The Red Stuff!
Ouch!/Glands
The Ticker
Onc/ Antibiotics
Resp / Psych
100
The nurse is caring for a patient receiving warfarin (Coumadin) for prevention of deep vein thrombosis who has an International Normalized Ratio (INR) value of 1.2. Which action by the nurse is most appropriate?

1. Prepare to administer protamine sulfate

2. Continue with the current prescription

3. Prepare to administer Vitamin K

4. Call the healthcare provider to increase the dose

What is Answer 4

An INR within the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse would contact the healthcare provider to discuss an order for an increase dose. International Normalized Ratio is a standard reference range used to establish consistency in reporting PT levels that accounts for normal variations seen in lab testing. INR leads to a better consensus of therapeutic management and ensures that evaluation of test results are based on common standards.

100
After administering an opioid analgesic to a client, the nurse would make which priority follow up assessments in addition to pain relief?

1. Respiratory rate and level of consciousness

2. Blood pressure and heart rate

3. Interactions with foods and other prescribed drugs

4 Oxygen saturation and bowel sounds

What is Answer 1

The primary purpose of administering opioid analgesics is pain relief. SE placing the client at greatest risk are respiratory depression and reduced LOC (option 1). Blood pressure and heart rate could decrease because of diminished sympathetic nervous system stimulation, but not priority over resp. rate and LOC. Concerns about drug interactions are pre-administration concerns (option 3) History of drug abuse and past experiences with pain management are also pre-admin issues (option 4)

100
A client is taking digoxin (Lanoxin) and furosemide (Lasix) to manage congestive heart failure (CHF). The nurse determines that the client understands diet therapy as it applies to these medications when the client makes which meal choice from a sample menu?

1.Vegetable beef soup, macaroni and cheese, and a dinner roll

2. Beef ravioli, spinach souffle, and Italian bread

3. Baked white fish, mashed potatoes, and carrot-raisin salad

4.Roasted chicken breast, brown rice and stewed tomatoes

What is Answer 3

Furosemide is frequently ordered with digoxin in the treatment of heart failure and furosemide depletes potassium stores because it is a potassium-wasting diuretic. Hypokalemia makes the client more susceptible to digitalis toxicity. Baked fish, potatoes, and carrots/raisins are the best choices because all three foods are high in potassium and low in sodium (option 3). Options 1,2, and 4 have higher sodium and fat intake which are not appropriate for heart failure.

100
The client has received chemotherapy 2 days a week every three weeks for the last 8 months. The client’s current lab values are Hgb and Hct 10.3 and31, WBC 5.2, neutrophils 50, and platelets 89. Based on the laboratory results, which information should the nurse teach the client?

1.Avoid individuals with colds or other infections.

2.Maintain nutritional status with supplements.

3.Plan for periods of rest to prevent fatigue.

4.Use a soft-bristled toothbrush and an electric razor.

What is Answer: 4, A platelet count of less than 100,000 is the definition of thrombocytopenia. The nurse should teach measures to prevent bleeding.

1.This is good information to teach, but it is not based on the laboratory values. The client’s WBC and absolute neutrophil counts are within normal range.

2.This is good information to teach, but it is not based on laboratory values. The client may develop mouth ulcers as a result of chemotherapy administration, and the nurse should discuss methods of maintaining nutrition for this reason but not because of the laboratory values.

3.This is good information to teach, but it is not based on the laboratory values. Fatigue related to cancer and its treatment is real and should be addressed, and an Hgb and Hct of around 8 and 24 could cause fatigue, but the client’s levels do not indicate this.

100
A child with asthma is being discharged to home and has an order for a bronchodilator (albuterol) to be administered via a metered dose inhaler (MDI). Which point should a nurse address for appropriate administration of this medication?

1. When administering medication via a MDI, avoid shaking the canister before discharging the medication.

2. Medication is ordered in two “puffs”; press on the canister twice in succession to discharge the medication.

3. There should be a tight seal around the mouthpiece of the inhaler before discharging the medication.

4. There should be a 2- to 3-inch space (or spacer device) between the inhaler and the open mouth of the child.

What is ANSWER: 4

Rationale: Children often have difficulty learning to depress and inhale their medications at the same time, and holding the MDI 2 to 3 inches away from the mouth or utilizing a “spacer” (an attachable device that provides space and contains the medication in a confined area) improves the effects of the medication. Shaking the MDI canister well before use supplies a better delievery of the aerosolized medication. When using two “puffs” of medication, waiting one minute between puffs allows for better absorption of the inhaled medication.

When using inhaled medications via an MDI the client should be instructed that wrapping the lips tightly around the mouthpiece consolidates the medication in the buccal cavity and decreases the effectiveness of inhaled medications. (Ohman, 2010)

200
A client diagnosed with iron deficiency anemia is taking iron supplements. The nurse should document which of the following in the teaching plan to enhance the effect of the medication.

