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Exam 4 Study Guide

Terms in this set (98)

An obese client who has an elevated triglyceride level and reduced high-density lipoprotein cholesterol is seen by the primary health care provider. What do these data suggest in this client?

The development of arthritic syndrome
The development of metabolic syndrome
The development of Tay-Sachs disease
The development of Reye's syndrome
The development of metabolic syndrome


Explanation:
Metabolic syndrome is noted when the client has elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein cholesterol, elevated blood pressure, and elevated fasting glucose. Elevated triglyceride level and reduced high-density lipoprotein cholesterol are not indicative of arthritic syndrome. Reye's syndrome is marked by acute encephalopathy and seen in children under the age of 15 years after an acute viral infection. Tay-Sachs is a genetic disease characterized by neurologic deterioration in the first year of life.
The nurse is caring for a client experiencing an acute angina attack. Sublingual nitroglycerin has been administered. The nurse assesses the client's vital signs for which reason?

Reassure client that they are okay.
Confirm report of headache.
Evaluate for recurrent pain.
Identify hypotension.
Identify hypotension.


Explanation:
When a client receives sublingual nitroglycerin, the nurse monitors vital signs to identify hypotension. The nurse does not monitor vital signs to identify headache, evaluate for recurrent pain, or to reassure the client that they are okay.
A nurse is caring for a client receiving warfarin therapy. The nurse instructs the client and family that certain foods must be ingested in moderation because of the possible interference with the effect of the therapy. Which foods must be taken in limited quantity?

Foods rich in vitamin C
Foods rich in Vitamin D
Foods rich in vitamin K
Foods rich in vitamin A
Foods rich in vitamin K


Explanation:
The nurse should inform the client to limit the intake of foods rich in vitamin K as they interfere with warfarin therapy. Foods rich in vitamin A, C, or D need not be limited, as they do not affect the treatment.
Elevated blood lipids are a major risk factor for atherosclerosis and vascular disorders. From where are blood lipids derived?

Diet
Kidneys
Medications
Exercise
Diet


Explanation:
Blood lipids, which include cholesterol, phospholipids, and triglycerides, are derived from the diet or synthesized by the liver and intestine. Medications, exercise, and the kidneys do not play a role in synthesis.
The client is prescribed warfarin. His INR is 5.2. At what level is this dose?

Subtherapeutic
Elevated
Therapeutic
Within prescribed limits
Elevated


Explanation:
Warfarin dosage is regulated according to the INR (derived from the prothrombin [PT] time), for which a therapeutic value is between 2.0 to 3.0 in most conditions. A therapeutic PT value is approximately 1.5 times the control, or 18 seconds.
Which would be most important to include when teaching a patient about using psyllium?

Taking the agent with a large amount of water
Taking the agent at bedtime
Limiting the use of high fiber foods
Taking other prescribed drugs along with the psyllium
Taking the agent with a large amount of water


Explanation:
A large amount of water is needed to prevent the laxative from swelling into a gelatin-like mass in the esophagus that could lead to obstruction. Psyllium can be taken any time, 1 to 3 times per day. Bulk laxatives, like psyllium, can increase the motility of the GI tract and interfere with the timing or process of absorption. Administration of other drugs with psyllium should be separated by at least 30 minutes. It would be important to encourage the patient to ingest high fiber foods to promote bowel evacuation and reduce the need for psyllium.
A client with constipation is prescribed psyllium. The client asks the nurse how the client should take the medication. What is the nurse's best response?

"Mix the medication with grapefruit juice and water."
"You should sprinkle the medication on the food."
"Drink 4 ounces of soda a day. "
"Take this medication with 8 ounces of water."
"Take this medication with 8 ounces of water."


Explanation:
The client should be instructed to take the psyllium with at least 8 ounces of water or another liquid. The medication is not sprinkled on food and does not need to be mixed with grapefruit juice and water. The nurse should encourage an overall intake of fluids to improve bowel regularity, but not soda.
During an assessment of a client experiencing diarrhea, which question is appropriate for the nurse in determining the possible cause of the diarrhea?

"Have you been vaccinated for hepatitis A?"
"Have you recently consumed uncooked ground beef?"
"Can you tell me what you ate in the last 24 hours?"
"Do you wash your hands after you use the restroom?"
"Can you tell me what you ate in the last 24 hours?"


Explanation:
During an assessment, the nurse should ask about food consumed in the last 24 hours. Intestinal infections with viruses, bacteria or protozoa are from uncooked ground beef, poultry, eggs, and dairy products. Asking about consumption of uncooked ground beef does not focus on the other sources of intestinal infections. Asking about washing hands after using the restroom is not appropriate since it is directed towards possible E.coli contamination. Vaccination for hepatitis A is not pertinent for the assessment at this time. Two of the most common viral organisms responsible for diarrhea are rotavirus or Norwalk-like virus.
When providing medication teaching to a client who has been prescribed spironolactone, what foods should the nurse instruct the client to avoid?

apples
crackers
fish
bananas
bananas


Explanation:
Bananas are high in potassium and should be avoided with potassium-sparing diuretics. It is acceptable for the client to eat fish, apples, and crackers because of their low sodium content.
The nurse is about to administer a laxative to a client for the first time. What should be included in client education?

