NURS 300 Exam 4 practice questions
A charge nurse is teaching a newly licensed nurse about the purpose of a client being prescribed a transdermal fentanyl patch. Which of the following clients should the charge nurse include in the teaching as a client who requires this medication? A. A client who is opioid-tolerant B. A client who has difficulty swallowing C. A client who has severe intermittent pain D. A client who is postoperative following abdominal surgery
A. A client who is opioid-tolerant The charge nurse should include in the teaching that a client who is opioid tolerant can be prescribed a fentanyl patch to manage pain.
A home-health nurse is caring for a client who has cancer and is using a fentanyl transdermal patch for pain control. Which of the following actions should the nurse take when caring for this client? A. Avoid using a heating pad on the area with the patch B. To decrease the dose, cut the patch in half C. Dispose of the used patch in the trash can D. Assess the client for urinary retention every 8 hr
A. Avoid using a heating pad on the area with the patch Applying heat over the site of the transdermal patch will increase the rate of absorption of the opioid medication and might cause respiratory depression.
A nurse is caring for a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following findings should the nurse identify as an indication that the client requires intervention? A. Heart rate 106/min B. Dry skin C. Oral temperature 36.8°C (98.2°F) D. Lethargy
A. Heart rate 106/min Tachycardia can be a manifestation of hyperthyroidism, possibly due to excessive hormone replacement. The client might require a lower dosage of levothyroxine.
A nurse is planning care for a client with thrombophlebitis who has a prescription to receive heparin via continuous IV infusion. Which of the following actions should the nurse include in the plan of care? A. Infuse the heparin using an electronic IV pump B. Administer vitamin K if the client has indications of hemorrhage C. Adjust the dosage of heparin based on the client's PT levels D. Inform the client that the heparin will dissolve the thrombus
A. Infuse the heparin using an electronic IV pump The nurse should administer heparin using an electronic IV pump, rather than by gravity, to prevent an accidental increase or change in the rate of infusion.
A nurse is caring for a client who is at 6 weeks of gestation and has just received a diagnosis of hyperthyroidism. The nurse should anticipate a prescription from the provider for which of the following medications? A. Propylthiouracil B. Liothyronine C. Methimazole D. cholestyramie
A. Propylthiouracil This medication is used to treat hyperthyroidism during the first trimester of pregnancy because it does not cross the placental barrier well, posing little risk to the fetus. However, methimazole is the preferred medication in the second and third trimesters of pregnancy.
A nurse is reviewing the medical record of a client. The medication administration record shows the client is taking clopidogrel. Which of the following events should the nurse expect in the client's medical history? A. Recent myocardial infarction B. History of hemorrhagic stroke C. Current outbreak of psoriasis D. History of hypertension
A. Recent myocardial infarction The nurse should expect the client's medical record to indicate a history of an atherosclerotic event such as myocardial infarction, ischemic stroke, or peripheral vascular disease. Clopidogrel is an antiplatelet medication that inhibits the aggregation of platelets to prevent such thrombotic events.
A nurse is providing teaching to a newly licensed nurse about administering morphine via IV bolus to a client. Which of the following pieces of information should the nurse include in the teaching? A. Respiratory depression can occur 7 min after the morphine is administered B. The morphine will peak in 10 min. C. Withhold the morphine if the client has a respiratory rate of <16/min. D. Administer the morphine over 2 min.
A. Respiratory depression can occur 7 min after the morphine is administered Respiratory depression can occur within 7 minutes of the administration of IV bolus morphine. The nurse should monitor the client's respirations and have naloxone available to reverse the effects of the morphine.
A nurse is providing teaching to a client who has rheumatoid arthritis and a prescription for long-term prednisone therapy. The nurse should instruct the client to monitor for which of the following adverse effects? A. Stress fractures B. Orthostatic hypotension C. Gingival ulcerations D. Weight loss
A. Stress fractures Prednisone can cause demineralization of the bones and can lead to osteoporosis and stress fractures.
A nurse is providing teaching to a client who has a new prescription for a fentanyl transdermal patch. Which of the following statements by the client indicates an understanding of the teaching? A. "The patch will not cause constipation like other pain medications do." B. "I will have to stop drinking grapefruit juice while using the patch." C. "I will place a heating pad over the patch to boost its effectiveness." D. "The patch will give me relief from my pain faster than pills can."