1. Include leafy green vegetables in daily diet.

2. Include whole-grain bread in daily diet.

3. Include raisins in diet three times per week

4. Use adequate sources of vitamin C in diet

What is Answer : 4

Vitamin C helps to enhance the absorption of iron supplements as well as dietary iron (option 4). Leafy green vegetables, whole-grain breads, and raisins are high in iron, but would not enhance the absorption of the medication.

200
A client has begun taking an anticholinergic medication. The nurse should make it a priority to assess for which of the following manifestations?

1. Tachycardia and hypertension

2. Urinary retention, hesitancy, and constipation

3. Pain resembling pattern associated with cholecystitis

4. Pain resembling renal colic

What is Answer 2 Anticholinergic medications block the action of acetylcholine, resulting in decreased stimulation in the GI and urinary tract systems. This leads to urinary and bowel problems such as urinary retention, hesitancy, and constipation.

Anticholinergic drugs stimulate the parasympathetic system and tachycardia and hypertension indicate sympathetic system stimulation. Cholinergic agonists, not anticholinergics, cause biliary tract contractions (option 3). Renal colic is also more commonly associated with agonists rather than anticholinergics (option 4)

200
A client is given amiodarone (Cordarone) in the emergency department for a dysrhythmia. Which of the following indicated that the drug is having the desired effects?

1.The ventricular rate is increasing

2.The absent pulse is now palpable

3.The number of premature ventricular contractions is decreasing

4.The fine ventricular fibrillation changes to coarse ventricular fibrillation

What is Answer: 3

Amiodarone is used for the treatment of premature ventricular contractions, ventricular tachycardia with a pulse, atrial fibrillation, and atrial flutter. Amiodarone is not used as initial therapy for a pulseless dysrhythmia

200
The nurse on an oncology floor is administering morning medications. Which medication would the nurse question?

1.Cyanocobalamin (vitamin B12) to a client with pernicious anemia.

2.Erythropoietin (Epogen) to a client with chronic lymphocytic leukemia.

3.Filgrastim (Neupogen) to a client with a solid tissue tumor.

4.Heparin intravenously to a client with disseminated intravascular coagulation

What is Answer: 2, Erythropoietin stimulates the bone marrow to produce more cells. Stimulation of the bone marrow is questioned when the cancer is in the bone marrow.

1.Cyanocobalamin is the treatment for pernicious anemia. The nurse would not question administering this medication.

3.Stimulation of the bone marrow is not questioned in clients with solid tissue tumors. The nurse would not question administering this medication.

4.Heparin is part of the standard treatment for disseminated intravascular coagulation (DIC).

200
Which statements best indicate to the nurse that the client understood instructions about self-administration of salmeterol (Serevent). SELECT ALL THAT APPLY.

1. “I will use this medication every six hours.”

2. “If my symptoms are not better within 20 minutes I should notify my healthcare provider.”

3. “Although it will remain regular, this med may decrease my heart rate.”

4. “This drug is supposed to prevent an asthma attack, but it isn’t good for treating one.”

5. “I will take a dose of this med when I notice I am wheezing.”

What is ANSWER: 2, 4

Rationale: (2) This drug should begin to take effect within 20 minutes, (4) use of Salmeterol is prophylactic, (1) it is dosed every 12 hours because of the 12 hour duration, (3) although it is a beta-2 stimulant it may occasionally cause tachycardia, (5) it is not used for treatment of an acute attack. (Hogan, 2007)

300
A 53 year-old male presents to the emergency department with symptoms of acute myocardial infarction. After diagnostic workup, the healthcare provider prescribes a 15mg IV bolus of alteplase (t-PA) followed by 50 mg infused over 30 minutes. In monitoring this patient, the nurse understands that which of the following symptoms, if present, indicates the most likely adverse reaction to this drug?

1. Uticaria, itching, and flushing

2. Blood pressure = 90/50

3. Decreasing level of consciousness

4. Potassium level = 5.5 mEq/L

What is Answer 3

Unlike streptokinase, alteplase (tPA) does not cause an allergic reaction or hypotension. The greatest risk with this drug is bleeding, with intracranial bleeding the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. Thrombolytic agents such as alteplase do not typically cause elevated potassium level.

300
A nurse administers naloxone (Narcan) to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication.

1.Drowsiness

2. Tics and tremors

3. Increased pain

4. Nausea and vomiting

What is Answer 3

Naloxone (Narcan) is a medication that reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of Narcan, pain will be more acute. The drug is a "pure" agonist. It blocks opioid receptor.

300
The physician orders continuous I.V. nitroglycerin infusion for the client with myocardial infarction. Essential nursing actions include which of the following?

1.Obtaining an infusion pump for the medication.

