patho/pharm exam 2
Which anti-inflammatory drug inhibits only one type of cyclooxygenase? a) Celebrex b) Nuprin c) Ecotrin d) Motrin
Answer: A Rationale: Celecoxib (Celebrex) inhibits only one type of the enzyme cyclooxygenase, COX-2. However, ibuprofen (Advil, Motrin, Nuprin) and aspirin (Bayer, Ecotrin) elicit a change in both types of cyclooxygenase, COX-1 and COX-2.
Identify either Cell-Mediated or Humoral immune response based on the description. 1. T-cells produce cytokines 2. B lymphocytes become plasma cells 3. Cytokines kill antigens 4. Plasma cells produce immunoglobulins 5. T lymphocytes are cloned 6. B cells are cloned 7. Cytokines strengthen macrophages 8. Antibodies code antigens for elimination
Answer: 1. Cell-Mediated 2. Humoral 3. Cell-Mediated 4. Humoral 5. Cell-Mediated 6. Humoral 7. Cell-Mediated 8. Humoral
Your client, Mario Sabatini, has survived myocardial infarction. Mr. Sabatini has just been prescribed carvedilol (Coreg) for hypertension and left ventricular dysfunction. In reviewing Mr. Sabatini's medical history, you see that he also suffers from occasional bronchial asthma attacks. As his nurse, what should you do? a) Question the prescription of an alpha-adrenergic antagonist. b) Question the prescription of a nonselective beta-adrenergic antagonist. c) Question the prescription of an adrenergic agonist. d) Question the prescription of a selective beta1-adrenergic antagonist.
Answer: Rationale: As the nurse, you should question the prescription of carvedilol (Coreg), a nonselective beta-adrenergic antagonist, because it may cause adverse effects such as bronchospasms in clients with COPD or asthma. Carvedilol is classified as a nonselective beta-adrenergic antagonist, not a selective beta1-adrenergic antagonist, an alpha-adrenergic antagonist, or an adrenergic agonist.
Your client, Mrs. Valya Nelson, has been taking celecoxib (Celebrex) for three years for rheumatoid arthritis. She recently self-medicated with 800 mg of ibuprofen (Advil) twice a day for pain. Mrs. Nelson reports being chronically tired. Her eyes and skin are jaundiced. What adverse effect do you suspect? a) High cholesterol b) Liver dysfunction c) Kidney disease d) Low potassium
Answer: Rationale: Jaundice is due to liver dysfunction, which is an adverse effect resulting from the client's use of celecoxib and ibuprofen. Kidney disease, high cholesterol, and low potassium do not lead to symptoms of jaundice.
What is the most common physical issue related to Non-steroidal Anti-inflammatory Drug (NSAID) therapy that the nurse should assess for before and during administration? a) Gastrointestinal (GI) bleeding b) Autoimmune disorder c) Migraine d) Dysrhythmia
Answer: Rationale: The most common major concern with the administration of Non-steroidal Anti-inflammatory Drug (NSAID) is a client history or occurrence of GI bleeding or peptic ulcer disease. The client may be receiving the NSAID due to an autoimmune disorder. Migraines and dysrhythmias are not contraindications for NSAID therapy, but they should be monitored.
Arrange the steps of an initial acute inflammatory response in the correct order. 1. Pathogen is destroyed 2. Pathogen invades 3. Nearby blood vessels dilate 4. Chemical mediators are released 5. Proteins enter affected area 6. Damage is repaired 7. Capillaries become permeable
Answer: 2, 4, 3, 7, 5, 1, 6
Following administration of phenylephrine (Neo-Synephrine), the nurse would assess for which of the following adverse drug effects? a) Insomnia, nervousness, hypertension b) Nausea, vomiting, hypotension c) Dry mouth, drowsiness, dyspnea d) Increased bronchial secretions, hypotension, and bradycardia
Answer: A Rationale: Adrenergic agonists such as phenylephrine (Neo-Synephrine) stimulate the sympathetic nervous system and produce symptoms including insomnia, nervousness, and hypertension. Options B, C, and D are incorrect. Nausea, vomiting, and drowsiness are not adverse effects known to occur with adrenergic agonists. Hypotension and bradycardia are potential adverse reactions related to the use of adrenergic antagonists. Dry mouth may occur from anticholinergics, and increased bronchial secretions are an effect of cholinergic agents. Dyspnea is not an adverse reaction related to adrenergic agonists, and adrenergic may be ordered for bronchodilation properties.
Cheryl Jones brings her 6-month-old infant to your clinic for a well-child checkup and immunizations. Mrs. Jones asks if the baby will have any side effects from the immunizations. How should you respond? a) Many children experience malaise, fever, irritability, and poor appetite. b) You may see redness and tenderness at the injection site but not a severe systemic response. c) Adverse effects from immunizations are uncommon. d) Don't be concerned if your child becomes very sleepy or has labored breathing.
Answer: A Rationale: Common adverse effects associated with immunizations include malaise, fever under 103°F (39.4°C), irritability, and poor appetite. Although slight redness may be seen at the administration site, the aforementioned adverse effects are systemic and common. Parents should seek immediate medical attention if serious side effects occur, including fever greater than 103°F (39.4°C), seizures, difficulty breathing, or decreased level of consciousness.
A 24 year old patient reports taking acetaminophen (Tylenol) fairly regularly for headaches. The nurse knows that a patient who consumes excessing acetaminophen per day or regularly consumes alcohol should be observed for what adverse effect? a) Hepatic toxicity b) Renal damage c) Thrombotic effects d) Pulmonary damage
Answer: A Rationale: Excessive doses of acetaminophen or regular consumption of alcohol may increase the risk of hepatic toxicity when acetaminophen is used. Options B, C, and D are incorrect. Renal or pulmonary toxicity and thrombotic events are not adverse effects associated specifically with acetaminophen.
Which category of immunosuppressants is developed by first injecting human T cells, B cells, or thymocytes into animals? a) Monoclonal antibodies b) Calcineurin inhibitors c) Cytotoxic agents d) Antimetabolites
Answer: A Rationale: Monoclonal antibodies are made by first injecting human T cells, B cells, or thymocytes into animals. The animals' immune systems recognize these cells as foreign, and produce antibodies against them. The animals' antibodies are later injected into humans in an effort to destroy T cells or T-cell receptors (polyclonal antibodies). Calcineurin inhibitors are immunosuppressants that target the enzyme calcineurin. Cytotoxic agents work by killing B cells and T cells, and antimetabolites work by suppressing B and T cell replication.
Neil McLean is an 80-year-old male client who has Parkinson's disease. His health care provider just prescribed benztropine (Cogentin), a muscarinic antagonist. Considering the possible adverse effects of this type of medication, what aspect of Mr. McLean's health history causes you concern? a) Difficulty with urination b) Muscular tremors c) Muscular rigidity d) Excessive sweating
Answer: A Rationale: Muscarinic antagonists, such as benztropine (Cogentin), can cause urinary retention, which poses a threat to males with enlarged prostates. Benztropine is used to reduce muscular tremors and rigidity in clients who have Parkinson's disease, so these symptoms do not present any contraindications to using this drug. Muscarinic antagonists typically decrease sweating, so the client's excessive sweating is not a cause for concern.
The patient or family of a patient taking neostigmine (Prostigmin) should be taught to be observant for which of the following adverse effects that may signal that a possible overdose has occurred? a) Excessive sweating, salivation, drooling b) Extreme constipation c) Hypertension and tachycardia d) Excessively dry eyes and reddened sclera
Answer: A Rationale: Overdosage of parasympathomimetics (cholinesterase-inhibitors) such as neostigmine (Prostigmin) may produce excessive sweating, drooling, dyspnea, or excessive fatigue. These symptoms should be promptly reported. Options B, C, and D are incorrect. Diarrhea is an adverse effect associated with cholinergics and cholinesterase-inhibitors, not constipation. Hypertension, tachycardia, dry eyes, or reddened sclera are not associated with these drugs.
