the parents that which of the following are true about vaccinations?(Select all that apply.) a.Are only required for infants b.Are part of primary prevention for system disorders c.Prevent the child from getting childhood diseases d.Help protect individuals and communities e.Are risk free f.Are recommended by the Centers for Disease Control and Prevention(CDC)

b.Are part of primary prevention for system disorders d.Help protect individuals and communities f.Are recommended by the Centers for Disease Control and Prevention(CDC) Immunizations are considered part of primary prevention, help protect individuals from contracting specific diseases and from spreading them to the community at large, and are recommended by the CDC. Immunizations are recommended for people at various ages from infants to older adults. Vaccination does not guarantee that the recipient won't get the disease,but it decreases the potential to contract the illness. No medication is risk free.

The nurse is caring for a patient who is being discharged home after a splenectomy. What information on immune function needs to be included in this patient's discharge planning? a.The mechanisms of the inflammatory response b.Basic infection control techniques c.The importance of wearing a face mask in public d.Limiting contact with the general population

b.Basic infection control techniques The spleen is one of the major organs of the immune system. Without the spleen, the patient is at higher risk for infection; so, the nurse must be sure that the patient understands basic principles of infection control. The patient with a splenectomy does not need to understand the mechanisms of inflammatory response. The patient with a splenectomy does not need to wear a face mask in public as long as the patient understands and maintains the basic principles of infection control.The patient who has had a splenectomy does not need to limit contact with the general population as long as the patient understands and maintains the basic principles of infection control.

Prior to drug administration the nurse reviews the seven rights, which include right patient, right medication, right time, right dose,right education,right documentation,and what other right? a.Room b.Route c.Physician d.Manufacturer

b.Route The right route (e.g., oral or intramuscular) is an essential component to verify prior to the administration of any drug. The patient does not need to be in a specific location. There may be a number of physicians caring for a patient who prescribe medications for any given patient. A similar drug may be made by a number of different companies, and checking the manufacturer is not considered one of the seven rights. However, the nurse will want to be aware of a difference, because different companies prepare the same medication in different ways with different inactive ingredients,which can affect patient response.

A nurse is instructing her patient with ulcerative colitis regarding the need to avoid enteric-coated medications. The nurse knows that the patient understands the reason for this teaching when he states which of the following? a."The coating on these medications is irritating to my intestines." b."I need a more immediate response from my medications than can be obtained from enteric-coated medications." c."Enteric-coated medications are absorbed lower in the digestive tract and can be irritating to my intestines or in adequately absorbed by my inflamed tissue." d."I don't need to use these medications because they cause diarrhea,and I have had enough trouble with diarrhea and rectal bleeding over the past weeks."

c."Enteric-coated medications are absorbed lower in the digestive tract and can be irritating to my intestines or in adequately absorbed by my inflamed tissue." Enteric coatings on medications are designed to prevent breakdown and absorption of the medication until lower in the digestive tract, usually to prevent stomach irritation or to reach a certain point in the digestive tract for optimal absorption. For the patient with ulcerative colitis,the intestinal lining is inflamed or susceptible to inflammation and can have impaired absorption; therefore, enteric-coated medications should be avoided. The coating is not irritating, but the medication can be. The response time of the medication is not a concern in this instance.Enteric-coated medicines do not cause diarrhea simply because they are enteric coated.

A student nurse and clinical instructor are discussing quality in health care. The instructor knows the student understands when the student makes which statement? a."Quality is apparent in all health care." b."Quality is an outcome of health care." c."Quality is seen and unseen in health care." d."Quality is achieved by collaboration in health care."

c."Quality is seen and unseen in health care." Quality in health care is tangible and intangible. Quality in health care is not apparent in all health care, as many areas of health care are lacking. Quality of care does not always affect the outcome of care; the patient may recover no matter what care is given. Quality is not always achieved by collaboration.

While caring for a patient preparing for a kidney transplant,the nurse knows that the patient understands teaching on immunosuppression when she makes which statement? a."My body will treat the new kidney like my original kidney." b."I will have to make sure that I avoid being around people." c."The medications that I take will help prevent my body from attacking my new kidney." d."My body will only have a problem with my new kidney if the donor is not directly related to me."

c."The medications that I take will help prevent my body from attacking my new kidney." Immunosuppressant therapy is initiated to inhibit optimal immune response. This is necessary in the case of transplantation, because the normal immune response would cause the body to recognize the new tissue as foreign and attack it. The body will identify the new kidney as foreign and will not treat it as the original kidney. While patients with transplants must be careful about exposure to others, especially those who are or might be ill, andpractice adequate and consistent infection control techniques, they don't have to avoidpeople or social interaction. The new kidney brings foreign cells regardless of relationship between donor and recipient

Two nurses are discussing health-care quality. They agree which event contributes to increased health-care quality? a.Magnet status hospitals b.Fewer adverse events c.Collaboration of multiple health-care agencies d.Increased patient education

c.Collaboration of multiple health-care agencies Multiple health-care agencies are able to collaborate and provide better outcomes for health-care personnel and patients. Magnet status hospitals may be good, but the status does not always mean a quality outcome. Fewer adverse events and increased patient education are good, but they maybe the result of other variables and not just quality of care rendered

The nurse is preparing to administer medications to a patient with rheumatoid arthritis (RA).The nurse should explain which goal of treatment to the patient? a.Eradicate the disease b.Enhance immune response c.Control inflammation d.Manage pain

c.Control inflammation Medications for RA are intended to control the inflammation that results from the body's hyperimmune response. Autoimmune diseases like RA are chronic and currently have no curative treatments. Autoimmune diseases like RA are caused by hyperimmune response.The immune system needs to be suppressed, not enhanced. While the medications used for RA might help with pain management,the goal of medication intervention is to manage the inflammation