"It is not uncommon to experience some abdominal discomfort and flatulence."
"It is important to avoid a large intake of fluids when taking this medication."
"If you are allergic to red dye number 5, you may have an allergic reaction to this medication."
"It is good to take this medication daily as it is non-habit forming."
"It is not uncommon to experience some abdominal discomfort and flatulence."


Explanation:
Laxatives may cause diarrhea, abdominal discomfort, nausea, vomiting, perianal irritation, and flatulence, as well as a number of other side effects. Prolonged use of a laxative can result in a "laxative habit," or dependence on a laxative to have a bowel movement. Some laxatives contain tartrazine (a yellow food dye), which may cause allergic-type reactions (including bronchial asthma) in susceptible individuals. Obstruction of the esophagus, stomach, small intestine, and colon has occurred when bulk-forming laxatives are administered without adequate fluid intake, or in clients with intestinal stenosis.
After teaching a group of students about loop diuretics, the instructor determines that the teaching has been successful when the students identify which agent as the safest for use in the home?

Torsemide
Ethacrynic acid
Bumetanide
Furosemide
Furosemide


Explanation:
Furosemide is less powerful than bumetanide and torsemide and therefore has a larger margin of safety for home use (see the Critical Thinking Scenario in this chapter for additional information about using furosemide in heart failure). Ethacrynic acid is used less frequently in the clinical setting because of the improved potency and reliability of the newer drugs.
What is the nurse's best response when the client who has a confirmed urinary tract infection asks why the nurse is obtaining a urine sample for culture and sensitivity?

"This test tells the health care provider if the infection has traveled to your kidneys."
"This test lets the health care provider know what medication will best treat the infection."
"This test is done to make sure that you are not pregnant."
"The test is needed to know that you are adequately hydrated."
"This test lets the health care provider know what medication will best treat the infection."


Explanation:
A urine for culture and sensitivity is performed to determine bacterial sensitivity to the drugs that will control the infection. It does not determine hydration or pregnancy status and will not reveal if the infection has traveled to the kidneys.
A 59-year-old client is on warfarin therapy. On follow-up visits to the clinic, the nurse will assess the client's:

intake of vitamin K.
blood glucose level.
presence of breathing disorders.
presence of skin-related disorders.
intake of vitamin K.


Explanation:
It is important to assess the client's usual vitamin K intake because warfarin interferes with the synthesis of vitamin K-derived clotting factors. Increases in vitamin K intake will interfere with the action of warfarin if the increase in intake occurs after the warfarin dosage has been titrated. In addition, a deficiency of vitamin K can increase the risk of bleeding. The client's sugar intake or the presence of a skin-related or breathing disorder does not affect the administration of warfarin.
A client who has been suffering from repeated sinus infections is diagnosed with allergic rhinitis and prescribed a daily antihistamine. What is the mechanism of action in the antihistamine medications?

It depletes norepinephrine and serotonin.
It prevents histamine from acting on target tissues.
It raises the seizure threshold by impairing vitamin D.
It catalyzes the enzymatic oxidation of uric acid.
It prevents histamine from acting on target tissues.


Explanation:
Antihistamines prevent histamine from acting on target tissues. Antihypertensive agents deplete norepinephrine and serotonin. Antigout medications catalyze the enzymatic oxidation of uric acid. Antiseizure medications, such as primidone, impair vitamin D metabolism.
Which drug would the nurse identify as turning a client's urine reddish orange?

Oxybutynin
Solifenacin
Phenazopyridine
Norfloxacin
Phenazopyridine


Explanation:
Phenazopyridine can change the urine color to reddish brown. There is no change in urine color with norfloxacin. oxybutynin, or solifenacin.
A client is discharged from the hospital with a prescription of warfarin. Which statement indicates successful client teaching?

"I will eat spinach or broccoli daily."
"I will avoid herbal remedies."
"If I miss a dose, I will take two doses."
"I will discontinue my other medications."
"I will avoid herbal remedies."


Explanation:
Most commonly used herbs and supplements have a profound effect on drugs for anticoagulation. The client should never double up on dosing related to a missed dose. The client should avoid green leafy vegetables due to vitamin K. The client should not discontinue his or her medications without first consulting with the primary health care provider.
The family nurse practitioner is caring for an adult client who has been noncompliant with the care regimen previously outlined for treatment of sinusitis. What should the nurse practitioner do to best promote compliance?

Assess the reasons why the client did not comply with treatment.
Give the treatment instructions to a member of the client's family.
Give the treatment instructions to the client's spouse.
Provide the instructions in large type.
Assess the reasons why the client did not comply with treatment.


Explanation:
Before performing any interventions, it is important that the nurse assess the reasons why the client did not comply. These findings would inform the nurse's choice of subsequent interventions.
After teaching a patient about the action of spironolactone, the nurse determines that the teaching was successful when the patient states:

"I should take the medicine around dinnertime for the best effect."
"I can still use my salt substitute if I want to."
"I need to make sure I don't eat too many high potassium foods."
"I need to take the drug on an empty stomach."
"I need to make sure I don't eat too many high potassium foods."


