Adult Test 3- NCLEX Review Questions
606. The home health care nurse is visiting a client who was recently diagnosed with Type 2 DM. THe client is prescribed repaglinide (Prandin) and metaformin (glucophage) and asks the nurse to explain these medications. The nurse should provide which instructions to the client? Select all that apply 1. Diarrhea may occur secondary to the metformin 2. the repaglinide is not taken if a meal is skipped 3. the repaglinide is taken 30 mins before eating 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes 5. Metformin increases hepatic glucose production to prevent hypoglycemia associated with repaglinide 6. Muscle pain is an expected effect of metformin and may be treated with acetaminophen (tylenol)
1. Diarrhea may occur secondary to the metformin 2. the repaglinide is not taken if a meal is skipped 3. the repaglinide is taken 30 mins before eating 4. A simple sugar food item is carried and used to treat mild hypoglycemia episodes Rationale: Repaglinide, s rapid-acting oral hypoglycemic agent that stimulates pancreatic insulin secretion, should be taken before meals (3), and should be withheld if the client does not eat (2). Hypoglycemia is a side effect of repaglinide and teh client shuold always be prepared by carryng a simple sugar with him/her at all times (4). Metformin is an oral hypoglycemic given in combo with repaglinide and works by decreasing hepatic glucose production(5). A commonside effect of metformin is diarrhea (1). Muscle pain may occur as an adverse effect from metformin but it might signify a more serious condition that warrants HCP notification, not the use of tylenol
616. A client with Dm visits a health care clinic. The client's DM previously had been well controlled with glyburide (DiaBeta) daily, but recently the fasting BG has been 180 - 200. Which med, if added to the clients regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Phenelzine (Nardil) 3. Atenolol (Tenormin) 4. Allopurinol (Zyloprim)
1. Prednisone Rationale: Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics and potassium supplements. 2- a monoamine oxidase inhibitor && 3- a beta-blocker : have their own intrinsic hypoglycemic activity 4. decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia
715. The nurse is assessing the neurovascular status of a client who returned to the surgical nursing unit 4 hours ago after undergoing aortoiliac bypass graft. The affected leg is warm and the nurse notes redness and edema. The pedal pulse is palpable and unchanged from admission. How should the nurse correctly interpret the client's neurovascular status? 1. The neurovascular status is normal because of increased bloodflow through the leg 2. the neurovascular status is moderately impaired, and the surgeon should be called 3. the neurovascular status is slightly deteriorating and should be monitored for another hour 4. the neurovascular status is adequate from an arterial approach, but venous complications are arising
1. The neurovascular status is normal because of increased bloodflow through the leg An expected outcome of aortoiliac bypass graft surgery is warmth, redness and edema in the surgical extremity because of increased blood flow.
602. Glimepiride (Amaryl) Is prescribed for a client with DM. The nurse instructs the client to avoid consuming which food while taking this med? 1. alcohol 2. organ meats 3. whole grain cereals 4. Carbonated beverages
1. alcohol when alcohol is combined with Glimepiride (Amaryl), a disulfiram-like reaction may occur. this syndrome include flushing, palpitations, and nausea. alcohol can also potentiate the hypoglycemic effets of hte med
578. The nurse is monitoring a client newly diagnosed with DM for signs of complications. Which sign, if exhibited in the client, would indicate hyperglycemia? 1. polyuria 2. diaphoresis 3. hypertension 4. increased pulse rate
1. polyuria classic symptoms of hyperglycemia: polydipsia, polyuria, and polyphagia diaphoresis can happen in hypoglycemia 3 & 4 are not signs of hyperglycemia either
589. The nurse is monitoring a client who was diagnosed with type 1 DM and is being treated with NPH and regular insulin. which client complaint(s) would alert the nurse to the presence of a possible hypoglycemic reaction? (select all that apply) 1. tremors 2. anorexia 3. irritability 4. nervousness 5. hot,dry skin 6. muscle cramps
1. tremors 3. irritability 4. nervousness hot, dry skin is mostly seen in hyperglycemia 2- hypoglycemia usually makes the client hungry
600. A nurse is teaching a pt how to mix regular and NPH insulin in the same syringe. Which action, if performed by the client, indicates the need for further teaching. 1. withdraws the NPH insulin first 2. withdraws the regular insulin first 3. injects air into the NPH insulin vial first 4. Injects an amount of air equal to the desired dose of insulin into each vial.
