Spooky
A patient is admitted to the hospital due to having a lower than normal potassium level in her bloodstream. She reports to the nurse she has been experiencing vomiting and diarrhea. Which foods should the nurse instruct the client to increase?
A. Whole grains and nuts
B. Milk products and whole grains
C. Pork products and canned vegetables
D. Meats, dried fruits, orange juice, and bananas
Correct answer: D. Meats, dried fruits, orange juice, and bananas
Rationale: Patients with hypokalemia need to increase the intake of foods high on potassium. Meats, dried fruits, orange juice, and bananas are high in potassium as well as raisins, apricots, avocados, beans, and potatoes. Potassium may be replaced and level maintained through the diet when the client is allowed oral food and fluids. If ordered by the PCP we could also administer oral supplements or IV replacement.
A patient’s lab results revealed a serum level of 2.0 mEq/L revealing hypocalcemia. Which assessment data does the nurse document when the nurse notices a facial spasm when tapping their face just below the temple and contractions of fingers and hand when an inflated BP cuff is placed?
A. Paresthesia & Tetany
B. Positive Chvostek & Positive Trousseau
C. Atrophy & Atony
D. Tremors & Positive Babinski
Correct answer B: Positive Chvostek & Positive Trousseau
Rationale: Positive Chvostek sign refers to tapping of the face just below the temple causing facial spasms. Positive Trousseau refers to an inflated blood-pressure cuff causing contraction of the finger and hands which both result from hypocalcemia. The contraction occurs due to the obstruction of blood supply to the ulnar nerve. A patient would experience paresthesia and tetany with hypocalcemia, but the symptoms the patient is experiencing are referring to the Chvostek and Trousseau symptoms.
A patient comes to the hospital experiencing extreme thirst, tented skin turgor and family reports that the patient has been restless and extremely agitated. Stating that has been having watery diarrhea for the past couple of days. Which electrolyte imbalance may be leading to these clinical manifestations?
A. Hypernatremia
B. Hypokalemia
C. Hyperkalemia
D. Hypophosphatemia
Correct answer A: Hypernatremia
Rationale: Hypernatremia refers to an elevated serum sodium level above 145. Typically, the client exhibits tented skin turgor and extreme thirst in conjunction with dry, sticky mucous membranes, lethargy and restlessness. Most patients present with symptoms suggestive of fluid loss and clinical signs of dehydration, in this patients case due to the watery diarrhea she has been experiencing.
A patient presents to the clinic with personality changes, tetany, and a positive Babinski sign leading their primary caregiver to diagnose them with hypomagnesemia. Which nursing intervention would be the most appropriate?
A. Avoiding the use of tight tourniquet when inserting an IV
B. Instituting seizure precaution to prevent injury
C. Teaching the client the importance of early ambulation
D. Instituting seizure precaution to prevent injury
Correct answer D: Instituting seizure precautions to prevent injury.
Rationale: Instituting seizure precaution is an appropriate intervention because the client with hypomagnesemia is at risk for seizures. Changes in mentation or the development of seizure activity in severe low magnesium increase the risk of client injury. Provide a quiet environment and subdued lighting. Reduces extraneous stimuli; promotes rest.
A patient has the following arterial blood gas values: pH of 7.34, partial pressure of arterial oxygen of 80 mm Hg, partial pressure of arterial carbon dioxide of 49 mm Hg, and a bicarbonate level of 24 mEq/L. Based on these results, which intervention should the nurse implement?
A. Instructing the client to breathe slowly into a paper bag
B. Administering low-flow oxygen
C. Encouraging the client to cough and deep breathe
D. Nothing, because these ABG values are within normal limits
Correct answer C: Encouraging the client to caught and deep breathe
Rationale: The ABG results indicate respiratory acidosis requiring improved ventilation and increased oxygen to the lungs. Coughing and deep breathing can accomplish this. Encourage and assist with deep-breathing exercises, turning, and coughing. Suction as necessary. Provide airway adjunct as indicated. Place in semi-Fowler’s position. These measures improve lung ventilation and reduce or prevent airway obstruction associated with the accumulation of mucus.
