Archer - CAT EXAM

Graves' disease

Additional Info ✓ Graves' disease is an autoimmune disease and is the most common cause of hyperthyroidism ✓ A hallmark finding of this disease is heat intolerance ✓ Other manifestations of hyperthyroidism include exophthalmos, weight loss, irritability, and the thinning of scalp hair ✓ The course of treatment is antithyroid medications (propylthiouracil or methimazole) or surgical intervention

Osteomyelitis

An invasion of bacteria into the bone characterizes osteomyelitis. Osteomyelitis may occur from severe cellulitis or an open fracture. Treatment is a lengthy course of parenteral antibiotics.

The nurse is caring for a group of children on the medical-surgical unit. The nurse should initially follow up on the child who A. is receiving treatment for Hirschsprung's disease and has a temperature of 101°F (38.3°C). B. has an indwelling urinary catheter and reports burning at the insertion site. C. has scant blood in their newly established ostomy pouch. D. has friends writing words on their fiberglass cast with different colored markers.

Choice A is correct. A major complication of Hirschsprung's disease is the development of enterocolitis manifested by fever, abdominal distention, vomiting, and increased abdominal pain. Emergent intervention is necessary because the child may develop sepsis leading to septic shock.

The nurse is caring for a client who is receiving prescribed aripiprazole. Which of the following client findings would indicate a therapeutic response? A. Reports of no hallucinations and delusions B. Increased concentration and attention C. Improved muscle coordination and gait D. No reports of insomnia or night terrors

Choice A is correct. Aripiprazole is an atypical (second generation) antipsychotic indicated in treating schizophrenia and certain mood disorders such as bipolar. If the client reports no hallucinations or delusions, a positive symptom associated with schizophrenia, this medication has exerted its therapeutic effect.

The emergency department nurse is caring for a client with an abdominal aortic aneurysm at risk of rupturing. The nurse will anticipate the primary healthcare provider (PHCP) to prescribe A. esmolol. B. dexamethasone. C. heparin. D. pantoprazole.

Choice A is correct. For a client with a suspected ruptured (or rupturing) abdominal aortic aneurysm, tight blood pressure control is essential. Having tight blood pressure control decreases the pressure on the aneurysm. Esmolol is a beta-blocker and will exert antihypertensive effects. For a client with an unstable abdominal aortic aneurysm, the nurse should provide close monitoring of their vital signs and adequate pain control. Choices B, C, and D are incorrect. These medications are not indicated in the management of abdominal aortic aneurysms. Dexamethasone is a steroid and has no role in AAA management. Heparin would be contraindicated for a client with an abdominal aortic aneurysm because if the client needs surgery, this could cause a delay. Pantoprazole is used for peptic ulcer disease, not AAA. Learning Objective Recognize that beta-blockers are often used to control the blood pressure in AAA and reduce the rate of AAA size expansion.

A client has just been diagnosed with a terminal illness. She decides to execute a living will in the unit and asks the nurse to be the witness of the will. What is the most appropriate response by the nurse? A. "I'm sorry, but under the law, we're not allowed to witness living wills." B. "Let me call the doctor. Maybe he can witness it for you." C. "Your family are the only people that can serve as witnesses." D. "Let me call the hospital attorney; he neds to be present when you sign your will."

Choice A is correct. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses. Choice B is incorrect. This statement is inaccurate. Nurses and other healthcare workers in the facility where the patient is receiving care are forbidden by law from becoming witnesses. Choice C is incorrect. This statement is false. Witnesses for the signing of the will can be specific individuals; it does not necessarily mean only family. Choice D is incorrect. The hospital lawyer is not needed to be present in signing the living will.

A client in the psychiatric unit is having fits of uncontrolled anger. He is also seen shouting at staff and threatening to hurt them. The psychiatric nurse's most appropriate action would be: A. Call security to restrain and then sedate the client. B. Tell the client to calm down. C. Threaten the client to remove his privileges if he does not stop. D. Observe the client and leave him alone to calm down.

Choice A is correct. Once the client is at risk of harming himself, other clients, or staff, the nurse should call for help and prepare to administer a sedative/tranquilizer to calm him down. De-escalation should be continued all the time, talking, reassuring, and negotiating. However, physical intervention should be undertaken quickly for this mentally unstable client. Physical restraint should be the minimum necessary for theshortest period. Control is best done seated on a bed or kneeling, then restrained supine, not prone. Physical restraint should be accompanied by rapid sedation with medications. Choice B is incorrect. The client is enraged and agitated. Telling the client to calm down will not de-escalate the crisis and may provoke the client even more. If the client is otherwise mentally stable, acknowledging his distress without making accusations may help. For example, comments such as 'you are upset' or 'you seem very angry' may help calm the client if he is not mentally unstable. In the case of mentally stable clients, one could also use disarming comments such as 'How can I help?'. Asking the client how to defuse the situation may also help, referred to as 'positive engagement' in mental health practice. In this client scenario, he is mentally unstable, and there is a risk of an impending threat to the staff involved. Choice D is incorrect. If a violent incident is imminent, you need to intervene. The criterion to act is a severe immediate risk of harm to the client, other clients, visitors, or staff. Leaving the client alone may lead to the client or others getting injured.

The nurse is teaching a client newly prescribed phenelzine. Which dietary items should the nurse instruct the client to avoid while taking this medication? A. smoked bacon B. scrambled eggs C. milk D. kale

Choice A is correct. Phenelzine is a monoamine oxidase inhibitor (MAOI) medication indicated for treating severe depression. Smoke bacon is contraindicated because it contains a high level of tyramine which may cause a client to develop a life-threatening hypertensive crisis. Other foods contraindicated when the client takes an MAOI for depression include bananas, raisins, cheeses, sour cream, yogurt, beer, red wines, and Italian green beans. Choice B is incorrect. Scrambled eggs are not contraindicated when the client is taking a monoamine oxidase inhibitor (MAO) for depression; however, bananas and raisins are contraindicated when the client is taking a monoamine oxidase inhibitor. Choice C is incorrect. Milk is not contraindicated when the client is taking a monoamine oxidase inhibitor (MAO) for depression; however, cheeses, sour cream, yogurt, beer, and red wines are contraindicated when the client is taking a monoamine oxidase inhibitor. Choice D is incorrect. Kale is not contraindicated when the client is taking a monoamine oxidase inhibitor (MAO) for depression; however, Italian green beans are contraindicated when the client is taking a monoamine oxidase inhibitor.

The nurse is researching evidence-based practice and needs related literature. The nurse understands that the best source of reliable writing is: A. Systematic review and meta-analysis studies B. Expert opinions C. Qualitative studies D. Case studies

Choice A is correct. Systematic reviews and meta-analysis studies provide current, recently summarized evidence, making them the most reliable form of evidence for studies. Choice B is incorrect. Expert opinions may involve bias on the subject, making them unreliable sources of data. Choice C is incorrect. Qualitative studies involve interpretation of the database on the author's understanding of the subject, making these types of literature unreliable sources of data. Choice D is incorrect. Case studies may also involve bias from the authors, making them unreliable sources of data as well.

