Quiz #3

The patient is prescribed warfarin [Coumadin] to treat deep vein thrombosis. The nurse is teaching the patient about dietary supplements that have the potential to interfere with coumadin therapy. What herbs should the nurse include in the teaching?

Garlic, Ginger root, and Gingko bilboa

A patient asks the nurse for a supplement that can be used to prevent motion sickness during a vacation cruise. The nurse suggests which supplement?

Ginger root

It would be a priority for the nurse to report which laboratory test result when a patient is taking high doses of vitamin A for acne?

ALT 250 IU/L

When should the nurse provide parents or legal guardians with vaccine information sheets?

Before each dose of each vaccine

The nurse would teach a patient who follows a vegan diet the importance of supplementation with which vitamin?

Cyanocobalamin

A patient is scheduled to start taking vitamin C. The nurse should teach the patient to observe for which side effect?

Nausea and diarrhea

The pediatric office nurse is responsible for obtaining vaccine information sheets to be provided to parents before they consent to vaccinations for their children. What is the best source of this information?

www.cdc.gov

Which statement by an 18-year-old woman vaccinated with Gardasil indicates that more teaching is necessary?

"This vaccination will cure the HPV infection I got when I was 16."

When a patient lives in an Alaskan Native village

- A patient who is pregnant - A 21-year-old patient with an allergy to neomycin - A 12-year-old patient with an allergy to gelatin - A 10-year-old patient who receives chemotherapy for the treatment of leukemia

What are appropriate measures to decrease discomfort associated with immunizations?

- Apply topical anesthetic to the injection site prior to administering the injection - Tell the child when the nurse is done with administration of the immunization - Use 25-26 gauge needles when administering the injection

What are indications for hepatitis A vaccine?

- Children with hemophilia that require clotting factor infusions - Children who will be traveling to the Caribbean

Routine vitamin supplementation is recommended with which vitamins?

- Cyanocobalamin (Vitamin B12) to prevent anemia in people older than 50 years old AND Folic acid for women before and during pregnancy

Which nursing actions would be critical when the office nurse is discussing a scheduled MMR vaccination with the parents of a 12-month old-boy?

- Determining whether the child has allergies to gelatin - Asking whether the child has received blood or blood products in the past 6 months - Instructing the parents to contact the office if they notice unusual bleeding or bruising

The nursery nurse would expect to administer which vaccination(s) to the neonate within 12 hours of birth if the neonate is HBsAg positive?

- Hepatitis B immunoglobulin (HBIG) - Recombivax HB

Which is true about echinacea?

- It can aggravate autoimmune disorders - It can produce an allergic reaction in patients allergic to ragweed the first time it is taken - It can suppress the immune system with long term use

The nurse would consult with the prescriber if which immunization was prescribed for a child who is receiving long-term high doses of prednisolone?

- MMR - Varicella vaccine

It would be of greatest priority to consult the prescriber if MMR was ordered in which situation?

- The child is being treated with chemotherapy for leukemia

In addition to vaccination for all children ages 12 through 23 months, hepatitis A vaccination (HepA) is recommended in which situations?

- When a male patient has sex with men - When a patient travels to Central America - When a patient lives in an Alaskan Native village

The healthcare provider ordered thiamine solution 100 mg in 50 mL IV piggyback for a patient with a history of alcohol abuse. The dose is ordered to run at 100 mL per hour. The nurse knows that the infusion will require how much time?

30 minutes

The nurse is working in an immunization clinic. Which patient will the nurse identify as not eligible to receive routine immunizations?

A 4-year-old with a fever and upper respiratory infection

Which child should return for a booster dose of varicella 1 months after the first dose?

A child who is 12 years old when receiving the first dose who has not had chickenpox

A nurse administers varicella vaccine [Varivax] to a child. The nurse then instructs the parent to avoid giving the child which product for 6 weeks?

Acetylsalicylic acid (aspirin

Foster parents bring a 14-month hold child in for the first visit at the pediatrician's office. The Child Protective Agency is unable to obtain any immunization records. The child has no contradictions to vaccination. What approach to immunizations is appropriate?

Administer immunizations as if the child has not received any vaccines per the catch-up schedule

What is an appropriate immunization strategy for a child who is behind in getting immunizations and is being seen at the pediatric office for a temperature of 100.6 F and uncomplicated acute otitis media that is treated with amoxicillin?

Administer immunizations during this visit

It would be a priority to educate which patient on the possible adverse effects of self-prescribing megadoses of vitamin A for healthy skin?

Adolescent female

Parents of a child with asthma were reluctant to have their 3-year old receive the flu vaccine because they were afraid that she would get the disease from the injection. The pediatrician convinced them to allow immunization in January of this year. When should the child receive the next annual flu vaccine?

