Test 6
A nurse is caring for a client who has a new prescription for oxytocin to stimulate uterine contractions. Which of the following interventions should the nurse make? (Select all that apply.)
A. Use an infusion pump for medication administration.
B. Obtain vital signs frequently and with every dosage change.
C. Stop infusion if uterine contractions occur every 4 min and last 45 seconds.
D. Increase medication infusion rate rapidly.
E. Monitor fetal heart rate continuously.
A, B, E
Oxytocin should be infused slowly using an IV pump, the changes to the rate are made gradually, vitals should be assessed frequently and before changing the rate, the FHR should be monitored continuously, and it should be only stopped for tachysystole or abnormal reactions (like htn, extreme tachycardia, fetal tachycardia, uterine rupture, etc.) (Tachysystole = >5 contractions in 10 min, contractions occurring within 1 min of each other, or a series of single contractions lasting greater than 2 min)
You have a patient that comes to you with a chief complaint of ringing in his ears. He states he take aspirin a few times a day to treat back pain. What do you think is going on with this patient?
Salicylism
- this happens when taking too much aspirin. Symptoms include: Tinnitus, sweating, headache, dizziness, and respiratory alkalosis
One of your patients has strep throat and is going to be prescribed an antibiotic to treat it. In their history, you find out they have a prolonged QT interval. Which medication should be avoided in this patient?
A. Erythromycin
B. Penicillin G
C. Cefepime
D. Ciprofloxacin
A.
Macrolides (like Erythromycin) have an adverse effect of increasing someone's QT interval and should be avoided in those who already have a prolonged QT interval because it raises the risk of sudden cardiac arrest.
A nurse is about to give a patient psyllium to treat constipation. What are some teaching points to go over with the patient about psyllium as well as other means to prevent constipation? (select all)
A. Take psyllium w/ at least 8 oz of water
B. Lay in bed all day to give this medication time to work
C. Increase your fluid and fiber intake (2-3 L of water daily, increase foods like whole grains, fruits, veggies)
D. Exercise on a daily basis (exercises like walking/running, weight training)
E. Take as much psyllium as you want until you have a bowel movement
A, C, D
Exercise, increasing fluids and fiber, and taking bulk forming laxatives like psyllium with plenty pf water are good teaching points to go over to prevent constipation. Taking too much of a bulk-forming laxative can cause megacolon and can be potentially dangerous if too much is taken.
This herbal supplement can be used topically to treat burns and orally as a laxative.
Aloe/Aloe vera
skin preps can cause a rash, it can increase menstrual flow in women going through menses,a nd it can cause fluid/electrolyte imbalances if used as a laxative.
A nurse is teaching a client about preventing otitis externa. Which of the following instructions should the nurse include?
A. Clean the ear with a cotton-tipped swab daily.
B. Place earplugs in the ears when sleeping at night.
C. Use a cool water irrigation solution to remove earwax.
D. Tip the head to the side to remove water from the ears after showering.
D.
The client should remove water from the ear after showering or swimming to reduce the risk for otitis externa.
You are the OR and your patient just spiked a fever of 105 F and became very rigged after being given general anesthesia. What should you do? Select all that apply.
A. Administer dantrolene
B. Stop all anesthesia medication
C. Provide fans/cooling blankets/ice packs for the patient
D. Keep going with the procedure
E. Give them more anesthesia to relax them
A, B, C
This is an indication of malignant hyperthermia and requires you to administer danrolene and cool the patient off as quickly as possible.
You just started one of your patients on Isoniazid and Rifampin to treat an active TB infection. What kind of education points should be gone over with them? (select all)
A. Take these 1 hr before meals or 2 hours after. If they upset your stomach, you can take them with meals.
B. Report any swelling or urinary retention
C. Report RUQ pain as well as any nausea or vomiting.
D. Report any abdominal pain, diarrhea, or bloody stools
E. Make sure to avoid alcohol while taking these medications
A, C, D, E
Isoniazid can cause things like liver injury and peripheral neuropathy and Rifampin can cause liver injury, pseudomembranous colitis and mild GI upset. Rifampin can also cause discoloration of bodily fluids (sweat, urine) and the patient should be warned of this.
One of your patients was just prescribed furosemide to treat CHF. What class of medication is this and what is one lab value that must be monitored closely while someone is taking this?
Furosemide (Lasix) is a high ceiling loop diuretic. One lab value that must be monitored closely is potassium because diuretics classically waste potassium.
What are the symptoms of hypermagnesemia? (select all)
A. Constipation
B. Respiratory Depression
C. Muscle weakness
D. Depressed deep tendon reflexes
E. Tachycardia
B, C, D
Other effects can be painful muscle contractions and cardiac arrhythmias. Calcium gluconate is the antidote to severe hypermagnesemia.
A patient of yours was just started on fluxoxetine to treat depression. What are some teaching points to go over with them? (select all)
A. This medication takes a few weeks to start working.
B. Make sure to rise and change positions slowly.
C. If you experience sexual dysfunction, you can take medication "holidays" or switch to an atypical antidepressant.
D. Take this medication at night to avoid daytime sleepiness.
E. Avoid use of St. John's wort while taking this medication.
A, C, E
Fluoxetine (Prozac) is an SSRI antidepressant so it should be taken in the morning, use of other antidepressants/st. john's wort should be avoided, it can result in sexual dysfunction, and it can cause agitation and insomnia instead of sedation.
This class of medication is widely used to treat status epilepticus.
