Pharmacology
A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
1) Check the client's vital signs
2) Request a dietitian consult.
3) Suggest that the client rests before eating the meal.
4) Request an order for an antiemetic.
1) Check the client's vital signs.
Answer Rationale:
It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bp
A nurse on a medical-surgical unit is caring for a client who reports pain in the jaw, back, and shoulder, and shortness of breath and nausea. Which of the following actions should the nurse take?
1) Obtain an EKG.
2) Administer enteric-coated acetaminophen.
3) Administer ibuprofen.
4) Maintain oxygen saturations greater than or equal to 92%.
1) Obtain an EKG.
Answer Rationale:
The nurse should obtain an EKG to detect heart rhythm abnormalities within 10 min of the client’s reported discomfort.
A nurse is caring for a client who has hypovolemic shock. Which of the following should the nurse recognize as an expected finding?
1) Hypertension
2) Flushing of the skin
3) Oliguria
4) Bradypnea
3) Oliguria
Answer Rationale:
Oliguria is present in hypovolemic shock as a result of decreased blood flow to the kidneys
A nurse is teaching a client who has septic shock about the development of disseminated intravascular coagulation (DIC). Which of the following statements should the nurse make?
1) "DIC is controllable with lifelong heparin usage."
2) "DIC is characterized by an elevated platelet count."
3) "DIC is caused by abnormal coagulation involving fibrinogen."
4) "DIC is a genetic disorder involving a vitamin K deficiency."
3) "DIC is caused by abnormal coagulation involving fibrinogen."
Answer Rationale:
DIC is caused by abnormal coagulation involving the formation of multiple small clots that consume clotting factors and fibrinogen faster than the body can produce them, increasing the risk for hemorrhage.
A nurse is caring for an 8-year-old child who has acute rheumatic fever. Which of the following assessments is the nurse's priority immediately after admission?
1. Auscultating the rate and characteristics of the child's heart sounds
2) Using a pain-rating tool to determine the severity of the joint pain
3) Identifying the degree of parental anxiety related to the diagnosis
4) Assessing the client's erythematous rash
1) Auscultating the rate and characteristics of the child's heart sounds
Answer Rationale:
Using the airway, breathing, circulation approach to client care, the nurse should place priority on auscultating the client's heart rate and heart sounds. Rheumatic fever is an inflammatory disease that begins with a strep throat from a streptococcal infection and can progress to rheumatic heart disease, which is a condition in which the heart valves are damaged by rheumatic fever. Auscultating heart sounds is the priority assessment because tachycardia and cardiac murmur indicate cardiac involvement, which can result in serious, life-threatening, and life-long complications
A nurse is caring for a client who is prescribed warfarin therapy for an artificial heart valve. Which of the following laboratory values should the nurse monitor for a therapeutic effect of warfarin?
1) Hemoglobin (Hgb)
2) Prothrombin time (PT)
3) Bleeding time
4) Activated partial thromboplastin time (aPTT)
2) Prothrombin time (PT)
Answer Rationale:
This test is used to monitor warfarin therapy. For a client receiving full anticoagulant therapy, the PT should typically be approximately two to three times the normal value, depending on the indication for therapeutic anticoagulation.
A nurse in the emergency department is caring for a client who is experiencing manifestations of a myocardial infarction (MI). Which of the following laboratory tests should the nurse expect the provider to prescribe?
1) Troponin
2) Creatinine kinase (CK)
3) Brain natriuretic peptide (BNP)
4) C-reactive protein
1) Troponin
Answer Rationale:
Troponin is released by the myocardial muscle when injury occurs. Troponin is not present in the body at any other time, making it very specific to cardiac injury. Troponin levels in the blood can rise within 2 to 3 hr of the onset of an MI. This allows for a quick diagnosis and is the gold standard when treating client's who have suspected MI.
A nurse assessing a client determines that he is in the compensatory stage of shock. Which of the following findings support this conclusion?
1) Confusion
2) Blood pressure 84/50 mm Hg
3) Anuria
4) Petechiae
1) Confusion
Answer Rationale:
Confusion is a manifestation of the compensatory stage of shock. Other manifestations include decreased urinary output, cold and clammy skin, and respiratory alkalosis
A nurse is assessing a client who has disseminated intravascular coagulation (DIC). Which of the following findings should the nurse expect?
