Respiratory
A patient with asthma is scheduled to start taking a glucocorticoid medication with a metered-dose inhaler (MDI). The nurse should give the patient which instruction about correct use of the inhaler?
A. “After you inhale the medication once, repeat until you obtain symptomatic relief.”
B. “Wait no longer than 30 seconds after the first puff before taking the second one.”
C. “Use a spacer with the inhaler and rinse your mouth after each dose administration.”
D. “Breathe in through the nose and hold for 2 seconds just before activating the inhaler.”
C.
Spacers are available for use with MDIs to prevent the patient from swallowing the dose and to allow for maximum delivery of medication to the lungs. Rinsing the mouth after administration is important for inhaled glucocorticoids to prevent candidiasis. Glucocorticoid inhalers are used for long-term prophylaxis of asthma, not for symptomatic relief. When two puffs are needed, an interval of at least 1 minute should separate the first puff from the second. Inhaling through the mouth just before activating the MDI is the proper technique.
The nurse plans to closely monitor for which clinical manifestation after administering furosemide [Lasix]?
A. Decreased pulse
B. Decreased temperature
C. Decreased blood pressure
D. Decreased respiratory rate
C. Decreased blood pressure
High-ceiling loop diuretics, such as furosemide, are the most effective diuretic agents. They produce more loss of fluid and electrolytes than any others. A sudden loss of fluid can result in decreased blood pressure. When blood pressure drops, the pulse probably will increase rather than decrease. Lasix should not affect respiration or temperature. The nurse should also closely monitor the patient’s potassium level.
Which organ regulates the body’s iron stores?
A. Intestines
B. Kidneys
C. Liver
D. Bloodstream
A.
Most of the iron absorbed in the body stays in place and there is not a great deal of iron turnover. Some is lost through the gastrointestinal (GI) tract, and much more can be lost through hemorrhage. The body prevents excessive buildup of iron by controlling the amount of uptake in the intestines. When stores are high, only about 2% to 3% of dietary iron is absorbed. Conversely, when iron levels are low, as much as 20% is absorbed.
The nurse identifies which symptom as a result of activation of histamine1 (H1) by allergic reaction?
A. Hypertension
B. Bronchoconstriction
C. Sweating
D.Pupillary dilation
B. Bronchoconstriction
Activation of H1 receptors in an allergic reaction causes bronchoconstriction. Vasodilation of small blood vessels and increased capillary permeability cause loss of fluid, which, if extensive, results in severe hypotension. Histamine has no effect on pupil reaction, nor does it cause sweating.
Which symptom is the most indicative of muscarinic poisoning?
A. Constipation
B. Heart rate of 140 beats/min
C. Blood pressure of 180/110 mm Hg
D. Blurred vision
D
Muscarinic poisoning can result from overdose of muscarinic agonists or cholinesterase inhibitors or from ingestion of certain mushrooms. The symptoms include profuse salivation, lacrimation, visual disturbances, bronchospasm, diarrhea, bradycardia, and hypotension.
Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which of these times?
A. Whenever needed (PRN) as a quick-relief agent
B. Twice daily combined with an inhaled glucocorticoid
C. Only with a long-acting beta2 agonist (LABA)
D. If nighttime awakenings occur more than 2 days a week
A.
For patients at step 1 in the stepwise approach to managing asthma, albuterol is a short-acting beta2 agonist (SABA) used only PRN to relieve ongoing asthma attacks and prevent exercise-induced bronchospasm. For patients at step 1, no long-term control medications are taken. A patient is at a higher step than 1 in the stepwise approach if the patient requires a daily inhaled glucocorticoid or LABA or awakens at night more often than 2 days a week. For patients at steps 2 to 6, albuterol is considered a quick-relief medication taken PRN.
The nurse is reviewing the home medication list with the patient. The nurse recognizes that hydrochlorothiazide is used primarily for which condition?
A. Hypertension
B. Edema
C. Diabetes insipidus
D. Protection against postmenopausal osteoporosis
A.