The nurse is caring for a client with the below laboratory result. Which early vital sign change would the nurse expect to support this finding? See the image below. A. Tachycardia B. Bradycardia C. Hypotension D. Bradypnea

Choice A is correct. The hemoglobin and hematocrit are critically low in this client. When critically low hemoglobin is evident, the nurse will likely see the client demonstrate tachycardia as a compensatory mechanism for the low blood volume. Tachycardia is the most reliable and earliest sign of hypovolemic shock. Choices B, C, and D are incorrect. Hypotension is not an early sign of hypovolemic shock. The first changes in vital signs seen in hypovolemic shock include increased diastolic blood pressure with narrowed pulse pressure. As volume status continues to decrease, systolic blood pressure drops. Bradypnea is a late sign of shock.

The nurse is caring for a client with a hyphema. The nurse should plan to take which action? A. Shield the affected eye. B. Place the client supine. C. Apply a cold compress to the eye. D. Request a prescription for aspirin.

Choice A is correct. The initial nursing priorities for a hyphema are shielding the affected eye and raising the head-of-the bed to 30 degrees. Choices B, C, and D are incorrect. Placing a client supine would aggravate the injury. The purpose of raising the head-of-the-bed to 30 degrees is because it promotes the settling of blood in the anterior chamber away from the visual axis. Cold compression of the eye would not be helpful. This compression may raise intraocular pressure which would be contraindicated. Aspirin and NSAIDs should be avoided because of their platelet inhibition which will promote more bleeding. Additional Info A hyphema is an ocular emergency caused by blood in the anterior chamber. This injury results from trauma and should be addressed promptly. Initial nursing actions include: ✓ Elevation of the head of the bed to 30 degrees. This will keep the blood below the visual axis. ✓ Application of an eye shield to the affected eye. This will prevent further injury. ✓ Prescribed pain medication should not include aspirin or NSAIDs. ✓ Educate the client to avoid any activity that raises the intraocular pressure, such as bending at the waist, vomiting, or coughing.

The nurse is caring for a client diagnosed with osteomalacia. The nurse is correct in characterizing osteomalacia as A. bone softening from insufficient levels of vitamin D. B. invasion of bacteria into the bone. C. decreased bone mass caused by a deficiency of calcium. D. a bone fracture caused by minimal trauma.

Choice A is correct. The most common etiology of osteomalacia is insufficient amounts of vitamin D. The low vitamin D levels cause the bones to soften, predisposing them to fractures. The most common cause of osteomalacia is malnutrition. Choice B is incorrect. An invasion of bacteria into the bone characterizes osteomyelitis. Osteomyelitis may occur from severe cellulitis or an open fracture. Treatment is a lengthy course of parenteral antibiotics. Choice C is incorrect. Decreased bone mass caused by a deficiency of calcium best characterizes osteoporosis. A decline in estrogen or testosterone also causes osteoporosis, as these hormones are key in preventing excessive osteoclastic activity. Choice D is incorrect. A bone fracture caused by minimal trauma characterizes a pathological fracture. Osteoporosis and osteomalacia may make bones more susceptible to this type of fracture.

The nurse is teaching a 57-year-old client about screening for colorectal cancer. Which of the following information should the nurse include? A. "It is recommended that colon cancer screening with a colonoscopy should begin at age 45." B. "It is recommended that colon cancer screening with a colonoscopy should begin at age 70." C. "It is recommended that colon cancer screening with a colonoscopy should begin at age 40." D. "It is recommended that colon cancer screening with a colonoscopy should begin at age 65."

Choice A is correct. The nurse should inform the client that a colonoscopy should begin at age 45. Current screening guidelines state that colon cancer screening with a colonoscopy should begin at age 45 unless known risk factors exist. Choices B, C, and D are incorrect. Certain clients with high-risk conditions (ulcerative colitis, lynch syndrome, family history of colon cancer) may develop colon cancer early. For these individuals, recommendations vary. There is no indication that the client in the vignette has a family history or high-risk predisposing condition.

The primary and ultimate purpose of reporting incidents, accidents, medical errors, and sentinel events is to: A. Prevent client injuries B. Comply with regulations C. Determine the cause D. Correct mistakes

Choice A is correct. The primary and ultimate purpose of reporting incidents, accidents, medical errors, and sentinel events is to prevent client injuries. Choice B is incorrect. Although regulations mandate the reporting of incidents, accidents, medical errors, and sentinel events, compliance is not the primary and ultimate purpose. Choice C is incorrect. Though determining the cause of incidents, accidents, medical errors, and sentinel events is an outcome of this reporting, this is not the primary and ultimate purpose. Choice D is incorrect. While correcting mistakes and faulty processes are outcomes of this reporting, this is not the primary and ultimate purpose. Additional Info ✓ Incident-reporting systems are set up as a way to report errors, especially safety errors. ✓ They are used to gather data and information about client safety occurrences for organizational learning. ✓ There are three types of incidents: a harmful incident, a no-harm incident, and a near miss. ✓ Incident-reporting systems are part of risk management efforts and are voluntary but set an expectation for reporting. ✓ Barriers to reporting include personal reasons such as fear, accountability, and nurse characteristics, as well as organizational factors including culture, the reporting system, and management behavior.

The nurse is caring for assigned clients in the mental health unit. The nurse should initially follow up on the client who A. is admitted for psychosis and is pacing in the hallway, mumbling to themselves. B. is being treated for obsessive compulsive disorder and has increased the number of times they wash their hands. C. has a substance use disorder and refuses to attend group therapy for the second time. D. is diagnosed with borderline personality disorder and is insisting on seeing the charge nurse for an allegation of abuse two days ago.

Choice A is correct. This client is demonstrating signs of aggression (mumbling, pacing), and the nurse should intervene to avoid any escalation and to prevent disruption to the milieu. Manifestations of aggressive behavior include pacing, hyperactivity, a rigid posture, clenched jaw or fist, mumbling to themselves, intense eye contact, or stone silence. The client's diagnosis of psychosis also supports intervention from the nurse because psychosis features impulsivity and irrational acts.

Which of the following statements correctly outlines the proper flow of blood through the heart? A. Superior and Inferior vena cavas → Right atrium → Tricuspid valve → Right ventricle → Pulmonary valve → Pulmonary artery → Lungs → Pulmonary veins → Left atrium → Mitral valve → Left ventricle → Aortic valve → Aorta → Systemic circulation B. Superior and Inferior vena cavas → Right atrium → Mitral valve → Right ventricle → Pulmonary valve → Pulmonary artery → Lungs → Pulmonary veins → Left atrium → Tricuspid valve → Left ventricle → Aortic valve → Aorta → Systemic circulation D. Superior and Inferior vena cavas → Right atrium → Tricuspid valve → Right ventricle → Aortic valve → Pulmonary veins→ Lungs → Pulmonary artery → Left atrium → Mitral valve → Left ventricle → Pulmonary valve → Aorta → Systemic circulation

Choice A is correct. This is the proper blood flow through a healthy heart with normal anatomy. The superior and inferior vena cavas are the large veins that bring back deoxygenated blood from the body to the heart's right atrium. The blood enters the right atrium, passes through the tricuspid valve into the right ventricle, and is pumped into the lungs through the pulmonary artery. In pulmonary circulation, the deoxygenated blood drops off its carbon dioxide and waste products and picks up fresh oxygen to deliver to the body. It is now oxygenated. The blood returns to the left atrium through the pulmonary veins, passes through the mitral valve to enter the left ventricle, and is pumped out to the body through the aorta. Oxygenated blood is now in the systemic circulation, where it can deliver oxygen to all body tissues.

