NRS 325 FINAL EXAM WITH ACTUAL CORRECT QUESTIONS AND VERIFIED DETAILED RATIONALES ANSWE, Exams of Nursing

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NRS 325 FINAL EXAM WITH

ACTUAL CORRECT QUESTIONS

AND VERIFIED DETAILED

RATIONALES ANSWERS

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The nurse is about to administer an MMR vaccine. Which patients should the nurse not administer the vaccine to? (SATA) a. A 55 year old man currently receiving chemotherapy b. A 17 year old boy with Type 1 diabetes c. A 30 year old woman who had a kidney transplant five years ago d. A 47 year old man who has heart disease e. A 32 year old woman in the second trimester of pregnancy

Rationale: A, C, and E are CORRECT - Patients A, C, and E should not receive an MMR vaccine because they are all immunocompromised and MMR is a live attenuated vaccine that COULD result in them becoming sick with the viruses the vaccine is attempting to prevent.

A nurse is helping an immunosuppressed patient understand more about their immune system. Which statement by the patient shows they need further teaching? a. "I am more susceptible to infections and sickness." b. "I should wear a mask when around other people" c. " After I take a few medications, my immune system will go back to normal" d. "I cannot take live vaccines because they would be more harmful to me"

Rationale: C is CORRECT - Depending on the reason for the patient's immunosuppression, this could be a lifelong state or could be temporary, but "taking a few medications" will not solve the problem. A, B, and D are incorrect - immunosuppressed patients ARE more susceptible to infections and sickness, should consider masking when around others, and should avoid live vaccines.

A nurse is describing a malignant tumor to a patient. Which of the statements is false about malignant tumors? a. Have high vascularity b. Invasive to the surrounding tissue c. Leads to necrosis in cells d. Keeps normal cell size

Rationale: D is CORRECT (false) because malignant tumors often change shape, size, and function when compared to a normal cell. A is incorrect (true) - neovascularization is a characteristic of malignant cells. B is incorrect (true) - malignant cells CAN invade surrounding tissues (and farther). C is incorrect (true) - malignant cells can lead to necrosis.

An outpatient clinic nurse is asking a patient if they have immunity to Hepatitis B. Which test would the nurse recommend the patient take to test for this? a. Skin test b. Antigen testing c. Antibody titer d. PCR

Rationale: C is CORRECT - an antibody titer test is the serological test that detects if a patient has the necessary amount/level of antibodies to be considered "immune." A is incorrect - a skin test will not detect immunity to Hepatitis B. B is incorrect - an antigen test looks for antigens of a virus in the patient's blood, and if present, it would indicate a Hepatitis infection. D is incorrect - a PCR test determines if viral DNA/a whole virus in the patient's body, indicating a current or recent infection but not immunity.

Which of the following teachings about antiviral drugs is true? a. Acyclovir helps cure the disease process b. Oseltamivir works in the first 48 hours after symptom onset c. Patients on valacyclovir are not infectious to others d. Oseltamivir blocks the action of only influenza A

Rationale: B is CORRECT - oseltamivir (Tamiflu) must be taken within the first 48 hours of symptom onset of influenza and a positive test. A is incorrect - antiviral medications do not cure illnesses, they inhibit their development, thus reducing the severity of the illness. C is incorrect - patients taking valacyclovir may still pass along the infection. D is incorrect - oseltamivir is effective for both influenza A and B.

You are caring for a patient that is receiving chemotherapy and review their most recent CBC results - RBC: 3.1 x106μL, HCT: 29 %, HGB: 9.5 g/dL, WBC: 2.6 x103 , Platelets: 0.97. What interventions would you implement to provide safe care? (SATA) a. Contact Precautions b. Standard Precautions c. Fall Precautions d. Neutropenic Precautions

Rationale: This patient's lab values indicate that they are experiencing pancytopenia as a result of their chemotherapy. B is CORRECT - Standard precautions should be used for all patients to prevent the spread of blood borne illness. C is CORRECT - Fall precautions should be implemented as the patient is at a higher risk for bleeding due to thrombocytopenia. D is CORRECT - Neutropenic precautions should be implemented as their neutropenia increases their risk of infection both in and out of the hospital (Think: What would this precaution look like both inside and out of the hospital setting).

You are caring for a client who is pregnant and is not up to date on their vaccinations. Which of the following vaccines are contraindicated in pregnancy? (SATA) a. Influenza b. Influenza nasal mist c. MMR d. Tdap e. COVID-

Rationale: B and C are CORRECT - they are attenuated or live virus vaccines and are contraindicated in immunocompromised patients such as pregnant patients A, D, and E are incorrect -Injectable influenza vaccines are inactivated or recombinant and are safe to give during pregnancy. Toxoid and mRNA vaccines are recommended for pregnant people.

A patient with reduced kidney and liver function is taking acyclovir for a viral infection, which of the following findings would be of most concern to the nurse. a. Temperature of 38.1 C b. Nausea c. BP of 108/ d. Urine output of 15 mL/hr

Rationale: D is CORRECT - This patient is exhibiting signs of kidney injury and the provider should be notified.

The nurse is caring for a patient who is receiving chemotherapy. Which lab value is the most concerning? a. Platelet count of 92 x 10⁹L b. RBC count of 5.6 x 10⁶/μL c. WBC count of 12.6 x 10³/mm³ d. Hematocrit of 52%

Rationale: A is CORRECT - While all of these lab values are out of range, low platelets are the most concerning due to the associated increased bleeding risk- ABC's!

Which of the following shows that patient teaching about neutropenic precautions has not been effective for a patient receiving chemotherapy? a. The patient asked their family members not to bring flowers to their hospital room b. The patient says that they will ask their visitors to wear masks c. The patient used to have sushi every day for lunch, but they have stopped since beginning chemo.

d. The patient understands the importance of adequate nutrition and has been having more snacks like sliced apples and celery instead of chips.