B. "I will have to stop drinking grapefruit juice while using the patch." The nurse should instruct the client to avoid drinking grapefruit juice while using the fentanyl transdermal patch. Grapefruit juice can increase the absorption of the medication, raising the amount of fentanyl in the client's blood. This effect can place the client at risk for CNS and respiratory depression.
A nurse is providing discharge teaching to a client who has venous thrombosis and a prescription for warfarin. Which of the following instructions should the nurse include in the teaching? A. Take ibuprofen as needed for headaches or other minor pains B. Carry a medical alert ID card C. Report to the laboratory weekly to have blood drawn for aPTT D. Increase intake of dark green vegetables
B. Carry a medical alert ID card A client who is taking warfarin is at increased risk for bleeding. In the case of an emergency, any medical personnel must be aware of the client's medication history.
A nurse is caring for a client who has been taking taken metformin for 6 months. Which of the following findings should the nurse identify as an expected therapeutic effect of the medication? A. Decreased vitamin B12 levels B. Decreased blood glucose level C. Abdominal bloating and diarrhea D. Decreased LDL level
B. Decreased blood glucose level A client who has taken metformin for 6 months should experience the expected therapeutic effect of a decrease in blood glucose levels. Metformin is a non-insulin medication for clients who have type 2 diabetes mellitus.
A nurse is caring for a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following prescriptions should the nurse anticipate? A. Desmopressin B. Hydrocortisone C. Dopamine D. Furosemide
B. Hydrocortisone The nurse should identify that a client who has Addison's disease and is experiencing an Addisonian crisis will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is due to the pituitary's inability to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels. An Addisonian crisis can cause sudden destruction of the adrenal gland or pituitary and become life-threatening.
A nurse is conducting a home visit for an older adult client who has diabetes mellitus and takes regular insulin subcutaneously before each meal. The client appears disoriented and weak and has slurred speech. Which of the following conditions should the nurse consider first when responding to these manifestations? A. Dementia B. Hypoglycemia C. Infection D. Transient ischemic attack
B. Hypoglycemia A client who has hypoglycemia can have slurred speech, disorientation, weakness, and confusion near meal time each day because regular insulin peaks in 2 to 4 hours, causing a drop in the client's blood glucose. Other manifestations of hypoglycemia include irritability, mental confusion, double vision, hunger, tachycardia, diaphoresis, and palpitations.
A nurse is providing teaching to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to watch for and report to the provider? A. Weight gain B. Myalgia C. Hypoglycemia D. Severe constipation
B. MyalgiaMyalgia, malaise, somnolence, and hyperventilation are manifestations of lactic acidosis, which rarely occur while taking metformin due to the blockage of lactic acid oxidation. The nurse should instruct the client to report these findings promptly to the provider
A nurse is assigned to care for several clients who are postoperative. The client taking which of the following medications is at risk of delayed wound healing? A. Nifedipine to treat hypertension B. Prednisone to treat persistent arthritis exacerbations C. Albuterol to treat asthma D. Chlorpromazine to treat schizophrenia
B. Prednisone to treat persistent arthritis exacerbations Prednisone is a corticosteroid that is associated with delayed wound healing. Clients who have arthritis often require high doses of prednisone to help resolve exacerbations.
A nurse is assessing a child who is postoperative. Which of the following findings should the nurse identify as an indication that naloxone should be administered? A. Crackles in the lung bases B. Respiratory depression C. Nausea and vomiting D. Tachycardia
B. Respiratory depression The nurse should monitor the child's respiratory status postoperatively and plan to administer naloxone if respiratory depression is present. Naloxone is an opioid antagonist used to reverse the effects of opioids administered perioperatively.
A nurse is teaching a client who has type 2 diabetes mellitus about a prescription for insulin lispro. Which of the following statements should the nurse include in the teaching? A. "The effects of the insulin lispro can last for 8 to 12 hours." B. "Administer insulin lispro 30 to 60 minutes before eating." C. "Insulin lispro has an onset of about 15 minutes." D. "This insulin can be given as a continuous intravenous bolus."
C. "Insulin lispro has an onset of about 15 minutes." Insulin lispro is a rapid-acting insulin and has an onset of 15 to 30 minutes.
A nurse is providing teaching about oxycodone to an adolescent who is experiencing a vaso-occlusive crisis. Which of the following pieces of information should the nurse include? A. "This medication can cause diarrhea." B. "This medication can cause an increase in blood pressure." C. "This medication might cause nausea." D. "This medication can cause an increase in salivation."
