Med surge practice questions for evolve

A nurse administers leucovorin calcium to a client before the prescribed methotrexate (Trexall). The client asks the reason for this. What effect of leucovorin calcium should the nurse consider when formulating a response? 1 Potentiates metabolite required for destruction of cancer cells 2 Supplies levels of folic acid required by blood-forming organs 3 Acts synergistically with antineoplastic drugs to destroy cancer cells 4 Increases production of phagocytes to help remove debris from destroyed cancer cells

2. Methotrexate (Trexall) is a folic acid antagonist that can depress the bone marrow; this serious toxic effect sometimes is prevented by administration of folic acid. Some health care providers advocate its administration after a course of methotrexate therapy to avoid interfering with methotrexate activity. Folic acid is a metabolite and does not destroy cancer cells. Leucovorin calcium does not increase the production of phagocytes.

A client with myasthenia gravis improves and is discharged from the hospital. The discharge medications include pyridostigmine bromide (Mestinon) 10 mg every six hours. The nurse evaluates that the drug regimen is understood when the client says, "I should: 1 Take the medication on an empty stomach." 2 Set an alarm so I take the medication on time." 3 Take my pulse rate before taking the medication." 4 Monitor for an increase in blood pressure after taking the medication."

2. Pyridostigmine is a vital drug that must be taken on time; a missed or late dose can result in severe respiratory and neuromuscular consequences or even death. Pyridostigmine should be taken with a small amount of food to prevent gastric irritation. It is unnecessary to take the pulse rate before taking pyridostigmine. Pyridostigmine may cause hypotension, not hypertension, which is a sign of cholinergic crisis.

Three weeks after a client gives birth, a deep vein thrombophlebitis develops in her left leg and she is admitted to the hospital for bedrest and anticoagulant therapy. Which anticoagulant does the nurse expect to administer? 1 Clopidogrel (Plavix) 2 Warfarin (Coumadin) 3 Continuous infusion of heparin 4 Intermittent doses of a low-molecular-weight heparin

3. Heparin is the medication of choice during the acute phase of a deep vein thrombosis; it prevents conversion of fibrinogen to fibrin and of prothrombin to thrombin. Clopidogrel (Plavix) is a platelet aggregate inhibitor and is used to reduce the risk of a brain attack. Warfarin (Coumadin), a long-acting oral anticoagulant, is started after the acute stage has subsided; it is continued for 2 to 3 months. A low molecular weight heparin (e.g., enoxaparin [Lovenox]) is not administered during the acute stage; it may be administered later to prevent future deep vein thromboses.

A nurse is assessing a client with a diagnosis of primary insomnia. Which findings from the client's history may be the cause of this disorder? Select all that apply. Chronic stress Incorrect 2 Severe anxiety Incorrect 3 Generalized pain Correct 4 Excessive caffeine 5 Chronic depression Correct 6 Environmental noise/distractors

Acute or primary insomnia is caused by emotional or physical stress not related to the direct physiologic effects of a substance or illness. Excessive caffeine intake can cause disruptive sleep hygiene; caffeine is a stimulant that inhibits sleep. Environmental noise causes physical and emotional discomfort and is therefore related to primary insomnia. Severe anxiety is usually related to a psychiatric disorder and therefore causes secondary insomnia. Generalized pain is usually related to a medical or neurologic problem and therefore causes secondary insomnia. Chronic depression is usually related to a psychiatric disorder and therefore causes secondary insomnia.

The nurse knows that additional discharge instructions are needed for parents whose infant has just undergone corrective surgery for cleft palate when the mother says: "We need to schedule regular hearing tests, even at this young age." Correct2 "Lying on the abdomen is prohibited, so we'll keep him in an infant seat." 3 "We know that some difficulty breathing is expected, so we'll position him upright." 4 "We'll use the elbow restraints you provided to keep him from putting his hands in his mouth.

After cleft palate repair the child is allowed to lie on the abdomen, especially immediately after surgery; this will allow drainage of secretions from the mouth. Children with cleft palate have an increased risk of middle ear infections, which can result in hearing loss, so hearing tests are scheduled early and repeated periodically throughout childhood. Until the infant adjusts to breathing through the mouth, he may exhibit difficulty breathing after surgery; this seldom requires more than positioning and support. Elbow restraints may be prescribed to keep the child's hands out of his mouth.

While a pacemaker catheter is being inserted, the client's heart rate drops to 38 beats/min. What medication should the nurse expect the health care provider to prescribe? 1Digoxin (Lanoxin) 2Lidocaine (Xylocaine) 3 Amiodarone (Cordarone) 4Atropine sulfate (Atropine)

Atropine blocks vagal stimulation of the sinoatrial (SA) node, resulting in an increased heart rate. Digoxin slows the heart rate; hence it would not be indicated in this situation. Lidocaine decreases myocardial sensitivity and will not increase the heart rate. Amiodarone is an antidysrhythmic drug used for ventricular tachycardia; it will not stimulate the heart rate.

A client is receiving epoetin (Epogen) for the treatment of anemia associated with chronic renal failure. Which client statement indicates to the nurse that further teaching about this medication is necessary?

Epoetin will increase a sense of wellbeing but it will not cure the underlying medical problem; this misconception needs to be corrected. Seizures are a risk during the first 90 days of therapy, especially if the hematocrit increases more than four points in a two week period. A dose adjustment may be necessary. Blood transfusions may still be necessary when the client is severely anemic. Supplemental iron therapy is still necessary when receiving epoetin because the increased red blood cell production still requires iron.

Which combination of foods, in addition to milk, should a nurse encourage a child with glomerulonephritis to include in the diet? 1Baked potato, ground beef, canned carrots, and banana 2 Rice, corn on the cob, baked chicken breast, and applesauce 3 Canned green beans, baked ham, bread and butter, and chips 4 Hot dog on a bun, French fries, dill pickle slices, and brownie

Rice, corn on the cob, baked chicken breast, and applesauce are all permitted on a low-sodium, low-potassium diet, which people with kidney disease require. Carrots are high in sodium, and a banana is high in potassium; both should be avoided. Canned green beans, baked ham, bread and butter, and chips are high in sodium. A hot dog and bun, French fries, dill pickle slices, and brownies are all high in sodium, potassium, or both and should be avoided.