The primary indication for hydrochlorothiazide is hypertension, a condition for which thiazides are often the drugs of first choice. Hydrochlorothiazides are used for other conditions, but the primary indication is hypertension.
The nurse is teaching a group of patients about dietary approaches to reduce cholesterol levels. Which statement is most important to include in the teaching?
A. “Lower your cholesterol to 300 mg/day.”
B. “Eliminate red meat and pork from your diet.”
C. “Read food labels and reduce your intake of saturated fats.”
D. “Reduce salt consumption to keep your sodium intake to 2400 mg/day.”
C.
An increase in dietary cholesterol intake does not produce a large increase in blood cholesterol because of the body’s feedback system. When cholesterol intake increases, endogenous production decreases. However, because the body uses dietary saturated fats to make cholesterol, an increase in saturated fat intake can produce a significant increase in blood cholesterol levels. To lower blood cholesterol, it is most important to lower saturated fat intake. Although red meat and pork should be limited, it is not necessary to eliminate them from the diet. Sodium intake is not directly related to lowering cholesterol levels.
A patient develops hypotension, laryngeal edema, and bronchospasm after eating peanuts. Which medication should the nurse prepare to administer?
A. Promethazine [Phenergan]
B. Epinephrine
C. Diphenhydramine [Benadryl]
D. Hydroxyzine [Vistaril]
B. Epinephrine
The patient is showing signs of anaphylaxis caused by a peanut allergy. Histamine1 activation plays a minor role in anaphylaxis; other substances are the principal mediators. Therefore, the drug of choice for anaphylaxis is epinephrine. The antihistamines promethazine, diphenhydramine, and hydroxyzine are effective only for symptoms of mild allergy; they may be used as adjuncts in the treatment of anaphylaxis, but they will have only limited benefit.
he nurse is teaching a patient with a history of anaphylaxis how to use an EpiPen. Which statement made by the patient indicates that he understands the proper use of this drug?
A. “I will keep my medication in the refrigerator when I’m not using it.”
B. “I should take this medication within 30 minutes of the onset of symptoms.”
C. “I must remove my pants before injecting the medication into the leg.”
D. “I will jab this medication firmly into my outer thigh if needed.”
D
The EpiPen should be stored in a cool, dark place, but refrigeration can damage the injection mechanism. The medication should be taken at the first sign of symptoms. Anaphylaxis can develop within minutes after allergen exposure. To use the EpiPen, the patient should form a fist around the unit with the black tip pointing down, remove the activation cap, jab the device firmly into the outer thigh, wait 10 seconds, remove the unit, and massage the area for 10 seconds. The medication can be given directly through clothing if necessary.
Which instruction should be included in the teaching for a patient for whom fluticasone propionate [Flovent] MDI has been ordered?
A. “Take the medication immediately at the onset of an attack.”
B. “Take your albuterol first, followed by the Flovent 5 minutes later.”
C. “Make sure you monitor your fingerstick blood glucose level each morning.”
D. Gargle after using your inhaler.”
D.
Patients should be taught to gargle after using inhaled glucocorticoids, such as fluticasone propionate, to minimize dysphonia and oropharyngeal candidiasis. The medication is not used to abort an acute attack. Short-acting bronchodilators, such as albuterol, should be administered 5 minutes before inhaled glucocorticoids to enhance delivery to the bronchial tree. Oral glucocorticoids pose a risk of hyperglycemia.
The nurse knows that diuretics mostly affect which function of the kidneys?
A. Cleansing and maintenance of extracellular fluid volume
B. Maintenance of acid-base balance
C. Excretion of metabolic waste
D. Elimination of foreign substances
A.
Most diuretics block sodium and chloride reabsorption, thus affecting the maintenance of extracellular fluid volume.
The nurse is caring for a patient with anemia. What is a common cause of iron deficiency in the United States?
A. Decreased intestinal uptake of iron
B. Chronic blood loss through the GI tract
C. Vegetarian eating patterns
D. Rapid growth during adolescence
B
The most common causes of anemia in the United States are changes in blood volume during pregnancy, infancy, and early childhood and chronic blood loss (usually of GI or uterine origin). In rare cases, decreased iron uptake is a cause of anemia.