1. withdraws the NPH insulin first short-acting insulin is drawn into the syringe first
604.The HCP prescribes exenatide (Byetta) for a client with Type 1 DM who take insulin. the nurse should plan to take which most appropriate action? 1. withhold the med and call the HCP, questioning the prescription for the client 2. Administer the med within 60 mins before the morning & evening meal 3. Monitor the client for GI side effects after administering the med 4. Withdrawal the insulin from the prefilled pen into an insulin syringe to prepare for administration
1. withhold the med and call the HCP, questioning the prescription for the client Byetta is an incretin mimetic used for Type 2 DM only. It is not recommended for pts using insulin.
595. The nurse is caring for a client who is 2 days Post OP folling an abdominal hysterectomy. The client has a hx of DM and has been recieving regular insulin according to capillary BG testing 4 times a day. A carb-controlled diet has been prescribed but the client has been complaining of nausea and is not eating. On entering the room, the nursie finds the client to be confused and diaphoretic. WHich action is MOST APPROPRIATE at this time? 1. Call a code to obtain needed assistance immediately 2. Obtain a capillary BG level and perform a focused assessment 3. As the unliscenced assistive personal to stay with the client while obtaining 15 to 30 grams of a carb snack for the client to eat. 4. stay with the client and ask the UAP to call the HCP for a prescription of 50% dextrose.
2. Obtain a capillary BG level and perform a focused assessment diaphoresis & confusion are moderate signs of hypoglycemia a code is called if the client is not breathing or the heart is not beating
601.The home care nurse visits a client recently diagnosed with DM who is taking Humulin NPH insulin daily. The client asks the nurse how to store the unopened vials of insulin. The nurse should tell the client to take which action? 1. freeze the insulin 2. refrigerate the insulin 3. store in a dark dry place 4. keep at room temp
2. refrigerate insulin in unopened vials should be stored under refrigeration until needed.
579. The nurse is preparing a plan of care for a client with DM who has hyperglycemia. The nurse places highest priority on which client problem? 1. Lack of Knowledge 2.Inadequate fluid volume 3.Compromised family coping 4.Inadequate consumption of nutrients
2.Inadequate fluid volume The more glucose in the blood stream = the more the kidneys will try to excrete in the urine. The glucose is excreted with fluids and electrolytes causing an osmotic diuresis leading to dehydration. The fluid loss must be replaced if it becomes severe.
615.Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin NPH insulin daily. WHich prescription change does the nurse anticipate during therapy with prednisone? 1. An additional dose of prednisone daily 2. A decreased amount of daily Humulin NPH insulin 3. An increased amount of daily Humulin NPH insulin 4. the addition of an oral hypoglycemic med daily
3. An increased amount of daily Humulin NPH insulin Rationale: Glucocorticoids can elevate the BG levels. Clients with DM may need their dosages of insulin or oral hypoglycemic meds increased during glucocorticoid therapy.
83. The nurse is instructing a client with HTN on the importance of choosing foods low in sodium. THe nurse should teach the client to LIMIT intake of which food? 1.apples 2. Bananas 3. Smoked sausage 4. Steamed veggies
3. Smoked sausage smoked foods are high in sodium
592. The nurse performs a physical assesment on a client with Type 2 DM. Findings include a fasting BG of 120 mg/dL, temp of 101 F, 88 bpm pulse, respirations of 22, and BP of 100/72. Which finding would be of MOST concern to the nurse? 1. Pulse 2. RR 3. Temp 4. BP
3. Temp. An elevated Temp may indicate an infection. Infection is the leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis.
