HLTH 314 Questions 5-8 with correct answers, Exams of Nursing

Download HLTH 314 Questions 5-8 with correct answers and more Exams Nursing in PDF only on Docsity! HLTH 314 Questions 5-8 with correct answers While a client is receiving an HMG-CoA Reductase inhibitor (statin), the nurse knows to monitor the client closely for the development of which problem? a. Pulmonary Problems b. Vitamin C deficiency c. Liver dysfunction d. Neutropenia - correct answer -C. Liver Dysfunction Response Feedback: HMG-CoA reductase Inhibitors (statins) may adversely affect liver function (where cholesterol synthesis occurs); therefore, liver function studies need to be closely monitored. The other options do not reflect problems that may occur with HMG-CoA Reductase Inhibitors (statins). Professor Reddington made fun of her father for experiencing what adverse effects of niacin (nicotinic acid)? a. Gout b. Flatulence c. Cutaneous flushing d. Pruitis - correct answer -C. Cutaneous Flushing Response Feedback: A younger professor Reddington made fun of her father's flushed, red face from taking niacin (nicotinic acid). Niacin (nicotinic acid). A common adverse effect of Niacin is an intense cutaneous flushing that can be accompanied by an itching/burning/prickly sensation. The administration of aspirin (ASA) or an NSAID (ibuprofen) 30 mins before the administration of niacin can help alleviate this discomfort. Pruitis is not a known adverse effect of Niacin. Gout can occur with niacin therapy due to increased serum levels of uric acid which can predispose to the development of gout, but was not an issue with Professor Reddington's HLTH 314 Questions 5-8 father. GI discomfort, such as flatulence, could occur with niacin therapy but luckily did not occur with Professor Reddington's father. A client calls the clinic office saying that the cholestyramine (Questran) powder he started yesterday clumps and sticks to the glass when he tries to mix it. The nurse will suggest what method for mixing this medication for administration? a. It is recommended not to drink the whole glass if there are clumps b. Mix the powder for at least one minute with at least 4 to 6 ounces of fluid or soft-like food c. Mix the powder in a carbonated soda drink to dissolve it faster. d. Sprinkle the powder into a spoon and take it dry, followed by a glass of water. - correct answer -b. Mix the powder for at least one minute with at least 4 to 6 ounces of fluid or soft-like food Response Feedback: Mix the powder for at least one minute (if not more) with soft foods like applesauce or yogurt or at least 4 to 6 ounces of fluid. The powder may not mix completely at first, but patients should be sure to mix the dose as much as possible and then dilute any undissolved portion with additional fluid. The powder should be dissolved for at least 1 full minute, and small remaining clumps are okay for administration. Powder and granule dosages are never to be taken in dry form, as the medication is activated by the liquid. Mixing in carbonated soda is not recommended due to a reaction with the carbonation and medication. A client on HMG-CoA reductase inhibitors (statins) therapy is complaining of muscle soreness and dark- colored urine. What is the nurse concerned about? a. Sick Sinus Syndrome b. Hypothyroidism c. Cinchonism d. Rhabdomyolysis - correct answer -D. Rhabdomyolysis Response Feedback: Taking HMG-CoA reductase inhibitors (statins) can cause a serious condition called rhabdomyolysis, which causes a breakdown of skeletal muscle fibers that leads to acute renal failure and death; muscle HLTH 314 Questions 5-8 A client asks the nurse why he should take his lipid-lowering medication at night. The nurse answers with what correct statement? a. "It is important to take the medication at night to avoid facial flushing" b. "It is important to take the medication at night because that's when your body is working to breakdown cholesterol" c. "It is important to take the medication at night so it will not interact with your morning medications" d. "It is important to take the medication at night to avoid low blood sugars" - correct answer -b. "It is important to take the medication at night because that's when your body is working to breakdown cholesterol" Response Feedback: Lipid-lowering agents should be taken at night to maximize the use of nighttime cholesterol synthesis. Avoiding drug interactions is not correct. Facial flushing is associated with Niacin and does not correlate with bedtime administration times. Low blood sugars are not associated with lipid-lowering medications. A client who has been anticoagulated with warfarin (Coumadin) has been admitted for gastrointestinal (GI) bleeding. A history and physical examination indicate that the client may have taken too much warfarin (Coumadin). The nurse anticipates that the patient could receive which of the following reversal agents? (Select all that apply) a. Vitamin K b. Protamine Sulfate c. Fresh Frozen Plasma (FFPs) d. Prothrombin Complex Concentrates (PCCs/Kcentra) e. Andexanet Alfa (Andexxa) - correct answer -A, C, and D Response Feedback: Vitamin K, FFPs, and Kcentra are all options to be given to reverse the anticoagulation effects of warfarin (Coumadin). Protamine sulfate is the antidote for a heparin overdose. Andexanet Alfa (Andexxa) can be used to treat uncontrolled bleeding or as the reversal agent for apixaban (Elliquis) and rivaroxaban (Xarelto) HLTH 314 Questions 5-8 A client with heart failure and diabetes asks why he is prescribed an Angiotensin-Converting Enzyme (ACE) Inhibitor. The nurse answers with which correct statement? a. "ACE inhibitors have cardioprotective effects that prevent the progression of diabetic neuropathy and disease" b. "ACE inhibitors lower your potassium level which helps maintain healthy blood sugar levels" c. "ACE inhibitors retain sodium and water to help maintain healthy blood sugar levels" d. "ACE inhibitors have renoprotective effects that prevent the progression of diabetic neuropathy and disease" - correct answer -D Response Feedback: ACE inhibitors have renoprotective effects that prevent the progression of diabetic neuropathy and disease. They reduce proteinuria, slow damage to the renal artery, and slow glomerular filtration pressure. They are often the cardiovascular drug of choice for clients with diabetes. ACE inhibitors do have cardioprotective effects such as decreasing systemic vascular resistance (SVR) and ventricular remodeling & hypertrophy and they are often the drug of choice for hypertensive patients with heart failure; however, this statement is incorrect regarding how cardioprotective effects relate to the client with diabetes. ACE inhibitors increase potassium levels (hyperkalemia) and lose sodium and water with their diuretic effect. What statement made by the client demonstrates an understanding of his antihypertensive medication regime of captopril (Catapres) and metoprolol (Lopressor)? a. "I can stop taking these medications when my symptoms subside" b. "I should move from sitting to standing slowly" c. "Some swelling of the feet is an expected side effect" d. "No laboratory monitoring is needed" - correct answer -B Response Feedback: Clients should be instructed to change positions slowly to avoid syncope from orthostatic postural hypotension. Patients should never abruptly stop these medications as rebound hypertension can occur (especially with the use of beta blockers like metoprolol). Lower extremity edema is often a side effect of calcium channel blockers or heart failure. It is important to monitor electrolytes (especially potassium levels) and if indicated, BUN/Cr, with the use of Captopril. HLTH 314 Questions 5-8 A client on digoxin admitted to the hospital for heart failure comments to the nurse that he sees "circles of lights" in his vision. The nurse makes which correct statement to the client? a. "This is an expected side effect of digoxin." b. "This is from increased intraocular pressure due to long-term digoxin use." c. "This is a sign of toxicity and I will notify the physician immediately." d. "This occurs when your potassium is low." - correct answer -C Response Feedback: "Halo vision" or vision changes that include seeing "circles of lights" is an adverse effect of digoxin which can signify toxicity. The physician should be immediately notified, and the drug held. Digoxin immune Fab (Digibind) can be given as an antidote if necessary. Long-term digoxin use does not cause increased intraocular pressure. Low potassium causes muscle weakness, lethargy, confusion, and EKG changes, not vision changes. A client is discharging home on Clonidine (Catapres) for their hypertension. What statements made by the nurse should be included in teaching? (select all that apply) a. Do not drink alcohol with this medication." b. "This medication will take weeks to see a therapeutic effect." c. "You can continue to take this medication if you become pregnant." d. "Do not abruptly stop taking this medication." e. "Chew gum or take small sips of water if experiencing dry mouth." - correct answer -A, D, and E Response Feedback: Clonidine can cause additive CNS depression when taken with alcohol. Clonidine has a fast onset of action (30-60 minutes). Clonidine can cause fetal harm and should not be taken during pregnancy. Never abruptly stop taking Clonidine for the risk of rebound hypertension. Xerostomia, or dry mouth, is initially common with Clonidine administration and clients should be encouraged to chew gum and/or take small sips of liquids. HLTH 314 Questions 5-8 Response Feedback: Vasodilators can cause hypotension to occur (especially with IVP) along with reflex tachycardia that occurs when the blood pressure is low (the heart is trying to compensate for the low blood pressure). Bradycardia, anxiety, and abnormal hair growth are other adverse effects that could occur. Dry mouth occurs with drugs that have anticholinergic properties or a central alpha2 agonist drug, such as clonidine. Constipation is often seen with calcium channel blockers. Arrythmias occur with antihypertensive drugs that affect the heart's conduction, vasodilators directly