Explanation:
The drug is a potassium sparing diuretic placing the patient at risk for hyperkalemia, especially if the patient consumes foods high in potassium. The patient should take the medication in the morning to prevent interfering with sleep by having to get up at night to void. The patient can take the drug with meals if GI upset occurs. Many salt substitutes contain potassium, which could increase the patient's risk for hyperkalemia.
The nurse is visiting a female client in her home for treatment of a wound. The client is concerned that her husband, a truck driver, is bothered by his seasonal allergies. A friend suggested diphenhydramine. What is the nurse's best response?

"The drug may exacerbate the allergies if used routinely."
"The drug is safe if it is purchased over the counter."
"The drug is safe in small doses."
"The drug may cause drowsiness and make driving unsafe."
"The drug may cause drowsiness and make driving unsafe."


Explanation:
A first-generation antihistamine may cause drowsiness and safety hazards in the environment (e.g., operating a car or other potentially hazardous machinery). In most people, tolerance develops to the sedative effects within a few days if they are not taking other sedative-type drugs or alcoholic beverages.
The order for the patient reads: ondansetron (Zofran) 2 mg IV now. The vial of Zofran on the floor contains 4mg/5mL. How many mL should be administered?
2.5


Explanation:
The vial contains 4 mg in each 5 mL. This can be calculated in two ways. The order is for 2 mg. Because 2 mg is half of 4 mg, then half of 5 or 2.5 mL would be given. Another method is to determine how many mg there are in each mL (4mg/5 mL = 0.8 mg/mL); to determine how may mL are needed for 2 mg, divide 2 by 0.8 and the answer is 2.5 mL.
Which instruction would be most appropriate for the nurse to give to a patient who is experiencing photosensitivity related to antiemetic therapy?

Use protective sunscreen when outside.
Avoid crowds of people.
Drink plenty of fluids when outside.
Wear cotton short-sleeved shirts.
Use protective sunscreen when outside.


Explanation:
Photosensitivity is an increased sensitivity to sunlight and ultraviolet light; protective clothing and sunscreen are important.
A client is being discharged home with a prescription for sublingual nitroglycerin. The nurse will instruct the client and family to do which?

transfer the tablets to a clear bottle.
keep the medication in the refrigerator.
discard the tablets if over a month old.
keep the tablets in the original dark bottle.
keep the tablets in the original dark bottle.


Explanation:
The nurse should instruct the client to keep the tablets in the original bottle and store in a dark, dry place. Sublingual tablets are likely to lose effectiveness if exposed to light, excessive heat, or moisture. However, it is not necessary to store the tablets in the refrigerator. The client should discard unused tablets 6 months after the bottle is opened.
A client is being administered heparin IV and has been started on warfarin. The client asks the nurse why both medications have been prescribed. What is the nurse's most accurate response?

"You will need both warfarin and heparin for several days."
"Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin."
"Warfarin cannot be given without heparin due to the amount of clotting you need."
"After a certain period of time, you must start warfarin and heparin together."
"Warfarin takes 3-5 days to develop anticoagulant effects, and you still need heparin."


Explanation:
Anticoagulant effects do not occur for 3 to 5 days after warfarin is started because clotting factors already in the blood follow their normal pathway of elimination. The statement, "After a certain period of time, you must start warfarin and heparin together" does not explain clearly the reason for the two medications concurrently. The statement, "You will need both warfarin and heparin for several days" does not explain clearly the reason for the two medications. The statement, "Warfarin cannot be given without heparin due to the amount of clotting you need" is not accurate.
Mucolytics are often used for patients with cystic fibrosis, COPD, or tuberculosis.

False
True
True


Explanation:
Mucolytics increase or liquefy respiratory secretions to aid the clearing of the airways in high-risk respiratory patients who are coughing up thick, tenacious secretions. Patients may be suffering from conditions such as chronic obstructive pulmonary disease (COPD), cystic fibrosis, pneumonia, or tuberculosis.
The instructor is discussing adverse effects associated with nasal decongestants. What is an effect of excessive use of these products when administered correctly?

Diarrhea
Rash
Rebound nasal congestion
Headache
Rebound nasal congestion


Explanation:
Rebound nasal congestion, chronic rhinitis, and ulceration of nasal mucosa are possible adverse effects of long-term or excessive use of nasal decongestants. They do not cause diarrhea or rash. If administered properly they will not cause headache, however, if forceful administration causes the medication to enter the sinuses this can result in a headache.
A client has requested an oral antiemetic to control motion sickness on an upcoming flight. While explaining proper use of the drug, the nurse should recommend that the client take the drug:

upon waking on the morning of the flight.
30 minutes prior to the flight.
when symptoms are at their peak.
at the onset of symptoms.
30 minutes prior to the flight.


Explanation:
Antiemetic drugs are more effective in preventing nausea and vomiting than in stopping them. Therefore, the drugs should be taken 30-60 minutes before a nausea-producing event when possible.
The nurse has just finished client education with a client who is being discharged home on bulk-forming laxatives. The nurse knows the client understands discharge instructions regarding these medications when which statement is made?

