Pharm review - Cardiovascular, Hematologic, and Lymphatic Systems

A client who is receiving phenytoin asks why folic acid was prescribed. Which explanation would the nurse provide? 1. Phenytoin inhibits absorption of folate from foods. 2. Folic acid potentiates the action of phenytoin. 3. Absorption of iron from foods is improved. 4. Neuropathy caused by phenytoin is prevented.

1. Phenytoin inhibits absorption of folate from foods. Phenytoin inhibits folic acid absorption and potentiates the effects of folic acid antagonists.

A client with a gastric hemorrhage is scheduled to receive two units of whole blood. List the nurse's activities in the order that they will be performed when administering a blood transfusion. 1. Verify that a type and crossmatch blood sample has been sent to the laboratory. 2. Obtain venous access, preferably with a 19-gauge needle or larger. 3.Ask another nurse to check the blood identification at the client's bedside. 4.Prime the blood infusion set tubing with normal saline at the bedside. 5.Run the blood at a slower rate during the first 10 minutes of the transfusion.

1. Verify that a type and crossmatch blood sample has been sent to the laboratory. 2. Obtain venous access, preferably with a 19-gauge needle or larger. 4.Prime the blood infusion set tubing with normal saline at the bedside. 3.Ask another nurse to check the blood identification at the client's bedside. 5.Run the blood at a slower rate during the first 10 minutes of the transfusion. ***In order of action of the nurse***

How is hemophilia A inherited? 1. X-linked recessive trait 2. Y-linked recessive trait 3. X-linked dominant trait 4. Y-linked dominant trait

1. X-linked recessive trait Hemophilia A is an X-linked recessive trait, not a dominant trait, meaning daughters who have the gene are carriers, and sons with the gene have the condition. The trait is not carried on the Y chromosome.

An intravenous solution containing potassium inadvertently infused too rapidly. The client is prescribed insulin added to a solution of 10% dextrose in water. Which would the nurse identify as the purpose of the insulin? 1. Glucose with insulin increases metabolism, which accelerates potassium excretion. 2. Increased potassium causes a temporary slowing of the pancreatic production of insulin. 3. Increased insulin accelerates the excretion of glucose and potassium, thereby decreasing the serum potassium level. 4. Potassium follows insulin and glucose into the cells of the body, thereby raising the intracellular potassium level.

4. Potassium follows insulin and glucose into the cells of the body, thereby raising the intracellular potassium level. Potassium follows insulin into the cells of the body, thereby raising the intracellular potassium level and preventing fatal dysrhythmias.

A 78-year-old client comes to the health clinic presenting with fatigue, and laboratory results indicate a hematocrit of 32% (0.32) and hemoglobin of 10.5 g/dL (105 mmol/L). Which action would the nurse take next? 1. Conduct a complete nutritional assessment of the client. 2. Plan to teach the client about taking daily iron supplements. 3. Schedule the client to return to have the test repeated in 3 months. 4. Explain that mild anemia is an expected response to the aging process.

1. Conduct a complete nutritional assessment of the client. A nutritional assessment starts the investigation for a cause of the client's anemia.

Which dysrhythmia is this client with weakness, dizziness, and dyspnea exhibiting? 1. Atrial fibrillation (AF) 2. Ventricular tachycardia (VT) 3. Junctional tachycardia 4. Supraventricular tachycardia (SVT)

1. Atrial fibrillation (AF) This client has AF, as seen from the wavy baseline with uncoordinated atrial electrical activity and irregular ventricular rhythm with normal QRS complexes.

Which actions would the nurse take to prevent venous thrombus formation in a postoperative client? Select all that apply. One, some, or all responses may be correct. 1. Encourage an increase in oral fluid intake. 2. Massage the client's extremities with lotion. 3. Instruct the client to avoid crossing the legs. 4. Remind the client to dorsiflex the feet frequently. 5. Help the client use prescribed pneumatic sequential stockings. 6. Plan discharge teaching about the need to avoid taking aspirin.