The nurse is reviewing newly prescribed medications for a client taking lithium. Which medication requires further follow-up? A. Venlafaxine B. Hydrochlorothiazide C. Gabapentin D. Verapamil

Choice B is correct. A client taking lithium should be instructed to avoid dehydration and hyponatremia. Lithium is a salt, and when the client has decreased fluid volume, the drug will accumulate and raise the lithium level. HCTZ is a thiazide diuretic and is contraindicated for a client taking lithium because of its ability to decrease fluid and sodium levels. Choices A, C, and D are incorrect. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor and has no contraindication with lithium. Further, gabapentin and verapamil have no contraindications as gabapentin is indicated for neuropathy, and verapamil is indicated for hypertension.

The nurse is caring for a hypothermic client and receiving warmed intravenous fluids. The nurse understands that rewarming must be done slowly for which primary reason? A. To prevent burns in the client B. To prevent ventricular fibrillation C. To prevent frostbite D. To avoid muscle spasms

Choice B is correct. Although rewarming should not be delayed, rewarming should be performed slowly while closely monitoring cardiac rhythm, as hypothermic clients are especially susceptible to the development of cardiac arrhythmias (ventricular extra systoles, atrial fibrillation, and ventricular fibrillation). Choice A is incorrect. Preventing burns is the nurse's responsibility when warming a client, but it is not the main reason for slow rewarming. Choice C is incorrect. Frostbite is a product of hypothermia to the extremities, not rewarming. Choice D is incorrect. Muscle spasms are not caused by rewarming. Learning Objective Recognize that ventricular fibrillation is a dreaded complication of rapid rewarming in hypothermic clients. Additional Info Rapid rewarming can disrupt the body's metabolic processes, leading to acid-base status and electrolyte levels imbalances, potentially further compromising organ function and/or overall health. For clients with moderate to severe hypothermia, therapy is determined by the presence or absence of a perfusing rhythm. Continuously monitor the client's core body temperature, vital signs, heart rhythm, and oxygen saturation during the rewarming process. Regularly assess the client's skin color, temperature, and perfusion of the extremities.

A 25-year-old female reports intermittent abdominal pain, bloating, and flatulence that has lasted for several months. Which of the following would the nurse tell the patient to avoid? A. Fiber B. Broccoli C. Yogurt D. Simple carbohydrates

Choice B is correct. Broccoli forms gas in the stomach and should be avoided for this patient. Choice A is incorrect. High fiber foods help assemble waste in the intestine by adding bulk to stool. Choice C is incorrect. Yogurt can help eliminate toxins and replace lousy gut bacteria with healthy bacteria. Choice D is incorrect. Complex carbohydrates are more likely to cause abdominal discomfort than simple carbohydrates.

The nurse is caring for a child admitted with congestive heart failure. Which of the following assessment findings would be expected? A. Pulse deficit B. Exercise intolerance C. Bradypnea D. Flattened neck veins

Choice B is correct. Exercise intolerance is common for a child with heart failure because the cardiac output cannot keep up with the demands of exercise. Fatigue may develop and irritability from the child's inability to participate in exercise-related activities. Choices A, C, and D are incorrect. A pulse deficit is the difference between the apical and peripheral pulses. It is abnormal to have a pulse deficit (for example, an apical pulse of 75; a radial pulse of 68) as this would be a common finding with an irregular heart rhythm, not heart failure. Tachypnea is a common feature of heart failure because of decreasing lung compliance; this is often seen with tachycardia. Flattened neck veins are unexpected in heart failure, whereas distended neck veins are common because of increased venous pressure.

he nurse is assessing a client with systolic heart failure receiving prescribed carvedilol. Which of the following findings would indicate a therapeutic response? A. Increased urinary output B. Increased left-ventricular ejection fraction (EF) C. Increased left-ventricular remodeling D. Increased brain natriuretic peptide (BNP)

Choice B is correct. Low-dose beta-blockers (along with ACE inhibitors) are the mainstay treatment in managing heart failure. Carvedilol is a popular drug because it decreases the sympathetic response in heart failure, including tachycardia. While this is a standard compensatory mechanism, it may have deleterious effects by remodeling the heart and causing a vascular strain. An increased left-ventricular ejection fraction (EF) would be a desired response because it increases the amount of blood being ejected per beat. The normal EF is 55% or greater. Systolic heart failure is diagnosed at an EF of 40% or less. For example, if a client has an EF of 30% and 100 mL of blood is in the left ventricle, only 30 mL is being ejected into the systemic circulation. Choice A is incorrect. Beta-blockers do relax vascular resistance, thereby allowing increased renal blood flow. However, they do not have a direct diuretic effect. Medications having a direct diuretic effect include loop diuretics, such as furosemide. Choice C is incorrect. Increased left-ventricular remodeling is an unwanted effect that occurs with heart failure. This can be inhibited by the client being prescribed an ACE inhibitor or, to a lesser effect, a low-dose beta-blocker such as carvedilol. This is a reminder of why these two medication classes, beta-blockers, and ACE inhibitors, are the mainstay treatment in systolic heart failure. Choice D is incorrect. An increased brain natriuretic peptide (BNP) would be a worsening sign of heart failure. As the ventricle stretches because of excessive volume, this peptide is released and can be measured via a laboratory test.

The nurse is caring for a client receiving mechanical ventilation. Which prescription from the primary healthcare physician (PHCP) should the nurse anticipate? A. hydroxyzine B. pantoprazole C. rivastigmine D. verapamil

Choice B is correct. Mechanical ventilation may cause a stress ulcer. A proton pump inhibitor (PPI) or a histamine-2 receptor antagonist (H2 blocker) may be utilized to prevent this ulcer which may lead to a gastrointestinal bleed. Choice A, C, and D are incorrect. Hydroxyzine is an anticholinergic utilized in allergic reactions and anxiety. Rivastigmine increases acetylcholine in the central nervous system and is indicated for dementia. Verapamil is a calcium channel blocker indicated for hypertension and migraine headache prophylaxis. These medications have no relevance to mechanical ventilation management. Additional Info ✓ Mechanical ventilation poses a risk for a stress ulcer to form. ✓ This is caused by hypersecretion of gastric acid and impaired protection of the gastric mucosa. ✓ Stress ulcers pose a serious risk as they may cause gastrointestinal bleeding. ✓ This bleeding may lead to perforation and then shock. ✓ PPIs such as pantoprazole or H2 blockers famotidine may be used to mitigate this risk. ✓ A concern with PPI usage is that it may increase the risk of pneumonia. This must be considered when a client is prescribed this type of therapy. ✓ Manifestations of stress ulcers include hematemesis, melena, anemia, and shock.

The nurse is caring for a client experiencing severe anxiety prior to an endoscopy procedure. The nurse anticipates a prescription for which medication from the primary healthcare provider (PHCP)? A. Oxycodone B. Midazolam C. Citalopram D. Haloperidol

Choice B is correct. Midazolam is a benzodiazepine used for acute anxiety attacks. Midazolam is preferred in this setting because of its rapid onset (2 to 5 minutes after IV administration) and short duration of action (3 to 8 hours). It can be administered intravenously or orally. Given these benefits, midazolam would be the most useful for clients experiencing an acute anxiety attack before or during endoscopic procedures or surgery. Additional benefits of midazolam during procedures are sedation and amnesia. Midazolam, as a continuous IV infusion, is also used in sedating mechanically ventilated clients in critical care settings. The nurse should keep flumazenil as an antidote ready in case severe respiratory depression occurs with benzodiazepines.