"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."
"I will mix the dry medication with applesauce."
"I will decrease the roughage in my diet while I am using this medication."
"I will use milk of magnesia in conjunction with this medication until I am having daily bowel movements."
"I will mix the medication with 4 to 8 ounces of liquid and follow it by an additional 4 to 8 ounces."


Explanation:
Bulk-forming laxatives need to be taken with at least 8 oz of water or other liquid. The other options are incorrect statements and would indicate further need for teaching.
A client is taking warfarin to prevent clot formation related to atrial fibrillation. How are the effects of the warfarin monitored?

Platelet count
RBC
PT and INR
aPTT
PT and INR


Explanation:
The warfarin dose is regulated according to the INR. The INR is based on the prothrombin time. The red blood cell count is not indicative of warfarin dosage. The aPTT is utilized to determine heparin dose. The platelet count is required to determine warfarin dose.
The nurse should advise clients taking phenazopyridine that they may notice a change in urine color. Which color would the nurse identify?

orange
green
blue
purple
orange


Explanation:
The nurse should advise clients taking phenazopyridine that their urine may become discolored and may appear a dark orange to brown color. Phenazopyridine does not cause the urine to become blue, purple, or green.
A nurse is caring for a 59-year-old client who has been prescribed nitroglycerin to control angina. Which adverse effect might the nurse observe in this client?

Sedation
Hypokalemia
Hypotension
Renal insufficiency
Hypotension


Explanation:
Adverse effects of nitroglycerin include hypotension, dizziness, lightheadedness, palpitations, and headache. Adverse reactions of nitroglycerine do not include hypokalemia, renal insufficiency or sedation.
An 86-year-old male client who was admitted earlier in the week with thrombophlebitis is being sent home on enoxaparin. Which statement by the client suggests that he understands proper management of his condition and proper use of the drug?

"I should call the health care provider to report severe bleeding, but I should just take care of less serious bleeding by myself."
"I should take the medication with grapefruit juice."
"The only thing I need to do to manage my condition is to take this medication."
"The medication will increase my risk of bleeding."
"The medication will increase my risk of bleeding."


Explanation:
Since antiplatelet and anticoagulant drugs increase the risk of bleeding, clients taking such drugs should take precautions to avoid injury. Clients should report any sign of bleeding to a health care professional.
A patient with allergic rhinitis is prescribed an antihistamine. The nurse instructs the patient to suck on a sugarless hard candy to prevent which condition?

Drowsiness and sedation
Altered sensation of taste
Dryness of the oral mucosa and the throat
Thickening of the bronchial secretion
Dryness of the oral mucosa and the throat


Explanation:
The nurse should instruct the patient to suck on a sugarless hard candy to prevent dryness of the oral mucosa and the throat seen as a side effect of antihistamine therapy. Sucking on candy does not relieve drowsiness, sedation, and thickening of the bronchial mucosa seen with antihistamine therapy. Altered sense of taste does not occur with most antihistamines.
Which would be most important prior to beginning therapy with a urinary anti-infective agent?

Inspecting the skin for rashes
Assessing the usual urinary pattern
Obtaining a urine culture and sensitivity test
Assessing client's level of orientation
Obtaining a urine culture and sensitivity test


Explanation:
Although assessing urinary pattern, skin, and level of consciousness would be important to obtain a baseline, obtaining a urine culture and sensitivity test would be most important to ensure proper treatment. Inspecting the skin for rashes would also be helpful once the therapy starts to evaluate for possible hypersensitivity reactions and adverse effects.
An ED nurse is caring for a patient who is receiving furosemide for treatment of pulmonary edema. What will the nurse monitor to observe for adverse effects of the drug?

Potassium levels
Temperature
Bone marrow function
Blood oxygen saturation
Potassium levels


Explanation:
Furosemide, a loop diuretic, causes potassium loss, which can lead to hypokalemia. Serum potassium levels should be monitored in patients taking the drug to help avoid the condition and its effects.
The clinic nurse has been assigned to a 43-year-old client who is obese and loves to eat. The client has been diagnosed with hyperlipidemia and has been prescribed lovastatin. Which dietary instruction would be a priority for the nurse to discuss with the client?

Decrease intake of plant stanols
Avoid drinking grapefruit juice
Increase intake of milk and other dairy products
Increase intake of fatty acids
Avoid drinking grapefruit juice


Explanation:
It is generally recommended that clients avoid grapefruit juice when taking lovastatin because it inhibits the action of CYP3A4, the isoenzyme that metabolizes lovastatin. Education regarding the need for adequate intake of milk and other dairy products along with plant stanols is important but would not be as critical as the grapefruit juice inhibiting the metabolism of the lovastatin.
A client is using psyllium hydrophilic mucilloid to promote evacuation of stool. What is the action of this medication?

It increases mass and water content of stool, promoting evacuation.
It creates a barrier between the colon wall and feces.
It irritates the intestinal mucosa, thus increasing intestinal motility.
It reduces the surface tension of bowel contents.
It increases mass and water content of stool, promoting evacuation.