585. A client with Type 1 DM calls the nurse to report recurrent episodes of hypoglycemia with exercising. WHich statement by the client indicates an INADEQUATE understanding of the peak action of NPH insulin and exercise? 1. The best time for me to exercise is 1 hour after I eat 2. The best time for me to exercise is after breakfast 3. the best time for me to exercise is mid to late afternoon 4. the best time for me to exercise is after my morning snack
3. the best time for me to exercise is mid to late afternoon clients should avoid exercise during the peak time of insulin. NPH peaks at 4-12 hours so in afternoon, working out is not best
576. The nurse provides instructions to a client newly diagnosed with type 1 DM. The nurse recognizes accurate understanting of measures to prevent diabetic ketoacidosis when the client make which statement? 1. I will stop taking my insulin if I am too sick to eat 2. I will decrease my insulin dose during times of illness 3. I will adjust my insulin dose accordin gto the level of glucose in my urine 4. I will notify my HCP if my BG levels get higher than 250
4. I will notify my HCP if my BG levels get higher than 250
696. A client admitted to the hospital with chest pain and hx of type 2 DM is scheduled for cardiac catheterization. WHich med would need to be withheld for 24 hours before the procedure and for 48 hours after the procedure? 1. Regular Insulin 2.Glipizide (Glucotrol) 3. Repaglinide (Prandin) 4. Metformin (Glucophage)
4. Metformin: B/c of the injection of contrast medium during the procedure. If the contrast medium affects kidney function, with metformin in the system, teh client would be a increased risk for lactic acidosis.
593. The nurse is interviewing a client with Type 2 DM. Which statement by the client indicated an understanding of the treatment for this disorder? 1. I take oral insulin instead of shors 2. by taking these meds i am able to eat more 3. When I become ill, I need to increase the number of pills I take 4. The meds I am taking help to release the insulin I already make
4. The meds I am taking help to release the insulin I already make
572. An external insulin pump is prescribed for a client with diabetes mellitus and the client asks the nurse about the functioning of the pump. The nurse bases the response on which information about the pump? a. Is timed to release programmed doses of short-acting or NPH insulin into the bloodstream at specific intervals b. continuously infuses small amounts of NPH into the blood while regularly monitoring BG levels c. Is surgically attached to the pancreas and infuses regular insulin into pancreas, which in turn releases it into bloodsteam 4. gives a small continuous dose of short-acting insulin SQ and the client can self administer the bolus with an additional dose from the pump before each meal.
4. gives a small continuous dose of short-acting insulin SQ and the client can self administer the bolus with an additional dose from the pump before each meal.
657. The nurse instructs the client to use the pursed-lip method of breathing and the client asks the nurse about the purpose of this type of breathing. The nurse responds, knowing that the primary purpose of pursed-lip breathing is promote which outcome? a. promote oxygen intake b. strengthen the diaphragm c. strengthen the intercostal muscles d. promote carbon dioxide elimination
4. promote CO2 elimination facilitates maximal expiration for clients with COPD, by increasing airway pressure that keeps air passages open during exhalation
81. A client with HTN has been told to maintain a diet lw in sodium. The nurse who is teaching this client about foods that are allowed should include which food item in a list provided to the client? 1. tomato soup 2. boiled shrimp 3. instant oatmeal 4. summer squash
4. summer squash foods low in sodium are: veggies & friuts saltwater & shelfish are high in sodium highly processed foods are higher in sodium unless labeled low sodium on label
721. The nurse provides discharge instrucitons to a client who is taking warfarin sodium (Coumadin). Which statement, by the client, reflects the need for further teaching? a. I will avoid alcohol consumption b. i will take my pills everyday at teh same time c. I have already called by family to pick up a medic-alert bracelet d. i will take ecotrin (enteric-coated aspirin) for headaches because it is coated
4.i will take ecotrin (enteric-coated aspirin) for headaches because it is coated aspirin should be avioded
722. A client who is recieving Digoxin daily, has a serum Potassium level of 3 and is complaining of anorexia. THe HCP prescribes determination of the serum digoxin level to rule out digoxin toxicity. the nurse checks the result, knowing that which value is the therapeutic serum range for digoxin? a. 0.5 -2 b. 1.2-2.8 c. 3.0-5.0 d. 3.5-5.5
A. 0.5 - 2.0
