Exam 2 Practice Questions
A nurse is assessing a client who has a casted compound fracture of the right forearm. Which of the following findings is an early indication of neurovascular compromise? a. Paresthesia b. Pulselessness c. Paralysis d. Pallor
A is Correct
A nurse is planning care for a client who suffered a spinal cord injury (SCI) involving a T12 fracture 1 week ago. The client has no muscle control of the lower limbs, bowel, or bladder. Which of the following should be the nurse's highest priority? a. A prevention of further damage to the spinal cord b. Prevention of contractures of the lower extremities c. Prevention of skin breakdown of areas that lack sensation d. Prevention of postural hypotension when placing the client in a wheelchair
A is Correct
The HIV-infected patient is taught health promotion activities including good nutrition; avoiding alcohol, tobacco, drug use, and exposure to infectious agents; keeping up to date with vaccines; getting adequate rest; and stress management. What is the rationale behind these interventions that the nurse knows? A. Delaying disease progression B. Preventing disease transmission C. Helping to cure the HIV infection D. Enabling an increase in self-care activities
A is Correct
The nurse is admitting a patient to the nursing unit with a history of a herniated lumbar disc and low back pain. In completing a more thorough pain assessment, the nurse should ask the patient if which action aggravates the pain? A. Bending or lifting B. Application of warm moist heat C. Sleeping in a side-lying position D. Sitting in a fully extended recliner
A is Correct Back pain that is related to a herniated lumbar disc often is aggravated by events and activities that increase the stress and strain on the spine, such as bending or lifting, coughing, sneezing, and lifting the leg with the knee straight (straight leg-raising test). Application of moist heat, sleeping position, and ability to sit in a fully extended recliner do not aggravate the pain of a herniated lumbar disc.
A nurse is preparing to give bethanechol [Urecholine]. What is an expected outcome of this drug? A. Nondistended bladder B. Increased heart rate and blood pressure C. Improved pulse oximetry reading D. Relief of cardiac rhythm problems
A is Correct Bethanechol is a muscarinic agonist and therefore activates muscarinic receptors. This can lead to relaxation of the urinary sphincter muscles and increased voiding pressure. It also can cause bradycardia and hypotension, bronchoconstriction, and dysrhythmias in hyperthyroid patients.
The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug? A. Cardiac rhythm B. Blood urea nitrogen C. Central nervous system (CNS) tremor D. Lung sounds
A is Correct Epinephrine can cause a number of adverse effects, including hypertensive crisis, dysrhythmias, angina, necrosis after extravasation, and hyperglycemia. Monitoring of the heart rhythm is essential to assess the patient for dysrhythmias.
Which instruction would be inappropriate to include in the teaching plan for a patient being started on carbamazepine [Tegretol]? A. "Take the medication with a glass of grapefruit juice each morning." B. "Notify the physician if you are gaining weight or your legs are swollen." C. "Nausea, vomiting, and indigestion are common side effects of carbamazepine." D. "Have liver function tests performed on a routine basis."
A is Correct Grapefruit juice can inhibit the metabolism of carbamazepine, possibly leading to increased plasma drug levels; therefore, it should be avoided. Carbamazepine can inhibit renal excretion of water by promoting increased secretion of antidiuretic hormone. Weight gain and swollen extremities can be a sign of water retention and should be reported to the physician. Nausea, vomiting, and indigestion are common adverse effects of valproic acid, and the patient should be made aware of them. Liver function studies are monitored for patients taking valproic acid because of the risk of liver toxicity.
When teaching a patient infected with HIV regarding transmission of the virus to others, which statement made by the patient would indicate a need for further teaching? A. "I will need to isolate any tissues I use so as not to infect my family." Correct B. "I will notify all of my sexual partners so they can get tested for HIV." C. "Unprotected sexual contact is the most common mode of transmission." D. "I do not need to worry about spreading this virus to others by sweating at the gym."
A is Correct HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.