C. "This medication might cause nausea." The nurse should instruct the adolescent that nausea is an adverse effect of oxycodone. Other adverse effects include dizziness, sedation, and confusion.
A nurse is providing education about continuous heparin therapy for a client who is 18 hours postpartum and has developed a deep vein thrombosis (DVT). Which of the following statements should the nurse include in the teaching? A. "An adverse effect of this medication is drowsiness." B. "This medication will require frequent monitoring of WBC levels." C. "Use a soft toothbrush to brush your teeth gently." D. "Avoid taking acetaminophen while receiving this medication."
C. "Use a soft toothbrush to brush your teeth gently."
A nurse is caring for a client who receives gastrostomy tube feedings and insulin. The client is scheduled to receive a tube feeding at 0700. At which of the following times should the nurse plan to administer insulin lispro subcutaneously? A. 0600 B. 0630 C. 0645 D. 0730
C. 0645 Lispro is a rapid-acting insulin with an onset of 15 minutes. The nurse should administer the insulin dose 15 min prior to the feeding.
A nurse is planning care for a client who is postoperative and scheduled to ambulate. At which of the following times should the nurse plan to administer PO morphine to the client for peak analgesic effect during the ambulation? A. 3 to 4 hr before ambulation B. 10 to 15 min prior to ambulation C. 60 to 90 min prior to ambulation D. Immediately before ambulation
C. 60 to 90 min prior to ambulation The peak effect of PO morphine takes 60 to 90 minutes to occur. Medicating the client 60 to 90 minutes prior to ambulation will provide the greatest analgesic effect.
A nurse is caring for a client who has a prescription for clopidogrel. The nurse should monitor the client for which of the following adverse effects? A. Insomnia B. Hypotension C. Bleeding D. Constipation
C. Bleeding Clopidogrel is an antithrombotic medication that inhibits platelet aggregation. It is used to prevent stenosis of coronary stents, myocardial infarctions, and strokes. The nurse should monitor for coffee-ground emesis, black tarry stools, ecchymosis, or any indication of bleeding.
A nurse is caring for a client who has a prescription for naloxone. Which of the following is the intended action of the medication in relation to the central nervous system (CNS)? A. Accentuate the effects of narcotics on the CNS B. Depress activity of the CNS C. Block the effects of narcotics on the CNS D. Stimulate activity of the CNS
C. Block the effects of narcotics on the CNS By blocking the effects of narcotics on the CNS, naloxone prevents CNS and respiratory depression in the newborn following delivery.
A nurse is providing teaching to a client who has gout and a new prescription for allopurinol. The nurse should instruct the client to discontinue taking the medication for which of the following adverse effects? A. Nausea B. Metallic taste C. Fever D. Drowsiness
C. Fever A fever can indicate a potentially fatal hypersensitivity reaction. The client should discontinue allopurinol and notify the provider if a fever or rash develops.
A nurse is teaching a client who has severe generalized rheumatoid arthritis and is scheduled to start taking prednisone for long-term therapy. The nurse should instruct the client to report which of the following as an adverse effect of prednisone? A. Thrombosis B. Immunosuppression C. Gastric ulceration D. Liver toxicity
C. Gastric ulceration The nurse should instruct the client to monitor for gastric ulceration as an adverse effect of the long-term use of prednisone. Other adverse effects of this medication include osteoporosis and adrenal suppression.
A nurse is monitoring a client who has diabetes insipidus and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect of this medication? A. Thirst B. Nocturia C. Headache D. Heart palpitations
C. Headache Headaches are an indicator of the adverse effect of water intoxication, which can occur as a result of taking desmopressin. This medication causes fluid retention and places the client at risk of water intoxication.
A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? A. Rifampin B. Loperamide C. Hydrocortisone D. Spironolactone
C. Hydrocortisone The nurse should identify that a client who has Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels.
A nurse is caring for a client who is taking fludrocortisone. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of the medication? A. Hypotension B. Weight loss C. Hypokalemia D. Anorexia
C. Hypokalemia The nurse should identify that hypokalemia is an adverse effect of fludrocortisone due to excessive sodium and water retention, resulting in the loss of excessive amounts of potassium.
A nurse is teaching a client with systemic lupus erythematosus who has a new prescription for prednisone. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. Hypoglycemia B. Tendinitis C. Infection D. Weight loss
C. Infection The nurse should instruct the client to avoid contact with people who are ill and monitor for manifestations of an infection such as a fever or a sore throat. Prednisone can suppress the client's immune response and mask the manifestations of an infection.
