Cardiovascular
Intravenous heparin therapy is prescribed for a client. While implementing this prescription, a nurse ensures while implementing this prescription, that which of the following medications is available on the nursing unit?
a. Protamine sulfate
b. Potassium chloride
c. Aminocaproic acid (amicar)
d. Vitamin K
a. Protamine Sulfate
Rationale: The antidote to heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrahge should occur. Vitamin K is an antidote for warfarin sodium. Amniocaproic acid is the antidote for thrombolytic therapy. Potassium chloride is administered for a potassium diet.
What is the antidote to opioid analgesics such as morphine?
a. Naproxen
b. Naloxone
c. Non opioid analgesics
d. Neomycin
Naloxone (Narcan)
antidote for opioid overdose
1) The client with Type 1 diabetes mellitus is taught to take the isophane insulin suspension NPH (Humulin N) at 5 pm each day. The client should be instructed that the GREATEST risk of hypoglycemia will occur at about what time?
a. 11 am shortly before lunch
b. 1 pm, shortly after lunch
c. 6 pm, shortly after dinner
d. 1 am, while sleeping
d. 1am, while sleeping
Rationale: NPH insulin/Humulin N is an intermediate insulin which peaks in 6-8 hours. Therefore, the client is at greatest risk at 1 am while sleeping. In order to help prevent this hypoglycemic episode, the client should eat a bedtime snack.
A client with allergic rhinitis is instructed on the correct technique for using an intranasal inhaler. Which of the following statements would demonstrate to the nurse that the client understands the instructions?
A. "I should limit the use of the inhaler to early morning and bedtime use"
B."It is important to not shake the canister because that can damage the spray device."
C. "I should hold one nostril closed while I insert the spray into the other nostril"
D. "The inhaler tip is inserted into the nostril and pointed towards the inside nostril wall."
C. "I should hold one nostril closed while I insert the spray into the other nostril"
Rationale: When using an intranasal inhaler, it is important to close off one nostril while inhaling to ensure the best inhalation of the spray. Use of the inhaler is not limited to mornings and bedtime. The canister should be shaken immiediately before use. The inhaler tip should be inserted into the nostril and pointed toward the outside nostril wall to maximize inhalation of the medication.
A client with diverticular disease is receiving psyllium hydrophillic mucilloid (Metamucil). The drug has been effective when the client tells the nurse that he:
A. Passes stool without cramping
B. No longer has diarrhea
C. Is not as anxious as he once was
D. Does not expel gas like he used to
A. Passes stool without cramping
Rationale: Diverticular disease is treated with a high fiber diet and bulk laxatives such as Metamucil. Bulk laxatives and fiber decrease the intraluminal pressure and make it easier for stool to pass through the colon.
A client with atrial fibrilation is receiving a continuous heparin infusion at 1000 units/hr. The nurse would determine that the client is receiving a therapeutic effect based on which of the following results?
a. Prothrombin time of 12.5 sec
b. activated partial thromboplastin time of 60 seconds
c. activated partial thromboplastin time of 28 seconds
d. activated partial thrombin time longer than 120 seconds
d. Activated partial thrombin time longer than 120 seconds (Normal aPTT is about 30-40 seconds)
Rationale: PT is used to assess response to warfarin (Coumadin) therapy. Normal activated partial thromboplastin time (aPTT) should be 1.5-2.5 times normal value.
You have just received tragic news about a family member, and are experiencing anxiety. Which medication, would the nurse expect an order for?
a. Keppra
b. Klonopin
c. Keflex
d. Ketorolac Tromethamine
B. Klonopin
This is a benzo
Metformin is prescribed for a client with type 2 diabetes mellitus. What is the most common side effect that the nurse should include in the client’s teaching plan?
A. Weight gain
B. Hypoglycemia
C. Flushing and palpitations
D. Gastrointestinal disturbances
D. Gastrointestinal disturbances
A nurse is teaching a client about taking antihistamines. Which of the following instructions should the nurse include in the teaching plan? Select all that apply.
A. Operating machinery and driving may be dangerous when taking antihistamines.
B. Continue taking antihistamines even if nasal infection develops.
C. The effect of antihistamines is not felt until a day later.
D. Do not use alcohol with antihistamines
E. Increase fluid intake to 2,000ml/day
A,D,E.