Rationale: D is CORRECT - Fresh fruits and vegetables should be avoided because of the risk of introducing any infectious bacteria.

What is not an appropriate nursing intervention for a patient who is receiving chemotherapy? a. Providing education about the importance of a diet high in calorie and nutrient-dense meals and snacks. b. Reminding the patient to take lots of breaks when moving around and doing tasks to conserve energy. c. Suggesting that the patient take iron supplements to help with their anemia associated with bone marrow suppression. d. Reminding the patient that their visitors should be limited and should wear masks.

Rationale: C is CORRECT (not appropriate) - this is not in the nurse's scope of practice. The nurse could educate the patient about the importance of including iron-rich foods in their diet, but cannot tell the patient to take any supplements.

A nurse is caring for a patient who has HIV. Which of the following statements by the nurse does not indicate effective teaching regarding necessary precautions? a. "I will wash my hands and wear gloves when brushing my patients teeth." b. "I will immediately report a needlestick to my supervisor, seek medical attention, and start PEP if indicated." c. "I will wear gloves when touching my patient." d. "I will wear a gown, and gloves when changing my patient's soaked dressing.'

Rationale: C is CORRECT (not effective teaching) - Skin contact does not pose a risk of infection of HIV. A is incorrect (is effective teaching) - washing hands is basic infection control and you will be coming into contact with fluids. As the nurse, you do not know if the patient has bleeding gums or cuts in their mouth. It is best practice to wear gloves. B is incorrect (is effective teaching) - this is an occupational exposure and should seek medication attention immediately. PEP must be started within 72 hours after an exposure. D is incorrect (is effective teaching) - there is a potential of exposure to blood/fluids.

A nursing student is learning about the different body fluids that transmit HIV. Which of the following build fluids will transmit HIV? (SATA) a. Blood b. Saliva c. Semen d. Vaginal secretions e. Breast milk

Rationale: A, C, D, and E are CORRECT - HIV is not spread through saliva

You are administering flu shots at a clinic, and a patient just received a vaccination on their left deltoid. Which of the following symptoms are the most concerning 10 minutes after administration? a. Rash on the left arm and chest. b. Erythema localized to the injection site.

c. Low-grade fever d. Pruritus on the left shoulder.

Rationale: A is CORRECT - this is a systemic reaction and indicates the beginning of an allergic reaction. However, the #1 most concerning symptom would be WHEEZING!!!!!! B and D are incorrect - they are localized to the injection site. C is incorrect - this is expected following vaccine administration.

The nurse is teaching a group of students about the risk factors for cancer. Which of the following patients are at the greatest risk for skin cancer? a. A 24-year-old who reports using the Beauty of Joseon sunscreen while outside b. A 50-year-old farmer who works outdoors every day c. A 40-year-old with light-colored skin and wears a wide brimmed hat at the beach d. A 5-year-old who avoids direct sun exposure from 10-4 pm

Rationale: B is CORRECT - As the oldest patient listed, working outdoors, and no mention of utilizing any form of protection from the sun, this patient is at the highest risk for skin cancer. A is incorrect - they are using sunscreen. C is incorrect - they are wearing a barrier to protect their skin. D is incorrect

- they are avoiding the sun.

You have a patient who is HIV+ and is starting antiretroviral therapy. Which of the following indicates that the patient has a good understanding of their Rx instructions. (SATA) a. I will be taking a "cocktail" containing multiple drugs. b. If I adhere to the prescription protocol as described by my provider, it can cure my disease. c. As long as I take breaks from my meds now and again, there is no risk of developing resistance. d. I will likely experience gastrointestinal distress as a side effect.

Rationale: A is CORRECT - a "cocktail" of multiple drugs increases the effectiveness while reducing the risk of resistance. B is incorrect - as of now, there is not a cure for HIV/AIDS, but antiretrovirals can help slow the progression and prevent transmission of the disease. C is incorrect because not strictly adhering to provider instructions greatly increases the risk of the virus developing resistance to the treatment. D is correct - this is a very common side effect and can make it difficult for patients to adhere to the prescribed guide. Patients should connect with their provider if the side effects are impacting their desire/ability to take the medication.

Assessment findings that you may see if your patient is experiencing an exaggerated immune response include which of the following? (SATA) a. Shortness of breath (SOB) b. Itchiness c. Frequent infections d. Change in level of consciousness (LOC)

Rationale: A, B, and D are CORRECT - these are signs of an exaggerated immune response. Additionally, B and D are signs with anaphylaxis, which is the most severe version of an exaggerated immune response and is an emergency situation. C is incorrect - frequent infections are associated with a suppressed immune response.

A nurse is providing teaching to their patient who is undergoing radiation treatment for cancer and is experiencing desquamation. Which statement by the nurse is correct? (SATA)

a. Clean the skin of the area affected by radiation 1xday with an alcohol based cleaner to ensure it remains sterile. b. Avoid scented creams and lotions c. Applying ice to the affected area can reduce swelling and provide non-pharmacological pain relief. d. Avoid unnecessary sun exposure and cover up with loose fabric when in the sun.

Rationale: B is CORRECT- scented lotions and creams should be avoided. D is CORRECT - these are ways to protect the tissue. A is incorrect - alcohol-based products should NOT be used as they are too harsh and can cause more damage to the tissue. C is incorrect - ice should NOT be applied to the affected area. Extreme temperatures (both heat and cold) should be avoided.