1) Excessive thrombosis and bleeding
2) Progressive increase in platelet production
3) Immediate sodium and fluid retention
4) Increased clotting factors
1) Excessive thrombosis and bleeding
Answer Rationale:
The nurse should expect excessive thrombosis and bleeding of mucous membranes because both DIC impairs both coagulation and anticoagulation pathways.
While auscultating a client's heart sounds, the nurse hears turbulence between the S1 and S2 heart sounds. The nurse should document this finding as which of the following?
1) A systolic murmur
2) A third heart sound (S3)
3) An expected heart sound
4) A fourth heart sound (S4)
1) A systolic murmur
Answer Rationale:
Cardiac murmurs are relatively loud, turbulent sounds the nurse can hear between the usual, expected heart sounds. They create a whooshing or a swishing sound. Those between S1 and S2 are systolic murmurs. Those between S2 and the next S1 are diastolic murmurs.
A nurse is providing discharge teaching to a client who has a new prescription for verapamil for angina. Which of the following instructions should the nurse include?
1) "Limit your fluid intake to meal times."
2) "Do not take this medication on an empty stomach."
3) "Increase your daily intake of dietary fiber."
4) "You can expect swelling of the ankles while taking this medication."
3) "Increase your daily intake of dietary fiber."
Answer Rationale:
The nurse should instruct the client to increase his daily intake of dietary fiber to reduce the risk of constipation associated with verapamil.
A nurse is collecting a medication history from a client who is scheduled to have a cardiac catheterization. Which of the following medications taken by the client interacts with contrast material and places the client at risk for acute kidney injury?
1) Atorvastatin
2) Metformin
3) Nitroglycerin
4) Carvedilol
2) Metformin
Answer Rationale:
Metformin interacts with contrast dye and can cause acute kidney damage.
A nurse is caring for a client who is experiencing hypovolemic shock. Which of the following blood products should the nurse anticipate administering to this client?
1) Cryoprecipitates
2) Platelets
3) Albumin
4) Packed RBCs
4) Packed RBCs
Answer Rationale:
Packed RBCs are given to restore blood volume and replace hematocrit and hemoglobin levels in clients who have hypovolemic shock.
A nurse is reviewing the PT, aPTT, and INR laboratory values for a client who is experiencing an acute episode of disseminated intravascular coagulation (DIC). Which of the following laboratory results should the nurse expect?
1) The laboratory values are within the expected reference range.
2) The laboratory values are prolonged.
3) The laboratory values are decreased
4) The laboratory values are the same as the previous test values.
2) The laboratory values are prolonged.
Answer Rationale:
These laboratory values measure clotting time. Because DIC results in the formation of multiple, small clots that consume key clotting factors, the nurse should expect the laboratory values to be prolonged.
A nurse in a provider's office is assessing a client who reports occasional atypical chest pain, palpitations, and exercise intolerance. On auscultation, the nurse notes a systolic click. The nurse should recognize this finding as a manifestation of which of the following conditions?
1) Aortic regurgitation
2) Mitral stenosis
3) Aortic stenosis
4) Mitral valve prolapse
4) Mitral valve prolapse
Answer Rationale:
Although many clients who have mitral valve prolapse are asymptomatic, others report atypical chest pain, palpitations, exercise intolerance, dizziness, and syncope. Auscultation of a client who has mitral valve prolapse reveals a systolic click that is caused by a valve leaflet prolapsing into the left atrium.
A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective?
1) Increased heart rate
2) Increased urine output
3) Decreased blood pressure
4) Decreased blood glucose level
2) Increased urine output
Answer Rationale:
Dobutamine is administered to clients who have heart failure to improve their hemodynamic status. The nurse should identify an increase in client's urine output as an indication that the medication is effective.
A nurse in the emergency room is caring for a client who presents with manifestations that indicate a myocardial infarction. Which of the following prescriptions should the nurse take first?
1) Attach the leads for a 12-lead ECG.
2) Obtain a blood sample.
3) Initiate oxygen therapy.
4) Insert the IV catheter.
3) Initiate oxygen therapy.
