Pharmacology
Which is the MOST appropriate action for the nurse to take before administering digoxin?
A. Monitor potassium level
B. Assess blood pressure
C. Evaluate urinary output
D. Avoid giving with thiazide diuretic
Answer: A. Monitor potassium level
A nurse instructor is about to administer a vitamin K injection to a newborn. The student nurse asks the instructor regarding the purpose of the injection. The appropriate response would be:
A. “The vitamin K provides active immunity.”
B. “The vitamin K will prevent the occurrence of hyperbilirubinemia.”
C. “The vitamin K will protect the newborn from bleeding.”
D. “The vitamin K will serve as protection against jaundice and anemia.”
Answer: C. “The vitamin K will protect the newborn from bleeding.”
Vitamin K is administered to the newborn in order to prevent bleeding disorders. Vitamin K promotes the formation of clotting factors II, VII, IX & X in which the infants lack because of insufficient intestinal bacteria needed for synthesizing fat-soluble vitamin K.
A nurse is caring for a client who is crying while reading from their devotional book. Which of the following interventions should the nurse take?
a) Contact the hospital’s spiritual service.
b) Ask them what is making them cry.
c) Provide quiet time for the moment.
d) Turn the television on for distraction.
Answer: C) Provide quiet time for the moment.
Providing privacy and a time for reading religious materials supports the client’s spiritual health.
A. Contacting the hospital’s spiritual services presumes there is a problem.
B. Asking the client about crying could be interpreted as discounting or disrespectful.
D. Providing a distraction could be interpreted as being disrespectful
A 65-year-old patient with pneumonia is receiving garamycin (Gentamicin). It would be MOST important for the nurse to monitor which one of the following laboratory values in this patient?
A. Hemoglobin & hematocrit
B. BUN & creatinine
C. Platelet count and clotting time
D. Sodium & potassium
Answer: B. BUN and creatinine - CORRECT: nephrotoxic; will see proteinuria, oliguria, hematuria, thirst, increased BUN, decreased creatine clearance
Gentamicin: broad spectrum antibiotic. SE: neuromuscular blockage, ototoxic to eighth cranial nerve (tinnitus, vertigo, ataxia, nystagmus, hearing loss), nephrotoxic. Monitor renal function, force fluids, monitor hearing acuity. Draw blood for peak levels 1 hr. after IM and 30 min - 1 hr. after IV infusion, draw blood for trough just before next dose.
A. can cause anemia; less common
C. do not usually change
D. hypokalemia infrequent problem
A nurse is preparing to administer morning doses of insulin
glargine and regular insulin to a client who has a blood glucose 278 mg/dL. Which of the following actions should the nurse take?
A. Draw up the regular insulin and then the glargine insulin
in the same syringe.
B. Draw up the glargine insulin then the regular insulin in the same syringe.
C. Draw up and administer regular and glargine insulin in separate syringes.
D. Administer the regular insulin, wait 1 hr, and then administer the glargine insulin.
Answer: C. Draw up and administer regular and glargine insulin in separate syringes.
A & B. These insulins are not compatible
D. These insulins should be administered at the same time. Regular insulin is short‑acting and should lower the blood glucose level in a short period of time. Insulin glargine is long‑acting and administered once a day.
The most toxic antiarrhythmic agent is:
A. digoxin (Lanoxin)
B. lidocaine (Xylocaine)
C. amiodarone (Cordarone)
D. quinidine (Cardioquin)
Answer: C. amiodarone (Cordarone)
This is the most toxic drug and should be used only if other less toxic agents have been tried. Digoxin, on the other hand, is cardiotonic, not antiarrhythmic agent. B and D are not known for their toxicity.
A nurse is assigned to a patient who is receiving Oxytocin (Pitocin) to induce labor. The nurse terminates the oxycontin infusion if which of the following is noted on the assessment of the client?
A. Early decelerations of the fetal heart rate.
B. Fatigue.
C. Nausea.
D. Uterine hyperstimulation.
Answer: D. Uterine hyperstimulation.
Oxytocin is used to induce labor by stimulating uterine contraction. Oxytocin infusion must be discontinued if any signs of uterine stimulation are present.