Which of the following pieces of information should the nurse provide when explaining the purpose of this therapy? A. Mineralocorticoids help the body metabolize carbohydrates, fats, and proteins. B. Mineralocorticoids support secondary sexual development. C. Mineralocorticoids maintain electrolyte and fluid balance. D. Mineralocorticoids reduce the risk of cardiac dysrhythmias.
C. Mineralocorticoids maintain electrolyte and fluid balance. Mineralocorticoids (specifically aldosterone) are necessary for the regulation of fluid and electrolyte balance (particularly for sodium, potassium, and water). Addison's disease results in a deficiency of cortisol and aldosterone production and requires supplementation with glucocorticoids and mineralocorticoids. Fludrocortisone is the only mineralocorticoid available.
A nurse is teaching self-administration of NPH insulin to a client who has type 2 diabetes mellitus. Which of the following instructions should the nurse include? A. Alternate injecting doses between the abdomen and the thigh B. Shake the vial before withdrawing the dosage C. Rotate injection sites within the same area D. Discard the vial if the insulin is cloudy
C. Rotate injection sites within the same area To prevent lipodystrophy, the client should rotate injection sites and keep them about 2.5 cm (1 in) apart within the same anatomical area.
A nurse is preparing a discharge teaching plan for a client who is scheduled to begin long-term oral prednisone for asthma. Which of the following instructions should the nurse include in the plan? A. Stop taking the medication if a rash occurs. B. Take the medication on an empty stomach to enhance absorption. C. Schedule the medication on alternate days to decrease adverse effects. D. Treat shortness of breath with an extra dose of the medication.
C. Schedule the medication on alternate days to decrease adverse effects. Some of the adverse effects caused by long-term glucocorticoid therapy (e.g. suppression of the adrenal gland) can be avoided by using alternate-day therapy.
A nurse is caring for a client who takes scheduled morphine for cancer pain. The client reports experiencing breakthrough pain. The nurse should anticipate a prescription from the provider for which of the following medications to treat breakthrough pain? A. Meperidine B. Buprenorphine C. Methadone D. Fentanyl
D. Fentanyl The nurse should expect a prescription for fentanyl transmucosal (nasal spray) to treat breakthrough pain. Fentanyl is an opioid agonist with a rapid onset and a duration of 2 to 4 hours. Fentanyl should not interfere with the client's long-term opioid medication but should relieve breakthrough pain.
A nurse is providing teaching to a newly licensed nurse about caring for a client who has a prescription for gemfibrozil. The nurse should instruct the newly licensed nurse to monitor which of the following laboratory tests? A. Platelet count B. Electrolyte levels C. Thyroid function D. Liver function
D. Liver function Gemfibrozil reduces triglycerides by decreasing the liver's uptake of fatty acids. It can cause liver toxicity; therefore, the nurse should monitor the client's liver function.
A nurse is assessing a client who is receiving a continuous morphine IV infusion and finds the client's respiratory rate has decreased from 20/min to 12/min. Which of the following actions should the nurse take? A. Flush the IV line with saline B. Administer flumazenil C. Lower the head of the bed D. Slow the rate of the infusion
D. Slow the rate of the infusion The nurse should decrease the infusion rate to reduce the amount of morphine the client receives and limit the risk of respiratory depression.
A nurse is teaching a client who is taking levothyroxine for hypothyroidism about a new prescription for a calcium supplement. Which of the following pieces of information should the nurse include in the teaching? A. The calcium supplement will enhance the effect of the levothyroxine. B. The calcium supplement will accelerate the metabolism of the levothyroxine. C. Take the medications together at 1700 for the greatest effect. D. Take the calcium supplement 4 hr after taking the levothyroxine.
D. Take the calcium supplement 4 hr after taking the levothyroxine. Levothyroxine should be taken in the morning on an empty stomach, and the calcium supplement should be taken at least 4 hours later. Food or supplements containing iron, magnesium, or zinc also bind to levothyroxine and prevent complete absorption of the medication.
A nurse is assessing a client who is receiving morphine via a patient-controlled analgesia (PCA) pump following a cesarean birth. Which of the following findings should the nurse report to the provider? A. Respiratory rate 14/min B. Temperature 37.8°C (100°F) C. Dizziness upon rising D. Urine output 20 mL/hr
D. Urine output 20 mL/hr Opioid analgesics such as morphine can cause urinary retention. The client should have a urinary output of at least 30 mL/hr. The nurse should report this finding to the provider.