Which nursing intervention is most appropriate when turning a patient following spinal surgery? A. Placing a pillow between the patient's legs and turning the body as a unit B. Having the patient turn to the side by grasping the side rails to help turn over C. Elevating the head of bed 30 degrees and having the patient extend the legs while turning D. Turning the patient's head and shoulders and then the hips, keeping the patient's body centered in the bed
A is Correct Placing a pillow between the legs and turning the patient as a unit (logrolling) helps to keep the spine in good alignment and reduces pain and discomfort following spinal surgery. Having the patient turn by grasping the side rail to help, elevating the head of the bed, and turning with extended legs or turning the patient's head and shoulders and then the hips will not maintain proper spine alignment and may cause damage
A diagnosis of AIDS is made when an HIV-infected patient has which of the following? a. CD4 T cell count below 200/uL b. A high level of HIV in the blood and saliva c. Lipodystrophy with metabolic abnormalities d. Oral hairy leukoplakia, an infection caused by Epstein-Barr virus
A is correct
During the postoperative period, the nurse instructs the patient with an above-the-knee amputation that the residual limb should NOT be routinely elevated because this position promotes which of the following? a. Hip flexion contractures b. Skin irritation and breakdown c. Clot formation at the incision site d. Increased risk of wound dehiscence
A is correct
The nurse is caring for a patient receiving atropine. Which is a therapeutic indication for giving this drug? A. Use as a preanesthesia medication B. Treatment of tachycardias C. Prevention of urinary retention D. Reduction of intraocular pressure in glaucoma
A is correct Atropine is a muscarinic antagonist and can help prevent dangerous bradycardia during surgery. It often is administered before the induction of anesthesia. Its side effects may include urinary retention, constipation, and tachycardia.
A nurse is caring for a client who experienced a cervical spine injury 3 months ago. Which of the following types of bladder management methods should the nurse use for this client? a. Condom Catheter b. Intermittent urinary catheterization c. Crede's method d. Indwelling urinary catheter
A is correct - Client who has a cervical spinal cord injury will also have an upper motor neuron injury, which is manifested by a spastic bladder.
The nurse is caring for a patient receiving phenytoin [Dilantin] for treatment of tonic-clonic seizures. Which symptoms, if present, would indicate an adverse effect of this drug? (Select all that apply.) A. Swollen, tender gums B. Measles-like rash C. Productive cough D. Unusual hair growth E. Nausea and vomiting
A, B, & C Adverse effects associated with phenytoin at therapeutic doses include mild sedation, gingival hyperplasia (swollen, tender gums), morbilliform (measles-like) rash, cardiovascular effects, and other effects, such as hirsutism (unusual hair growth) and interference with vitamin D metabolism.
A nurse is teaching a client how to manage an external fixation device upon discharge. Which of the following statements by the client indicates an understanding of safe management? (select all that apply) a. I will clean the pins twice a day b. I will use a separate cotton swab for each pin c. I will report loosening of the pins to my doctor d. I will move my leg by lifting the external fixation device in the middle e. I will remove any crusting that forms at the pin site
A, B, & C are Correct
Which statements about the anticholinergic drug scopolamine are true? (Select all that apply.) A. A side effect is sedation. B. It is used for motion sickness. C. A side effect is nausea and vomiting. D. It is used for preanesthetic sedation. E. It causes CNS excitation.
A, B, & D are correct Scopolamine is an anticholinergic drug with actions much like those of atropine, but with two exceptions. First, whereas therapeutic doses of atropine produce mild CNS excitation, therapeutic doses of scopolamine produce sedation. And second, scopolamine suppresses emesis and motion sickness, whereas atropine does not. Principal uses for scopolamine include motion sickness and production of preanesthetic sedation.