Answer Rationale:
The greatest risk to the client’s safety is myocardial ischemia and cellular death; therefore, the priority action the nurse should take is to administer oxygen to help minimize this possibility.
A nurse is assessing a client who is receiving a continuous IV infusion of dopamine. Which of the following findings should the nurse recognize as a therapeutic effect?
1) Increased pulse
2) Increased urine output
3) Decreased blood pressure
4) Decreased dysrhythmias
2) Increased urine output
Answer Rationale:
Dopamine is used for the treatment of shock and heart failure. It increases cardiac output by increasing myocardial contractility. This medication also dilates renal blood vessels, which increases renal perfusion and leads to an increase in the client’s urinary output. This finding should indicate to the nurse a therapeutic effect has been achieved.
A nurse is reviewing the laboratory values of a client who is at risk for disseminated intravascular coagulopathy. Which of the following values should the nurse report to the provider?
1) Platelets 156,000/mm3
2) PT 12 seconds
3) PTT 64 seconds
4) Fibrinogen 85 mg/dL
4) Fibrinogen 85 mg/dL
Answer Rationale:
This fibrinogen level is below the expected reference range and should be reported to the provider. A decreased fibrinogen level can result from its depletion during the blood clotting process.
A nurse is monitoring the pulmonary artery wedge pressure (PAWP) for a client. The nurse should identity that a reading of 15 mm Hg is an indication of which of the following conditions?
1) Fluid volume deficit
2) Right ventricular failure
3) Mitral regurgitation
4) Afterload reduction
3) Mitral regurgitation
Answer Rationale:
Hemodynamic monitoring allows the nurse to monitor the pressures within the heart and the great vessels. The PAWP reflects left atrial pressure. A reading of 15 mm Hg is above the expected reference range, which can indicate mitral regurgitation, hypervolemia, or left ventricular failure. The nurse should monitor for trends in value, which can be more reliable than individual values.
A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication?
1) Heart rate 46/min
2) Oxygen saturation 95%
3) Respiratory rate 18/min
4) Blood pressure 160/94 mm Hg
1) Heart rate 46/min
Answer Rationale:
The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 50/min, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction.
A nurse in a coronary care unit is admitting a client who has had CPR following a cardiac arrest. The client is receiving lidocaine IV at 2 mg/min. When the client asks the nurse why he is receiving that medication, the nurse should explain that it has which of the following actions?
1) Prevents dysrhythmias
2) Slows intestinal motility
3) Dissolves blood clots
4) Relieves pain
1) Prevents dysrhythmias
Answer Rationale:
Lidocaine is an antidysrhythmic medication that delays the conduction in the heart and reduces the automaticity of heart tissue.
A nurse in the emergency department is assessing a client who has internal injuries from a car crash. The client is disoriented to time and place, diaphoretic, and his lips are cyanotic. The nurse should anticipate which of the findings as an indication of hypovolemic shock?
1) Increased heart rate
2) Widening pulse pressure
3) Increased deep tendon reflexes
4) Pulse oximetry 96%
1) Increased heart rate
Answer Rationale:
The nurse should anticipate an increased heart rate as an early indication of shock because the body attempts to compensate for decreased circulatory volume.
A nurse is caring for a client in a critical care unit who suffered a knife wound to the chest. The nurse suspects the client is developing cardiac tamponade. Which of the following assessment findings should the nurse identify as supporting this suspicion?
1) Sudden lethargy.
2) Muffled heart sounds.
3) Flattened neck veins.
4) Bradycardia.
2) Muffled heart sounds.
Answer Rationale:
Muffled heart sounds are a key indicator of cardiac tamponade because of the excess amount of fluid surrounding the heart.
A nurse is planning care for a client following a cardiac catheterization accessed through his femoral artery. Which of the following actions should the nurse plan to take?
1) Instruct the client to perform range-of-motion exercises to his lower extremities.
2) Perform neurovascular checks with vital signs.
3) Ambulate the client 1 hr following the procedure.
4) Restrict the client's fluid intake.
2) Perform neurovascular checks with vital signs.
Answer Rationale:
The nurse should assess color, temperature, and pulse in the affected extremity and monitor the client for neurovascular changes that can indicate a stroke, such as slurred speech and visual disturbances.