An unvaccinated patient's serum antibody test results for COVID-19 shows that they do have antibodies present in their blood. They reported having COVID-19-like symptoms three months ago but never got tested. What can we determine based on these results? a. The patient is currently sick with the virus, which is why the antibodies are in their blood. b. The patient likely was positive for COVID-19 three months ago (or at a different time) without knowing it, therefore their body has produced antibodies through acquired active immunity. c. This patient's lab results indicated that they can no longer contract COVID-19 because they are considered immune. d. This lab result doesn't give us any definitive answers regarding the patient and COVID-

Rationale: B is CORRECT - if they have never received the vaccination for COVID-19 then the antibodies they have must have come from a previous infection, which is active acquired immunity. A is incorrect - if they were actively sick with the virus, ANTIGENS would be present. C is incorrect - the presence of antibodies for COVID-19 does NOT indicate immunity. D is incorrect because of answer B's rationale..

A pregnant patient's chart shows that they are not up to date with their Tdap vaccine. The provider encourages them to receive the immunization while pregnant and explains that after birth, their newborn will receive some immunity to pertussis by way of which form of immunity? a. Passive innate immunity b. Active acquired immunity c. Passive acquired immunity d. Active innate immunity

Rationale: C is CORRECT - the newborn would acquire passive immunity from their gestational carrier. A is incorrect - passive innate immunity is non-specific, therefore wouldn't specifically affect the newborns immunity of pertussis. B is incorrect - the pregnant person's immune system would produce the antibodies and then pass them to the fetus/newborn vs. the fetus/newborn's immune system creating the antibodies themselves. D is incorrect - this isn't a thing.

A patient has been informed that they have a small malignant mass in their breast. While these cells are still within their original organ (the breast), they have spread to nearby tissues within the organ. How would this mass be staged? a. Stage 1 b. Carcinoma In-situ

c. Stage 4 d. Metastasized

Rationale: A is CORRECT - this is a small malignant mass that has spread to nearby tissues, but not out of the organ, indicating stage 1. B is incorrect - carcinoma in-situ is precancerous AND has not spread outside of the lining of the tissue that it began in. C is incorrect - by stage four, the mass would have expanded and spread farther locally. D is incorrect - this mass has not spread to other organs (metastasized).

A patient's CBC with differential results are in and there is an evident "left shift" in their neutrophils. What does this mean? a. There are more mature segmented neutrophils than immature banded neutrophils and their immune system is fighting the infection effectively. b. There are more immature segmented neutrophils than mature banded neutrophils and their body's infection is no longer effectively fighting the infection. c. There are more immature banded neutrophils than mature segmented neutrophils and their immune system is no longer effectively fighting the infection. d. There are more mature banded neutrophils than immature segmented neutrophils and their body is fighting the infection effectively.

Rationale: C is CORRECT - immature neutrophils are "bands" and when there is a "left shift," it indicates that there are MORE immature neutrophils (bands) than mature neutrophils (segs) and that either the infection is severe enough or has been around long enough that the patient's immune system is struggling to fight the infection, causing immature (think untrained kids) neutrophils to fight the battle as the mature (trained adult soldiers) are worn out and destroyed. A is incorrect - there are FEWER segs. B is incorrect - segs are MATURE. D is incorrect - bands are IMMATURE.

Metaplasia means: a. A proliferation of cells and they are still uniform in shape and size b. A loss of the mass of the cells but not a reduction in the number of cells c. A mitotic growth in the mass of the cells but not in the number of the cells d. A proliferation of cells that are subtly irregular in shape and size

Rationale: D is CORRECT - this is the definition of metaplasia. A is incorrect - this is the definition of HYPERPLASIA. B is incorrect - this is the definition of ATROPHY. C is incorrect - this is the definition of HYPERTROPHY.

What must the nurse consider regarding tertiary management of a patient's cancer? (SATA) a. Palliative goals b. The patient's definition of "quality of life" c. Prophylactic pharmacology for anxiety, nausea, vomiting d. The family's goals over the patient's goals e. The psychosocial impacts of disease control vs. disease cure

Rationale: A, B, C, and E are CORRECT - A) palliative goals CAN be combined with curative goals, B) the patient's definition of "quality of life" absolutely needs to be considered as it may differ from the medical care team or the patient's family! C) prophylactic treatment of anxiety, nausea, and vomiting

can definitely help the patient's experience of treatment, E) as a nurse, we need to realize the far- reaching impacts of whatever goals/treatments our patients choose. D is incorrect - while the family's goals are absolutely important and should be listened to, our greatest loyalty is to the patient and their desires.

Which of the following statements regarding immunological cells is accurate? a. CD8 cytotoxic T cells, which attack and kill antigens, are destroyed by HIVAIDS, which leads to immunodeficiency in HIV+ patients. b. Plasma B cells produce and store antibodies for specific antigens. c. CD4 helper T cells are the cells that provide help to the immune system by producing antibodies for specific antigens. d. Memory plasma cells mature in the plasma and direct the CD8 cytotoxic T cells where to go and how to kill antigens.

Rationale: B is CORRECT - plasma B cells are the producers/storers of antibodies. A is incorrect - while CD8 cytotoxic T cells DO attack and kill antigens, we are most concerned with HIV/AIDS destroying CD helper T cells, which leads to immunodeficiency. C is incorrect - CD4 helper T cells are the cells that conduct the B cells (memory and plasma cells). D is incorrect - Memory B cells are not the same as Plasma B cells and they do not direct the CD8s. Memory B cells DO remember how to make antibodies for specific antigens for use in future infections if an antigen. They tell the Plasma B cells how to make the antibodies. Plasma B cells make and store antibodies.

Primary prevention for optimal immune function includes all of the following except: a. Sleep b. Standard allergy testing c. Vaccinations d. Exercise

Rationale: B is CORRECT - standard allergy testing is NOT primary prevention for immune function. A, C, and D are incorrect - these ARE forms of primary prevention for effective immune function.