Antimuscarinic adverse effects include which of the following? (Select all that apply.) A. Xerostomia (Dry Mouth) B. Blurred vision C. Diarrhea D. Decrease in intraocular pressure E. Anhidrosis
A, B, & E are correct Antimuscarinic side effects include xerostomia (dry mouth), blurred vision, constipation, and anhidrosis. Diarrhea and decrease in intraocular pressure are incorrect
A nurse is completing an assessment of a client who had an external fixation device applied 2 hours ago for a fracture of the left tibia and fibula. Which of the following findings indicate compartment syndrome? (Select all that apply) a. Intense pain when the left foot is passively moved b. Edematous left toes compared to the right c. Hard, swollen muscle in the left leg d. Buring and tingling of the distal left foot e. Minimal pain relief following a second dose of opioid medication administration
A, C, D, & E are correct
The nurse is conducting discharge teaching related to a new prescription for phenytoin [Dilantin]. Which statements are appropriate to include in the teaching for this patient and family? (Select all that apply.) A. "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B. "You may have some mild sedation. Do not drive until you know how this drug will affect you." C. "This drug may cause easy bruising. If you notice this, call the clinic immediately." D. "It is very important to have good oral hygiene and to visit your dentist regularly." E. "You may continue to have wine with your evening meals, but only in moderation."
A,B, & D Patients taking an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin, even at therapeutic levels. Carbamazepine, not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it; dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants, because they have an additive depressant effect.
The patient is admitted to the ED with fever, swollen lymph glands, sore throat, headache, malaise, joint pain, and diarrhea. What nursing measures will help identify the need for further assessment of the cause of this patient's manifestations (select all that apply)? A. Assessment of lung sounds B. Assessment of sexual behavior C. Assessment of living conditions D. Assessment of drug and syringe use E. Assessment of exposure to an ill person
B & D are Correct With these symptoms, assessing this patient's sexual behavior and possible exposure to shared drug equipment will identify if further assessment for the HIV virus should be made or the manifestations are from some other illness (e.g., lung sounds and living conditions may indicate further testing for TB).
A nurse is caring for a client with a spinal cord injury who reports a severe headache and is sweating profusely. Vital signs include BP 220/110 mm Hg, with a HR of 54 BPM. Which of the following actions should the nurse take first? a. Notify the provider b. Sit the client upright in bed c. Check the client's urinary catheter for blockage d. Administer antihypertensive medication
B is Correct
The nurse is caring for a group of patients who are all receiving anticholinergic drugs. In which patient is an anticholinergic drug contraindicated? A. A 60-year-old woman with an overactive bladder (OAB) B. A 72-year-old man with glaucoma C. A 45-year-old woman with peptic ulcer disease (PUD) D. A 26-year-old man being prepared for surgery today
B is Correct
The nurse is teaching a patient newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of therapy with antiepilepsy medication? A. "With proper treatment, we can completely eliminate your seizures." B. "Our goal is to reduce your seizures to an extent that helps you live a normal life." C. "Epilepsy medication does not reduce seizures in most patients." D. "These drugs will help control your seizures until you have surgery."
B is Correct
During a health screening event which assessment finding would alert the nurse to the possible presence of osteoporosis in a white 61-year-old female? A. The presence of bowed legs B. A measurable loss of height C. Poor appetite and aversion to dairy products D. Development of unstable, wide-gait ambulation
B is Correct A gradual but measurable loss of height and the development of kyphosis or "dowager's hump" are indicative of the presence of osteoporosis in which the rate of bone resorption is greater than bone deposition. Bowed legs may be caused by abnormal bone development or rickets but is not indicative of osteoporosis. Lack of calcium and Vitamin D intake may cause osteoporosis but are not indicative it is present. A wide gait is used to support balance and does not indicate osteoporosis.
The nurse is caring for a patient receiving propranolol [Inderal]. Which clinical finding is most indicative of an adverse effect of this drug? A. A heart rate of 100 beats per minute B. Wheezing C. A glucose level of 180 mg/dL D. Urinary urgency
B is Correct Beta blockers, such as propranolol, are known to cause bronchoconstriction, which could manifest as wheezing. Other adverse effects could include bradycardia, atrioventricular (AV) heart block, heart failure, rebound cardiac excitation, inhibition of glycogenolysis, and potential central nervous system (CNS) effects.