The nurse is caring for a client diagnosed with pernicious anemia. The nurse should anticipate a prescription for which medication? A. Thiamine B. Cyanocobalamin C. Iron dextran D. Folic acid

Choice B is correct. Pernicious anemia is characterized by the inability of the body to utilize Vitamin B12. This results in a decrease in hemoglobin, giving the client anemia. The nurse should anticipate a prescription for Vitamin B12, which may be administered parenterally for the greatest benefit. Choices A, C, and D are incorrect. Thiamine is a B-vitamin and is commonly administered for alcohol withdrawal to prevent permanent encephalopathy. Iron dextran is indicated for iron deficiency anemia. Finally, folic acid is administered for folic acid deficiency anemia which may be caused by alcoholism or certain medications such as methotrexate. Additional Info ✓ Classic manifestations of vitamin B12 anemia include cognitive slowing, numbness and tingling in the extremities, glossitis, insomnia, and irritability ✓ This macrocytic anemia caused by a gastrectomy is treated with parenteral vitamin B12 injections (IM or SubQ) ✓ Common causes of pernicious anemia include decreased intake of vitamin B12 (eg, reduced intake of animal products, strict vegan diet, breastfeeding by a vitamin B12-deficient mother), decreased absorption of vitamin B12 (eg, gastrectomy, bariatric surgery, Crohn's disease, celiac disease, pancreatic insufficiency, bacterial overgrowth, fish tapeworm infection, gastric atrophy associated with aging), and medications such as metformin

The nurse is taking the vital signs of a pregnant client in active labor. When she inflates the blood pressure cuff, she looks at the fetal monitor and notices that the fetal heart rate increases above baseline and then returns to baseline about 15 seconds later. What is the priority nursing action? A. Notify the healthcare provider B. Document and continue to monitor C. Place the mother on her left side D. Administer 100% FiO2 via face mask

Choice B is correct. Since the nurse has noted a reassuring sign of the fetal heart rate, it is appropriate for her to document the findings and continue to monitor the mother. If the nurse had noticed a non-reassuring sign, other interventions would be necessary. Choice A is incorrect. The nurse has observed an acceleration in the fetal heart rate, which is an increase in fetal heart rate by 15 bpm above the baseline. An acceleration lasts about 10-15 seconds and then the heart rate returns to baseline. Accelerations are a reassuring sign observed on a fetal heart rate monitoring strip. The nurse does not need to report this to the healthcare provider. Choice C is incorrect. Accelerations are a reassuring sign observed on a fetal heart rate monitoring strip and do not require repositioning of the mother to the left side. Repositioning the mother to the left-lateral position will be needed if a non-reassuring sign (e.g. fetal bradycardia, late decelerations) is noted. Choice D is incorrect. Accelerations are a reassuring sign observed on a fetal heart rate monitoring strip and do not require administration of 100% FiO2 via face mask.

The nurse received a prescription for a continuous infusion of weight-based heparin for a client with acute coronary syndrome. Prior to administering the medication, the nurse should A. obtain a blood specimen to measure the creatinine. B. weigh the client. C. obtain a blood specimen to measure the international normalized ratio (INR). D. verify that the client has a 20-gauge peripheral venous access device (VAD).

Choice B is correct. The client needs to be weighed for prescribed a weight-based heparin infusion. It is inappropriate for the nurse to rely on the client's stated or estimated weight because this could lead to a severe dosing error. An accurate weight, along with a baseline activated partial thromboplastin time (aPTT) and platelet count, should be obtained prior to the start of the infusion. Choices A, C, and D are incorrect. Serum creatinine level is not required because kidney function does not affect heparin dosing. This is not true if the client were prescribed a low molecular weight-based heparin such as enoxaparin which is excreted by the kidneys; their biological half-life may be prolonged in clients with kidney failure. INR does not need to be obtained. This laboratory parameter is monitored when a client is receiving warfarin. Heparin does not require a 20-gauge peripheral vascular access device. This is a true statement for a client receiving a unit of packed red blood cells but not heparin. Additional Info ✓ Unfractionated heparin is an anticoagulant that may be administered for a client with acute coronary syndrome, venous thromboembolism, and pulmonary embolism ✓ Heparin is a high-risk medication requiring a double-check with another nurse to ensure that it is an accurate dose ✓ An accurate weight is needed as most (not all) protocols require a weight-based dosing structure ✓ Heparin is advantageous because it has a rapid onset of action and offset of action in the event the client needs surgery

The nurse is caring for a client two days post-operative following gastroduodenostomy. After reviewing the clinical data, the nurse should take which action? A. obtain a prescription for an antihypertensive B. determine if the client's pain is being controlled C. assess the client's surgical wound for signs of infection D. notify the physician for concerns of hypovolemic shock

Choice B is correct. The client's blood pressure and pulse have steadily increased. Manifestations of poor pain control include sympathetic responses, which cause an increase in blood pressure and pulse. Other nonverbal manifestations include pupil dilation, sweating, guarding of the surgical wound (or affected area), and social withdrawal. Choice A is incorrect. In the context of the client being postoperative and having increasing blood pressure and pulse, the nurse should determine if the client's pain is controlled because an antihypertensive would mask the client's vital signs, which suggest pain. Choice C is incorrect. It is too early for the client to demonstrate manifestations of infection. Postoperative infection usually begins at the end of postoperative day three or postoperative day four. This would be an inappropriate assessment, considering the time frame. Choice D is incorrect. Hypovolemic shock may occur, but the vital signs suggest hypovolemic shock are tachycardia and hypotension. The diastolic blood pressure would temporarily increase in the early stages of shock, and then both would start to trend downward. The client's blood pressure is not trending downward. Additional Info ✓ Poor pain control may delay postoperative healing as the client's sympathetic nervous system would increase glucose levels, blood pressure, and pulse. ✓ The client may also become withdrawn and resist dressing changes and participating in ambulation or physical therapy. ✓ Self-report is the best tool in assessing a client for pain, but that does not exclude the nurse from assessing for nonverbal indicators.

The nurse is caring for a toddler diagnosed with Reye syndrome. Upon assessment of the child's medical history, which condition should the nurse expect? A. cellulitis B. influenza C. meningitis D. mumps

Choice B is correct. Upon assessment of the child's medical history, the nurse should anticipate a finding of a viral infection, specifically influenza (A or B) or varicella, within the preceding two-week period. This is because individuals with these viral infections may have a fever, and taking aspirin could trigger this complication. Choice A is incorrect. Cellulitis is a bacterial infection not typically associated with Reye syndrome. Choice C is incorrect. Meningitis, including viral meningitis, is not commonly associated with Reye syndrome. Choice D is incorrect. Mumps, although viral, is not generally associated with Reye syndrome. Learning Objective Correlate Reye Syndrome (also commonly referred to as Reye's Syndrome) with the finding of a diagnosis of influenza or varicella within the preceding two weeks. Additional Info ✓ Reye syndrome is a rare form of acuteencephalopathy and fatty infiltration of the liver that tends to occur after some acute viral infections, mainly when salicylates (aspirin) are used during the illness. ✓ Symptoms include abrupt onset of vomiting, diarrhea, hyperventilation, restlessness, seizures, and coma. ✓ In June 1982, the Secretary of Health and Human Services began a public campaign to educate against using salicylates in pediatric clients. The New York Timesran a front-page article that included the following first line: "The Government announced plans today to advise doctors and parents against using aspirin to treat children's chicken pox or flu-like symptoms because studies have linked aspirin to Reye's Syndrome, a rare but often fatal children's disease." With decreased use of salicylates among children, Reye's syndrome is now very rare.