. An elderly client was admitted to a hospital in a coma. Analysis of the arterial blood gave the following results: CO2 of 55, HCO3 of 42, and pH of 7.1. As a well-rounded nurse, you know that a normal value of HCO3 is:
A. 20
B. 28
C. 24
D. 36
Correct answer C: 24
Rationale: The normal range for bicarbonate is 22-26. (Remember 2 + 2 + 2 is 6)
A patient is prescribed Septra (Trimethoprim/ Sulfamethoxazole) for their bacterial infection of the eye diagnosed as trachoma. Which of the following should the patient be taught to report to their primary healthcare provider as it’s considered a medical emergency?
A. Paresthesia
B. Steven Johnson Syndrome
C. Dehydration
D. Vomiting
Correct answer B: Steven Johnson Syndrome
It is a rare, serious disorder of the skin and mucous membranes. A medical emergency, this is often a reaction to the medication or infection. Which first appears with Flu-like symptoms which then transition to painful rash that spreads with blisters later appearing. If left untreated can cause serious complications including: skin problems like a skin infection, changes in skin color and scarring. Problems with organs, such as the lungs, liver and kidneys. eye problems, such as long-term inflammation or sight problems.
A 7-year-old patient has been prescribed Doxycycline to treat their acne. As the nurse administering this medication, why would you want to hold the prescribed medication knowing which adverse reaction could result?
A. Permanent discoloration of the teeth
B. Nephrotoxicity
C. Diarrhea & vomiting
D. Oliguria
Correct answer A: Permanent discoloration of the teeth
Rationale: Doxycycline a Tetracycline is contraindicated in children younger than 8 years of age because it can cause permanent discoloration of the teeth in child’s teeth. It has the possibility of also hindering their development.
A patient presents to the hospital experiencing vomiting, nausea, flushing, sweating, and headaches. The patient states she was recently prescribed Ceftriaxone to treat her bacterial infection. What questions should the nurse prioritize in asking the patient?
A. “Do you have a Penicillin allergy?”
B. “Have you recently taken an anticoagulant?”
C. “When was the last time you consumed alcohol?”
D. “Have you recently been given the Flu vaccine?”
Correct answer C: “When was the last time you consumed alcohol?”
Rationale: Ceftriaxone (Rocephin) is a Cephalosporin which is not to be taken if ingesting alcohol as it can cause a disulfiram-like reaction (intolerance to alcohol). Which can happen up to three days after taking some type of Cephalosporins like Rocephin. The nurse should recognize those signs and symptoms as a possible interaction between alcohol and Cephalosporins, and ask hoe recently alcohol was consumed. Cephalosporins should not be taken with anticoagulants either but their symptoms would present themselves differently as they would experienced an increase in bleeding.
A patient is being treated for a sinus infection with Omnicef (cefdinir). You’re assessing your patient's allergies before administering the medication following your 8 rights. What medication allergy stated by the patient requires you to hold the prescribed medication and contact the primary care provider for further orders?
A. Ciprofloxacin
B. Penicillin
C. Vancomycin
D. Gentamicin
Correct answer B: Penicillin
Rationale: Penicillins and Cephalosporins have a similar chemical structure. Therefore, due to this, there is a cross-sensitivity risk. This means the patient may be allergic to a Cephalosporin if they are allergic to Penicillins.
A nurse is caring for a patient who has been prescribed azithromycin to treat pneumonia. The patient is also on digoxin to treat their heart arrhythmia. Which of the following would you know is an interaction that occurs when using azithromycin and digoxin together that you would assess for and report immediately?