Rationale: Antihistamines have an anticholinergic action and a drying effect. They reduce nasal, salivary, and lacrimal gland hypersecretions (runny nose, tearing, and itchy eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during use. The client should ensure adequate fluid intake of atleast 8 glasses per day due to the drying effect of this drug.
A client with peptic ulcer disease is taking ranitidine (Zantac). What is the expected outcome of this drug?
A. Heal the ulcer
B. Protect the ulcer surface from acids
C. Reduce acid concentration
D. Limit gastric acid secretion
D. Limit gastric acid secretion
Rationale: Ranitidine is a Histamine-2 receptor antagonist, meaning that is reduces gastric acid secretion. Anti-secretory or proton-pump inhibitors such as Prilosec, help ulcers heal quickly in 4-8 weeks. Cytoprotective drugs such as Carafate protect the ulcer surface against acid, bile and pepsin. Antacids are responsible for reducing acid concentration and helping to reduce symptoms.
3) Which of the following comments indicates that a client understands the nurse’s teaching about sertraline (Zoloft)?
a. “Zoloft will probably cause me to gain weight”
b. “This medication can cause delayed ejaculations”
c. “Dry mouth is a permanent side effect of Zoloft”
d. “I can take my medicine with St. John’s wort”
b. “This medication can cause delayed ejaculations”
Rationale: Sertraline is an SSRI which can cause decreased libido and sexual dysfunction. SSRI’s do not cause weight gain, but can cause decreased appetite and weight loss. Dry mouth is a possible side effect, but is temporary. St. John’s wort should not be taken with SSRI's because it can cause serotonin syndrome.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which findings support this diagnosis? Select all that apply.
A. Increase in pH
B. Comatose state
C. Deep, rapid breathing
D. Decreased urine output
E. Elevated blood glucose level
Answers: B, C, E.
Rationale: Because of the profound deficiency of insulin associated with DKA, glucose cannot be used for energy, and the body breaks down fat as a secondary source of energy. Ketones, which are acid byproducts of fat metabolism, build up, and the client experiences a metabolic ketoacidosis. High serum glucose contributes to an osmotic diuresis, and the client becomes severely dehydrated. If untreated, the client will become comatose due to severe dehydration, acidosis, and electrolyte imbalance. Kussmaul’s respirations, the deep rapid breathing associated with DKA, is a compensatory mechanism by the body. The body attempts to correct the acidotic state by blowing off carbon dioxide (CO2), which is an acid. In the absence of insulin, the client will experience severe hyperglycemia. Option A is incorrect because, in acidosis, the pH would be low. Option D is incorrect because a high serum glucose will result in an osmotic diuresis and the client will experience polyuria.
The nurse should include which of the following instructions when developing a teaching plan for a client who is receiving Isoniazid (INH) and Rifampin (Rifamate) for treatment of tuberculosis?
A. Take the medication with antacids
B. Double the dosage if a drug dose is missed
C. Increase intake of dairy products
D. Limit alcohol intake
D. Limit alcohol intake
Rationale: INH and Rifamate are hepatotoxic drugs. The client should be warned to limit the intake of alcohol during drug therapy. These drugs should be taken on an empty stomach. If antacids are needed for GI distress, they should be taken 1 hour before or 2 hours after drug administration. The client should not double the dose due to potential toxicity. Clients taking these drugs should avoid foods rich in tyramine, such as cheese and dairy products, to avoid development of hypertension.
Ms. Creasy, a 62 y.o. female patient underwent a colostomy for ruptured diverticulum. She did well during the surgery and returned to your med-surg floor in stable condition. You assess her colostomy 2 days after surgery. Which finding do you report to the doctor?
A. Blanched stoma
B. Edematous stoma
C. Reddish-pink stoma
D. Brownish-black stoma
D.
rationale:
A brownish-black color indicates lack of blood flow, and maybe necrosis
4) The client with acute mania is prescribed 600 mg of lithium (lithium carbonate) PO TID. The physician also orders 5 mg of haloperidol (Haldol) PO at bedtime. Which action should the nurse take?
a. administer the medication as ordered
b. question the physician about the order
c. Administer the haldol, but not the lithium
d. Consult with the nursing supervisor before administering the medication
a. administer the medication as ordered
Rationale: Administer the medication as ordered. Lithium has lag time response of 1-2 weeks. Haldol is prescribed temporarily to produce a neuroleptic effect until the Lithium starts to produce a clinical response. Haldol is usually discontinued when the Lithium starts to take effect
The client with Addison’s disease is taking glucocorticoids at home. Which of the following statements indicates that the client understands how to take the medication?