694. The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? a. I must take the medicine as prescribed b. once i start the medication, I will no longer be contagous c. I will not get any cold or infections while taking this medicine d. This med has minimal side effects and I can return to normal activities
a. I must take the medicine as prescribed Antiviral meds must be taken as prescribed they do not prevent the spread of influenza clients are usually contagous for up to 2 days after the initiation of antiviral meds Secondary bacterial infections may occur despite antiviral treatment Side effects occur with these meds and may necessitate change in activities, especially when driving or operating machinery if dizziness occurs
681. The nurse teaches a client about the effects of diphenhydramine (Benadryl), which has been prescribed as a cough suppressant. The nurse determines that the client needs further teaching if the client makes which statement? a. I will take the med on an empty stomach b. i wont drink alcohol while taking this med c. I will use sugarless gum, candy or oral rinses to decrease dryness in my mouth d. I wont do activities that require mental alertness while taking this medication
a. I will take the med on an empty stomach Instructions for use of Benadryl: take with food or milk to decrease GI upset use oral rinses to minimize dry mouth Avoid alcohol use (due to the drowsy side effect) Avoid activities that require mental alertness (due to CNS depressant)
692. A client has begun therapy with theophylline (Theo-24), an asthma drug. The nurse should paln to teach the client to limit the intake of which items while taking this medication? a. coffee, cola and chocolate b. oysters, lobster and shrimp c. melons, oranges, and pineapple d. cottage cheese, cream cheese and dairy creamers
a. coffee, cola and chocolate Theo-24 is a methylxanthine bronchodilator the nurse teaches the client to limit the intake of xanthin-containing foods while taking this medication (this includes coffee, cola and chocolate)
671. A client with acquired immunodeficiency syndrome (AIDS) has histoplamosis. The nurse should assess the client for which expected finding? a. dyspnea b. headache c. weight-gain d. hypothermia
a. dyspnea Histoplasmosis is an opportunistic fungal infection that can occur in the client with AIDS. The infection begins as respiratory infection and can progress to disseminated infection. TYpucal s/s include fever, dyspnea, cough, and weight loss. Enlargement of the clients lymphnoses, liver and spleen may occur as well.
674. An oxygen delivery system is prescribed for a client with COPD to deliver a precise oxygen concentration. Which oxygen delivery system would the nurse anticipate to be prescribed? a. face tent b. venturi mask c.aerosol mask d. Tracheostomy collar
b Venturi Mask The venturi mask delivers the most accurate oxygen concentration. it is the bes oxygen delivery system for the client with chronic airflow limitation because it delivers a precise oxygen concentration. The face tent, aerosol mak and tracheostomy collar are also high-flow oxygen delivery systems but most often are used to administer high- humidity
729. The nurse is monitoring a client who is taking digoxin for adverse effects. WHich findings are characteristic of digoxin toxicity? Select all that apply. a. tremors b. diarrhea c. irritability d. blurred vision e. nausea and vomiting
b,d,e: diarrhea, blurred vision, nausea and vomiting
732. IV heparin therapy is prescribed for a client. While implementing this prescription, the nurse ensures that which med is available on the nursing unit? a. Vitamin K b. Protamine Sulfate c. Potassium Chloride d. Aminocaproic Acid (Amicar)
b. Protamine Sulfate The antidote to heparin is protamine sulfate; it should be ready if excessive bleeding or hemorrhage should occur
656. The nurse is caring for a client hospitalized with acute exacerbation of COPD. Which finding would the nurse expect to note on assessment of this client? Select all that Apply a. hypocapnea b. a hyperinflated chest noted on the chest x-ray c. decreased oxygen saturation with mild exercise d. a widened diaphragm noted on the chest x-ray e. Pulmonary function tests that demonstrate increased vital capacity
b. a hyperinflated chest noted on the chest x-ray & c. decreased oxygen saturation with mild exercise clinical manifestations of COPD: hypoxemia, hypercapnia, dyspnea on exertion and at rest, oxygen desaturation with exercise, and the use of accessory muscles of respiration if disease advanced: xrays show hyperinflated chest and a flattened diaphragm Pulmonary function tests will demonstrate decreased Vital capacity
717. The nurse is caring for a client who had a resection of an abdominal aortic aneurysm yesterday. The client has an IV infusion at 150 mL/hr, unchanged for the last 10 hours. The clients urine output for the last 3 hours has been 90, 50 and 28 mL. The clients BUN is 35 & Creatinine is 1.8, measured this morning. Which nursing action is the priority? a. check the urine specific gravity b. call the HCP c. check to see if the client had a sample for a serum albumin level drawn d. put the IV line on a pump so that the infusion rate is sure to stay stable