The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that what is a diagnostic criterion for AIDS? A. Presence of HIV antibodies B. CD4+ T cell count below 200/µL C. Presence of oral hairy leukoplakia D. White blood cell count below 5000/µL
B is Correct Diagnostic criteria for AIDS include a CD4+ T cell count below 200/µL and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease but do not define the advancement of HIV infection to AIDS.
Which statement made by a female patient newly diagnosed with complex partial seizures and starting treatment with valproic acid indicates a need for further teaching by the nurse? A. "The medication should not make me feel sleepy." B. "I should take the medication on an empty stomach." C. "I'll need to discuss a reliable form of birth control with my gynecologist." D. "I'll call my physician immediately if I develop a yellow tint to my skin or my urine appears tea-colored."
B is Correct Gastrointestinal side effects, such as nausea, vomiting, and indigestion, can occur when valproic acid is taken on an empty stomach; this statement indicates that further teaching is needed. Valproic acid has minimal sedative effects, is teratogenic, and can lead to hepatotoxicity. Female patients of child-bearing age must use effective methods of birth control to prevent pregnancy and must be taught the signs of liver failure (abdominal pain, malaise, jaundice), which must be reported immediately.
Why does the nurse anticipate administering metoprolol [Lopressor] rather than propranolol [Inderal] for diabetic patients who need a beta-blocking agent? A. Metoprolol is less likely to cause diabetic nephropathy. B. Propranolol causes both beta1 and beta2 blockade. C. Metoprolol helps prevent retinopathy in individuals with diabetes. D. Propranolol is associated with a higher incidence of foot ulcers.
B is Correct Metoprolol is a second-generation beta blocker and as such is more selective. At therapeutic doses, it causes less bronchoconstriction and suppression of glycogenolysis, which can cause problems in diabetic patients. Propranolol blocks both beta1 and beta2 receptors.
A patient is to be discharged home with a new prescription for prazosin [Minipress]. Which statement is most important for the nurse to include in the teaching plan? A. "You should increase your intake of fresh fruits and vegetables." B. "You should move slowly from a sitting to a standing position." C. "Be sure to wear a Medic Alert bracelet while taking this medication." D. "Take your first dose of this medication first thing in the morning."
B is Correct Orthostatic hypotension is the most serious adverse effect of prazosin and other alpha1 blockers. Patients should be taught to move slowly when changing from a supine or sitting position to an upright position to avoid dizziness and prevent falls.
The nurse was accidently stuck with a needle used on an HIV-positive patient. After reporting this, what care should this nurse first receive? A. Personal protective equipment B. Combination antiretroviral therapy C. Counseling to report blood exposures D. A negative evaluation by the manager
B is Correct Postexposure prophylaxis with combination antiretroviral therapy can significantly decrease the risk of infection.
A 25-year-old male patient has been diagnosed with HIV. The patient does not want to take more than one antiretroviral drug. What reasons can the nurse tell the patient about for taking more than one drug? A. Together they will cure HIV. B. Viral replication will be inhibited. C. They will decrease CD4+ T cell counts. D. It will prevent interaction with other drugs.
B is Correct The major advantage of using several classes of antiretroviral drugs is that viral replication can be inhibited in several ways, making it more difficult for the virus to recover and decreasing the likelihood of drug resistance that is a major problem with monotherapy. Combination therapy also delays disease progression and decreases HIV symptoms and opportunistic diseases.
The nurse identifies a nursing diagnosis of pain related to muscle spasms for a 45-year-old patient who has low back pain from a herniated lumbar disc. What would be an appropriate nursing intervention to treat this problem? A. Provide gentle ROM to the lower extremities. B. Elevate the head of the bed 20 degrees and flex the knees. C. Place the bed in reverse Trendelenburg with the feet firmly against the footboard. D. Place a small pillow under the patient's upper back to gently flex the lumbar spine.
B is Correct The nurse should elevate the head of the bed 20 degrees and flex the knees to avoid extension of the spine and increasing the pain. The slight flexion provided by this position often is comfortable for a patient with a herniated lumbar disc. ROM to the lower extremities will be limited to prevent extremes of spinal movement. Reverse Trendelenburg and a pillow under the patient's upper back will more likely increase pain.