relax arteriolar (mostly) or venous smooth muscle (or both) and do not affect heart conduction. Prof Reddington's husband developed an annoying, dry cough from taking which drug for his mild hypertension? a. Beta-blockers b. Angiotensin-converting enzyme (ACE) inhibitors c. Angiotensin II receptor blockers (ARBs) d. Calcium channel blockers (CCBs) - correct answer -B Response Feedback: Prof Reddington's husband was taking captopril, an ACE inhibitor. ACE inhibitors cause a characteristic dry, non-productive cough that reverses when therapy is stopped. The other drug classes do not cause this cough. In order to produce asystole that quickly converts into a sinus rhythm, the nurse administers what drug? a. Lidocaine (Xylocaine) b. Digoxin (Lanoxin) c. Amiodarone (Cordarone) d. Adenosine (Adenocard) - correct answer -D Response Feedback: Adenosine (Adenocard) will cause a brief asystole (up to 6 seconds) when converting supraventricular tachycardia (SVT) to sinus rhythm. Amiodarone and lidocaine are more HLTH 314 Questions 5-8 often used for ventricular dysrhythmias and do not have a mechanism of action by inducing asystole; neither does Digoxin. A client is in the intensive care unit because of an acute myocardial infarction (MI). He is experiencing severe ventricular dysrhythmias. The nurse will prepare to give which drug of choice for this dysrhythmia? a. Amiodarone (Cordarone) b. Adenosine (Adenocard) c. Verapamil (Calan) d. Diltiazem (Cardizem) - correct answer -A Response Feedback: Amiodarone (Cordarone) is the drug of choice for ventricular dysrhythmias according to the Advanced Cardiac Life Support (ACLS) guidelines. The other drugs are not used for acute ventricular dysrhythmias. A client will be discharged on quinidine sulfate (Quinidex) extended-release (ER) tablets for the treatment of ventricular ectopy. The nurse will include which information in the teaching plan? a. It is important to use sunscreen products when outside because of increased photosensitivity b. The medication should be stopped once the cardiac symptoms subside c. Signs of cinchonism, such as tinnitus (loss of hearing), confusion, and blurry vision may occur. d. You can crush your quinidine sulfate - correct answer -C Response Feedback: Quinidine may cause the symptoms of cinchonism, including tinnitus (loss of hearing), blurry vision, and confusion. The medication will need to be continued even after cardiac symptoms subside, or the symptoms may return. Photosensitivity does not occur with class Ia drugs such as quinidine. Extended- release or sustained-release drugs should never be crushed because doing so will cause a dangerous rapid absorption of a large dose that was intended to be released slowly over many hours. A client is ordered for oral metoprolol (Lopressor) to treat their newly diagnosed atrial fibrillation. Which priority actions by the nurse should be completed prior to their first dose? (Select all that apply) HLTH 314 Questions 5-8 a. Check the client's blood pressure b. Check the client's serum electrolytes c. Check the client's heart rate d. Listen to lung sounds e. Check an electrocardiogram (EKG) on the client - correct answer -A, C, E Reponse feedback: Metoprolol (Lopressor) is a beta-blocker that can be used to control ventricular rate in arrhythmias such as atrial fibrillation. Beta-blockers block beta receptors in the heart which results in a decreased heart rate (HR), so heart rate should be checked prior to administration and held if HR <60 (bradycardia). Beta-blockers also reduce the force of myocardial contraction, and this action decreases cardiac output and lowers blood pressure, so blood pressure should be checked prior to administration and held if SBP <100. Beta-blockers affect the conductivity of the heart (suppresses the SA node & slows the speed of conduction through the AV node), so an EKG should be checked prior to the initiation of therapy to confirm the patient does not have Sick Sinus Syndrome (SSS) or 2nd/3rd heart block, which are contraindications to antiarrhythmic therapy (can cause profound bradycardia). Electrolytes do not need to be checked with beta-blocker therapy and lung sound The nurse is caring for a client with new onset atrial fibrillation who was started on a continuous intravenous (IV) infusion of the class IV antidysrhythmic calcium channel blocker medication diltiazem (Cardizem). Which new development by the client would require the nurse to stop the infusion and immediately alert the primary health care provider? a. Continued atrial fibrillation. b. Conversion to normal sinus rhythm (NSR) c. 3rd degree (complete) heart block. d. Appearance of occasional prem - correct answer -C Continued atrial fibrillation is a normal finding with IV diltiazem and may indicate that an increased dose is needed. Conversion to normal sinus is the expected result of IV diltiazem and indicates that the medication is working correctly. PVCs are extra heartbeats originating in the ventricles that are a common finding with clients in atrial fibrillation. Occasional PVCs often cause few or no symptoms and would not warrant the discontinuation of the IV diltiazem infusion. 