Module 1

Which antipsychotic medication is most likely to cause very little sedation? Thioridazine Loxapine Prochlorperazine Chlorpromazine

Prochlorperazine Rationale Prochlorperazine has alow sedative effect. Thioridazine and chlorpromazine have high sedative effects. The sedative effect of loxapine is moderate.

the part or chamber of the heart capable of generating the largest force or contraction is the right ventricle left atrium right atrium left ventricle

left ventricle

heart muscle tissue contains an inherent ability to contract in a rhythmic pattern. This ability of the muscle is called? adaptability irritability automaticity conductivity

automaticity

Which statements by a patient indicate the need for further teaching about neuroleptic malignant syndrome (NMS)? Select all that apply. " It occurs in many patients like me taking antipsychotic pills ." " It occurs most often when the drug is given using an IV needle ." " It usually occurs in patients younger than age 40." " I will notify my healthcare provider if my pulse goes below 60." " I will routinely check my temperature ."

" It occurs in many patients like me taking antipsychotic pills ." " It occurs most often when the drug is given using an IV needle ." " I will notify my healthcare provider if my pulse goes below 6 0." Rationale NMS occurs in only 0.5% to 1.4% of patients taking antipsychotic medications and occurs most often when the medication is given intramuscularly. Tachycardia, not bradycardia, is a symptom of NMS. Most cases of NMS do indeed occur in patients younger than 4 0years. Fever is a symptom of NMS, and the patient should routinely monitor the temperature.

A cardiac patient is prescribed exercise-stress electrocardiography (ECG) However, the patient is unable to tolerate the prescribed exercises. Which order does the nurse expect the health care provider to instruct? "Discontinue the procedure at once." "Administer dipyridamole (Persantine)." "Administer radioisotope intravenously.' "Prepare the patient for echocardiography."

"Administer dipyridamole (Persantine)." Rationale Dipyridamole (Persantine) makes the patient's heart respond as if it is under activity. As a result, it helps monitor the patient's myocardial ischemia, dysrhythmia, and cardiac capability. The exercise-stress ECG is continued because the administration of medications helps proceed with the test. Radioisotopes used for thallium scanning while the patient exercises on a treadmill. Echocardiography helps detect the size, shape, and position of cardiac structures and is not an alternative to an ECG.

A nurse is caring for a patient receiving digitalis (Digoxin) Which statement if made by the patient, would alert the nurse to digitalis toxicity? "Everything just went blurry, and I'm unable to see anything." "I'm starting to hear voices from people know are not here." "I feel dizzy when I stand up too fast. Could my blood pressure be too low?" "I've had four loose stools today. Could I please have an antidiarrheal medication?"

"Everything just went blurry, and I'm unable to see anything." Rationale Symptoms of digitalis toxicity include visual disturbances, dysrhythmias, headache, fatigue, and nausea and vomiting Auditory hallucination, hypotension, and diarrhea are not symptoms associated with digitalis toxicity.

Which information does the nurse provide to a patient who has been taking imipramine for the past year concerning parkinsonian symptoms noted during assessment? "Have you been taking any antihistamines? They can cause these types of symptoms to appear." "I know these symptoms are upsetting, but they can be controlled by antiparkinsonian medications." "Your healthcare provider needs to be informed about these symptoms; the imipramine will likely be discontinued or the dose reduced." "You will need to determine what you would like to do; sometimes there are trade-offs between intended and unintended medication effects.'

"Have you been taking any antihistamines? They can cause these types of symptoms to appear." Rationale Tricyclic antidepressants can cause parkinsonian symptoms;if these occur, the dos will either be reduced or the drug discontinued. Antihistamines enhance the anticholinergic activity of this medication. Antiparkinsonian medications will not control these symptoms. Although the statement that there are often tradeoffs between intended and unintended effects is valid, in this situation the drug would need to be discontinued or the dosage decreased.

While collecting data from a patient for orthopnea, which important question would the nurse ask? "How many times do you get up at night to urinate?" "How many pillows do you use for sleeping at night?" "Do you get awakened by shortness of breath at night?" "Are you comfortable with walking and talking at the same time?"

"How many pillows do you use for sleeping at night?" Rationale Patients with heart failure often experience orthopnea. Patients with this condition may feel the need to sleep with the head elevated and use several pillows to sleep upright. When collecting data from a patient suffering from nocturia, the nurse asks the patient how frequently the patient gets up at night to urinate. When collecting data from the patient for paroxysmal nocturnal dyspnea, the nurse asks if the patient wakes up at night because of shortness of breath at night. When checking for shortness of breath during daily activities, the nurse asks the patient whether he or she is comfortable with walking and talking at the same time.

The nurse has provided discharge teaching to a patient who has angina pectoris about the care to be taken at home. Which statement by the patient indicates the need for additional teaching? "I should stop the activity immediately when I sense chest pain." "I should stay in a calm environment; it would relieve my stress." "I should avoid nitroglycerine after perform any strenuous activity." "I should change my position slowly after administering nitroglycerine."

"I should avoid nitroglycerine after I perform any strenuous activity." Rationale Nitroglycerine should be used to avoid pain caused by strenuous at it. A calm environment would relieve stress, which would, in turn, reduce fatigue and increase the tolerance of pain. The patient should immediately stop the activity if any chest pain is sensed because it may cause low tissue perfusion. The patient should slowly change position after administering nitroglycerine to avoid orthostatic hypotension.

A nurse is instructing the family of a patient on hospice who is receiving opioid pain medications on ways to prevent constipation. Which statement, if made by a family member, indicates a need for further teaching? "Increased fluid intake will help prevent constipation." "We should provide her with a stool softener when she takes her pain medication." "Because she is not eating as much as she used to, she will have less frequent stools." "If she develops constipation, we should withhold the pain medication until she stools."

"If she develops constipation, we should withhold the pain medication until she stools." Rationale The patient should not be denied pain medication because of constipation. Constipation can be prevented with increased fluid intake and stool softeners. The family should know that the patient will stool less frequently with less oral intake.

The family of an elderly patient who has been diagnosed with terminal cancer tells the nurse, "We can't afford hospice care. How are we going to provide for our mother? "Which response by the nurse is best? "Hospice is generally provided as a free service by churches to their patrons." "Medicaid requires three physicians to write letters stating your mother has less than l month to live." "I'm sorry, the best I can recommend is to sell your mother's home and use the funds to pay for her hospice care.'

"If two physicians provide documentation that your mother has less than 6 months to live, Medicare will pay for hospice." Rationale Medicare and Medicaid will pay for hospice care if two physicians provide documentation that the patient has less than 6 months to lie. Hospice is not a free service provided by churches. Medicaid does not require three physicians to attest to a patient's prognosis of less than l month to live. The nurse should not tell the family to sell the patient's home.

The nurse is collecting data from a patient with Raynaud's disease. Which information does the nurse teach the patient to prevent recurrent episodes? "Wear thin, light clothing to allow better circulation." "Use a cold compress or heating pad, as needed, for comfort." "Immerse hands in warm water to decrease vasospasm and promote normal blood circulation." "Drink small amounts f caffeine throughout the day to stimulate heartbeats and increase circulation."

"Immerse hands in warm water to decrease vasospasm and promote normal blood circulation." Rationale Raynaud's disease is triggered by stress and cold, and immersing hands in warm water often may decrease vasospasm. The patient should wear loose, warm clothing to protect from the cold, including gloves when handling cold objects. The patient should avoid extreme temperatures at all times, so the use of a cold compress or heating pad would not be recommended. The patient should stop using all tobacco products and avoid caffeine and any drugs that have vasoconstrictive effects, such as cocaine, amphetamines ergotamine, and pseudoephedrine.

The nurse is teaching a student nurse about ambulatory electrocardiography(ECG). Which statement by the student nurse implies effective learning? "It monitors the heart rate for not more than l2 hours at a stretch." "It is used to record the position, shape, size, and outline of the patient's heart." "Itis useful in patients with symptoms of heart disorder and normal ECG at rest." "It does not show the effect of medication on the heart rate at various time intervals."

"It is useful in patients with symptoms ofheart disorder and normal ECG at rest." Rationale Ambulatory ECG is particularly useful in patients whose clinical symptoms indicate heart disorder but have normal ECG at rest. Ambulatory ECG is used to monitor the heart rate for a prolonged period. An ECG is used to monitor the electrical activities of the myocardium. It does not record the position, shape, size, and outline of the heart. The effect of medication on the heartbeat at different time intervals is monitored by ambulatory ECG.

Which statements are true regarding coronary artery disease? Sele all that apply. "It occurs as a result of the narrowing of the arteries." "It occurs as a result of disorders of the blood vessels of the arms and legs." "It occurs as a result of a rupture of blood vessels in the brain.' "It may lead to angina pectoris and a myocardial infarction." "It occurs as a result of abnormalities in the electrical conduction pathways of the heart."

"It occurs as a result of the narrowing of the arteries." "It may lead to angina pectoris and a myocardial infarction." Rationale Coronary artery disease occurs as a result of the narrowing or obstruction of arteries of the heart. Coronary artery disease also leads to angina pectoris and myocardial infarction. Peripheral vascular disease, not coronary artery disease, occurs as a result of disorders of the blood vessels in the arms and legs. A stroke is a rupture or blockage of blood vessels in the brain. Dysrhythmias are abnormalities in the electrical conduction pathways of the heart.

Which instruction given by the healthcare provider is most important for a patient taking colestipol (Colestid) and glipizide (Glucotrol)? "Take the two medications concurrently." "Take colestipol (Colestid) with meals and a sufficient amount of water." "Take colestipol (Colestid) medication by crushing the tablets and dissolving them in juice." "Take glipizide (Glucotrol) either l hour before or 4 hours after administration of colestipol (Colestid)."

"Take glipizide (Glucotrol) either l hour before or 4 hours after administration of colestipol (Colestid)." Rationale Colestipol (Colestid is a bile acid-binding resin that can bind with glipizide (Glucotrol) Tavill effects, the healthcare provider should instruct the patient to take glipizide (Glucotrol either l hour before or 4 hours after administration of colestipol (Colestid) Glipizide (Glucotrol) and colestipol (Colestid) should not be taken concurrently. Colestipol (Colestid) can be taken with meals and a sufficient amount of water; however, this is not the most appropriate instruction to a patient taking glipizide(Glucotrol). Colestipol (Colestid) tablets should be swallowed whole; they should not be crushed or chewed.

Which instruction would be most beneficial to a patient prescribed lovastatin (Mevacor)? "Take the medication with food at bedtime." "Take the medication along with grapefruit juice." "Report any signs of gas and abdominal bloating immediately.' "Red-tinged or pinkish urine is a common side effect while on this medication."

"Take the medication with food at bedtime." Rationale Characterized as a statin, lovastatin (Mevacor) should be taken with food at bedtime to enhance the drug's absorption. Grapefruit juice inhibits the metabolism of lovastatin (Mevacor) and this combination can place the patient at risk of myopathy. Gas and abdominal bloating are common adverse effects of the medication and disappear with continued therapy. Red-tinged or pinkish urine is an early indication of rhabdomyolysis, which should be reported immediately.

A patient is taking warfarin (Coumadin) and cholestyramine (Questran) How does the nurse instruct this patient to take the medications? "Take them together with food." "Take warfarin (Coumadin) l hour before or 4 hours after taking cholestyramine (Questran)." "Take them together between meals." "Take cholestyramine (Questran) in the morning and warfarin (Coumadin) at bedtime."

"Take warfarin (Coumadin) l hour before or 4 hours after taking cholestyramine (Questran)." Rationale When cholestyramine (Questran) and warfarin (Coumadin) are taken at the same time, cholestyramine (Questran) binds with warfarin (Coumadin), which reduces its absorption. Taking warfarin (Coumadin) l hour before or 4 hours after taking cholestyramine (Questran)is a way to avoid this effect. Cholestyramine (Questran) and warfarin (Coumadin) should not be taken at the same time; they can be taken at intervals closer than morning and bedtime.

The family of the patient who has been on hospice for over 5 months is concerned that reimbursement will end for their mother's care after 6 months. Which response by the nurse is best? "I'm sorry, but all payment will cease after the 6 months has ended." "Medicare will continue to pay for hospice as long as the doctor states your mother has less than 6 months to live.' "After the first 6 months of reimbursement, three doctors must attest to the prognosis of fewer than 3 months to live." "The original process of two physicians attesting to a prognosis of fewer than 6 months to live will repeat until your mother passes away.'

"The original process of two physicians attesting to a prognosis of fewer than 6 months to live will repeat until your mother passes away.' Rationale For reimbursement for hospice care to continue, two physicians must document the patient's prognosis of fewer than 6 months to live. Payment does not cease after the first 6 months. One physician's statement of the prognosis is not enough for reimbursement by Medicare. It is not necessary to have three doctors give a prognosis of less than 3 months to live.

When reviewing the lab values of a patient being treated with lithium for bipolar disorder, which lithium level would the nurse interpret as a normal therapeutic value? 0.2 mEq/L 02.0 mEq/L 0.8 mEq/L 1.6 mEq/L

0.8 mEq/L Rationale Anormal lithium level is between 0.4 mEq/Land 1.2mEq/L. A level of0.2mEq/Lis too low and would not be considered within the therapeutic range. level of2.0 mEq/L orl.6mEq/Lis to high and can indicate toxicity.

The healthcare provider is instructing a patient with metabolic syndrome to increase physical activity and reduce his or her weight. Which range represents the goal for the ideal body mass index for this patient? 18.5 to 24.9 kg/m 2 25 to 29.9 kg/m 2 0 30 to 34.9 kg/m2 35to 39.9 kg/m 2

18.5 to 24.9 kg/m 2 Rationale A patient with metabolic syndrome is generally overweight, which is based on body mass index. A body mass index of 18.5 to 24.9 kg/ m is considered a normal weight. Weight loss and increased physical activity are usually the first steps of treatment for metabolic syndrome.

The nurse reminds the patient who is on Coumadin for the treatment of atrial fibrillation that the ideal is to maintain the international normalized ratio (INR) at between: 4 and 5 1 and 2 2 and 3 3 and 4

2 and 3

When can a patient who has been started on a selective serotonin reuptake inhibitor (SSRI expect to no longer feel depressed? 1 week 10 days 2 to 4 weeks 4 to 6 months

2 to 4 weeks Rationale It takes it takes 2 to 4 weeks of therapy with an SSRl to obtain the full therapeutic beneft when treating depression. period of 1 week or lo daysis not enough time to establish a blood level of the medication, and a decreasein depression is not expected to be seen. Patients will see improvement before 4 to 6 months of SSRI therapy.

Which body mass index (BMl) range is consistent with the diagnosis of overweight? Less than 18.5 kg/m 2 25 to 29.9 kg/m 2 30 to 34.9 kg/m 2 Greater than 40kg/m 2

25 to 29.9 kg/m 2 Rationale A BMl ranging from 25 to 29.9 kg/m 2 indicates an overweight patient. patient with BM ranging from 30 to 34.9 kg/m 2 would be in the class of obesity class I. A patient with a BMI less than 8.5 kg/m 2 is underweight. BMI greater than 40 kg/m 2 indicates obesity, class III.

Which of the five aspects of human functioning must a nurse address when dealing with a grieving person? (Select all that apply) A. Physical B. Emotional C. Intellectual D. Financial E. Spiritual

A. Physical B. Emotional C. Intellectual E. Spiritual

Which range represents the body mass index (BMl) range of obesity, mass I patient? 0 25 to 29.9 kg/m 2 30 to 34.9 kg/m2 35 to 39.9 kg/m2 18.5 to 24.9 kg/m2

30 to 34.9 kg/m2 Rationale The BMl range of an obese, lassI patient is between 30 and 34.9kg/m?. A BMlranging from 25 to 29.9 kg/m2indicates that the patient is overweight A BMI ranging from 35 to 39.9 kg/m? indicates obesity, class II. A BMI ranging from l8.5to24.9 kg/m 2is considered normal.

Which type of statin lowers low-density lipoproteins (LDLs) by 40%? 1 mg pitavastatin Livalo) 40 mg fluvastatin (Lescol) 10 mg simvastatin (Zocor) 40 mg pravastatin Pravachol)

40 mg pravastatin Pravachol) Rationale Forty milligrams of pravastatin (Pravachl)is used to lower LDLs by30%to49%. One milligram of pitavastatin (Livalo) is used to lower LDLs by less than 30%. Twenty mlligrams to 40 mg of fluvastatin Lescol) is used to lower LDLs by less than 30%.Ten mligrams ofsimvastatin (Zocor)is used to lower LDLs by less than 30%.

A nurse is evaluating lab work for a new patient in the skilled nursing facility. The nurse notes the patient has an elevated troponin I level, which indicates a myocardial injury occurred no more than how many days ago? 1 to 2 days 5 to 7 days 18 to 21 days 25 to 30 days

5 to 7 days Rationale The presence of troponin indicates a myocardial injury occurred in the last 5 to 7 days. Troponin levels return to normal after about 7 days, so the patient's myocardial injury would have occurred less than 18 to 30 days ago.

A nurse is educating a patient with diabetes mellitus and hypertension on the importance of reducing blood pressure. The nurse bases education on an understanding that reducing diastolic blood pressure by l0 mm Hg leads to which percentage decrease in risk of a cardiovascular event? 10% 30% 50% 100%

50% Rationale The nurse should educate the patient that a 10 mm Hg decrease in diastolic blood pressure decreases the patient's risk for a cardiovascular event by 50%. The other answer options are not correct.

The hospice nurse explains that to qualify for admission to a hospice the attending health care provider must cerfity that the patien has a life expectancy of fewer than how many months?

6 months

the nurse modifies the "Lubb" sound of the "Lubb/Dubb" of the cardiac cycle as the sound of the

AV valve closing

Which statement regarding diagnosable mood disorders in the United States for all age groups is correct? About 0.4% to 1.6% of people will have a diagnosable mood disorder during their lifetimes. About 15% to 20% of people will have a diagnosable mood disorder during their lifetimes. About 20% to 30% of people will have a diagnosable mood disorder during their lifetimes. About 45% to 60% of people will have a diagnosable mood disorder during their lifetimes.

About 15% to 20% of people will have a diagnosable mood disorder during their lifetimes. Rationale About 15%to 20%of people in the United States will experience a diagnosable mood disorder during their lifetimes About 45%to 60% of patients with depression suffer from endocrine abnormalities, such as excessive secretion of cortisol and abnormal thyroid-stimulating hormone. About 20% to 30% of patients with major depression recover fully and do not experience another bout of depression. The prevalence rate of bipolar disorder is 0.4%to 1.6%of the adult population of the United States.

Which statement about patients with depression is correct? Depressive symptoms are seen more in men. Manic depression is also called a unipolar disorder. Beta-adrenergic blocking agents are used to control depression. About 45%to 60% of patients with depression have endocrine abnormalities.

About 45% to 60% of patients with depression have endocrine abnormalities. Rationale Excessive secretion of cortisol and abnormal thyroid-stimulating hormone are the results of endocrine abnormalities. These abnormalities are found in 45%to 60% of patients with depression. The frequency of depressive symptoms is about 26% for women and 12% for men. Bipolar disorders were once known as manic depression, not a unipolar disorder. Beta-adrenergic blocking agents are used to control hypertension; in fact, these drugs are known to cause depression.

Which symptoms indicate a patient is experiencing myopathy from taking lovastatin (Mevacor)? Select all that apply. Aches Fatigue Nausea Soreness Weakness

Aches Soreness Weakness Rationale Symptoms of myopathy include aches, soreness, and weakness. Fatigue and nausea are symptoms of hepatotoxicity.

A nurse is caring for a patient with the following lipid panel results: low-density lipoprotein (LDL) cholesterol = 225 mg/dL;high-density lipoprotein (HDL cholesterol=70mg/dL.The nurse would provide which education to the patient? Ways to maintain current cholesterol levels How to increase both HDL and LDL cholesterol levels Methods to decrease both HDL and LDL cholesterol levels Actions to decrease LDL and maintain HDL cholesterol levels

Actions to decrease LDLand maintain HDL cholesterol levels Rationale The nurse should educate the patient on ways to decrease LDL cholesterol, which is very high, and maintain HDL cholesterol, which is at an appropriate level. HDL cholesterol is considered "good" cholesterol and should be maintained at a high level.

Which is the most important action the healthcare team should take to help improve the therapeutic success of tricyclic antidepressants? Adjusting the antidepressant dosage by monitoring therapeutic serum levels Anticipating the potential for adverse effects associated with this antidepressant Assessing the patient's physiologic response to previously prescribed antidepressants Assessing for any concurrent medical conditions such as obesity and seizure

Adjusting the antidepressant dosage by monitoring therapeutic serum levels Rationale The healthcare team should regularly monitor the therapeutic serum levels. The dosage of the medication should be adjusted accordingly to help improve therapeutic success with tricyclic antidepressants. The potential for adverse effects associated with different classes of antidepressants is an important factor to consider when selecting an antidepressant drug, but it is not the most relevant action. The patient's response to previously prescribed antidepressants is an important action to note before selecting a particular antidepressant. Concurrent medical conditions such as obesity and seizure history should be considered in the initial therapy selection.

The nurse is caring for a patient who has angina pectoris. The patient complains of persistent pain even after the nurse administers nitroglycerine sublingually. Which intervention by the nurse is best? Administer the same dose of nitroglycerine after 5 minutes. Inform the health care provider immediately. Place the patient in the side lateral position immediately. Place the patient on oxygen supplementation immediately.

Administer the same dose of nitroglycerine after 5 minutes . Rationale The nurse should repeat the dose of nitroglycerine in 5 minutes if the pain does not subside. If the patient still complains of pain even after three doses of nitroglycerine at intervals of 5 minutes, then the nurse should inform the health care provider immediately. Placing the patient in the lateral position would not relieve the pain, so this intervention is not required. Oxygen supplementation is given to high -risk patients with unstable angina.

A nurse is assisting with the selection of goals for the patient on hospice. Which goa(s) would be most appropriate for the patient on hospice? Select all that apply. Curing the patient's disease Alleviating the patient's symptoms Maintaining patient and family confidence Involving the patient and family in care planning decisions Encouraging the patient to conserve as much strength as possible

Alleviating the patient's symptoms Maintaining patient and family confidence Involving the patient and family in care planning decisions Rationale The goals of hospice care include alleviating symptoms, maintaining patient and family confidence, and involving the patient and family in care planning decisions. The patient should be encouraged to live life to the fullest versus conserving strength (when appropriate). Curing the patient's disease is not a goal of hospice care.

Which symptoms will a nurse expect to observe in a patient diagnosed with psychosis and exhibits negative symptoms? Select all that apply. Alogia Poor eye contact Reduced spontaneous movement Garbled or unrecognizable speech False sensory perceptions experienced without an external stimulus

Alogia Poor eye contact Reduced spontaneous movement Rationale Alogi (minimal speech with the only brief, slow, monotone replies given in response to questions) is a negative symptom. Negative symptoms also include reduced emotional expressiveness, which includes poor eye contact and reduced spontaneous movement. At its most serious, disorganized thinking extends into pronunciation itself and the speaker's words become garbled or unrecognizable. False sensory perceptions experienced without an external stimulus that seems real to the patient are known as hallucinations.

A patient is prescribed rivaroxaban Xarelto) in preparation for discharge. The nurse would question the prescription of which additional medication? Penicillin G Azithromycin Acetaminophen Diphenhydramine

Azithromycin Rationale The nurse would question the prescription of azithromycin, which is one of several drugs that interact with rivaroxaban (Xarelto) Penicillin G, acetaminophen, and diphenhydramine are safe medications to take with rivaroxaban (Xarelto).

Which cardiovascular disease would be suspected when the patient's laboratory report reveals the presence of plaques? Dysrhythmias Myocardial infarction Coronary artery disease Atherosclerotic cardiovascular disease

Atherosclerotic cardiovascular disease Rationale Hypercholesterolemia is characterized by the presence ofatherosclerotic plaques, which may occur in a patient with heart disease. This condition can narrow the arteries and lead to atherosclerotic cardiovascular disease. Dysrhythmias are abnormalities in the electric conduction pathways of the heart. Myocardial infarctions occur because ofan insuficient oxygen supply to the heart. Coronary artery disease refers to the narrowing or obstruction of the arteries of the heart.

Which antilipemic medication is beneficial for patients with primary hypercholesterolemia? Fluvastatin (Lescol) Atorvastatin (Lipitor) Simvastatin (Zocor) Pravastatin (Pravachol)

Atorvastatin (Lipitor) Rationale Primary hypercholesterolemia is a genetic condition that affects low-density lipoprotein cholesterol levels. Primary hypercholesterolemia is treated with high-density statins such as atorvastatin (Lipitor) Fluvastatin (Lescol) and pravastatin (Pravachol) are low-density statins. Simvastatin (Zocor) is a moderate-intensity statin.

Which medications are classified as high-intensity statins that lower low-density lipoproteins (LDLs) by greater than 50%? Select all that apply. Fluvastatin (Lescol) Simvastatin (Zocor) Lovastatin (Mevacor) Atorvastatin (Lipitor) Rosuvastatin (Crestor)

Atorvastatin (Lipitor) Rosuvastatin (Crestor) Rationale Atorvastatin (Lipitor) and rosuvastatin (Crestor) are classified as high-intensity statins that lower LDLs by greater than 50%. Fluvastatin (Lescol), simvastatin (Zocor), and lovastatin Mevacor are classified as moderate-intensity (lowers LDLs by 30%to 49%) or low-intensity statins (lowers LDLs by less than 30%), depending on their dosage.

Which statement is true regarding statin dosage recommendations? Fluvastatin (Lescol) 80 mg lowers low-density lipoprotein (LDL by less than 30%, Atorvastatin (Lipitor) 40 to 80 mg lowers LDL by greater than 50%. Rosuvastatin (Crestor) 5 to l0 mg lowers LDL by 30% to 49%, Pravastatin (Pravachol) 10 to 20 mg lowers LDL by 30% to 49%,

Atorvastatin (Lipitor) 40 to 80 mg lowers LDL by greater than 50%. Rationale Atorvastatin (Lipitor I a high-intensity statin that lowers LDL levels by greater than 50%. Fluvastatin (Lescol) 80 mg is a moderate-intensity lipoprotein that lowers LDL levels by 30% to 49%. Rosuvastatin (Crestor) 5 to l0 mg is a high-intensity statin that lowers LDL levels by greater than 50%. Pravastatin (Pravachol) 10 to 20 mg is a low-intensity statin that lowers LDL levels by less than 30%.

A nurse notes that the patient with terminal lung cancer has extreme muscle weakness and appears emaciated. The nurse knows to use which term to document this patient's condition? Anorexia Cachexia Spasticity Malnutrition

Cachexia Rationale Cachexia is characterized by extreme emaciation and weakness and is associated with a terminal disease. Anorexia is a lack of appetite and oral intake. Spasticity refers to the prolonged contraction of muscles. Malnutrition may contribute to cachexia.

Which are the minor adverse effects of omega-3 fatty acids? Select all that apply. Chills Nausea Arm pain Joint pain Muscle aches

Chills Joint pain Muscle aches Rationale Chills, joint pain, and muscle aches are minor adverse effects associated with omega- fatty acids Severe adverse effects include nausea and arm pain.

Which medicine does the nurse expect to find in the prescription of a patient with high blood pressure who reports a recent development of depression? Clonidine Serotonin Levodopa Progestins

Clonidine Rationale Clonidine is an antihypertensive known to contribute to depression. Serotonin is a neurotransmitter and not a drug Levodopa is a medicine used by patients suffering from Parkinson's disease; it is not an antihypertensive drug. Progestins are hormones that may contribute to depression.

Which chemical is not a neurotransmitter? Clonidine Serotonin Acetylcholine Norepinephrine

Clonidine Rationale Clonidine is not a neurotransmitter; it is an antihypertensive drug. Serotonin, acetylcholine, and norepinephrine are neurotransmitters.