A nurse is preparing to administer 100 units of insulin glargine and 4 units of NPH insulin subcutaneously to a client. Which of the following actions should the nurse plan to take? A. Verify with the provider about giving insulin glargine at 1700 B. Ensure the insulin glargine is a cloudy suspension C. Request a prescription for giving insulin glargine twice daily D. Use separate syringes for administering insulin glargine and NPH insulin
D. Use separate syringes for administering insulin glargine and NPH insulin The nurse should not mix insulin glargine with any other insulin. The nurse should administer the NPH insulin and insulin glargine separately.
A nurse is caring for a client who has been in the PACU for more than 1 hr, has a respiratory rate of 9/min, and is difficult to arouse. The nurse should expect a prescription for which of the following medications? A. Pentazocine B. Naloxone C. Naltrexone D. Butorphanol
B. Naloxone The nurse should expect a prescription for naloxone. This medication displaces opiate medications from receptor sites, reversing the respiratory depression, sedation, and analgesia that opiates cause.
A nurse is caring for a client with diabetic ketoacidosis who has a prescription for an intravenous infusion of insulin. The nurse should document that which of the following types of insulin was administered intravenously to treat ketoacidosis? A. Regular insulin B. Insulin lispro C. Insulin aspart D. Insulin glargine
A. Regular insulin Treatment for diabetic ketoacidosis is directed at correcting hyperglycemia and acidosis. Therefore, the client's insulin levels are restored with an initial IV bolus of regular insulin followed by continuous infusion.
A nurse is caring for a client who had a myocardial infarction 2 hours ago and is receiving alteplase. Which of the following findings should the nurse identify as an adverse effect of receiving this medication? A. Bleeding B. Increased clot formation C. Shortness of breath D. Blockage of the central venous catheter
A. Bleeding The nurse should identify that an adverse effect of alteplase is bleeding. Severe bleeding can occur as a result of the alteplase-plasminogen complex, which catalyzes the conversion of other plasminogen molecules that digest fibrin clots. This action of the medication can contribute to hemorrhage.
A nurse is caring for a client who received naloxone for a suspected opioid overdose. Which of the following findings should the nurse identify as an adverse effect of this medication? A. Report of pain B. Respiratory rate 8/min C. Report of numbness D. Report of abdominal cramping and diarrhea
A. Report of pain The nurse should identify that naloxone is used to reverse the effects of an opioid overdose administered for pain, sedation euphoria, and respiratory depression. Excess doses of naloxone can cause the return of pain but can improve the client's respiratory rate.
A nurse is providing teaching for a client who has gout and a prescription for allopurinol. Which of the following statements by the client should indicate to the nurse that the teaching was effective? A. "I should start taking this medication at 800 mg daily." B. "I will have an increased risk for diabetes with this medication." C. "I will increase my fluids to at least 2 liters per day." D. "I should take this medication twice daily."
C. "I will increase my fluids to at least 2 liters per day." The nurse should identify that an adverse effect of allopurinol is renal injury. Therefore, clients are encouraged to drink at least 2,000 mL/day to maintain a urine output of at least 2 L/day.
A nurse is assessing a client who has hypothyroidism and takes levothyroxine. Which of the following findings indicates that the client is experiencing acute levothyroxine overdose? A. Bradycardia B. Cold intolerance C. Tremor D. Hypothermia
C. Tremor Tremors and anxiety are expected findings in acute levothyroxine overdose. These findings are similar to those seen in hyperthyroidism.
A nurse is caring for a client who takes warfarin 2.5 mg PO daily and has an INR of 6.2. The nurse should anticipate a prescription from the provider for which of the following medications? A. Protamine sulfate B. Fondaparinux C. Vitamin K D. Bivalirudin
C. Vitamin K The nurse should anticipate the provider to prescribe vitamin K for a client who has an INR of 6.2. Vitamin K antagonizes warfarin's actions, which can reverse warfarin-induced inhibition of clotting factor synthesis.
A nurse is caring for an older adult client who has a hip fracture and rates his pain as 8 on a scale of 0 to 10. Which of the following medications should the nurse administer? A. Capsaicin topical gel B. Oxycodone/acetaminophen 7.5/325 tablet PO C. Celecoxib 200 mg capsule PO D. Aspirin 325 mg tablet PO
B. Oxycodone/acetaminophen 7.5/325 tablet PO A client who rates his pain as 8 on a scale of 0 to 10 is experiencing severe pain, and the nurse should administer an opioid. Oxycodone/acetaminophen is a combination of an opioid and a nonopioid analgesic medication and is appropriate to administer to the client. The nurse should monitor the client for adverse effects like respiratory depression and proactively address constipation that occurs with opioid use.