The nurse is assessing the skin of a newly admitted 70-year-old client when a rash is noted on the trunk of the body. What condition, caused by a virus but preventable by vaccination, does the nurse suspect? a) Shingles b) Psoriasis c) Atopic dermatitis d) Rheumatoid arthritis
Answer: A Rationale: Shingles is caused by the varicella zoster virus, which can be prevented by vaccination. Psoriasis is an inflammatory skin condition associated with an autoimmune response. Psoriasis is characterized by plaques with surrounding inflammation. Atopic dermatitis, also referred to as eczema, is a chronic skin condition. It can be exhibited as oozing blisters or dry patches on the skin. Rheumatoid arthritis is a chronic, progressive autoimmune disease that causes joint inflammation and disfigurement of the affected joints.
The nurse is preparing an oral dose of a sulfonamide antibiotic for an adult male client with a urinary tract infection. Which describes the action of sulfonamide medications? a) Sulfonamides are folic acid inhibitors. b) Sulfonamides are considered a specific antibiotic. c) Sulfonamides only work on the kidney. d) Sulfonamides are calcium inhibitors.
Answer: A Rationale: Sulfonamides inhibit the synthesis of folic acid and stop bacteria from growing; they have no effect on calcium metabolism. Sulfonamides work on the entire urinary tract. Sulfonamides are used because they are broad-spectrum antibiotics that are effective against both gram-negative and gram-positive bacteria, making them very effective in urinary tract infections
The nurse is monitoring a client for adverse effects associated with the administration of an adrenergic antagonist. The nurse correctly teaches the client that which adverse effect is related to the first-dose phenomenon? a) Syncope b) Urinary hesitancy c) Blurred vision d) Edema
Answer: A Rationale: Syncope is an adverse effect of adrenergic antagonists that is related to the first-dose phenomenon. Urinary hesitancy, blurred vision, and edema are potential adverse effects of adrenergic antagonists, but are not related to the first-dose phenomenon.
When vaccinations are administered to prevent disease, what is the result called? a) Active immunity b) Passive immunity c) Immunosuppression d) Immunoactivation
Answer: A Rationale: When an individual is vaccinated with a foreign protein, the immune system responds by producing memory B cells or T cells. When an individual is vaccinated with a foreign protein, we refer to it as providing active immunity. Some vaccines require periodic boosters to maintain this immunity. Passive immunity is received from another person, such as an infant receives from a mother. Immunosuppression refers to agents that suppress the immune system. Immunoactivation refers to general stimulation of the immune system, not a specific type of immunity.
To avoid the first-dose phenomenon, the nurse knows that the initial dose of prazosin (Minipress) should be: a) Very low and given at bedtime b) Doubled and given before breakfast c) The usual dose and given before breakfast d) The usual dose and given immediately after breakfast
Answer: A Rationale: Drugs that cause a "first-dose phenomenon" should have very low initial doses administered at bedtime. The decline in blood pressure due to prazosin is often marked when beginning pharmacotherapy and when increasing the dose. This "first- dose phenomenon" can lead to syncope due to reduced blood flow to the brain. Options B, C, and D are incorrect. Doses of antihypertensive medications should never be doubled, but should be gradually increased to avoid hypotension, and the best time to give prazosin in the initial phases of therapy is at bedtime.
The nurse is assessing a client with tonsillitis. The client asks the nurse why the tissues in the neck seem swollen. Which nursing response is best? a) "Your lymph nodes and tissues sometimes swell in attempts to fight infection." b) "The swelling is a direct effect of histamine being released throughout the body." c) "The neck area contains proteins that collect and cause the swelling." d) "T cells are activated in the neck area, which causes the neck to swell."
Answer: A Rationale: Lymph tissues and nodes located throughout the body filter pathogens during infection, and may swell because of this action. This response by the nurse answers the question best. It is not true that proteins collect and cause swelling; proteins that inhibit infection are located in the mucous membranes. Histamines are released to start the inflammatory process, but the histamine does not cause the swelling. T cells are a part of the cell-mediated immune response, which is not related to the swelling of the lymph tissue.
A patient who is taking an adrenergic-blocker for hypertension reports being dizzy when first getting out of bed in the morning. The nurse should advise the patient to: a) Move slowly from the recumbent to the upright position b) Drink a full glass of water before rising to increase vascular circulatory volume c) Avoid sleeping in a prone position d) Stop taking the medication
Answer: A Rationale: The nurse should suspect that the patient is describing orthostatic hypotension induced by the medication. Most patients find it helpful to move slowly from a recumbent position to avoid dizziness and syncope. Options B, C, and D are incorrect. Although drinking a full glass of water with the medication is a health promotion activity that the nurse might suggest, this action does not eliminate orthostatic hypotension. Sleeping positions do not influence the presence of orthostatic hypotension. The patient should never abruptly stop taking antihypertensive medication. Such action could result in hypertensive crisis, stroke, or heart attack.
What are the most common routes of administration for immunizing agents? ***Select all that apply. a) Intranasal b) Deltoid injection c) Subcutaneous d) Rectal e) Sublingual
Answer: A, B, C Rationale: The most common routes of administration for vaccinations are intranasal, deltoid injection, and subcutaneous injection. Vaccinations are not routinely given through the rectal or sublingual routes.
Which nonspecific body defenses are considered the first line against infection? ***Select all that apply. a) Mucous membranes b) Cilia c) Skin d) Lymph node e) Phagocytes
Answer: A, B, C Rationale: The body's external, nonspecific defenses -the skin and mucous membranes - are its first line of defense. Mucous membranes contain cilia, microscopic, hair-like projections that inhibit the growth of pathogens. The body's internal, nonspecific defenses, such as phagocytes, natural killer cells, and lymph nodes, are its second line of defense.
The nurse is assessing an adult client with signs of a serious bacterial infection. Which facts about the etiology of bacterial infections will guide the nurse's assessment when looking for sources of infection? ***Select all that apply. a) Bacteria can be inhaled. b) Bacteria can enter the body through mucous membranes. c) Bacteria can enter a break in the skin. d) Bacteria can be found in food products. e) Bacteria can be generated by the immune system.
Answer: A, B, C, D Rationale: Bacteria, often more generally called pathogens, can enter the body in several ways and cause a bacterial infection. Pathogens can enter the body through a break in the skin, inhalation, ingestion with food products, or through mucous membranes. Bacteria are not generated by the immune system; the immune system is the body system that fights infection.
The nurse is caring for a client who is receiving glycopyrrolate (Robinul) for the treatment of peptic ulcer disease. The nurse should assess the client for which symptoms that indicate the presence of an anticholinergic crisis? ***Select all that apply. a) Fever b) Confusion c) Dysphagia d) Hallucinations e) Incontinence
Answer: A, B, C, D Rationale: Dysphagia, confusion, fever, and hallucinations are all symptoms of an anticholinergic crisis. Urinary retention, not incontinence, is a symptom of an anticholinergic crisis.
Prostaglandins provide several beneficial effects. Which beneficial effects are reduced when aspirin (Bayer) is used? ***Select all that apply. a) Blood flow to the kidneys b) Maintenance of bronchial smooth muscle c) Clotting of blood d) Reduction of inflammation e) Protection from stomach acid
Answer: A, B, C, E Rationale: Aspirin (Bayer) reduces these beneficial effects provided by prostaglandins: protecting the stomach against acid; making sure the kidneys receive sufficient blood flow; maintaining smooth muscles in the uterus, blood vessels, and bronchial tubes; and clotting of blood. Aspirin, not prostaglandins, decreases inflammation.
Before administering a cholinergic antagonist to a client, for what should you specifically assess? ***Select all that apply. a) Bowel and bladder habits b) History of glaucoma c) History of malignant hyperthermia d) Skin elasticity e) Symptoms of cholinergic crisis
Answer: A, B, C, E Rationale: Before administering cholinergic antagonists, be sure to assess for history of glaucoma and assess bowel and bladder habits. If symptoms of cholinergic crisis are observed, a cholinergic antagonist should not be administered. Skin elasticity is irrelevant to this class of medication. A personal or family history of malignant hyperthermia must be assessed before administering a cholinergic antagonist, as this history contraindicates the use of these medications.
The nurse is preparing to educate a client who has been prescribed an adrenergic agonist inhaler. The nurse should include which instructions in the client education? ***Select all that apply. a) Avoid sharing the inhaler with other family members. b) Sit straight up when administering the inhaler. c) Rinse the mouth with water after using the inhaler. d) Monitor for rebound congestion. e) Shake the inhaler prior to administration.
