Weeks 2,3
Week 4,6
Week 7,8
Week 9,10
Week 11,12,13
100
The nurse has entered the room of a client who is being treated with regular doses of morphine. The client is unresponsive to voice but responsive to touch, with a respiratory rate of 6 breaths per minute. In addition to informing the care team, what is a priority action?
1. Administration of naloxone as prescribed27%
2. Administration of acetylcysteine as prescribed
3. Cardiac monitoring
4. Auscultating the client’s lungs
5. Dry skin
1
100
What is the primary purpose of nitrous oxide in the surgical setting?
1. It allows the anesthesia provider to administer lower doses of other anesthetics.
2. It facilitates ventilation, perfusion, and diffusion while the client is intubated.
3. It produces neuromuscular blockade when combined with volatile gases.
4. It allows the anesthesia provider to initiate emergence immediately.
1
Nitrous oxide cannot produce general anesthesia by itself. However, its additive effect will permit a lower concentration or dose of the volatile or intravenous anesthetics. It does not promote gas exchange or neuromuscular blockade. Nitrous oxide does not directly make emergence more rapid.
100
When a new adult client arrives at a mental health clinic reporting feelings of depression, what condition(s) should be screened for before the client is prescribed antidepressants? Select all that apply.
1. thyroid disease
2. hormonal imbalance
3. cardiovascular disorders
4. Parkinson's disease
5. diabetes mellitus
1,2,3
Adults using these drugs should have physical causes for their depression ruled out before therapy is begun. Thyroid disease, hormonal imbalance, and cardiovascular disorders can all lead to the signs and symptoms of depression. There is no indication that Parkinson’s disease or diabetes is manifested by depression.
100
What is the antidote for warfarin? Heparin?
Warfarin= Vitamin K
Heparin= Protamine Sulfate
100
The client with a diagnosis of cancer is receiving epoetin alfa (Epogen, Procrit) as part of the treatment regimen. The nurse evaluates the effectiveness of this drug by?
monitoring the hematocrit and hemoglobin level. There is a Black Box Warning for use of epoetin alpha in clients with hemoglobin above 11 g/dL indicating that there is an increased risk of death in those clients.
200
The nurse is preparing to administer a dose of ergotamine to a client. After administration, what assessments should the nurse prioritize to assure safe care? Select all that apply.
1. heart rate
2. temperature
3. respiratory rate
4. blood pressure
5. oxygen saturation level
1,4
Following administration of ergotamine, the nurse assesses for cardiovascular adverse effects. Measurement of the pulse and blood pressure are essential and are consequently prioritized over other vital signs.
200
The nurse reviews the medical history for a client being prepared for a surgical procedure. From this information, which action would the nurse take?
1. Anticipate the use of nitrous oxide.
2. Expect a barbiturate anesthetic to be used.
3. Question the use of a volatile liquid anesthetic.
4. Teach the client on the types of local anesthetics.
3
Volatile liquid anesthetics are inhaled and have a rapid onset. However, they should be avoided in clients with respiratory problems. Also, all of the volatile liquid anesthetics have the potential to trigger malignant hyperthermia. Because the client developed malignant hyperthermia during a previous surgery, the use of volatile liquid anesthetics should be questioned. Nitrous oxide can cause acute sinus and middle-ear pain, bowel obstruction, and pneumothorax because it so rapidly moves into and accumulates in closed spaces. With the client’s partial bowel resection, the use of nitrous oxide would not be the most appropriate to use. A barbiturate anesthetic can cause respiratory depression. With the client being treated for asthma, this anesthetic would not be the most appropriate to use. Local anesthetics are used to reduce sensation in limited areas of the body. Because the type of surgery the client is having is not provided, this type of anesthesia would not be the most appropriate to use.
200
The nurse is caring for a client suspected of developing serotonin syndrome. What frequent assessments should the nurse include in the client’s plan of care? Select all that apply.
1. temperature
2. blood pressure
3. cardiac function
4. respiratory function
5. level of consciousness
1,2,5
Serotonin syndrome, a serious and sometimes fatal reaction characterized by hypertensive crisis, hyperpyrexia, extreme agitation progressing to delirium and coma, muscle rigidity, and seizures, may occur due to combined therapy with an drugs that potentiate serotonin neurotransmission. While worthy of assessment, neither cardiac nor respiratory functions are usually affected.