Benzodiazepines
- Status epilepticus is a seizure lasting for more than a few minutes and can become life threatening if not treated.
A nurse is teaching a patient who has breast cancer about tamoxifen. Which of the following adverse effects of tamoxifen should the nurse discuss with the patient?
A. Irregular heart beat
B. Abnormal uterine bleeding
C. Yellow sclera or dark-colored urine.
D. Difficulty swallowing
B.
Vaginal discharge and bleeding are adverse effects of tamoxifen. Those who take tamoxifen are also at increased risk for endometrial cancer, so any abnormal uterine bleeding should be carefully monitored and evaluated.
One of your patients was just prescribed albuterol to treat their asthma. What are some adverse effects that you should warn the patient about? (select all)
A. Lightheadedness
B. Tremors
C. Sedation
D. N/V
E. Tachycardia/angina
B, E
Albuterol is a beta2 adrenergic agonist and so can cause adverse effects like tachycardia/angina and tremors. Other effects can be things like dry mouth, headaches, and insomnia.
This supplement is given to treat megaloblastic anemia but should not be given indiscriminately for it can cover the effects of B12 deficiency.
Folate/folic acid
It is also recommended that pregnant women or those of child-bearing age to get extra amounts of it to reduce the risk of neural tube defects.
A patient of yours is postmenopausal and is thinking about starting estrogen replacement therapy. What are some adverse effects of estrogen therapy that you should teach them about? (select all)
A. Increased risk for breast and/or endometrial cancer.
B. High cholesterol.
C. Increased risk for osteoporosis.
D. Increased risk of clot formation (MI, stroke, PE).
E. Headaches.
A, D, E
Estrogen is actually cardioprotective (lowers LDL) and reduces the risk of osteoporosis but can increase the risk of estrogen-dependent cancers and clot formation.
On of your patients is on neostigmine to treat Myasthenia Gravis and starts to have severe respiratory depression and increased salivation. What drug do you give them to reverse this?
A. Donepezil
B. Atropine
C. Naloxone
D. Flumazenil
B.
Neostigmine helps increase the amount of ACh available in the body to help treat the manifestations of Myasthenia Gravis but can cause a cholinergic crisis which is treated with atropine.
What are some education points to make when a patient is taking ferrous sulfate to treat their iron deficiency anemia? (select all)
A. Rinse your mouth out after ingesting the liquid
B. Stools may become dark/green
C. Take it with antacids to increase absorption
D. Take it with citrus fruit or foods containing vitamin C
E. Increase your fiber and fluid intake because this can cause constipation
A, B, D, E
All of these are important teaching points to tell the patient.
A nurse in a provider’s office is monitoring serum electrolytes for four older adult patients who take digoxin. Which of the following electrolyte values increases a patient's risk for digoxin toxicity?
A. Calcium 9.2 mg/dL
B. Calcium 10.3 mg/dL
C. Potassium 3.4 mEq/L
D. Potassium 4.8 mEq/L
C.
Low potassium can cause fatal dysrhythmias, especially in older patients who take digoxin. The nurse should notify the provider, who might prescribe a potassium supplement or a potassium-sparing diuretic for the client.
One of your patients on the L+D floor is on a magnesium sulfate and you go to check on them. Their RR is 6 and deep deep tendon reflexes are absent. What should you give them?
A. potassium chloride
B. Calcium gluconate
C. Iron sulfate
D. Cyanocobalamin
B.
Severe respiratory depression and depressed deep tendon reflexes are signs of magnesium toxicity and calcium gluconate is the antidote to this.
A patient of yours with depression was just prescribed phenelzine (an MAOI) to treat it. What is one education point to go over with them to avoid the risk of a hypertensive crisis?
Avoid eating foods that contain high amounts of tyramine (aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein dietary supplements, soups, soy sauce, some beers, and red wine).
MAOIs not only raise the levels of serotonin, norepinephrine, and dopamine, but also tyramine. Too much tyramine can raise the BP to dangerous levels.
You gave a patient IV diazepam a few minutes ago and they now have an altered level of consciousness and severe respiratory depression. What medication should you give them?
A. Naloxone
B. Flumazenil
C. Atropine
D. Zolpidem
B.
Flumazenil is the antidote to benzodiazepine toxicity and should be given in this situation.
One of your patients is receiving prednisone to treat a rheumatoid arthritis flair up. What lab value should be monitored more closely while giving this medication?
A. RBC
B. Cre
C. BUN
D. Blood glucose
D.
Prednisone is a corticosteroid and has the added adverse effect of raising BG and causing hyperglycemia.
You're working in the OR and one of your patients is going to receive ketamine before the procedure. What should you warn the patient about before giving them this medication?
A. This may cause you to have a severe headache when you wake up.
B. You won't be able to move but you will be able to feel everything. That is why we will give you other medications to make you fall asleep.
C. This may cause nightmares and hallucinations.
D. This will cause you to have amnesia after the procedure.
C.
Ketamine can cause severe nightmares and hallucinations after administering it so monitor for manifestations of these.
One of your patients was prescribed atorvastatin to treat their hyperlipidemia. What are S/S of adverse effects to this medication? (Select all)
A. N/V and RUQ pain
B. Muscle pain and tenderness
C. Flushing of the face
D. Tingling of the fingers and toes
A, B
Statins are liver toxic and can cause myopathy so look for signs of liver injury (RUQ pain, N/V, anorexia, jaundice) and myopathy (muscle pain/tenderness, increased CK levels)