A client asks the nurse about an herbal product used to treat insomnia. The nurse should recommend the client ask their physician about which herbal supplement to promote sleep? A. Raspberry leaf tea B. Valerian root C. Glucosamine D. Black Cohosh

Choice B is correct. Valerian root is a common herbal remedy used to treat occasional insomnia but may interact with some medications. Clients should be encouraged to discuss herbal remedies with their doctors. Choice A is incorrect. Raspberry tea leaf is a popular herbal tea used to induce labor and expedite the shrinking of the uterus post-partum. It is not used to treat insomnia. Choice C is incorrect. Glucosamine is a commonly recommended amino sugar used to promote joint health. It does not correct insomnia. Choice D is incorrect. Black cohosh is an herbal supplement sometimes used to induce abortion in the early first trimester or to induce labor after a woman is forty weeks pregnant. It does not help with insomnia.

The nurse is preparing to transfuse fresh frozen plasma (FFP) to a client. Which of the following actions would be appropriate for the nurse to take? A. Obtain baseline platelet count B. Verify ABO compatibility C. Infuse over two to four hours D. Obtain a 12-lead electrocardiogram

Choice B is correct. When infusing fresh frozen plasma (FFP), the nurse should ensure that the FFP is ABO compatible with the recipient. FFP should be ABO compatible because plasma may contain enough antibodies and may cause hemolysis in the recipient.

The nurse is caring for a client who is experiencing acute mania. Which of the following actions should be prioritized by the nurse? A. Plan structured solitary activities B. Redirect the client's speech and ideas C. Provide high-calorie, small, frequent meals D. Initiate a psychiatry referral

Choice C is correct. A client experiencing acute mania manifests symptoms such as inflated self-esteem, flight of ideas, psychomotor agitation, and an expansive affect. The client experiencing mania often has difficulty sleeping and exerts excessive physical energy. Thus, the nurse must meet the client's nutrition needs by offering high-calorie, small, frequent meals. This is the priority based on Maslow's Hierarchy of Needs (physiological). Choices A, B, and D are incorrect. Structured solitary activities are recommended for a client experiencing mania because group activities may trigger conflict. The nurse should redirect the client's fragmented speech and ideas as well as consult psychiatry. However, this is not the priority over the client's physical need for appropriate nutrition. Additional Info ✓ Manifestations of mania include an expansive affect, tangential speech, impaired reality testing, flight of ideas, and psychomotor agitation ✓ Medications used to treat bipolar disorder include lithium, quetiapine, aripiprazole, olanzapine, and oxcarbazepine

The nurse is educating a client with glaucoma. Which of the following classifications of medications should the nurse instruct the client to avoid? A. Osmotic diuretics B. Beta-adrenergic blockers C. Anticholinergics D. Alpha-2 adrenergic blockers

Choice C is correct. Anticholinergic medications (atropine, scopolamine) can increase intraocular pressure (IOP) and worsen the condition of clients with glaucoma. Anticholinergic agents also have the potential to produce central side effects in adults, such as confusion, an unsteady gait, or drowsiness. Other classes of medications, such as tricyclic antidepressants and antihistamines, also have anticholinergic side effects and should be avoided in glaucoma. Choices A, B, and D are incorrect. Osmotic diuretics, beta-blockers, and alpha-adrenergic agents are used in treating glaucoma. Osmotic diuretics (mannitol) and carbonic anhydrase inhibitors (acetazolamide) are most often used to manage acute closed-angle glaucoma urgently (choice A). Beta-adrenergic blockers (timolol) are used to treat glaucoma (choice B). Alpha-2 adrenergic agents (brimonidine) are also used to treat glaucoma less frequently than other anti-glaucoma medications. They produce minimal cardiovascular and pulmonary side effects. They may cause drowsiness, dry mucosal membranes, irritated eyelids, and headaches (choice D).

The nurse has been made aware of the following client situations. The nurse should first follow up with the client A. receiving a chemotherapy infusion who reports nausea and vomiting. B. newly diagnosed with polycystic kidney disease reporting hematuria and flank pain. C. being treated for aplastic anemia and has a temperature of 101.1° F (38.4° C). D. being treated for pulmonary tuberculosis and ambulating in the hallway wearing a surgical mask.

Choice C is correct. Aplastic anemia (AA) can cause a critically low neutrophil count because of the pancytopenia it induces. The low neutrophil count puts the client at risk for a life-threatening infection. The client's remarkable fever warrants prompt follow-up so the nurse may initiate measures such as blood culture collection, administer prescribed antibiotics and antifungals, and provide supportive measures such as antipyretics. Choices A, B, and D are incorrect. Chemotherapy-related nausea and vomiting are common side effects and require treatment with antiemetics and intravenous fluids. This is an expected occurrence. Polycystic kidney disease (PKD) has a cardinal feature of flank pain and hematuria. This is an expected finding and is treated with dry heat and acetaminophen. The client with pulmonary tuberculosis may ambulate while wearing a surgical mask. The healthcare worker must wear a respirator (N95 mask) when providing care to the client. Additional Info ✓ Aplastic anemia ranges in severity but causes a client to develop pancytopenia (low red blood cells; low white blood cells; low platelets) ✓ Life-threatening complications include bleeding due to thrombocytopenia, fatigue due to anemia, and serious infection because of neutropenia ✓ Treatment includes a stem cell transplant

The emergency department (ED) nurse is caring for a client with suspected bacterial meningitis. The nurse should take which priority action? A. Notify public health services B. Dim the lights in the assigned room C. Obtain blood cultures D. Explore the client's feelings regarding the diagnosis

Choice C is correct. Bacterial meningitis is a medical emergency, and priority actions for the nurse are to assess the client's airway, breathing, and circulation; beyond the assessment of the ABCs and vital signs, the nurse should immediately establish a peripheral vascular access device and obtain blood cultures and laboratory work such as lactic acid and complete blood count. Lactic acid is a marker that may support the co-existing diagnosis of sepsis. The client will need an immediate lumbar puncture which will definitively exclude or confirm the diagnosis of bacterial meningitis. Considering this client has been diagnosed with bacterial meningitis, the nurse must collect blood cultures and then administer prescribed antibiotics that are aggressively dosed. Antibiotics commonly prescribed for bacterial meningitis include ceftriaxone and vancomycin. Choices A, B, and D are incorrect. These are all actions the nurse should take when it comes to caring for a client with bacterial meningitis. Notifying public health services is required because it can be spread via infected droplets. A manifestation associated with bacterial meningitis is a significant headache and photophobia; thus, part of caring for the client is to dim the lights and provide a low-stimulation environment. However, that does not prioritize the collection of blood cultures and the administration of empiric antibiotics. Exploring the client's feelings regarding their diagnosis is helpful, but physical needs will prioritize over psychosocial needs.

The nurse is caring for a client diagnosed with Generalized Anxiety Disorder (GAD). The nurse should anticipate a prescription for which medication? A. Haloperidol B. Fluphenazine C. Buspirone D. Methylphenidate

Choice C is correct. Buspirone is a serotonergic agent that is efficacious in the treatment of anxiety. It is approved by Food and Drug Agency (FDA) for generalized anxiety disorder (GAD). While buspirone is primarily used to treat generalized anxiety disorder, it also treats depression, social phobia, and ataxia. Buspirone takes time to work (approximately two to four weeks), and the clients should be counseled that they may not appreciate a symptom improvement during that period. Choices A, B, and D are incorrect. Haloperidol and fluphenazine are typical antipsychotics indicated in the treatment of schizophrenia (choices A, B). These medications do not modulate serotonin; therefore, they have no use in anxiety disorders. Methylphenidate is indicated in the treatment of ADHD, and its stimulating effects may even worsen anxiety (choice D).