Troponin I and Troponin T

• cardiac labs
• values rise in 3-4 hours, peak in 10-12 hours
• last up to 10-14 days

Troponin I (cTnI)

less than 0.35 mcg/L

Troponin T (cTnT)

less than 0.2 mcg/L

Creatine Kinase—Myoglobin (CK-MB)

• cardiac lab
• tells us if skeletal muscle, heart, or brain are damaged
• values peak in 10-24 hours, and last up to 48 hours

Serum Lactate

0.5-2.2 mmol/L

stressed w/o hypoxia

serum lactate >2 mmol/L

lactic acidosis

serum lactate >4 mmol/L

HDL

60 mg/dL

measures good cholesterol (high-density lipoprotein)

LDL

<100 mg/dL

measures bad cholesterol (low-density lipoprotein)

Total Cholesterol

140-199 mg/dL

Triglycerides

<150 mg/dL

Serum Potassium

3.5-5.2 mEq/L

hypokalemia causes dangerous dysrhythmias, hypotension, and decreases cardiac output and peripheral perfusion, which can lead to cardiac and respiratory arrest

normal sinus

60-100 bpm

sinus bradycardia

<60 bpm normal sinus rhythm

sinus tachycardia

100 bpm normal sinus rhythm

atrial fibrillation

• irregular atrial signaling (no P wave)
• decreased CO, increased risk of clotting

premature ventricular contraction (PVC)

occasional irregular beat (d/t ventricular signaling)

ventricular tachycardia

• can be sustained or non-sustained
• sustained (>60 seconds) is an EMERGENCY
• wide/broad QRS complex

ventricular fibrillation

• no identifiable rhythm
• sustained (>60 seconds) is an EMERGENCY

give or hold? Patient who is watching TV, ready for breakfast BP: 106/66, HR: 60 Med due: Lisinopril

give; vitals fine, not symptomatic

give or hold? Patient who is reporting dizziness this morning when they stand BP: 98/64, HR: 96 Med due: Prazosin

hold; dizziness, prazosin will just make symptoms worse

give or hold? Patient who has a hx of chronic respiratory problems, and is feeling very wheezy this morning BP: 128/88, HR: 88, SpO2: 90% Med due: Propanolol

hold; Propanolol is a nonselective beta-blocker which can affect the airway and make chronic respiratory problems worse

give or hold? Patient whose morning labs showed a potassium level of 5.5 mEq/L BP: 100/56, HR: 72 Med due: Digoxin

give; vitals are ok, potassium is elevated, but we can still give the med—it will just be less effective. notify provider about potassium!

give or hold? Patient who mentions their muscles are feeling more sore than usual

BP: 148/92, HR: 100

Med due: Lovastatin

hold; sore muscles can be a sign of rhabdomyolysis

give or hold? Patient who is reporting constipation and ankle swelling BP: 162/94, HR: 104 Med due: Diltiazem

give; these side effects are expected and can be treated

perfusion in infants

• How does their skin tone look? Cyanosis, duskiness, pallor
• How is their activity?Do they take a lot of breaks or squat a lot? (sign of poor perfusion)
• For newborns - how are they eating? Taking lots of breaks to breathe is a sign they're not perfusing well
• Are they growing? (We can measure this too)

Transposition of arteries is life threatening AT BIRTH - we'd see right away Tetralogy of fallot (multiple defects)- we start to see in infancy

Atrial septal defect is the milder defect - more apparent in toddler hood

perfusion in pregnancy

Anything affecting the parental perfusion affects the fetus!

We expect that you are going to increase your blood volume, which can increase BP and hydrostatic pressure (monitor BP during pregnancy!) Decreased venous return because of the fetus, so swelling in the feet/ankles

avoid grapefruit juice

verapamil

do not take sildenafil with this med

nitroglycerin

check your blood glucose more closely

metoprolol

let us know if you have any history of angioedema

enlapril

this medication will make it easier to urinate

tamsulosin

notify us if you experience kidney or flank pain

simvastatin

you'll need to come in routinely to have your labs checked

digoxin

what causes cardiogenic shock?

pump failure

what causes hypovolemic shock?

volume loss

what causes septic shock?

infection

what causes anaphylactic shock?

anaphylaxis

what causes neurogenic shock?

spinal cord injury

what causes obstructive shock?

obstruction (i.e.; thromboses)

what lab helps confirm shock?

serum lactate

preload

volume of blood that returns to the heart (what ventricles will need to pump)

afterload

resistance when the heart beats

hydrostatic pressure

at the capillaries and pushes fluid into the tissues (can cause edema when high)

oncotic pressure

pulls fluid back from tissues

this is a rhythm to monitor, but not immediately concerning

premature ventricular contraction

this rhythm greatly increases your risk of stroke

atrial fibrillation

this rhythm is immediately life-threatening if identified

ventricular fibrillation

the only thing abnormal about this is its rate

sinus bradycardia

this rhythm can be caused by exercise or anxiety

sinus tachycardia

this rhythm change can indicate a myocardial infarction

ST-segment elevation

this is the normal rhythm of your heart

sinus rhythm

this rhythm may need emergency action

ventricular tachycardia (if sustained >60 seconds)

Your 72-year-old patient is at an increased risk of perfusion problems due to which of the following? SATA A. Increased blood volume B. Decreased SA node control C. Less efficient heart muscle D. Stiffening of the blood vessels

B, C, D

Rationale: Lifespan considerations for older adults include: (c) Myocardium becomes less efficient and less contractible, (b) SA node has decreased control, (d) vessels stiffen, and (not an answer option here, but important to remember) left ventricular hypertrophy. (a) increased blood volume occurs during pregnancy.