Answer: A, B, C, E Rationale: Clients should be taught to sit straight up when administering an inhaler, to shake the inhaler prior to administration, to rinse the mouth with water after using the inhaler (to decrease the risk of infection), and not to share their inhalers with family members. Clients should not be taught to monitor for rebound congestion; this is only appropriate for a client who uses a nasal spray.
The nurse is providing discharge teaching to a client prescribed steroids for long-term use. Which adverse effects should the nurse include in the discussion? ***Select all that apply. a) Porous bones (osteoporosis) b) Obesity c) Cataracts d) Hypotension e) Changes in mental status
Answer: A, B, C, E Rationale: Osteoporosis, the development of cataracts, changes in mental status, and weight gain are all possible adverse effects of long-term steroid use. Hypertension, not hypotension, can result from long-term steroid use.
The charge nurse is giving a pharmacology lecture on bacterial infections to new employees. Which factors that affect a microorganism's ability to cause infection could the nurse include in the discussion? ***Select all that apply. a) The microorganism's invasiveness b) The ability of the microorganism to avoid the body's defenses c) The organism's release of exotoxins d) The microorganism's shape e) How quickly the organism can multiply
Answer: A, B, C, E Rationale: Several factors directly affect a microorganism's ability to cause infection, including the rate at which the microorganism can reproduce, the microorganism's ability to avoid the body's natural defense mechanisms, the ability of the microorganism to invade the body directly, and the microorganism's release of exotoxins. The shape of a microorganism is not directly related to its ability to cause infection.
Anticholinergics may be ordered for which of the following conditions? ***Select all that apply. a) Peptic ulcer disease b) Bradycardia c) Decreased sexual function d) Irritable bowel Syndrome e) Urine retention
Answer: A, B, D Rationale: Anticholinergics are used in the treatment of peptic ulcer disease, irritable bowel syndrome, and bradycardia because they suppress the effects of Ach and stimulate the sympathetic nervous system. Options C and E are incorrect. Anticholinergics may cause decreased sexual function because the parasympathetic impulses are blocked. Urine retention is a potential adverse effect of anticholinergics.
When administering a vaccination to a client, what should the nurse consider? ***Select all that apply. a) Route of administration b) Dose and timing c) Time of last food intake d) Precautions and contraindications e) Anaphylaxis and adverse reactions
Answer: A, B, D, E Rationale: Several vaccines must be given at scheduled time periods to maintain immunity. Some vaccines also require booster doses. The nurse must know the proper route of administration before administering a vaccine. The nurse also needs to consider precautions and contraindications, to ensure that the vaccine is not administered to individuals whom the drug will harm. The nurse must know, be able to identify, and teach clients the clinical manifestations of anaphylaxis and adverse reactions, to ensure client safety. The time that the client last ate is not a factor in the administration of vaccines.
The nurse is teaching a client how to recognize the symptoms of a cholinergic crisis. The nurse knows that the client understands the information when she identifies which as symptoms of this type of crisis? ***Select all that apply. a) Muscle weakness b) Headache c) Mydriasis d) Nausea e) Rapid heart rate
Answer: A, B, D, E Rationale: Nausea, tachycardia, muscle weakness, and headache are symptoms associated with a cholinergic crisis. Miosis (constriction of pupils), not mydriasis (dilation of pupils), is a symptom associated with a cholinergic crisis.
The nurse is reviewing the use of acetylsalicylic acid (aspirin [Bayer]) in the client population. Which clients could benefit from the use of aspirin? ***Select all that apply. a) A client with mild back pain after a fall b) An adult client with a fever c) A client with gastrointestinal bleeding d) A client with inflammatory arthritis e) A client with primary dysmenorrhea
Answer: A, B, D, E Rationale: The analgesic action of aspirin reduces mild to moderate pain. The inflammatory action of aspirin reduces pain in clients with arthritis. Aspirin can be given to decrease painful menstruation (dysmenorrhea). Aspirin has antipyretic actions to reduce fever but should only be given to adults, not children, because aspirin increases the risk of Reyes Syndrome in children with flu-like symptoms and chicken pox. Aspirin use is contraindicated in clients with gastrointestinal bleeding because it reduces platelet aggregation and could cause serious bleeding.
When administering a recommended dose of acetaminophen (Tylenol) to an adult client, what results can you expect? ***Select all that apply. a) Reduction of pain b) Reduction of fever c) Reduction of inflammation d) No progression of inflammation e) Few adverse effects
Answer: A, B, E Rationale: Acetaminophen (Tylenol) is used to reduce fever and mild to moderate pain. Although life-threatening effects can occur with chronic ingestion or overdose, adverse effects in adults are typically negligible when taken in recommended doses for a short period of time. It does not have anti-inflammatory properties.
Which signs are associated with aspirin (Bayer) toxicity? ***Select all that apply. a) Tinnitus b) Stomach discomfort c) Blood clots d) Inflammation of joints e) Decreased hearing
Answer: A, B, E Rationale: Signs of an aspirin overdose include tinnitus, stomach discomfort, and decreased hearing. Aspirin may prevent blood clots, not cause them; it also acts as an anti-inflammatory agent, not an inflammatory agent.
Which two factors affect a micro-organism's ability to cause a bacterial infection? a) Cellular structure and sensitivity b) Pathogenicity and virulence c) Susceptibility and immune response d) Invasiveness and toxicity
Answer: B Rationale: Pathogenicity and virulence determine a micro-organism's ability to cause infection. Pathogenicity refers to how quickly the organism can multiply, and its ability to avoid the body's natural defense mechanisms. Virulence is the measurement of the micro-organism's pathogenicity, which is related to invasiveness and toxicity (release of exotoxins and endotoxins). Cell structure, sensitivity, and susceptibility are subfactors related to the severity of the infection.
If a client has a fever, why may immunostimulant drug therapy have to be delayed? ***Select all that apply. a) Fever makes it harder to distinguish adverse effects of drug therapy from effects of the infection. b) Fever increases the needed duration of immunostimulant drug therapy. c) Fever puts the client more at risk for drug adverse effects. d) Fever indicates the need to choose a different medication regimen. e) Fever indicates the need for intravenous antibiotics to be added to the prescribed therapy.
Answer: A, C Rationale: Before starting drug therapy, the nurse assesses the client for any signs of infection. Administration of immunostimulants may have to be delayed for clients with an elevated temperature, because fever may put the client more at risk for drug adverse effects. Fever also makes it harder to distinguish between adverse effects caused by the drug therapy and adverse effects caused by the infection. The presence of a fever does not indicate the need to select a different medication regimen, nor does it indicate the need for intravenous antibiotics. In addition, fever does not affect the length of time for which immunostimulant drug therapy is prescribed.
In nervous system communication, what happens with neurotransmitters when the action potential reaches the synaptic cleft? ***Select all that apply. a) They are released by presynaptic neuron vesicles. b) They are absorbed into presynaptic neuron vesicles. c) They help move the impulse across the cleft. d) They use the mechanism of diffusion. e) They block the mechanism of diffusion.
Answer: A, C, D
Before administering an adrenergic agonist, for what health conditions should the nurse assess in particular? ***Select all that apply. a) Hypertension b) Psoriasis c) Hyperthyroidism d) Diabetes e) Angina
Answer: A, C, D, E Rationale: As the nurse, you should assess the client for any health conditions that may cause complications with using an adrenergic agonist drug, including hypertension, angina, diabetes, and hyperthyroidism. You may note psoriasis, but it is not known to cause complications in using an adrenergic agonist.
The nurse is teaching a client how anti-epileptic medications can be used to treat her seizure disorder. The nurse plans the teaching based on the knowledge that medications affect the synaptic transmission through which means? ***Select all that apply. a) Increasing or decreasing neurotransmitter synthesis b) Enhancing the storage of neurotransmitters c) Preventing the breakdown of neurotransmitters d) Increasing or decreasing the release of neurotransmitters e) Stimulating or inhibiting the autonomic nervous system
Answer: A, C, D, E Rationale: Medications can both increase and decrease neurotransmitter synthesis and the release of neurotransmitters. Medications will inhibit (not enhance) the storage of neurotransmitters. Medications can stimulate or inhibit the autonomic nervous system and can prevent the breakdown of neurotransmitters.