While assessing a newborn infant in the nursery, you observe bounding 3+ radial pulses and faint 1+ pedal pulses. You also notice that the feet are cold and pale, while the hands are warm and pink. Which cardiac defect do you suspect this infant has? A. Tetralogy of Fallot (TOF) B. Hypoplastic left heart syndrome C. Coarctation of the aorta (COA) D. Transposition of the great arteries

Choice C is correct. Coarctation of the aorta is a narrowing of the aorta near the ductus arteriosus. Because of this narrowing, there is increased blood flow to the upper extremities and decreased blood flow to the lower extremities. That causes the symptoms described in the question: bounding upper pulses, faint lower pulses, and overall better perfusion to the upper extremities. Choice A is incorrect. In the tetralogy of Fallot, four defects are combined - an overriding aorta, pulmonary stenosis, hypertrophy of the right ventricle, and a VSD. At birth, the nurse would appreciate a murmur and mild to severe cyanosis, depending on the case. The described symptoms do not fit the tetralogy of Fallot. Choice B is incorrect. In hypoplastic left heart syndrome, the left side of the heart is underdevelopment. The nurse would note cyanosis and murmur at birth, but the described symptoms do not fit hypoplastic left heart syndrome. Choice D is incorrect. In the transposition of the great arteries, the pulmonary artery leaves the left ventricle, and the aorta leaves the right ventricle. These infants are severely cyanotic at birth and need surgery early in life, but the described symptoms do not fit the transposition of the great arteries.

The nurse is caring for a client taking a prescribed naproxen. The nurse should assess the client for which adverse effect? A. Low blood glucose B. Agitation C. Bleeding D. Nasal congestion

Choice C is correct. Naproxen is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs have been commonly implicated in causing adverse bleeding episodes. Specifically, bleeding in the gastrointestinal tract. All NSAIDs can be ulcerogenic and induce gastrointestinal bleeding due to their activity against tissue COX-1 which causes an inhibition against platelet aggregation. Choices A, B, and D are incorrect. NSAIDs do not cause these effects. While NSAIDs may cause a low risk for mood lability, agitation has not been specifically reported. Learning Objective Recognize a correlation between long-term NSAID use and decreased platelet adhesiveness. Additional Info ✓ NSAIDs include ibuprofen, naproxen, oxaprozin, and ketorolac ✓ NSAIDs are efficacious for pain or pyrexia ✓ NSAIDs are nephrotoxic; therefore, monitoring renal function (BUN and creatinine) is essential ✓ NSAIDs may adversely cause gastrointestinal bleeding, renal insufficiency, myocardial infarction (MI), or stroke ✓ Clients with peptic ulcer disease, congestive heart failure, renal injury, or a previous MI should not use NSAIDs

Which of the following maternal infections may increase the risk of developing congenital heart defects in the fetus? A. Parainfluenza B. Adenovirus C. Rubella D. Measles

Choice C is correct. Rubella is a maternal infection that is known to increase the risk that the fetus will have a congenital heart defect. All mothers should be tested for rubella, and if found to be positive, should have a fetal echocardiogram performed to evaluate the fetus' heart more closely. Choice A is incorrect. Parainfluenza is not known to affect the risk for congenital heart disease. Choice B is incorrect. Adenovirus is not known to affect the risk for congenital heart disease. Choice D is incorrect. Measles is not known to affect the risk for congenital heart disease. NCSBN Client Need Topic: Effective, safe care environment; Subtopic: Maternal/Fetal infection control and safety

The nurse is preparing a staff development conference on milieu therapy. Which of the following information should the nurse include? A. This type of environment is established in inpatient treatment facilities, emphasizing physical well-being. B. This therapy primarily focuses on helping clients develop emotional connections with individuals in the community. C. An emphasis of this therapy is the setting, the structure, and the emotional climate as important to the client's healing. D. The approach to milieu therapy is unstructured and allows clients to self-regulate what they feel should be allowed.

Choice C is correct. The cornerstone of milieu therapy is to provide an all-inclusive (staff and clients) structured environment that fosters routine, safety, and acceptance. This environment enables healing and promotes positive outcomes. ✓ Hildegard Peplau referred to the therapeutic milieu as an all-inclusive term that recognizes the people (clients and staff), the setting, the structure, and the emotional climate as essential to healing. ✓ Whether the setting involves treating children with psychotic disorders, adult clients in a psychiatric hospital, clients with substance use disorder in a residential treatment center, or clients in a day treatment program. The milieu therapy aims to offer clients a sense of security and promote healing. ✓ The nurse can help maintain the therapeutic milieu by Minimizing disruptions in the unit through appropriate client placement Rendering culturally sensitive care Selecting appropriate activities that meet both the physical and mental needs Using the least restrictive environment

The nurse is caring for a client with the following clinical data, as shown in the exhibit. Which medication would the nurse be concerned about before administration based on the vital signs? See the exhibit. A. Metoprolol 50 mg PO Daily B. Lisinopril 40 mg PO Daily C. Albuterol 2.5 mg via nebulizer Daily D. Diltiazem XR 120 mg PO Daily

Choice C is correct. The vital signs (VS) show an increased pulse (123 bpm) and elevated blood pressure. Albuterol is a beta-receptor agonist and would foreseeably worsen the tachycardia that the client is already experiencing. The nurse should clarify the albuterol prescription with the primary health care provider (PHCP) because albuterol may increase heart rate. Choices A, B, and D are incorrect. Metoprolol and diltiazem treat hypertension and certain dysthymias, such as atrial fibrillation. These medications help decrease the heart rate and blood pressure. Therefore, they need not be held in this client with tachycardia and hypertension. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor that therapeutically decreases blood pressure without impacting the pulse. Lisinopril is indicated in treating congestive heart failure, diabetic nephropathy, polycystic kidney disease, and hypertension. The client is hypertensive, and it is appropriate to administer the prescribed lisinopril.

The nurse has received a prescription to administer thiamine to a client. The nurse understands that this medication is intended to treat A. systemic lupus erythematosus. B. pernicious anemia. C. Wernicke encephalopathy. D. iron deficiency anemia.

