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VSIM - STAN CHECKETTS JERMAINE JONES EXAM QUESTIONS AND
ANSWERS
It will be important to reconcile Jermaine Jones's medications prior to discharge. What is the purpose of this process? (Select all that apply.) A) Compare current medications to all medications taken. B) Prevent duplication of medications. C) Ensure disposal of all home medications. D) Provide a complete list of new medications. E) Avoid possible drug interactions. - correct answer a) Compare current medications to all medications taken. B) Prevent duplication of medications. D) Provide a complete list of new medications. E) Avoid possible drug interactions. Medication reconciliation refers to the process of comparing a patient's medication orders to all medications that the patient has been taking. Reconciliation is done to avoid medication errors, such as omissions, duplications, dosing errors, and drug interactions. The nurse is aware that the most common cause of small bowel obstruction is which of the following? A) Neoplasms B) Volvulus C) Adhesions D) Hernias - correct answer c) Adhesions Most bowel obstructions occur in the small intestine. Adhesions are the most common cause of small bowel obstruction, followed by hernias and neoplasms. Volvulus (twisting of the bowel) is another cause, but it is not the most common. A patient with abdominal distention experiences reflux vomiting, which the nurse knows can lead to which of the following acid-base disturbances? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory alkalosis D) Respiratory acidosis - correct answer b) Metabolic alkalosis The reflux vomiting in the loss of hydrogen ions and potassium from the stomach, leading to reduction of the serum electrolytes chloride and potassium in the blood and causing metabolic alkalosis.
The initial symptom of abdominal pain described by the patient in which of the following ways would lead the nurse to suspect a small bowel obstruction? A) Sharp, knife-like B) Colicky, crampy C) Dull, aching D) Rebound, squeezing - correct answer b) Colicky, crampy The initial symptom is usually crampy pain that is wavelike and colicky due to persistent peristalsis both above and below the blockage. The nurse is aware that untreated small bowel obstruction can progress to which type of shock? A) None of these B) Distributive C) Hypovolemic D) Cardiogenic - correct answer c) Hypovolemic The vomiting that accompanies small bowel obstruction can lead to acute fluid losses, which can lead to hypovolemic shock. Hypovolemia can occur from the fluid shifts related to the edema and congestion occurring in the bowel. The nurse anticipates that the initial treatment for small bowel obstruction will involve which of the following? A) Decompression of bowel via nasogastric tube B) Surgical intervention C) Insertion of a rectal tube for drainage D) Colonoscopy and irrigation - correct answer a) Decompression of bowel via nasogastric tube Decompression of the bowel through the nasogastric (NG) tube is necessary for all patients with small bowel obstruction to relieve the pressure and calm the intestine. Potassium chloride may be administered in the patient with small bowel obstruction and dehydration to correct hypokalemia. The nurse knows that a patient experiencing decreased potassium levels would exhibit which of the following signs and symptoms? A) Hypotension, muscle weakness B) Increased thirst, polyuria C) Increased reflexes, tachycardia D) Hypertension, bradycardia - correct answer a) Hypotension, muscle weakness
The nurse anticipates that the IV fluid therapy for a patient with hypovolemia would be which of the following? A) Isotonic B) Hypotonic C) Colloids D) Hypertonic - correct answer a) Isotonic An isotonic solution that expands the extracellular fluid volume is used in hypovolemic states. Is the following statement true or false? The preferred method of checking the placement of a nasogastric (NG) tube is the inject air through the NG while auscultating.
- correct answer False A properly obtained and interpreted X-ray is recommended to confirm placement of any blindly inserted NG tube before its initial use for feedings or medication administration. Why was Stan Checketts NPO in the scenario? A) To prevent further vomiting B) To prevent diuresis C) To prevent fluid overload D) None of the choices - correct answer a) To prevent further vomiting Stan Checketts presented with vomiting for that past 1 to 2 days. NPO indicates the patient is to have nothing by mouth. This order was necessary to prevent further vomiting and decrease the likelihood of further complications. Until the bowel is free from obstruction, the patient will remain NPO. In the patient experiencing small bowel obstruction, vomiting can result in severe dehydration. Laboratory values that would reflect this include which of the following? A) Increased hematocrit B) Decreased white blood cells C) Increased platelets D) Decreased hemoglobin - correct answer a) Increased hematocrit The hematocrit (HCT) test can be used to diagnose abnormal states of hydration. A low HCT suggests anemia, hemodilution, or massive blood loss; a high HCT indicates polycythemia or hemoconcentration caused by fluid volume loss and dehydration. Observing which of the following characteristic would lead the nurse to suspect metabolic alkalosis? A) Decreased ph, decreased PCO
B) Increased ph, increased HCO C) Decreased ph, increased HCO D) Increased ph, increased PCO2 - correct answer b) Increased ph, increased HCO Metabolic alkalosis is a clinical disturbance characterized by a high ph (decreased hydrogen concentration) and a high plasma bicarbonate concentration (HCO3). In addition to hypokalemia, Stan Checketts developed hypochloremia. The nurse recognizes that signs and symptoms of hypochloremia include which of the following? A) Tachypnea B) Muscle cramps C) Hypoactive reflexes D) Pitting edema - correct answer b) Muscle cramps Signs and symptoms of hypochloremia include muscle cramps, agitation, irritability, tremors, slow shallow respirations, tetany, dysrhythmias, and hypertonicity. Which of the following are assessment findings by the nurse that suggest a resolving bowel obstruction? (Select all that apply.) A) Pain managed with opiates B) Decreased nasogastric output C) Hypoactive bowel sounds D) Decreased urine output E) Abdominal distention F) Passage of flatus - correct answer c) Hypoactive bowel sounds F) Passage of flatus Improvement in bowel function is assessed by passage of flatus or stool, decrease in nasogastric output, normal bowel sounds, decrease in abdominal distention, and report of improvement in abdominal pain and tenderness. A decrease in urine output suggests the complication of fluid volume deficit. A patient at the clinic with complaints of insomnia, loss of appetite, lack of energy for the last 3 weeks, and feelings of worthlessness. The nurse asks if the patient is feeling depressed. Which of the following statements best describes the rational for the nurse's question? A) Physical complaints, such as reported by the patient, are indicators of major depression. B) Questions about depression are a required part of the nursing assessment for all patients. C) Self-reporting of depression verifies the presence of a clinical disorder versus "the blues."