Your 72-year-old patient mentioned above IS experiencing decreased perfusion. Which of the following are potential symptoms they may be exhibiting related to that decreased perfusion? SATA A. Irregular heart rhythm B. Increased BP C. Shortness of breath D. Increased energy

A, B, C

Rationale: (a) Decreased SA node control (electrical misfiring) can lead to heart rhythm irregularities. (b) Blood pressure increases due to the stiffening of the vessels that occurs with age. (c) left ventricular hypertrophy can lead to left-sided heart failure. This causes fluid to back up into the lungs (pulmonary

edema), causing shortness of breath, wheezing, crackles, etc. (d) Energy will decrease, not increase due to reduced perfusion.

Your patient is presenting with chest pain that worsens with exercise and it is diagnosed as stable angina pectoris. Which of the following medications treats angina pectoris? A. metoprolol B. digoxin C. nitrogylcerin D. atorvastatin E. nifedipine

A, C, E

Rationale: (a) metoprolol is a cardioselective beta 1 blocker, which can be used to treat angina pectoris. (b) digoxin is not used to treat angina pectoris. (c) nitroglycerine is a potent vasodilator, which can relieve angina pectoris pain. (d) atorvastatin is a lipid-lowering medication that does not treat angina pectoris. In theory, lowering cholesterol could help prevent angina pectoris from occurring, but statins are not used to treat angina pectoris (e) nifedipine is a calcium channel blocker with action on the blood vessels that causes vasodilation, helping to treat angina pectoris pain.

A patient is currently experiencing pain in their chest and reports "My heartbeat feels very fast." The provider ordered a dose of propranolol for the patient to take, which the nurse administered. What is a priority for the nurse to do? A. Teach the patient side effects of the medication B. Administer Digoxin for the patient to help with their symptoms C. Tell the patient which over-the-counter medications can help with their symptoms D. Monitor for changes in heart rate and pain

D

Rationale: D. The nurse should monitor for any changes in HR and pain to assess for changes in the patient’s symptoms.

The nurse is discharging a patient who was given nitroglycerine. The nurse knows their teaching was effective with which statement made by the patient? A. "If my pain doesn't dissolve after the first dose, I will just take another dose and not call anyone." B. "The medication will cause my blood pressure to be really low, which is normal." C. "Before starting my new medication which may affect my BP, I must notify my provider." D. "It's okay to have a beer with these medications, as long as it's an hour after."

C

Rationale: A is wrong because you should first call 911 then take another dose. Unresolved angina could be a sign of an oncoming MI. B is wrong because too low of a blood pressure is concerning and the patient should contact the provider. D is wrong because taking alcohol with this medication is contraindicated

The nurse is caring for patient and gets the following lab results back and gets the following results shown on the right. The patient is currently not on any medications. Which lab level is most concerning?

LDL

HDL

Total Cholesterol

Triglycerides

Potassium

HDL

50 mg/dL

LDL

150 mg/dL

Total Cholesterol

160 mg/dL

Triglycerides

100 mg/dL

Potassium Serum levels

4.0 mEq/L

A

Rationale: Increase LDL levels could lead to harmful plaque buildup in the arteries.

A patient comes in for hypertension and is ordered to take Valsartan. The nurse notes that the patient is also taking sulfamethoxazole for a current infection they have. What is a priority intervention the nurse should do? A. Administer ordered Valsartan B. Ask the patient when was their last dose of sulfamethoxazole C. Hold the medication and contact the provider D. Administer Lisinopril to avoid harmful drug interactions

C

Rationale: ACEIs and ARBs both cause hyperkalemia and sulfa drugs also cause hyperkalemia as a side effect. The nurse should hold the drug and contact the provider about this drug interaction.

You are caring for a patient who is taking lovastatin, you recognize that there is a need for further teaching when the patient states the following. A. I should increase my intake of fruits, especially grapefruit. B. Reducing cholesterol in my diet is also important to reduce my cholesterol levels. C. I need to report any flank pain or dark urine as this is a sign of a serious side effect. D. It is best to take this medication at night.

A

Rationale: A is correct - grapefruit can cause med levels in the body to increase and can reach toxic levels. B is incorrect - dietary modification is important in controlling hyperlipidemia. C is incorrect - these signs may indicate the patient is experiencing rhabdomyolysis. D is incorrect - lovastatin should be taken at bedtime.

You are reviewing the ECG for your patient and see that it has a "shaky" baseline with visible QRS complexes, but no P waves. Which cardiac rhythm are they experiencing? A. Sinus Bradycardia B. Ventricular Fibrillation C. Atrial Fibrillation D. Premature Ventricular Contractions

C

Rationale: this patient’s rhythm is Atrial Fibrillation.

When administering digoxin, which steps should the nurse take to administer the medication safely? A. Administer a potassium supplement with the digoxin. B. Keep the medication in an airtight container away from body heat. C. Administer insulin to prevent hyperglycemia. D. Assess the apical pulse for a full 60 seconds.

D

Rationale: D is correct, the apical pulse needs to be assessed for 60 seconds to safely administer digoxin. A is incorrect as potassium can cause digoxin to become toxic in low serum levels or less effective in high serum levels. B is incorrect as this consideration applies to nitroglycerin. C is incorrect as digoxin does not impact blood glucose levels.

A patient comes in complaining of anxiety and chest pain, upon assessment their heart rate is abnormal. After reviewing their labs their potassium is at 7.5, what would you expect to find on their ECG? A. A peaked T-wave B. Normal QRS complex C. Short PR Interval D. Present P-wave

A

Rationale: A is correct because the patient is experiencing hyperkalemia. One of the early signs of hyperkalemia is tall, peaked T-waves. These T-waves may look pointed or sharp.