2.Monitoring blood pressure every 4 hours.

3.Monitoring urine output hourly.

4.Obtaining serum potassium level daily

What is Answer: 1

I.V. nitroglycerin infusion requires an infusion pump for precise control of the medication. Blood pressure monitoring would be done with a continuous system, and more frequently than every 4 hours. Hourly urine outputs are not always required. Obtaining serum potassium levels is not associated with nitroglycerin infusion

300
The HCP prescribes amoxicillin/clavulanate (Augmentin), an antibiotic, for a client diagnosed with chronic obstructive pulmonary disease (COPD) who has a cold. Which intervention should the nurse implement?

1.Discuss the prescription with the HCP because antibiotics do not help viral infections.

2.Teach the client to take all the antibiotics as ordered.

3.Encourage the client to seek a second opinion before taking the medication.

4.Ask the client if he or she is allergic to sulfa drugs or shellfish.

What is Answer: 2, Clients prescribed antibiotics should always be taught to take all the medication as ordered to prevent resistant strains of bacteria from developing.

1.Antibiotics do not treat viral infections, but HCPs will frequently provide prophylactic antibiotics for clients with comorbid conditions (such as COPD) to prevent a secondary bacterial infection.

3.There is no reason for a second opinion; this is standard medical practice.

4.This is a penicillin preparation, not a sulfa medication or iodine.

300
The nurse withholds the currently scheduled drug dose after noting that a client with which health problem is receiving flucatisone aerosol (Flovent)?

1. AIDS

2. Asthma

3. COPD

4. Systemic Lupus Erythematosus

What is ANSWER: 1

Rationale: (1) Steroids suppress the immune system and administration of these drugs is contraindicated in AIDS. (2)It is commonly used to treat asthma, (3) It may be used in COPD,(4)It is sometimes used in SLE

400
The nurse should teach which of the following items of information to a client being discharged on long term warfarin (Coumadin) therapy following cardiac valve replacement

1.Eat lettuce and tomatoes for lunch only a few times per week.

2.Limit dietary intake of yellow wax beans to twice a week.

3.Use aspirin for minor aches and pains

4.Wear shoes that completely enclose the feet

What is Answer 4

Because of the high risk of bleeding, the client should protect the feet from injury (option 4). Lettuce and tomatoes and wax beans do not contain enough vitamin K to interact negatively with Coumadin and so they do not need to be limited (option 1). Aspirin increases the risk of bleeding and therefore should not be used while taking an anticoagulant such as warfarin.

400
Which of the following medications should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy?

1.Sodium phosphate

2.Calcium gluconate

3.Diltiazem (Cardizem)

4.Sodium bicarbonate

What is Answer: 2

The client with tetany is suffering from hypocalcemia, which is treated by administering an I.V. preparation of calcium, such as calcium gluconate or calcium chloride. Oral calcium is then necessary until normal parathyroid function returns. Sodium phosphate is a laxative. Diltiazem is a rhythm stabilizer not effective for tetany. Sodium bicarbonate is a potent systemic antacid.

400
A client has a history of heart failure and has been taking several medications, including furosemide (Lasix) digoxin, (Lanoxin), and potassium chloride. The client has nausea, blurred vision, headache and weakness. The nurse notes that the client is confused. The telemetry strip shows a first-degree AV block. The nurse should assess the client for signs of which condition?

1.Hyperkalemia

2.Digoxin toxicity

3.Fluid deficit

4.Pulmonary edema

What is Answer: 2

Early symptoms of digoxin toxicity include anorexia, nausea, and vomiting. Visual disturbances can also occur, including double or blurred vision and visual halos. Hypokalemia is a common cause of digoxin toxicity because low serum potassium can enhance ectopic pacemaker activity. Although vomiting can lead to fluid deficit, given the client’s history, the vomiting is likely due to the adverse effect of digoxin toxicity. Pulmonary edema is manifested by dyspnea and coughing.

400
4. The nurse is administering medications to clients on a urology floor. Which medication would the nurse question?

1.Ceftriaxone (Rocephin), a third generation cephalosporin, to a client who is pregnant.

2.Cephalexin (Keflex), a cephalosporin, to a client who is allergic to penicillin.

3.Trimethoprim sulfa (Bactrim), a sulfa antibiotic, to a client post-prostate surgery.

4.Nitrofurantoin (Macrodantin), a sulfa antibiotic, to a client with urinary stasis.

What is Answer: 2,

A cross-sensitivity exists in some clients between penicillin and the cephalosporins. The nurse should assess the type of reaction the client experienced when taking penicillin. If the client indicates any symptom of an anaphylactic reaction, the nurse would hold the medication and discuss the situation with the HCP.

1.Rocephin is in the pregnancy risk category B. No research has shown harm to the fetus in humans or animals. The nurse would not question this medication.