succeed. Once the patient's suicide potential has been determined, precautions should be implemented based on the patient's suicide potential. Determining the patient's intent related to suicide and securing the patient's safety need to be done prior to contracting the physician or arranging mental health counseling. A patient is newly diagnosed with depression. In determining the selection of a medication to treat the patient, the healthcare provider wants to select a medication with the least side effects. Which of the following medications would be the best choice of treatment for this patient? A) Fluoxetine B) Amoxapine C) Phenelzine D) Selegiline - correct answer a) Fluoxetine Fluoxetine is a selective serotonin reuptake inhibitor (SSRI). Ssris are usually the first medications prescribed for depression because they do not have the adverse effects associated with tricyclic antidepressants (tcas) and monoamine oxidase inhibitors (maois). Amoxapine and selegiline are maois. Phenelzine is a TCA. A patient taking escitalopram for depression arrives in the emergency room with vomiting, diarrhea, muscle spasms, and restlessness. The patient's heart rate is 122 bpm and the temperature is 101.2 F (38.4 C). The patient is diaphoretic. The patient reports that the symptoms started approximately 2 hours after taking the first dose of escitalopram. The patient reports treating the depression with St. John's wort prior to being prescribed escitalopram. Which of the following drug classifications would most likely be prescribed to treat the cause of this patient's symptoms? A) Renin inhibitor B) Opioid antagonist C) Antihistamine D) Serotonin blocker - correct answer d) Serotonin blocker The patient is most likely suffering from serotonin syndrome. Serotonin syndrome is usually caused by taking a medication or combination of medications that affect serotonin levels in the brain. Escitalopram is an SSRI. St. John's wort is an over-the- counter herbal medication taken for depression. Patients who take ssris and St. John's wort are at an increased risk for serotonin syndrome. Serotonin (5-HT) blockers may be used to decrease the symptoms of serotonin syndrome. Symptoms of serotonin syndrome will not be affected by antihistamines, renin inhibitors, or opioid antagonists. A patient comes to the clinic 5 days after starting on an antidepressant. The patient asks, "When will I start feeling better?" Patient education for this patient would include which of the following statements? A) Another antidepressant will need to be added if this one is not working.
B) You can stop taking the antidepressant now if you are not feeling better. C) You will start feeling better 7 to 10 days after starting an antidepressant. D) It can take up to 4 weeks before feeling the effects of antidepressants. - correct answer d) It can take up to 4 weeks before feeling the effects of antidepressants. The effects of drug therapy may not be seen for 4 weeks. Seven to 10 days is not enough time for drug effects to be seen. It is important to continue the therapy for at least 4 weeks with one medication before changing drugs or adding additional medications. A patient with a history of a cardiac disorder has been diagnosed with depression. Which of the following antidepressant agents is contraindicated for this patient? A) Buproprion B) Sertraline C) Clomipramine D) Citalopram - correct answer c) Clomipramine Clomipramine is a TCA. Tcas are contraindicated for patients with cardiac disorders because of the cardiac stimulatory effects of the drug. Bupropion is classified as an atypical agent used for depression. Bupropion is not contraindicated for patients with a history of cardiac disorders. Citalopram and sertraline are ssris. Ssris are not indicated for patients with a history of cardiac disorders. The nurse is providing education to a client who takes an MAOI for depression. Which of the following foods should the patient avoid? (Select all that apply.) A) Broccoli B) Chocolate C) Avocados D) Salami E) Shrimp - correct answer b) Chocolate C) Avocados D) Salami Tyramine (a pressor amine found in food) is normally broken down by the MAO enzymes in the gastrointestinal tract. Tyramine may be absorbed in large concentrations in the presence of an MAOI, resulting in increased blood pressure. Salami contains high amounts of tyramine. Avocados contain moderate amounts of tyramine. Chocolate contains low amounts of tyramine. Broccoli and shrimp and safe to eat when taking an MAOI. Which of the following information is correct regarding ssris? A) ssris can be stopped abruptly if side effects are unmanageable. B) Patients taking ssris are at an increased risk of suicidal behavior.