A nursing student is reviewing content for a community presentation regarding primary prevention with regulating perfusion. What should be included in their teachings? SATA A. Having a healthy diet with lots of red meat is essential to a healthy heart B. Diet should consist of greens and grains and limit trans fat foods/ fast food C. A sedentary lifestyle will not affect perfusion

D. Exercise can reduce issues related to perfusion E. Smoking cessation can help with reducing the risk of cardiovascular events

B, D, E

Rationale: b, d, e are correct because: A heart-healthy diet that includes fruits, vegetables, whole grains, and limits saturated and trans fats can contribute to cardiovascular health. Trans fats and saturated fats can contribute to the development of atherosclerosis, which may impair perfusion. Regular physical activity is associated with improved cardiovascular health. Exercise helps maintain healthy blood vessels, lowers blood pressure, and reduces the risk of conditions that can affect perfusion, such as atherosclerosis. Smoking is a significant risk factor for cardiovascular disease. Tobacco smoke contains chemicals that can damage blood vessels and heart tissue, leading to impaired perfusion. Quitting smoking is a crucial step in preventing cardiovascular events.

A patient is taking Losartan for their high blood pressure, which of the following side effects takes priority? A. Dry cough and hoarseness B. Dizziness and lightheadedness C. Hyperkalemia (elevated potassium levels) D. Increased appetite and weight gain

C

Rationale: While some common side effects of Losartan include options A and B, these are generally mild and may not necessarily raise alarms. However, option C, hyperkalemia, is a potentially serious side effect that can lead to cardiac arrhythmias. Losartan, as an angiotensin II receptor blocker (ARB), can affect the balance of electrolytes, including potassium. Monitoring for signs of hyperkalemia, such as muscle weakness, irregular heartbeat, or numbness/tingling, is crucial for patient safety. Option D is not typically associated with Losartan use and may suggest another issue unrelated to the medication.

A 50-year-old patient with a history of peripheral arterial disease (PAD) complains of intermittent pain and coolness in the lower extremities. The nurse is assessing the patient's peripheral pulses. Which finding would be consistent with impaired arterial perfusion? A. Strong and bounding pulses in both dorsalis pedis and posterior tibial arteries. B. Weak and thready pulses in both dorsalis pedis and posterior tibial arteries C. Absent pulses in the dorsalis pedis with normal pulses in the posterior tibial arteries. D. Absent pulses in both dorsalis pedis and posterior tibial arteries.

B

Rationale: B is correct. Weak and thready pulses suggest reduced blood flow and perfusion to the extremities. In PAD, arterial narrowing or blockages can limit blood flow, leading to diminished pulses.

The mother of an infant born earlier that day tells the nurse, "I'm worried- my baby isn't eating well. He takes only an ounce or two at a time and seems very sleepy." What is the best response by the nurse? A. "That is normal after birth. Keep an eye on him and let us know if you're still noticing the same thing in a few days." B. "This could be a sign of a heart condition, so I'm going to do an assessment and let the doctor know."

C. "Your baby is probably cold since infants can't thermoregulate. I'll get you another blanket to wrap him in so he can focus on eating." D. "You are probably feeding him too much."

B

Rationale: B. This infant could have a congenital heart condition.

The nurse is preparing to administer digoxin to a patient. While reviewing the latest labs, the nurse sees that the patient's serum potassium was 5.3. What is the appropriate nursing action? A. Hold the medication and call the provider B. Assess vitals and if the apical pulse is greater than 60, administer the medication C. The nurse can administer the medication if it is PO, but should hold and call if it is IV D. Hold the medication and administer the patient's PRN nitroglycerin instead

B

Rationale: B. This potassium level is high, which may decrease the effectiveness of the digoxin, but will not cause harmful effects.

The nurse is speaking with a patient who has a new prescription for nitroglycerin. Which of the following patient statements shows a need for further teaching? A. "I know that I cannot take sildenafil (Viagra) now that I have this new prescription. B. "I need to store this medication in the original bottle in a place where it won't be exposed to heat or sunlight." C. I have been prescribed this medication for my chest pain." D. "If I have chest pain, I should take one dose and wait 5 minutes. If the pain persists, I should take another dose. If I must repeat this more than 3 times, I must call 911."

D

Rationale: D. The patient should take one dose and call 911.

Which of the following nursing interventions can help decrease preload? A. Sit the patient upright B. Administer ordered propranolol C. Help the patient lie down D. Elevate the patient's legs

A

Rationale: A. Sitting up makes it harder for blood to return to the heart (gravity), which will decrease the amount of blood volume the heart has to pump. Propranolol is a non-cardio selective beta blocker, this will help lower BP which will decrease afterload. Lying the patient down and elevating their legs will make it easier for blood to return to the heart, increasing preload.

The nurse is assessing the patient and sees that for the last minute, the patient's heart rhythm has displayed a repeated wide QRS interval. What is the indicated nursing action? A. Ask the patient if they have a heart condition and if this is normal for them B. Call the provider to notify them of this heart rhythm

C. Continue to monitor D. Activate the emergency response team

D

Rationale: Ventricular tachycardia is an emergency (code situation) if it occurs for longer than 60 seconds.

When reviewing the patient's most recent lab values, which value should the nurse be concerned about? A. HDL 94 mg/dL B. Serum lactate 1.9 mEq/L C. cTnI 0.25 mcg/L D. Serum potassium 5.4 mEq/L

D

Rationale: Serum potassium value is high which affects the heart

The patient is walking around on a hot day, and they start to experience chest pain. Once they sit down and take a sublingual nitrate, the chest pain resolves. What type of angina is this patient experiencing? A. Unstable angina B. Stable angina C. Normal angina D. Full occlusion angina

B

Rationale: Stable angina resolves with rest and medication. Unstable angina does not resolve with rest and medication → could indicate a heart attack.

A 65-year-old client presents to the emergency department with a 3-day history of diarrhea and vomiting. The nurse notices that the client's pulse is 128 bpm. What is the most likely cause of the increased heart rate? A. Dehydration from loss of fluids B. The client's age C. Stress from being sick D. Effects of medications the client has taken

A

Rationale: heart is compensating for decreased blood volume.