Explanation:
Bulk-forming laxatives increase mass and water content of the stool, promoting evacuation. Bulk-forming laxatives do not reduce surface tension of bowel contents. Bulk-forming laxatives do not irritate the intestinal mucosa to increase intestinal motility. Bulk-forming laxatives do not create a barrier between the colon wall and feces.
Which is an appropriate intervention for a side effect of a urinary antispasmodic medication?

Use caffeinated drinks to prevent drowsiness.
Take milk of magnesia daily to control constipation.
Suck on ice or hard candy to treat dry mouth.
Reduce fluid intake to avoid nocturia.
Suck on ice or hard candy to treat dry mouth.


Explanation:
Antispasmodics may cause dry mouth, constipation, and drowsiness. Ice or hard candy will treat dry mouth, but caffeine will not prevent drowsiness, and milk of magnesia is too harsh for constipation that can be controlled with fiber, fluid, and exercise. Patients with urinary tract conditions should maintain fluid intake.
Which assessment finding serves to contraindicate the use of an antiemetic agent?

History of chronic liver dysfunction
Currently receiving radiation therapy
History of lung cancer
Demonstrated signs/symptoms associated with menopause
History of chronic liver dysfunction


Explanation:
Assess for possible contraindications or cautions include a history of impaired hepatic function, which could interfere with the excretion of the drug. None of the other options presents contraindications for the use of an antiemetic agent.
A client is unconscious and experiencing increasing intracranial pressure. What type of diuretic will the client most likely be prescribed?

Thiazide diuretic
Potassium-sparing diuretic
Loop diuretic
Osmotic diuretic
Osmotic diuretic


Explanation:
An osmotic diuretic is used to reduce intracranial pressure related to a head injury. Loop diuretics, potassium-sparing diuretics, and thiazide diuretics do not reduce intracranial pressure.
The nurse is providing education ANTIHISTAMINES to a client who has been prescribed diphenhydramine. What information should the nurse convey to the client?

"You might have a dry cough for a few hours after taking this drug."
"This drug is likely to make you feel drowsy."
"Some people find that this drug makes their muscles weak."
"This drug will likely make you urinate more than usual."
"This drug is likely to make you feel drowsy."


Explanation:
First-generation antihistamines like diphenhydramine cause sedation. They do not cause urinary frequency, increased muscle tone, or cough.
A client has been prescribed intravenous heparin. What laboratory value will the nurse prioritize when providing care for this client?

D-dimer
platelet count
factor XIII levels
aPTT
aPTT


Explanation:
Prescribers use the activated partial thromboplastin time (aPTT), which is sensitive to changes in blood clotting factors, except factor VII, to regulate heparin dosage. d-dimer test is used to help rule out deep vein thrombosis (DVT) and pulmonary embolism (PE). A platelet count measures how many platelets are present in the blood. Platelets are parts of the blood that help the blood clot. Factor XIII levels are assessed when diagnosing/managing hemophilia A.
When describing angina to a group of clients, what would be most accurate?

Chest pain that occurs with exercise
Pain due to lack of oxygen in the heart muscle
Damage to the heart muscle
Spasm of the blood vessels
Pain due to lack of oxygen in the heart muscle


Explanation:
Angina is most accurately described as the body's response to a lack of oxygen in the heart muscle. It commonly is manifested as chest pain, but it can occur at rest or with activity. Angina does not necessarily indicate damage to the heart muscle. Ischemia leads to damage. Prinzmetal angina is a type of angina that is due to vessel spasm.
A female patient is taking warfarin (Coumadin) after open heart surgery. The patient tells the home care nurse she has pain in both knees that began this week. The nurse notes bruises on both knees. Based on the effects of her medications and the report of pain, what does the nurse suspect is the cause of the pain?

Bleeding
Degenerative joint disease
Arthritis
Torn medial meniscus
Bleeding


Explanation:
The main adverse effect of warfarin (Coumadin) is bleeding. The sudden onset of pain in the knees alerts the nurse to assess the patient for bleeding. Arthritis, torn medical meniscus, and degenerative joint disease could all be symptoms of knee pain, but the onset and combination of anticoagulant therapy is not an etiology of these types of injuries and disease.
The nurse is caring for a patient who is receiving ondansetron IV for treatment of nausea. The nurse can be confident that treatment is effective when:

the patient states that nausea has decreased.
the patient expresses hunger.
the patient's heart rate falls to 65 bpm.
the patient's blood pressure does not exceed 110/65 mm Hg.
the patient states that nausea has decreased.


Explanation:
Nausea is an unpleasant sensation of abdominal discomfort accompanied by a desire to vomit. The most reliable indication of effective therapy is the patient's statement that nausea has decreased. Ondansetron would not alter blood pressure, heart rate, or sensation of hunger in the patient.
The client has been prescribed a nitroglycerin patch for anginal pain. The nurse is teaching the client about safe and proper use of the nitroglycerin patch. What should the nurse caution the client to avoid?