Which atypical antipsychotic drug is most likely to cause hypotension? Asenapine Aripiprazole Ziprasidone Clozapine

Clozapine Rationale Clozapine is an atypical antipsychotic drug that is highly hypotensive; a patient taking this drug needs to be monitored for hypotension. Asenapine is an atypical antipsychotic drug that is moderately hypotensive. Aripiprazole and ziprasidone are atypical antipsychotic drugs that have low hypotensive effects.

Which medication is an atypical antipsychotic? Thiothixene Clozapine Haloperidol Fluphenazine

Clozapine Rationale The patient has been prescribed clozapine, which is an atypical antipsychotic agent. Thiothixene, haloperidol, and fluphenazine are typical antipsychotic agents.

The nurse finds that a patient has arterial spasms and chronically cold hands and feet. Which diagnostic test is most useful in the patient? Fluoroscopy Electrocardiography Cold stimulation test Doppler ultrasonography

Cold stimulation test Rationale Arterial spasms and chronically cold hands and feet are indicative of Raynaud's disease. A cold stimulation test is used to diagnose Raynaud's disease. It measures the temperature change by a thermistor attached to each finger. Fluoroscopy is used to diagnose arterial aneurysms. Electrocardiography is used to measure cardiac dysrhythmias;it is not the primary diagnostic test for Raynaud's disease. Doppler ultrasonography is used as a diagnostic test in venous stasis ulcers.

A nurse is caring for a patient receiving sustained-release morphine (MSContin )for intractable cancer pain. Which side effects would the nurse be prepared to treat? Select all that apply Tachycardia Constipation Hypertension Hypoventilation Nausea and vomiting

Constipation Nausea and vomiting Rationale The nurse should be prepared to treat the side effects of nausea and vomiting and constipation for the patient receiving sustained-release morphine ( MSContin ). Tachycardia, hypertension, and hypoventilation are not expected side effects of sustained-release morphine therapy.

When planning care for a patient receiving tricyclic antidepressants, which potential problem does the nurse consider? Gastrointestinal| (Gl) bleeding Constipation Renal calculi Hypernatremia

Constipation Rationale Constipation is an anticholinergic effect common in patients taking tricyclic antidepressants. Patients must be monitored for this problem and preventive measures taken. Tricyclic antidepressants do not cause Gl bleeding, renal calculi formation, or hypernatremia.

The nurse reviewing the electrocardiography(ECG) reports of a patient finds abnormality in the P wave. Which improper action of the heart does the nurse infer from these findings? Relaxation of the atria Contraction of the atria Relaxation of the ventricles Contraction of the ventricles

Contraction of the atria Rationale ECG is a graphic study of the electrical activities of the myocardium. The p wave represents the depolarization of the atria, which is the electrical activity when the heart contracts. Therefore, an abnormality in the P wave is indicative of improper contraction in the atria. P wave does not indicate atrial repolarization. trial repolarization is not represented in ECG reports Relaxation of the ventricles is represented by a T wave. QRS complex represents a contraction of the ventricles.

The nurse is caring for the patient and has administered atropine sublingually. Which condition would be the reason for the administration? Dyspnea Anorexia Death rattle Constipation

Death rattle Rationale Death attle is a characteristic coarse and loud sound that air makes as it passes through the mucus It is coarse and loud. It is usually heard due to the accumulation of mucus and fluids in the posterior area of the pharynx 24 to 48 hours before death. Anticholinergic drugs such as transdermal scopolamine or sublingual atropine are used to prevent excess mucus production, thus decreasing the death rattle. Atropine is not used in the treatment of dyspnea anorexia, or constipation. Bronchodilators help in relieving dyspnea. Anorexia can be managed by providing small frequent meals to the patient. Constipation can be relieved with the help of laxatives.

Which potential effect of cholestyramine (Questran) can cause bleeding gums, bruising, or dark tarry stools? Interference with platelet aggregation Binding of the Christmas factor Activation of thromboplastin Deficiency of vitamin K

Deficiency of vitamin K Rationale Cholestyramine (Questran) is a bile acid-sequestering resin that, if taken on along-term basis, can cause a deficiency offat-soluble vitamins. Vitamin Kis a fat-soluble vitamin essential to blood clotting. Vitamin K deficiency results in abnormal bleeding often manifested by bleeding gums, easy bruising and melena (blood in the stool). Cholestyramine (Questran) does not affect platelet aggregation, the Christmas factor, or thromboplastin.

Which are common adverse effects of ezetimibe (Zetia)? Select all that apply. Flushing Bloating Diarrhea Headache Abdominal pain

Diarrhea Abdominal pain Rationale Ezetimibe (Zeti) i an antilipemic medication that blocks the absorption of cholesterol from the small intestine. Diarrhea and abdominal pain are common adverse effects of ezetimibe (Zetia) Flushing is a common adverse effect of niacin. Bloating is a common adverse effect of fbricacids and bile acid-binding agents. Headaches are common adverse effects associated with niacin and statins.

Which condition might be present in a patient with metabolic syndrome who is prescribed statins? Dyslipidemia Hypertension Central obesity Type 2 diabetes mellitus

Dyslipidemia Rationale Metabolic syndrome is a group of disorders consisting ofobesity, dyslipidemia, hypertension, and type 2 diabetes. Statins are reductase inhibitors, which treat dyslipidemia by lowering triglyceride and low-density lipoprotein cholesterol levels and raising the high-density lipoprotein cholesterol lel. Using a combination ofa thiazide diuretic plus an angiotensin-converting enzyme inhibitor or calcium channel blocker will treat hypertension. Central obesity is treated by weight loss and exercise to reach an ideal body mass index.Type 2 diabetes mellitus is treated with thiazolidinediones, sulfonylureas, and alpha-glucosidase inhibitors.

A healthcare provider has prescribed fabric acid derivatives for a patient with metabolic syndrome. What condition would the nurse expect to find in the patient? Dyslipidemia Hypertension Central obesity Postprandial hyperglycemia

Dyslipidemia Rationale Dyslipidemia is characterized by elevated plasma cholesterol or triglyceride levels, or a low high-density lipoprotein cholesterol level. Fibric acid derivatives are used to normalize plasma cholesterol levels. Hypertension can be treated with thiazide diuretics or calcium channel blockers. Central obesity is treated by controlling the diet and increasing physical ativity. Postprandial hyperglycemia can be treated by administering alpha-glycosidase inhibitors.

The nurse at the hospice center is caring for a patient approaching death. The patient is unable to cough up secretions effectively. Which intervention should the nurse perform for this patient? Offer ice chips frequently. Massage the patient's forehead. Elevate the head of the bed with pillows. Use moist swabs to keep the lips and mouth moist.

Elevate the head of the bed with pillows. Rationale if the patient is unable to cough up secretions, the nurse should elevate the head of the patient. Pillows may be used for this purpose. The patient is offered ice chips to prevent dryness of the mouth and lips. The patient's forehead is massaged to soothe the restless patient with decreased metabolism and slowed circulation to the brain. Moist swabs are used to keep the lips and mouth moist in patients with reduced metabolic needs.

Which condition would the nurse expect in a patient with metabolic syndrome who is prescribed statins and thiazide diuretics? Select all that apply. Elevated blood pressure Elevated triglyceride levels Increased insulin resistance Increased plasma glucose levels Elevated low-density lipoprotein cholesterol levels

Elevated blood pressure Elevated triglyceride levels Elevated low-density lipoprotein cholesterol levels Rationale Statins and thiazide diuretics are prescribed to cure lipid disorders and lower blood pressure. Thus this patient may have elevated blood pressure, elevated triglyceride levels, and elevated low-density lipoprotein cholesterol levels. Increased insulin resistance is treated with thiazolidinediones. An increase in fasting plasma glucose may indicate diabetes; this condition can be treated with alpha-glycosidase inhibitors.

Which statement regarding patients with depression is correct? Levodopa, an antihypertensive, may contribute to depression. Excessive secretion of cortisol occurs in patients with depression. Patients with depression are two to three times more likely to commit suicide. Patients with the major depressive disorder suffer from chronic symptoms of depression for at least 2 years.

Excessive secretion of cortisol occurs in patients with depression. Rationale About 45% to 60% of patients with depression have endocrine abnormalities. Such patients secrete excessive cortisol and abnormal thyroid-stimulating hormone. Levodopa, an antiparkinsonian medicine, may cause depression. Relatives of patients with depression are two to three times more likely to develop depression. Major depressive disorder is characterized by major depressive episodes that repair themselves for a period of greater than 2 years Patients with dysthymia, not a major depressive disorder, are known to suffer from chronic symptoms of depression that last for at least 2 years.

what diagnostic test allows observation of real-time movement via radiography? Fluoroscopy Echocardiography Angiography PET Scan

Fluoroscopy

Which medication increases the pharmacologic effects of sulfonylureas? Ranitidine (Zantac) Gemfibrozil (Lopid) Cimetidine (Tagamet) Omeprazole (Prilosec)

Gemfibrozil (Lopid) Rationale Gemfbrozil (Lopid) is a fbric acid used to treat hyperlipidemia.This medication enhances the pharmacologic efects of sulfonylureas Ranitidine (Zantac), cimetidine (Tagamet), and omeprazole (Prilosec) are medications that significantly increase fuvastatin Lescol) levels.

The DASH (Dietary Approaches to Stop Hypertension) diet plan is recommended to an overweight patient to reduce the intake of saturated fat. Which condition might be present in the patient? Dyslipidemia Hypertension Central obesity Diabetes mellitus

Hypertension Rationale A diet plan called DASH (Dietary Approaches to Stop Hypertension) is used to treat hypertension. It involves goals to control blood pressure and lipid levels Dyslipidemia is treated with the goal of lowering triglyceride and low-density lipoprotein cholesterol levels and raising the high-density lipoprotein cholesterol level. Controlling the risk factor defining limits of waist circumference and weight, or increasing physical activity can reduce central obesity. Controlling plasma glucose levels and fasting blood glucose levels would benefit patients with diabetes mellitus.

Which tricyclic antidepressant is approved for treating enuresis in children 6 years of age and older? Clomipramine Trimipramine Imipramine Amitriptyline

Imipramine Rationale Imipramine is effective in treating enuresis in children aged 6years and older. Clomipramine is approved to treat obsessive-compulsive disorder. Trimipramine is not indicated for the treatment of enuresis in children. Amitriptyline has been shown to be effective in treating depression in older individuals.

Which are the purposes of hospice care? Select all that apply. Provides care that postpones death Implements an interdisciplinary approach to patient care Directs care to provide the relief of symptoms Promotes patient comfort during the dying process Admits patients with a prognosis of l year or less to live

Implements an interdisciplinary approach to patient care Directs care to provide the relief of symptoms Promotes patient comfort during the dying process Rationale Hospice care uses an interdisciplinary approach to patient care and works toward providing relief of symptoms. Hospice care also promotes patient comfort during the dying process. Hospice care does not postpone or hasten death and admits patients with a prognosis of 6 months or less to live.

Which antiparkinsonian medicine may cause depression? Levodopa Reserpine Progestin Methyldopa

Levodopa Rationale Levodopa is an antiparkinsonian medication that may contribute to depression. Reserpine and methyldopa are antihypertensive drugs that may cause depression Progestin is a hormone that causes depression.

Pain control for a hospice patient is best attained through the use of long-acting medications. Which medications are long-acting medications? Select all that apply. Lortab ibuprofen MS Contin OxyContin Duragesic patch

MS Contin OxyContin Duragesic patch Rationale These long-acting medications (MS Contin, OxyContin, and Duragesic patch provide better pain management and are more convenient for the patient and the caregiver. Lortab is not as strong a narcotic; therefore its effects do not last as long, leading to ineffective pain management. Ibuprofen may be used as adjunctive therapy to assist with pain relief, but as anti-inflammatory it is not effective enough to control the pain.

which instruction by the nurse is accurate to include in a patient's care to manage metabolic syndrome?

Manage and reduce stress

The health care provider instructs the nurse to avoid suctioning for a patient who reports dyspnea Which factor regarding suctioning would be the reason for this? Elevates anxiety in the patient Heightens tumor pressure in the patient Increases mucus production in the patient Causes respiratory distress in the patient

O Increases mucus production in the patient Rationale Dyspnea is a symptom that arises from a variety of possible conditions, such as heart failure, dysrhythmias, infection, and tumor growth. Breathing effectively is difficult for many patients, especially during the final stage of illness. Use of a fan to circulate air and use of morphine to decrease the respiration effort are recommended during dyspnea. Suctioning should be minimized because it stimulates the production of mucus. This may aggravate dyspnea. Suctioning should be performed only if the patient is choking and unable to recover. Suctioning does not increase anxiety in the patient. Suctioning helps in decreasing tumor pressure and respiratory distress in the patient.

A nurse is caring for a patient in the beginning stages of the dying process. The patient has anorexia because of stomatitis. Which instruction would be most helpful t facilitate increased oral intake? Provide high-protein liquid drinks. Prepare only the patient's favorite foods. Prepare food outside the home and bring it to the patient. Make the dining process as pleasurable and enjoyable as possible.

Provide high-protein liquid drinks. Rationale The patient with stomatitis is likely not eating because his or her mouth is too painful to eat. Therefore liquid protein drinks may be more tolerable. If the patient were not eating because of nausea and vomiting it might be helpful to prepare only the patient's favorite foods, prepare the food outside the home, and make the dining process as enjoyable as possible.

Which effect will metformin have on a patient who is obese? Select all that apply. Reduced blood pressure Reduced insulin resistance Reduced the production of glucose Reduced postprandial hyperglycemia Reduced triglyceride and low -densitylipoprotein cholesterol levels

Reduced insulin resistance Reduced the production of glucose Rationale Metformin reduces insulin resistance in peripheral tissues and also lowers the production of glucose in the liver. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers are used to lower blood pressure. Alpha-glucosidase inhibitors reduce postprandial hyperglycemia. Statins and fabric acid derivatives are prescribed to control triglyceride and low-density lipoprotein cholesterol levels.

What is the additional beneficial effect of statins aside from their lipid-lowering capacity? Reduction of inflammation Reduction of blood pressure Treatment of digitalis glycoside toxicity Treatment of pseudomembranous colitis

Reduction of inflammation Rationale Inaddition to their lipid-lowering capacity, statins help reduce infammation and stabilize atherosclerotic plaques. Statins, as a drug class, are not directly responsible for lowering blood pressure, nor are they used in the treatment of digitalis glycoside toxicity or pseudomembranous colitis.

The nurse is planning care for a patient with terminal cancer on hospice. How would pain medication be administered for the best possible pain control? On an as-needed basis Regularly around the clock Regularly while the patient is awake When nonpharmacologic methods fail

Regularly around the clock Rationale Pain medication should be scheduled around the clock to ensure proper pain control. Medication should also be available on an as-needed basis for breakthrough pain. Pain medication should be scheduled regularly while the patient is awake. Nonpharmacologic pain-control methods should be used in addition to prescription pain medications for terminal cancer pain.

Which medication lowers the levels of fluvastatin (Lescol) when given concurrently? Rifampin (Rifadin) O Ranitidine (Zantac) O Omeprazole (Prilosec) Cimetidine (Tagamet)

Rifampin (Rifadin) Rationale Administration of rifampin (Rifadin concurrently with fluvastatin (Lescol) results in significantly lower levels of fluvastatin (Lescol) Ranitidine Zantac) cimetidine (Tagamet) and omeprazole (Prilosec) significantly increase fluvastatin (Lescol) levels.

Which neurotransmitters are known to change in the brains of patients with depression? Select all that apply. Glutamate Epinephrine Serotonin Dopamine Norepinephrine

Serotonin Dopamine Norepinephrine Rationale Brain neurotransmitters such as serotonin, dopamine, and norepinephrine are changed in patients with depression. Glutamate is a neurotransmitter that plays a role in learning and memory. Epinephrine is a neurotransmitter involved in the stimulation of the sympathetic nervous system.

Who are the members of a core interdisciplinary team? Select all that apply. Pharmacist Social worker Nurse coordinator Primary spiritual leader Bereavement coordinator

Social worker Nurse coordinator Rationale A core interdisciplinary team develops and supervises hospice care in conjunction with ll those individuals involved in the care. The interdisciplinary team is comprised of a social worker and a nurse coordinator in addition to a medical director and spiritual coordinator. A social worker takes care of the psychosocial needs of the patient, provides counseling, and serves as a resource for community services. The nurse coordinator is a registered nurse who coordinates the implementation of the care plan for each patient. A pharmacist, primary spiritual leader, and bereavement coordinator are the members of the primary hospice team.

Which phrase describes the benefits of sulfonylurea for a patient with metabolic syndrome? Reduces postprandial hyperglycemia Lowers triglyceride and cholesterol levels Treats insulin resistance in peripheral tissues Stimulates the beta cells of the pancreas to release insulin

Stimulates the beta cells of the pancreas to release insulin Rationale Sulfonylureas are administered to stimulate the beta cells of the pancreas to release insulin in type 2 diabetes. Postprandial hyperglycemia is treated with alpha-glycosidase inhibitors. Statins are used to control plasma triglyceride levels and reduce cholesterol levels. Thiazolidinedione is used to treat insulin resistance in peripheral tissues.

A nurse caring for a patient receiving palliative care notices that the patient is demonstrating signs of air hunger. Which medication would the nurse request from the provider? Oral oxycodone Sublingual morphine Intravenous meperidine (Demerol) No medication will ease the patient's air hunger.

Sublingual morphine Rationale Sublingual morphine can relax the patient's respiratory effort and can improve air hunger. Oxycodone and Demerol are not helpful for relieving air hunger.

Respiratory distress is seen often during the end stages of an illness Which physiologic adaptation does the nurse know the patient may exhibit 24 to 48 hours before death? The death rattle Increased period of apnea Decreased depth of breathing Increased anxiety

The death rattle Rationale Patients may exhibit the death rattle, which is an accumulation of mucus and fluids in the posterior area of the pharynx. Periods of apnea decreased depth of breathing, or increased anxiety can occur in a terminally ill patient days or weeks before dying.

A patient suffering from a malignant tumor stops responding to the treatment. The health care provider states that curative care is no longer possible. Which information does the nurse give to the patient's family members and the patient about hospice admission? The hospice team will continue aggressive curative care. The hospice team will provide support to control the symptoms. The disease is no longer curable, and the patient will die shortly. There is no hope for treatment, and the patient can be discharged.

The hospice team will provide support to control the symptoms. Rationale Patients who are terminally ill and no longer responding to curative care are admitted into hospice. The hospice team provides palliative care to such patients, which includes measures to control the symptoms and provide emotional support to the patient and the family. The hospice team does not continue curative care of the patient who stopped responding to the treatment. It is not advisable t tell the family members and the patient directly about the death, as it may lead to emotional stress Instead the nurse should explain to them the treatment given to the patient, that the patient has stopped responding to the treatment, and how the hospice team would care for the patient. Patients are not discharged or sent home if there is no hope for treatment or they stop responding to treatment, but they are advised to be admitted to hospice.

Why are second-generation antidepressants recommended as first-line agents to treat depression? They are less toxic in the case of an overdose. They have more prolonged action. They are safer for patients with cardiovascular disease. They are more effective in preventing symptoms of mania.

They are less toxic in the case of an overdose. Rationale Second-generation antidepressants have lower toxicity in case of an overdose than first-generation antidepressants. Therefore second-generation antidepressants are recommended as first-line agents. All antidepressants block the reuptake of neurotransmitters and reduce their destruction; thus the actions of these drugs are prolonged. Electroconvulsive therapy for the treatment of depression and bipolar disorder is safer than many drug therapies for patients with cardiovascular disease. In patients with bipolar disorder lithium is more effective in preventing the signs and symptoms of mania than those of depression.

A patient who has been diagnosed with metabolic syndrome has a blood pressure of 160/95 mm Hg and a plasma glucose level ofl30 mg/dL. Which medications would the nurse expect to be prescribed to the patient? Select all that apply. Thiazide diuretics Thiazolidinediones Fibric acid derivatives Alpha-glycosidase inhibitors 3-Hydroxy-3-methyl glutaryl coenzyme A(HMG-CoA) reductase inhibitors

Thiazide diuretics Thiazolidinediones Alpha-glycosidase inhibitors Rationale A normal blood pressure and a normal blood plasma glucose level is 150/90 mm Hg and 120 mg/dL, respectively. Thiazide diuretics are used to reduce elevated blood pressure. Thiazolidinediones are used to treat insulin resistance. Alpha-glycosidase inhibitors are prescribed to reduce the absorption of glucose from the intestine, thereby treating diabetes Mellitus. Fibric acid derivatives and HMG-CoA reductase inhibitors are used to treat lipid disorders such as dyslipidemia.

Which medications would be prescribed to treat a patient whose laboratory report suggests increased glucose production and insulin resistance? Select all that apply. Statins Thiazolidinediones Calcium channel blockers Alpha glycosidase inhibitors 3-Hydroxy-3-methylglutary| coenzyme A(HMG-CoA) reductase inhibitors

Thiazolidinediones Alpha glycosidase inhibitors Rationale Thiazolidinediones are administered to reduce insulin resistance. Alpha glycosidase inhibitors are administered to reduce the absorption of glucose and reduce the risk of type 2 diabetes. Statins are used to control plasma triglyceride and cholesterol levels, which treats dyslipidemia. Calcium channel blockers are used to treat hypertension. Patients with dyslipidemia are commonly treated with HMG-CoA reductase inhibitors.

Which antipsychotic medication is the most potent alpha-l blocker? Thioridazine Trifluoperazine Haloperidol Fluphenazine

Thioridazine Rationale Thioridazine, along with chlorpromazine, is the most potent alpha-l blocker. Trifluoperazine and fluphenazine are notas potent as thioridazine. Haloperidol has almost no effect on alpha-l receptors.

Which first-generation antipsychotic drug is available only as tablets? Thiothixene Loxapine Trifluoperazine Fluphenazine

Trifluoperazine Rationale Trifluoperazine is a first-generation antipsychotic drug that is available only as tablets. Thiothixene and loxapine are available only as capsules. Fluphenazine is available in the forms of tablets, elixirs, concentrates, and injections.

Which symptoms does the nurse expect to observe in a patient who displays disorganized behavior? Select all that apply. Aimless behavior Unusual manner of dressing Inappropriate sexual behavior Unpredictable, non-triggered agitation Behavior motivated by delusional beliefs

Unusual manner of dressing Inappropriate sexual behavior Unpredictable, non-triggered agitation Rationale Disorganized behaviors defined as problems with any form of goal-directed behavior that lead to difficulties with performing activities of daily living. The patient may appear markedly disheveled and may dress in an unusual manner. For example, the patient may wear several layers of clothing, scarves, and gloves on a hot day. The patient may also display inappropriate sexual behavior, such as public masturbation. Unpredictable, non-triggered agitation (such as shouting or swearing) may also be observed. Disorganized behavior is different from the behavior that is merely aimless or generally not purposeful. It is also different from organized behavior that is motivated by delusional beliefs.

Which laboratory parameter supports an assessment of obesity? Triglyceride level of 145 mg/dL Waist circumference of42 inches (1.07 m) Plasma glucose level of 95 mg/dL Blood pressure level of 130/85mm Hg

Waist circumference of 42 inches (1.07 m) Rationale The standard risk factor defining limit for waist circumference is 40 inches (1.02 m) in men and 35 inches in women. A waist circumference of 42inches (1.07m) implies obesity. The triglyceride level of 145 mg/dL is below the risk factor limit of 150 mg/dL. The plasma glucose level of95 mg/dL is below the risk factor limit of 100 mg/dL.A blood pressure level of 130/85 mm Hg is normal for both men and women.

Which atypical antipsychotic drug has the lowest hypotensive effects? Lurasidone Asenapine iloperidone Ziprasidone

Ziprasidone Rationale Of the four drugs listed, ziprasidone has the lowest hypotensive effects.

How does a perceived loss differ from an actual loss? A perceived loss is more quickly resolved A perceived loss has a superficial response. A perceived loss is situational. A perceived loss is easily overlooked

a percieved loss is easily overlooked

A patient is prescribed a bile acid resin. The nurse intructs inspects the patient to reprot which advers reaction to vitamin k dificency?

coffee ground emesis

the vein that returns blood from the coronary circulation to the right atrium is the ______ superior vena cava coronary arteries coronary sinus coronary valves

coronary sinus

the nurse differentiates between curative and palliative care. What is true of curative treatment? Curative treatment is not concerned with dying Curative treatment is the only care covered by health insurance Curative treatment is focused on prolonging life Curative treatment is centered on symptom control

curative treatment is focused on prolonging life

what is the final stage of human growth and development? Integrity Depression Death Happiness

death

the cardiac cycle refers to a complete heartbeat. The two atria contract while the two ventricles relax. When the ventricles contract, the two atria relax. the phase of relaxation is called systole diastole coronary circulation PR interval

diastole

How is a durable power of attorney helpful to an incapacitated patient?

it directs an agent to make health care decisions

modifiable risk factors for coronary artery disease include which group? Smoking, heredity Family history, smoking Diabetes, family history High cholesterol, obesity

high cholesterol obesity

the nurse is aware that the muscle layer of the heart which is responsible for the hearts contraction is the pericardium myocardium mediastinum endocardium

myocardium

Which vitamin has antilipemic actions?

niacin

The hospice nurse tells the family that the nurse coordinator and RN will visit them. What is the role of the nurse coordinator? Collect initial fees for the hospice service Assist with funeral planning Officially admit the patient to the hospice service Assist with accessing community resources

officially admit the patient to the hospice service

what is the termination of tube feedings to a dying patient considered? Terminal care Holistic care Active euthanasia Passive euthanasia

passive euthanasia

what is the desired effect of any antilipemin therapy ?

reduce LDLs and increase HDLs

the aortic and pulmonary valves are collectively known as the _____ valves semilunar valves septum papillary muscles atrioventricular valves

semilunar valves

the normal pacemaker of the heart is the Purkinje fibers bundle of His atrioventricular node sinoatrial node

sinoatrial node

the order in which impulses travel through the hear is: bundle of His, Purkinje fibers, sinoatrial node, AV node sinoatrial node, atrioventricular node, bundle of His, Purkinje fibers Purkinje fibers, bundle of His, AV node, sinoatrial node atrioventricular node, bundle of His, sinoatrial node, Purkinje fibers

sinoatrial node, a

This refers to a circulation that occurs when blood is pumped from the left ventricle of the heart through all parts of the body and returns to the right atrium pulmonary circulation coronary circulation hepatic circulation systemic circulation

sytemic circulation

What do dark or "cold" spots on a thallium scan indicate? tissue with adequate blood supply tissues that have inadequate perfusion dilated vessels areas of neoplastic growth

tissues that inadequate perfusion

the right atrioventricular valve is also known as the ______ valve. Purkinje fibers Tricuspid Bicuspid Mitral

tricuspid

The nurse is teaching about modifiable factors contributing to cardiovascular disease. Which statement by a student nurse indicates the need for further teaching? "Hypertension is a silent killer because it contributes to cardiovascular disease.' "Nicotine reduces the amount of available oxygen, causing cardiovascular disease." "An individual with type D personality has a reduced risk of cardiovascular disease compared with one with type A personality.' "Increase in body mass index (BMl) is indicative of increased risk of cardiovascular disease."

"An individual with type D personality has a reduced risk of cardiovascular disease compared with one with type A personality.' Rationale Psychological factors contribute to cardiovascular disease. Individuals with type A personality are those who are angry irritated, and hostile most of the time, and those with type D personality are pessimistic and socially inhibited. according to research, individuals with type D personality are at higher risk compared with those with type A personality. Hypertension is characterized by high blood pressure, which increases the risk of heart diseases, such as myocardial infarction. Therefore, this statement does not indicate that the nurse needs further teaching. Nicotine releases catecholamines that cause vasoconstriction and decrease available oxygen, increasing the risk of cardiovascular disease. An increase in BMI is indicative of an increase in weight, which increases the risk of diabetes and hypertension, indirectly contributing to cardiovascular disease.