a. “Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage”.
b. “My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day.”
c. “Glucocorticoids are cumulative, so I will take a dose every third day”
d. “I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids”
a. “Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage”
Rationale: The need for glucocorticoids changes with circumstances. The basal dose given is determined at discharge, but the dose covers only normal daily needs and does not include additional stressors. The client needs to be the manager of the medication schedule and have the knowledge of the signs and symptoms of excessive and insufficient dosages. Needs for glucocorticoids fluctuate and the client must be able to manage according to their needs.
A client is prescribed metaproterenol (Alupent) via a metered-dose inhaler, two puffs every 4 hours. The nurse instructs the client to report adverse effects. Which of the following are potential adverse effects of metaproterenol?
A. Irregular heartbeat
B. Constipation
C. Pedal edema
D. Decreased pulse rate
A. Irregular heartbeat
Rationale: Irregular heartbeats should be reported promptly to the PCP. Metaproterenol (Alupent) may cause irregular heartbeat, tachycardia, or anginal pain because it has an adrenergic effect on beta-adrengergic receptors in the heart. This adverse effect should be immediately reported to a provider. This medication is not recommended for use in clients with known cardiac disorders. Metaproterenol does not cause constipation, pedal edema, or bradycardia.
The nurse is reviewing the medication record of a female client with acute gastritis. Which medication, if noted on the client’s record, would the nurse question?
A. Digoxin
B. Furosemide
C. Indomethacin
D. Propranolol hydrochloride
C.
rationale:
Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug and can cause ulceration of the esophagus, stomach, or small intestine. Indomethacin is contraindicated in a client with gastrointestinal disorders. Furosemide (Lasix) is a loop diuretic. Digoxin is a cardiac medication. Propranolol (Inderal) is a β-adrenergic blocker. Furosemide, digoxin, and propranolol are not contraindicated in clients with gastric disorders.
5) A young adult client diagnosed with bipolar disorder has been managing the disorder effectively with medication and treatment for several years. The client suddenly becomes manic. The nurse reviews the client’s medication record. Which of the following medications may have contributed to the development of his manic state?
a. Elavil (amitriptyline) 50 mg PO daily at bedtime
b. Prednisone 20 mg PO daily
c. BuSpar (buspirone) 5 mg PO TID
d. Neurotonin (gabapentin)- 300 mg PO TID
b. Prednisone.
Rationale: The use of steroids can initiate a manic state in a bipolar client even if well controlled on medications. The other medications would decrease the client's depression, mood swings, and anxiety, making him calmer rather than more agitated.
The nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 120 mg/dL (6.8 mmol/L), a temperature of 101 °F (38.3 °C), a pulse of 102 beats/minute, respirations of 22 breaths/minute, and blood pressure of 142/72 mm Hg. Which finding would be the priority concern to the nurse?
A. Pulse
B. Respiration
C. Temperature
D. Blood pressure
C. Temperature
Rationale: In the client with type 2 diabetes mellitus, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. The other findings are within normal limits.
The nurse administers theophylline (Theo-Dur) to a client. To evaluate the effectiveness of this medication, which of the following drug actions should the nurse anticipate?
A. Suppression of the client's respiratory infection
B. Decrease in bronchial secretions
C. Relaxation of bronchial smooth muscle
D. Thinning of tenacious, purulent sputum
C. Relaxation of bronchial smooth muscle.
Rationale: Theophylline (Theo-Dur) is a bronchodilator that is administered to relax the airways and decrease dyspnea in patients with COPD. It is not used to treat infections and does not have an effect on secretions.
Bethanechol (Urecholine) has been ordered for a client with gastroesophageal reflux disease (GERD). The nurse should assess the client for which of the following adverse effects.
A. Constipation
B. Urinary urgency
C. Hypertension
D. Dry oral mucosa
B. Urinary urgency
Rationale: Bethanecol (Urecholine), a cholinergic drug, may be used in GERD to increase lower esophageal sphincter pressure and facilitate gastric emptying. Cholinergic adverse effects may include urinary urgency, diarrhea, abdominal cramping, hypotension, and increased salivation.