Which nursing action indicates that a nurse is more likely to incur a medication error during medication administration? a.Checks the original medication order on the patient's chart b.Asks the patient to state his/her name and date of birth c.Does not scan the barcode of the patient prior to administering the medication d.Does not provide the patient with a glass of water

c.Does not scan the barcode of the patient prior to administering the medication Use of barcode scanning of both the medication and the patient's hospital band is critical to maintaining safe practice during medication administration. The nurse by not scanning the barcode is not maintaining the required elements and as a result is more likely to incur a medication error. Checking the original order and asking the patient to provide identification are required elements. Not providing a glass of water to the patient is not related to a medication error but does not represent best practice unless the patient is NPO except meds which would require sips of water

The nurse reviews the patient's complete blood count (CBC) results and notes that the neutrophil levels are elevated, but monocytes are still within normal limits. This indicates what type of inflammatory response? a.Chronic b.Resolved c.Early stage acute d.Late stage acute

c.Early stage acute Elevated neutrophils and monocytes within normal limits are findings indicative of early inflammatory response. Neutrophils increase in just a few hours, while it takes the body days to increase the monocyte levels. Chronic inflammation results in varying elevations in WBCs dependent on multiple issues. Elevated neutrophils are not indicative of resolved inflammation.Elevations in monocytes occur later in the inflammatory response.

The nurse is reviewing principles of immunization. What type of immunization occurs when antibodies pass from mother to infant during breastfeeding or through the placenta during pregnancy? a.Artificial active immunization b.Attenuating immunization c.Natural passive immunization d.Artificial passive immunization

c.Natural passive immunization

A pregnant patient who is at 32 weeks' gestation has a cold and calls the office to ask about taking an over-the-counter medication that is rated as pregnancy category A. Which answer by the nurse is correct? a. "This drug causes problems in the human fetus, so you should not take this medication." b. "This drug may cause problems in the human fetus, but nothing has been proven in clinical trials. It is best not to take this medication." c. "This drug has not caused problems in animals, but no testing has been done in humans. It is probably safe to take." d. "Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it."

d. "Studies indicate that there is no risk to the human fetus, so it is okay to take this medication as directed if you need it."

Administration of the diphtheria, tetanus, and pertussis (DTP) vaccine is contraindicated for which patient? a. A patient with a history of malarial infection b. A patient with a history of urinary tract infection c. A patient with a history of a psychological disorder d. A patient with a history of systemic hypersensitivity reaction

d. A patient with a history of systemic hypersensitivity reaction

When the nurse is reviewing a list of medications taken by an 88-year-old patient, the patient says, "I get dizzy when I stand up." She also states that she has nearly fainted "a time or two" in the afternoons. Her systolic blood pressure drops 15 points when she stands up. Which type of medication may be responsible for these effects? a. Nonsteroidal anti inflammatory drugs (NSAIDs) b. Cardiac glycosides c. Anticoagulants d. Antihypertensives

d. Antihypertensives

Administration of which of the following provides passive immunity? a. Toxoids b. Vaccines c. Antitoxins d. Immunoglobulins

d. Immunoglobulins

Which is an example of an active immunizing drug? a. Digoxin immune Fab b. Tetanus immunoglobulin c. Vaccinia immunoglobulin d. Meningococcal bacterial vaccine

d. Meningococcal bacterial vaccine

The physiologic differences in the pediatric patient compared with the adult patient affect the amount of drug needed to produce a therapeutic effect. The nurse is aware that one of the main differences is that infants have which of these factors? a. Increased protein in circulation b. Fat composition lower than 0.001% c. More muscular body composition d. Water composition of approximately 75%

d. Water composition of approximately 75%

A sentinel event refers to which situation? a.An event that could have harmed a patient, but serious harm didn't occur because of chance. b.An event that harms a patient as a result of underlying disease or condition. c.An event that harms a patient by omission or commission, not an underlying disease or condition. d.An event that signals the need for immediate investigation and response

d.An event that signals the need for immediate investigation and response A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof called sentinel, because it signals the need for immediate investigation and response. A near-miss refers to an error or commission or omission that could have harmed the patient, but serious harm did not occur as a result of chance. Harm that relates to an underlying disease or condition provides the rationale for the close monitoring and supervision provided in a healthcare setting. An adverse event is one that results in unintended harm because of the commission or omission of an act.

The nurse is caring for a patient who was started on intravenous antibiotic therapy earlier in the shift. As the second dose is being infused, the patient reports feeling dizzy and having difficulty breathing and talking. The nurse notes that the patient's respirations are 26 breaths/min with a weak pulse of 112 beats/min. The nurse suspects that the patient is experiencing which condition? a.Suppressed immune response b.Hyperimmune response c.Allergic reaction d.Anaphylactic reaction

d.Anaphylactic reaction The patient is exhibiting signs and symptoms of an anaphylactic reaction to the medication.These signs and symptoms during administration of a medication do not correspond to a suppressed immune response but a type of hyperimmune response. While the patient is experiencing a hyperimmune response, the signs and symptoms allow for a more specific response. While the patient is experiencing an allergic reaction, the signs and symptoms presented in the scenario allow for a more specific response.

To promote safety, the nurse manager sensitive to point of care (sharp end) and systems level (blunt end) exemplars works closely with staff to address which point of care exemplar? a.Care coordination b.Documentation c.Electronic records d.Fall prevention

d.Fall prevention The most common safety issues at the sharp end include prevention of decubitus ulcers,medication administration, fall prevention, invasive procedures, diagnostic workup,recognition of/action on adverse events, and communication. These are the most common issues the staff nurse providing direct patient care encounters. Each of the other options are classified as systems level exemplars.