Which statement by the nursing student indicates effective learning regarding the action of antipsychotic medications? "A typical antipsychotic agents block only serotonin receptors." "Typical antipsychotic medications block both serotonin and dopamine receptors." "Antipsychotic medications always stimulate cholinergic neurotransmitter receptors." "Antipsychotic medications stimulate or block alpha-adrenergic neurotransmitter receptors."

"Antipsychotic medications stimulate or block alpha-adrenergic neurotransmitter receptors." Rationale Antipsychotic medications stimulate or block cholinergic, histaminic, nicotinic, alpha-adrenergic, and beta-adrenergic neurotransmitter receptors to varying degrees, accounting for many of the adverse effects of the therapy. Atypical antipsychotic agents block dopamine receptors, but they also block serotonin receptors to varying degrees. Typical antipsychotic medications block only the neurotransmitter dopamine in the central nervous system. Antipsychotic medications can either stimulate or block cholinergic neurotransmitter receptors.

Which question must be answered before a 40-year-old woman can begin statin therapy? "Have you experienced any symptoms of menopause?" "Are you pregnant?" "Is there a family history of breast cancer?" "Have you ever had a blood clot?"

"Are you pregnant?" Rationale Statins are contraindicated for pregnant women; it is critical to determine whether the patient is pregnant before beginning statin therapy. Experiencing symptoms of menopause, a family history of breast cancer, and a history of having a blood clot are irrelevant to statin therapy.

The son of a patient on hospice tells the nurse he is concerned about his father's lack of oral intake. How would the nurse respond? "You should be sure to offer only your father's favorite foods." "It is vital that you encourage the patient to eat enough calories every day." "We can discuss the use of total parenteral nutrition to provide calories for your father." "As life comes to an end, the need for food and drink decreases. Your father will not starve to death."

"As life comes to an end, the need for food and drink decreases. Your father will not starve to death." Rationale The nurse should educate the son that the patient will not starve to death or die of dehydration. Often, forcing the patient to eat or drink can cause more harm than good. Although offering the father's favorite foods may help to some degree, this is not the most helpful statement. Total parenteral nutrition is not often used for patients on hospice.

A nurse is admitting a patient to hospice care and explaining all the benefits that the hospice covers. The spouse asks about bereavement support. Which response by the nurse is the most appropriate response? "We will refer you to a spiritual advisor of your choice." "Support for the family ends after the funeral of the loved one." "Bereavement follow-up care lasts for at least l year after death." "There are certain criteria that have to be met to receive bereavement support."

"Bereavement follow-up care lasts for at least 1 year after death." Rationale The Medicare Hospice Benefit provides for bereavement follow-up care for at least 1 year after the death of the loved one. Bereavement support may involve special bereavement teams with counselors, support groups, and so on. The Medicare Hospice Benefit will provide support for the family beyond the funeral. There are no specific criteria for bereavement care. It usually continues as part of hospice care after the death of the patient.

Which statement by a patient indicates the need for further teaching about the management of hyperlipidemia? "By taking my antilipemic medication, will not need to modify my diet." "It is important to increase how much exercise get.' "It is important for me to learn as much as possible about my medications." "Regular blood tests will indicate if my lifestyle changes and therapy are working to lower my cholesterol."

"By taking my antilipemic medication, will not need to modify my diet." Rationale Dietary changes and taking antilipemic medication are important in managing hyperlipidemia. Medication therapy is not to be used as a substitute for diet. An increase in daily exercise with a goal of 30 minutes of moderate-intensity exercise most days of the week is strongly recommended to help lower cholesterol levels. The patient should be taught, at minimum, to know the names) of the medication he or she is taking, dosage, route, times of administration, and common and serious adverse effects. The patient should have blood studies done regularly to monitor serum levels (eg. lipid profile values, liver studies, bleeding times). This helps track progress, identify the need for modifications in therapeutic interventions, and detect possible adverse effects to the medications.

Which statement by the nurse about a cardiac cycle indicates effective learning? "The cardiac cycle involves diastole and systole, which occurs in 0.l second." "Complete diastole and systole of atria and ventricles make one cardiac cycle." "The heart sounds lub and dub indicate an ineffective closure of the valves." "A murmur is heard during the cardiac cycle when the atrioventricular (AV) valves close."

"Complete diastole and systole of atria and ventricles make one cardiac cycle." Rationale The contraction phase of the cardiac cycle is called systole, and the relaxation phase is called diastole. The complete diastole and systole make one cardiac cycle. This cycle is completed in an average of 0.8 seconds. The heart sounds lub and dub are normal sounds that occur as a result of the closure of the valves. A murmur is heard during the cardiac cycle because of the rapid filling of the ventricles.

Which instruction would the healthcare provider give the patient regarding administering cholestyramine powder packets? Select all that apply. "Do not attempt to swallow the dry powder." "Avoid mixing the powder with soup or juice." "Do not allow the powdered mixture to stand." "Swallow the mixture without gulping air." "Mix the powder with 2to 6 ounces of water or applesauce."

"Do not attempt to swallow the dry powder." "Swallow the mixture without gulping air." "Mix the powder with 2 to 6 ounces of water or applesauce." Rationale Cholestyramine is a bile acid-binding resin that is available in powder packet and tablet forms. The dry powder of cholestyramine should not be swallowed because it may lead to adverse effects such as bloating. The powdered mixture should be swallowed without gulping air to prevent constipation, bloating fullness, nausea, and flatulence. The powder should be mixed with 2to 6ounces of water, applesauce, or crushed pineapple to minimize the medication's objectionable taste. The medication should be mixed with noncarbonated, pulpy juices or sauces to minimize the adverse effects of the medication. The powdered mixture should be allowed to stand for a few minutes to allow absorption or dispersion.

Which instruction is important to give to a patient taking bile acid-sequestering resins? "Limit the intake of whole grains." "Limit the intake of raw fruits and vegetables.' "Increase the intake of water-soluble vitamins." "Drink eight to ten 8-ounce glasses of water daily."

"Drink eight to ten 8-ounce glasses of water daily." Rationale The nurse should encourage a patient taking bile acid-sequestering resins to drink eight to ten 8-ounce glasses of water daily to minimize adverse constipation effects. The nurse should encourage the patient to increase the intake of high-bulk foods such as whole grains, raw fruits, and vegetables to minimize the constipating effects of resins. Patients taking bile acid-sequestering resins require fat-soluble vitamin supplements because these vitamin levels may decrease after long-term resin therapy.

The family of a patient on hospice calls to tell the nurse that the patient is not breathing for 10 to 30 seconds at a time. Which information would the nurse tell the family first? "I will be there as soon as l can to make your loved one more comfortable." "Elevating the head of the patient's bed can provide relief for your loved one." "The periods of apnea signal impending death. You should call your remaining family." "Increase the flow of the patient's oxygen to decrease your loved one's air hunger."

"Elevating the head of the patient's bed can provide relief for your loved one." Rationale The nurse should first tell the family how to make their loved one more comfortable because this is the philosophy of hospice. Then the nurse should plan to visit the family. Also, the nurse should discuss the likelihood of impending death. Increasing the flow of the patient's oxygen may not be helpful to the patient.

Which education is appropriate for a patient with metabolic syndrome who has a laboratory report suggesting elevated low-density-lipoprotein cholesterol levels? Select all that apply. "Exercise for an average of 40 minutes per session." "Jog 4 to 5 miles in 20 to 30 minutes twice per week." "Walk at a rate of4 to 5 miles per hour when exercising." "Exercise twice per week in addition to performing activities of daily living." "Exercise three or four times per week in addition to performing activities of daily living."

"Exercise for an average of 40 minutes per session." "Walk at a rate of4 to 5 miles per hour when exercising." "Walk at a rate of4 to 5 miles per hour when exercising." Rationale Elevated levels of low-density-lipoprotein cholesterol indicate a lipid disorder. Instructing the patient to exercise for an average of 40 minutes per session, three to four times a week, and walking at a rate of4to5 miles per hour when exercising would be beneficial. The patient should be encouraged to jog 4 to 5 miles in 20 to 30 minutes three to four times per week, not twice per week. The patient should exercise three to four times per week, not two.

A patient in hospice who is experiencing anxiety and fear reports nausea and vomiting. Which instruction would be appropriate for this patient? "Eat high-fiber food." "Take medications as prescribed." "Feel free to verbalize your fears." "Avoid eating strong-smelling foods."

"Feel free to verbalize your fears." Rationale In some cases, severe anxiety and fear may cause nausea and vomiting. In such patients, it is important to encourage the patient to verbalize fears This helps in reducing anxiety, which is the cause of vomiting in this case. Eating high-fiber foods is a general suggestion for patients with constipation and does not help reduce nausea and vomiting Encouraging the patient to take medications as prescribed is a general nursing intervention. Avoiding strong-smelling foods is not relevant in the case of vomiting caused by anxiety and fear.

Which instruction does the nurse include when teaching a patient with hyperlipidemia about how to take the powdered form of cholestyramine (Questran)? "Take the drug with a sip of water." "Use a straw to help swallow the drug." "Mix the powder with to 6 ounces of water or juice." "Swallow the dry powder and follow with a full glass of water."

"Mix the powder with to 6 ounces of water or juice." Rationale The powdered form o cholestyramine (Questran) must be mixed with 6 ounces of water, juice, soup, applesauce, or crushed pineapple, and it should be allowed to stand for a few minutes to allow absorption and dispersion before administration. Cholestyramine (Questran) powder should not be taken with a sip of water. Cholestyramine (Questran) does not stain the teeth, so a straw is not needed. The dry powder form of cholestyramine (Questran) should not be swallowed because this could cause the patient to aspirate.

The nurse is caring for a patient who has undergone thallium scanning. Which advice does the nurse give the patient after the procedure? "Drink lots of fluid after the procedure." "Stand slowly from the sitting or lying position." "Resume normal activities after the procedure." "Avoid drinking beverages such as coffee or tea."

"Stand slowly from the sitting or lying position."

A nurse is caring for a patient receiving hospice through the Medicare Hospice Benefit. The patient is concerned about who will be there to comfort her family after she has passed. Which response by the nurse would be appropriate? "I promise will be here to comfort your family when you pass." "I can point your family in the direction of grief support groups and counseling." "Your family members will have to rely on one another for support during that difficult time." "The Medicare Hospice Benefit provides for bereavement counseling for 1 year after you have passed."

"The Medicare Hospice Benefit provides for bereavement counseling for 1 year after you have passed." Rationale The Medicare Hospice Benefit offers bereavement counseling for up to l year after the hospice patient has passed. The nurse should not make promises to the patient. Although the nurse should refer the family to support groups, this is not the most appropriate answer. The nurse should not tell the patient that the family will have only one another to rely on after the patient has passed.

A patient in the terminal stage of breast cancer is admitted to hospice. The family caregiver tells the nurse to reduce the dosage of pain medication because it is making the patient sleepy. Which response is the most appropriate answer by the nurse to the caregiver? "If sleepiness does not lessen after 3 days, the pain medication dose will be adjusted.' "As long as the patient's pain is controlled, the level of sedation should be maintained." "Sleepiness is an indication of the progression of the disease and the patient letting go." "The patient had not slept well because of pain; the patient is resting better with reduced pain."

"The patient had not slept wel because of pain; the patient is resting better with reduced pain." Rationale The patient may be exhausted from not sleeping well while in pain; the medication helps to reduce pain and the patient is now able to sleep. The nurse needs to educate the family about pain medications and their side effects Pain medication dosages are adjusted depending on the pain level. The medication is used to reduce pain and not sedate the patient. Sleepiness in this patient may not be an indication of the progression of the disease or the patient letting go.'

What questions should the nurse ask to assess the psychomotor function of a patient with a mood disorder? Select all that apply. "Do you take regular naps?" "When did you last go to work?" "Do you visit your parents or friends regularly?" "Have you lost weight in recent months?" "Did you brush your teeth this morning?"

"When did you last go to work?" "Do you visit your parents or friends regularly?" "Did you brush your teeth this morning?" Rationale The nurse assesses the psychomotor function to determine the patient's activity level. T assess if the patient is able to work, the nurse asks,"When did you last go to work?" The answer to the question, "Do you visit your parents or friends regularly?" helps the nurse determine the patient's ability to fulfill social responsibilities. To assess if the patient is able to perform activities of daily living the nurse asks, "Did you brush your teeth this morning?" The answer to the question, "Do you take regular naps?" helps the nurse asks the patient's sleep pattern; this question is unrelated to psychomotor functions. Weight loss or gain provides information on the patient's dietary history, not psychomotor function.

The nurse finds a client tensing while lying in bed staring at the cardiac monitor. The client states, "There sure are a lot of wires around there. I sure hope we don't get hit by lightning!" Which is the nurse's best response? "I know about your concerns. Your family can stay with you every night if you want to." "Yes the equipment is a little scary. Can we talk about how the cardiac monitor works?" "Would you like a mild sedative to help you relax?" "Oh don't worry, the weather is supposed to be sunny and clear today."

"Yes the equipment is a little scary. Can we talk about how the cardiac monitor works?"

How soon after treatment with antipsychotic medications is a neuroleptic malignant syndrome (NMS) likely to develop? 24 to 72 hours 3 to 9 days 2 to 3 weeks 3 to 4 years

3 to 9 days Rationale NMS typically occurs after 3 to 9 days of treatment with antipsychotic medications. Once NMS begins, symptoms rapidly progress over 24 to 72 hours. Pseudoparkinsonian symptoms associated with the extrapyramidal symptoms of using antipsychotic medication begin after 2 to 3 weeks of antipsychotic drug therapy. Tardive dyskinesia develops in about 20% to 25% of patients receiving typical antipsychotic medications on a long-term basis (months to years).

Which atypical antipsychotic drug causes moderate levels of extrapyramidal symptoms (EPSs)? Asenapine Aripiprazole loperidone Olanzapine

Asenapine Rationale Asenapine causes moderate levels of EPSs. Aripiprazole iloperidone, and olanzapine cause lower levels of EPSs.

When assessing four patients who are suspected to have metabolic syndrome, which patients would the nurse classify as high risk of developing cardiovascular disease? Select al that apply. A patient with high-density lipid cholesterol level of 25 mg/dL A patient with a triglyceride level of ll0 mg/dL A patient with fasting blood sugar of 70 mg/dL A patient with a blood pressure of 120/80 mm Hg A patient with a waist circumference of 44 inches (1.12 m)

A patient with high-density lipid cholesterol level of 25 mg/dL A patient with a waist circumference of 44 inches (1.12 m) Rationale A patient with a high-density lipid level of 25 mg/dL may have metabolic syndrome; note that the standard lower risk factor defining limit is 40 mg/dL. A patient with a waist circumference of 44 inches (1.12 m) is above the upper-risk factor defining limit of 40 inches (1.02 m); this patient may also have metabolic syndrome. All the other patients' readings are within the normal ranges.

Which patient undergoing vilazodone therapy is at potential risk for gastrointestinal bleeding? A patient who drinks grapefruit juice regularly A patient who underwent general anesthesia A patient undergoing monoamine oxidase inhibitor therapy A patient undergoing nonsteroidal antiinflammatory drug therapy

A patient undergoing nonsteroidal anti-inflammatory drug therapy Rationale Selective serotonin reuptake inhibitors (such as vilazodone) may enhance the anticoagulant effects of nonsteroidal anti-inflammatory drugs and increase the potential for gastrointestinal bleeding. Grapefruit juice inhibits the metabolism of vilazodone, which increases its serum levels and the potential for toxicity. anesthetics enhance the sedative effects associated with vilazodone therapy. Severe reactions such as excitement, diaphoresis rigidity, convulsions, hyperpyrexia, and death may result from the concurrent use of monoamine oxidase inhibitors and vilazodone.

Which patients does the nurse expect to exhibit hallucinatory symptoms associated with psychosis? Select all that apply. A patient who always appears markedly disheveled A patient who withdraws from relationships, work, and self-care A patient who has the sensation of insects crawling under the skin A patient who claims to smell orange blossoms at certain times of the day, every day A patient who believes that the lyrics of a popular song by a celebrity contain a message for the patient

A patient who has the sensation of insects crawling under the skin A patient who claims to smell orange blossoms at certain times of the day, every day Rationale Hallucinations are false sensory perceptions that are experienced without an external stimulus and seem real to the patient. a patient who has the sensation of insects crawling under the skin is experiencing a hallucination of bodily sensations patient who claims to smell orange blossoms at certain times of the day is experiencing hallucinations of smell A patient who always appears markedly disheveled displays disorganized behavior Withdrawal from areas of functioning that affect interpersonal relationships, work, education, and self-care is known as asociality; this condition is associated with negative symptoms of psychosis. a patient who believes that the lyrics of a popular song sung by a celebrity contain a message for the patient exhibits delusions of reference.

While obtaining objective data during the assessment of the cardiovascular system of a patient, which findings would be the cause(s) for concern for a nurse? Select all that apply. A thready pulse is present. Hands and feet are cold to the touch. Edema is absent in the extremities. Veins in the neck are not distended. Capillary refill takes longer than 2 seconds.

A thready pulse is present. Hands and feet are cold to the touch. Caillry refll takes longer than 2 seconds. Rationale Blood loss, decreased cardiac output, aortic valve disease, or peripheral arterial disease can result in a thready pulse. Hands and feet that are cold to the touch may indicate intermittent claudication, peripheral arterial disease, low cardiac output, or severe anemia. capillary refill taking longer than 2 seconds indicates the possibility of reduced arterial capillary perfusion or anemia. The absence of edema in the extremities and lack of distention of the veins in the neck are not causes for concern.

Which class to medication is used to treat postprandial hyperglycemia? Meglitinides Sulfonylureas Calcium channel blockers Alpha-glycosidase inhibitors

Alpha-glycosidase inhibitors Rationale Alpha-glycosidase inhibitors are used to treat postprandial hyperglycemia. Meglitinides and sulfonylureas are used in the treatment of type 2 diabetes; these medications stimulate the beta cells of the pancreas to release more insulin. Calcium channel blockers are used to treat hypertension.

Which class of antidiabetic drugs inhibits alpha-glucosidase and delays glucose absorption? Thiazolidinediones Biguanides Alpha-glycosidase inhibitors Sulfonylureas

Alpha-glycosidase inhibitors Rationale Alpha-glycosidase inhibitors reduce the absorption of glucose from the intestine. Thiazolidinediones treat insulin resistance by reducing insulin resistance in peripheral tissues. Biguanides decrease the production of glucose and increase its uptake. Sulfonylureas stimulate insulin release from beta cells in the pancreas.

The healthcare provider suspects that a patient has hyperglycemia after eating most meals. Which medication could be beneficial for this patient? Sulfonylureas Calcium channel blockers Alpha-glycosidase inhibitors Angiotensin-converting enzyme inhibitors

Alpha-glycosidase inhibitors Rationale Hyperglycemia that occurs after eating is termed postprandial hyperglycemia. Alpha-glycosidase inhibitors reduce the absorption of glucose from the intestine, therefore reducing postprandial hyperglycemia. Sulfonylureas are used to increase the production of insulin to control glucose production. Calcium channel blockers and angiotensin-converting enzyme inhibitors are administered to treat hypertension.

The healthcare provider suspects that a patient has hyperglycemia after eating most meals. Which medication could be beneficial for this patient? Sulfonylureas Calcium channel blockers Alpha-glycosidase inhibitors Angiotensin-converting enzyme inhibitors

Alpha-glycosidase inhibitors- AGIs delay the absorption of carbohydrates from the small intestine and thus have a lowering effect on postprandial blood glucose and insulin levels. Rationale Hyperglycemia that occurs after eating is termed postprandial hyperglycemia.Alpha-glycosidase inhibitors reduce the absorption of glucose from the intestine, therefore reducing postprandial hyperglycemia. Sulfonylureas are used to increase the production of insulin to control glucose production. Calcium channel blockers and angiotensin-converting enzyme inhibitors are administered to treat hypertension.

Which complication can develop as a result of an obstruction in the arteries of the heart? Select all that apply. Stroke Dysrhythmias Angina pectoris Myocardial infarction Deep vein thrombosis

Angina pectoris Myocardial infarction Rationale Angina pectoris and myocardial infarctions are caused by obstruction in the arteries of the heart. Stroke refers to either an obstruction orarupture of blood vessels in the brain resulting in brain death. Dysrhythmias are the result of electronic conduction abnormalities in the heart's conduction system and not associated with obstruction in the arteries. Deep vein thrombosis is a venous disorder.

While reviewing the laboratory reports of a patient, the nurse finds that the electrocardiogram report indicates cardiac dysrhythmia. The patient also has high C-reactive protein and leukocyte counts. What does the nurse expect the health care provider will prescribe? Corticosteroids Oxygen therapy iron supplements Antibiotic therapy

Antibiotic therapy Rationale Rheumatic heart disease is characterized by cardiac dysrhythmia along with elevated C-reactive protein and leukocyte counts. The patient with rheumatic heart disease should be treated with long-term antibiotic therapy. Corticosteroids are administered for pericarditis, not cardiac dysrhythmia. The patient will not have major respiratory problems, so oxygen therapy is not required. iron supplements are not administered to a patient with rheumatic heart disease.

Which type of adverse reaction is occurring in a patient taking amitriptyline and experiencing blurred vision and constipation? Cholinergic effects Akathisia symptoms Anticholinergic effects Tardive dyskinesia symptoms

Anticholinergic effects Rationale Anticholinergic effects include blurred vision; constipation; dryness of the mouth, nose, and throat; and urinary retention. Amitriptyline has the most anticholinergic activity and desipramine the least. Dryness of the mouth may be relieved by sucking hard candy o ice chips or by chewing gum. Stool softeners should be used for constipation. Cholinergic effects include increased heart rate, constipation, urinary retention, and decreased sweating Akathisia symptoms include pacing and inability to oststill Tardive dyskinesia symptoms are random movements in the tongue, lips, or jaw, and facial grimacing; movements of arms, legs fingers, and toes; or even swaying movements of the trunk or hips. The movements disappear during sleep, and they can be mild, moderate, or severe.

Which statement is a major advantage of using selective serotonin reuptake inhibitors (SSRls) over tricyclic antidepressants in the treatment of depression? Anticholinergic or cardiovascular effects do not occur with SSRIs. SSRIs do not have sedative or other central nervous system effects. There are minimal interactive effects with other drugs and SSRIs. There is no lag period before the full therapeutic effect of SSRIs.

Anticholinergic or cardiovascular effects do not occur with SSRIs. Rationale A particular advantage of the SSRIs is that they do not have anticholinergic or cardiovascular side effects that often limit the use of tricyclic antidepressants. SSRls have a sedative effect and may induce restlessness, agitation, anxiety, and insomnia early in therapy. SSRls interact with phenytoin and a variety of other neuroleptic drugs. It takes 2 to 4 weeks to experience the full therapeutic effects ofSSRIs.

A nurse notes a pulsating mass in a patient in whom she was palpating for abdominal tenderness After reporting this finding to the provider, the nurse anticipates the patient will undergo which test? Aortography Angiography Fluoroscopy Abdominal x-ray examination

Aortography- x-ray examination of the body's main artery, the aorta Rationale The patient most likely has an abdominal aortic aneurysm, which is diagnosed with aortography. Angiography, fluoroscopy, and abdominal x-ray examination are not the best tests for diagnosing aneurysms.

The nurse is assessing a patient with superficial vein thrombosis Which finding would the nurse expect in this patient? Presence of edema with pain Tenderness to palpation over the involved vein Appearance of the vein as a palpable cord Induration of the overlying muscle

Appearance of the vein as a palpable cord Rationale In superficial vein thrombosis, the vein appears as a palpable cord. Edema rarely occurs in superficial vein thrombosis. Tenderness to palpation over the involved vein, presence of edema with pain, and induration of overlying muscle are noted in venous thromboembolism.

A nurse caring for a patient in the hospice setting assesses the development of a stage ll pressure ulcer on the patient's sacral area. Which nursing intervention is appropriate? Apply a skin protector. Cleanse the area with hot, soapy water. Apply a wet-to-dry dressing. Provide daily tub baths.

Apply a skin protector. Rationale If pressure ulcers occur, cleaning with normal saline, drying ell, and applying a skin protector are helpful measures. Cleansing with hot, soapy water, application of a wet-to-dry dressing; and daily tub baths are not appropriate interventions for a stage ll pressure ulcer and can lead to infection and/or further skin breakdown.

Which atypical antipsychotic agent causes low sedation in a patient? Asenapine Aripiprazole iloperidone Clozapine

Aripiprazole Rationale Aripiprazole is an atypical antipsychotic that causes low sedation asa drug sid effect. Asenapine and iloperidone are atypical antipsychotics that cause moderate sedation. Clozapine is an atypical antipsychotic that causes high sedation.

Which atypical agents have low levels of extrapyramidal symptoms (EPSs)? Select all that apply. Asenapine Aripiprazole loperidone Clozapine Chlorpromazine

Aripiprazole iloperidone Clozapine Rationale Aripiprazole, iloperidone, and clozapine are all atypical antipsychotics that have low EPSs. Asenapine is an atypical antipsychotic that has moderate EPSs. Chlorpromazine is a typical antipsychotic that has moderate EPSs.

The health care provider has advised synthetic graft surgery to a patient. Which possible patient condition does the nurse infer about the patient from this instruction? Arterial embolism Arterial aneurysm Buerger's disease Raynaud's disease

Arterial aneurysm Rationale An arterial aneurysm is a dilated portion of an artery that exceeds 3 cm. Synthetic graft fiber is used to surgically graf the dilated artery. Arterial embolism refers to clots in the arterial bloodstream. It is treated by endarterectomy using balloon catheters and other instruments. Buerger's disease is an occlusive vascular condition with inflamed arteries; it requires surgical intervention or amputation. Raynaud's disease is caused by intermittent arterial spasms whose possible surgical intervention is sympathectomy.

The nurse is caring for a patient who is terminally ill and finds that the patient is experiencing dyspnea Which nursing interventions should be performed to relieve dyspnea? Select all that apply. Ask the patient to rate the respiratory effort. Monitor the heart rate of the patient regularly. Check for compliance with the medication schedule. Monitor the need for oxygen use by measuring oximetry. Educate the patient on methods to ease respiratory distress.

Ask the patient to rate the respiratory effort. Monitor the need for oxygen use by measuring oximetry. Educate the patient on methods to ease respiratory distress. Rationale Whenever a terminally ill patient reports dyspnea or shortness of breath, it is necessary to ask the patient to rate the respiratory effort on a scale of 0 to 10. It is also important to monitor the respiratory status of the patient. Monitoring the need for oxygen using oximetry helps in determining the amount of oxygen needed per nasal cannula. Educating the patient on methods to ease respiratory distress helps the patient to breathe wl and to improve the respiratory status. Monitoring the heart rate does not help in relieving dyspnea. Checking for compliance with medication is a general intervention performed in all terminally ill patients.

Which interventions should the nurse implement in the plan of care for a patient with heart failure (HF)? Select all that apply. Assess the patient for depression. Auscultate the lung fields frequently. Ask the patient to sleep in the supine position. Elevate the bed as well as the patient's legs. Measure abdominal girth and total body weight.

Assess the patient for depression. Auscultate the lung fields frequently. Elevate the bed as well as the patient's legs. Measure abdominal girth and total body weight. Rationale The patient with HF may experience depression because of the disease. Therefore, the nurse should assess the patient for any signs of depression so that any pharmacologic or psychological interventions can be initiated. The nurse auscultates the patient's lung fields to detect the presence of crackles and wheezes, which helps identify respiratory problems. The nurse elevates the bed to 45 degrees to decrease the patient's oxygen demands. The nurse elevates the patient's legs to prevent edema. An increase in abdominal girth or the patient's total body weight may indicate fluid retention. The patient should not sleep in the supine position. Rather, the patient should sleep in the upright position to decrease oxygen demands.