slurred, but he can answer questions coherently. His eye open to verbal command, and he is able to follow instructions and move all extremities. Which of the following Glasgow Coma Scale totals would reflect Mr. Jones's presenting signs and symptoms? A) 9 B) 7 C) 15 D) 13 - correct answer d) 13 The Glasgow Coma Scale provides a standard reference for assessing or monitoring level of consciousness in a patient with a suspected or confirmed brain injury. This scale measures in a patient with a suspected or confirmed brain injury. This scale measures three responses to stimuli--eye opening, motor response, and verbal response--and assigns a number to each of the possible responses within these categories. The lowest possible total score is 3; the highest, 15. A total score of 7 or less indicates coma. Eyes open to verbal command = 3; able to following instructions = 6; and disoriented and can converse = 4 = a total score of 13. Jermaine Jones consumed alcohol while taking alprazolam and sertraline. Which of the following best explains the reason this combination decreased Jermaine Jones's level of consciousness? A) The alcohol blocked the liver's ability to metabolize sertraline and alprazolam. B) Depression intensifies the effect of alcohol, alprazolam, and sertraline. C) Combining alprazolam, sertraline, and alcohol results in serotonin syndrome. D) Sertraline, alcohol, and alprazolam are all central nervous system depressants. - correct answer d) Sertraline, alcohol, and alprazolam are all central nervous system depressants. Alcohol, alprazolam, and sertraline are each central nervous system (CNS) depressants. The risk of CNS depression increases if benzodiazepines are taken with alcohol or other CNS depressants, so combinations should be avoided. Alcohol, sertraline, and alprazolam are metabolized in the liver. Alcohol in itself would not block the liver's ability to metabolize the other medications. It would be very unlikely that combining alcohol (a CNS depressant), alprazolam (a benzodiazepine), and sertraline (an SSRI) would result in serotonin syndrome. Chemical changes in the brain due to depression do not intensify the effects of CNS depressants, benzodiazepines, and/or ssris. The result of the blood alcohol level for Jermaine Jones was 75 mg/dl. What is the significance of this result? A) This level indicates intoxication. B) This level is considered positive. C) This level confirms alcoholism.
D) This is a normal finding for this test. - correct answer b) This level is considered positive. A positive result is a blood alcohol level over 40 mg/dl. Drunk driving laws consider a positive result to be a level of 80 mg/dl. A negative result for blood alcohol test is a level below 10 mg/dl. The US Department of Transportation considers levels below 20 mg/dl as negative. Alcoholism is a medical condition. A blood alcohol levels measures the amount of alcohol in the blood. The test does not confirm the diagnosis of alcoholism. Flushing, decreased reflexes, and impaired visual acuity occur in patients with ethanol levels of 50 to 100 mg/dl. Blood alcohol level alone does not indicate intoxication. Appearance of being drunk, confusion, stumbling, and somnolence are signs and symptoms of intoxication. Jermaine Jones took his wife's alprazolam. Which of the following is a common side effect of this medication? A) Diarrhea B) Sedation C) Rash D) Irritability - correct answer b) Sedation Alprazolam is a benzodiazepine. The adverse effects of benzodiazepines are associated with the impact of these drugs on the central and peripheral nervous systems. Nervous system effects include sedation, drowsiness, depression, lethargy, blurred vision, headache, apathy, light-headedness, amnesia, and confusion. Diarrhea, rash, and irritability are not side effects associated with alprazolam. Which of the following statements identifies why Jermaine Jones may be at higher risk for the adverse effects of benzodiazepines? A) Some African Americans are genetically predisposed to delayed metabolism of benzodiazepines. B) Thirty-five-year olds have decreased renal function, causing a delay in metabolism of the drug. C) Changes in serotonin levels caused by depression increase the adverse effects of benzodiazepines. D) Men tolerate high doses of benzodiazepines. - correct answer a) Some African Americans are genetically predisposed to delayed metabolism of benzodiazepines. About 15% to 20% of African Americans are genetically predisposed to delayed metabolism of benzodiazepines. As a result, they may develop high serum levels of these drugs, with increased sedation and an increased incidence of adverse effects. Renal function decreases in older adults. Anabolic steroid levels do not affect tolerance of benzodiazepines. Serotonin levels do not affect metabolism or tolerance to benzodiazepines.
D) I should not have taken the medication prescribed for my wife. Ssris, benzodiazepines, and alcohol are CNS depressants. Therefore, any combination should be avoided. Taking drugs prescribed for another person can result in serious and life-threatening adverse effects. Any percentage of alcohol used in combination with medications and/or altering prescribed doses of medication can result in adverse effects