Option A: Early decelerations of the fetal heart rate are a reassuring sign, but it does not indicate fetal distress.
Options B and C are probably caused by the labor experience itself.
A nurse is planning care for a client who is a devout Moslem and is 3 days postoperative. The client is scheduled for 2 physical therapy sessions on a daily basis. Which of the following statements by the nurse indicates culturally app0ropriate care for the client?
a) “I will make sure the menu includes kosher options.” Clients of Jewish culture, not Islam, require kosher options.
b) “I will discuss the daily schedule with the client to make sure the client has time for prayer.”
c) “I will make sure to use direct eye contact with the client.” In Middle Eastern cultures direct eye contact can be perceived as rude.
d) “I will make sure daily communion is available for the client.” Daily communion is a ritual considered for a Catholic client.
Answer: B. “I will discuss the daily schedule with the client to make sure the client has time for prayer.”
Devout Muslims pray 5 times a day. Without proper awareness and planning the client could refuse necessary such as physical therapy.
a) Clients of Jewish culture, not Islam, require kosher options.
c) In Middle Eastern cultures direct eye contact can be perceived as rude.
d) Daily communion is a ritual considered for a Catholic client.
To enhance the percutaneous absorption of nitroglycerine ointment, it would be MOST important for the nurse to select a site that is
A. muscular.
B. near the heart.
C. non-hairy.
D. over a bony prominence.
Answer: C. non-hairy -- CORRECT: skin site free of hair will increase absorption; avoid distal part of extremities due to less than maximal absorption
Nitroglycerine: used in treatment of angina pectoris to reduce ischemia and relieve pain by decreasing myocardial oxygen consumption; dilates veins and arteries. Ointment applied to skin; sites rotated to avoid skin irritation. Prolonged effect up to 24 hours
A & B not most important. D. most important that the site be non-hairy
Patient is considered to be pre-diabetic if their Glycosylated Hemoglobin is:
A. 5.4 %
B. 6.5 %
C. 5.5 %
D. 5.7 %
Answer: D. 5.7%
6.5% or more = DM
5.7% to 6.4% = Pre-DM
less than 5.7% = Normal
Epinephrine is used to treat cardiac arrest and status asthmaticus because of which of the following actions?
A. Increased speed of conduction and gluconeogenesis
B. Bronchodilation and increased heart rate, contractility, and conduction
C. Increased vasodilation and enhanced myocardial contractility
D. Bronchoconstriction and increased heart rate
Answer: B. Bronchodilation and increased heart rate, contractility, and conduction
Bronchodilation results from stimulated beta receptors, and cardiac effects result from the stimulation of ß1 receptors. Choice A does not address respiratory effects of medication. Choice C is incorrect because α-stimulating drugs cause vasoconstriction. Bronchodilation, not bronchoconstriction, results from ß2 activity.
A nurse is preparing Dinoprostone to a client to induce labor. Which of the following nursing intervention must be questioned?
A. Have the client hold void before administration.
B. Place the client on a side lying position for 30 to 60 minutes after the administration.
C. Monitor maternal vital signs.
D. Have the client void before administration.
Answer A. Have the client hold void before administration.
Dinoprostone is a prostaglandin use in the induction of labor. It is administered vaginally so in order for the medication not to be contaminated with urine, the nurse should let the client void before administration.
A nurse is caring for a client who has Stage IV lung cancer and is 3 days postoperative following a wedge resection. The client states, “I told myself that I would go through the surgery and quit smoking, if I could just live long enough to attend my daughter’s wedding.” Based on Kubler-Ross model, which stage of grief is the client experiencing?
a) Anger- The client’s statement does not display anger.
b) Denial-The client is not denying the severity of his diagnosis.
c) Bargaining
d) Acceptance-Although the client might have accepted their diagnosis and prognosis this statement does not convey coming to terms with the situation.
Answer: C. Bargaining-The client is displaying bargaining by attempting to negotiate more time to live and see his daughter get married.
a)The client’s statement does not display anger.
b)The client is not denying the severity of his diagnosis.
d)Although the client might have accepted their diagnosis and prognosis this statement does not convey coming to terms with the situation.