A nurse notes that the patient on hospice has not had a bowel movement in 7 days. Which action should the nurse do first? Administer a stool softener. Assess the patient's abdomen. Administer a stimulant laxative. Perform a digital rectal examination.

Assess the patients abdomen. Rationale Before the nurse takes any action, the nurse should inspect, auscultate, and palpate the patient's abdomen to determine the presence of peristalsis firmness, tenderness, or distention. The nurse should plan treatment based on the assessment of the patient's abdomen. The nurse should administer a stool softener or a stimulant laxative after assessing the patient's abdomen. An assessment of the patient's abdomen can confirm the need for a digital rectal examination.

A patient has been prescribed trazodone hydrochloride and is being taken off a monoamine oxidase inhibitor (MAOl). How soon can the patient start take the trazodone? Immediately; there is no interaction between these two medications Within 5 days of discontinuing the MAOl Within l0 days of discontinuing the MAOl At least 14 days after discontinuing the MAOl

At least 14 days after discontinuing the MAOl Rationale A period of 14 days (not 5 or 10 days) is the minimum amount of time that should elapse between discontinuing an MAOl and starting trazodone. Severe reactions can occur, including rigidity, convulsions, hyperpyrexia, and death, when these two medications are taken together or when trazodone is taken too soon after discontinuing an MAOl.

The nurse finds that a patient with an intracranial tumor has a pulse rate of 58 beats/min. Which drug does the nurse expect the health care provider to prescribe to the patient? Atropine (Atreza) Digoxin (Lanoxin) Diltiazem (Cardizem) Amiodarone (Cordarone)

Atropine (Atreza) Rationale A pulse rate of 58 beats/min in a patient with an intracranial tumor indicates sinus bradycardia. Atropine (Atreza)is prescribed to the patient to increase the heartbeat. Digoxin (Lanoxin) helps decrease the heart rate and is prescribed in case of supraventricular tachycardia. Diltiazem (Cardizem) is a calcium channel blocker that is prescribed in supraventricular tachycardia. Amiodarone (Cordaron) is an antidysrhythmic prescribed for supraventricular tachycardia to reduce heart rate.

Which nursing assessment is a priority for a patient taking a monoamine oxidase inhibitor (MAOl) and who reports a severe occipital headache, stiff neck, sweating, nausea, and vomiting? White blood cell count Blood pressure Deep tendon reflexes MAOI serum level

Blood pressure Rationale Severe occipital headache, stiff neck, sweating, nausea, and vomiting along with sharply elevated blood pressure are common prodromal symptoms of hypertensive crisis, which is a major potential complication of MAOl therapy. lf a patient taking MAOl experiences these symptoms, blood pressure should be checked immediately. Changes in white blood cells are not seen with the described side effects from MAOls. Assessment of deep tendon reflexes is not indicated by the clinical manifestations expressed by the patient. Measurement of an MAOl serum level is not indicated by these clinical manifestations.

Which criterion meets a general treatment goal for patients with metabolic syndrome? A blood pressure reading of 128/72mmHg Low-density lipoprotein (LDL) level of 104 mg/dL High-density lipoprotein (HDL) level of39 mg/dL Fasting plasma glucose level of 138 mg/dL

Blood pressure reading of 128/72 mm Hg Rationale The blood pressure goal for successful treatment of metabolic syndromeis 130/80 mm Hg, or 125/75 mmHg ifl g/day of proteinuriais present. LDL goals for successul treatment of metabolic syndrome are less than 100 mg/dL (primary goal), or less than 70 mg/dL (alternative goal for patients with cardiovascular disease). HDL goals for successful treatment of metabolic syndrome are 40 mg/dL for men and 50 mg/dL for women. fasting blood glucose goal for successful treatment of metabolic syndrome is 120 mg/dL.

How do statins remove low-density lipoproteins from blood circulation? By inhibiting the enzyme that converts 3-hydroxy-3-methylglutaryl coenzyme A(HMG-CoA) to mevalonate By blocking the absorption of cholesterol from the small intestine By inhibiting very-low-density lipoprotein (VLDL) synthesis by liver cells By blocking the absorption of cholesterol derived from the cholesterol secreted in the bile

By inhibiting the enzyme that converts 3-hydroxy-3-methylglutaryl coenzyme A(HMG-CoA) to mevalonate Rationale Statins, or3-hydroxy-3-methylglutary| coenzyme A(HMG-CoA) reductase enzyme inhibitors inhibit the enzyme that converts HMG-CoA to mevalonate in the biosynthetic pathway. Ezetimibe inhibits the absorption of cholesterol from the small intestine and inhibits the absorption of cholesterol derived from the cholesterol secreted in the bile. Niacin inhibits VLDL synthesis by liver cells.

Which medication would be beneficial for the treatment of hypertension? Select all that apply. Sulfonylureas Fibric acid derivatives Calcium channel blockers Angiotensin receptor blocker 3-Hydroxy-3-methylglutary| coenzyme A(HMG-CoA) reductase inhibitors

Calcium channel blockers Angiotensin receptor blocker Rationale Calcium channel blockers and angiotensin receptor blockers are used to lower blood pressure and reduce hypertension. Sulfonylureas stimulate the beta cells of the pancreas to release more insulin. Fibric acid derivatives and HMG-CoA reductase inhibitors are used to treat dyslipidemia by reducing low-density lipoprotein cholesterol and triglyceride levels.

Which medications would be used to treat a patient with metabolic syndrome who has a blood pressure of 160/90 mm Hg? Select all that apply. Statins Sulfonylureas Thiazolidinediones Calcium channel blockers Angiotensin-converting enzyme inhibitors

Calcium channel blockers Angiotensin-converting enzyme inhibitors Rationale A metabolic syndrome patient with a blood pressure of 160/90 mm Hg has hypertension. Calcium channel blockers and angiotensin-converting enzyme inhibitors should be prescribed to lower blood pressure. Statins are reductase inhibitors that are used in the treatment of dyslipidemia. Sulfonylureas treat diabetes mellitus by increasing insulin release. Thiazolidinediones are used to reduce insulin resistance in peripheral tissues.

A nurse is called to the room of a patient who complains of angina and dizziness. The patient's vital signs are a heart rate of 3 5beats /min and blood pressure of 7 5/56mm Hg. Which action should the nurse perform first? Call the rapid response team. Rub the patient's sternum vigorously. Call the health care provider. Perform 1 2-lead ( ECG).

Call the rapid response team. Rationale The patient is most likely suffering a third-degree heart block but has asymptomatic bradycardia, requiring immediate assessment and intervention. The rapid response team can evaluate and intervene quickly. It is not yet necessary to call the code team or perform a sternal rub because the patient remains conscious. The rapid response team would be a better choice than the health care provider because they can assess and intervene all at once.

A nurse is caring for a 45-year-old patient with atrial fibrillation refractory to medical treatment. The nurse plans to prepare the patient for which procedure? Discharge Stent placement Catheter ablation Removal of Purkinje fibers

Catheter ablation Rationale Catheter ablation is used to destroy the muscle fibers that are firing erroneously in the heart to return the patient to a normal sinus rhythm. The patient is not yet ready for discharge Stent placement and removal of Purkinje fibers are inappropriate for this patient.

The nurse is caring for a patient who has undergone aortography. Which intervention provided by the nurse after the procedure is best? Check whether the patient has an allergy from the dye. Ensure that the compression device is properly placed. Check the site of catheter insertion in the groin area. Ensure that the patient is in the side-lying position.

Check the site of catheter insertion in the groin area. Rationale Aortography refers to the x-ray visualization of the abdominal aorta and the major leg arteries after a contrast media is injected through a catheter. The nurse should check the site of catheter insertion in the groin area for bleeding. If excess bleeding takes place, then it is necessary to inform the health care provider. The nurse should ensure that the patient is not allergic to the dye prior to conducting the procedure, not after. The nurse should ensure that the compression device is properly placed; however, this can be done after checking the catheter device. The nurse should ensure that the patient is in the supine position, not the side-lying position. The side-lying position may cause pressure at the catheter site.

Which drug is a typical antipsychotic agent? Asenapine Lurasidone Aripiprazole Chlorpromazine

Chlorpromazine Rationale Chlorpromazine is a typical antipsychotic agent. Asenapine, lurasidone, and aripiprazole are atypical antipsychotic agents.

Which antipsychotic medication is most suitable for a patient who is very agitated and may cause self-harm unless kept sedated? Perphenazine Loxapine Fluphenazine Chlorpromazine

Chlorpromazine Rationale Chlorpromazine has a high sedative effect and should be prescribed to the patient. Perphenazine and fluphenazine have a much lower sedative effect. The sedative effect of loxapine is moderate.

Which drug is a low-potency antipsychotic drug? Trifluoperazine Haloperidol Fluphenazine Chlorpromazine

Chlorpromazine Rationale Chlorpromazine is a low-potency antipsychotic drug. Trifluoperazine, haloperidol, and fluphenazine are high-potency antipsychotic drugs.

Which medication has received U.S. Food and Drug Administration (FDA) approval for reducing blood glucose and glycosylated hemoglobin (A 1l) in adult patients with type 2 diabetes? Cholestyramine (Questran) Colesevelam (Welchol) Colestipol (Colestid) Cyclosporine (Restasis)

Colesevelam (Welchol) Rationale Colesevelam (Welchol) is an FDA-approved drug for reducing blood glucose and A 1cin adult patients with type 2 diabetes. It may be used alone or in combination with metformin (Glucophage) sulfonylureas, or insulin. Cholestyramine (Questran), colestipol (Colestid), and cyclosporine Restasis) do not reduce blood glucose.

Which antilipemic agent blocks the enterohepatic recirculation of amiodarone (Cordarone)? Niacin Gemfibrozil Lopid) Colestipol (Colestid) Fenofibrate (Tricor)

Colestipol (Colestid) Rationale Colestipol ( Colestid)is a bile acid -bindingresin that blocks the enterohepatic recirculation of amiodarone ( Cordarone).Niacin causes myopathy when coupled with hydroxy methylglutaryl coenzyme A reductase inhibitors . Gemfibrozil ( Lopid) and fenofibrate Tricor)are fabric acids that enhance the pharmacologic effects of warfarin (Coumadin).

Which action would the nurse take when a patient taking phenelzine is also prescribed meperidine? Contact the healthcare provider for another analgesic. Have the patient take the last dose of phenelzine before 6 PM. Ask the patient to avoid foods containing indirect sympathomimetic amines. Consult the healthcare provider to prescribe a stool softener.

Contact the healthcare provider for another analgesic. Rationale Concurrent use of meperidine(a narcotic analgesic) and monoamine oxidase inhibitors such as phenelzine may cause hyperpyrexia restlessness hypertension, hypotension, convulsions and coma. Thus the nurse would contact the healthcare provider for another analgesic. Morphine may be used to control pain instead of meperidine. The last dose of phenelzine may be administered before 6 PM to minimize insomnia, but this intervention is unrelated to the concurrent use of meperidine and phenelzine. Foods such as overripe bananas are rich in indirect sympathomimetic amines. Such foods may pose arisk for a hypertensive crisis in the patient taking tranylcypromine in particular. Constipation is a common side effect of monoamine oxidase inhibitor drugs. Stool softener can alleviate the condition, but this intervention is unrelated to the concurrent use of meperidine and phenelzine.

Which action would the nurse take for a patient after l0 days on an antipsychotic medication for schizophrenia who has no reduction in hallucinations observed? Continue with the current therapy. Change the medication prescribed. Combine the current medication with lorazepam. Increase the dosage of the medication until the therapeutic effect is observed.

Continue with the current therapy. Rationale The full therapeutic effect of antipsychotics typically takes at least 6 to 8 weeks to occur. Thus the healthcare provider would not change the patient's medication after l0 days. Combined therapy with benzodiazepines like lorazepam and antipsychotic medications allows lower dosages of the antipsychotic medication to be used. This reduces the risk of serious adverse effects but has no effect on reducing the antipsychotic response time. Rapid increases in the dosing of antipsychotic medications will not reduce the antipsychotic response time, and it may, in fact, increase the risk of adverse effects.

The nurse reviewing the electrocardiography (ECG)reports of a patient finds abnormality in the P wave. Which improper action of the heart does the nurse infer from these findings? Relaxation of the atria Contraction of the atria Relaxation of the ventricles Contraction of the ventricles

Contraction of the atria Rationale ECG is a graphic study of the electrical activities of the myocardium. P wave represents the depolarization of the atria, which is the electrical activity when the heart contracts. Therefore, an abnormality in the P wave is indicative of improper contraction in the atria. P wave does not indicate atrial repolarization. Atrial repolarization is not represented in ECG reports. Relaxation of the ventricles is represented by a T wave. QRS complex represents a contraction of the ventricles.

To provide effective hospice care, the nurse needs to have an understanding ofthe goals of hospice care. Which statement appropriately addresses the goals of hospice care? Select all that apply. Control and alleviate the patient's symptoms. Terminate all activities except those that provide pain relief. Encourage the patient and caregiver to live life to the fullest. Allow the patient and caregiver to be involved in the decisions regarding the plan of care. Provide support only when the patient and family request it to help achieve the goals of the plan of care.

Control and alleviate the patient's symptoms. Allow the patient and caregiver to be involved in the decisions regarding the plan of care. Encourage the patient and caregiver to live life to the fullest. Rationale The goals of hospice are to control and alleviate the patient's symptoms, encourage the patient and caregiver to live life to the fullest, and allow the patient and caregiver to be involved in the decisions regarding the plan of care. Patients on hospice care may continue to have chemotherapy or radiation if that is what the patient desires. Hospice care provides continuous support to maintain patient and family confidences and reassurances to achieve these goals.

A patient with insulin resistance has prescribed a thiazolidinedione. Which other condition can be prevented with this prescription? O Central obesity O Rheumatoid arthritis Coronary artery disease Postprandial hyperglycemia

Coronary artery disease Rationale Insulin resistance may cause diabetes mellitus, which induces atherosclerosis and results in cardiovascular disease. Thiazolidinedione medication is prescribed to treat insulin resistance and therefore reduce the risk of cardiovascular diseases such as coronary artery disease. Central obesity and rheumatoid arthritis cannot be treated with thiazolidinedione medications. Postprandial hyperglycemia can be treated with sulfonylureas or metformin.

Which term is the milder form of bipolar illness? Mania Euphoria Dysthymia Cyclothymia

Cyclothymia Rationale Cyclothymia is a mild form of bipolar illness. Its symptoms are episodes of depression and hypomania; note that these symptoms are not severe enough to meet the full criteria for bipolar disorder. Elation is characteristic of mania, and distinct episodes of mania are seen in bipolar disorder. A heightened mood (euphoria) is a symptom of acute mania. Dysthymia is a unipolar disorder in which the patient suffers from chronic, ongoing symptoms of depression that last for at least 2 years.

A nurse is supervising care of a patient receiving hospice care from a hospice aide. The nurse would instruct the aide to report which signs of impending skin impairment? Petechiae Erythema Diaphoresis Dryness

Erythema Rationale Erythema that does not blanch with pressure is a sign of impending skin impairment. Petechiae area sign of bleeding. Diaphoresis and dryness should be reported but are not necessarily signs of impending skin impairment.

Which drug interacts with simvastatin (Zocor) to increase the incidence of myopathy? Rifampin (Rifadin) Diltiazem (Cardizem) Propranolol (Inderal) Cimetidine (Tagamet)

Diltiazem (Cardizem) Rationale When taken concurrently with diltiazem (Cardizem) simvastatin (Zocor) increases the incidence of myopathy. Rifampin (Rifadin) and propranolol (Inderl will lower the levels of simvastatin (Zocor) Cimetidine (Tagamet) will cause an increase of simvastatin (Zocor) levels if these drugs are taken together.

Which clinical characteristic supports the diagnosis of deep vein thrombosis? Rupture of blood vessels in the brain Formation of atherosclerotic plaques Disorder of the blood vessels in the arms and legs Abnormality in the electrical conduction pathways of the heart

Disorder of the blood vessels in the arms and legs Rationale Deep vein thrombosis is a disorder of the blood vessels in the arms and legs A rupture of blood vessels in the brain is called a stroke. The formation of atherosclerotic plaques is a clinical characteristic of atherosclerotic cardiovascular disease. Dysrhythmias are abnormalities in the electrical conduction pathways of the heart.

Which antidepressant therapy can cause a metallic taste? Lithium Vilazodone Trazodone Vortioxetine

Lithium Rationale Lithium is a monovalent cation that may cause a metallic taste as a rare adverse effect. Vilazodone adverse effects include diarrhea, nausea, and vomiting. Trazodone is a triazolopyridine antidepressant that may cause orthostatic hypotension. Vortioxetine antagonizes serotonin receptors and may cause abnormal dreams.

Which instruction does the nurse give to a patient beginning lovastatin (Mevacor) therapy? < Do not drink grapefruit juice. Use an over-the-counter (OTC) pain reliever as needed for muscle aches. Take the medication at lunchtime when possible. Return for weekly liver function tests.

Do not drink grapefruit juice. Rationale Grapefruit juice inhibits the metabolism of lovastatin (Mevaco) increasing its plasma concentration and increasing the risk of myopathy. lfsigns of myopathy such as muscle aches, soreness, and weakness occur, they must be reported immediately. Muscle aches are a symptom of myopathy and should not be treated with OTC pain relievers Lovastatin (Mevacor) must be taken with food, but itis besttaken at night, which is the peak production time for cholesterol. Ongoing liver function tests are necessary but not needed weekly.

A nurse is preparing to administer digitalis to a patient with dysrhythmia. The nurse auscultates the patient's apical pulse and finds that it is 65 beats/min. Which action by the nurse is best? Request an increased dose. Document apical pulse, and administer medication. Hold the medication, and notify the provider of apical pulse reading. Administer the medication, and notify the provider of apical pulse reading.

Document apical pulse, and administer medication. Rationale The nurse should determine that the patient's apical pulse is greater than 60 beats/min before administering each dose. The nurse should document the apical pulse reading and administer the medication. The nurse does not need to request an increased dose, hold the medication, or notify the provider.

A nurse is interpreting electrocardiography (ECG) findings in a patient on the telemetry floor. The ECG shows the following characteristics: heart rate of 85 beats/min, P wave before every QRS complex, and occurrence of each complex at a regular interval. Which action would the nurse perform first? Call the provider. Document the findings. Obtain a full set of vital signs. Prepare the patient for cardioversion.

Document the findings. Rationale The patient's ECG shows a regular heart rate and rhythm. The nurse should document the findings. It is not necessary to call the provider, obtain vital signs, or prepare the patient for cardioversion.

Which information is included in the selection ofan antipsychotic medication? O High-potency drugs are used for acute problems; low-potency drugs are used for chronic problems. The drug selected depends on the expected duration o pharmacologic therapy. Typical antipsychotic drugs are used when the cause of the problem relates to dopamine; atypical antipsychotics are used when it relates to serotonin. Drug selection is based primarily on adverse effects to be avoided.

Drug selection is based primarily on adverse effects to be avoided. Rationale All antipsychotic drugs are equal in efcacy when used in equipotent doses, although some unpredictable variation between patients can occur. As a result, the selection of medication should be based on the need to avoid certain adverse effects that have an effect on concurrent medical or psychiatric disorders. Low and high potency refers only to the milligram doses used for medications and does not suggest any difference in effectiveness or use. The expected duration of therapy is neither a basic guide to drug selection nor the cause of the problem, which is most often not clearly understood. Al antipsychotic agents are similar in that they act by blocking the action of dopamine in the brain. Atypical antipsychotic agents also block serotonin receptors They are all equal in efficacy when used in equipotent doses. The selection of a drug is based on a different factor.

Which information is included in the selection of an antipsychotic medication? O High-potency drugs are used for acute problems; low-potency drugs are used for chronic problems. The drug selected depends on the expected duration of pharmacologic therapy. Typical antipsychotic drugs are used when the cause of the problem relates to dopamine; atypical antipsychotics are used when it relates to serotonin. Drug selection is based primarily on adverse effects to be avoided.

Drug selection is based primarily on adverse effects to be avoided. Rationale All antipsychotic drugs are equal in efficacy when used in equipotent doses, although some unpredictable variation between patients can occur. As a result, the selection of medication should be based on the need to avoid certain adverse effects that have an effect on concurrent medical or psychiatric disorders. Low and high potency refers only to the milligram doses used for medications and does not suggest any difference in effectiveness or use. The expected duration of therapy is neither a basic guide to drug selection nor the cause of the problem, which is most often not clearly understood. All antipsychotic agents are similar in that they act by blocking the action of dopamine in the brain. Atypical antipsychotic agents also block serotonin receptors. They are all equal in efficacy when used in equipotent doses. The selection of a drug is based on a different factor.

A patient is prescribed doxepin. At which time does the nurse instruct the patient to take doxepin? With the morning meal At breakfast and lunch to decrease insomnia One hour before or 2 hours after a meal to increase absorption During the evening hours

During the evening hours Rationale Doxepin should be taken in the evening because increased sedation is a known side effect of this medication, especially during the onset of therapy. Doxepin causes increased sedation and should not be taken at the beginning of the day. Doxepin does not cause insomnia. Taking doxepin with meals does not affect its absorption.

Which assessment tool specifically describes the type of tardive dyskinesia and allows diagnoses to change over time? Clinical Global Impression (CGl) Brief Psychiatric Rating Scale (BPRS) Abnormal Involuntary Movement Scale (AIMS) Dyskinesia Identification System: Condensed User Scale (DISCUS)

Dyskinesia Identifcation System: Condensed User Scale (DISCUS) Rationale The DISCUS evaluation specifically describes the type of tardive dyskinesia and allows diagnoses to change over time. The CGl and BPRS are used for baseline clinical evaluation. The AlMS rates dyskinetic movements, but it is not exclusively diagnostic for tardive dyskinesia.

A healthcare provider prescribes a3-hydroxy-3-methylglutary| coenzyme A(HMG-CoA) reductase inhibitor to a patient with elevated low-density-lipoprotein cholesterol levels. Which condition would the nurse expect? Dyslipidemia Hypertension Abdominal obesity Type 2 diabetes mellitus

Dyslipidemia Rationale Statins, or HMG-CoA reductase inhibitors, are used to treat dyslipidemia. They are prescribed to lower triglyceride and low-density-lipoprotein cholesterol levels and to raise the high-density-lipoprotein cholesterol levels Hypertension is treated with thiazide diuretics, angiotensin-converting enzyme inhibitors, calcium channel blockers, or angiotensin receptor blockers. Abdominal obesity is controlled by reducing the patient's weight and body mass index. Type 2 diabetes mellitus is treated by prescribing thiazolidinediones, alpha-glycosidase inhibitors, and sulfonylureas

A nurse sees the telemetry monitor of a patient change from a heart rate of 85 beats/min with regular rhythm to a heart rate of 250 beats/min that still maintains a regular rhythm. The nurse hurries to the patient's room and expects the patient to exhibit which symptom(s)? Select all that apply. Dyspnea Hypertension Hyperthermia Complains of chest pain Report of heart palpitations

Dyspnea Complains of chest pain Report of heart palpitations Rationale The patient is experiencing supraventricular tachycardia and is likely to have dyspnea, chest pain, and heart palpitations. The patient may not necessarily have hypertension or hyperthermia.

Which cardiovascular disease involves abnormalities in the electrical conduction pathways of the heart? Stroke Dysrhythmias Hypertension Myocardial infarction

Dysrhythmias Rationale Dysrhythmias involve abnormalities in the electrical conduction pathways of the heart, which lead to inefficient pumping of blood through the circulatory system. Stroke refers to either an obstruction or a rupture of blood vessels in the brain. Hypertension is an increase in blood pressure. Myocardial infarctions are caused by narrowing or obstruction of the arteries of the heart.

Which instructions would a nurse give to encourage a patient on chemotherapy reporting nausea? Select all that apply. Eat slowly. Eat sweets. Drink fluids. Verbalize fears. Relax after eating.

Eat slowly. Drink fluids. Verbalize fears. Relax after eating. Rationale Nausea is a possible side effect of chemotherapy and can result from any obstructions, tumor, uncontrolled pain, constipation, and even the smell of food. The nurse should encourage the patient to eat slowly to control nausea. The nurse should encourage the patient to drink liquids to avoid dehydration. anxiety and fear are causes of nausea and vomiting verbalizing fears is helpful. The nurse should ask the patient to relax after eating to prevent nausea. Sweet, greasy, spicy, or strong-smelling foods should be avoided in a patient with nausea,

A student nurse is caring for a patient who has thrombophlebitis. Which intervention by the student nurse indicates the need for additional teaching? Apply warm, moist heat to the extremity. Elevate the affected extremity using a pillow. Administer warfarin (Coumadin) to the patient. Put an anti-embolism stocking on the unaffected extremity.

Elevate the affected extremity using a pillow. Rationale Thrombophlebitis refers to vein inflammation in conjunction with the formation of thrombus It is necessary to elevate the extremity to allow proper perfusion, but pillows should not be used because this may cause pain in the calf. Applying warm, moist heat to the extremity would provide comfort to the patient. Warfarin (Coumadin) is an anticoagulant and can be administered to the patient. An anti-embolism stocking would help prevent clots in the unaffected extremities.

A patient is having trouble with nausea and vomiting after chemotherapy. Which nursing intervention is most appropriate? Instruct the patient to avoid taking any antiemetics unless necessary. Instruct the patient to avoid taking any pain medication when nauseated. Encourage the patient to eat and drink even if nauseated to prevent dehydration and malnutrition. Encourage the patient to eat slowly in a pleasant atmosphere, with relaxation and rest periods after eating.

Encourage the patient to eat slowly in a pleasant atmosphere, with relaxation and rest periods after eating. Rationale A good way to control nausea is to eat slowly and in a pleasant atmosphere, with relaxation and rest periods after eating. Antiemetics need to be taken routinely as prescribed. Ineffective pain control is often the reason for nausea and vomiting. The patient should take pain medications routinely. A patient should never be forced to eat or drink if there is no desire to; this response may compromise the dignity of the patient.

The nurse at the hospice center is caring for a terminal patient. Which psychosocial intervention by the nurse provides support to the patient and family? Encouraging reminiscence Explanation of the impending loss Avoiding discussion about spirituality Refraining from discussing physical signs of death

Encouraging reminiscence Rationale The nurse should encourage reminiscence for both the patient and family to provide the ability to attain perspective and enhance meaning. The nurse should not try to explain the impending loss to the family; it may not be acceptable. The nurse should promote spirituality as well if the patient and family are receptive and should teach the family about the physical signs of death.

Which nursing action is most appropriate when a patient with mania becomes aggressive? Evaluating the coherency of the patient's thoughts Ensuring the availability of another staff member in the vicinity Checking for the presence or absence of tremors in the patient identifying the areas where a patient is capable of providing input to set goals and make decisions

Ensuring the availability of another staff member in the vicinity Rationale The nurse should plan to approach a patient in the manic phase in a quiet, safe environment. The nurse should also ensure that other staff members are available in case the patient has become aggressive or threatens either self-harm or injury to others. The nurse evaluates the coherency of the patient's thoughts and identifies the areas in which the patient is capable of providing input to set goals and make decisions after securing the availability of another staff member. The presence or absence of tremors in the patient is assessed to determine the patient's psychomotor function.

A nurse is caring for an older woman with cardiac disease. How does the older cardiac patient differ from the younger cardiac patient? The cardiac output tends to be increased in older adults. The younger adult tends to have a more extensive network of collateral circulation compared with the older adult. Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity. Dyspnea is a typical symptom of myocardial infarction in the younger adult, whereas angina is the more common symptom in the older adult.

Even with lower doses of medications, the olderadult should be observed for signs and symptoms of toxicity. Rationale Even with lower doses of medications, the older adult should be observed for signs and symptoms of toxicity because the rate of drug metabolism and excretion decreases with age. The older adult should be encouraged to maintain regular contact with his or her health care provider and to seek care at the first sign of problems. The cardiac output tends to be decreased in older adult because of changes in cardiac musculature and reduced efficiency and strength. Progressive coronary artery changes can lead to the development of collateral coronary circulation. The older adult tends to have a more extensive network of collateral circulation compared with the younger adult. Angina is a typical symptom ofa myocardial infarction in the younger adult, whereas dyspnea may be a more common symptom in the older adult because the severity of signs and symptoms may be modifed by the development of collateral circulation.