A nurse is reviewing the medication administration record of a client who is receiving an opioid medication for pain. Which of the following prescriptions should the nurse clarify with the provider? A. Metoprolol B. Ondansetron C. Lorazepam D. Naloxone
C. Lorazepam The nurse should identify that lorazepam can cause central nervous system depression, which can result in increased respiratory depression and sedation when administered with an opioid. The nurse should clarify the prescription with the provider.
A nurse is planning care for a client who has acute systemic lupus erythematosus (SLE) and is scheduled to begin treatment for systemic manifestations. Which of the following types of medications should the nurse plan to administer? A. Corticosteroids B. Antimalarials C. Antidepressants D. Opioids
A. Corticosteroids Corticosteroids such as prednisone are the treatment of choice for systemic manifestations of SLE because of their rapid anti-inflammatory action.
A nurse is caring for a client who takes Ginkgo biloba daily at home. Which of the following effects should the nurse expect from the use of this herbal supplement? A. Decreased platelet aggregation B. Prevention of migraine headaches C. Increased risk of deep-vein thrombosis D. Lowered cholesterol and triglyceride levels
A. Decreased platelet aggregation Ginkgo biloba can decrease platelet aggregation by inhibiting the ability of platelets to clump together. The nurse and the client should discuss the potential increase in bleeding tendencies when taking Ginkgo biloba and other antiplatelet aggregates, such as NSAIDs and clopidogrel.
A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift in which the client received atenolol instead of allopurinol. Which of the following interventions is the nurse's priority? A. Measure the client's apical pulse B. Administer the allopurinol to the client C. Inform the nurse manager D. Complete an incident report
A. Measure the client's apical pulse
A nurse is reviewing the laboratory reports of a child with acute nephrotic syndrome who has been receiving prednisone by mouth for the past week. Which of the following findings should the nurse report to the provider? A. Serum sodium 142 mEq/L B. Serum potassium 4 mEq/L C. WBC count 3,000/mm^3 D. Platelet count 298,000/mm^3
C. WBC count 3,000/mm^3 The nurse should understand that the use of corticosteroids suppresses the child's immune system and increases the risk of infection. The nurse should identify that a WBC count of 3,000/mm^3 is below the expected reference range for a child and should report this finding to the provider.
A charge nurse is monitoring a newly licensed nurse who is caring for a postoperative client who is receiving morphine through a PCA pump. Which of the following actions by the newly licensed nurse requires intervention? A. Instructing the client to administer a PCA dose prior to a dressing change B. Providing increased fluids while the client is using the PCA pump C. Informing the client's partner that only the client should administer the PCA doses D. Maintaining the client on bed rest while the PCA pump is in use
D. Maintaining the client on bed rest while the PCA pump is in use Use of a PCA pump does not prevent ambulation following surgery. Early ambulation should be encouraged. The nurse should instruct the client to sit at the side of the bed prior to standing to reduce the risks of orthostatic hypotension and falls.
A nurse is teaching a client about a new prescription for extended-release oxycodone for pain management. Which of the following statements should the nurse include in the teaching? A. "Swallow this medication whole." B. "Take this medication before meals and at bedtime." C. "Constipation decreases with continued use." D. "Avoid taking other supplemental analgesics with this medication."
A. "Swallow this medication whole." The nurse should tell the client that extended-release oxycodone is a long-acting opioid medication and should not be cut in half or crushed to prevent immediate absorption of the entire dose. This medication should be swallowed whole and is administered every 12 hours.
A nurse is preparing to administer levothyroxine to a client who has hypothyroidism. The nurse should identify which of the following laboratory results as supporting the administration of this medication? A. Thyroid-stimulating hormone (TSH) 8 microunits/mL B. Free triiodothyronine (T3) 300 pg/dL C. Free thyroxine (T4) 7 mcg/dL D. Thyroxine-binding globulin 2.3 mg/dL
A. Thyroid-stimulating hormone (TSH) 8 microunits/mL The expected reference range for TSH is 0.3 to 5 microunits/mL. When a client has primary hypothyroidism, the TSH level becomes elevated in an attempt to normalize the thyroid gland's function. When the client has had a therapeutic response to treatment, the TSH level returns to the expected reference range.