b. call the HCP Following an abdominal aortic aneurysm resection or repair, the nurse monitors the client for signs of acute kidney injury. Acute kidney injury can occur because often, too much blood is lost during the surgery and depending on the aneurysm location, the renal arteries may be hypoperfused for a short period during surgery
575. A client with diabetes mellitus demonstrates acute anxiety when first admitted to the hospital for the treatment of hyperglycemia. What is the most appropriate intervention to decrease the clients anxiety? a. administer a sedative b. convey empathy, trust and respect toward the client c. ignore the signs and symptoms of anxiety so they will soon disappear d. Make sure the client knows all the correct medical terms to understand what is happening
b. convey empathy, trust and respect toward the client
668. THe nurse is preparing to give a bed bath to an immobilized client with TB. Th enurse should wear which item when performing this care? a. Surgical mask and gloves b. particulate respirator, gown and gloves c. particulate respirator and protective eyewear d. Surgical mask gown andprotective eyewear
b. particulate respirator, gown and gloves
666. The nurse is discussing the techniques of chest physiotherapy and postural drainage (respiratory treatments) to a client having expectoration problems because of chronic thick, tenacious mucous production in the lower airway. The nurse explains taht after the client is positioned for postural drainage the nurse will perform which action to help loosen secretions? a. palpations and clubbing b. percussion and vibration c. hyperoxygenation and suctioning d. administer a bronchodilator and monitor peak flow
b. percussion and vibration
685. A client has been taking isoniazid for 1.5 months. THe client complains of numbness, paresthesias and tingling in the extremities. The nurse interprets that the client is experiencing which problem? a. hypercalcemia b. peripheral neuritis c. small blood vessel spasm d. impaired peripheral circulation
b. peripheral neuritis isoniazid is a drug used in the treatment of TB (antitubercular med) Common side effects of Isoniazid: peripheral neuritis, maifested by numbness, tingling and paresthesias in the extremities. Can minimize these effects with Vitamin B!!
686. A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? a. Use alcohol in small amounts only b. report yellow eyes or skin immediately c. Increase of Swiss or aged cheeses d. Avoid vitamin supplements during therapy
b. report yellow eyes or skin immediately Isoniazid is hepatotoxic & therefore the pt is taught to report s/s of hepatitis imediately (yellowing of the sclera and skin) Alcohol should also be avoided b/c of this Avoid intake of swiss cheese, fish (such as tuna) and foods containing tyramin b/c they may cause a reaction (itching of skin and redness, flushing, sweating, tachycardia, headache, lightheadedness)
690. The nurse has a prescription to give a client salmeterol (Serevent Diskus), two puffs, and beclomethasone dipropionate (Qvar), two puffs, by metered dose inhaler. The nurse should administer the medication using which procedure? a. beclomethasone first then salmeterol b. salmeterol first then the beclomethasone c. Alternating a single puff of each, beginning with the salmeterol d. Alternating a single puff of each, beginning with the beclomethasone
b. salmeterol first then the beclomethasone Salmeterol is an adrenergic type of bronchodilator and beclomethasone dipropionate is a glucocorticoid. Bronchodilators are always administered before glucocorticoids when being given at the same time. This allows for the widening of the airways by the bronchodilators which them make the glucocorticoids more effective
574. The nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and ketoacidosis. The client demonstrates an understanding of the teaching by stating that a form of glucose should be taken if which symptoms develop? a. polyuria b. shakiness c. palpitations d. blurred vision e. lightheadedness f. fruity breath odor
b. shakiness c. palpitations e. lightheadedness polyuria, blurred vision and fruity breath odor are all signs of hyperglycemia
724. The nurse is monitoring a client who is taking propranolol. Which assessment data indicated a potential serious complication associated with this med? a. the development of complaints of insomnia b. the development of audible expiratory wheezes c. a baseline BP of 150/8- mgHG followed by a BP of 138/72mmhg after 2 doses of the med d.A baseline resting HR of 88 bpm followed by a resting HR of 72 bpm after 2 doses of the med