Which statement by a patient indicates understanding of a nurse’s teaching about fluticasone nasal spray [Flonase]?
A. “I’ll gradually stop taking this so I don’t have any problems with withdrawal.”
B. “I’ll have to be more careful about not falling, because my bones may break more easily.”
C. “I realize that I only need to take this when my symptoms are really bad.”
D. “This drug will help prevent the inflammation and irritation from my allergies.”
D. “This drug will help prevent the inflammation and irritation from my allergies.”
Fluticasone nasal spray is a steroid drug used to prevent the symptoms of allergy. Its effect is localized; therefore, the patient does not have systemic adverse effects with normal use and does not have to wean down the medication, as with oral corticosteroids. Intranasal glucocorticoids are most effective for preventing and treating allergic rhinitis.
The nurse in the cardiac care unit is caring for a patient receiving epinephrine. Which assessment criterion takes priority in the monitoring for adverse effects of this drug?
A. Cardiac rhythm
B. Blood urea nitrogen
C. Central nervous system (CNS) tremor
D.Lung sounds
A.
Epinephrine can cause a number of adverse effects, including hypertensive crisis, dysrhythmias, angina, necrosis after extravasation, and hyperglycemia. Monitoring of the heart rhythm is essential to assess the patient for dysrhythmias.
Which statements will the nurse include when teaching a patient about isoniazid therapy for the treatment of tuberculosis? (Select all that apply.)
A.Take the isoniazid on an empty stomach.”
B. “Notify your healthcare provider if your skin starts to turn yellow.”
C. “Numbness or tingling in your extremities is a normal response when taking this drug.”
D. “Your urine will turn reddish orange because of the effects of this drug.”
E. “Use of this drug is associated with vision problems.”
A,B
Numbness and tingling in the extremities is associated with the development of peripheral neuropathy and should be reported to the healthcare provider. Rifampin, not isoniazid, causes discoloration of body fluids. Ethambutol, not isoniazid, is associated with optic neuritis. The other two statements are true and can be included in patient teaching.
The nurse is teaching a patient prescribed captopril [Capoten] for the treatment of hypertension. Which instructions should the nurse include? (Select all that apply.)
A. Take the medication with food.
B.Expect a sore throat and fever.
C. Avoid potassium salt substitutes.
D. A persistent dry cough may occur.
E. Report difficulty in breathing immediately.
C,D,E
Salt substitutes contain potassium and may increase the risk of hyperkalemia with ACE inhibitors. A persistent, dry, nonproductive cough may develop. Angioedema includes edema of the tongue, glottis, and pharynx that may cause difficulty breathing which requires immediate medical attention. Captopril [Capoten] must be taken at least one hour before meals. A sore throat and fever are not expected adverse effects. ACE inhibitors can lower white cell count and decrease the body’s ability to fight an infection. Early signs of infection include fever and sore throat.
Which are beneficial effects that can be derived from simvastatin [Zocor] and other drugs in this class? (Select all that apply.)
A. Reduction of LDLs
B. Elevation of HDLs
C. Stabilization of the plaque in coronary arteries
D.Reduction of risk of cardiovascular events
E.Improvement of liver function
A,B,C,D
The statin drugs have many benefits, the most important being reduction of LDLs. They also promote an increase in HDLs, stabilization of atherosclerotic plaque, and reduced inflammation at the plaque site. Among other benefits, they also slow progression of coronary artery calcification. The statins reduce the overall risk of cardiovascular events. They can have serious adverse effects on the liver, but these are relatively rare.
A patient has received a toxic dose of an antihistamine. It is most important for the nurse to assess the patient for what?
A. Seizure activity
B. Tinnitus
C. Lethargy
D. Visual disturbances
A. Seizure activity
Toxicity associated with antihistamines can produce CNS stimulation, and seizures may result. Tinnitus, lethargy, and visual disturbances are not associated with increased doses of antihistamines.