The nurse is assessing an adult client who has been prescribed antibiotics for an infection. What signs and symptoms of a superinfection will the nurse include when educating the client before discharge? ***Select all that apply. a) Vaginal discharge b) Fine red rash c) Sore mouth d) Foul-smelling feces e) White patches in mouth
Answer: A, C, D, E Rationale: White patches in the mouth can be the result of a secondary or superinfection from antibiotic therapy. Vaginal discharge can be the result of a secondary or superinfection from antibiotic therapy. Foul-smelling feces may indicate a superinfection of the intestine while on antibiotic therapy. Sores in the mouth may indicate a superinfection resulting from antibiotic therapy. A fine red rash might indicate an allergic reaction, but not a superinfection.
The nurse is preparing to administer a beta-adrenergic antagonist to a client. The nurse anticipates that this medication will have which effects on the client? ***Select all that apply. a) Decreased force of myocardial contraction b) Increased blood pressure c) Decreased heart rate d) Increased conduction through the AV node e) Decrease in angina
Answer: A, C, E Rationale: Beta-adrenergic antagonists will decrease, not increase, the client's heart rate and blood pressure, conduction through the AV node, the force of myocardial contractions, and angina.
During the implementation phase of administering an adrenergic antagonist, for what adverse effects should you especially monitor? ***Select all that apply. a) Syncope b) Hypertension c) Tinnitus d) Double vision e) Orthostatic hypotension
Answer: A, C, E Rationale: During the implementation phase, you should monitor for adverse effects such as orthostatic hypotension, complications of syncope related to the first-dose phenomenon, edema, blurred vision, urinary hesitancy, and tinnitus. Hypertension and double vision are not adverse effects typically associated with the administration of an adrenergic antagonist.
The pediatric nurse is assessing a child in the clinic who has tested positive for an influenza virus. Assessment vital signs reveal a temperature of 102.4°F (39.4°C). Which medication does the nurse anticipate will be ordered for the client? Select all that apply. ***Select all that apply. a) Ibuprofen (Motrin) b) Brompheniramine/phenylephrine (Dimetapp) c) Diphenhydramine (Benadryl) d) Acetaminophen (Tylenol) e) Acetylcyclic acid (aspirin)
Answer: A, D Rationale: Acetaminophen is effective in reducing temperature in children and is not contraindicated in children. Ibuprofen is classified as a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen has antipyretic effects and is commonly used in children. Infants, children, and adolescents with flulike symptoms should not be given aspirin, due to the increased risk of Reye syndrome with this drug. Diphenhydramine is an antihistamine that does not lower body temperature. Brompheniramine/phenylephrine is a combination decongestant with no antipyretic properties.
The nurse is going over the side effects of penicillins with the parents of an infant who has a bacterial infection. Which side effects will the nurse include when educating the parents on possible allergic reactions? ***Select all that apply. a) Fever b) Abnormal crying c) Sensitivity to cephalosporins d) Urticaria e) Delayed skin reaction
Answer: A, D, E Rationale: An infant who shows sensitivity to penicillin may develop a skin rash. An infant on penicillin may develop a fever after taking the antibiotic. A delayed skin reaction can occur after taking penicillin for several days and even after discontinuing the medication. A cross-hypersensitivity to cephalosporins may occur if the infant develops an allergic reaction to penicillin. Abnormal crying is not an allergic reaction to penicillin; an infant may cry from the infection, pain, or discomfort of the illness, but the crying is not an allergic reaction. Sensitivity to cephalosporins would only occur when there is an actual allergic reaction it is not a side effect.
What instructions should you give to a client who is taking enteric-coated aspirin? ***Select all that apply. a) Do not crush or chew the medication. b) Take with 240 mL of water or milk. c) Stop medication 2 days before dental work. d) Avoid alcoholic beverages. e) Report pregnancy.
Answer: A, D, E Rationale: If your client is told to take enteric-coated aspirin, he/she must not crush or chew the tablet or capsule. As with all types of aspirin, alcoholic beverages should be avoided and pregnancy should be reported to the health care provider. Enteric-coated aspirin should not be taken with milk because the medication will dissolve too quickly. Clients who are scheduled for dental work or surgery must stop taking aspirin 7dash14 days prior to the surgery.
The nurse is caring for a child with pneumonia and fever of 100°F (38.1°C). The child's parent asks the nurse, "Why doesn't the doctor have something ordered for the temperature before it gets to 101 degrees?" Which is the nurse's best response? a) "Your doctor does not want to give your child unnecessary medication." b) "A low-grade fever can aid in defense and repair of the body." c) "A little fever is not going to hurt your child." d) "Don't worry. We will not let your child's temperature get too high."
Answer: B Rationale: A fever is part of the body's inflammatory response and, if not excessive, can assist in fighting an infection. Although "a little fever" is not harmful, this statement does not answer the parent's question. The responses that staff will prevent excessive temperature elevation and that unnecessary medication administration is to be avoided also do not answer the question the parent asked.
Tommy Powell and his mother have come to your clinic. Tommy is a 6-year-old who presents with symptoms of chickenpox. What is the drug of choice for controlling Tommy's fever and pain? a) Celecoxib (Celebrex) b) Acetaminophen (Tylenol) c) Aspirin (Bayer) d) Morphine sulfate (Duramorph)
Answer: B Rationale: Acetaminophen (Tylenol) is the drug of choice for infants, children, and adolescents who present with flu-like symptoms or chickenpox. Unlike aspirin (Bayer), acetaminophen is not known to place young clients at risk for Reye syndrome. Although celecoxib (Celebrex) is effective in decreasing pain and fever, celecoxib is generally given to adults, not children. Morphine sulfate (Duramorph), though effective for pain, is not indicated for the initial management of chickenpox.
The nurse is educating a client on the effects that adrenergic antagonists have on the body. Which statement by the client indicates appropriate understanding of the teaching provided? a) "My medication will cause my eyes to be dry." b) "My medication will decrease my heart rate." c) "My medication will increase my blood pressure." d) "My medication will cause my mouth to be dry."
Answer: B Rationale: Adrenergic antagonists illicit parasympathetic responses. Adrenergic antagonists decrease blood pressure and heart rate, but cause an increase in salivation and lacrimation.
A client is seen in the clinic after receiving a vaccination. Which reported clinical manifestation causes the nurse the most concern? a) Malaise b) Confusion c) Loss of appetite d) Irritability
Answer: B Rationale: Confusion could indicate an adverse reaction to the vaccination, which the nurse is required to report to the health care provider. Malaise, poor appetite, and irritability are possible side effects of the vaccine that do not require intervention.
The nurse is preparing to administer an indirect-acting cholinergic agonist to help promote chewing and swallowing for a client on a medical-surgical unit. When will the nurse plan to administer this medication? a) 60 minutes prior to meals b) 30 minutes prior to meals c) 15 minutes prior to meals d) Anytime within the medication administration window
Answer: B Rationale: Indirect-acting cholinergic agonists should be administered 30 minutes prior to meals to promote chewing and swallowing. Administration 15 minutes before the meal is not enough time to facilitate the desired reaction; 60 minutes prior to meals is too early, as the medication may lose its effectiveness before the client receives the meal.
The nurse is evaluating drug effects in a patient who has been given interferon alfa-2b (Intron-A) for hepatitis B and C. Which of the following is a common adverse effect? a) Depression and thoughts of suicide b) Flulike symptoms of fever, chills, or fatigue c) Edema, hypotension, and tachycardia d) Hypertension, renal or hepatic insufficiency
Answer: B Rationale: Interferon alfa-2b (Intron-A) commonly causes flulike symptoms in up to 50% of patients receiving the drug. Options A, C, and D are incorrect. Depression with suicidal thoughts, hypo- or hypertension, tachycardia, edema, and renal or hepatic insufficiency are not common adverse effects of the drug.
The nurse is teaching a group of clients with asthma about the ways in which adrenergic agonists stimulate the sympathetic nervous system. Which clinical effect is evidence of this type of stimulation? a) Decreased heart rate b) Dilated pupils c) Decreased blood pressure d) Increased peristalsis
Answer: B Rationale: Medication that stimulates the sympathetic nervous system will dilate the pupils. Medications that stimulate the sympathetic nervous system will increase blood pressure and heart rate, but not peristalsis.