Exercise
Milk products
Synthetic fabrics
Alcoholic beverages
Alcoholic beverages


Explanation:
Since both alcohol and nitrate antianginal drugs dilate blood vessels, concomitant use of the two can cause an excessive drop in blood pressure. Exercise, milk products and synthetic fabrics have no effects on nitrates.
A client is receiving meclizine. The nurse would caution the client to avoid:

Alcohol
Aged cheese
Chocolate
Caffeine
Alcohol


Explanation:
There is an increased risk of sedation if meclizine is combined with other CNS depressants such as alcohol. The client should be instructed to avoid this combination. Meclizine does not interact with caffeine or chocolate. Aged cheese should be avoided by clients taking monoamine oxidase inhibitors.
A client reports experiencing severe nasal congestion since starting to use an over-the-counter (OTC) nasal decongestant spray a week ago. This symptomology most supports what possible medical condition?

sinusitis
rebound congestion
bronchitis
a drug allergy
rebound congestion


Explanation:
Nasal decongestants are rapidly effective because they come into direct contact with nasal mucosa. However, if used longer than the recommended 3 days or in excessive amounts, these products may produce rebound nasal congestion that result from the irritation and swelling of the nasal mucosa. The other options would present with distinctive symptomology.
A client with a long-standing diagnosis of asthma is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem?

Pneumonia
Pleural effusion
Bronchospasm
Hyperglycemia
Bronchospasm


Explanation:
Clients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung. The client will not experience hyperglycemia, pleural effusion, or pneumonia as a result of this medication.
The nurse is caring for a client who is experiencing elevated intracranial pressure following neurosurgery. The health care provider orders an osmotic diuretic to reduce pressure. Which medication would the nurse expect to be ordered?

Mannitol
Ethacrynic acid
Spironolactone
Bumetanide
Mannitol


Explanation:
Mannitol is an osmotic diuretic used frequently in cases of increased ICP. Bumetanide and ethacrynic acid are loop diuretics, and spironolactone is a potassium-sparing diuretic.
The nurse instructs the client that he can repeat the dose of nitroglycerin every 5 minutes up to a maximum total of how many doses?

Five
Four
Two
Three
Three


Explanation:
Nitroglycerin can be repeated every 5 minutes if relief is not felt for a total of three doses.
A nurse is caring for a client with pseudomembranous colitis. The health care provider has prescribed loperamide HCl to the client. How does the nurse know that the drug has been effective?

Rectal bleeding is noted.
Nausea and vomiting are resolved.
Diarrhea is resolved.
Elevation in temperature is noted.
Diarrhea is resolved.


Explanation:
Loperamide HCl (Lomotil) is an antidiarrheal medication. The nurse will know that the medication is effective if the diarrhea is resolved in the client. The nurse should monitor the client for an elevation in body temperature, severe abdominal pain, abdominal rigidity, or distention because these are the indicators of intestinal perforation. The nurse should monitor for rectal bleeding when laxatives are administered.
The nurse is teaching a 61-year-old client about the narcotic antitussive syrup that the health care provider has prescribed. Which client statement suggests understanding of what the nurse has taught?

"If this medicine works, I shouldn't cough at all."
"I should take this medicine followed by a glass of water."
"This medication might cause drowsiness, so I will avoid driving while I use it."
"If my cough doesn't improve right away, I'll increase my dose."
"This medication might cause drowsiness, so I will avoid driving while I use it."


Explanation:
Although narcotic antitussives include only small doses of narcotics, some of the adverse effects of that drug category (e.g., drowsiness, dizziness) are still possible. To decrease the risk of adverse effects, clients should take antitussives at the prescribed schedule and dosage. They should not dilute the medications with fluids or take them with food because doing so may clear the medications from the pharynx, reducing their benefit. Antitussives are intended to suppress only non-purposeful cough; suppression of all coughing can prevent the clearance of secretions.
A nurse is aware of the high incidence and prevalence of hyperlipidemia and the consequent need for antihyperlipidemics. Treatment of high cholesterol using statins would be contraindicated in which client?

An obese male client who is a heavy alcohol user and who has cirrhosis of the liver
A 72-year-old man who has emphysema and a long history of cigarette smoking
A female client who had a laparoscopic cholecystectomy (gall bladder removal) earlier this year
A resident of a long-term care facility whose Alzheimer disease is being treated with donepezil (Aricept)
An obese male client who is a heavy alcohol user and who has cirrhosis of the liver


Explanation:
Active liver disease is a contraindication to the use of statins. As well, heavy alcohol use increases the risk of liver dysfunction. Respiratory disease, recent surgery, and organic cognitive deficits do not preclude the use of statins for high cholesterol.
A 94-year-old client is to begin taking psyllium hydrophilic mucilloid daily. What instructions should the nurse include in the discharge teaching?

Drink at least 8 ounces of fluid with the medication.
Add all of the medications to the mucilloid.
Discontinue the mucilloid if no bowel movement occurs in 24 hours.
Mix the medication with your food at your evening meal.
Drink at least 8 ounces of fluid with the medication.


Explanation:
Psyllium needs to be taken with at least 8 oz of water or other liquid. The nurse would not tell the patient to mix the medication with food, to add all medications to the psyllium, or to discontinue the drug.
A client with a cough has been prescribed 400 mg of benzonatate daily by a physician. The on-hand availability of benzonatate is a 100 mg softgel capsule. How many capsules will the nurse have to administer to the client daily?