The nurse manager in a pediatric clinic presents an in-service program to staff members about parental consent requirements. After the program, which clients will the nurse expect staff to recognize as needing parental consent? (Select all that apply.)
1. A minor in college who requires emergency surgery.
2. A minor who is married and the parent of a toddler child.
3. Minors who are determined to be emancipated by a court.
4. A school-age client who lives with a grandparent and requires an MRI.
5. An adolescent who seeks screening for a sexually transmitted infection.
Answer: 1 & 4
1. A minor who is in college and requires emergency surgery will need parental consent. An exception would be if the minor were emancipated, which is not indicated.
4. A school-age client who is currently living with a grandparent will still require parental consent for medical treatment. An exception is if the grandparent has full custody of the client, which is not indicated.
Rationales:
2. A minor who is married and is a parent of a toddler child is considered emancipated. This client would not need parental consent for medical treatment.
3. Minors who are emancipated by the court do not need parental consent for medical care.
5. An adolescent client who is seeking screening for a sexually transmitted infection (STI) does not need parental consent. This is an exception to allow minors to seek medical treatment in a confidential manner. Without such an exception, the opportunity for assistance may be lost.
Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?
A. Fluid balance
B. Apical pulse rate
C. Nutritional intake
D. Orientation and alertness
Answer: B. Apical pulse rate
Following norepinephrine (Levophed) administration, it is essential to the nurse to assess:
A. electrolyte status
B. color and temperature of toes and fingers
C. capillary refill
D. ventricular arrhythmias
Answer: B. color and temperature of toes and fingers
Because decreased perfusion is a side effect of norepinephrine (Levophed), the nurse must check circulation frequently.
A client in preterm labor (32 weeks) who is dilated to 5cm has been given magnesium sulfate and the contractions have stopped. If the labor can be delayed for the next 2 days, which of the following medication does the nurse expect that will be prescribed?
A. Fentanyl (Sublimaze).
B. Sufentanil (Sufenta).
C. Betamethasone (Celestone).
D. Butorphanol tartrate (Stadol).
Answer: C. Betamethasone (Celestone).
Glucocorticoids such as betamethasone and dexamethasone are being used to increase the production of surfactant to aid in fetal lung maturation. It is being given to patients who are in preterm labor at 28-32 weeks of gestation if the labor can be stopped for 2 days.
Option A, B, and D are opioid analgesic.
A nurse is assisting a newly licensed nurse with postmortem care of a client. The family wishes to view the body. Which of the following statements by the newly licensed nurse indicate an understanding of the procedure? (Select all that apply).
a) “I will remove the dentures from the body.” The nurse should insert the client’s dentures so that the face looks as normal as possible.
b) “I will make sure the body is laying completely flat.” The body should not be completely flat. One pillow is placed under the head and shoulders to prevent dislocation of the face.
c) “I will apply fresh linens and place a clean gown on the body.” The body and the environment should be as clean as possible. This includes washing soiled areas of the client’s body.
d) “I will remove all equipment from the bedside.” The environment should be as clutter free as possible. The nurse should remove equipment and supplies from the area.
e) I will dim the lights in the room.” Diming the lights helps to provide a calm environment for the family.
Answer: C, D, E
c) The body and the environment should be as clean as possible. This includes washing soiled areas of the client’s body.
d)The environment should be as clutter free as possible. The nurse should remove equipment and supplies from the area.
e) Diming the lights helps to provide a calm environment for the family.
Rationale for incorrect Qs:
a)The nurse should insert the client’s dentures so that the face looks as normal as possible.
b)The body should not be completely flat. One pillow is placed under the head and shoulders to prevent dislocation of the face.
A patient is to receive 3,000 ml of 0.9% NaCl IV in 24 hours. The intravenous set delivers 15 drops per milliliter. The nurse should regulate the flow rate so that the patient receives how many drops of fluid per minute?
A. 21
B. 28
C. 31
D. 42
Answer: C. 31
total volume x the drop factor divided by the total time in minutes.