The nurse in the neurological unit is discussing the nervous system with a colleague who was recently transferred to that unit. The nurse tells the colleague that the central nervous system communicates with the parasympathetic nervous system through which cells? a) Norepinephrine b) Neurons c) Epinephrine d) Acetylcholine
Answer: B Rationale: Neurons are nerve cells that enable the central nervous system to communicate with the parasympathetic nervous system. Acetylcholine, norepinephrine, and epinephrine are neurotransmitters that help accomplish the communication process.
Which is a potential effect of low-dose nicotinic agonists? a) Decreased pulse rate b) Increased blood pressure c) Relief of nausea d) Symptoms of sedation
Answer: B Rationale: Nicotinics, or nicotinic agonists, can have varied effects on the body. Possible adverse effects include increased blood pressure, pulse rate, and nausea. Mental alertness may also increase rather than decrease.
What term is used for infections acquired in the hospital? a) Mutated b) Resistant c) Transmitted d) Nosocomial
Answer: D Rationale: Infections acquired in the hospital setting are referred to as nosocomial infections or health care associated infections (HAIs). Many are from resistant strains of bacteria that may have resulted from mutations occurring in the original bacterial cell. Transmitted infections refer to all infections, no matter where they are acquired.
The nurse is assessing a client with abdominal pain and a history of daily non-steroidal anti-inflammatory drug (NSAID) use for 6 months. Which assessment finding causes the nurse the most concern? a) Nausea related to the intake of food b) Bright red blood in the stools c) Pain in the epigastric area of the abdomen d) Dry mucous membranes in the oral cavity
Answer: B Rationale: The blood in the stools could indicate an active bleed in the gastrointestinal tract, which would require immediate health care provider notification. Bleeding can occur with chronic non-steroidal anti-inflammatory drug (NSAID) use. The client is admitted with abdominal pain, so the finding of epigastric pain is to be expected, and may not have much significance unless other, more concerning symptoms are also present. Nausea would be treated, documented, and reported, but it would not be the nurse's major concern. An assessment finding of dry mucous membranes would require documentation and further investigation to check for dehydration and fluid depletion, but it would not be of as much concern as active bleeding.
The nurse is preparing to administer a cholinergic antagonist to a client on a medical-surgical unit. Which assessment parameter is most appropriate to review before administering this medication? a) History of diplopia b) History of glaucoma c) Muscle strength d) Ability to chew
Answer: B Rationale: The nurse would assess this client for a history of glaucoma, as cholinergic agonists may increase ocular pressure. The nurse would assess the client's ability to chew, problems with diplopia, and muscle strength prior to administering a cholinergic agonist, not a cholinergic antagonist.
The nurse is preparing to administer a metered-dose inhaler to a client with asthma. How long should the nurse instruct the client to wait before administering a second dose? a) At least 3 minutes b) At least 2 minutes c) At least 1 minute d) There is no need to wait between doses
Answer: B Rationale: The nurse would teach a client to wait at least 2 minutes between each dose of the metered-dose inhaler. The other answer options are not appropriate.
Which factor in the patient's history would cause the nurse to question a medication order for atropine? a) A 32 year old man with a history of drug abuse b) A 65 year old man with benign prostatic hyperplasia c) An 8 year old boy with chronic tonsillitis d) A 22 year old woman on the second day of her menstrual cycle
Answer: B Rationale: Atropine causes urinary retention to worsen in patients with BPH. Options A, C, and D are incorrect because they are not contraindications for using atropine.
The nurse is checking a client's blood pressure in preparation for administering an adrenergic antagonist medication. Which systolic blood pressure is unsafe for administering this class of medication? a) 130 mmHg b) 90 mmHg c) 110 mmHg d) 150 mmHg
Answer: B Rationale: It is not safe to administer the medication to a client whose systolic blood pressure is less than 100 mmHg. It is safe to administer the medication when systolic blood pressure reads 110 mmHg, 130 mmHg, or 150 mmHg.
A client with arthritis has been prescribed acetylsalicylic acid (aspirin [Bayer]). Which information should the nurse teach the client about the drug? ***Select all that apply. a) Expect black stools as a side effect. b) Avoid using alcohol while taking aspirin. c) Swallow the aspirin with a full glass of water, milk, or food. d) Stop using aspirin 7 to 14 days prior to any scheduled surgery. e) Use ear plugs for ringing in the ears.
Answer: B, C, D Rationale: Aspirin should be administered with adequate amounts of water, milk, or food to decrease the incidence of gastrointestinal irritation. Aspirin should be stopped prior to surgery and dental work to decrease the chance of excessive bleeding. Alcohol combined with aspirin increases the chance of stomach irritation. Any ringing in the ears or difficulty with hearing should be reported to the health care provider for possible intervention. Black, tarry stools are an adverse effect of aspirin and should be reported to the health care provider, because they could indicate bleeding in the gastrointestinal tract.
When the immune system chronically produces cytokines, what autoimmune conditions may result? ***Select all that apply. a) Malignant melanoma b) Rheumatoid arthritis c) Crohn disease d) Psoriasis e) Hepatitis C
Answer: B, C, D Rationale: Chronic, autoimmune disorders triggered by the immune system include rheumatoid arthritis, psoriasis, and Crohn disease. Hepatitis C is a viral infection and malignant melanoma is a type of skin cancer, neither of which are autoimmune disorders.
The nurse is preparing a teaching plan for administering immunizing agents. What should the nurse include as teaching points for clients or caregivers? ***Select all that apply. a) Expect a change in mental status after administering a vaccine. b) Be aware of common side effects of the vaccine. c) Comply with the vaccination schedule. d) Report a temperature over 103degreesF (39.4degreesC). e) A mild pain reliever to minimize pain or other discomforts may be administered.
Answer: B, C, D, E Rationale: Clients may experience a fever after immunizations have been administered, but a temperature greater than 103°F (39.4°C) should be reported. The schedule for the vaccinations must be adhered to for the vaccination to be effective in providing immunity. The common side effects of the vaccine should be taught so that the client/caregiver will know what to expect. The client/caregiver or nurse may administer a mild pain reliever to decrease some of the side effects (fever, pain at injection site) of the vaccine. Changes in mental status or a decrease in the level of consciousness are adverse reactions that should be reported to the health care provider; they are not expected to occur.
The nurse is describing how medication can affect synaptic transmission. The nurse correctly states that medications are capable of what actions? ***Select all that apply. a) Increasing the storage of neurotransmitters in synaptic vesicles b) Preventing the breakdown or reuptake of neurotransmitters after the action potential is conveyed c) Binding to the postganglionic cells to stimulate or inhibit the autonomic nervous system response d) Increasing or decreasing the release of neurotransmitters e) Increasing or decreasing neurotransmitter synthesis
Answer: B, C, D, E Rationale: Medications can affect synaptic transmission by increasing or decreasing neurotransmitter synthesis and by inhibiting (not increasing) the storage of neurotransmitters in synaptic vesicles, by binding to the postganglionic cells to stimulate or inhibit the autonomic nervous system response, and by increasing or decreasing the release of neurotransmitters. Medications can also prevent the breakdown or reuptake of neurotransmitters after the action potential is conveyed, causing the autonomic response to continue.
The nurse is teaching a client with an ankle sprain about the drug ibuprofen (Advil). What should be included in the teaching? ***Select all that apply. a) Expect to have visual changes. b) Report any unusual bruising to the health care provider. c) Do not take aspirin and ibuprofen together. d) Use sunscreen and protective clothing when outdoors. e) Avoid the use of alcohol while taking ibuprofen.
Answer: B, C, D, E Rationale: Clients taking ibuprofen should limit the amount of time in the sun and cover any exposed skin. The combination of aspirin and ibuprofen can increase the risk of adverse effects. The client should notify the health care provider of any bruising, which might indicate an adverse reaction to the drug. The use of alcohol in combination with ibuprofen can increase the risk of stomach irritation. Visual changes, such as blurriness or a decrease in vision, are not expected or normal with the use of ibuprofen, and should be reported to the health care provider.