1. Encourage an increase in oral fluid intake. 3. Instruct the client to avoid crossing the legs. 4. Remind the client to dorsiflex the feet frequently. 5. Help the client use prescribed pneumatic sequential stockings. Actions such as increasing fluid intake, avoiding crossing the legs, frequent dorsiflexion of the feet, and using pneumatic sequential stockings when in bed all help decrease venous thrombus risk

After the nurse provides discharge teaching for a client who had a femoropopliteal bypass graft, which client action indicates that the teaching has been effective? 1. Walking for 10 minutes twice a day 2. Elevating the legs when sitting or lying 3. Taking a hot bath before going to bed 4. Discontinuing prescribed daily aspirin

1. Walking for 10 minutes twice a day After surgery for peripheral arterial disease, clients are instructed to start taking short walks and to gradually increase frequency and distance.

Daily regular insulin has been prescribed for a client with type 1 diabetes. The nurse administers the insulin at 8 AM. When will the nurse monitor the client for a potential hypoglycemic reaction? 1. At breakfast 2. Before lunch 3. Before dinner 4. In the early afternoon

2. Before lunch Regular insulin is short acting and peaks in 2 to 4 hours, which in this case will be at or before lunch.

Which information would the nurse include in teaching a client who is advised to wear compression stockings for varicose veins? 1. Put the stockings on at the first sign of discomfort. 2. Don the stockings before getting out of bed in the morning. 3. Ensure that the cuff of the stockings reaches the middle of the knees. 4. Substitute elastic bandages for compression stockings if they are more comfortable.

2. Don the stockings before getting out of bed in the morning. To prevent distention of the veins, stockings should be applied before the legs are placed in a dependent position, before getting out of bed in the morning.

When teaching a client with heart failure about signs and symptoms that indicate a need to contact the primary health care provider, which clinical manifestations would the nurse include? Select all that apply. One, some, or all responses may be correct. 1. Weight loss 2. Extreme fatigue 3. Coughing at night 4. Excessive urination 5. Difficulty breathing

2. Extreme fatigue 3. Coughing at night 4. Excessive urination 5. Difficulty breathing Fatigue is caused by a lack of adequate oxygenation of body cells caused by a decreased cardiac output. As the cardiac output decreases, pulmonary congestion increases, resulting in pulmonary edema; coughing, especially when lying down, and blood-tinged sputum occur. Dyspnea (difficulty breathing) is associated with pulmonary congestion that occurs as cardiac output decreases.

The nurse assesses a client with tuberculosis for adverse responses to isoniazid (INH). The nurse determines that prompt intervention is needed for which client response? 1. Orange feces 2. Yellow sclera 3. Temperature of 96.8°F (36°C) 4. Weight gain of 5 pounds (2.3 kilograms)

2. Yellow sclera An adverse reaction to isoniazid (INH) is hepatitis, resulting in jaundice.

A client who has multiple myeloma tells the nurse about plans for airline travel to visit family members. Which topic will the nurse include in discharge planning? 1. Avoidance of travel to prevent fatigue 2. Need to restrict fluid intake when flying 3. Ways to prevent infection during travel 4. How to fill prescriptions away from home

3. Ways to prevent infection during travel Prevention of infection is important for client with impaired bone marrow production of leukocytes and immunoglobulins.

When the nurse is assessing a 20-year-old client who has come to the clinic reporting recent unintended weight loss and fatigue, which finding would be most important to communicate to the health care provider? 1. Pallor of skin 2. Heart rate 98 beats/minute 3. Cool feet and decreased pedal pulses 4. Nontender enlarged cervical lymph node

4. Nontender enlarged cervical lymph node Nontender and enlarged lymph nodes in a 20-year-old client suggest possible Hodgkin lymphoma, especially with the client's history of unintended weight loss.

When reviewing laboratory results for a client with heart failure who has been receiving furosemide daily, the nurse notes a blood urea nitrogen (BUN) of 42 mg/dL (15.2 mmol/L) and a creatinine of 1.1 mg/dL (97 mcmol/L). Which action by the nurse is a priority? 1. Administering the furosemide as scheduled 2. Starting strict intake and output measurements 3. Sending a urine specimen for specific gravity testing 4. Notifying the health care provider about the results.

4. Notifying the health care provider about the results. Elevations in BUN and creatinine can occur because of hypovolemia caused by diuresis or because of poor renal perfusion caused by heart failure.