Prothrombin Time (PT)

-test of the ability of blood to clot -11-13.5 seconds

International Normalized Ratio (INR)

-blood coagulation test, often used with patients on anticoagulants -normal ~1, therapeutic (varies) usually 2-3

Partial Thromblastin Time (PTT)

-normal 21-35 seconds -therapeutic usually 60-80 seconds

D-dimer

-measures D-dimer, a protein fragment your body makes when a blood clot dissolves -high levels may indicate clotting disorder (also pregnancy, heart disease, recent surgery, trauma, infection)

A patient has an infected wound and is taking penicillin. Which of the following symptoms reported by the patient should the nurse report to the provider? SATA A. Watery diarrhea B. Bruises on arms and forehead C. Flank pain D. Moderate amount of serosanguinous drainage from wound E. Rash and hives

Answer: A, B, C, E

Rationale: Watery diarrhea could indicate C. diff. Bruising can be related to the bleeding risk associated with taking penicillin, and if the patient has hit their head we should be concerned about intracranial bleeding. Flank pain can be related to the kidneys, and this medication is nephrotoxic. Serosanguinous drainage does not contain pus or a large amount of blood, so this can be a normal sign of healing. A rash and hives are signs of an allergic reaction.

The nurse is caring for a patient who is taking sulfamethoxazole to treat an infection. Which of the following lab results would the nurse want to report to the provider? SATA A. Platelets 1.2 B. WBCs 14 C. Urinalysis positive for crystals D. Potassium 5.4 E. RBCs 5.3

Answer: A, C, D

Rationale: Platelets are low, and blood dyscrasias such as thrombocytopenia are side effects of sulfonamides. The WBCs are high, but this is a somewhat expected finding since the patient has an infection and is taking an antibiotic to treat it, therefore this value doesn’t need to be reported to the provider. Crystalluria is a side effect of sulfonamides and should be reported. The potassium is high which is a side effect of sulfonamides and should be reported since it can cause cardiac issues. RBCs are normal.

The nurse has a new order to give a patient amoxicillin. The patient tells the nurse that they are allergic to penicillin. Which of the following nursing actions is most appropriate to do first?

A. Give them the amoxicillin B. Call the provider and suggest that they put in an order for a cephalosporin instead C. Discontinue the antibiotic and anticipate a change in order D. Ask the patient what symptoms they experienced when they had a reaction to penicillin

Answer: D

Rationale: We should not give a patient a medication they are allergic to so we must determine if the reaction is a true allergy. Cephalosporins have a cross sensitivity with penicillins, so this patient also should not take cephalosporins. Holding the medication might be indicated, but it is not within a nurse's scope to discontinue a medication nor would holding the medication be the first action. The nurse should ask the patient about the allergy symptoms they experienced, because sometimes patients will experience a normal side effect of antibiotics (N/V/D) and think that these are allergy symptoms. The nurse should find out if the patient has anaphylaxis, rash, or hives or if the patient experienced normal side effects.

The nurse has an order to administer ceftriaxone. For which patient should the nurse hold the medication and call the provider? A. A patient who breastfeeds her six month old baby B. A patient who has a diagnosis of alcohol dependence C. A patient who was admitted with a foot wound and has a temperature of 38 C, HR 135, and BP 88/60 D. A patient who reports an allergy to sulfamethoxazole

Answer: B

Rationale: A. Cephalosporins enter breast milk but are considered safe unless the baby is allergic. B. We should not give cephalosporins to a patient who has recently consumed alcohol or will consume it while taking this medication because of the disulfiram reaction (projectile vomiting) that will occur. C. Patient C shows potential signs of sepsis, which is likely why they are being given antibiotics. This systemic infection is likely why the antibiotic was ordered, so it is very important to administer it. Important note: if these symptoms appeared after we gave them a medication, these are also symptoms of anaphylaxis!!! We would not want to give this drug again if we think it caused the symptoms. Septic shock and anaphylactic shock have physiologic similarities (vasodilation, rapid HR, low BP), but we need to look at the big picture to determine which it is. In this case we would think sepsis because of the wound, the fever, and the onset of the symptoms would likely be more gradual and progressive. Anaphylaxis would likely be accompanied by airway swelling, wheezing, and would be faster onset as a reaction to a medication or introduction of an allergen. D. Sulfonamides and cephalosporins do not have cross sensitivities.

Which statement from a diabetic patient taking prednisone requires further teaching? SATA A. "I should immediately stop taking this medication if I notice my skin looking thin or if I have weight gain in my abdomen." B. "I am taking this medication orally so it's likely that I will have some side effects." C. "I should notify my doctor if I experience any heart palpitations." D. "While I am taking this medication, I might feel dizzy because my blood pressure will be lower, so I should be careful when standing up so I don't fall." E. "I should monitor my blood sugar levels carefully and my insulin doses may need to be adjusted."

Answer: A, D

Rationale: A: these side effects can occur, but the patient needs to notify the provider and should not ever just stop taking the medication. B is a correct patient statement, because side effects are more likely to cause side effects than a topical or inhaled route. C is a correct patient statement because heart palpitations can indicate hypokalemia, which is a concerning side effect of corticosteroids. D is incorrect because the patient will most likely see high blood pressure while taking this medication. E is correct because hyperglycemia can be an issue for patients with diabetes while taking corticosteroids.

While teaching your patient about their treatment plan for their infection and prescribed antibiotics, which of the following statements by the patient indicate a need for further teaching? SATA A. It is important for me to drink no more than 8 glasses of water a day to avoid diluting the effects of the medication. B. I will notify my provider right away if I experience shortness of breath, swelling in my neck, and/or a rash/itchiness on my chest. C. I will take the medication as directed until I feel better, and then I will slowly wean down the dose until it is gone. D. I should expect GI distress so if I begin having watery diarrhea with mucous, I should follow the BRAT diet and don't need to notify my provider.