The nurse is preparing a presentation for a group of newly hired nurses to give an overview of immunostimulants and the immune response system. Which points would the nurse include in the presentation? ***Select all that apply. a) T-cell lymphocytes are responsible for creating antibodies, used in the development of long-term immunity against antigens. b) The immune response protects the body against invading organisms or agents. c) Immunomodulators are drugs that increase the immune response in the body. d) B-cell lymphocytes regulate the body's immune response by releasing cytokines. e) Cytokines are the chemicals that help facilitate the body's immune response.
Answer: B, C, E Rationale: When a foreign substance enters the body, the immune system recognizes it as "non-self" and an immune response is triggered. Immunomodulators are drugs that affect the immune system's ability to defend the body; an immunostimulant is a type of immunomodulator. When a non-self organism is recognized, cell-to-cell communication to start an attack on the organism is accomplished by cytokine secretion. T-cell lymphocytes regulate the immune response by releasing cytokines. B-cell lymphocytes create antibodies used in the development of long-term immunity against antigens.
Which statements accurately describe the mechanisms of action of adrenergic drugs? ***Select all that apply. a) Sympathomimetics inhibit the SNS. b) Adrenergic antagonists inhibit the SNS. c) All adrenergic drugs produce a fight-or-flight response. d) Adrenergic agonists stimulate the SNS. e) Adrenergic agonists inhibit the SNS.
Answer: B, D Rationale: There are two primary groups of adrenergic drugs. Adrenergic agonists, also called sympathomimetics, stimulate the sympathetic nervous system (SNS). Adrenergic antagonists, also called adrenergic blockers, inhibit the SNS. Although both groups of drugs affect the SNS, only the adrenergic agonists mimic the SNS's fight-or-flight response. Adrenergic antagonists block this response.
What do anticholinergic medications do? ***Select all that apply. a) Stimulate the PNS b) Treat target SNS organ conditions c) Aid acetylcholine in binding to receptor sites d) Block acetylcholine from binding to receptor sites e) Inhibit the PNS
Answer: B, D, E Rationale: Anticholinergics, also called cholinergic antagonists, block acetylcholine (ACh) from binding at receptor sites; they do not aid ACh in binding to receptor sites. Anticholinergics are mostly used to inhibit - not stimulate - the parasympathetic nervous system (PNS). However, some anticholinergics are used to treat conditions in target organs related to the sympathetic nervous system (SNS).
A patient with a history of hypertension is to star drug therapy for RA. Which of the following drugs would be contraindicated, or used cautiously, for this patient? ***Select all that apply. a) Aspirin b) Ibuprofen (Advil, Motrin) c) Acetaminophen (Tylenol) d) Naproxen (Aleve) e) Methylprednisolone (Medrol)
Answer: B, D, E Rationale: NSAIDs such as ibuprofen and naproxen have been shown to increase the risk of serious thrombotic events, MI, and stroke which can be fatal. These drugs should be used cautiously or avoided in patients with HTN. Corticosteroids such as methylprednisolone may cause fluid retention, which may increase the patient's blood pressure. Cautious and frequent monitoring will be required if the patient takes this drug. Options 1 and 3 are incorrect. Aspirin or acetaminophen will not increase the patient's blood pressure. Acetaminophen would only provide pain relief without treating the underlying inflammation associated with RA.
Your client, Carrie Nelson, is experiencing fluid retention a day after an operation on her hand. What is a likely outcome of administering an oral cholinergic agonist to Ms. Nelson? a) Muscle weakness increases b) Pulse increases temporarily c) Urination and digestion are aided d) Blood pressure rises
Answer: C Rationale: A cholinergic agonist will stimulate Ms. Nelson's parasympathetic nervous system, increasing the production of the neurotransmitter acetylcholine (ACh). ACh is responsible for transmitting the nerve responses that enable urination and digestion. Effects typically associated with cholinergic agonists are decreased blood pressure (due to vasodilation) and decreased pulse. Muscle weakness would improve if a cholinergic agonist were given.
A client admitted with gastric discomfort and peptic ulcer disease has a temperature of 102.8°F (39.65°C). Which ordered medication does the nurse select to administer? a) Ketoprofen (Orudis) b) Acetylsalicylic acid (aspirin) c) Acetaminophen (Tylenol) d) Ibuprofen (Advil)
Answer: C Rationale: Acetaminophen could safely be administered to a client with ulcer disease. Unlike non-steroidal anti-inflammatory drug (NSAID), acetaminophen does not cause gastric irritation or bleeding. Aspirin, ketoprofen, and ibuprofen are all classified as NSAIDs, and would not be safe to administer to a client with ulcer disease because they could worsen the gastrointestinal irritation and cause bleeding.
The nurse is caring for a client who is taking an adrenergic agonist. Which cardiopulmonary system effects should the nurse expect this medication to produce? a) Bronchospasm b) Decreased blood pressure c) Bronchodilation d) Decreased heart rate
Answer: C Rationale: Adrenergic agonists cause bronchodilation, not bronchospasm. Adrenergic agonists cause an increase, not decrease, in blood pressure and heart rate.
A nurse is preparing to administer a hepatitis B vaccination to a patient. Which of the following would cause the nurse to withhold the vaccination and check with the healthcare provider? a) The patient smoked cigarettes, one pack per day b) The patient is frightened by needles and injections c) The patient is allergic to yeast and yeast products d) The patient has hypertension
Answer: C Rationale: An allergy to yeast or yeast products is a contraindication to the hepatitis B vaccination. Options A, B, and D are incorrect. Smoking, HTN, and a fear of needles or injections are not contraindications for the drug. These conditions may be managed with appropriate health teaching.
The nurse is preparing to administer a cholinergic antagonist to a client. When reassessing the client, which finding would the nurse consider an adverse effect of the medication? a) Increased blood pressure b) Dry mucous membranes c) Arrhythmia d) Increased pulse rate
Answer: C Rationale: An arrhythmia is an adverse reaction that may occur when a client takes a cholinergic antagonist. Increased blood pressure, pulse, and dry mucous membranes are expected outcomes for a client who is taking a cholinergic antagonist.
When Ms. Baxter asks how often she will need to take interferon alfa-2b (Intron A), what should your response be? a) Once every other week b) Once a day c) Three times per week d) Once a week
Answer: C Rationale: For chronic hepatitis B or C, interferon alfa-2b (Intron A) is administered three times per week for 18-24 months. Interferons with names that begin with "peg" contain the polymer polyethylene glycol, which lengthens the drugs' effects. As a result, peginterferon may be administered just once a week
The patient has been taking aspirin for several days for headache. During the assessment, the nurse discovers that the patient is experiencing ringing in the ears and dizziness. What is the most appropriate action by the nurse? a) Question the patient about history of sinus infections. b) Determine whether the patient has mixed aspirin with other medications. c) Tell the patient not to take any more aspirin. d) Tell the patient to take the aspirin with food or milk.
Answer: C Rationale: High doses of aspirin can produce side effects of tinnitus, dizziness, headache, and sweating. These symptoms should be reported to the health care provider. Options A, B, and D are incorrect. Sinus infections may cause dizziness if the eustachian tubes are blocked but should not cause tinnitus. The nurse should assess whether any of the patient's medications also contain aspirin, but most OTC combination remedies include acetaminophen and not aspirin. Taking aspirin with food or milk may decrease the incidence of GI upset but will not prevent tinnitus.
Older adults taking bethanechol (Urecholine) need to be assess more frequently because of which of the following adverse effects? a) Tachycardia b) Hypertension c) Dizziness d) Urinary retention
Answer: C Rationale: The nurse should monitor older adult patients for episodes of dizziness caused by CNS stimulation from the parasympathomimetics system. Options A, B, and D are incorrect. Bethanechol does not cause tachycardia or hypertension and is used to treat non-obstructive urinary retention.
The nurse has just administered a muscarinic agonist to a client on a medical-surgical unit. Which physiological effect does the nurse anticipate the client may experience as a result of the medication? a) Increased blood pressure b) Decreased pulse c) Decreased urinary output d) Decreased gastrointestinal motility
Answer: C Rationale: Muscarinic receptors are located on target tissues affected by postganglionic neurons in the parasympathetic division. A muscarinic agonist will illicit the rest-and-digest response. Muscarinic medication will increase gastrointestinal motility and urinary output. These medications will also decrease the client's pulse and blood pressure.