b. the development of audible expiratory wheezes this may indicate a serios adverse reaction: bronchospasm. Beta-blockers may induce this reaction, particularly in patients with COPD or asthma. Insomnia is a frequent but mild side effect of the drug & should be monitored c&D are both expected effects of the drug
718. A client with angina complains that the anginal pain is prolonged and severe and occurs at the same time each day, most often at rest in the absecence of precipitating factors. How would the nurse best describe this type of anginal pain? 1. stable angina 2. variant angina 3. unstable angina 4. nonanginal pain
b.Variant angina or Prinzmental's angina, is prolonged an severe and occurs at the same time each day, most often at rest. stable angina is induced by exercise and relieved by rest or nitroglycerine tablets unstable angina occurs at lower levels of activity or at rest, is less predictable and is often a precursor for MI
687. A client has been started on long-term therapy with rifampin (Rifadin). The nurse should provide which information to the client about the medication? a. should always be taken with food or antacids b. should be double-dosed if one dose is forgotten c. Causes orange discoloration of sweat, tears, urine and feces d. May be discontinued independently if symptoms are gone in 3 months
c. Causes orange discoloration of sweat, tears, urine and feces TB drug Rifampin should be take exactly as directed. (not doubled or skipped doses) give on empty stomach unless GI upset do not stop therapy without HCP knowing antacids should be take 1 hour before
684. Zafirlukast (Accolate) is prescribed for a client with bronchial asthma. Which lab test does the nurse expect to be prescribed before the administration of this medication? a. Platelet count b. Neutrophil count c. Liver function tests d. Complete blood count
c. Liver function tests Accolate is a leukotriene receptor antagonist used in the prophylaxis and long-term treatment of bronchial asthma. Use with caution in pts with impaired hepatic function Liver function lab tests should be performed to obtain a baseline and the levels should be monitored during admin of this drug
677. The nurse performs an admission assessment on a client with a diagnosis of TB. The nurse should check the results of which diagnostic test that will confirm this diagnosis? a. Chest X-ray b. Bronchoscopy c. Sputum Culture d. TB skin test
c. Sputum Culture
679. A client has a prescription to take guaifenesin (Mucinex). The nurse determines that the client understands the proper administration of this med if the client states that he or she will perform which action? a. take an extra dose if fever develops b. take the med with meals only c. take the tablet with a full glass of water d. decrease the amount of daily fluid intake
c. Take the tablet with a full glass of water Mucinex is an expectorant and should be taken with a full glass of water to decrease the viscosity of the secretions.
659.The nurse is caring for a client after a bronchoscopy and biopsy. Which finding, if noted in teh client should be reported immediately to the HCP? a. dry cought b. hematuria c. bronchospasms d. blood-streaked sputum
c. bronchospasms blood-streaked sputum is expected for several hours if biopsy was performed during a bronchoscopy (frank blood indicates a hemorrhage) a dry cough may be expected hematuria is unrelated to this surgery Complications from bronchoscopy: cyanosis, dyspnea, stridor, bronchospasms, hemoptysis (coughing up blood), tachycardia, hypotension and dysrhythmias
727. the nurse is planning to administer hydrochlorothiazide to a client. THe nurse understands that which is a concern related to the admin of this med? a. Hypouricemia, hyperkalemia b. risk of osteoporosis c. hypokalemia, hyperglycemia, sulfa allergy d. Hyperkalemia, hypoglycemia, penicillin allergy
c. hypokalemia, hyperglycemia, sulfa allergy thiazide diuretics are sulfa-based meds and a client with a sulfa-allergy is at risk for an allergic reaction Clients are also at risk for : hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia and hyperuricemia
689. A client with TB is being started on anti-tuberculosis therapy with isoniazid. Before giving the client the first dose, teh nurse should ensure that which baseline study has been completed? a. electrolyte levels b. coagulation times c. liver enzyme levels d. Serum creatinine level
c. liver enzyme levels Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. So liver enzymes are monitored when therapy is initiated & during the first 3 months of therapy (possibly longer in >50yr, or alcoholics)
667. The nurse has conducted discharge teaching with a client diagnosed with TB, who has been recieving meds for 1.5 weeks. The nurse determines that the client has understood the information if the client makes which statemtent? a. I need to continue drug therapy for 2 months b. i cant shop at the mall for the next 6 months c. i can return to work if a sputum culture comes back negative d. I should not be contagous after 2-3 weeks of medication therapy