Choice C is correct. Thiamine (vitamin B1) is dosed for individuals at risk of developing Wernicke encephalopathy. This encephalopathy may cause an individual to experience an array of neurological abnormalities that may not be reversible. Manifestations include nystagmus, ataxia, neuropathy in the lower extremities, and altered mental status. If not treated, these manifestations may become permanent. Additional Info ✓ Wernecke encephalopathy causes an individual to experience ataxia, nystagmus, altered mental status, and memory impairments. ✓ Risk factors include chronic alcoholism and malnutrition ✓ Treatment is necessary because the neurological impairments may become permanent ✓ Thiamine is the prescribed treatment which is given parenterally to maximize its absorption

The nurse cares for a client receiving mechanical ventilation and reviews the client's most recent arterial blood gas (ABG). The nurse communicates the result with the primary healthcare provider (PHCP) and should recommend a prescription for which medication? See the A. Pancuronium B. Midazolam C. Theophylline D. Famotidine

Choice C is correct. This client's ABG depicts respiratory acidosis and would benefit from aggressive pulmonary hygiene measures and potentially theophylline, which is a bronchodilator and is advantageous because it may be administered intravenously. Theophylline, a bronchodilator, would promote the exhalation of the CO2 needed to treat respiratory acidosis. Choices A, B, and D are incorrect. Pancuronium is a neuromuscular blocking agent (paralytic). This is used for those being mechanically ventilated to keep the client paralyzed so the ventilator can do the work and prevent any resistance. Essentially, if the client's condition is so fragile, a continuous infusion of a paralytic may be given. This would not treat respiratory acidosis. Midazolam is a benzodiazepine and is given as a continuous infusion to provide sedation to the client and to promote comfort. This would not treat respiratory acidosis. Famotidine is a histamine blocker used to prevent a stress ulcer caused by a mechanical ventilator.

The nurse is caring for a client newly diagnosed with an abdominal aortic aneurysm. The nurse should anticipate a prescription for which of the following medications? A. naproxen B. digoxin C. prednisone D. atenolol

Choice D is correct. An abdominal aortic aneurysm (AAA) is a severe condition that may lead to potential rupture. Depending on the size of the aneurysm, clients may be taken in for emergent or elective surgery. Priority action is to maintain the blood pressure appropriately. Hypertension is a potential risk factor for abdominal aorta aneurysms. In patients with AAA, hypertension should be aggressively treated with a blood pressure goal of < 140/90 mmHg. Apart from controlling blood pressure, beta blockers have another advantage of reducing an AAA's expansion rate. Thus, beta-blockers such as atenolol are used to lower blood pressure and decrease the risk of aneurysm progression and the risk of rupture. Choice A is incorrect. Naproxen is not used for AAA as it does not impact blood pressure. Naproxen is an NSAID indicated in the treatment of mild to moderate pain. Choice B is incorrect. Digoxin is not indicated for an AAA because of its inability to decrease blood pressure, which is essential for AAA management. Choice C is incorrect. Prednisone, a corticosteroid, would be indicated for inflammatory conditions, not AAA.

The nurse is caring for a client who experienced a myocardial infarction (MI) 24 hours ago. It would be necessary for the nurse to immediately notify the primary health care provider (PHCP) if the client has which of the following? A. An elevated troponin level B. A white blood cell (WBC) count of 13,000 mm3 (Both Sexes: 5-10 mm3) C. Apprehension about attending cardiac rehabilitation D. Crackles auscultated to the midline of the lung fields

Choice D is correct. Following a myocardial infarction (MI), the client is at risk for developing pulmonary edema due to the heart's inability to eject blood, resulting from myocardial insult. When caring for an MI client, nurses should monitor for life-threatening ventricular arrhythmias and pulmonary edema, characterized by lung crackles, tachypnea, and hypoxia. Choice A is incorrect. Elevations in troponin levels are expected 24 hours after an MI and can persist for up to two weeks. Choice B is incorrect. Leukocytosis (elevated white blood cell count) is a common response to an MI, reflecting myocardial inflammation. Choice C is incorrect. Apprehension about cardiac rehabilitation is a normal response, as it often requires a lifelong commitment to lifestyle changes as part of tertiary prevention strategies. Additional Info ✓ Myocardial infarction (MI) occurs when there is a sudden interruption in the blood supply to a part of the heart muscle, leading to ischemia (lack of oxygen) and subsequent tissue damage in the affected area of the heart. The lack of oxygen-rich blood can cause irreversible damage to the heart muscle cells. ✓ A client experiencing an MI will have symptoms such as substernal chest pain (which may be described as tightness or pressure), which may radiate to the jaw or down the arm, diaphoresis, dyspnea, or a feeling of apprehension. ✓ The nurse should immediately obtain a 12-lead electrocardiogram to confirm the presence of an acute myocardial infarction (may be ST elevation MI or a non-ST elevation MI). ✓ Administer prescribed medications, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors, and beta-blockers, as ordered. These medications play a significant role in managing cardiac workload and preventing complications moving forward.

The nurse is performing discharge teaching for a client with Graves' disease. Which of the following client statements indicates effective understanding? A. "I will take my pulse daily and report a rate less than 60 beats/minute." B. "I am going to add hot yoga to my exercise routine." C. "I will increase the amount of fiber in my diet." D. "I should tell my physician if my blood pressure's top number exceeds 140."

Choice D is correct. Grave's disease is the most common form of hyperthyroidism. A significant complication of this condition is the potential for a thyroid storm. A thyroid storm is caused by a surge in thyroid hormone in the bloodstream, which causes the client to experience tachycardia, fever, hypertension, diaphoresis, and tachydysrhythmias. Choice A is incorrect. A thyroid storm is the most concerning complication of Grave's disease and would be manifested by tachycardia, not bradycardia. Choice B is incorrect. Grave's disease causes the client to have heat intolerance, and the client performing hot yoga would not be recommended. Choice C is incorrect. This statement would be applicable to the client with hypothyroidism because constipation is a common finding. This statement is not relevant to a client with Grave's disease. Additional Info ✓ Graves' disease is an autoimmune disease and is the most common cause of hyperthyroidism ✓ A hallmark finding of this disease is heat intolerance ✓ Other manifestations of hyperthyroidism include exophthalmos, weight loss, irritability, and the thinning of scalp hair ✓ The course of treatment is antithyroid medications (propylthiouracil or methimazole) or surgical intervention

The nurse is reviewing the concept of acute kidney injury (AKI) with a student nurse. Which of the following would be correct as a cause of prerenal AKI? A. nephrotoxicity B. bladder cancer C. contrast media D. hypovolemia

Choice D is correct. Hypovolemia is a common prerenal cause of acute kidney injury (AKI). Prerenal reasons are those factors that are external to the kidney. Hypovolemia causes a decrease in blood flow to the organs. Hypovolemia can lead to intrarenal kidney disease. Other prerenal causes of AKI include sepsis, shock, and burns. Choices A and C are incorrect. Intrarenal causes of AKI are those that cause direct damage to the kidneys, such as medications (nephrotoxicity) and contrast media injection. The most common cause of intrarenal AKI is acute tubular necrosis (ATN). Choice B is incorrect. Postrenal causes of AKI involve obstruction of urine flow out of the kidneys. Although not a common cause of AKI, the postrenal causes can often be resolved by removing the blockage. Bladder cancer and prostatic hyperplasia are common postrenal causes of AKI. Additional Info ✓ Acute kidney injury can be divided into prerenal, intrarenal (intrinsic), or postrenal. ✓ Prerenal is caused by a source outside the kidney, such as dehydration, sepsis, shock, and burns. ✓ Intrarenal (intrinsic) is caused by a source inside the kidney, such as allergic disorders, embolism or thrombosis of the renal vessels, and nephrotoxic agents. ✓ Postrenal is caused by urine flow obstruction such as a stone, strictures, or tumor.

The nurse is caring for a client diagnosed with Multiple Sclerosis (MS). The nurse should anticipate a prescription for which medication? A. Topiramate B. Risperidone C. Prazosin D. Baclofen

Choice D is correct. Multiple Sclerosis (MS) may produce symptoms such as muscle spasticity, optic neuritis, fatigue, heat intolerance, and symptoms that seem to intensify on occasion (relapses). Muscle spasticity is best controlled with muscle relaxers such as baclofen. Choices A, B, and C are incorrect. Topiramate is an anticonvulsant drug indicated in the treatment of epilepsy as well as psychiatric conditions such as bipolar disorder. Risperidone is indicated for psychotic disorders such as schizophrenia. Prazosin is an antihypertensive that may be used for high blood pressure. This medication also may be indicated for psychiatric illnesses such as PTSD.