The nurse is preparing a plan of care for a patient with myasthenia gravis. Which of the following outcome statements would be appropriate for a patient receiving a cholinergic agonist for this condition? The patient will exhibit: a) An increase in pulse rate, blood pressure, and respiratory rate b) Enhanced urinary elimination c) A decrease in muscle weakness, ptosis, and diplopia d) Prolonged muscle contractions and proprioception
Answer: C Rationale: Myasthenia gravis is a neurologic disorder characterized by muscle weakness and ptosis. A decrease in these symptoms is an expected therapeutic outcome for a cholinergic agonist. Options A, B, and D are incorrect because the symptoms listed are not usual problems faced by the patient with myasthenia gravis and would therefore be inappropriate outcome statements.
The nurse on a surgical unit is assessing the incision of a client who underwent an exploratory laparotomy. Which incision description indicates a normal inflammatory response? a) Odor, necrosis, and hot to touch b) Drainage, pallor, and pain c) Redness, edema, and warmth to touch d) Pink skin, separation, and pain
Answer: C Rationale: Redness, edema, and warmth to touch indicate that the protective mechanism of inflammation is present. Although it is normal to have some drainage from the area of the incision, pallor and pain are not a part of the inflammatory response. Odor, necrosis, and hot to touch are abnormal clinical manifestations that could indicate a complication warranting notification of the health care provider. These are not part of the inflammatory response. Separation, pain, and pink skin are not associated with inflammation.
What is true about cholinergic antagonists and adrenergic agonists? ***Select all that apply. a) Results differ dramatically b) Both block the action of ACh c) Mechanisms of action are different d) Many bodily effects are similar e) Mechanisms of action are similar
Answer: C, D Rationale: Cholinergic antagonists produce many of the same bodily effects as adrenergic agonists. However, the mechanisms of actions of these two groups are different. Cholinergic antagonists block the action of acetylcholine (ACh) in the cholinergic synapses, and prevent ACh from binding at receptor sites. This prevents a cholinergic effect from occurring and allows the sympathetic nervous system response to dominate. In contrast, adrenergic agonists stimulate an autonomic response by binding at adrenergic receptor sites or increasing the amount of norepinephrine in the synaptic cleft.
In what ways can microorganisms enter the body. ***Select all that apply. a) Walking barefoot in the sand b) Swimming in the ocean c) Eating spinach containing Escherichia coli d) Through a laceration of the skin e) Exposure to droplets through a coworker's cough
Answer: C, D, E Rationale: Bacterial infections are caused by microorganisms that enter the body through a break in skin integrity, inhalation into the lungs, ingestion of a contaminated substance, or contact with mucous membranes. Although there may be bacteria in sand or ocean water, an individual must either ingest sufficient quantities or be exposed through an actual break in the skin for possible infection to occur.
The nurse is educating a female client who continues to have frequent urinary tract infections. When the nurse is explaining the anatomy of the urinary tract and why females get more UTIs than males, which information should be included in client education? ***Select all that apply. a) The ureters are part of the urinary tract. b) The urethra may become inflamed or infected. c) The female urethra is considerably shorter compared to the male urethra. d) Urine enters the bladder from the kidneys and stays there until released. e) The anus is in close proximity to the urethra.
Answer: C, E Rationale: The female urethra is shorter and located closer to the anus than in a male, making it more likely to become contaminated with bacteria that can cause infections. The anus is not part of the urinary tract, but it is in close proximity to the urethra and can contribute to contamination and urinary tract infection. The urinary bladder, ureters, and the kidneys are part of the urinary tract and may become infected if the pathogen spreads to these areas. However, the question specifically asks for the etiology of the UTI.
Sierra Solina has been taking an AChE inhibitor, but is exhibiting signs of tachycardia and muscle weakness. After a small dose of edrophonium chloride (Enlon) is administered, Ms. Solina shows no symptomatic improvement. What action do you expect the health care provider to take next? a) Discontinue the AChE inhibitor b) Increase the dose of the AChE inhibitor c) Increase the dose of edrophonium chloride (Enlon) d) Administer atropine sulfate
Answer: D Rationale: A cholinergic crisis occurs when the parasympathetic nervous system is overstimulated, as in the case of an AChE inhibitor overdose. Because some symptoms-tachycardia, muscle weakness, and respiratory distress-of myasthenic crisis are similar to those of cholinergic crisis, a careful diagnosis must be made. If there is no symptomatic improvement after a very small dose of edrophonium chloride (Enlon) is administered, then a cholinergic crisis will likely be diagnosed and atropine sulfate administered as an antidote. Although the health care provider will probably discontinue the AChE inhibitor, the most immediate action would involve treatment of the cholinergic crisis.
Rosa Dillon, a 10-year-old client, is in the hospital following a car accident. She has sustained two broken ribs, along with cuts and bruises. As you clean and dress her wounds, Rosa worries because they are so swollen. As her nurse, what should you do to address Rosa's concerns? a) Consult with her admitting nurse. b) Assess for relief of symptoms. c) Explain to her how the lymphatic system works. d) Explain how inflammation helps her body heal.
Answer: D Rationale: As a nurse, an important part of your role is educating your clients at their level of understanding. Most 10-year-olds can understand that swelling helps protect and repair the body, but perhaps not how the lymphatic system works. Barring other issues, there is no need to consult with Rosa's admitting nurse. While you are always assessing for relief of symptoms, your first goal in this case is calming Rosa's concern about inflammation.
The nurse is counseling a mother regarding antipyretic choices for her 8 year old daughter. When asked why aspirin is not a good drug to use, what should the nurse tell the mother? a) It is not as good an antipyretic as is acetaminophen b) It may increase fever in children under age 10 c) It may produce nausea and vomiting d) It increases the risk of Reye's syndrome in children under 19 with viral infections
Answer: D Rationale: Aspirin and salicylates are associated with an increased risk of Reye's syndrome in children under 19, especially in the presence of viral infections. Options A, B, and C are incorrect. Acetaminophen is not significantly different from aspirin or salicylates for the treatment of fever. Use of aspirin or salicylates should not increase fever although it may cause nausea or vomiting related to GI irritation; however, it is not contraindicated in children specifically for this reason.
The nurse is preparing to teach a client about cholinergic antagonists. The nurse plans to explain to the client that the health care provider or pharmacist may also refer to this type of drug by what other name? a) Muscarinic agonists b) Indirect-acting muscarinic agonists c) Direct-acting muscarinic agonists d) Anticholinergics
Answer: D Rationale: Cholinergic antagonists are also referred to as anticholinergics. Muscarinic agonists, both direct-acting and indirect acting, are types of cholinergic agonists. Muscarinic agonists is another name for direct-acting parasympathomimetics - they bind directly to cholinergic receptors to produce the rest-and-digest response. Indirect-acting muscarinic agonists inhibits action of AchE which allows Ach to avoid destruction and bind to cholinergic receptors for a longer time.
The health care provider prescribes epinephrine (adrenalin) for a patient who was stung by several wasps 30 minutes ago and is experiencing an allergic reaction. The nurse knows that the primary purpose of this medication for this patient is to: a) Stop the systemic release of histamine produced by the mast cells b) Counteract the formation of antibodies in response to invading antigen c) Increase number of white blood cells produced to fight primary invader d) Increase a declining blood pressure and dilate constricting bronchi associated with anaphylaxis
Answer: D Rationale: Epinephrine is used during anaphylaxis to prevent hypotension and bronchoconstriction. Options A, B, and C are incorrect because the administration of epinephrine for anaphylaxis does not prevent the formation of histamine or the formation of antibodies in response to an invading antigen, nor does it affect white blood cell function.
Which of the following statements by a patient who is taking cyclosporine (Neoral, Sandimmune) would indicate the need for more teaching by the nurse? a) "I will report any reduction in urine output to my health care provider." b) "I will wash my hands frequently." c) "I will take my blood pressure at home everyday." d) "I will take my cyclosporine at breakfast with a glass of grapefruit juice."
Answer: D Rationale: Grapefruit juice increases cyclosporine levels 50% to 200%, resulting in drug toxicity. Options A, B, and C are incorrect. These statements reflect an understanding of the nurse's teaching. Hand washing is important to prevent infection. Renal toxicity and HTN are adverse effects of cyclosporine therapy.