200
What would the nurse teach the client about the safe and effective use of nitroglycerin? Select all that apply.
1. “The tablet should fizzle or burn when placed under the tongue.”
2. “Protect the drug from heat and light.”
3. “Always replace when past the expiration date.”
4. “Older tablets may require you to use two tablets at one time.”
5. “Nitroglycerin does not lose its potency easily.”
1,2,3
Ask the client if the tablet “fizzles” or burns, which indicates potency. Always check the expiration date on the bottle and protect the medication from heat and light because these drugs are volatile and lose potency easily. The client would not take more than the prescribed amount of one tablet regardless of the date the medication was filled. Nitroglycerin can lose potency if not properly stored, and due to time.
200
The demonstration of what symptom would suggest that an insulin-dependent client is experiencing a hypoglycemic reaction? Select all that apply.
1. weakness
2. diaphoresis
3. mental confusion
4. increased pulse rate
5. decreased respiratory rate
6. decreased urinary output
1,2,3,4
Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in blood drops below normal. Symptoms of hypoglycemia include tachycardia, palpitations, nervousness, weakness, confusion, hunger, and sweating. A decrease in blood glucose activates the sympathetic nervous system to produce a stress response. The nurse also assesses for such central nervous system effects as mental confusion, incoherent speech, visual changes, convulsions, and coma.
300
The nurse is reviewing the discharge instructions with the client going home on an opioid for pain management. What would the nurse include in the instructions? Select all that apply.
1. Take a laxative/stool softener.
2. Avoid driving
3. Rise slowly from a sitting or lying position.
4. Eat frequent small meals
5. Limit fluid intake.
1,2,3,4
Constipation is an issue in clients receiving opioid analgesics, therefore taking a laxative/stool softener may be necessary, as well as increasing fluid intake and keeping a record of bowel movements. A drop in blood pressure (orthostatic hypotension) would require care in rising from a sitting or lying position. To minimize GI distress eat frequent, small meals. Avoid driving or other activities since reflex response time can be affected.
300
What should the nurse's pre-administration assessment for a client receiving a sedative or hypnotic include? (Select all that apply.)
1. Blood pressure
2. Pulse
3. Pulse ox
4. Respiratory rate
5. Temperature
1,2,4,5
The nurse's pre-administration assessment for a client receiving a sedative or hypnotic should include blood pressure, pulse, temperature, and respiratory rate.
300
A client who has been prescribed long-term lithium therapy reports taking the medication only erratically since starting a new job. What assessments should the nurse prioritize? Select all that apply.
1. manic behavior
2. mood swings
3. suicidal ideation
4. fine tremors
5. memory lapses
1,2
Subtherapeutic levels of lithium may result in worsening symptoms of bipolar disorder. Primarily, this involves mood swings and mania. Tremors and weakness are adverse effects of lithium therapy. Cognitive changes and suicidal ideation would not be expected.
300
During ongoing assessment of a client receiving an antihyperlipidemic drug, what should the nurse collect? (Select all that apply.)
1. Blood glucose
2. Vital signs
3. Assessment of bowel function
4. Input and output
5. Stool sample
2,3
Clients on antihyperlipidemic medications should have vital signs checked and bowel function assessed.
300
The nurse is providing care for several clients who have diabetes. Which client should the nurse monitor most closely for signs and symptoms of hypoglycemia?
1. a client who received 12 units of Humulin R 45 minutes ago
2. a client who received 12 units of metformin minutes ago
3. a client whose most recent blood glucose level was 150 mg/dL
4. a client whose type 2 diabetes was diagnosed one week ago
1
Administration of regular insulin will create a greater risk for hypoglycemia than metformin, which is used in the treatment of type 2 diabetes. A blood glucose level of 150 mg/dL is nominally elevated, and creates no particular risk for “rebound” hypoglycemia. Clients whose diabetes has been recently diagnosed must be monitored closely, but this does not mean that the client faces a particular risk for hypoglycemia.