A nurse in the emergency department is planning care for a client who has a right hip fracture. Which of the following immobilization devices should the nurse anticipate in the plan of care? a. Skeletal traction b. Buck's traction c. Halo traction d. Gardner-wells traction
B is correct
A nurse is preparing a plan of care to prevent a client from developing flexion contractions following a below-the-knee amputation 24 hours ago. Which of the following should the nurse include in the plan of care? a. Elevate the residual limb on a pillow b. Position the client prone several times each day c. Wrap the stump in a figure-eight pattern d. Encourage sitting in a chair during the day.
B is correct
A nurse is providing instructions to the parents of an adolescent client who has a new prescription for albuterol PO inhalation. Which of the following instructions should the nurse include? a. "You can take this medication to abort an acute asthma attack" b. "Tremors are an adverse effect of this medication" c. "Prolonged use of this medication can cause hyperglycemia" d. "This medication can slow skeletal growth rate"
B is correct
Which label most aptly describes the drug atropine [Sal-Tropine]? A. Cholinergic B. Parasympatholytic C. Muscarinic agonist D. Parasympathomimetic
B is correct Atropine is a muscarinic antagonist agent. Other terms for this agent are parasympatholytic, antimuscarinic, muscarinic blocker, and anticholinergic.
The nurse is preparing to give terbutaline [Brethine] to prevent preterm labor. Which concepts are important to keep in mind when working with this drug? (Select all that apply.) A. Terbutaline must be given by a parenteral route. B. The selectivity of terbutaline is dose dependent. C. The patient may experience tremor with terbutaline. D. Terbutaline is a sympathomimetic drug. E. Bronchoconstriction is a potential adverse effect of terbutaline.
B, C, and D are correct Tremor and tachycardia are potential adverse effects. Terbutaline can be used to treat asthma and does not typically cause bronchoconstriction. When given at low therapeutic doses, it is selective for beta2 receptors.
The nurse suspects that a female patient is experiencing phenytoin toxicity if which manifestation is noted? (Select all that apply.) A. The patient complains of excessive facial hair growth. B. The patient is walking with a staggering gait. C. The patient's gums are swollen, tender, and bleed easily. D. The patient complains of double vision. E. The nurse observes rapid back-and-forth movement of the patient's eyes.
B, D, & E are correct Manifestations of phenytoin toxicity can occur when plasma levels are higher than 20 mcg/mL. Nystagmus (back-and-forth movement of the eyes) is a common indicator of toxicity, as are ataxia (staggering gait), diplopia (double vision), sedation, and cognitive impairment. Hirsutism (excess hair growth in unusual places) and gingival hyperplasia (swollen, tender, bleeding gums) are adverse effects of phenytoin.
A nurse is caring for a client who has a prescription for bethanechol 50 mg PO TID. The nurse should recognize that which of the following findings is a clinical manifestation of extreme muscarinic stimulation? a. Tachycardia b. Hypertension c. Excessive perspiration d. Fecal impaction
C correct
The nurse is admitting a patient who complains of a new onset of lower back pain. To differentiate between the pain of a lumbar herniated disc and lower back pain from other causes, what would be the best question for the nurse to ask the patient? A. "Is the pain worse in the morning or in the evening?" B. "Is the pain sharp or stabbing or burning or aching?" C. "Does the pain radiate down the buttock or into the leg?" D. "Is the pain totally relieved by analgesics, such as acetaminophen (Tylenol)?"