A. Decreased serum digoxin levels
B. Increased serum digoxin levels
C. Decreased effectiveness of azithromycin
D. No interaction
Correct answer B: Increased serum digoxin levels
Rationale: Azithromycin can interact with digoxin, anticoagulants, some psychiatric medications and increase their effects. Macrolides alter the gastrointestinal flora that metabolize digoxin to less active dihydro metabolites, leading to the increased serum digoxin concentration which can adversely cause digoxin toxicity.
A patient is receiving Vancomycin through their IV to treat their diagnosis of pneumonia. As the nurse you know to monitor for signs of Red Man Syndrome. What symptoms should you be very attentive to when infusing the antibiotic?
A. Increased heart rate and hypotension
B. Flushing, sweating, and hypotension
C. Nausea and vomiting
D. Dehydration
Correct answer B: Flushing, sweating, and hypotension
Rationale: Red Man Syndrome is characterized by flushing, rash, sweating and hypotension. The flushing red tone is very prominent on the face and upper body and is commonly caused by rapid infusion of Vancimycin. As the nurse we should be aware to slowly administer the medication to avoid causing Red Man Syndrome in our patients.
A nurse is preparing to educate a patient on the importance of prophylactic antibiotics that help against bacterial endocarditis in at-risk clients prior to dental procedures. Which antibiotic class is commonly prescribed for this procedure?
A. Tetracyclines
B. Cephalosporins
C. Penicillins
D. Lipoglycopeptides
Correct answer C: Penicillins
Rationale: Penicillins are commonly prescribed as prophylactic treatment as they hold a broad spectrum of activity against both gram-positive and gram-negative bacteria. Additionally, penicillins have a well-established safety profile and they are generally well tolerated by patients except those who are allergic.
A patient presents to the emergency department with green discharge and pain during discharge the primary physician diagnoses him with gonorrhea and prescribes Tetracycline. What products would you educate the patient to avoid while on the antibiotic? SATA
A. Dairy products
B. Grapefruit
C. Antacids
D. Iron supplements
Corrects answer A, C, D : Dairy products, antacids, and iron supplements
Rationale: Dairy products trigger chemical reactions that reduce the amount that the Tetracycline can be absorbed in the body leading to decreased effectiveness. Antacids that contain magnesium, aluminum or calcium interfere with the absorption of antibiotics as well. It is recommended to take the antibiotic and wait up to 2 hrs to take the antacid. Additionally, the same thing occurs with iron supplements but it is recommended to separate the doses waiting up to 3 hrs to take the supplement.
A patient has recently been prescribed gentamicin (Garamycin) for a serious gram-negative infection. Which of the following should the patient be taught to report to their primary healthcare provider? Select all that apply.
A. Pain, swelling, and redness at the Achilles tendon site
B. Tinnitus, headaches, and/or hearing loss
C. Damage to the teeth and bones
D. A decreased urinary output
Correct answers: B & D
Rationale: Gentamicin (Garamycin) falls into the aminoglycosides antibiotics class. (Remember: “It’s my sin to give a -micin”). Aminoglycosides come with a boxed warning alerting healthcare professionals to the serious risk of ototoxicity (ear toxicity) and nephrotoxicity (kidney toxicity). Ototoxic effects may lead to tinnitus, headaches, balance changes, and/or hearing loss. Renal toxicity, which may progress to renal failure, may lead to a decreased urine output and abnormal renal lab values such as the BUN & Creatinine. Pain, swelling, and redness at the Achilles tendon site may be complications of fluoroquinolones such as Levaquin and Cipro. Damage to the teeth and bones may result from tetracyclines such as doxycycline.
A patient in the hospital recently received Lasix 20–40 mg IV for acute pulmonary edema secondary to heart failure. Which of the following adverse effects of Lasix should be reported to the physician? Select all that apply.