400
An opioid antagonist will reverse which opioid effects? (Select all that apply.)
1. Respiratory depression
2. Constipation
3. Analgesia
4. Hypotension
5. Bradycardia
1,2,3,4,5
400
Which of the client’s statement(s) should the nurse attribute to benzodiazepine withdrawal syndrome? Select all that apply.
1. “I feel like my vision has been blurry the last few days.”
2. “I feel dizzy from time to time, even when I’m lying still.”
3. “I almost feel like I have a touch of the flu.”
4. “Sometimes I can feel my heart skip a beat.”
5. “I’ve completely lost my appetite the last little while.”
2,3
Abrupt cessation of benzodiazepines may lead to a withdrawal syndrome characterized by nausea, headache, vertigo (dizziness), malaise (flulike symptoms), and nightmares. The nurse would not categorize palpitations, anorexia, or visual disturbances as signs of benzodiazepine withdrawal.
400
A client is admitted with arrhythmias and placed on cardiac monitoring and prescribed an antiarrhythmic. Which finding on ongoing assessment should the nurse immediately notify the primary health care provider? Select all that apply.
1. Sudden change in mental state
2. A pulse rate of 100 bpm
3. Dry mouth and gums
4. Increased restlessness
1
The nurse should report to the health care provider any sudden change in mental status as a decrease in dosage may be necessary. A pulse rate above 120 bpm or below 60 bpm should be immediately reported to the health care provider. Dry mouth and gums is an expected adverse reaction for which the nurse should recommend the client take frequent sips of water or chew sugarless gum. Somnolence and not restlessness is a possible adverse reaction to antiarrhythmic drugs.
400
After teaching a group of students about nitrates, the instructor determines that the teaching was successful when the students identify what as a contraindication?
1. Cerebral hemorrhage
2. Hypotension
3. Liver dysfunction
4. Hypovolemia
1
Nitrates would be contraindicated in patients with cerebral hemorrhage because the relaxation of the cerebral vessels could cause intracranial bleeding. Nitrates should be used cautiously in patients with hypotension, which could be exacerbated by the drug. Nitrates should be used cautiously in patients with liver dysfunction, which could alter the drug's metabolism. Nitrates should be used cautiously in patients with hypovolemia, which could be exacerbated by the drug therapy.
400
The client receives a prescription for a lipid-lowering medication from the primary health care provider. The nurse knows additional lifestyle modifications would enhance the management of the client’s lipid levels. What recommendations should the nurse make? Select all that apply.
1. quitting smoking
2. exercising regularly
3. following a low-sodium diet
4. reducing stress
5. abstaining from alcohol
6. increasing fluid intake
1,2,4
500
What examples of common adverse effects shoould the nurse discuss with a client prescribed an opioid? Select all that apply.
1. respiratory depression
2. suppressed cough reflex
3. confusion
4. constipation
5. miosis
respiratory depression
suppressed cough reflex
confusion
constipation
miosis
500
The nurse evaluates teaching as effective when a client taking a benzodiazepine makes what statement(s)? Select all that apply.
1. “I should notice a lessening of my anxiety.”
2.“I could fall so I must be careful when I take the medication."
3. “I should empty my bladder before taking this medication.”
4. “I should avoid smoking for the duration of treatment.”
5. “I’ll arrange for my daughter to do all my shopping so I don’t risk catching a cold while I’m out.”
1,2,3
The sedative properties of the medication increase the risk of falling. Voiding before taking the medication will help minimize the risk of falls. This classification of medications should decrease anxiety. While smoking is generally discouraged, it has no particular relevance to this mediation therapy. Benzodiazepines are not generally associated with negatively affecting the immune system.
500
Before the administration of any anti-arrhythmic, what should the nurse's pre-assessment of the client's general condition include? (Select all that apply.)
1. Skin color
2. Blood glucose
3. Input and output
4. Orientation
5. Level of consciousness
1,4,5
The pre-administration assessment of the client's general condition should include observations such as skin color, orientation, level of consciousness, and the client's general status.
500
The nurse instructs a client with a deep vein thrombosis (DVT) taking a prescribed anticoagulant on actions to prevent bleeding. Which client statement(s) indicates to the nurse that teaching was effective? Select all that apply.