C is Correct
The nurse is providing care for a patient who has been living with HIV for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? A. A new onset of polycythemia B. Presence of mononucleosis-like symptoms C. A sharp decrease in the patient's CD4+ count D. A sudden increase in the patient's WBC count
C is Correct A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion
Which medication should the nurse anticipate administering to a patient in convulsive status epilepticus to halt seizure activity? A. Phenytoin [Dilantin] 200 mg IV over 4 minutes B. Phenobarbital 30 mg IM C. Lorazepam [Ativan] 0.1 mg/kg IV at a rate of 2 mg/min D. Valproic acid [Depacon] 250 mg in 100 mL of normal saline infused IV over 60 minutes
C is Correct Intravenous benzodiazepines, such as lorazepam or diazepam, are used for abrupt termination of convulsive seizure activity. Lorazepam is preferred over diazepam because of its longer effects. Once seizures have been stopped with a benzodiazepine, phenytoin may be administered for long-term suppression. Phenytoin and valproic acid are not benzodiazepines.
A pregnant woman who was tested and diagnosed with HIV infection is very upset. What should the nurse teach this patient about her baby's risk of being born with HIV infection? A. "The baby will probably be infected with HIV." B. "Only an abortion will keep your baby from having HIV." C. "Treatment with antiretroviral therapy will decrease the baby's chance of HIV infection." D. "The duration and frequency of contact with the organism will determine if the baby gets HIV infection."
C is Correct On average, 25% of infants born to women with untreated HIV will be born with HIV. The risk of transmission is reduced to less than 2% if the infected pregnant woman is treated with antiretroviral therapy. Duration and frequency of contact with the HIV organism is one variable that influences whether transmission of HIV occurs. Volume, virulence, and concentration of the organism as well as host immune status are variables related to transmission via blood, semen, vaginal secretions, or breast milk.
The nurse is caring for a 60-year-old woman who has been prescribed oxybutynin [Ditropan] for the treatment of overactive bladder (OAB). Which statement by the nurse will be the most helpful to include in the teaching plan? A. "You may experience a slower heart rate. Call your doctor if it is below 60." B. "Ditropan is very effective. Most patients experience significant relief." C. "Sip on water and suck on hard candy to help with the problem of dry mouth." D. "Antihistamines, such as Benadryl, can help with some of the side effects of Ditropan."
C is Correct Oxybutynin is an anticholinergic drug that commonly causes dry mouth. Other side effects include constipation, tachycardia, urinary hesitancy, urinary retention, and visual disturbances. Oxybutynin is only moderately effective (30% better than placebo). It should not be taken with other drugs with anticholinergic properties, such as antihistamines, because of the additive anticholinergic effects.
The nurse is caring for several patients prescribed propranolol [Inderal]. In which patient condition is propranolol [Inderal] contraindicated? A. Cardiac dysrhythmias B. Hypertension C. Diabetes D. Angina
C is Correct Propranolol inhibits glycogenolysis and thus can produce hypoglycemia, which can cause problems in patients with diabetes. It also suppresses tachycardia, which is an important warning sign of hypoglycemia in patients with diabetes. It is safe to use propranolol in dysrhythmias, hypertension, and angina.
The nurse determines that dietary teaching for a 75-year-old patient with osteoporosis has been successful when the patient selects which highest-calcium meal? A. Chicken stir-fry with 1 cup each onions and green peas, and 1 cup of steamed rice B. Ham and Swiss cheese sandwich on whole wheat bread, steamed broccoli, and an apple C. A sardine (3 oz) sandwich on whole wheat bread, 1 cup of fruit yogurt, and 1 cup of skim milk D. A two-egg omelet with 2 oz of American cheese, one slice of whole wheat toast, and a half grapefruit
C is Correct The highest calcium content is present in the lunch containing milk and milk products (yogurt) and small fish with bones (sardines). Chicken, onions, green peas, rice, ham, whole wheat bread, broccoli, apple, eggs, and grapefruit each have less than 75 mg of calcium per 100 g of food. Swiss cheese and American cheese have more calcium, but not as much as the sardines, yogurt, and milk
The nurse has reviewed proper body mechanics with a patient with a history of low back pain caused by a herniated lumbar disc. Which statement made by the patient indicates a need for further teaching? A. "I should sleep on my side or back with my hips and knees bent." B. "I should exercise at least 15 minutes every morning and evening." C. "I should pick up items by leaning forward without bending my knees." D. "I should try to keep one foot on a stool whenever I have to stand for a period of time."