Answer: A, C, D

Rationale: A - Drinking water does not dilute the medication and it is important to drink plenty of water with antibiotics to protect the kidneys from the medication’s nephrotoxicity. B – The patient is correct— these are potential signs of an anaphylactic allergic response. C – The patient should take the abx as directed for the entire prescription, even once symptoms have improved, to increase the likelihood of healing the infection and reduce the likelihood of developing resistance. D – While GI distress can be a side effect of abx, watery diarrhea is a symptom of c. diff which can be caused by antibiotic use and MUST be reported to the provider immediately.

Which of the following lab results are THE MOST concerning for your 80-year-old patient with a diagnosed infection? A. Increased ESR - 35 mm/hr B. Elevated Urine pH - 8.2 C. Elevated Segmented Neutrophils - 75% D. Elevated Banded Neutrophils - 10%

Answer: D

Rationale: While an increased ESR, pH of 8.2, and elevated segmented neutrophils are all abnormal findings, they are expected findings associated with infection. However, elevated banded neutrophils indicate that the patient’s immune system is struggling to fight the infection.

Your pregnant patient has been diagnosed with an infection and has been prescribed a course of antibiotics. Which ordered antibiotics would lead you to question the order prior to administration? SATA A. ciprofloxacin B. erythromycin

C. cefazolin D. sulfamethoxazole

Answer: A & D

Rationale: Ciprofloxacin is a fluoroquinolone and is to be avoided during pregnancy (also during lactation and in children <18). Erythromycin is a macrolide and while it can cross the placenta, there are no fetal adverse effects observed therefore it is not contraindicated. Cefazolin is a cephalosporin, which is not contraindicated during pregnancy. Sulfamethoxazole is a sulfonamide and is contraindicated in pregnancy (and newborns)

What does the nurse identify as an adverse effect of long-term usage of broad-spectrum antibiotic therapy? A. Cyanosis and gray discoloration of the skin B. Frequent loose, watery stools with mucus and blood C. Reduction in all blood cells produced in the bone marrow D. Elevated bilirubin, with dark urine and jaundice

Answer: B Rationale: Frequent loose, watery stools with mucous and blood are symptoms of c. diff, which is a superinfection that can be caused by long-term antibiotic usage.

A newly admitted patient reports a penicillin allergy. The prescriber has ordered cefotetan as a part of the therapy. Which nursing action is appropriate? A. Call the prescriber to clarify the order because of the patient's allergy B. Give the medication and monitor for adverse effects C. Ask the pharmacy to change the order to cephalexin or cefazolin D. Administer the drug with an NSAID drug to reduce adverse effects

Answer: A

Rationale: Penicillins and cephalosporins share cross-sensitivity therefore if the patient has a penicillin allergy, they will likely also experience an allergic reaction to cefotetan. Additionally, answer C (ask the pharmacy to change the order) is out of a nurse's scope of practice.

A 24 y/o woman was admitted for an infection and is currently receiving ampicillin. Upon history-taking, she stated that she is taking oral contraceptive pills and has multiple sexual partners. What should be included in the nurse's health teaching? A. Patient should use condoms throughout the full course of antibiotic treatment B. Patient should stop taking oral contraceptive pills and abstain from sexual activity throughout duration of treatment and a week after C. Patient should increase dosage of oral contraceptive pills D. Patient should increase frequency of oral contraceptive pills

Answer: A Rationale: Penicillins (penicillin G, penicillin V, amoxicillin, and ampicillin) interfere with oral contraceptives and a backup method is recommended if the patient is trying to avoid pregnancy.

The nurse should include which instructions when teaching a patient about sulfamethoxazole therapy? SATA A. "Use sunscreen when you are outside" B. "If you have diarrhea more than five times a day, notify your healthcare provider" C. "Avoid using this drug if you are pregnant" D. "Stop taking the drug if you experience nausea" E. "Stop taking the drug if you experience vomiting"

Answers: A, B, C

Rationale: A - sulfamethoxazole has a side effect of photosensitivity therefore the patient should cover up and use sunscreen when in direct sunlight. B - This is a symptom of a superinfection (such as c. diff) and the provider should be notified. C - sulfamethoxazole is contraindicated in pregnancy (and in newborns). D & E - These can be expected side effects of antibiotic use.

You are ordered to take a peak and trough for a patient on vancomycin. The student nurse shadowing you asks why this is important. Which statement by the nurse would be the best response? A. "It's to show how well the medication is metabolizing in the body." B. "These tests help identify what kind of infection the body is fighting." C. " These tests help determine if a medication is in therapeutic range." D. " Using these tests will help us decide if we need to switch to another drug."

Answer: C Rationale: A peak and trough is obtained to help determine whether a drug is in therapeutic range for it to be effective. If the peak is too high, the drug becomes toxic, and if it becomes too low, then the drug is not as effective.

You are treating a patient with vancomycin and begin to see redness around the IV site and the patient reports that, "my throat feels a little tight". Which is a priority intervention that the nurse can do. A. Call the provider B. Stop the infusion C. Give the patient epinephrine D. This is a normal reaction to the drug

Answer: B

Rationale: This is an adverse reaction and the drug should be stopped immediately. Calling the provider is also important, but not the priority action. Epinephrine may be indicated, but it is still not the priority action in this scenario.

A patient comes in feeling fatigued and has redness in different areas of their skin. The doctor concludes that they have a fungal infection and prescribed amphotericin B as a medication. The nurse notes the patient has adequate understanding of the drug with which statement? A. "I should watch my teeth for any yellowing while on this medication" B. " I will be more prone to bleeding and infections." C. " I should decrease my activity and exercise less." D. " I will feel sleepy when I take this medication."