3,000 x 15 divided by 24 x 60
A nurse enters a client’s room and notes that the client’s lawyer is present and that the client is preparing a living will. The living will requires that the client’s signature be witnessed, and the client asks the nurse to witness the signature. Which of the following is the appropriate nursing action?
A. Decline to sign the will.
B. Sign the will as a witness to the signature only.
C. Call the hospital lawyer before signing the will.
D. Sign the will, clearly identifying credentials and employment agency.
Answer: A. Decline to sign the will.
Living wills are required to be in writing and signed by the client. The client’s signature either must be witnessed by specified individuals or notarized. Many states prohibit any employee from being a witness, including a nurse in a facility in which the client is receiving care.
A nurse is interviewing a patient who is about to receive bumetanide. Which of the following is a concern related to the administration of the medication?
A. Penicillin allergy.
B. Sulfa allergy.
C. Soy containing allergy.
D. Cephalosporin allergy.
Answer: B. Sulfa allergy.
Loop diuretics such as bumetanide are sulfa-based medications, and a client with sulfa allergy is at risk for an allergic reaction.
A nurse is caring for a patient receiving oxytocin therapy suddenly is experiencing hypertonic contractions. Which of the following priority nursing actions should the nurse do? Select all that apply.
A. The nurse leaves the client to ask for help.
B. Stop the oxytocin infusion.
C. Increase the flow rate of the intravenous additive solution.
D. Place the client in the supine position.
E. Administer oxygen at 8 to 10 liters per minute.
Answer: B, C, and E.
The presence of hypertonic contractions indicates the need to initiate emergency measures. The oxytocin infusion must be stopped to reduce uterine stimulation, administering oxygen will promote increased fetal and maternal oxygenation.
Option A: The nurse should stay with the client.
Option D: Placing the client in a supine position will not promote an increase in placental oxygenation.
A nurse is caring for a client who has terminal lung cancer. The nurse observes the family assisting with all the ADL’s. Which of the following rational for self-care should the nurse communicate to the family?
a) Allowing the client to function independently will strengthen the muscles and promote healing.
b) The client needs to be given privacy at times for self-reflecting and organizing their life.
c) The client’s sense of loss can be lessened through retaining control of certain areas of life.
d) Performing ADL.s is required prior to discharge from an acute care facility.
Answer: C. The client’s sense of loss can be lessened through retaining control of certain areas of life.
Allowing the client as much control as possible maintains dignity and self-esteem.
a) Strengthening muscles is not a priority in palliative care,
b) Privacy for periods of self-reflection can be achieved at times apart from performance of ADL’s.
d) Performance of ADL’s is not a criteria for discharge from an acute care facility.
A man is admitted to the Telemetry Unit for evaluation of complaints of chest pain. Eight hours after admission, the patient goes into ventricular fibrillation. The physician defibrillates the patient. The nurse understands that the purpose of defibrillation is to:
A. increase cardiac contractility and cardiac output.
B. cause asystole so the normal pacemaker can recapture
C. reduce cardiac ischemia and acidosis.
D. provide energy for depleted myocardial cells.
Answer: B. cause asystole so the normal pacemaker can recapture - CORRECT: allows SA node to resume as pacer of heart activity
A, C, D are inaccurate
While inserting a nasogastric tube, the nurse should use which of the following protective measures?
A. Gloves, gown, goggles, and surgical cap.
B. Sterile gloves, mask, plastic bags, and gown.
C. Gloves, gown, mask, and goggles.
D. Double gloves, goggles, mask, and surgical cap.
Answer: C. Gloves, gown, mask, and goggles.
Mask, eye protection, face shield protect mucous membrane exposure; used if activities are likely to generate splash or sprays. Gowns used if activities are likely to generate splashes or sprays.
A. Gloves, gown, goggles, and surgical cap - surgical caps offer protection to hair but aren’t required.
B. Sterile gloves, mask, plastic bags, and gown - plastic bags provide no direct protection and aren’t part of universal precautions
D. Double gloves, goggles, mask, and surgical cap - surgical cap not required; unnecessary to double glove