C is Correct The patient should avoid leaning forward without bending the knees. Bending the knees helps to prevent lower back strain and is part of proper body mechanics when lifting. Sleeping on the side or back with hips and knees bent and standing with a foot on a stool will decrease lower back strain. Back strengthening exercises are done twice a day once symptoms subside
The nurse is assessing a patient receiving valproic acid [Depakene] for potential adverse effects associated with this drug. What is the most common problem with this drug? A. Increased risk of infection B. Reddened, swollen gums C. Nausea, vomiting, and indigestion D. Central nervous system depression
C is Correct Valproic acid is generally well tolerated. Gastrointestinal effects, which include nausea, vomiting, and indigestion, are the most common problems but tend to subside with use and can be lessened by taking the medication with food. Valproic acid does not cause hematologic effects resulting in an increased risk of infection, nor does it cause gingival hyperplasia. It causes minimal sedation.
The nurse is reviewing drugs on the emergency cart with regard to their therapeutic action. Which medications can help initiate heart contraction during a cardiac arrest? A. Topical phenylephrine B. Subcutaneous terbutaline C. Intravenous epinephrine D. Inhaled albuterol
C is correct
The woman is afraid she may get HIV from her bisexual husband. What should the nurse include when teaching her about preexposure prophylaxis (select all that apply)? A. Take fluconazole (Diflucan). B. Take amphotericin B (Fungizone). C. Use condoms for risk-reducing sexual relations. D. Take emtricitabine and tenofovir (Truvada) regularly. E. Have regular HIV testing for herself and her husband.
C, D, & E are correct
The nurse is preparing to give epinephrine by the IV push route. Which actions are essential before giving this drug? (Select all that apply.) A. Check the blood urea nitrogen (BUN) and creatinine levels. B. Obtain insulin from the medication cart. C. Assess the patency of the IV line. D. Review the allergy history. E. Assess the vital signs.
C, D, and E are correct All of the actions mentioned might be appropriate for this patient. However, because epinephrine can cause necrosis with extravasation, the first priority is to assess the patency of the IV line before beginning administration. Reviewing the patient's allergy history is essential, as is assessing the vital signs, particularly the heart rate and blood pressure. Epinephrine is a vasoconstrictor and can cause a dramatic increase in the heart rate and blood pressure.
A Patient with a stable, closed fracture of the humorous caused by trauma to the arm has a temporary splint with bulky padding applied with an elastic bandage. The nurse suspects compartment syndrome and notifies the physician when the patient experiences which of the following? a. Increasing edema of the limb b. Muscle spasms of the lower arm c. Rebounding pulse at the fracture site d. Pain when passively extending fingers
D is Correct
A nurse is caring for a client who has a C4 spinal cord injury. Which of the following should the nurse recognize the client as being at the greatest risk for? a. Neurogenic shock b. Paralytic ileus c. Stress ulcer d. Respiratory compromise
D is Correct
Antimuscarinic poisoning can result from overdose of antihistamines, phenothiazines, and tricyclic antidepressants. Differential diagnosis is important, because antimuscarinic poisoning resembles which other condition? A. Epilepsy B. Diabetic coma C. Meningitis D. Psychosis
D is Correct Antimuscarinic poisoning often resembles psychosis and psychotic episodes. It is important to differentiate, because antipsychotic drugs have antimuscarinic properties and could intensify the symptoms of poisoning.
This morning a 21-year-old male patient had a long leg cast applied and wants to get up and try out his crutches before dinner. The nurse will not allow this. What is the best rationale that the nurse should give the patient for this decision? A. The cast is not dry yet, and it may be damaged while using crutches. B. The nurse does not have anyone available to accompany the patient. C. Rest, ice, compression, and elevation are in process to decrease pain. D. Excess edema and other problems are prevented when the leg is elevated for 24 hours.