The nurse is teaching the patient about atenolol [Tenormin]. Which statement by the patient indicates a correct understanding of the nurse’s instruction?
A.“I will need to wait for 6 months and then stop this medication.”
B. “One missed dose will not affect my blood pressure.”
C. “I may experience occasional chest pain and discomfort.”
D. “I will not stop taking this drug without the approval of my healthcare provider.”
D.
Atenolol is a beta blocker and can cause rebound cardiac excitation if withdrawn abruptly. To decrease the risk of rebound excitation the dose should be tapered over 1 or 2 weeks. Patients should carry an adequate supply when traveling.
Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? (Select all that apply.)
A.More of the drug is delivered to the lungs and less to the oropharynx. Correct
B. Use of a spacer is not necessary.
C. Less propellant is needed to deliver the medication.
D. Less hand-lung coordination is required.
E. DPIs pose no environmental risk.
B,D,E
DPIs deliver more drug to the lungs (20% of the total released, compared to 10% for MDIs). Spacers are not necessary with DPIs; they are recommended for use with MDIs to increase the delivery of drug to the lungs rather than the oropharyngeal mucosa. DPIs do not require the hand-lung coordination needed with MDIs. DPIs present no environmental hazard, because no propellant is required for delivery.
A nurse assesses the history of a patient who has had multiple complicated UTIs for which risk factors? (Select all that apply.)
A. Female gender, child-bearing age
B. Indwelling catheter
C. Prostate hypertrophy
D. Fair skin tone
E. Urinary tract stones
B,C,E
Complicated UTIs occur in males and females and usually are associated with some predisposing factor, such as calculi, prostatic hypertrophy, or catheters. Uncomplicated UTIs occur primarily in women of child-bearing age and are not associated with any specific predisposing factor. Fair skin tone is unrelated to UTI occurrence.
The nurse should review which baseline data before starting epoetin alfa [Epogen] therapy in a patient with chronic renal failure (CRF)? (Select all that apply.)
A. Ferritin level
B. Temperature trends
C. Blood glucose level
D. Blood pressure trends
E. Hemoglobin and hematocrit
A,D,E
Baseline data that should be collected and evaluated before initiation of epoetin alfa [Epogen] include blood pressure, blood chemistry (blood urea nitrogen [BUN], uric acid, creatinine, phosphorous, potassium), degree of transferrin saturation, ferritin concentration, and hemoglobin and hematocrit. The ferritin concentration should be at least 100 ng/mL for epoetin alfa therapy to be effective. In patients with CRF, epoetin alfa is associated with a rise in blood pressure. Knowledge of baseline blood pressures is essential to determine whether changes are occurring. Baseline hemoglobin/hematocrit levels serve as a measure of comparison for determining the effectiveness of therapy. It is not essential to know the temperature trends or blood glucose level before starting therapy.
A nurse should teach a patient receiving oral pseudoephedrine [Sudafed] to observe for which adverse effects? (Select all that apply.)
A. Sedation
B. Irritability
C. Paranoia
D. Anxiety
E. Weight loss
B. Irritability, D. Anxiety
Oral pseudoephedrine activates alpha1 receptors on nasal and systemic blood vessels, causing vasoconstriction and central nervous system (CNS) excitation. This results in restlessness, irritability, anxiety, and insomnia. Sedation, paranoia, and weight loss are not adverse effects associated with pseudoephedrine.
Which statements about the anticholinergic drug scopolamine are true? (Select all that apply.)
A. A side effect is sedation.
B. It is used for motion sickness.
C. A side effect is nausea and vomiting.
D. It is used for preanesthetic sedation.
E. It causes CNS excitation.
A,B,D
Scopolamine is an anticholinergic drug with actions much like those of atropine, but with two exceptions. First, whereas therapeutic doses of atropine produce mild CNS excitation, therapeutic doses of scopolamine produce sedation. And second, scopolamine suppresses emesis and motion sickness, whereas atropine does not. Principal uses for scopolamine include motion sickness and production of preanesthetic sedation.