Melanie Baxter is a 56-year-old client who is being treated in your clinic for chronic hepatitis C. Ms. Baxter asks why she is prescribed interferon alfa-2b (Intron A) for hepatitis when this drug is used to treat different types of cancer. What is your best response? a) Because clinical manifestations of hepatitis C mimic those of a malignancy, hepatitis C responds well to interferon alfa-2b (Intron A). b) Interferon alfa-2b (Intron A) was prescribed to prevent the development of a malignancy related to hepatitis C, not to treat the hepatitis. c) Interferon alfa-2b (Intron A) is not used to treat hepatitis C, so you should consult your health care provider to discuss the error. d) Interferon alfa-2b (Intron A) has a broad range of actions that help the immune system better fight both cancers and viruses.
Answer: D Rationale: Interferon alfa-2b (Intron A) is a cytokine with broad-spectrum activity, including antiviral, antineoplastic, and immunomodulating actions. It is used to treat hairy cell leukemia, chronic hepatitis B or C, malignant melanoma, and AIDS-related Kaposi sarcoma. The clinical manifestations of hepatitis C do not mimic those seen with a malignancy. Intron A is not prescribed to prevent the development of a malignancy. If you suspect that a medication was prescribed in error, discuss your concerns with the health care provider, gather more information about the intended action of the medication, and clarify the health care provider's order for the medication.
The nurse is preparing to administer a medication that will suppress the parasympathetic nervous system. Which response does the nurse anticipate the client will experience after receiving the medication? a) Decreased blood pressure b) Increased peristalsis c) Decreased heart rate d) Pupil dilation
Answer: D Rationale: Pupil dilation occurs when the parasympathetic nervous system is suppressed. Decreased blood pressure, decreased heart rate, and increased peristalsis occur when the parasympathetic nervous system is stimulated, not when it is suppressed.
The nurse is reviewing the pathophysiology of the immune system. Which condition may occur in clients who have continual secretion of the immune response chemicals? a) Peptic ulcers b) Diabetes c) Hypertension d) Rheumatoid arthritis
Answer: D Rationale: Rheumatoid arthritis is an autoimmune condition that can occur when cytokines are chronically secreted. Hypertension, peptic ulcer disease, and diabetes are not autoimmune disorders and are not affected by chronic cytokine secretion.
The nurse is admitting a patient with RA. The patient has been taking prednisone for an extended time. During the assessment, the nurse observes that the patient has a very round moon-shaped face, bruising, and an abnormal contour of the shoulders. What does the nurse conclude based on these findings? a) These are normal reactions with the illness b) These are probably birth defects c) These are symptoms of myasthenia gravis d) These are symptoms of adverse drug effects from the prednisone
Answer: D Rationale: Signs and symptoms of bruising and a characteristic pattern of fat deposits in the cheeks (moon face), shoulders (buffalo hump), and abdomen are common adverse effects associated with long-term prednisone use. Options A, B, and C are incorrect. These symptoms are not indicative of the disease process, birth defects, or myasthenia gravis.
The nurse is reviewing the orders of a client admitted with a diagnosis of gastrointestinal (GI) bleeding. Which order would the nurse question? a) Intravenous infusion of 5% dextrose in half-normal saline at 125 mL/hr b) Acetaminophen (Tylenol) 650 mg PO as needed for fever (38.4 C) every 4 hours c) Serum hemoglobin and hematocrit levels now d) Ibuprofen (Advil) 200 mg, 2 tablets PO every 6 hours as needed for pain
Answer: D Rationale: The nurse would question the order of ibuprofen (Advil) 2 tablets as needed for pain because ibuprofen should not be given to clients with GI bleeding; bleeding is an adverse effect of this drug. An order for hemoglobin and hematocrit levels would be necessary to determine whether blood volume levels are depleted in a client with GI bleeding. Intravenous access and continuous fluid administration is an appropriate order that presents no reason to question the health care provider. Acetaminophen would be the drug of choice for temperature elevation in a client with GI bleeding.
The nurse on the orthopedic unit is caring for a client with bone infection secondary to an open fracture of the right leg. The client was found in a field following a tornado injury. Which best explains the cause of the infection? a) The introduction of bacteria when the dressings were changed b) The orthopedic surgeon's lack of sterility when treating the fracture c) Inadequate nutrition to boost immunity d) The break in the skin caused by the open-fracture injury
Answer: D Rationale: The skin is a mechanical barrier that protects against and prevents invasion by bacteria. When the skin is broken, these pathogens are allowed to enter and cause infection. Although infections can be caused by other means, such as introduction by the surgeon or other staff or the institution's failure to follow sterile technique, this client's situation of an open fracture and environmental element exposure suggests that the most likely cause is the break in the skin. An adequate, well-balanced diet is necessary to prevent infection, but there is no evidence that this client had an inadequate diet; given the client's situation, poor nutrition is not the most likely cause of the infection.
The nurse is educating a client about a spinal cord injury. Which statement by the client indicates the need for further teaching regarding the effect the injury will have on the autonomic nervous system? a) "My breathing may be affected by the injury." b) "I may not have control of bladder functions." c) "My blood pressure may be affected by the injury." d) "I won't be able to feed myself."
Answer: D Rationale: The somatic nervous system is responsible for voluntary control of skeletal muscles, so a client response regarding voluntary body control indicates a need for further education. The autonomic nervous system is responsible for involuntary control of many body systems; therefore, client responses indicating an understanding that the cardiovascular, respiratory, and genitourinary systems may be affected are correct and do not require further teaching.
What "triggers" an immune system response? a) Antibody entering the body b) Redness/swelling at an injury site c) Fever d) Antigen entering the body
Answer: D Rationale: When a foreign substance (antigen) enters the body, the immune system recognizes it to be "non-self" and an immune response is triggered. The body releases antibodies in response to invading antigens. Fever and/or redness and swelling at the site of an injury are clinical manifestations of the immune system's inflammatory response. However, they do not trigger that response.
A 55 year old female patient is receiving cyclosporine (Neoral, Sandimmune) after a heart transplant. The patient exhibits a WBC count of 12,000 cells/mm3, a sore throat, fatigue, and a low-grade fever. The nurse suspects which of the following conditions? a) Transplant rejection b) Heart failure c) Dehydration d) Infection
Answer: D Rationale: Due to immune system suppression by the cyclosporine (Neoral, Sandimmune), infections are common. While the WBC count is slightly elevated, this drug suppresses the function of the immune cells (T-cells) and does not suppress bone marrow production of WBCs. Options A, B, and C are incorrect. Prevention of transplant rejection is a therapeutic indication for the use of cyclosporine. The patient's symptoms of sore throat and low-grade fever are not symptomatic of heart failure or dehydration.
A five year old child is due for prekindergarten immunizations. After interviewing her mother, which of the following responses may indicate a possible contraindication for giving this preschooler a live vaccine (ex: MMR) at this visit and would require further exploration by the nurse? a) Her cousin has the flu b) The mother has just finished her series of hepatitis B vaccines c) Her arm become very sore after her last tetanus shot d) They are caring for her grandmother who has just finished her second chemotherapy treatment for breast cancer
Answer: D Rationale: Live vaccines may be contraindicated when patients present an exposure risk of the infectious agent to immunocompromised people such as those on chemotherapy or immunosuppressant therapy. Options 1, 2, and 3 are incorrect. Assuming that the cousin has a normal and active immune system, the cousin's flu would not be a contraindication. The mother would not be at risk and because she has received recent vaccinations, assessment of her immune system would have been completed at that time. Localized soreness or tenderness is a potential (mild) adverse effect of immunizations and can be managed symptomatically.
The nurse is preparing to administer a gastrointestinal medication to a client. Which portion of the nervous system is most likely to be affected by this medication? a) Efferent neurons b) Afferent neurons c) Somatic nervous system d) Autonomic nervous system
Answer: D Rationale: The autonomic nervous system is responsible for involuntary control of vital functions in muscles and glands, including the gastrointestinal system. Thus, the gastrointestinal medication will most likely affect this portion of the nervous system. Afferent neurons are responsible for carrying sensory impulses to the brain and efferent neurons are responsible for carrying motor impulses away from the brain and spinal cord to the periphery. A gastrointestinal medication will not affect this portion of the nervous system. The somatic nervous system is responsible for voluntary control. A gastrointestinal medication will not affect this portion of the nervous system.