10 capsules
6 capsules
8 capsules
4 capsules
4 capsules


Explanation:
The benzonatate dosage to be administered is 400 mg. However, the on-hand availability of the drug is a 100-mg capsule. Hence, the nurse will have to administer 400/100 = 4 capsules daily to the client.
A client is prescribed sublingual nitroglycerin for treatment of angina. The nurse instructs the client to do what if chest pain occurs?

"If the medication burns or causes a headache, get a new prescription."
"Use the nitroglycerin if your chest pain doesn't subside on its own in 3 minutes."
"The pills are usually good for 12 to 18 months after the prescription is filled."
"If the chest pain doesn't go away after three tablets are given 5 minutes apart, call 911."
"If the chest pain doesn't go away after three tablets are given 5 minutes apart, call 911."


Explanation:
The client should take 1 pill as soon as chest pain occurs. Burning indicates the medication is active, and it often causes a headache because of the vasodilation. The pills are only good for approximately 6 months. If chest pain is not relieved after the first pill, the client may take the second pill 5 minutes after the first and then may take a third pill 5 minutes later. At this point, if the client still has chest pain, the client should call 911.
The nurse is teaching a client with angina who is prescribed sublingual tablets. The nurse would instruct the client to use a tablet at which frequency when experiencing an acute attack?

Every 15 minutes
Every 10 minutes
Every 5 minutes
Every 2 minutes
Every 5 minutes


Explanation:
Sublingual nitroglycerin should be taken every 5 minutes up to a maximum number of 3 tablets in 15 minutes. The client should seek medical care if pain is not relieved after the 3 doses.
A client comes to the clinic with reports of dysuria and frequency. The nurse practitioner suspects that the client is experiencing a UTI. Before instituting anti-infective therapy, which laboratory testing would be most important?

white blood cell count
urine glucose evaluation
urine culture and sensitivity
serum sodium level
urine culture and sensitivity


Explanation:
When a UTI is diagnosed, urine culture and sensitivity tests are performed to determine bacterial sensitivity to the drugs that will control the infection. Serum sodium and urine glucose levels would not be necessary. Although a white blood cell count might be completed to evaluate for an infection, a urine culture and sensitivity test is most important.
A nurse has educated a client about the drug phenazopyridine. Which client statement indicates clear understanding?

"Pain relief should occur in a few days."
"I will limit my fluid intake to meal times."
"This drug has anti-infective results."
"My urine could be reddish orange."
"My urine could be reddish orange."


Explanation:
Phenazopyridine has a fairly rapid onset and is used to reduce pain from UTI, but has no anti-infective properties. It also causes the urine and tears to become reddish orange. Clients should increase fluids to help eliminate irritating substances in the bladder.
A client is prescribed oxymetazoline, a decongestant, for the treatment of hay fever. What should the nurse evaluate to assess the efficacy of therapy?

Maintenance of effective airway clearance
Maintenance of effective hydration of the skin
Maintenance of an effective urine output
Maintenance of an effective heart rate
Maintenance of effective airway clearance


Explanation:
Evaluation of the maintenance of effective airway clearance helps in assessing the efficacy of oxymetazoline, which is a decongestant drug. The hydration of the skin, the heart rate and the urine output are usually not changed in decongestant therapy.
What are the most common adverse effects associated with drug therapy?

nausea and vomiting
lethargy and elevated temperature
respiratory depression and skin rash
elevated temperature and anorexia
nausea and vomiting


Explanation:
Nausea and vomiting are the most common adverse effects of drug therapy. While the other options are possible, they are not as common as is nausea and vomiting.
A female client has used long-acting nitroglycerin pills, which the health care provider prescribed at a dosage of twice per day, for the last 6 months. She contacts the provider's office and states that the medication is not working as well as when she started taking the medication. What would be the most appropriate nursing action?


Ask the client how she is currently taking the medication so that you can determine whether she is taking the medication properly.

Advise the client that the period of ineffectiveness will resolve shortly.

Advise the client to take the medication early in the evening after dinner.

Advise the client not to take the medication for several days and then to restart the medication at the previous dose.
Ask the client how she is currently taking the medication so that you can determine whether she is taking the medication properly.


Explanation:
Answers to the nurse's inquiries would guide the next step in patient education. The client developed a tolerance to the medication, but the reason for this is unclear without obtaining additional information. Tolerance to the vascular and antianginal effects may develop. Tolerance is minimized by starting with as small a dose as possible and removing the nitroglycerin (paste or transdermal patches) from the client for 10 to 12 hours a day. The sublingual and translingual spray forms of the drug are the least likely to produce tolerance. The transmucosal form also appears to produce minimal tolerance.
A female patient has been administered metoclopramide (Reglan) for nausea. Which statements indicates that she has understood the teaching provided by the nurse?

"When I have episodes of nausea, I will drink clear liquids."
"I should eat before I take this medication."
"I may experience drowsiness with this medication."
"I will need to take potassium with this medication."
"I may experience drowsiness with this medication."


Explanation:
Metoclopramide will produce drowsiness in the patient. The patient should not drink clear liquids with nausea. The patient should not eat with nausea. The patient should not take potassium with metoclopramide.
When describing the possible adverse effects associated with nitroglycerin, what would the nurse include?