Which actions are the nursing interventions to be performed for pain control in a terminally ill patient Select all that apply? Explain the measures to control pain. Monitor for side effects of medications. Evaluate the cause of pain in the patient. Ask the patient to rate the pain on a scale of O to 10. Suggest that the patient and caregiver keep a pain diary.

Explain the measures to control pain. Monitor for side effects of medications. Ask the patient to rate the pain on a scale of 0 to 10. Suggest that the patient and caregiver keep a pain diary. Rationale The nurse explains various techniques of controlling pain, which include repositioning methods, heat and cold treatments, and transcutaneous electric nerve stimulation. Pain management includes drug therapy, and hence it is important to monitor for side effects of the medication prescribed. It is also important to ask the patient to rate the pain because this informs about the intensity of pain. Nursing interventions to control the pain also include suggesting that the patient and the caregiver keep a pain diary. This helps the nurse understand the status of pain in the patient. It is the responsibility of the health care provider to evaluate the cause of the pain.

Which risk does the nurse expect for a patient in hospice who is administered prochlorperazine (Compazine)? Anxiety and fear Low blood pressure Increased heart rate Extrapyramidal side effects

Extrapyramidal side effects Rationale Prochlorperazine (Compazine) is an antiemetic. Prochlorperazine (Compazine) causes extrapyramidal side effects, such as acute dystonic reactions, pseudo parkinsonism, or akathisia. It can cause dry mouth in the patient and induce depression in the patient. Anxiety is not a side effect of prochlorperazine (Compazine). However, it I a side effect associated with antidepressants. Hypotension and tachycardia are side effects of droperidol (lnapsine), another antiemetic medication

Which antilipemic agent acts by blocking the absorption of cholesterol from the small intestine? Niacin Omega-3 fatty acids Ezetimibe (Zetia) Simvastatin (Zocor)

Ezetimibe (Zetia) Rationale Ezetimibe (Zetia) is an antilipemic agent that blocks the absorption of cholesterol from the small intestine. Niacin inhibits very-low-density lipoprotein synthesis by the live cells, resulting in a decrease in low-density lipoprotein and triglyceride production. Omega-3 fatty acids are used to reduce synthesis of triglycerides in the liver. Simvastatin (Zocor) is a statin that acts by inhibiting the enzyme that converts hydroxymethylglutaryl coenzyme A to mevalonate, which subsequently limits cholesterol synthesis in the liver.

Which abnormal parameter would lead a nurse to suspect a patient to be at a higher risk of developing diabetes? Triglycerides Blood pressure Fasting blood glucose High-density lipoprotein cholesterol

Fasting blood glucose Rationale Any increase above the risk factor defining limit for fasting blood glucose, 120 mg/dL, may indicate hyperglycemia. An abnormally high triglyceride level mayindicatealipid disorder. Elevated blood pressure may indicate hypertension. Decreased levels of high-density lipoprotein cholesterol may indicate a lipid disorder such as dyslipidemia.

Which clinical findings support the suspicion of metabolic syndrome in a patient? Select all that apply. Triglyceride level of 145 mg/dL Fasting glucose level of 105 mg/dL The blood pressure level of 130/85 mm Hg A waist circumference of 38 inches (0.97 m) High-density lipoprotein cholesterol level of55 mg/dL

Fasting glucose level of 105 mg/dL Waist circumference of 38 inches (0.97 m) Rationale Patients who have central obesity and are at or beyond at least two of the risk factor defining limits are considered to have metabolic syndrome. According to the National Cholesterol Education Program, the fasting glucose level of 105 mg/dL is beyond the upper risk factor defining limit of 100 mg/dL, which is similar in both men and women. A waist circumference of38 inches is greater than the risk factor defining limit of 35 inches (0.89 m) in women. Because these two values are abnormal, the patient is considered to have metabolic syndrome. The patient's triglyceride, blood pressure, and high-density lipoprotein levels are considered normal.

Which supplemental vitamins may be required for patients taking bile acid-sequestering resins? Water-soluble vitamins Al B vitamins Fat-soluble vitamins Vitamins C,B6, and B 12

Fat-soluble vitamins Rationale Absorption offat-soluble vitamins may be decreased in long-term therapy with bile acid-sequestering resins. Therefore, patients taking this medication may need supplemental vitamins Water-soluble vitamins all B vitamins, and vitamin Care not affected by bile acid-sequestering resins.

Which conditions are the serious adverse effects of fabric acids? Select all that apply. Fatigue Malaise Bloating Anorexia Flatulence

Fatigue Malaise Anorexia Rationale Fatigue, malaise, and anorexia are serious adverse effects of fibric acids. These disorders are early symptoms of gallbladder disease and hepatotoxicity. Bloating and flatulence are common adverse effects of fibric acids.

When reviewing dietary instructions with a patient diagnosed with metabolic syndrome, which food would the nurse encourage the patient to consume in greater amounts? Cheese Potatoes Pork Fish

Fish Rationale Fish is high in omega-3 fatty acids, which helps increase high-density lipoprotein levels and reduce triglyceride lels. Cheese should belimited because itis high in saturated fats. Potatoes are simple carbohydrates that may increase blood glucose levels. Pork is higherin saturated fats and should belimited.

Which diagnostic test allows observation of real-time movement via radiography? Fluoroscopy Angiography Echocardiography Cardiac monitoring

Fluoroscopy Rationale Fluoroscopy is the diagnostic test that allows observation of real-time movement via radiography. This is invaluable for the placement of pacemakers and intracardial catheter placement. Angiography is a series of radiographs taken after administration of contrast dye. This test aids in the diagnosis of vessel occlusion, pooling in various heart chambers, and congenital abnormalities. Echocardiography uses high-frequency ultrasound directed at the heart. The refected sound is recorded outlining the size, shape, and position of cardiac structures. This is useful in detecting pericardial effusion and evaluating ventricular function, cardiac chamber size and contents, ventricular muscle and septal motion and thickness, cardiac output, cardiac tumors, valvular function, and congenital heart disorders. Cardiac monitoring records the cardiac electrical activity of patients. A cardiac monitor displays information transferred via the conductive electrodes, which transfer electrical activity of the heart and relay it to a video display screen. This is useful for patients with known or suspected arrhythmias or patients who may be likely to develop arrhythmias.

The nurse is reviewing the medical report of a 16-year-old patient suffering from congenital heart disease and major depressive disorder. Which medication does the nurse anticipate finding on the medication list of a patient who has congenital heart disease and major depressive disorder? Fluoxetine Paroxetine Phenelzine Tranylcypromine

Fluoxetine Rationale Fluoxetine is a selective serotonin reuptake inhibitor (SSR). This class of drugs does not have adverse cardiovascular effects. In addition, fluoxetine has been approved for use in treating depression in children and adolescents. Paroxetine, a type of SSR,is not recommended for patients younger than 18 years. Fluoxetine is the only SSRI approved for use in treating depression in children and adolescents. Both phenelzine and tranylcypromine are monoamine oxidase inhibitors that can develop side effects related to the cardiovascular system.

Which first-generation antipsychotic drug is available as an elixir? Loxapine Haloperidol Fluphenazine Prochlorperazine

Fluphenazine Rationale Fluphenazine is available as an elixir Loxapineis available only in capsule form. Haloperidol is available in the form of tablets, concentrates, and injections. Prochlorperazine is available as tablets, injections, and suppositories.

Which points should the nurse discuss with a patient who was admitted for the treatment of acute depression before discharging the patient from the psychiatry unit? Select all that apply. Follow-up plan Desired treatment outcome Enhancement of coping skills Availability of group activities Possible emergence of anxiety

Follow-up plan Desired treatment outcome Rationale The entire follow-up plan (including frequency of therapy sessions prescribed medications, physician visits, and return-to-work goals should be explained to the patient or the patient's family before discharge from the psychiatry unit. The nurse must also ensure that the patient and the family understand the desired outcome of the therapy. The discussions of the enhancement of coping skills, availability of group activities, and the possible emergence of anxieties would be discussed during the patient's stay at the hospital.

Which behaviors will a nurse expect to observe in a patient with psychosis who displays an extreme form of disorganized thinking? Select all that apply. Garbled or unrecognizable speech Unpredictable, non-triggered agitation Overly concrete and inexpressive speech Decreased ability to experience pleasure from positive stimuli Obliquely related or completely unrelated answers to questions

Garbled or unrecognizable speech Overly concrete and inexpressive speech Obliquely related or completely unrelated answers to questions Rationale Disorganized thinking is associated with the incoherence of thought that can extend into pronunciation itself, and the speaker's words become garbled or unrecognizable. People displaying disorganized thinking may have overly concrete and inexpressive speech and may answer questions in such a way that the answers are either obliquely related or completely unrelated. Unpredictable, non-triggered agitation is associated with disorganized behavior, which is another common characteristic of psychosis. Anhedonia (decreased ability to experience pleasure from positive stimuli is associated with negative symptoms (or changes in affect) that may also be symptoms of psychosis.

Which statement is the best description of drug interactions with fibric acids? Resins bind to fibric acids and enhance absorption. Fibric acids reduce the pharmacologic effects of warfarin (Coumadin). Gemfibrozil (Lopid) enhances the pharmacologic effects of insulin. Fibric acids, when added to an hydroxy methylglutaryl coenzyme A reductase inhibitors regimen, reduce the risk of myopathy.

Gemfbrozil (Lopid) enhances the pharmacologic effects ofinsulin. Rationale Gemfibrozil (Lopid), when taken concurrently with insulin, enhances the pharmacologic effects of insulin. Resins bind to fibric acids and reduce absorption. Fibric acids enhance the pharmacologic effects of warfarin (Coumadin) When they are coupled with hydroxy methylglutaryl coenzyme A reductase inhibitors, fibric acids increase the risk of myopathy.

What is the risk factor defining limit for triglycerides in men and women? Less than 40 mg/dL Greater than 40 mg/dL Greater than 100 mg/dL Greater than 150 mg/dL

Greater than 150 mg/dL Rationale The risk factor defining limit for triglycerides i 150 mg/dl in both men and women lt i a standard limit and one of the characteristics of metabolic syndrome as defined by the National Cholesterol Education Program. The lowest high-density lipoprotein cholesterol limit is 40 mg/dl in men and 50 mg/dl in women. The upper-risk factor defining limit for fasting glucose level in men and women is 100 mg/dL.

The nurse instructs a patient to take a monoamine oxidase inhibitor (MAOl) to avoid which food? Orange juice Egg salad sandwiches ice cream Grilled cheese sandwiches

Grilled cheese sandwiches Rationale Patients taking MAOls should avoid tyramine-rich foods, such as cheese, because they may cause a hypertensive crisis. Orange juice and milk products, such as ice cream, have not been shown to affect MAOIs. Patients should not be concerned about eating eggs while taking MAOls.

Which nonphenothiazine antipsychotic medication has a low hypotensive effect? Thiothixene Thioridazine Loxapine Haloperidol

Haloperidol Rationale Haloperidol is a nonphenothiazine antipsychotic medication that has a very low hypotensive effect. Thiothixene does have alow hypotensive effect; however, it is a thioxanthene. Thioridazine is neither a nonphenothiazine nor does it have a very low hypotensive effect. Loxapine is a nonphenothiazine that produces a moderate hypotensive effect.

A nurse is called to the room of a patient who appears dyspneic and who complains of palpitations. The nurse requests 12-lead electrocardiography (ECG), which shows supraventricular tachycardia (SVT) Which action would the nurse perform first? Administer adenosine. Have the patient bear down. Prepare the patient for cardioversion. Sit with the patient until the heart rate slows.

Have the patient bear down. Rationale The nurse should first have the patient bear down in an attempt to shift the patient out of SVT because this is the least invasive treatment option. If unsuccessful, the nurse should alert the health care provider, who may prescribe the necessary drugs, such as adenosine. Cardioversion can be done either with medications or electrically The patient requires some sort of intervention, so simpy sitting with the patient would not be appropriate.

A family member of a patient at the hospice center tells the nurse that the patient has been seeing and talking to people not visible to others. Which explanation does the nurse give the family member about what the patient is doing? Hallucinating Experiencing a drug reaction Having vision-like experiences Preparing to "let go" from relationships

Having vision-like experiences Rationale The patient who is nearing death often has vision-like experiences. Such patients often have visions of people or things that do not exist. The patient is not hallucinating having a drug reaction or preparing to "let go' from relationships.

A patient with metabolic syndrome is prescribed metformin. Laboratory findings that show an increased level of which component supports this prescription? Select all that apply. Hemoglobin A1c Fasting plasma glucose Postprandial plasma glucose Low-density lipoprotein White blood cell

Hemoglobin A1c Fasting plasma glucose Postprandial plasma glucose Rationale Increased hemoglobin 1c, fasting plasma glucose, and postprandial plasma glucose levels indicate diabetes mellitus. Any increase in these factors implies the presence of metabolic syndrome. Metformin decreases the production of glucose by the liver. Increased low-density lipoprotein cholesterol levels can be controlled by administering calcium channel blockers or statins, but not metformin. Increased white blood cells indicate infection but not diabetes mellitus.

In women, which clinical indicator suggests a decreased risk for cardiovascular disease? A waist circumference of 37 inches (0.94m) A waist circumference of 38 inches (0.97m) A high-density lipid cholesterol level of 55 mg/dL A high-density lipid cholesterol level of 30 mg/dL

High-density lipid cholesterol level of 55 mg/dL Rationale For metabolic syndrome, the risk factor defining limit for high-density lipoprotein cholesterol level is 40 mg/dL in men and 50 mg/dl in women. Therefore a high-density cholesterol level of55 mg/dL denotes a finding consistent with a reduced risk for cardiovascular disease. A waist circumference of less than 35 inches (0.89 m)indicates a decreased risk of cardiovascular disease.

A family member of a patient who is in a coma asks the nurse about information regarding a do-not-resuscitate (DNR)order. Which prior awareness is important for the nurse to answer the family member's query? Consent of the family Patient's spiritual beliefs Patient's medical condition Hospital policies and procedures

Hospital policies and procedures Rationale Patients who are terminally ill and are nearing death may opt for a do-not-resuscitate (DNR) order. DNR is a legal order according to which the patient wishes not to be given life support when he or she has cardiac or respiratory arrest. While providing information regarding this order, nurses should be aware of the hospital's policies and procedures. This helps them to addess any questions and concerns properly. Consent of the family is obtained after completely explaining a DNR. Awareness of the patient's spiritual beliefs is important while giving emotional support to the patient. Prior knowledge about hospital policies is more important than patients' medical conditions while explaining the order.

When evaluating a patient with metabolic syndrome 6 months after diagnosis, the nurse observes that the patient achieved a 15-pound (6.8 kg) weight reduction. Which condition would the nurse expect to be improved in this patient? Dyslipidemia Hyperglycemia Pulmonary disease Hypertriglyceridemia

Hyperglycemia Rationale Being overweight and maintaining a sedentary lifestyle are predisposing factors for metabolic syndrome. A weight loss of l0 to l5 pounds (4.5 to 6.8kg) helps control hyperglycemia by reducing blood plasma glucose levels. Dyslipidemia can be improved by reducing low-density lipoprotein cholesterol. Pulmonary disease can be alleviated by quitting or reducing cigarette smoking. Hypertriglyceridemia can be reduced by controlling triglyceride levels.

In evaluating risk factors for cardiovascular disease, which risk factor does the nurse identify as modifiable? Age Active lifestyle Hyperlipidemia Family history of cardiovascular disease

Hyperlipidemia- abnormally high concentration of fats or lipids in the blood. Rationale Hyperlipidemiaisa modifiable risk factor for cardiovascular disease. The ratio of high-density lipoproteins (HDLs) to low-density lipoproteins (LDLs) is the best predictor for cardiovascular disease. A diet high in saturated fat, calories, and cholesterol contributes to hyperlipidemia. Dietary control is an important factor in modifying the risk factor. Advanced age is a risk factor for cardiovascular disease; however, t is a nonmodifiable risk factor. An inactive lifestyle is a modifiable risk factor for cardiovascular disease. Regular exercise can improve the heart's efficiency, lower blood glucose levels lower blood pressure, help the patient to reduce weight, reduce stress improve the ratio of HDLs to LDLs, and improve overall feelings of well-being. Family history of cardiovascular disease is a risk factor for cardiovascular disease; however, it is a non modifiable risk factor.

When monitoring a patient who began lithium therapy 3 weeks ago to treat bipolar disorder, which signs and symptoms potentially indicate serious adverse effects? Select all that apply. Hyperreflexia Excessive thirst Profuse diarrhea Gastric irritation Lethargy and weakness

Hyperreflexia Profuse diarrhea Lethargy and weakness Rationale Hyperreflexia, profuse diarrhea and lethargy, and weakness are serious adverse effects of lithium therapy that indicate impending toxicity. Excessive thirst is a common, mild adverse effect that generally resolves over time. Gastric irritation is a common adverse effect that can be addressed by taking the drug with food or milk.

When is the best time for a patient to take gemfibrozil (Lopid)? Any time during the day Only before breakfast With food at the evening meal In two divided doses 30 minutes before AM and PM meals

In two divided doses 30 minutes before AM and PM meals Rationale Gemfibrozil (Lopid) a fbric acid, should be administered in two divided doses: one dose before the morning meal and the other before the evening meal. Statins such as atorvastatin (Lipitor) pravastatin Pravachol), and rosuvastatin (Crestor) can be taken any time. Lovastatin (Mevacor) should be taken with food at the evening meal.

A patient has a critically low serum calcium ion concentration. The nurse knows this imbalance must be fixed to prevent which complication? Fluid imbalance The inability of the heart muscle to contract Overexcitability of the neuromuscular junction The inability of hearing muscle to relax between beats

Inability of heart muscle to contract Rationale Appropriate serum calcium ion concentration is necessary for the cardiac muscle to contract. Sodium helps prevent fluid imbalance. Magnesium prevents the overexcitability of the neuromuscularjunction. Potassium is necessary to allow the heart muscle to relax between beats.

Which action can the patient take colesevelam (Welchol do to relieve constipation and bloating? Take the medication with an antacid. Take the medication with meals. Increase fluid and fiber intake. Increase the amount of exercise.

Increase fluid and fber intake. Rationale Increasing fluid and fiber intake will help decrease constipation and bloating from colesevelam (Welchol). Antacids are not indicated for constipation and bloating. Colesevelam (Welchol) should be taken with meals; however, this does not affect constipation and bloating caused by colesevelam (Welchol). Increased exercise will not affect constipation and bloating caused by colesevelam (Welchol).

Which action can the patient taking colesevelam (Welchol) do to relieve constipation and bloating? Take the medication with an antacid. Take the medication with meals. Increase fluid and fiber intake. Increase the amount of exercise.

Increase fuid and fiber intake. Rationale Increasing fluid and fiber intake will help decrease constipation and bloating from colesevelam (Welchl). Antacids are not indicated for constipation and bloating. Colesevelam (Welchol) should be taken with meals; however, this does not affect constipation and bloating caused by colesevelam (Welchol). Increased exercise will not affect constipation and bloating caused by colesevelam (Welchol).

Which outcome is the focus of drug treatment for dyslipidemia? Decrease insulin resistance to lipids, enabling them to be used by the cells Decrease high-density lipoproteins (HDLs) and increase low-density lipoproteins (LDLs) Increase production of insulin by the beta cells in the pancreas Increase the level of HDLs and lower the level of LDLs in the body

Increase the level of HDLs and lower the level of LDLs in the body Rationale Drug treatment for dyslipidemia is generally to lower triglycerides and LDL cholesterol and raise HDL cholesterol. Drug treatment ofdyslipidemia does not focus on insulin resistance, decreasing HDLs and increasing LDLs, orincreasing the production ofinsulin.

Which activities are important to aid in improving cardiovascular function? Select all that apply. Increasing physical activity Decreasing high-density lipoprotein (HDL levels Maintaining daily maximum caloric levels based on height, weight, and gender Maintaining body weight in adults within a body mass index (BMI) range of 18 to 25 kg/m2 Reducing job-related stress

Increasing physical activity Maintaining daily maximum caloric levels based on height, weight, and gender Maintaining body weight in adults within a body mass index (BMI) range of 18 to 25 kg/m2 Reducing job-related stress Rationale Physical activity improves circulation, increases HDL levels, and burns calories. Daily maximum caloric intake of food should be based on height, weight, and gender for four different levels of physical activity: sedentary, low active, active, and very active. A BMl range of l8to 25 kg/m 2is considered to be a healthy BMl for adults. A study demonstrated that patients with job-related stress had a twofold increase in their risk of recurrent unstable angina and myocardial infarction. Reducing stress can reduce this risk, thereby improving cardiovascular function. To improve cardiovascular function, HDL levels should increase, not decrease.

The hospice nurse knows that constipation is a problem in terminally ill patients. When opioids are initiated to treat pain, which intervention may be recommended to prevent constipation in the terminally ill patient? Reminder to increase fluids Encouragement to eat a diet high in fiber Encouragement to get daily exercise Initiation of a stool softener and stimulant

Initiation of a stool softener and stimulant Rationale Prevention of constipation is important; the initiation of a stool softener and stimulant will help counteract the side effect of an opioid. Often, terminally ill patients have nausea and vomiting, decreasing the ability to increase fluids or eat, which contributes to constipation. Tmialall patients are generally weak and are unable to exercise, contributing to constipation.

Which nursing interventions should be performed for a patient with skin impairment? Select all that apply. Inspect the patient's skin frequently. Moisturize the patient's skin frequently. Teach the basics of skincare to the patient Stress the need to avoid harsh soaps and detergents. Assist in personal hygiene and bathing of the patient.

Inspect the patient's skin frequently Teach the basics of skincare to the patient Stress the need to avoid harsh soaps and detergents. Assist in personal hygiene and bathing of the patient. Rationale Increased weakness, poor nutrition, and decreased mobility increase the risk of skin impairment. The nurse should inspect the patient's skin frequently to prevent the risk of increased skin impairment. The patient should be taught about the basics of skincare to decrease the risk of skin damage. Harsh soaps and detergents can cause skin irritation and thus should be avoided. The nurse should assist the patient with personal care, hygiene, and bathing. The patient 'should be kept as dry as possible. Frequent use of moisturizers may cause skin damage.

A patient admitted to hospice experiences severe pain. The patientis prescribed fentanyl (Duragesic) transdermal patch for pain relief. Which intervention is the best to be performed while using this drug? Check for control of nausea in the patient. Encourage the patient to drink more fluids such as water and juices. Instruct the patient to rise slowly from the sitting or reclining position. Instruct the patient to wash the skin only with water once the patch is applied.

Instruct the patient to wash the skin only with water once the patch is applied. Rationale A fentanyl (Duragesic) transdermal patch is an opioid given to relieve moderate to severe pains. The best nursing intervention is to instruct the patient to wash the skin only with water once the patch is applied. Washing the area of the patch with soap or any other solution may be of the patch. It is not relevant to check for control o nausea in the patient because this is a transdermal patch and does not cause nausea. Patients are encouraged to drink more fluids while taking drugs that cause constipation, diarrhea, or dehydration. It is not necessary to advise the patient to rise slowly from a sitting position because the drug does not cause drowsiness or hypotension.

Which disorder currently rank as the leading cause of disease burden in the United States? Bipolar disorder Major depression Ischemic heart disease Endocrine abnormalities

Ischemic heart disease Rationale Ischemic heart disease is the leading cause of disease burden (years lived with the disability) in the United States. About 0.4 % to l.6 % of the adult population in the United States suffers from bipolar disorder. Major depression currently ranks as the second leading cause of disease burden. About 45% to 60% of patients with depression suffer from endocrine abnormalities.

Which disorder currently ranks as the leading cause of disease burden in the United States? Bipolar disorder Major depression Ischemic heart disease Endocrine abnormalities

Ischemic heart disease Rationale lschemic heart disease is the leading cause of disease burden (years lived with the disability in the United States. About 0.4% to 1.6% of the adult population in the United States suffers from bipolar disorder. Major depression currently ranks as the second leading cause of disease burden.About 45% to 60% of patients with depression suffer from endocrine abnormalities.

When the patient is diagnosed with an obstruction of a blood vessel in the brain, which outcome would the nurse expect? Ischemic stroke Hemorrhagic stroke Coronary artery disease Atherosclerotic cardiovascular disease

Ischemic stroke Rationale An ischemic stroke occurs because of the obstruction of blood vessels in the brain. A hemorrhagic stroke is a rupture of blood vessels in the brain. Coronary artery disease occurs as a result of the narrowing or obstruction of the arteries in the heart. Atherosclerotic cardiovascular disease refers to the narrowing of arteries caused by atherosclerotic plaques.

Which statement precisely differentiates between isoniazid and iproniazid? Isoniazid cannot inhibit monoamine oxidase, whereas iproniazid can. Isoniazid has antitubercular properties that iproniazid does not have . Isoniazid is available as tablets, whereas iproniazid is available as a transdermal patch. Isoniazid is most effective for atypical depression, whereas iproniazid is approved for treatment of major depressive disorder .

Isoniazid cannot inhibit monoamine oxidase, whereas iproniazid can. Rationale Isoniazid cannot inhibit the enzyme monoamine oxidase; however, iproniazid can inhibit the enzyme.Both isoniazid and iproniazid can tuberculosis .The monoamine oxidase inhibitor with the generic name isocarboxazid is available as tablets, whereas selegiline is available as a transdermal patch. Isocarboxazid is most effective for atypical depression, whereas selegiline is approved for the treatment of the major depressive disorder.

Which statement precisely describes moderate depression? It causes minor functional impairment. It significantly impairs daily functioning. It affects both symptomatology and functionality. It causes several symptoms that exceed the minimum diagnostic criteria.

It affects both symptomatology and functionality. Rationale Patients with moderate depression have an intermediate degree of impairment. This impairment affects both symptomatology and functionality. Mild depression causes minor functional impairment. Patients with severe depression often require hospitalization because their ability to manage daily functions is significantly impaired. Such patients also have several symptoms that exceed the minimum diagnostic criteria.

Which statement precisely describes moderate depression? It causes minor functional impairment. It significantly impairs daily functioning. It affects both symptomatology and functionality. It causes several symptoms that exceed the minimum diagnostic criteria.

It affects both symptomatology and functionality. Rationale Patients with moderate depression have an intermediate degree of impairment. This impairment affects both symptomatology and functionality. Mild depression causes minor functional impairment. Patients with severe depression often require hospitalization because their ability to manage daily functions is significantly impaired. Such patients also have several symptoms that exceed the minimum diagnostic criteria.

Which statement best describes unipolar disorder? Select all that apply. It begins during the late 20s. Mania is a distinguishing feature of unipolar disease. Unipolar depression has only one level of depression. Unipolar disorder is manifested by varying degrees of depression. Dysthymia is a form of unipolar depression.

It begins during the late 20s. Unipolar disorder is manifested by varying degrees of depression. Dysthymia is a form of unipolar depression. Rationale The onset of a depressive disorder tends to occur during the late 20s, although it can occur at any age. Unipolar disorders (such as major depressive disorder MDD] and dysthymia) are characterized by varying degrees of depression. MDD and dysthymia are known as unipolar disorders, manifested by varying degrees of depression. Mania is a symptom of bipolar disorder.

Why would a nurse plan a stimulating activity during the day for a patient with mania? It helps the patient sleep during the night. It provides a new environment for the patient. It helps limit the patient's interaction with other patients. It provides an opportunity for the patient to express feelings.