D is Correct For the first 24 hours after a lower extremity cast is applied, the leg will be elevated on pillows above the heart level to avoid excessive edema and compartment syndrome. The cast will also be drying during this 24-hour period. RICE is used for soft tissue injuries, not with long leg casts
A nurse prepares to administer a new prescription for bethanechol [Urecholine]. Which information in the patient's history should prompt the nurse to consult with the prescriber before giving the drug? A. Constipation B. Hypertension C. Psoriasis D. Asthma
D is Correct Muscarinic agonists induce bronchospasm, which would cause problems for a patient with a history of asthma.
Which symptom is the most indicative of muscarinic poisoning? A. Constipation B. Heart rate of 140 beats per minute C. Blood pressure of 180/110 mm Hg D. Blurred vision
D is Correct Muscarinic poisoning can result from overdose of muscarinic agonists or cholinesterase inhibitors or from ingestion of certain mushrooms. The symptoms include profuse salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension.
The nurse is reinforcing health teaching about osteoporosis with a 72-year-old patient admitted to the hospital. In reviewing this disorder, what should the nurse explain to the patient? A. With a family history of osteoporosis, there is no way to prevent or slow bone resorption. B. Continuous, low-dose corticosteroid treatment is effective in stopping the course of osteoporosis. C. Estrogen therapy must be maintained to prevent rapid progression of the osteoporosis. D. Even with a family history of osteoporosis, the calcium loss from bones can be slowed by increased calcium intake and exercise.
D is Correct The rate of progression of osteoporosis can be slowed if the patient takes calcium supplements and/or foods high in calcium and engages in regular weight-bearing exercise. Corticosteroids interfere with bone metabolism. Estrogen therapy is no longer used to prevent osteoporosis because of the associated increased risk of heart disease and breast and uterine cancer
The patient is brought to the emergency department after a car accident and has a femur fracture. What nursing intervention should the nurse implement to prevent a fat embolus in this patient? A. Administer enoxaparin (Lovenox). B. Provide range-of-motion exercises. C. Apply sequential compression boots. D. Immobilize the fracture preoperatively.
D is Correct To prevent fat emboli, the nurse immobilizes the long bone to reduce movement of the fractured bone ends and decrease the risk of a fat embolus from the bone before surgical reduction. Enoxaparin is used to prevent blood clots not fat emboli. Range of motion and compression boots will not prevent a fat embolus in this patient.
A nurse in a provider's office is reviewing the health record of a client who reported urinary incontinence and asked about a prescription for oxybutynin. The nurse should recognize that oxybutynin is contraindication in the presence of which of the following conditions? a. Bursitis b. Sinusitis c. Depression d. Glaucoma
D is correct
What is the most appropriate nursing intervention to help an HIV-infected patient adhere to a treatment regimen? a. Set up a drug pillbox for the patient every week b. Give the patient a video and a brochure to view and read at home c. Tell the patient that the side effects of the drugs are bad but that they go away after a while d. Assess the patient's routines and find adherence cues that fit into the patient's life circumstances
D is correct
The nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug? A. "I will keep my medication in the refrigerator when I'm not using it." B. "I should take this medication within 30 minutes of the onset of symptoms." C. "I must remove my pants before injecting the medication into the leg." D. "I will jab this medication firmly into my outer thigh if needed."
D is correct The EpiPen should be stored in a cool, dark place, but refrigeration can damage the injection mechanism. The medication should be taken at the first sign of symptoms. Anaphylaxis can develop within minutes after allergen exposure. To use the EpiPen, the patient should form a fist around the unit with the black tip pointing down, remove the activation cap, jab the device firmly into the outer thigh, wait 10 seconds, remove the unit, and massage the area for 10 seconds. The medication can be given directly through clothing if necessary.
A nurse is caring for a client who experienced a cervical spine injury 24 hours ago. Which of the following types of prescribed medications should the nurse clarify with the provider? a. Glucocorticoids b. Plasma expanders c. H2 antagonists d. Muscle relaxants
D is correct - the client will still be in spinal shock 24 hours following the injury. The client will not experience muscle spasms until after the spinal shock has resolved, making the muscle relaxants unnecessary at this time.