Hypertension
Constipation
Chills
Dizziness
Dizziness


Explanation:
Dizziness is a possible adverse effect. Hypotension is a possible adverse effect. Flushing is a possible adverse effect. Constipation is not associated with nitroglycerin.
A nurse is caring for a client with acute renal failure. The health care provider has prescribed a diuretic therapy for the client to promote dieresis. What intervention should the nurse perform to prevent the inconvenience caused by increased urination?

Encourage the client to exercise.
Gradually increase the drug dosage.
Administer the drug early in the day.
Ask the client to decrease fluid intake.
Administer the drug early in the day.


Explanation:
The nurse should administer the drug early in the day to prevent any nighttime sleep disturbance caused by increased urination when caring for a client receiving a diuretic therapy for acute renal failure. The nurse need not ask the client to decrease fluid intake, gradually increase the drug dosage, or encourage the client to exercise as these are not appropriate interventions and will not help in reducing the discomfort caused by increased urination.
Which is an example of a loop diuretic?

Hydrochlorothiazide (Microzide)
Spironolactone (Aldactone)
Acetazolamide (Diamox)
Furosemide (Lasix)
Furosemide (Lasix)


Explanation:
Furosemide (Lasix) is an example of a loop diuretic.
Pantoprozole (Protonix) is used for?
Inhibits acid secretions
When is the most appropriate time to administer antacids?
1 hour before or 2 hours after eating or before bedtime
Which laxative is used for endoscopy prep?

Psyllium
Methylcellulose
Mineral Oil
Polyethylene glycol
Polyethylene Glycol
What is a likely side effect for a chemical stimulant laxative?

Rectal Bleeding
Abdominal Cramping
Confusion
Gastroesophageal Reflux Disease
Abdominal cramping
When is the best time to take an oral antiemetic for motion sickness?

30 minutes prior to trip
When symptoms first begin
10 minutes prior to trip
3 hours prior to trip
30 minutes prior to trip
First line Antiemetic for treatment of n/v postoperatively

Dronabinol
Hydroxyzine
Dimenhydrinate
Ondansetron
Ondansetron
Food you should avoid while taking Verapamil?
Grapefruit Juice
Priority teaching for a client taking a sustained-release anti-hypertensive drug

Take blood pressure only at night so it is the most accurate
Swallow whole and do not chew
You may use over-the-counter cough suppressants
Take drug before bed to reduce risk of falls
Swallow whole and do not chew
Nitroprusside:

Increases blood pressure
Decreases blood pressure
Decreases blood pressure
How do we help people with hypertension?
Lifestyle changes, medication compliance, monitor for drug effect
Which herb should the client taking Digoxin avoid?
Ginseng
The priority goal for a client with arrhythmia?

Maintain fluid intake
Maintain urine output
Maintain nutritional intake
Maintain cardiac output
Maintain cardiac output
What are the instructions for using nitro tabs?
3 doses total 5 minute between each dose. It is sublingual so it goes under the tongue
Beta blockers cause what in Asthmatics?
Bronchospasms
What lab monitors Warfarin?
PT/ INR
What is the antidote for Warfarin
Vitamin K
People taking a diuretic should?

Limit potassium
Take meds before bedtime
Take daily weights and report changes
Limit high-sugar foods
Take daily weights and report changes
Patients on Spironolactone:

Avoid potassium
Increase potassium
Avoid Potassium
Ways to know at your urinary anti-infective as been effective
Lab work and diminishing s/s of infection
An athlete with exercise induced asthma should?

Use inhaler everyday at same time
Use inhaler 2-3 hours before exercise
Take albuterol 30-60 minutes prior to exercise
Use the inhaler as symptoms start
Take albuterol 30-60 minutes prior to exercise
What directions would you provide a person using a Metered Dose Inhaler?
Shake it, exhale, take a deep breath while pushing down , hold it for about 10 seconds, exhale, wait a full minute before a second puff. Rise mouth after to avoid thrush!!
What do Statin drugs do?
Decrease serum cholesterol and LDL levels
A nursing diagnosis or someone using milk of magnesia might be

Disturbed sensory perception
Risk for imbalance fluid volume
Impaired physical mobility
Ineffective tissue perfusion
Risk for imbalance fluid volume
What is Sucralfate and when should it be taken?
it is a protectorate and should be taken before meals and at bedtime
Directions for administering a bulk forming laxative
Mix with 4-8 ounces of liquid and follow up with another 4-8 oz
Why do we not give syrup of ipecac in the community anymore?
Not safely used, not always appropriate treatment
A gallbladder patient has begun vomiting. What nursing diagnosis related to use of antiemetics n this patient is appropriate?

Risk for injury
Acute Pain
Functional urinary tract
Decreased cardiac output
Risk for Injury
Hypertension related to renal disease is:

Primary Hypertension
Secondary Hypertension
Secondary Hypertension
Antidote for digoxin
DigiFab
Antidote for Heparin
Protamine Sulfate
People on furosemide should?

Avoid potassium
Increase potassium
Increase potassium
People on Phenazopyridine will have urine turn what color?
Reddish Orange
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