A. Increased urinary output
B. Blood pressure of 85/55 mm Hg
C. Weakness, muscle cramps, trembling, nausea, vomiting, and diarrhea
D. Arrhythmias
Correct answers: B, C, D
Rationale: Lasix (furosemide) is a loop diuretic used in the treatment of acute HF, acute pulmonary edema, hypertension, and edema of HF, renal disease, or liver disease. As Lasix (furosemide) is a loop diuretic, increased urinary output is an expected finding. Severe hypotension and signs and symptoms of hypokalemia such as weakness, muscle cramps, trembling, nausea, vomiting, diarrhea, and arrhythmias should be reported to the physician.
A patient taking Aldactone should be advised to consume foods such as apricots, dried fruit, avocados, apples, oranges, spinach, and bananas. true/false
Correct answer: false
Rationale: Spironolactone (Aldactone, Carospir) is a potassium-sparing diuretic promoting the retention of potassium. All of these food choices are high in potassium.
A patient comes into the clinic experiencing hyperventilation from a panic attack. Their lab values come back as follows: pH: 7.7, CO2: 31, HCO3: 25. As the nurse, you would identify that the patient is currently experiencing:
A. Respiratory alkalosis uncompensated
B. Metabolic alkalosis partially compensated
C. Respiratory alkalosis compensated
D. Metabolic alkalosis uncompensated
Correct answer: A
Rationale: The patient is expelling all of their CO2 causing them to be more basic. As the bicarbonate levels are within normal limits, the kidneys are not trying to compensate for this alteration.
A patient arrives to the clinic reporting severe diarrhea for the past 3 days. Their lab values come back as follows: pH: 7.28, CO2: 42, HCO3: 19. As the nurse, you would identify that the patient is currently experiencing:
A. Metabolic acidosis partially compensated
B. Respiratory acidosis uncompensated
C. Metabolic acidosis uncompensated
D. Respiratory acidosis partially compensated
Correct answer: C Metabolic acidosis uncompensated
Rationale: The patient is losing their bicarbonate levels due to severe diarrhea. As the lungs are not trying to compensate for this change due to the CO2 being in normal range, the patient is experiencing metabolic acidosis uncompensated.
A patient with renal failure has had their recent bloodwork done. Their lab values come back as follows: pH: 7.37, CO2: 30, HCO3: 19. As the nurse, you would identify that the patient is currently experiencing:
A. Metabolic acidosis uncompensated
B. Respiratory acidosis compensated
C. Metabolic acidosis partially uncompensated
D. Metabolic acidosis compensated
Correct answer: D Metabolic acidosis compensated
Rationale: As the patient’s kidneys are not working probably, they are not producing enough bicarbonate leading to metabolic acidosis. However, the lungs are compensating for this by causing us to breathe out and retain less CO2 maintaining our pH balance within the normal range.
A postoperative patient’s bloodwork has just arrived. Their lab values come back as follows: pH: 7.30, CO2: 56, HCO3: 41. As the nurse, you would identify that the patient is currently experiencing:
A. Metabolic acidosis uncompensated
B. Respiratory acidosis compensated
C. Respiratory acidosis uncompensated
D. Respiratory acidosis partially compensated
Correct answer: D Respiratory acidosis partially compensated
Rationale: A postoperative patient may retain more CO2 leading to respiratory acidosis. However, the kidneys are attempting to compensate for this by holding onto the bicarbonate to keep the person more basic. Although, the pH is STILL out of range meaning that the patient is only partially compensated.
Knowing that the antineoplastic drug, fluorouracil can cause bone marrow suppression, what would the nurse want to monitor for in the patient taking this drug?
A. Fatigue, shortness of breath, and pale skin
B. Fever, chills, and sweats
C. Bloody gums or stools
D. All of the above
Correct answer: D All of the above
Rationale: The bone marrow is responsible for producing our blood cells. If the bone marrow is suppressed, the patient may experience leukopenia, anemia, thrombocytopenia, and/or pancytopenia. Signs and symptoms of anemia include fatigue, shortness of breath, and pale skin. Leukopenia can lead to suppressed immune system function leading the nurse to monitor for s/sx of infection. Thrombocytopenia can lead to bloody gums and stools due to decreased platelets in the blood.