It helps the patient sleep during the night. Rationale A manic patient can possibly miss several nights of sleep, which can be life-threatening. Thus the nurse may plan activities for the patient during the day to stimulate the individual and promote sleep at night. An accepting environment focuses on the patient's strengths and minimizes weaknesses. This may help the patient identify his or her strengths. Because manic patients may harm others, the nurse may want to limit the interactions of a manic patient with other patients. Stimulating activity may not help achieve this goal. Active listening and therapeutic communication techniques (not a stimulating activity) may provide an opportunity for the patient to express his or her feelings.

Which statement regarding the effectiveness of electroconvulsive therapy for depression and bipolar illness is correct? It minimizes the rate of relapse. It prevents recurrences of mood disorders. It is safer for patients with cardiovascular disease. It is more effective in preventing the symptoms of mania than those of depression.

It is safer for patients with cardiovascular disease. Rationale Electroconvulsive therapy is a form of nonpharmacologic treatment for depression and bipolar illness that is more effective and safer for patients with cardiovascular disease than many drug therapies. After electroconvulsive therapy, drug therapy is done to minimize the rate of relapse. The aim of maintenance therapy (not electroconvulsive therapy is to prevent recurrences of the mood disorder. Lithium is more effective in preventing the signs and symptoms of mania than those of depression.

Which statements regarding angina pectoris are true? Select all that apply. It occurs only at rest. It may appear as jaw pain. It is usually relieved by nitroglycerin. It may resemble heartburn or indigestion. It indicates a lack of oxygen and blood supply to the heart.

It may appear as jaw pain. It is usually relieved by nitroglycerin. It may resemble heartburn or indigestion. It indicates a lack of oxygen and blood supply to the heart. Rationale Patients may not have the "lassic" symptom of chest pain, especially older adults and women. Although the pain from angina is typically substernal chest pain, it may be present in different ways. It may radiate to the chest, arm, or jaw. Angina may appear as posterior thoracic or jaw pain only. Angina is usually relieved by nitroglycerin. Angina can be differentiated from a myocardial infarction (M) in that pain resulting from Ml is generally not relieved by nitroglycerin. The patient should be instructed to take a nitroglycerin tablet and lie down when experiencing an anginal attack. If the pain is not relieved, the patient may take two more nitroglycerin tablets, 5 minutes apart. If the pain still unrelieved after the third nitroglycerin tablet, the patient needs to seek emergency medical attention. Angina may resemble heartburn or indigestion in some patients. Angina typically occurs with an increased cardiac workload (e.g, exercise, heavy meal, cold stress) and may disappear at rest and/or with the administration of nitroglycerin. Angina indicates a lack of oxygen and blood supply to the coronary arteries, usually as a result of a narrowing of the lumen. When the myocardial oxygen demand exceeds the available supply, ischemia occurs, resulting in chest pain or angina.

Which statement describes the function of the left atrium of the heart? It receives oxygenated blood through the pulmonary veins. It receives oxygenated blood through the pulmonary artery. It receives deoxygenated blood through the superior vena cava. It receives deoxygenated blood through the inferior vena cava.

It receives oxygenated blood through the pulmonary veins Rationale The left atrium is the upper left chamber of the heart, which receives oxygenated blood through the pulmonary veins. Pulmonary arteries carry deoxygenated blood from the right ventricle to the lungs. The superior vena cava brings deoxygenated blood to the right atrium. The lower left chamber is also known as the left ventricle. It receives oxygenated blood from the left atrium. The inferior vena cava returns deoxygenated blood to the right atrium.

Which conditions are the serious adverse effects of niacin in patients with hyperlipidemia? Select all that apply. Jaundice Anorexia Dizziness Faintness Hypotension

Jaundice Anorexia Rationale Jaundice and anorexia are serious adverse effects of niacin. Dizziness, faintness, and hypotension are common cardiovascular adverse effects of niacin.

The nurse is caring for a patient after vein ligation surgery. Which nursing intervention is important for this patient? Ask the patient to avoid deep breathing. Keep the patient's legs elevated at l5 degrees. Report any bruising and discoloration. Maintain elastic compression stocking at all times.

Keep the patient's legs elevated at 15 degrees. Rationale After vein ligation surgery, the nurse should ensure that the patient keeps his or her legs elevated at 15 degrees to reduce edema. The patient should be encouraged to breathe deeply to promote venous return. Some bruising and discoloration are normal. Elastic compression stockings should be removed every 8 hours for short periods and reapplied.

For a patient with metabolic syndrome, which level should be the ongoing goal for the body mass index ( BMI)during the first year of treatment? Less than 25kg /m2 Less than 30kg /m2 Greater than 35kg /m2 Greater than 40kg /m2

Less than 25 kg /m2 Rationale The initial therapeutic goal for BMI in a metabolic patient should be less than 2 5kg /m2, as this implies normal weight. A body mass index ranging from 2 5to 3 0kg /m2 implies that the patient is overweight. A body mass index ranging from 3 5to 4 0kg /m2 denotes obesity, class II. A body mass index of 4 0kg /indicates obesity, class Ill.

What is the risk factor defining limit for high-density lipoprotein cholesterol in women? Less than 50 mg/dL Less than 150 mg/dL Greater than 40 mg/dL Greater than 50 mg/dL

Less than 50 mg/dL Rationale According to the National Cholesterol Education Program, the risk factor defining limit for high-density lipoprotein cholesterol is less than 50 mg/dl in women. The risk factor defining limit for high-density lipoprotein cholesterol is less than 40 mg/dl in men. The plasma glucose level should be less than 100in men and women. The risk factor defining limit for triglycerides is greater than l50 in women and men.

what is the most critical approach to the treatment of metabolic syndrome?

Lifestyle management

A nurse caring for a patient with cancer knows that which specific prognosis regarding death is necessary for the patient to be admitted into a hospice? Imminent Likely within the next year Likely within the next 30 days Likely within the next 6 months

Likely within the next 6 months Rationale Patients with a prognosis of less than 6 months to live are eligible for admission into hospice. A prognosis of greater than 6 months does not qualify the patient for admission into hospice.

The nurse is advising a patient about necessary precautions to reduce hypertension. Which patient action indicates the need for further teaching? Limiting sodium intake to 2.4g per day Limiting alcohol intake to 1 ounce of ethanol per day Stopping smoking to decrease the risk of heart disease Limiting potassium-rich fruits and vegetables in the diet

Limiting potassium-rich fruits and vegetables in the diet Rationale Potassium-rich food should be included in the diet because potassium helps decrease blood pressure. High sodium intake increases blood pressure, so it should be limited to 2.4g per day. Excess alcohol intake contributes to hypertension, so it should be limited to ounce of ethanol per day. Cigarette smoking is a major risk factor for hypertension and increases susceptibility to heart disease.

A patient is receiving treatment for malignant hypertension. Which nonpharmacologic interventions will benefit this patient? Select all that apply. Reducing exercise Losing excess weight Reducing saturated fat Reducing sodium intake Consuming potassium-rich foods

Losing excess weight Reducing saturated fat Reducing sodium intake Consuming potassium-rich foods Rationale Malignant hypertension is a severe elevation of blood pressure. Obesity is associated with increased blood pressure, and therefore, the patient needs to lose excess weight. The patient's fat intake should be less than 30% of total calories to normalize blood lipid levels. Sodium increases blood pressure, so it should be reduced in the diet. Potassium-rich foods help to decrease blood pressure and combat hypertension. The patient should exercise regularly for 30 to 45 minutes to decrease the risk for hypertension and cardiovascular disease.

The nurse is collecting data from a patient with lower extremity peripheral artery disease (PAD). Which symptom would the nurse find in the patient? Presence of peripheral pulses Presence of edema in the lower leg Heaviness in the calf or thigh Loss of hair on legs, feet, and toes

Loss of hair on legs, feet, and toes Rationale Patients with lower extremity PAD experience loss of hair on the legs, feet, and toes. Peripheral pulses are absent, and lower leg edema is absent unless the leg is constantly in a dependent position. Patients with venous disease experience lower leg edema and heaviness in the calf or thigh.

A patient on antilipemic medication therapy is diagnosed with rhabdomyolysis. Which medication is responsible for patient developing rhabdomyolysis? Omega-3 fatty acids Lovastatin Colesevelam Cholestyramine

Lovastatin Rationale Rhabdomyolysis is a serious condition that results in kidney damage from progressing myopathy. Statins such as lovastatin result in rhabdomyolysis. Omega- fatty acids, colesevelam, and cholestyramine are bile acid- binding resins that do not cause rhabdomyolysis.

Which statement is true regarding omega-3 fatty acids? Lovaza reduces platelet aggregation and tightness in the chest. Lovaza should be used with caution in patients who are allergic to fish. Lovaza is less effective compared with niacin when combined with statins. Lovaza acts by blocking the absorption of cholesterol from the small intestine.

Lovaza should be used with caution in patients who are allergic to fish. Rationale Lovaza is a combination product of two omega-3 fatty acids such as eicosapentaenoic acid and docosahexaenoic acid. These are referred to as fish oils because higher concentrations of these fatty acids are found in fish. Lovaza should be used with caution in patients who are allergic to fish. Lovaza does not reduce platelet aggregation and can cause tightness in the chest. Lovaza is more effective than the use of niacin combined with statins because Lovaza does not cause myositis or rhabdomyolysis. Ezetimibe (Zetia) acts by blocking the absorption of cholesterol from the small intestine.

In assessing the patient diagnosed with metabolic syndrome, which patient data needs improvement? Blood pressure of 128/72 mm Hg Low-density lipoprotein (LDL level of 104 mg/dL High-density lipoprotein (HDL) level of 35 mg/dL Postprandial plasma glucose level of168 mg/dL

Low-density lipoprotein (LDL level of 104 mg/dL Rationale The LDL goal for the treatment of metabolic syndrome is less than 100 mg/dL(or less than 70 mg/dL for patients with cardiovascular disease). The blood pressure goal for the treatment of metabolic syndrome is 130/80mm Hg, or 125/75 mm Hgifl g/day of proteinuria is present. The HDL goal for treatment of metabolic syndrome is 40 mg/dL for men and 50 mg/dL for women. The postprandial plasma glucose goal for the treatment of metabolic syndrome is 180 mg/dL.

Which type of lipoprotein is the primary target of cholesterol-lowering therapy? Chylomicrons Low-density lipoproteins (LDLs) High-density lipoproteins (HDLs) Very-low-density lipoproteins (VLDLs)

Low-density lipoproteins (LDLs) Rationale LDLs are the primary targets of cholesterol-lowering therapy because they are the major contributors to atherosclerosis. Chylomicrons, which consist of90% triglycerides and 5% cholesterol, are not the target of cholesterol-lowering therapy. HDLs are referred to as good lipoproteins because they remove cholesterol from vascular tissues. VLDLs consists of 15% to 20% of total serum cholesterol and most of the total blood triglyceride concentration; they are not the targets of cholesterol-lowering therapy.

For the patient diagnosed with metabolic syndrome, which instructions given to the patient would assist in the treatment of the condition? Select all that apply. Maintain a hemoglobin A lc of less than 7%. Maintain a blood pressure of less than 130/80 mm Hg. Maintain fasting plasma glucose of less than 130 mg/dL. Maintain postprandial plasma glucose of less than 180 mg/dL. Maintain postprandial plasma glucose of less than 220 mg/dL.

Maintain a hemoglobin A lc of less than 7%. Maintain blood pressure of less than 130/80 mm Hg. Maintain postprandial plasma glucose of less than 180 mg/dL. Rationale Metabolic syndrome includes a group of diseases (such as hypertension, diabetes Mellitus, and hyperlipidemia) that may increase the risk of heart disease. Maintaining blood pressure levels, lipid level, and blood glucose levels within the desirable range may control this disorder. Maintaining a hemoglobin A lc of less than 7%is one of the blood glucose goals necessary to ward off metabolic syndrome. To reduce the risk of metabolic syndrome, the patient's blood pressure should be less than 130/80 mm Hg, and his or her postprandial plasma glucose level should be less than 180 mg/dL.A patient with metabolic syndrome should maintain fasting plasma glucose of less than 100 mg/dL.

What second-generation antipsychotic agent is available as extended-release tablets? Lurasidone loperidone Ziprasidone Quetiapine

Quetiapine Rationale Quetiapine is available as extended-release tablets. Lurasidone and iloperidone are also available as tablets, but notextended-release tablets. Ziprasidone is available in capsule and injection forms.

Which functions would the nurse coordinator perform for a patient in hospice? Select all that apply. Manage the patient's care. Provide spiritual support to the patient. Assign the primary team for the patient. Evaluate the psychosocial needs of the patient. Assist with counseling in grief issues of the patient.

Manage the patient's care. Assign the primary team for the patient. Rationale The interdisciplinary team in hospice is a multi-professional health team whose members work together caring for a terminally ill patient. The interdisciplinary team members are the medical director, the nurse coordinator, the social worker, and the spiritual coordinator. The nurse coordinator's responsibility is to manage the patient's scare and to explain the service to the patient. The nurse coordinator admits the patient into hospice and assigns the primary team to take care of the patient. The spiritual coordinator's responsibility is to coordinate and provide spiritual support to the patient. The social worker's responsibility is to evaluate the psychosocial needs of the patient and to assist with counseling in the grief issues of the patient.

The hospice nurse knows to plan care based on which philosophy? Curing the patient's acute disease Maximizing the quality of the patient's remaining life Returning the patient to a previous level of functioning Making the patient's death as quick and painless as possible

Maximizing the quality of the patient's remaining life Rationale Hospice care is focused on maximizing the quality and dignity of the patient's remaining life in the presence of terminal disease. Acute care is concerned with curing the patient. Rehabilitation care focuses on returning the patient to a previous level of functioning. Hastening the patient's death s illegal.

A patient is admitted with type 2 diabetes mellitus, and the nurse finds that the patient has inadequate insulin secretion. Which medications would help treat this patient? Select all that apply. Meglitinides Sulfonylureas Thiazolidinediones Fibric acid derivatives Alpha-glycosidase inhibitors

Meglitinides Sulfonylureas Rationale Meglitinides and sulfonylureas treat type 2 Diabetes Mellitus by stimulating the beta cells of the pancreas to release insulin. Thiazolidinediones are administered to reduce insulin resistance in the peripheral tissues. Fabric acid derivatives are used to control plasma triglyceride levels Alpha-glycosidase inhibitors are used to reduce glucose absorption.

Which intervention would the nurse expect to do when caring for a patient on warfarin therapy while taking a selective serotonin reuptake inhibitor(SSRI)? Recommend that the patient discontinue warfarin for weeks. Monitor the patient closely for bradycardia and hypotension. Monitor prothrombin time and international normalized ratio. Advise the patient to be cautious while performing the tasks that require alertness.

Monitor prothrombin time and international normalized ratio. Rationale SSRIs such as fluoxetine, paroxetine, sertraline, citalopram, and fluvoxamine may enhance the anticoagulant effects of warfarin. The nurse should monitor prothrombin time and an international normalized ratio 5-week stop interval is recommended between discontinuing fluoxetine and starting monoamine oxidase inhibitors. The nurse should monitor the patient closely for bradycardia and hypotension if the patient is concurrently using fluvoxamine and citalopram. During SSRl therapy, the nurse should advise the patient to be cautious while performing tasks that require alertness.

Which nursing action is appropriate for a patient undergoing bupropion therapy in combination with nicotine replacement products to help with smoking cessation? Increase the dose of bupropion. Alert the patient that blurred vision may occur. Send the blood sample for a liver function test. Monitor the patient's blood pressure regularly.

Monitor the patient's blood pressure regularly. Rationale Coadministration of nicotine replacement products with bupropion may cause hypertension. Thus the nurse should monitor the patient's blood pressure on a regular basis. Cigarette smoking enhances the metabolism of tricyclic antidepressants, not bupropion. Before initiating selective serotonin reuptake inhibitor therapy, the nurse should check the patient's hepatic studies. This intervention is not required for bupropion therapy. if the patient undergoes monoamine oxidase inhibitor therapy, then the nurse should caution the patient that blurred vision may occur as a side effect.

A nurse is caring for a patient with a new pacemaker. Nursing care for this patient would include which of the following? Bed rest for 24 hours Scheduling of a magnetic resonance imaging (MRl) to verify pacemaker placement Monitoring the heart rate and rhythm by assessing apical pulse and electrocardiogram (ECG) ptterns Performing range-of-motion exercises every 4 hours to the arm on the pacemaker side for the first 2 days

Monitoring the heart rate and rhythm by assessing apical pulse and electrocardiogram (ECG) ptterns Rationale Nursing care for a patient with a new pacemaker would include closely monitoring the heart rate and rhythm by assessing apical pulse and ECG patterns Also, vital signs and level of consciousness are checked frequently. The insertion site is observed for erythema, edema, and tenderness, which could be signs of infection. Bed rest for 24 hours is not necessary for a patient with a new pacemaker. Nursing care for a patient with a new pacemaker would include bed rest for the first few hours only unless unexpected complications occurred. Scheduling of MRl to verify pacemaker placement would be inappropriate. The patient must avoid proximity to high-output generators and to large magnets, such as in MRl scanners. Performing range-of-motion exercises every 4 hours to the arm on the pacemaker side would be inapproprite. The arm on the pacemaker side should be immobilized for the first few hours, and the patient should not raise the arm above the head for several days. After this time, normal activities can be resumed.

Which is defined as a sustained emotional feeling perceived along a normal continuum of sad to happy that affects the patient's perception of the surroundings? Mood Mania Dysthymia Depression

Mood Rationale A mood is a sustained emotional feeling perceived along a normal continuum of sad to happy that affects our perception of our surroundings. Mania is an abnormally elated mental state characterized by feelings of euphoria, racing thoughts, talkativeness, and irritability. A patient with chronic, ongoing symptoms of depression that last for at least 2 years is said to be suffering from dysthymia. Patients with depression display varying degrees of emotional, physical, cognitive, and psychomotor symptoms.

which are the signs and symptoms of approaching death? Increase consciousness Mottled extremities Significant increase in urine output Alteration in rhythmic respiration Increased restlessness

Motted extremeties increased restlessness alterations in rythmic respiration

Which guidelines stress the importance of educating the public about and preventing metabolic syndrome? Academy of Sciences MyPlate Food Guide The American Heart Association National Heart, Blood, and Lung Institute

MyPlate Food Guide Rationale The MyPlate Food Guide organization provides guidelines about the importance of educating the public about and preventing metabolic syndrome. The Academy of Sciences stresses the importance of balancing a healthy diet with physical activity to improve circulation, increase high-density lipoprotein cholesterol levels, and burn calories. The American Heart Association created a diet plan to curb hypertension. The National Heart, Blood, and Lung Institute issued a report titled "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults," which describes weight in proportion to height as the body mass index.

Which complication from antilipemic therapy aligns with a creatinine phosphokinase level of l0 times the upper limit? Myopathy Hepatotoxicity Rhabdomyolysis Gallbladder disease

Myopathy Rationale Myopathy is a serious musculoskeletal adverse effect characterized by muscle aches, sores, and weakness. sign of this disease is a serum creatine phosphokinase level l0 times the upper limit. A rise to three times the upper limit of transaminase levels indicates hepatotoxicity. Rhabdomyolysis is a serious condition resulting in kidney damage from progressing myopathy. Pinkish or red-tinged urine is an early indication of rhabdomyolysis. Fatigue, anorexia, jaundice, and malaise indicate gallbladder disease.

Which organization encourages balancing a healthy diet with physical activity to improve circulation and to burn calories in an effort to prevent metabolic syndrome? National Cholesterol Education Program MyPlate Food Guide American Heart Association National Heart, Blood, and Lung Institute

National Cholesterol Education Program Rationale The latest report from the National Cholesterol Education Program emphasizes the importance of balancing diet with physical activity to improve circulation and burn calories to curb metabolic syndrome. The MyPlate Food Guide provides guidelines for the primary prevention of metabolic syndrome. The American Heart Association issues a diet plan to curb hypertension. The National Heart, Blood, and Lung Institute issued a report titled "Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, which describes weight in proportion to height as the body mass index.

Which adverse effects associated with omega-3 fatty acids should be immediately reported to the healthcare provider? Select all that apply. Nausea Sweating Wheezing Hoarseness Difficult urination

Nausea Sweating Wheezing Rationale The serious adverse effects associated with omega-3 fatty acids include nausea, sweating, and wheezing. These adverse effects should be reported to the healthcare provider immediately. Hoarseness and difficult urination are minor adverse effects and should be reported only if they persist.

A patient complains of tingling and burning pain in the extremities. The nurse knows to document this as which type of pain? Visceral Somatic Phantom Neuropathic

Neuropathic Rationale Neuropathic pain is often described as tingling or burning. Visceral pain originates from the internal organs. Somatic pain is musculoskeletal pain. Phantom pain is pain the patient experiences as coming from where an amputated limb used to be.

Which antilipemic agent raises high-density lipoprotein cholesterol (HDL-C) levels by 20% to 35%? Niacin Gemfibrozil Simvastatin Fenofbrate

Niacin Rationale Niacin is an antilipemic agent that raises HDL-C levels by 15%to35%. Gemfbril s a fibrate that raises high-density lipoprotein (HDL by 20% to 25%. Simvastatin is a statin that raises HDL by 2% to 15%. Fenofbrate is a fbrate that raises HDL by 10% to 25%

Which antilipemic medication inhibits very-low-density lipoprotein (VLDL) synthesis by liver cells? Niacin Gemfbrozil Pitavastatin Colesevelam

Niacin Rationale Niacin is used in the treatment of hyperlipidemia. Niacin inhibits VLDL synthesis by liver cells, which decreases low-density lipoprotein and triglyceride production. Gemfibrozil lowers triglyceride levels by 20% to 40%. Pitavastatin inhibits the enzyme that allows hydroxy methyl glutaryl coenzyme A to synthesize cholesterol in the liver. Colesevelam binds to bile acids in the intestine to prevent enterohepatic recirculation of bile acids.

Which medication has the greatest effect on increasing high-density lipoprotein (HDL) levels ? Ezetimibe Gemfibrozil Pravastatin Niacin

Niacin Rationale Niacin increases HDL levels by 1 5%to 3 0%,offering the greatest effect of the four choices .Ezetimibe has a minimal effect on raising HDL levels .Gemfibrozil increases HDL levels by 1 0%to 1 5%,but another medication has a higher effect .Pravastatin increases HDL levels by 5 %to 1 0%,but another medication has a higher effect .

Which medications are used to lower elevated cholesterol levels in patients with dyslipidemias? Select all that apply. Niacin Ezetimibe (Zetia) Fluvastatin (Lescol) Fenofibrate (Tricor) Omega-3 fatty acids

Niacin Ezetimibe (Zetia) Fluvastatin (Lescol) Rationale Niacin is used, in conjunction with dietary therapy, to decrease elevated cholesterol concentrations in patients with dyslipidemias. Ezetimibe (Zetia), an antilipemic agent, and fluvastatin Lescol) a statin, are used to lower elevated cholesterol levels in patients with dyslipidemias. Fenofibrate (Tricor), a fibric acid derivative, and eicosapentaenoic acid, and docosahexaenoic acid, an omega-3 fatty acid, are used to lower triglyceride levels.

Which medications are highly effective in lowering low-density lipoprotein cholesterol (LDL-C)? Select all that apply. Niacin Lovaza Gemfbrozil Colestipol Atorvastatin

Niacin Colestipol Atorvastatin Rationale Antilipemics such as niacin, bile acid-binding resins such as colestipol, and statins such as atorvastatin are highly effective in lowering LDL-C levels. Lovaza is an omega-3 fatty acid that reduces triglyceride levels. Gemfibrozil is a fibric acid that does not usually produce substantial reductions in LDL-C.

Which statement is true about antilipemic medications used to treat dyslipidemias? Niacin is the most effective medication for raising high-density lipoprotein cholesterol (HDL-C) levels. Statins are to treat very high triglyceride levels. Fibric acids are first-line drugs for the treatment of hyperlipidemia. Resins are the most potent, effective, and safe drugs for lowering low-density lipoprotein cholesterol (LDL-C) levels.

Niacin is the most effective medication for raising high-density lipoprotein cholesterol (HDL-C) levels. Rationale Niacin is the most effective therapy for raising HDL-C levels. It increases the HDL-C levels by 20%to 35%. Omega-3 fatty acids are used to treat very high triglyceride levels. Fibric acids are not first-line drugs for the treatment of hyperlipidemia, because they do not usually produce substantial reductions in LDL-C levels. Statins are the most effective at lowering LDL-C levels.

Which statement is true regarding niacin? Niacin should be used with caution in patients with diabetes. Dietary supplements of niacin can be used to treat dyslipidemia. Niacin is used alone to decrease elevated cholesterol concentrations in dyslipidemia. Immediate-release niacin products have a higher possibility of causing hepatotoxicity.

Niacin should be used with caution in patients with diabetes. Rationale Niacin may induce hyperglycemia and should be used with caution in patients with diabetes. Dietary supplements of niacin should not be used to treat dyslipidemia. Niacin is used in combination with dietary therapy to decrease elevated cholesterol concentrations in dyslipidemia. Sustained-release niacin products have a higher possibility of causing hepatotoxicity.

A nurse learns in a report that a patient has a significantly elevated B-type natriuretic peptide (BNP). The nurse anticipates the patient's position of comfort will be which position in bed? Prone Left side-lying Supine with one pillow None; the patient sleeps in a recliner

None; the patient sleeps in a recliner Rationale BNP is released when the heart muscle is stretched as a result of heart failure. The patient will likely be most comfortable with the head of the bed elevated, with multiple pillows, or in a recliner. The patient would not be comfortable in the prone, left side-lying, or supine position.

The nurse correctly interprets that a patient with a body mass index (BMl) of 23 is in which BMI category? Underweight Normal weight Overweight Obese

Normal weight Rationale A BMI of 23is considered normal weight; normal BMlis 18.5to 24.9. A BMl of less than 18.5 is considered underweight. BMl of25 to 29.9is considered overweight. BMl of30 to 34.9 is considered obese.

A nurse notes that the patient on hospice has a fecal impaction. Which action should the nurse do first? Administer a Xanax. Administer a Fleet enema. Administer a stimulant laxative. Encourage the patient to drink more fluids.

O Administer a Xanax. Rationale The nurse should first administer an anti-anxiety medication such as Xanax to help the patient tolerate the procedure better. Fleet enema can be used instead of digital removal. A stimulant laxative should not be administered with an impaction because of the risk of damage to the colon. The nurse should encourage the patient to drink fluids to prevent another impaction.

Which type of assessments is the nurse conducting when using the Beck Depression Inventory tool in a patient with a mood disorder? Basic mental status Psychomotor function Interpersonal relationships History of the mood disorder

O Basic mental status Rationale The Beck Depression Inventory is a widely used tool used to assess a patient's basic mental status. Psychomotor function tests assess the patient's activity level. While assessing the patient's interpersonal relationships, the nurse tries to identify any supportive people in the patient's life. The nurse obtains the history of the patient's mood disorder by determining the precipitating factors contributing to the mood changes.

The nurse is providing hospice care for a patient nearing death who has loud, wet respirations. Which intervention should the nurse perform for this patient? Reposition the patient onto one side. Perform oropharyngeal suctioning. Administer appropriate antibiotics. Provide hyoscyamine (Levsin) every 4 hours.

O Reposition the patient onto one side. Rationale When caring for the patient with loud, wet respirations, the nurse repositions the patient to one side and places a towel under the mouth to collect secretions. Oropharyngeal suctioning is not recommended for loud secretions in the bronchi or oropharynx because it is not effective and may only agitate the patient. Administration of antibiotics is not recommended for a patient for whom death is imminent. Hyoscyamine (Levsin) is generally administered every 6 hours orally or sublingually to dry up secretions.

The licensed practical nurse finds that the body mass index (BMl) of a patient 32. What is the relationship to weight in this patient's condition? Overweight Normal weight Obesity, class I Obesity, class Il

Obesity, class I Rationale The National Heart, Blood, and Lung Institute guidelines describe overweight and obesity in terms of BMI. BMI is calculated by dividing weight in kilograms by height in meters squared. A BMI within the range of 30 to 34.9 indicates obesity lass I A BMl within the range of25 to 29.9is considered overweight. A BMI within the range of 18.5to 24.9is considered normal. A BM within the range of 35 39.9 indicates obesity, class Il.