1. “I will use an electric razor to shave.”
2. “My hard-bristled toothbrush is safe to use.”
3. “Bowling will be a safer activity than pick-up football with my friends.”
4. “I ordered a medical alert medal to be worn on a chain around my neck.”
5. “I won’t use over-the-counter medications until I check with my provider.”
1,3,4,5
Clients prescribed anticoagulants need to be instructed on safety measure to prevent bleeding. Using an electric razor instead of a straight razor prevents accidental injuries when shaving. Because contact sports should be avoided, bowling would be a safer activity. Wearing medical alert identification is recommended in case of an emergency. Over-the-counter medications should be avoided until reviewed with the health care provider. A soft-bristled toothbrush should be used to protect the gums and prevent bleeding.
500
What nursing intervention should the nurse implement for a client diagnosed with diabetes insipidus? Select all that apply.
1. strict monitoring of fluid intake and urine output
2. test urine for presence of glucose
3. monitor blood glucose levels
4. monitor client for signs of dehydration
5. provide client with liquids to satisfy reported thirst
1,2,3,4
Diabetes insipidus is characterized by the production of a large amount of dilute urine containing no glucose. Blood becomes concentrated and blood glucose levels are higher than normal, and the patient presents with polyuria (lots of urine), polydipsia (lots of thirst), and dehydration. With this rare metabolic disorder, patients produce large quantities of dilute urine and are constantly thirsty. Water intoxication must be avoided with careful monitoring of the client's fluid intake.
600
A client is prescribed propranolol. The nurse would withhold the drug and notify the primary health care provider if the assessment revealed which findings. Select all that apply.
1. pulse rate of 52 bpm
2. irregular heart rhythm
3. systolic blood pressure 110 mm Hg
4. client reports lightheadedness
5. client reports dry mouth
1,2
The nurse would withhold the dose of the drug and notify the primary health care provider if the pulse rate is below 60 bpm, the heart rate or rhythm is irregular, or the systolic blood pressure is less than 100 mm Hg. Lightheadedness and dry mouth are common adverse reactions that should be reported but do not require the drug to be withheld.
600
The nurse should question an order for benzodiazepine for which clients? Select all that apply.
1. A client with schizophrenia who is experiencing a psychotic episode
2. A client with acute narrow-angle glaucoma
3. A client who is intoxicated with alcohol
4. A client who takes a sustained serotonin reuptake inhibitor for depression
5. A client who has peptic ulcer disease
1,2,3
Benzodiazepines would be contraindicated in clients with psychosis , acute narrow-angle glaucoma and acute alcohol intoxication. There is no contraindication for clients with depression or peptic ulcer disease.
600
Which physiological conditions are common triggers for the development of cardiac arrhythmias? Select all that apply.
1. Respiratory distress
2. Potassium imbalance
3. Decreased blood volume
4. Metabolic acidosis
5. Faulty sinoatrial (SA) node
1,2,4,5
Electrolyte disturbances, decreases in the oxygen delivered to the cells, structural damage in the conduction pathway, drug effects, acidosis, or the accumulation of waste products can trigger arrhythmias. A decrease in blood volume results in hypotension and ultimate cardiac arrest.
600
Prior to administering an anti-anginal drug, what should the nurse assess the client for? Select all that apply.
1. Pain
2. Physical appearance
3. Lung function
4. Heart function
5. Vital signs
1,2,3,4,5
Client pre-assessment for anti-anginal drugs should include a thorough pain assessment, history of medication allergies and disease processes, assessment of physical appearance, auscultating the lungs for adventitious sounds, a cardiac evaluation to establish a baseline electrocardiogram, and obtaining vital signs.
600
A client has been prescribed a growth hormone antagonist. The nurse should educate the client to the importance of which regularly scheduled diagnostic lab test? Select all that apply.
1. thyroid function
2. glucose tolerance
3. complete blood count (CBC)
4. growth hormone levels
5. serum sodium levels
1,2,4
Monitor thyroid function, glucose tolerance, and GH levels periodically to detect problems and to institute treatment as needed. Neither CBC or sodium levels are routinely monitored while on a growth hormone antagonist.