A nurse is caring for a client who has a new diagnosis of rheumatoid arthritis. The nurse should anticipate a prescription from the provider for which of the following medications for daily management of this condition? A. Celecoxib B. Prednisone C. Adalimumab D. Abatacept
A. Celecoxib The nurse should anticipate that the provider will prescribe celecoxib, which is a nonsteroidal anti-inflammatory drug (NSAID). This medication or another NSAID should be initiated for a client who has a new diagnosis of rheumatoid arthritis.
A nurse is teaching a client who has primary adrenal insufficiency (Addison's disease) and a prescription for hydrocortisone. Which of the following statements should the nurse include in the teaching about this medication? A. "You may need to take a lower dosage when you are ill or experiencing stress." B. "Take this medication before going to bed because it will make you tired." C. "Carry a supply of pills and a single-use injectable preparation with you at all times." D. "You will need to stop this medication before routine procedures such as a colonoscopy."
C. "Carry a supply of pills and a single-use injectable preparation with you at all times." The nurse should tell the client to carry an emergency supply of the medication to take during times of unexpected stress. The client should carry an adequate supply at all times, which should include an injectable preparation plus a supply equal to the regular oral dosage. The single-use injectable preparation should be administered IM if the client has an emergency and needs an extra dose of the glucocorticoid.
A nurse is teaching a client who has a new prescription for enteric-coated aspirin as stroke prophylaxis. The client asks the nurse why the provider prescribed an enteric-coated medication. Which of the following responses should the nurse give? A. "The enteric coating allows a lower dosage to be given." B. "Enteric-coated medications have better absorption in the body." C. "Enteric-coated medications cause less gastric irritation." D. "The enteric coating provides a steady release of the medication over time."
C. "Enteric-coated medications cause less gastric irritation." Enteric-coated medications do not dissolve until they reach the small intestine, which reduces the risk of gastric irritation.
A nurse is administering subcutaneous heparin to a client who is at risk for deep vein thrombosis. Which of the following actions should the nurse take? A. Administer the medication into the client's abdomen B. Inject the medication into a muscle C. Massage the site after administering the medication D. Use a 22-gauge needle to administer the medication
A. Administer the medication into the client's abdomen
A nurse is teaching a client who is about to start taking propylthiouracil to treat hyperthyroidism. Which of the following statements should the nurse identify as an indication that the teaching has been effective? A. "I will need laboratory tests to check my liver function." B. "I should take this medication once daily." C. "If I get a rash, I am probably having an allergic reaction." D. "If I have difficulty sleeping, it is probably because of this medication."
A. "I will need laboratory tests to check my liver function." Propylthiouracil is hepatotoxic and can cause severe liver injury. The nurse should instruct the client to report dark urine and yellowing of the eyes, which can indicate an injury to the liver.
A nurse is teaching about the adverse effects of morphine with a client who has acute pain. Which of the following statements should the nurse include in the teaching? A. "You might notice that you see better in dim areas." B. "You should increase your fluid intake." C. "You should expect to have excessive urination." D. "You might experience difficulty sleeping."
B. "You should increase your fluid intake." The nurse should inform the client that an adverse effect of morphine is constipation. Therefore, the nurse should encourage the client to increase oral fluids to promote motility of the bowel.
A nurse is teaching a client who is using a patient-controlled analgesia (PCA) pump to deliver morphine for pain management. Which of the following statements should the nurse identify as an indication that the client understands the instructions? A. "I'll limit pushing the button so I don't get an overdose." B. "If I push the button and still have pain after 2 minutes, I'll push it again." C. "I'll ask my niece to push the button when I am sleeping." D. "I can still use my transcutaneous electrical nerve stimulation unit while I'm pushing the PCA button."
D. "I can still use my transcutaneous electrical nerve stimulation unit while I'm pushing the PCA button." The nurse should encourage the client to utilize nonpharmacological methods of pain management such as transcutaneous electrical nerve stimulation (TENS) while using a PCA pump to reduce the amount of opioid dosing the client needs.
A nurse is caring for a client who has peptic ulcer disease and reports a headache. Which of the following medications should the nurse plan to administer? A. Ibuprofen B. Naproxen C. Aspirin D. Acetaminophen
D. Acetaminophen Acetaminophen is an analgesic used for mild to moderate pain. It can be administered to a client who has peptic ulcer disease because it does not affect blood coagulation and does not increase the risk of gastrointestinal bleeding.