As soon as this new vaccine is available

What is a priority nursing action when a nurse discovers that a patient self-prescribes herbal products?

Assess for drug interactions and adverse effects of this product

Before giving the hepatitis B vaccine (HepB), it is most important for the nurse to ask the patient whether he or she is allergic to what?

Baker's yeast

Which laboratory test would be a priority for the nurse to monitor if a patient with heart failure was prescribed warfarin and self-prescribes coenzyme Q-10, saw palmetto, resveratrol, garlic, and/or ginkgo biloba?

INR

The nurse should be aware that which disorder puts the patient at greatest risk for bleeding and bruising of vitamin K deficiency?

Celiac disease

Based on German studies, it is important for the nurse to teach women prescribed antihypertensives and taking black cohosh for hot flashes and insomnia to?

Change positions slowly

A patient with rough, scaling skin and a sore tongue may be experiencing niacin deficiency. The nurse teaches that which foods are high in niacin?

Chicken, peanuts, and cereal bran

Which factor in a patient's history is most likely related to the development of thiamine (vitamin B1) deficiency?

Chronic alcohol abuse

The nurse is assessing a new admission. Th patient lists echinacea, garlic, and kava among the products that she uses regularly. On first observation, the nurse notes that the patient's skin has a yellowish color. What is the most appropriate action for the nurse to take next?

Continue to assess the patient

The triage nurse receives a call from parents who are concerned about their 2-month old son, who received DTaP 5 days ago. Which symptoms would be of most concern to the nurse?

Crying inconsolably for the past 24 hours

A patient has an international normalized ratio [INR] that is elevated to an unsafe level. A nurse administers vitamin K, expecting which therapeutic result?

Decrease in bleeding tendencies

An oncology nurse is providing health teaching to a patient who is starting chemotherapy. The patient has heard that chemotherapy can cause painful mouth ulcers. The patient would like to know if there is anything she can do to help prevent these ulcers. The nurse could teach about adequate consumption of which foods that are rich in vitamin A?

Deep yellow, orange, and green vegetables and fruits

In assessing a patient with a vitamin A deficiency, the nurse should determine whether the patient has which manifestation?

Impaired night vision

What is a priority concern for the nurse when a patient with multiple medical disorders self prescribed St.Johns's wort?

Effect on other prescribed drugs

A patient receives an immunization with an attenuated vaccine. Which response should a nurse expect if the vaccine produces active immunity?

Endogenous production of antibodies

Because cases of anaphylaxis associated with MMR can be severe, the nurse should ensure immediate access within the office to which drug before administering any immunizations?

Epinephrine (Adrenaline)

The preoperative patient's medication history includes hydrochlorothiazide 25mg once a day, calcium 40mg 4 times a day, and vitamin E 1000mg twice a day. The nurse should document the findings and notify the surgeon of the medication history because the patient is at risk for what issue?

Excessive bleeding during surgery

A patient who is taking metronidazole is at risk for disulfiram-like (Antabuse) reaction if also taking an herbal product in which form?

Extracts or tinctures containing alcohol

A patient tells the nurse that she is thinking about becoming pregnant. The nurse teaches the patient that which vitamin should be her priority for supplementation before planning a pregnancy?

Folic acid

A child receives a vaccine for measles, mumps, and rubella (MMR). Six hours after the injection, the child's parent reports local soreness, erythema, lethargy, and a fever of 101°F to a nurse. Which action should the nurse take?

Give instructions on relieving symptoms with acetaminophen (Tylenol).

The nurse is completing an admission assessment for a patient who requires treatment of an anxiety disorder. The patient states "I take the dietary supplement kava every day to help my anxiety and stress." The nurse understands the patient is at risk for which serious adverse effect?

Hepatotoxicity

Which action should a nurse take when preparing to administer vitamin D to a patient diagnosed with hyperparathyroidism?

Hold the vitamin and consult the prescriber

A teacher sends a Hispanic migrant worker's child to the school nurse's office because he is concerned that the child has a smooth, swollen tongue and cracks in the corners of her mouth and lips. The nurse thinks that this may be vitamin deficiency, possibly caused by a diet whose main component is?

Home-ground corn

A patient who regularly takes feverfew to prevent migraine headaches stopped taking the herb right before elective surgery. The nurse should assess the patient for what?

Insomnia

A patient is taking black cohosh (Cimicifuga racemosa) for relief of menopausal symptoms. The nurse should caution her about adverse interactive effects with which conventional medication?

Insulin

The nurse is aware that which herbal supplement has been associated with liver failure?

Kava

Current Good Manufacturing Practices are designed to ensure that dietary supplements?

List their active and inert ingredients

Which product did the U.S. Food and Drug Administration (FDA) ban in the United States because of the serious adverse effects of myocardial infarction, stroke, and death?