The emergency department (ED) nurse is caring for a client admitted with septic shock. After administering prescribed intravenous fluids (IVF), which laboratory test does the nurse anticipate the physician will order to evaluate the IVF's efficacy? A. serum troponin B. serum glucose C. serum white blood cells D. serum lactic acid

Choice D is correct. Serum lactic acid levels are a high-yield blood test to determine if a client may have sepsis. This laboratory test, combined with septic manifestations (tachycardia, hypotension, fever (or hypothermia), and leukocytosis), is essential to determine if a client has this life-threatening condition. The normal serum lactate level is less than 2 mmol/L. The higher the level, the worse the acidosis the client is experiencing. Lactic acidosis frequently accompanies severe illnesses and tissue hypoperfusion. If the client has responded favorably to the isotonic fluid bolus given for sepsis (30 mL/kg), the lactic acid level will decline. Choice B is incorrect. Glucose levels are typically elevated in an individual with septic shock because of the excess of catecholamines the adrenal secretes. However, they are not a marker to determine if the fluid bolus was efficacious. Choice C is incorrect. Leukocytosis is common in sepsis. Although the white blood cell count plays into the equation of a client potentially having sepsis, it is not a lone laboratory test used for diagnosis. Nor is this laboratory test used to determine if the client responded to an isotonic fluid bolus.

The nurse has become aware of the following client situations. The nurse should first assess the client A. with chronic obstructive pulmonary disease (COPD), who is using pursed-lip breathing and reporting a productive cough. B. who had a laparoscopic cholecystectomy three hours ago and is reporting right shoulder pain and abdominal cramping. C. with ulcerative colitis, who had three bloody stools in the past two hours and reporting abdominal cramping. D. two hours postoperative following a tonsillectomy and is reporting throat pain while vomiting.

Choice D is correct. The client's vomiting following a tonsillectomy requires immediate follow-up because vomiting and coughing may trigger hemorrhage. This client requires immediate follow-up so the nurse may treat the vomiting with prescribed anti-emetics and assess the client for potential hemorrhage. Choices A, B, and C are incorrect. A client with COPD experiencing a productive cough and experiencing pursed-lipped breathing is an expected finding. Further, coughing indicates a patent airway. This client does not require immediate follow-up. A client recovering from laparoscopic procedures will likely have abdominal cramping and shoulder pain because of gastric insufflation (the process of instilling air or carbon dioxide into the abdominal cavity to visualize the abdominal organs); this is often relieved by having the client ambulate. An exacerbation of ulcerative colitis often causes a client to have multiple bloody stools accompanied by abdominal cramping. This is an expected finding. Additional Info ✓ Following a tonsillectomy, the nurse should discourage coughing as this may stress the operative site and lead to hemorrhage ✓ Nausea and vomiting following a tonsillectomy should be promptly treated to prevent stress to the operative that may lead to hemorrhage

The nurse is counseling a client with opioid use disorder. Which of the following medications may be used to treat this disorder? Selegiline Naltrexone Methadone Buprenorphine Bupropion

Choices B, C, and D are correct. Naltrexone, Methadone, and Buprenorphine are three agents approved for the management of opioid use disorder. These medications have various mechanisms of action. Naltrexone is an opioid receptor antagonist and may be administered as a single dose injection. Buprenorphine is a partial agonist and is available in preparations such as sublingual tablets or film. Methadone is a full agonist that may be used daily. It is dispensed in a supervised setting. Choices A and E are incorrect. Selegiline is a monoamine oxidase inhibitor and is used in depression and Parkinson's disease. Bupropion is indicated in the treatment of depressive disorders. This medication may be useful in the management of nicotine addiction.

osteoporosis

Decreased bone mass caused by a deficiency of calcium best characterizes osteoporosis. A decline in estrogen or testosterone also causes osteoporosis, as these hormones are key in preventing excessive osteoclastic activity.

Choices A, B, C, and E are correct. Furosemide, vancomycin, ibuprofen, and enalapril are all medications that may lead to nephrotoxicity. The concern is that this client's BUN and creatinine are elevated, suggesting an acute kidney injury. If a client has increased creatinine, a thorough review of the medications should be conducted to avoid worsening the acute kidney injury. Furosemide is a loop diuretic and sulfa based. Sulfa is hard on the kidneys and would be avoided in situations like this, where the client's creatinine is elevated. Vancomycin is a glycopeptide and is implicated in causing acute kidney injury. NSAIDs, like ibuprofen, should also be avoided because they decrease renal blood flow. Enalapril is an ACE inhibitor, and while they are nephroprotective, it should not be used if the client has current renal insufficiency.

The nurse is caring for an assigned client. Which prescription requires clarification with the primary healthcare provider (PHCP) based on the laboratory data? See the image below. Select all that apply. furosemide vancomycin ibuprofen citalopram enalapril

Brown-Sequard syndrome (BSS)

a hemisection of the spinal cord and does not cause Raccoon's eyes. Symptoms of the BSS include weakness and loss of proprioception on one side of the body (ipsilateral side of injury) and loss of temperature sensation on the opposite side. Causes for the BSS include a spinal cord tumor, trauma, ischemia, or infectious or inflammatory diseases (tuberculosis, or multiple sclerosis).

The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. captopril for a client with congestive heart failure B. metoprolol for a client with multiple premature ventricular contractions (PVCs) C. verapamil for a client with atrial fibrillation D. spironolactone for a client with end-stage renal disease

hoice D is correct. Spironolactone is a potassium-sparing diuretic and is primarily indicated in treating essential hypertension. The potential (significant) issue is that clients with end-stage renal disease commonly have hyperkalemia because of the significantly reduced glomerular filtration rate and rely on dialysis to remove nitrogenous waste, water, and electrolytes. It would be detrimental for a client with ESRD to receive spironolactone because this medication will raise serum potassium levels that are already high. This prescription requires follow-up. Choice A is incorrect. Captopril is an ACE inhibitor. ACE inhibitors are highly recommended in managing heart failure because they decrease the complication of cardiomegaly, which may cause a further reduction in cardiac output. Choice B is incorrect. Metoprolol for a client with multiple premature ventricular contractions (PVCs) is appropriate. PVCs are generally benign and cause the ventricles to empty before they are filled. This may give the client a palpitation or flutter sensation. The nurse should identify the underlying cause for multiple PVCs, such as hypokalemia, hypomagnesemia, or central nervous stimulants. If the cause cannot be identified, beta-blockers may slow the heart rate to prevent premature firing. Choice C is incorrect. Atrial fibrillation is an irregularly irregular arrhythmia with two treatment goals: 1. prevention of stroke 2. rate control between 60-100 beats per minute. Verapamil is a calcium channel blocker that may be used for an individual with atrial fibrillation; this will help maintain rate control. Another medication that may be used instead of verapamil would be diltiazem or amiodarone.

subarachnoid hemorrhage

include severe headache (often stated by the patients as "the worst headache of their life"), photophobia, nausea, vomiting, and vision changes. Causes of SAH include aneurysmal rupture or trauma.