A nurse in the emergency department is caring for a child who accidentally ingested an overdose of acetaminophen. Which of the following medications should the nurse expect to administer? A. Naloxone B. Diphenhydramine C. Glucagon D. Acetylcysteine
D. Acetylcysteine The nurse should expect to administer acetylcysteine to the child because it is an antidote to acetaminophen.
A nurse is caring for a client who is 12 hours postoperative following a total hip arthroplasty. Which of following medications should the nurse anticipate administering to this client to prevent deep vein thrombosis (DVT)? A. Aspirin B. Warfarin C. Ticagrelor D. Enoxaparin
D. Enoxaparin The nurse should anticipate the administration of enoxaparin for a client who is 12 hours postoperative following surgery. Enoxaparin is low-molecular-weight (LMW) heparin that is used to prevent a DVT by inhibiting the effects of antithrombin and thrombin.
A nurse is assessing an adolescent who is receiving fentanyl via epidural. Which of the following assessments should the nurse identify as the priority? A. Skin around the catheter site B. Blood pressure C. Pain level D. Oxygen saturation
D. Oxygen saturation When using the airway, breathing, and circulation (ABC) lapproach to client care, the nurse should identify that checking the adolescent's oxygen saturation level is the priority. By monitoring the adolescent's oxygen saturation level and respiratory status, the nurse can identify if the client has developed opioid-induced respiratory depression.
A nurse is caring for a client who is experiencing acute pain and is receiving morphine. Which of the following findings should indicate to the nurse the need to withhold the client's next dose of morphine? A. The client reports an inability to void. B. The client's respiratory rate is 10/min. C. The client has hypoactive bowel sounds. D. The client has vomited once in the last 4 hours.
The nurse should identify that morphine can cause respiratory depression. Therefore, if the client's respiratory rate is less than 12/min, the nurse should withhold the next dose of morphine and notify the provider.
A nurse is caring for a child who has sickle cell anemia and is experiencing a vaso-occlusive crisis. Which of the following actions should the nurse take? A. Administer ibuprofen B. Limit daily fluid intake C. Apply cold compresses to painful joints D. Withhold live virus immunizations
A. Administer ibuprofen The nurse should administer ibuprofen or acetaminophen for mild to moderate pain. If pain is not relieved, the nurse should administer an opioid analgesic.
A nurse is preparing to administer a hydromorphone IV infusion to a client for pain. Which of the following actions should the nurse take? A. Administer the medication over 4 to 5 minutes B. Place the client in a high-Fowler's position C. Assess the client's pain level after administering the medication D. Review the client's last set of vital signs
A. Administer the medication over 4 to 5 minutes The nurse should administer the IV injection of this opioid medication over 4 to 5 minutes to prevent the adverse effects of the medication such as respiratory depression and cardiac arrest.
A nurse is reviewing laboratory values for a client who reports fatigue and cold intolerance. The client has an increased thyroid-stimulating hormone (TSH) level and a decreased total T3 and T4 level. The nurse should anticipate a prescription for which of the following medications? A. Methimazole B. Somatropin C. Levothyroxine D. Propylthiouracil
C. Levothyroxine Levothyroxine replaces thyroid hormone for a client who has hypothyroidism. Laboratory values for hypothyroidism include an increased TSH level and decreased total T3 and T4 levels. Clinical manifestations of hypothyroidism include fatigue, cold intolerance, and a decreased body temperature and pulse.
A nurse in the emergency department is caring for a client who has Addison's disease and reports nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should prepare to administer which of the following medications? A. Calcium B. Potassium C. Iodine D. Hydrocortisone
D. Hydrocortisone Addison's disease causes adrenal gland hypofunction and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening and can lead to severe fluid and electrolyte imbalances. Without treatment, sodium levels fall, and potassium levels increase. Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high dose corticosteroids such as hydrocortisone are vital to correct the glucocorticoid deficiency.
A nurse is caring for a client who is taking warfarin. Which of the following laboratory values should the nurse recognize as an effective response to the medication? A. Hct 45% B. Hgb 15 g/dL C. aPTT 35 seconds D. INR 3.0
D. INR 3.0 Warfarin is an anticoagulant that prevents thrombus formation in susceptible clients. The INR measures its effectiveness. For most clients taking warfarin, an INR of 3.0 indicates effective therapy.