Ma huang

The nurse is caring for a patient who admits to using mail order ma huang (ephedra) for weight loss. It is a priority for the nurse to do what?

Monitor vital signs

The nurse is preparing the discharge teaching plan for a patient who had a mechanical valve replacement and has been prescribed coumadin. The nurse reviews the patient's medication history and notes the patient is taking the herbal supplement glucosamine to treat osteoarthritis. Which instructions should the nurse give to this patient?

Notify the healthcare provider immediately if you experience any signs of bleeding

In a patient with a thiamine deficiency, which finding would indicate the development of Wernicke-Korsakoff syndrome?

Nystagmus

Why does the CDC currently recommend administration of the inactivated poliovirus vaccine (IPV [IPOL], or Salk) instead of the oral polio vaccine (OPV/Sabin)?

OPV can cause vaccine-induced polio

Which characteristic of the older adult could cause vitamin D deficiency?

Older adults consume fewer dairy products

A patient who is prescribed glipizide (Glucotrol) for type 2 diabetes mellitus and celecoxib (Celebrex) for inflamed joints informs the nurse that she has stared taking ginger because she read in a magazine that it helps arthritis. It is a priority to teach the patient to be alert for possible hypoglycemia symptoms, including?

Palpitations and sweating

A nurse administers Gardasil, the human papillomavirus (HPV) vaccine, to an 11-year-old girl. The nurse informs the parent that routine screening with which diagnostic test is needed?

Pap test

Research suggests which possible side effect of cranberry juice?

Preventing bacteria from adhering to bladder wall

Pregnant nurses should wear gloves if they are administering which herbal supplement?

Saw palmetto

The triage office nurse receives a call from the father of a 16-year old who received a varicella vaccine 10 days prior. The teenager experienced a fever after the injection, which was treated with aspirin. Yesterday he stayed home from school with stomach flu. He has not yet vomited today, but the father is having difficulty awakening him. What directions should the nurse provide to the father?

Seek emergency medical care for his son immediately

It is a priority to inform patients with which disorder that ginkgo biloba can aggravate their condition?

Seizures

A patient who has pellagra is taking niacin. Which outcome would be most appropriate for a nurse to establish with the patient?

Smooth, intact skin in sun-exposed areas

What is an appropriate outcome for a 12-year old child relating to probiotics prescribed during a rotavirus infection?

Soft, formed stool

The nurse administers Rotarix rotavirus to an infant at a medical clinic in the Dominican republic. It is of greatest priority for the nurse to teach the child's caregivers to seek immediate emergency care if within the next month the infant exhibits which symptom?

Stool looks like jelly

Which information on the product label of an herbal supplement would comply with the regulations established by the Dietary Supplement Health and Education Act (DSHEA)?

Supports the immune system

It would be of greatest priority for the parent to contact the prescriber if a child experienced which symptom after administration of a DTaP immunization?

Swelling around the lips

A 3-year-old child is scheduled to receive pneumococcal vaccine (PCV). Which condition should the nurse recognize as a contraindication to the vaccine in this child?

Temperature of 103 F

Which information would be a reason to consult the prescriber before administering the varicella vaccine to a 15-month old child?

The child's aunt and her newborn are temporarily staying with the family

The nurse is preparing to administer Gardasil to an 18-year old college-bound female patient. Then nurse tells the patient, "You can not get pregnant for 2 months if I give you this shot." Why is this not a good statement for the nurse to make to this adolescent?

The patient may interrupt the statement as meaning the injection prevents pregnancy

A patient who has had a splenectomy asks why he needs to get a meningitis vaccine. What is the basis for the nurse's response.

The spleen helps fight bacteria causing pneumonia and meningitis

The nurse knows what is true about vitamins?

They are needed for energy transformation and regulation of metabolic processes

The nurse knows which statement is true about RDAs?

They do not consider increased needs during illness

The nurse includes in her health promotion teaching that vitamin C supplementation has been approved for which use?

Treatment of scurvy

The nurse recognizes that the supplement echinacea (Echinacea angustifolia) should not be taken as prolonged therapy for patients with which condition?

Tuberculosis

The priority teaching when a patient chooses to use a dietary supplement is that it is best to?

Use products that have the seal of approval from the USP

A patient with a malabsorption disease is at risk for low levels of fat-soluble vitamins. The nurse is aware that which vitamins are fat soluble?

Vitamin A, D, and E

The nurse is providing nutritional teaching to a patient with advanced esophageal cancer. It is most important for the nurse to assess if the patient is self-medicating with which vitamin that has been falsely promoted as a treatment for cancer and can cause GI irritation?

Vitamin C

A patient tels the nurse that he takes a multivitamin containing vitamin K. The nurse reports this information to the patient's prescriber because the patient has been prescribed which drug?

Warfarin