3rd degree or complete heart block is a medical emergency that demonstrates complete atrial-ventricular (AV) dissociation with an absence HLTH 314 Questions 5-8 c. Hypovolemic shock d. Previous transfusion reaction - correct answer -B Response Feedback: Fresh frozen plasma is used as an adjunct to massive blood transfusion in the treatment of patients with underlying coagulation disorders. The other options are not indications for fresh frozen plasma. Which drugs can treat hyperkalemia? (Select all that apply) a. Subcutaneous (SQ) insulin b. Intravenous (IV) insulin c. Hemodialysis d. IV Potassium Chloride (KCl) e. Sodium polystyrene sulfonate (Kayexalate) - correct answer -B, C, E Response Feedback: Medications that can treat hyperkalemia include sodium polystyrene sulfonate (Kayexalate), intravenous (IV) insulin (followed by an injection of D50 to counteract the hypoglycemic effects of IV insulin), hemodialysis (can dialyze the potassium out of the bloodstream), and IV sodium bicarbonate, calcium gluconate or calcium chloride (per the textbook). Subcutaneous insulin would not be effective in removing potassium from the bloodstream and is usually given to treat hyperglycemia. IV KCl is given to treat hypokalemia. What solutions are considered crystalloids? (SELECT ALL THAT APPLY) a. D5NS (Dextrose 5% and Normal Saline) b. Albumin 5% c. Lactated Ringers (LR) d. 0.9% sodium chloride (Normal Saline or NS) e. Cryoprecipitate - correct answer -A, C, D HLTH 314 Questions 5-8 Response Feedback: D5NS, NS, and LR are all considered crystalloids. Crystalloids are solutions containing fluids and electrolytes that are normally found in the body. Albumin is a colloid and cryoprecipitate is a blood product. A client has been taking iron supplements for anemia for two months. During a follow-up assessment, the nurse will observe for which therapeutic response? a. Decreased blood pressure b. Increased activity tolerance c. Increased liver function d. Decreased weight - correct answer -B Response Feedback: Absence of fatigue, increased activity tolerance and well-being, and improved nutrition status are therapeutic responses to iron supplementation. The other options are incorrect. During therapy with the drug epoetin alfa (Epogen), the nurse instructs the patient of adverse effects which include? a. Anxiety and an increase in platelet levels b. Hypertension and increased risk of thrombosis c. Constipation and increased risk of arrythmias d. Lethargy and decrease in stomach mobility - correct answer -B Response Feedback: Hypertension and increased risk of thrombosis are adverse effects of the drug epoetin alfa (Epogen). The new RBC production causes increased intravascular pressure which leads to hypertension. There is a back box warning for increased risk of thrombosis due to the cellular effects of the drug (increases thrombogenicity, or the tendency for the blood to produce a thrombus). The other options are incorrect. HLTH 314 Questions 5-8 A client with hyperkalemia (K 6.1) is ordered for intravenous (IV) insulin. The client asks why he needs insulin when he does not have diabetes. The nurse makes what correct statement? a. "The insulin is used to decrease the amount of potassium in your blood" b. "The insulin is given to countereffect the dextrose in the intravenous (IV) fluid you are getting" c. "You are correct. I think the doctor ordered this medication in error" d. "Insulin binds to calcium in the cell which will decrease your high potassium level" - correct answer -A Response Feedback: Intravenous (IV) insulin (along with a dextrose source to prevent hypoglycemia) forces potassium out of the extracellular fluid (ECF) to the intracellular fluid (ICF) thus decreasing the amount of potassium in the blood and restoring potassium homeostasis. Insulin does not bind to calcium and is not a treatment for maintenance intravenous (IV) fluids. A client with hyponatremia is given salt (NaCl) tabs 2 grams three times a day (TID). Which teaching statement made by the nurse is correct regarding the administration of this medication? a. "These pills will help keep your blood pressure low when your sodium level is abnormal" b. "These pills are often fruit-flavored and you can chew them" c. "Here is a glass of water with these pills. Drink the whole glass to ensure proper absorption of the medication" d. "Here is some ginger ale to take with these pills. We want you to avoid drinking water when your sodium level is low" - correct answer -D Response Feedback: Clients with hyponatremia should avoid free water so as to not cause additional drops in their sodium levels (free water can flush sodium from the body). Salt tablets should not be crushed and are not flavored; in fact, most patients complain of a bad aftertaste with this medication. Salt tabs will not lower blood pressure. Why does Prof Reddington prefer to take the delayed-release (Slow Fe) version of the ferrous sulfate supplement for her pregnancy-induced anemia? HLTH 314 Questions 5-8