3.There is no reason for the nurse to question Bactrim for a client who has had prostate surgery.

4.There is no reason for the nurse to question Macrodantin for a client who has urinary stasis. Macrodantin is used to prevent or treat chronic urinary tract infections.

400
A nurse is reviewing the medications for all assigned clients on an inpatient psychiatric unit. The nurse anticipates assessing for extrapyramidal symptoms (EPS) in clients taking:

1. risperidone (Risperdal®)

2. clozapine (Clozaril ®)

3. haloperidol (Haldol ®)

4. ziprasidone (Geodon ®)

What is Answer: 3

Haloperidol is the only medication listed with a high probability of EPS. Risperidone, clozapine, and ziprasidone are members of newer generation anti-psychotics with less potential for EPS.

500
The laboratory calls the nursing unit to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for treatment of postoperative DVT. Which action by the nurse is most appropriate?

1. Call the healthcare provider and discuss the reduction or withdrawal of heparin

2. Call the healthcare provider and to discuss the increasing heparin dose to achieve a therapeutic level.

Obtain vitamin K and prepare to administer it by IM injection

Observe the patient and monitor the aPTT as indicated.

What is Answer 1 Heparin-induced thrombocytopenia (HIT) is a fatal immune-mediated potential adverse effect of heparin infusions. HIT is suspected when platelet counts fall significantly. A PLT count below 100,000/mm3 would warrant the discontinuation of heparin.
500
A client is to receive glargine (Lantus) insulin in addition to a dose of aspart (NovoLog). When the nurse checks the blood glucose level at the bedside, it is greater than 200 mg/dL. How should the nurse administer the insulins?

1.Put air into the glargine insulin vial, and then air into the aspart insulin vial, and draw up the correct dose of aspart insulin first.

2.Roll the glargine insulin vial, then roll the aspart insulin vial. Draw up the longer-acting glargine insulin first.

3.Shake both vials of insulin before drawing up each dose in separate insulin syringes.

4.Put air into the glargine insulin vial, and draw up the correst dose in an insulin syringe; then, with a different insulin syringe, put air into the aspart vial and draw up the correct dose.

What is Answer: 4

Glargine (Lantus) is a long-acting recombinant human insulin analog. Glargine should not be mixed with any other insulin product. Insulin should not be shaken; instead, if the insulin is cloudy, roll the vial or insulin pen between the palms of the hands.

500
A client with acute chest pain is receiving I.V. morphine sulfate. Which of the following results are intended effects of morphine in this client? Select all that apply.

1.Reduces myocardial oxygen consumption.

2.Promotes reduction in the respiratory rate.

3.Prevents ventricular remodeling.

4.Reduces blood pressure and heart rate.

5.Reduces anxiety and fear.

What is Answer: 1, 4, 5

Morphine sulfate acts as an analgesic and sedative. It also reduces myocardial oxygen consumption, blood pressure, and heart rate. Morphine also reduces anxiety and fear due to its sedative effects and by slowing the heart rate. It can depress respirations, however, such an f may lead to hypoxia, which should be avoided in the treatment of chest pain. Angiotensin-converting enzymes- inhibitor drugs, not morphine, may help to prevent ventricular remodeling.

500
The 18 year old male client is diagnosed with gonorrhea of the pharynx. The HCP has prescribed ceftriaxone (Rocephin), a cephalosporin. Which intervention should the nurse implement?

1.Administer the medication intramuscularly in the gluteus muscle.

2.Have the client drink a full glass of water with the pill.

3.Use a tuberculin syringe to draw up the medication.

4.Make sure the client has eaten before administering the drug.

What is Answer: 1, Rocephin is administered IM or IV. There is no pill form of the medication. The medication burns when administered and should be administered in the large gluteus muscle.

2.There is no pill form of Rocephin, so drinking water will not affect the medication.

3.Rocephin is administered IM or IV. A tuberculin syringe is used to administer medications by the subcutaneous or intradermal route.

4.There is no pill form of the medication, so eating will not affect the medication.

500
At discharge, a nurse documents that a client taking lithium has an accurate understanding of self-care. On which client statement should the nurse base this judgment?

1.” I know I need to restrict foods high in sugar while I’m taking lithium.”

2. “I need to come back and have my blood lithium level checked every 2 weeks.”

3. "I should take my lithium on an empty stomach for the best absorption.”

4. “I need to eat enough foods containing sodium and drink at least 2 to 3 liters of fluid daily.”

What is Answer: 4

A client must consume adequate dietary sodium as well as 2,500 to 3,000 mL of fluid per day to prevent dehydration leading to lithum toxicity. Sugary foods should only be avoided if weight gain becomes a problem. Lithium levels should be checked every 1 to 2 months, not every 2 weeks. Lithium often causes stomach upset and can be taken with food for better tolerance. (Ohman, 2010)

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