The nurse expects fluvoxamine to be prescribed for a patient with which condition? Pruritus related to an allergic reaction Postoperative nausea and vomiting (PONV) Obsessive-compulsive disorder (OCD) Short-term anxiety

Obsessive-compulsive disorder (OCD) Rationale Fluvoxamine is used to treat OCD when obsessions or compulsions cause marked distress, are time-consuming, or interfere substantially with social or occupational responsibilities. Hydroxyzine (Vistaril) is used to control PONVand pruritus associated with allergic reactions. Meprobamate (Miltown) is used for short-term relief of anxiety and as a mild skeletal muscle relaxant.

A nurse is supervising an unlicensed assistive personnel UAP) in the care of a patient who received adenosine for cardioversion from new-onset supraventricular tachycardia 3 hours ago. Which action by the UAP would prompt the nurse to intervene immediately? Offering regular coffee with breakfast Offering grapefruit juice between meals Assisting the patient to ambulate to the toilet Massaging the legs and feet with unscented lotion

Offering regular coffee with breakfast Rationale Caffeine inhibits adenosine and should not be given within 4 to 6 hours of the dose. Grapefruit juice, ambulation, and leg massages are appropriate for this patient.

Which atypical antipsychotic agent would be prescribed for a patient undergoing initial pharmacologic treatment for bipolar disorder as monotherapy? Valproate Olanzapine Lamotrigine Carbamazepine

Olanzapine Rationale Olanzapine is an atypical antipsychotic agent used for the initial treatment of a patient with acute mania as monotherapy. Valproate is also used for the initial treatment of acute mania as a monotherapy, but valproate is not an atypical antipsychotic agent. Lamotrigine and carbamazepine are used for patients who do not adequately respond to lithium.

Which antilipemic medication reduces the synthesis of triglycerides in the liver? Niacin Omega-3 fatty acids Ezetimibe (Zetia) Pitavastatin (Livalo)

Omega-3 fatty acids Rationale Omega-3 fatty acids reduce triglyceride synthesis in the liver; this medication can lower triglyceride levels by 20% to 50%.Niacin inhibits very-low-density lipoprotein synthesis, which results in a decrease in low-density lipoprotein (LDL) and triglyceride production. Ezetimibe (Zetia) blocks the absorption of cholesterol from the small intestine. Pitavastatin (Livalo) is a statin that inhibits the enzyme that converts hydroxymethylglutaryl coenzyme A to mevalonate in the biosynthetic pathway. As a result, LDL will be removed from the blood circulation.

Which class of medications is most effective in reducing triglyceride levels? Fibric acids Omega-3 fatty acids Bile acid-binding resins 3-Hydroxy-3-methylglutary| coenzyme A (HMG-CoA) reductase enzyme inhibitors

Omega-3 fatty acids Rationale Omega3 fatty acids are effective in reducing triglyceride levels by 20% to 50%. Fibric acids lower triglyceride levels by 20% to 40%. Bile acid-binding resins increase triglyceride levels by 5% to 10%. HMG-CoA reductase enzyme inhibitors reduce triglyceride levels by 20% to 30%,

A patient in hospice is suffering from constipation. Which teachings regarding patient care would the nurse reinforce to the caregiver? Select all that apply. Opioids are expected to cause constipation as an adverse effect. A decrease in oral intake decreases the stool expelled in the patient. Exhaustion may cause exacerbation to fall other signs and symptoms. Bowel movements can occur even in the absence of oral intake by the patient. Bowel movements and abdominal firmness should be assessed after active treatment.

Opioids are expected to cause constipation as an adverse effect. A decrease in oral intake decreases the stool expelled in the patient. Bowel movements can occur even in the absence of oral intake by the patient. Rationale Patients in hospice are generally prescribed opioids for pain relief. These opioids may cause constipation, and the laxatives should be given as adjuvants. Reinforcing health education to the patient and the caregiver is the primary concern of a nurse. The nurse should tell the caregiver that a decrease in oral intake decreases the amount of stool expelled but does not stop bowel movements. Teaching regarding exhaustion is not relevant to constipation. Bowel movements and abdominal firmness should be assessed before any active treatment.

The nurse is caring for a patient in hospice who reports anorexia due to stomatitis. The nurse instructs the patient to use oral swabs dipped in water rather than mouthwash. Which patient factor would be the reason for this instruction? Nausea Oral ulcers Dry mouth Use ofartificial saliva

Oral ulcers Rationale Sometimes anorexia can be due to stomatitis or oral infections. In this case, it is recommended to use sponge-tipped oral swabs dipped in mouthwash to improve oral hygiene. Oral swabs dipped in water are preferred because mouthwash may cause discomfort in patients with oral ulcers. Nausea is not related to the use oforal swabs. Oral swab usage is not an intervention for dry mouth. Artificial saliva is used in patients with dry mouth.

The body mass index of a patient is found to be 28 kg/m2. What is the relationship to weight in this patient's condition? Overweight Underweight Obesity, class I Obesity, lass II

Overweight Rationale Abody mass index of 28 kg/m 2is in the range of25 to 29.9 kg/m ,which indicates that the patient is overweight. A patient with a body mass inde lss than 18.5 kg/m 2is considered underweight. A body mass index between 30 and 34.9 kg/m2implies obesity lass I. A body mass index between 35 and 39.9kg/m 2 indicates obesity, class Il.

What are the avoidable adverse effects of niacin? Select all that apply. Rash itching Flushing Anorexia Hepatotoxicity

Rash itching Flushing Rationale Rash, itching, and flushing are common adverse effects of niacin. These side effects can be reduced by taking aspirin or ibuprofen 30 minutes before each dose of niacin. Anorexia and hepatotoxicity are serious adverse effects associated with niacin and should be reported to the healthcare provider immediately.

Which medications is the nurse likely to find in the prescription for a patient with acute myocardial infarction (Ml)? Select all that apply. Oxygen therapy Diazepam (Valium) Lidocaine (Xylocaine) Amlodipine (Norvasc) Morphine (MS Contin)

Oxygen therapy Diazepam (Valium) Amlodipine (Norvasc) Morphine (MS Contin) Rationale Oxygen facilitates cardiac tissue perfusion in a patient with Ml. Diazpam (Valium) is used t alleviate anxiety in the patient. Amlodipine (Norvasc) is a calcium channel blocker that helps decrease morbidity and mortality. Morphine (MS Contin) helps relieve pain in the patient. Lidocaine (Xylocaine) is prescribed in case of ventricular fibrillation, but not for Ml.

While conducting a cardiac assessment fora patient who is 78 years old, the nurse notes that the patient is suffering from sinus dysrhythmias. Which cells are reduced in this condition? Conduction cells in the bundle of His Conduction cells in the internodal tracts Conduction cells in the bundle branches Pacemaker cells in the sinoatrial (SA) node

Pacemaker cells in the sinoatrial (SA) node Rationale A reduction in the number of pacemaker cells in the SA node may account for sinus dysrhythmias in the older adult patient. Reductions in the number of conduction cells in the internodal tracts, a bundle of His, and bundle branches contribute to the development of atrial dysrhythmias and heart blocks.

A patient with bone metastasis reports shortness of breath. Which outcomes would indicate that the nursing interventions were effective? Select all that apply. Needing oxygen administration Performing relaxation techniques Performing diaphragmatic breathing Improved respiratory status Breathing easily while doing exercises

Performing relaxation techniques Performing diaphragmatic breathing Improved respiratory status Breathing easily while doing exercises Rationale A patient with bone metastasis and shortness of breath requires nursing interventions to improve respiratory status. The nurse should educate the patient about methods such as relaxation techniques and diaphragmatic breathing that will ease respiratory distress. Improved respiratory status, which is indicated by increased oxygen saturation levels and normal rate and depth of breathing would also indicate that the nursing interventions were effective. The patient being able to perform deep-breathing exercises and diaphragmatic breathing independently indicates that the nursing interventions were effective. The ability to breathe easily while doing exercises would also indicate that the nursing interventions were effective. The patient will not need oxygen administration if the nursing interventions are effective.

Which layers comprise the heart wall? Select all that apply. Pericardium Myocardium Endocardium Mediastinum Chordae tendineae

Pericardium- two layers serous membrane Myocardium Endocardium Rationale The pericardium is a two-layered serous membrane and the outermost layer of the heart. The myocardium is composed of cardiac muscle tissue and is the strongest layer of the heart. The endocardium is the innermost layer and is made up of a thin layer of connective tissue. This layer lines the interior of the heart, the valves, and the large vessels of the heart. The mediastinum is the region between the lungs where the heart is located. Chordae tendineae are small cordlike structures that prevent the backflow of blood when the ventricles contract.

The nurse finds that the ankle-brachial index of a patient is 0 .70and also observes redness in the lower legs. Which possible condition does the nurse infer from these findings? Angina pectoris Sinus bradycardia Essential hypertension Peripheral arterial disease

Peripheral arterial disease Rationale The ankle-brachial index is the ratio of the systolic blood pressure at the ankle to the systolic blood pressure in the arm. An ankle-brachial index of 0 .70and rubor redness)in lower legs indicate peripheral arterial disease .patient who has sinus bradycardia would have a pulse rate of fewer than 6 0beats /min. A patient suffering from essential hypertension would have systolic blood pressure above 1 40mm Hg and diastolic blood pressure below 9 0mm Hg.

A nurse is preparing a patient with left-sided heart failure for diagnostic imaging. The nurse anticipates the diagnostic imaging will show which anomaly? Splenomegaly Hepatomegaly Pleura effusion Mediastinal shift

Pleura effusion Rationale Left-sided heart failure leads to pleural effusion. Right-sided heart failure leads to splenomegaly and hepatomegaly. Left-sided heart failure does not lead to a mediastina shift.

A nurse is preparing a patient with left-sided heart failure for diagnostic imaging. The nurse anticipates the diagnostic imaging will show which anomaly? Splenomegaly Hepatomegaly Pleural effusion Mediastinal shift

Pleural effusion Rationale Left-sided heart failure leads to pleural effusion. Right-sided heart failure leads to splenomegaly and hepatomegaly. Left-sided heart failure does not lead to mediastinal shift.

Which factors may lead to skin impairment in a terminally ill patient? Select all that apply. Poor nutrition Dehydration Impaired circulation Increased weakness Decreased body temperature

Poor nutrition Dehydration Impaired circulation Increased weakness Rationale Poor nutrition due to anorexia may lead to dehydration and weight loss. A reduction in soft tissue, especially on the bony areas of the knees, hips, elbows, and buttocks, leads to skin impairment. Terminally ill patients have reduced blood supply to the skin. This leads to skin impairment. Increased weakness is notable in the last stages of a terminal illness. It often leads to activity intolerance and causes the terminally ill patient to spend most of the time reclining, which leads to a risk of skin impairment. A decrease in body temperature does not affect skin integrity in terminally ill patients.

A patient with colon cancer being admitted to hospice care does not have an advance directive. Which elements does the nurse include in the discussion with the patient and family about advance directives? Select all that apply. Portable do-not-resuscitate (DNR) order Instruction about life-sustaining treatment Instructional directive for health care professionals A durable power of attorney for health care (DPOAHC) Instruction that an advance directive cannot be changed once it is fled

Portable do-not-resuscitate (DNR) order Instruction about life-sustaining treatment Instructional directive for health care professionals A durable power of attorney for health care (DPOAHC) Rationale At the time of admission to hospice care, the nurse should document the presence of an advance directive by the patient. An advance directive is a legal document or directive about the patient's decisions regarding life-sustaining treatment when he or she loses decision-making capacity. Living wills and medical directives such as DNR orders are instructional directives that help health care professionals make the appropriate decision(s) as per the patient will portable DNR order or DNR order written in advance is an advance directive. A patient can appoint a health-care proxy by providing a DPOAHC regarding health care to make decisions for the patient in the event of loss of decision-making capacity. An advance directive can be altered once it is fled but will need to be witnessed again.

Which feature is common among depressive and bipolar disorders? The extent of irritable mood Timing of irritable mood Presence of irritable mood Assumed etiology of irritable mood

Presence ofirritable mood Rationale The presence of an irritable mood is one of the features in both depressive and bipolar disorders. Duration, timing, and assumed etiology of the irritable mood difr between these disorders.

Which typical antipsychotic medication is available as a suppository? Loxapine Fluphenazine Prochlorperazine Chlorpromazine

Prochlorperazine Rationale Prochlorperazine is the only typical antipsychotic agent available as a suppository. Loxapine, fluphenazine, and chlorpromazine are not available as suppositories.

An anorexic patient reports dry mouth. Which measures help in reducing the symptoms of dry mouth? Select all that apply. Provide appealing meals. Use water-soaked swabs. Weigh the patient regularly. Provide small frequent drinks. Give the patient crushed ice via mouth.

Provide small frequent drinks. Give the patient crushed ice via mouth. Rationale A patient with anorexia may have a dry mouth. Small frequent drinks and crushed ice or artificial saliva are useful in relieving dry mouth. The patient feels frequent thirst and dryness in the mouth, so small frequent drinks should be provided. The ice helps to moisten the mouth. If the odor of food causes anorexia, the patient should not be allowed in the kitchen during meal preparation, and the meals should be made as appealing as possible. Water-soaked swabs should be used to lessen the discomfort of the mouth. The nurse should avoid weighing the patient; a marked reduction in weight may increase the anxiety in the patient.

The nurse is providing hospice care for a terminally ill patient who has stopped oral intake for about l2 hours. The family requests the nurse to administer intravenous (lV) fluids. Which information does the nurse tell the patient's family about the patient's intake? I fluids will be administered the next day. Providing fluid or food may cause discomfort. Anorexia is uncommon in patients at this stage. It is a temporary phase, and the patient may restart oral intake.

Providing fluid or food may cause discomfort Rationale Giving fluid or food to the patient in hospice can cause discomfort; the patient may be at risk for aspiration. The nurse should reassure the family that anorexia is normal at this stage. The nurse should sensitively explain to the family that giving fluids can lead to increased secretions and cause discomfort in the patient with multisystem slowdown. Nurses often must reassure the caregiver that anorexia is part of the end-of-dying process and that forcing the patient to eat may be harmful. Once the patient is unable to swallow, oral intake should stop;it is not a temporary phase and the patient will not restart oral intake..

Which symptom of schizophrenia may be reduced within a week of antipsychotic therapy in a patient with schizophrenia? Delusions Hallucinations Thought disorder Psychomotor agitation

Psychomotor agitation Rationale Reduced psychomotor agitation is a therapeutic effect of antipsychotic therapy that is observed within 1 week. Reduction in delusions, hallucinations and thought disorders often requires 6 to 8 weeks of treatment to achieve the full therapeutic effect.

A nurse is preparing care for a patient with new-onset atrial fibrillation ("Afb"). The nurse knows the patient is at an increased risk for which condition? Aortic aneurysm Hemorrhagic stroke Pulmonary embolism Premature ventricular contraction

Pulmonary embolism Rationale Blood pools in the atrium, leading to the formation of clots, which can become pulmonary emboli if ejected from the hearing. The patient is not at an increased risk for aortic aneurysm, hemorrhagic stroke, or premature ventricular contraction.

Which information noted in the health history of a patient with atypical depression prevents the nurse from giving the prescribed monoamine oxidase inhibitors (MAOls) and requires consultation with the prescriber? Recurrent congestive heart failure Chronic seizures Intolerance of dairy products Allergy to eggs

Recurrent congestive heart failure Rationale MAOIs are contraindicated in patients with a history of severe congestive heart failure or renal, hepatic, or cerebrovascular disease. The medication should not be given until the prescriber is consulted. Use of MAOls is not contraindicated by seizures, intolerance to dairy products, or an allergy to eggs.

A patient has been diagnosed with terminal cancer and has been given a prognosis of 3 months to live. How would the nurse introduce the subject of palliative and hospice care? Redirection of care Withdrawal of care Homeopathic medicine used to find a cure Discharge from the health care provider's care

Redirection of care Rationale Palliative and hospice care are considered are directions of care from finding a cure to alleviating the patient's symptoms. It is not a withdrawal of care, homeopathic medicine used to find a cure, or discharge from the health care provider's care.

Which impulse pattern of the cardiac conduction system is correct? Pacemaker > Bundle of His > Sinoatrial (SA) node> Bundle branches Purkinje fbers > SA node> Right and left bundle branches >Atrioventricular(AV) node Pacemaker >SA node> Bundle of His> AVnode > Purkinje fbers SA node +AV node -> Bundle of His +Right and left bundle branches + Purkinje fibers

SA node +AV node -> Bundle of His +Right and left bundle branches + Purkinje fibers Rationale The impulse pattern of the cardiac conduction system is as follows: SA node>AVnode> Bundle of His -> Right and left bundle branches > Purkinje fibers.

A nurse witnesses a visitor at the hospital collapse. The nurse assesses the visitor as unresponsive. Which action would the nurse do first? Search for a pulse. Begin high-quality chest compressions. Call the code team. Provide rescue breaths.

Search for a pulse. Rationale The nurse's first action is to detrmine if the patienthas a pulse. If no pulse is found, the nurse should begin chest compressions and call the code team. Rescue breaths should be provided according to basic life support (BLS) guidelines.

Which adverse effects would the nurse expect to observe in a patient taking an antipsychotic medication that blocks histamine-l receptors? Select all that apply. Sedation Dry mouth Drowsiness Appetite stimulation Postural hypotension

Sedation Drowsiness Appetite stimulation Rationale Blocking histamine-l receptors cause sedation, drowsiness, and appetite stimulation. Blocking the cholinergic receptors causes anticholinergic effects such as dry mouth. Blocking alpha-l and alpha-2 adrenergic receptors cause postural hypotension.

Which class of antidepressants is chemically unrelated to other antidepressants? Tricyclic antidepressants Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Serotonin-norepinephrine reuptake inhibitors

Selective serotonin reuptake inhibitors Rationale Selective serotonin reuptake inhibitors are a newer class of antidepressants that are chemically unrelated to other antidepressants.

Which therapy does the nurse anticipate for a patient in whom tricyclic antidepressants were ineffective? Selegiline Fluoxetine Amoxapine Venlafaxine

Selegiline Rationale Selegiline is an approved monoamine oxidase inhibitor used to treat the major depressive disorder. If tricyclic antidepressant therapy is unsatisfactory or electroconvulsive therapy is inappropriate or refused, a transdermal patch of selegiline is advised. Fluoxetine is a selective serotonin reuptake inhibitor that is recommended for treating depression in children and adolescents. Amoxapine is a tricyclic antidepressant; the patient did not have satisfactory results with this group of drugs. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor that is not used to treat the major depressive disorder.

Which premedication assessments should the nurse perform before initiating selective serotonin reuptake inhibitor therapy? Select all that apply. Monitor the patient's blood glucose level to establish baseline values. Obtain the patient's baseline blood pressures in the supine position. Send the patient's blood sample to the laboratory for a liver function test. Assess the patient for the presence of any gastrointestinal symptoms. Ensure that the patient has not eaten food containing high amounts of tyramine in the past few days.

Send the patient's blood sample to the laboratory for a liver function test. Assess the patient for the presence of any gastrointestinal symptoms. Rationale The nurse should check the patient's hepatic studies before initiating the selective serotonin reuptake inhibitor therapy. Liver function should be checked periodically throughout the course of administration of the drug. Before the start of selective serotonin reuptake inhibitor therapy, the nurse must note the presence of any gastrointestinal symptoms in the patient. The nurse should monitor the patient's blood glucose level to establish baseline values before initiating monoamine oxidase inhibitor therapy. Before administering selective serotonin reuptake inhibitor drugs, the nurse should record the patient's baseline blood pressures in the supine, sitting, and standing positions. Food containing high amounts of tyramine may pose a threat to patients undergoing monoamine oxidase inhibitor therapy.

A nurse is caring for a patient undergoing an echocardiogram to determine the ejection fraction. The patient is shown to have an ejection fraction of35%. The nurse knows this can be interpreted as which degree of heart failure? Normal Mild heart failure Severe heart failure Moderate heart failure

Severe heart failure Rationale Ejection fraction is the amount of blood pumped out of the heart with each beat. An ejection fraction of less than 40%is considered severe heart failure. The normal ejection fraction is 55 % to 70 %. Mild heart failure is not distinguished. Patients with moderate heart failure have an ejection fraction of 40 % to 55 %.

Which patient action would the nurse document as a psychomotor symptom? Expressing feelings of guilt Unable to remember recent events Shouting suddenly without any cause Waking up frequently early in the morning

Shouting suddenly without any cause Rationale An outburst of shouting without any cause is a psychomotor symptom of depression. patient with depression often has feelings of guilt. This is an emotional symptom of depression. Poor memory of recent events is a cognitive symptom commonly found in older patients with depression. Terminal insomnia (a condition where a patient frequently wakes up early in the morning) is a physical symptom of depression.

Which statin is moderate intensity and used in the treatment of hyperlipidemia? Fluvastatin (Lescol) Simvastatin (Zocor) Lovastatin (Mevacor) Pravastatin (Pravachol)

Simvastatin (Zocor) Rationale Simvastatin (Zocor) is a moderate-intensity statin that is used to treat hyperlipidemia. Fluvastatin (Lescol), lovastatin (Mevacor) and pravastatin (Pravachol) are low-intensity statins used to treat hyperlipidemia.

Which successful forms of treatment for metabolic syndrome are the most cost-effective? Select all that apply. Smoking cessation Antihyperglycemic agents Dietary modification Antihypertensive agents Exercise

Smoking cessation Dietary modification Exercise Rationale Smoking cessation is a very cost-effective and successful form of treatment for metabolic syndrome. This approach actually saves the patient the amount of money spent on cigarettes. Dietary modification is a very cost-effective and successful form of treatment for metabolic syndrome. It does not cost the patient significantly more money to modify the types of foods purchased. Exercise is very cost-effective and successful in treating metabolic syndrome. Walking, running, or exercising at home does not cost the patient anything. Antihyperglycemic and antihypertensive agents are effective but can be costly.

Which symptom of depression would be improved in a patient after 2 to 4 weeks of antidepressant therapy at an effective dosage? Palpitations Social withdrawal Sleep disturbances Change in appetite

Social withdrawal Rationale Social withdrawal is a psychological symptom of depression. The optimum antidepressant dosage typically improves psychological symptoms after 2 to 4 weeks of therapy. Palpitations, sleep disturbances and changes in appetite are physiologic manifestations of depression that should lessen within the frst week of therapy.

A nurse is educating the patient and family on the structure of hospice care. The nurse would include which individuals as the core interdisciplinary team members? Select all that apply. Hospice aide Social worker Primary nurse Medical director Nurse coordinator Spiritual coordinator

Social worker Medical director Nurse coordinator Spiritual coordinator Rationale The core interdisciplinary hospice team includes the social worker, medical director, nurse coordinator, and spiritual coordinator. The hospice aide and primary nurse are members of the primary hospice team.

The nurse reports that a patient has malignant hypertension. Which findings in the patient would be consistent with malignant hypertension? Spontaneous epistaxis Reduced body temperature Pregnancy-induced hypertension Blood pressure of 140/90 mm Hg

Spontaneous epistaxis Rationale Malignant hypertension is advanced hypertension. Spontaneous epistaxis or nosebleed is a major symptom of malignant hypertension. Body temperature changes are caused by infection, not hypertension. Pregnancy-induced hypertension is usually secondary hypertension, but not malignant. Malignant hypertension is a severe form of secondary hypertension. Diastolic blood pressure above 120 mm Hg is indicative of malignant hypertension, but the patient has a blood pressure of 140/90 mm Hg.

While communicating with a patient who is terminal, the nurse finds that the patient is experiencing visceral pain. Which description by the patient leads the nurse to such a conclusion? Tingling Burning Stabbing Squeezing

Squeezing Rationale Pain that originates from the internal organs is called visceral pain. Patients generally describe this pain by using words such as dull pain, cramping, pressure, or squeezing pain. Neuropathic pain arises from the nerve endings. Tingling, burning, and shooting pains generally have a neuropathic origin. Somatic pain arises from the musculoskeletal system and is described by words such as stabbing, aching, or throbbing.

A nurse observes the patient's electrocardiogram (ECG) rhythm change from a rate of 80 beats/min in sinus rhythm to disorganized electrical activity with no detectable rate. The nurse rushes to the patient's room to find the patient unresponsive with no pulse. Which action should the nurse perform first? Call the code team. Provide rescue breaths. Defibrillate the patient. Start chest compressions.

Start chest compressions. Rationale The nurse should start chest compressions first to ensure adequate blood supply to the brain. The nurse would then call the code team, provide rescue breaths, and prepare to defibrillate the patient.

Which medication would be appropriate for a patient with metabolic syndrome whose triglyceride level is l60 mg/dL? Select all that apply. Statins Sulfonylureas Fibric acid derivatives Alpha-glycosidase inhibitors Angiotensin-converting enzyme inhibitors

Statins Fibric acid derivatives Rationale A metabolic syndrome is a group of disorders that predispose a patient to heart disease. To avoid further complications, the patient's triglyceride level should be reduced to l50 mg/dL o less. Statins and fabric acid derivatives should be administered to treat dyslipidemia Sulfonylureas and alpha-glycosidase inhibitors are used to treat type 2 diabetes. Angiotensin-converting enzyme inhibitors are administered to treat hypertension.

Which statements are true regarding statins? Select all that apply. Statins are more effective if administered at night. Statins reduce high-density lipoproteins (HDLs) by 5% to 15%. Statins cause orthostatic hypotension in patients who are on antihypertensives. Statins increase very-low-density lipoproteins (VLDLs and triglyceride levels by 20% to 30%. Statins reduce inflammation, thrombin formation, platelet aggregation, and plasma viscosity.

Statins are more effective if administered at night. Statins reduce inflammation, thrombin formation, platelet aggregation, and plasma viscosity. Rationale Statins work most effectively at night because peak production of cholesterol occurs in the evening. In addition to lipid regulation, statins also reduce inflammation, thrombin formation, platelet aggregation, and plasma viscosity. Statins mildly increase HDLs by5% to 15%. Niacin causes orthostatic hypotension in patients who are on antihypertensive agents. Statins reduce VLDLs and triglyceride levels by 20% to 30%

The nurse is caring for a patient who has undergone surgery for vasoconstriction. The patient has been advised to use clopidogrel (Plavix for3 months Which patient condition does the nurse infer from these findings? On nitroglycerine therapy On fluid replacement therapy Synthetic graf in the artery Stent placement in the artery

Stent placement in the artery Rationale Stent placement is used to treat abrupt vessel closure. Stents are thrombogenic in nature; therefore, the patient is advised to use the anticoagulant clopidogrel (Plavix) for 3 months. Nitroglycerine is a potential vasodilator, but it may reduce the action of an anticoagulant, so these are not administered together. Fluid replacement therapy may cause heart failure but does not require an anticoagulant. A synthetic graft is applied in the arterial aneurysms and does not require an anticoagulant.

Which nursing intervention is best when a patient with major depressive disorder and congestive heart failure is prescribed a monoamine oxidase inhibitor? Anticipate oral hyperglycemic therapy. Encourage the patient to eat meals with a high tyramine content. Stop the medication and consult the prescriber. Measure the blood pressure at regular intervals after initiating therapy.

Stop the medication and consult the prescriber. Rationale Patients with a history of congestive heart failure are not the right candidates for monoamine oxidase inhibitor drugs. In such a case, the nurse should not start the therapy and contact the healthcare provider for consultation. Monoamine oxidase inhibitors may cause hypoglycemia, not hyperglycemia. Monoamine oxidase inhibitor therapy cannot be initiated if the patient has consumed high-tyramine meals during the past few days. The patient's blood pressure should be monitored both before and at regular intervals after initiating therapy.