d. I should not be contagous after 2-3 weeks of medication therapy
728.The home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398. The client is taking cholestyramine (Questran). Which statement, by the client, indicated the need for further education? a. Constipation and bloating might be a problem b. I'll continue to watch my diet and reduce my fats 3. Walking a mile each day will help the whole process 4. I'll continue my nicotinic acid from the health food store
d. I'll continue my nicotinic acid from the health food store Nicotinic acid should be avoided because it may lead to liver abnormalities. All lipid lowering meds can also cause liver abnormalities, so a combo of these two need to be avoided
735. A client is prescribed nicotinic acid for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? a. It is not necessary to avoid the use of alcohol b. the med should be taken with meals to decrease flushing c. clay-colored stools are common side effects and should not be of concern d. Ibuprofen taken 30 mins before the nicotinic acid should decrease the flushing
d. Ibuprofen taken 30 mins before the nicotinic acid should decrease the flushing Flushing is a side effect of this med aspirin can be taken 30 mins prior to decrease flushing a. avoid alcohol- will enhance the flushing side effect b. should be taken with meals to decrease GI upset (not flushing) c. clay colored stools are a sign of hepatic dysfunction and should be reported immediately to the HCP
693. The nurse has just administered the first dose of Omalizumab (Xolair), used to treat allergic asthma. WHich statement by the client would alert the nurse that the client may be experiencing a life-threatening effect? a. I have a severe headache b. My feet are quite swollen c. i am nauseated & may vomit d. My lips and tongue are swollen
d. My lips and tongue are swollen anaphylactic reaction
675.The nurse is instructing a hospitalized patient with a diagnosis of emphysema about measures that will enhance the effectiveness of breathing during dyspneic periods. Which position should the nurse instruct the client to assume? a. Sitting up in bed b. Side-lying in bed c. Sitting in a recliner chair d. Sitting on the side of a bed and leaning on an over bed table
d. Sitting on the side of a bed and leaning on an over bed table positions that help clients with emphysema breath: sitting up & leaning on an overbed table sitting up and resting elbows on the knees standing and leaning against the wall
580. The home health nurse visits a client with a diagnosis of type 1 DM. THe client relates a hx of vomiting and diarrrheaand tells the nurse that no food has been comsumed for the last 24 hours. Which additional statement by the client indicated a need for further teaching? 1 "I need to stop my insulin" 2. I need to increase my fluid intake 3. i need to monitor my BG every 3-4 hours 4. I need to call the HCP because of these symptoms
1 "I need to stop my insulin" If a DM pt is unable to eat normally, they should still take their prescirbed insulin or oral meds. They SHOULD consume additional fluids, and notify teh HCP as well as monitor the BG q3-4h Pt should also monitor the urine for ketones
605. A client is taking Humulin NPH insulin and regular insulin every morning. The nurse should provide which instruction to the client? Select all that apply. 1. Hypoglycemia may be experienced before dinnertime 2. the insulin dose should be decreased if illness occurs. 3. The insulin should be administered at room temperature 4. the insulin vial needs to be shaken vigorously to break up the precipitates 5. the NPH insulin should be drawn into the syringe first, then the regular insulin
1 & 3 (1)Humulin NPH is an intermediate-acting insulin. the onset of action is 1.5 hours, it peaks 4-12 hours and its duration of action is 24 hours. Regular insulin is short-acting. Depending on the type, the onset of action is 0.5 hour, it peaks in 2-5.5 hours and its duration is 5-8 time. Hypoglycemic reactions most likely occur during peak time. (2)Clients may need their insulin increased during times of illness. (3) Insulin should be at room temp when administered. (4)Insulin vials should never be shaken vigorousely (5)Regular insulin is always drawn up before NPH
698. The nurse in a medical unit is caring for a client with HF. The client suddenly develops extreme dyspnea, tachycardia, and lung crackles and the nurse suspects pulmonary edema. the nurse immediately asks another nurse to contact the HCP and prepares to implement which PRIORITY interventions? Select all that apply 1. Administer Oxygen 2. Insert a foley 3. Administer Lasix 4. Administer morphine sulfate IV 5.Transport client to Coronary Care Unit 6.Place the client in low Fowler's side-lying position