Which symptoms may occur if the patient consumes overripe bananas and mozzarella cheese while taking tranylcypromine? Select all that apply. Sweating Stiff neck Blurred vision Mucosal dryness Severe occipital headache

Sweating Stiff neck Severe occipital headache Rationale Hypertensive crisis is a major potential complication, particularly with tranylcypromine, that is caused by foods such as overripe bananas and mozzarella cheese because they may contain indirect sympathomimetic amines. Common prodromal symptoms include sweating, a stiff neck, and a severe occipital headache. Blurred vision and mucosal dryness are common adverse effects of monoamine oxidase inhibitors.

A patient was admitted yesterday after myocardial infarction. Which statement is true regarding treatment for a patient with myocardial infarction? Thrombolytic agents must be initiated within 24 hours of the onset of symptoms to be effective. Thrombolytic agents, such as aspirin, are used to minimize infarct size and maximize heart function. The patient with an acute myocardial infarction will be on bed rest with commode privileges for 24 to 48 hours. Morphine sulfate is contraindicated in a patient with a myocardial infarction because of its effects on the central nervous system.

The patient with an acute myocardial infarction will be on bed rest with commode privileges for 24 to 48 hours. Rationale The patient with an acute myocardial infarction will be on bed rest with commode privileges for 24 to 48 hours. After this period, activities are resumed gradually, depending on the size of the infarct and patient characteristics. program of cardiac rehabilitation will be designed for the patient and implemented. Thrombolytic agents must be initiated within 3 to 5 hours of the onset of symptoms to be effective, although they are most effective if administered within 30 minutes to l hour. Thrombolytic agents are used to minimizing infarct size and maximize heart function. Aspirin is an antiplatelet medication, not a thrombolytic agent. Morphine sulfate is useful for the patient with a myocardial infarction because it helps with vasodilation of coronary arteries, relief of pain, and reduction of apprehension. It also decreases myocardial oxygen demands, reduces contractility, and slows the heart rate.

Which statement indicates that a patient with bipolar disorder is showing an initial response to therapy? The patient's full function is restored. The patient has become non-compliant or abandoned the program. The symptoms are significantly reduced. The healthcare provider checks the patient on a weekly basis.

The symptoms are significantly reduced . Rationale The initial response significantly reduces the symptoms of bipolar disorder so that the patient no longer fits the criteria for the illness. Most patients with bipolar disorder pass through three stages - acute, continuation, and maintenance. After this, full function is restored. About half of patients with bipolar disorder become noncompliant with the therapy or abandon the program. Therefore the treatment of the acute phase is often prolonged. The acute phase for medication response typically takes 10 to 12 weeks. During this time, to monitor symptoms and adverse effects, the healthcare provider sees the patient weekly or biweekly. The healthcare provider makes dosage adjustments and provides support during this period.

Which drug categories are used as preferred antihypertensive treatments in patients with metabolic syndrome? Select all that apply. Calcium channel blockers Thiazide diuretics Beta-blockers Angiotensin-converting enzyme (ACE) inhibitors Alpha blockers

Thiazide diuretics Beta-blockers Angiotensin-converting enzyme (ACE) inhibitors Rationale In addition to helping control blood pressure, thiazide diuretics, beta-blockers, and ACE inhibitors improve the action of insulin and thus are beneficial to patients with metabolic syndrome. Calcium channel blockers and alpha-blockers are metabolically neutral and are not a preferred treatment for patients with metabolic syndrome.

While collecting the vital signs of a patient with metabolic syndrome, the nurse notes that the patient's blood pressure is 160/90 mm Hg. Which medications would the nurse anticipate being administered to treat this condition? Select all that apply. Statins Thiazide diuretics Thiazolidinediones Calcium channel blockers Angiotensin-converting enzyme inhibitors

Thiazide diuretics Calcium channel blockers Angiotensin-converting enzyme inhibitors Rationale Metabolic syndrome includes a group of factors that increase the risk of heart disease. The patient has a blood pressure of 160/90 mm Hg, which indicates hypertension. Thiazide diuretics, calcium channel blockers, and angiotensin-converting enzyme inhibitors are used in the treatment of hypertension. Statins are reductase inhibitors that are used in the treatment of dyslipidemia. Thiazolidinediones are used to reduce insulin resistance in peripheral tissues.

Which drugs are most appropriate for treating hypertension in non-African-American patients? Select all that apply. Thiazide diuretics Thiazolidinediones Calcium channel blockers Alpha-glycosidase inhibitors Angiotensin-converting enzyme inhibitors

Thiazide diuretics Calcium channel blockers Angiotensin-converting enzyme inhibitors Rationale Thiazide diuretics, calcium channel blockers, and angiotensin-converting enzyme inhibitors are beneficial in lowering blood pressure in non-African-American patients. Thiazolidinediones are administered to reduce insulin resistance in the peripheral tissues. Alpha-glycosidase inhibitors are prescribed to treat type 2 diabetes mellitus.

Which behaviors are most likely to be exhibited by patients with psychoses who also exhibit delusional behavior? Select all that apply. Often masturbates in public Believes the devil speaks to him or her Has overly concrete and inexpressive speech Thinks newspaper articles often warn him or her about impending danger Believes his or her impulses and actions are controlled by an a lie life force

Thinks newspaper articles often warn him or her about impending danger Believes his or her impulses and actions are controlled by an a lie life force Rationale A delusion is a false or irrational belief that is firmly held despite obvious evidence to the contrary. When a patient attributes a special, irrational, and usually negative significance to other people, objects, or events, such as song lyrics or newspaper articles, this phenomenon is known as delusions of reference. common bizarre delusion is the patient's belief that his or her thinking process, body parts, or actions or impulses are controlled or dictated by some external force. Exhibiting clearly inappropriate sexual behavior (such as public masturbation) is an example of disorganized behavior. Auditory hallucinations experienced as voices that are characteristically heard commenting negatively about the patient in the third person are prominent among patients with schizophrenia. The patient who believes the devil speaks to him or her displays this type of psychosis. Disorganized thinking can be associated with the loss of the ability to think in abstract terms; this is often expressed as overly concrete and inexpressive speech.

Why would the provider instruct a patient to take 325 mg of aspirin 30 minutes before each dose of niacin? To reduce gas To reduce itching To reduce hepatotoxicity To reduce abdominal discomfort

To reduce itching Rationale Niacin is a water-soluble B vitamin that decreases low-density lipoprotein and triglyceride production. itching, flushing, and rash are common integumentary adverse effects of niacin. Thus taking aspirin 30 minutes before each dose o niacin will help reduce itching. Gas and abdominal discomfort are common gastrointestinal adverse effects of niacin that can be reduced by starting on low doses. Hepatotoxicity is a serious gastrointestinal adverse effect of niacin that can be reduced by limiting the timed-release product intake to 1500 mg daily.

The nurse is reviewing the cholesterol report for 30-year-old woman and finds it to be normal Which values did the nurse find in the report? Total cholesterol 180 mg/dL;low-density lipoprotein (LDL 90 mg/dL;high-density lipoprotein (HDL) 55 mg/dL Total cholesterol 230 mg/dL;LDL80mg/dL;HDL40mg/dL Total cholesterol 240 mg/dL;LDL 140 mg/dL; HDL60mg/dL Total cholesterol 250mg/dL; LDL160 mg/dL;HDL65mg/dL

Total cholesterol 180 mg/dL;low-density lipoprotein (LDL 90 mg/dL;high-density lipoprotein (HDL) 55 mg/dL Rationale Total cholesterol of 180 mg/dL, LDL of90 mg/dL,and HDLof55 mg/dLindicate normal cholesterol levels in a woman. As total cholestero less than 200 mg/dLis desirable, LDL less than 100 mg/dL is optimal, and HDL should be between 50 and 60 mg/dLin a woman. If total cholesterol is 230 mg/dL, LDLis 80 mg/dL, and HDL is 40 mg/dL, this indicates borderline total cholesterol and very low HDL Iftotal cholesterol is 240 mg/dL, LDL is 140 mg/dL,and HDLis 60 mg/dL, this indicates high total cholesterol, high LDL, and high HDL.If total cholesteroli 250 mg/dL, LDLis 160 mg/dL,and HDLi 65 mg/dL, this indicates very high cholesterol levels,

A nurse is caring for a patient on hospice with intractable nausea and vomiting in addition to severe cancer pain. Which medication would be most appropriate for this patient on a long-term basis? Oral morphine Transdermal fentanyl Parenteral meperidine Acetaminophen suppository

Transdermal fentanyl Rationale Transdermal fentanyl is a long-acting patch that delivers a continuous amount of pain medication to the patient and I easily administered by caregivers. Oral morphine is likely to be vomited before it can be absorbed. Parenteral meperidine requires intravenous access and a health care provider for administration. Acetaminophen suppositories are not as helpful for pain control.

A patient on hospice is unarousable and demonstrating the "death rattle," which is proving to be distressing for the patient's family. Which medication would the nurse request from the provider? Nebulized albuterol Sublingual morphine Oral diphenhydramine Transdermal scopolamine

Transdermal scopolamine Rationale Anticholinergic medications such as scopolamine can decrease secretions that cause the "death rattle." Albuterol and sublingual morphine can be used to decrease feelings of air hunger. Or diphenhydramine would not be appropriate for this patient.

A nurse is caring for a patient with refractory atrial fibrillation. The nurse is preparing the patient for electrical cardioversion. Which test or procedure would the nurse ensure is completed before the electrical cardioversion? Chest x-ray study Prothrombin time (PT) International normalized ratio(INR) Transesophageal echocardiography

Transesophageal echocardiography Rationale The nurse should ensure that transesophageal echocardiography has been performed and that no clots exist in the pooled blood in the heart. Clots are likely to be ejected from the heart after a normal sinus rhythm is established, leading to pulmonary embolism, myocardial infarction, or cerebrovascular accident. A chest x-ray study is not necessary at this time. Electrical cardioversion is not invasive, so PTand INR (bleeding times) are not necessary.

Which drugs would result in the development of serotonin syndrome when given concurrently with vilazodone? Select all that apply. Trazodone Haloperidol Linezolid St. John's wort Monoamine oxidase inhibitors

Trazodone Linezolid St. John's wort Monoamine oxidase inhibitors Rationale When trazodone is used in conjunction with vilazodone, serotonin syndrome may develop. Concurrent use of vilazodone with linezolid, St. john's wort, and monoamine oxidase inhibitors may stimulate excess serotonin levels, which may also cause serotonin syndrome. Because vilazodone inhibits the metabolism of haloperidol, its dose may have to be reduced to prevent potential toxicity, but there is no risk of serotonin syndrome.

Which antidepressant medications require the nurse to monitor a patient's blood pressure in the supine, sitting, and standing positions before initiating therapy? Select all that apply. Trazodone therapy Mirtazapine therapy Monoamine oxidase inhibitor therapy Selective serotonin reuptake inhibitor therapy Serotonin-norepinephrine reuptake inhibitor therapy

Trazodone therapy Mirtazapine therapy Selective serotonin reuptake inhibitor therapy Rationale Trazodone, mirtazapine, nefazodone, and selective serotonin reuptake inhibitor therapies require the nurse to record the patient's baseline blood pressures in the supine, sitting, and standing positions. For monoamine oxidase inhibitor therapy, the nurse obtains the patient's blood pressure and pulse rate before and at regular intervals after initiating the therapy. Serotonin-norepinephrine reuptake inhibitor therapy requires the nurse to obtain the patient's baseline weight and blood pressure.

What actions of bile acid-binding resins help treat hyperlipidemia Sele all that apply. Reduction of plasma viscosity Reduction of thrombin formation Treatment of digitalis glycoside toxicity Treatment of diarrhea secondary to excess fecal bile acid Reduction of triglyceride levels in patients at risk for pancreatitis

Treatment of digitalis glycoside toxicity Treatment of diarrhea secondary to excess fecal bile acid Rationale Bile acid-binding resins are used to treat digitalis glycoside toxicity and diarrhea secondary to excess fecal bile acid. Statins aid in the reduction of plasma viscosity and reduction of thrombin formation in patients with hyperlipidemia In conjunction with dietary therapy, fibric acids help reduce triglyceride levels in patients at risk for pancreatitis.

What actions of bile acid-binding resins help treat hyperlipidemia? Select all that apply. Reduction of plasma viscosity Reduction of thrombin formation Treatment of digitalis glycoside toxicity Treatment of diarrhea secondary to excess fecal bile acid Reduction of triglyceride levels in patients at risk for pancreatitis

Treatment of digitalis glycoside toxicity Treatment of diarrhea secondary to excess fecal bile acid Rationale Bile acid-binding resins are used to treat digitalis glycoside toxicity and diarrhea secondary to excess fecal bile acid. Statins aid in the reduction of plasma viscosity and reduction of thrombin formation in patients with hyperlipidemia. In conjunction with dietary therapy, fibric acids help reduce triglyceride levels in patients at risk for pancreatitis.

The nurse is caring for a patient who has darkened veins and complains of muscle cramps. On further examination, the nurse finds that the patient's legs feel heavy and edematous and have ulcers. Which diagnostic test does the nurse expect for diagnosis of the patient's condition? Trendelenburg's test Cold stimulation test Electrocardiography Fluoroscopy

Trendelenburg's test Rationale Darkened veins with muscle cramps and ulcer, edema, and heavy feelings in the legs are the symptoms of varicose veins. Trendelenburg's testis used to diagnose the darkened vein's ability to support a column of blood by measuring the venous fling time. cold stimulation test is performed for Raynaud's disease to detect a continuous change of temperature. Electrocardiography is used to measure cardiac dysrhythmias it is not a primary diagnostic test performed for varicose veins. Fluoroscopy is used for the diagnosis of arterial aneurysm.

Which drugs are first-generation antidepressants? Select all that apply. Vortioxetine Tricyclic antidepressants Monoamine oxidase inhibitors Selective serotonin reuptake inhibitors Serotonin-norepinephrine reuptake inhibitors

Tricyclic antidepressants Monoamine oxidase inhibitors Rationale Tricyclic antidepressants and monoamine oxidase inhibitors are first-generation antidepressants. Vortioxetine is a miscellaneous agent used to treat depression. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are second-generation antidepressants.

A patient is diagnosed with central obesity, and the history confirms the patient has metabolic syndrome. Which clinical findings support this result? Select all that apply. Triglycerides 155 mg/dL Fasting glucose 105 mg/dL Blood pressure 130/85 mm Hg Waist circumference 40 inches (1.02 meters) High-density lipoprotein cholesterol 40 mg/dL

Triglycerides 155 mg/dL Fasting glucose 105 mg/dL Waist circumference 40 inches (1.02 meters) Rationale Patients with central obesity and at least two of the risk factor defining limits are considered to have metabolic syndrome. According to the National Cholesterol Education Program, a triglyceride level of 155 mg/dL is a risk factor for metabolic syndrome. A fasting glucose level of 105 mg/dL is above the risk factor defining limit of 100 mg/dL. A waist circumference of 40 inches (1.02 meters) is greater than the risk factor defining limit of 35 inches (0.89 meters) in women. Because the patient has three abnormal levels, he or she is considered to have metabolic syndrome. blood pressure of 130/85 mm Hg is the limiting factor in men and women. A high-density lipoprotein cholesterol level of 40 mg/dL is congruent with the standard risk factor defining limit.

Which cardiac marker is specific to the heart, is not influenced by skeletal muscle trauma or renal failure, and rises 3 hours after a myocardial infarction? Creatine kinase-muscle/brain (CK-MB) Troponin I Myoglobin Homocysteine

Troponin I Rationale Troponin l is a myocardial muscle protein released into circulation after myocardial injur. It can identify very small amounts of myocardial injury. It rises 3 hours after myocardial infarction, peaks at 14 to l8 hours, and returns to normalin5to7 days. Troponin is specific to the heart is not influenced by skeletal muscle trauma or renal failure and is very useful in diagnosing myocardial infarction. CK-MB is a cardiac enzyme that also is elevated after myocardial infarction; however, it is also elevated by other factors (surgery, muscle trauma). lt rises in 2to 3 hours after myocardial infarction, peaks at 24 hours, and returns to normal in 24 to 40 hours. Myoglobin is a cardiac marker that is released into circulation a few hours after myocardial infarction. Because it is also present in skeletal muscle, it lacks cardiac specificity. Homocysteine is not a cardiac marker. l is an amino acid produced during protein digestion. Elevated levels of homocysteine may act as an independent risk factor for ischemic heart disease, cerebrovascular disease, peripheral arterial disease, and venous thrombosis. It appears to promote the development of atherosclerosis by causing endothelial damage, promoting low-density lipoprotein deposits, and promoting vascular smooth muscle growth.

A patient arrives at the emergency department with acute-onset crushing chest pain that began 4 hours after the patient's last meal. The nurse suspects a myocardial infarction (Ml) and knows that which laboratory result will be used to diagnose it? Troponin I Serum amylase International normalized ratio (INR) Prothrombin time/partial thromboplastin time (PT/PTT)

Troponin I Rationale Troponin lis produced by cardiac muscle afteran injuy. Serum amylase, INR, and PT/PTT may be tested, but troponin is produced only by injured cardiac muscle and is indicative of an Ml.

Which drugs increase serotonin levels in patients undergoing selective serotonin reuptake inhibitor therapy? Select all that apply. Cimetidine Tryptophan Carbamazepine Amphetamines Pseudoephedrine

Tryptophan Amphetamines Pseudoephedrine Rationale Tryptophan, amphetamines, and pseudoephedrine increase serotonin levels when used concurrently with selective serotonin reuptake inhibitors. The supervision of a healthcare provider is required if these drugs are used together. Cimetidine inhibits the metabolism of paroxetine and sertraline. Patients undergoing cimetidine and paroxetine therapies simultaneously should be closely monitored. Concurrent use of carbamazepine and fluoxetine increases the concentration of carbamazepine, causing toxicity.

Which conditions are the key characteristics found in individuals who have been diagnosed with metabolic syndrome? Select all that apply. Type 1 diabetes mellitus Type 2 diabetes mellitus Abdominal obesity Generalized obesity Hypertriglyceridemia

Type 2 diabetes mellitus Abdominal obesity Hypertriglyceridemia Rationale Individuals who are diagnosed with metabolic syndrome exhibit type 2 diabetes mellitus, abdominal obesity, and hypertriglyceridemia. Individuals who are diagnosed with metabolic syndrome do not typically exhibit type l diabetes mellitus or generalized obesity.

A patient in the terminal stage of acute myeloid leukemia has become unconscious On examination, the nurse finds that the patient's mouth is very dry. How should the nurse help the patient to restore the moisture? Select all that apply. Give ice chips. Give sips of fluids. Use moist cloths for the oral mucosa. Provide complete and regular oral care. Apply lubricant to the lips and oral mucous membrane as needed.

Use moist cloths for the oral mucosa. Provide complete and regular oral care. Apply lubricant to the lips and oral mucous membrane as needed. Rationale Dehydration can occur in the last stages of life. The nurse must continuously assess for excessive dryness to prevent any discomfort. In an unconscious patient, the nurse must use moist cloths or swabs to prevent aspiration. Providing complete and regular oral care provides comfort to the patient and prevents dehydration of mucous membranes Applying lubricant to the lips and oral mucous membrane helps in moisturizing the lips. In a conscious patient, ice chips and sips of fluids can be given.

Which type of arrhythmia is the most serious? Atrial fibrillation Sinus bradycardia Ventricular fibrillation Supraventricular tachycardia

Ventricular fbrillation Rationale Ventricular fibrillation is a medical emergency that will result in death if left untreated. It is a state whereby the ventricles are quivering with disorganized electrical and mechanical activity. Treatment including cardiopulmonary resuscitation (CPR)and defibrillation is essential and must be performed promptly (ideally within 20 seconds) to give the patient the best chance of recovery. Atrial fibrillation, although serious, is not as imminently life-threatening as ventricular fibrillation. In atrial fibrillation, electrical activity is disorganized, and the atria quiver at a rate of350 to 600 per minute rather than contracting in an organized manner. The ventricular response may be l00 to l80 beats/min, and the patient experiences decreased cardiac output along with symptoms of palpitations, dyspnea, syncope, light-headedness, decreased level of consciousness, and pulmonary edema. Treatment involves slowing the ventricular rate, treating the atrial irritability, and treating the cause of the arrhythmia Sinus bradycardia is a slow rhythm that originates in the sinoatrial(SA) node and is characterized by a rate of fewer than 60 beats/min. Causes can include obstructive sleep apnea, vomiting, intracranial tumors, myocardial infarction, vagal stimulation, endocrine disorders, and hypothermia. It may be completely normal in athletes. Treatment of sinus bradycardia depends on the cause. Supraventricular tachycardia is the sudden onset of a rapid heartbeat, originating in the atria. It is characterized by a pulse rate of l50 to 250 beats/min. The patient with supraventricular tachycardia may experience palpitations, light-headedness, dyspnea, and angina.

A patient has been admitted to hospice with end-stage colon cancer. During the initial assessment, the patient tells the nurse that there is squeezing pain on the left side of the abdomen. The nurse performing the assessment knows this as what type of pain? Visceral Somatic Generalized Neuropathic

Visceral Rationale Visceral pain originates from the internal organs. The words commonly used to describe the pain are cramping, pressure, dull, or squeezing Somatic pain arises from the musculoskeletal system;itis described as aching, stabbing, or throbbing. Generalized pain is nonspecifc pain and is usally described as aching ll over. Neuropathic pain is initiated from the nerves or nervous system and is usally described as tingling, burning, or shooting.

A nurse is reviewing the medication administration record of a patient on hospice for terminal cancer. The nurse notes the patient is administered droperidol Inapsine) daily. The nurse knows this patient is likely experiencing which symptom? Pain Anxiety Vomiting Constipation

Vomiting Rationale Droperidol (lnapsine) is used in the treatment of frequent vomiting. Pain can be treated with various opioid and nonopioid analgesics. Anxiety is treated with medications such as lorazepam (Ativan) Constipation is treated with stool softeners or laxatives.

Which statements regarding the antidepressant drug vortioxetine are correct? Select all that apply. Vortioxetine is an agonist of the serotonin 5-HTlAreceptors. Vortioxetine may result in renal failure. A patient taking vortioxetine may experience episodes of dizziness. The use of monoamine oxidase inhibitors (MAOls) with vortioxetine may cause excitement, diaphoresis, rigidity, convulsions, and possible death. Vortioxetine inhibits serotonin and norepinephrine reuptake from the neuronal cleft.

Vortioxetine is an agonist of the serotonin 5-HTlAreceptors. A patient taking vortioxetine may experience episodes of dizziness. Use of monoamine oxidase inhibitors (MAOls) with vortioxetine may cause excitement, diaphoresis, rigidity, convulsions, and possible death. Rationale Vortioxetine is a new medication that acts as a selective serotonin reuptake inhibitor, an agonist of the serotonin 5-HTlA receptors that enhances serotonin activity, and antagonizes the serotonin 5-HT 3receptors. The patient can experience episodes of dizziness. The nurse should provide for patient safety during these episodes. Severe reactions-including excitement, diaphoresis, rigidity, convulsions, hyperpyrexia, and death-may result from the concurrent use of MAOls and vortioxetine. Vortioxetine does not cause renal failure. Vortioxetine does not inhibit serotonin and norepinephrine reuptake from the neuronal cleft.

Which statement about metabolic syndrome is true? Treatment requires a generalized approach. Drinking alcohol may delay the onset of metabolic syndrome. Weight loss and increased physical activity are usually the first steps of treatment. Medications are a required part of treatment.

Weight loss and increased physical activity are usually the first steps of treatment. Rationale Weight loss and increased physical activity are usually the first steps to treatment. Reducing the number of calories consumed, while at the same time burning more calories, can have positive effects in reducing metabolic syndrome. Because a variety of factors are associated with the presence of metabolic syndrome, an individualized approach to treatment based on a person's specific risk factors and diseases present is required. Drinking alcohol, which is high in carbohydrates increases the risk of developing metabolic syndrome; thus patients should be instructed to avoid alcohol. Lifestyle management, which includes diet and increased physical activity, is usually the first step to treating and preventing metabolic syndrome. If after lifestyle modifications, diet, and exercise the patient is not able to meet therapeutic goals, then drug therapy may be necessary.

Which specific test does the nurse anticipate will be ordered by the healthcare provider for a patient who has been prescribed clozapine? Blood glucose level Daily weight Serum electrolyte levels White blood cell (WBC) count

White blood ell (WBC) count Rationale With clozapine therapy, there is a high incidence of agranulocytosis; WBCs should be monitored for patients taking this drug. Fora patient taking an antipsychotic medication, check the patient's electrolyte levels, body weight, waist circumference, height, blood glucose level, lipid profile, hepatic function, cardiac function, and thyroid function before initiating therapy and periodically throughout the course of treatment.

Which statement describes the correct use of antipsychotic drugs? Agitation should always be treated with sedating drugs. Withdrawn patients do not always need to be treated with nonsedating drugs. Atypical antipsychotic agents cause a higher incidence of hyperprolactinemia. Typical antipsychotic agents are more effective in relieving schizophrenia symptoms.

Withdrawn patients do not always need be treated with nonsedating drugs. Rationale Despite practice trends, no proof exists that withdrawn patients respond best to nonsedating drugs. There is no proof that agitation responds best to sedating drugs Atypical antipsychotic agents cause a lower incidence of hyperprolactinemia Atypical agents also tend to be more effective in relieving negative and cognitive symptoms associated with schizophrenia.

Which atypical antipsychotic drug causes the least weight gain? Olanzapine Quetiapine Ziprasidone Risperidone

Ziprasidone Rationale Ziprasidone causes the least weight gain. Olanzapine causes the most weight gain. Quetiapine and risperidone cause moderate weight gain.

because the family is confused about the meaning of palliative care the hospice nurse needs to explain the focus of care. What is the focus of palliative care? A form of organized care, which relieves the family of responsibility Integrated service of support for alleviation of symptoms An aggressive approach to prolong the life A protocol of pain relief

an integrated service of support for alleviating of symptoms

The largest artery in the body is the Brachial Aorta Carotid Jugular

aorta

the semilunar valves are the aortic and mitral aortic and pulmonary pulmonary and bicuspid mitral and bicuspid

aortic and pulmonary

the valve preventing blood from backflow to the left ventricle is the pulmonary valve aortic valve tricuspid valve mitral valve

aortic valve

The nurse is assessing a patient who is being evaluated for hyperlipidemia. Which assessment will most increase the risk for coronary artery disease? Walks 3 miles briskly, usually 4 days a week Blood pressure, 168/90 mm Hg Hemoglobin A1c, 6% Eats five servings of fruits and vegetables daily

blood pressure 168/90 mm Hg

An abnormally slow heart rate is termed tachycardia bradycardia palpitations bradypnea

bradycardia

the heart sound that is heard when the semilunar valves closed is of short duration and a sharp sound is usually described by the syllable? lubb gallop dubb snub

dubb

The nurse is preparing medications for a patient. When is the best time for the nurse to administer lovastatin (Mevacor)?

during the patients dinner Lovastatin is in a class of medications called HMG CoA reductase inhibitors (statins). It works by slowing the production of cholesterol

the nurse caring for a patient recovering from a myocardial infract who is on remote telemetry recognizes the need add instruction when the patient says

i always take the telemetry device when i shower

Which medication is a second-generation antipsychotic agent? Trifuoperazine Loxapine iloperidone Fluphenazine

iloperidone Rationale Second-generation antipsychotic agents are known as atypical antipsychotic agents iloperidone is an example of an atypical antipsychotic agent. Trifluoperazine, loxapine, and fluphenazine are typical, or first-generation, antipsychotic agents.

A 53 year old patient with a history of dysrthymias is to wear a holster monitor. The nurse should explain that the holster monitors?

is a portable electrocardiographic device

what is the overall objective of hospice service?

keep the patient comfortalbe as death approaches

the heart chamber that receives blood from the lungs is the left atrium right atrium right ventricle left ventricle

left atrium