1,2,3,4 If Pulmonary Edema: (1)Oxygen always prescribed (6)Place in High Fowler's position (to ease breathing) (3)Lasix is a quick-acting diuretic that will eliminated accumulated fluid (2) A foley is inserted to measure output accurately (4) IV mag sulfate reduces venous return (preload), decreases anxiety and reduces the work of breathing
658.The nurse is preparing a list of home care instructions for a client who has been hospitalized and treated for TB. Which instructions should the nurse include on the list? Select all that apply 1. activities should be resumed gradually. 2. avoid contact with other individuals, except family members for atleast 6 weeks 3. a sputum culture is needed every 2-4 weeks once meds are started 4. respiratory isolation is not necessary because family members have already been exposed 5. cover the mouth and nose when coughing or sneezing and put tissues into plastic bag 6. When one sputum culture is negative, the client is no longer considered infectious and usually can return to former employment
1,3,4,5 it is unlikely after 2-3 weeks of therapy that it is unlikely the pt will infect anyone need to eat well-balanced diet that is rich in iron, protein and vitamin c to promote healing and prevent recurrence of infection when results of 3 cultures are negative, the client is no longer considered infectious and can return to regular life
731. A client being treated for HF is administered IV Bumetanide. Which outcome indicated the med has achieved the expected effect? a. Cough becomes productive of frothy pink sputum b. the serum potassium level changes from 3.8 to 3.1 c. B-natriuretic peptide factor increases from 200 to 262 d. Urine output increases from 10 mL/hour to greater than 50 mL/hour
d. Urine output increases from 10 mL/hour to greater than 50 mL/hour Bumetanide is a diuretic and expected outcomes inclued increased urine output, decreased crackles and decreased weight
676. The community health nurse is conducting an educational session with community members regarding the symptoms associated with TB. Which is one of the FIRST manifestations associated with TB? a. dyspnea b. chest pain c. a bloody, productive cough d. a cough with the expectoration of mucoid sputum
d. a cough with the expectoration of mucoid sputum
682. A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the side and adverse effects of this med and should tell the client that whhich undesireable effect is associated with this med? a. insomnia b. constipation c. hypotension d. bronchospasm
d. bronchospasm Cromolyn sodium is an inhaled nonsteroidal anti-allergy agent and a mast cell stabilizer. Undesireable effects associated with inhalation therapy of Cromolyn Sodium are: bronchospasm, cough, nasal congestion, throat irritation, and wheezing. Oral effects: pruritus, nausea, diarrhea and myalgia
688. The nurse has given a client taking ethambutol (Myambutol) information about the medication. The nurse determines that the client understands the instructions if the client states he or she will IMMEDIATELY report which finding ? a. impaired sense of hearing b. GI side effects c. Orange-red discoloration of body secretions d. difficulty in discriminating the color red from green
d. difficulty in discriminating the color red from green Ethambutol causes optic neuritis, which decreases visual acuity and the ability to descriminate between the colors red and green. take with food if GI upset Impaired hearing results from anti-TB therapy with Streptomycin. Orange-red secretions come as side effect with Rifampin
730. Prior to administering a client's daily dose of digoxin, the nurse reviews the client's lab data & notes the following results: serum calcium (9.8), serum magnesium (1.2), serum potassium (4.1), serum creatinine (0.9). Which should alert the nurse that the client is a risk for digoxin toxicity? a. calcium level b. potassium c. creatinine d. magnesium
d. magnesium an increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism and impair renal function. The calcium, creatinine and potassium levels were all within normal limits. The normal range for magnesium is 1.6-5.6 and the results in the correct option are reflective of hypomagnesemia.
A client with diabetes mellitus has a glycosated hemoglobin A1C level of 9%. On the basis of this test result, the nurse plans to teach the client about the need for which measure? a. Avoid infection b. taking adequate fluids c. preventing & recognizing hypoglycemia d. preventing & recognizing hyperglycemia
d. preventing & recognizing hyperglycemia In the test result for hlycosylated hemoglobin A1C, levels higher than 8% are considered poor control of diabetes. THis test measures the amount of glucose that has become permenently bound ot the RBCs from circulating glucose. Elevations in the blood glucose level will cause elevations in the amount of glycosylation. So if elevated % = hyperglycemia