Q&A - Pharmacology 2 Questions are numbered by the order in which they appeared in the test.

. * Represents the correct answer.

Question 3
A nurse who has been named in a lawsuit can use which o these actors or the best protection in a court o law" 'linical specialty certi ication in the A# associated area o practice $ocumentation on the speci ic client record &# with a ocus on the nursing process 3early e%aluations and pro iciency reports '# prepared by nurses manager .eri ication o pro%ider4s orders or the plan $# o care with identi ication o outcomes Review Information* +he correct answer is &* $ocumentation on the speci ic client record with a ocus on the nursing process $ocumentation is the 5ey to protect nurses when a lawsuit is iled. +he thorough documentation should include all steps o the nursing process 6 assessment, analysis, plan, inter%ention, e%aluation. 7n addition, it should include pertinent data such as times, dosages and sites o actions, assessment data, the nurses response to a change in the clients condition, speci ic actions ta5en, i and when the noti ication occurred to the pro%ider or other health care team members, and what was prescribed along with the clients outcomes.

Question 1
A 4 year-old child is admitted with burns on his legs and lower abdomen. When assessing the childs hydration status, which o the ollowing indicates a less than ade!uate luid replacement" $ecreasing hematocrit and increasing urine A# %olume Rising hematocrit and decreasing urine &# %olume (alling hematocrit and decreasing urine '# %olume )table hematocrit and increasing urine $# %olume Review Information* +he correct answer is &* Rising hematocrit and decreasing urine %olume A rising hematocrit indicates a decreased total blood %olume, a inding consistent with dehydration.

Review Information* +he correct answer is '* low at $ue to age related changes, the diet o the elderly should include a lower !uantity and higher !uality o ood. (ewer carbohydrates and ats are re!uired in their diets.

Question 5
A client is to recei%e : doses o potassium chloride ;9 m<! in ;99cc normal saline to in use o%er :9 minutes each. Which o the ollowing is a priority assessment to per orm be ore gi%ing this medication" A# =ral luid inta5e &# &owel sounds '# >rip strength $# ?rine output Review Information* +he correct answer is $* ?rine output ,otassium chloride should only be administered a ter ade!uate urine output -@A9cc1hour or A consecuti%e hours# has been established. 7mpaired ability to eBcrete potassium %ia the 5idneys can result in hyper5alemia.

Question 2
,rior to administering Alteplase -+,A# to a client admitted or a cerebral %ascular accident -'.A#, it is critical that the nurse assess* A# /euro signs &# 0ental status '# &lood pressure $# ,+1,++ Review Information* +he correct answer is $* ,+1,++ +,A is a potent thrombolytic en2yme. &ecause bleeding is the most common side e ect, it is most essential to e%aluate clotting studies including ,+, ,++, A,++, platelets, and hematocrit be ore beginning therapy.

Question 4
+he nurse is caring or clients o%er the age o 89. +he nurse 5nows that due to age-related changes, the elderly clients tolerate diets that are A# high protein &# high carbohydrates '# low at $# high calories

Question
A hypertensi%e client is started on atenolol -+enormin#. +he nurse instructs the client to immediately report which o these indings" A# Rapid breathing &# )low, bounding pulse '# Caundiced sclera $# Weight gain Review Information* +he correct answer is &*

)low, bounding pulse Atenolol -+enormin# is a beta-bloc5er that can cause side e ects including bradycardia and hypotension.

&# (ace lushing '# )alty taste $# Gi%es Review Information* +he correct answer is $* Gi%es +his is a sign o anaphylaBis and should be reported immediately. +he other reactions are considered normal and the client should be in ormed that they may occur.

Question !
$uring nursing rounds which o these assessments would re!uire immediate correcti%e action and urther instruction to the practical nurse -,/# about proper care" +he weights o the s5in traction o a client A# are hanging about A inches rom the loor A client with a hip prosthesis ; day post &# operati%ely is lying in bed with internal rotation and adduction o the a ected leg +he nurse obser%es that the ,/ mo%es the '# eBtremity o a client with an eBternal iBation de%ice by pic5ing up the rame A client with s5eletal traction states D+he other nurse said that the clear, yellow and $# crusty drainage around the pin site is a good signD Review Information* +he correct answer is &* A client with a hip prosthesis ; day post operati%ely is lying in bed with internal rotation and adduction o the a ected leg +his position should be pre%ented in order to pre%ent dislodgment o the hip prosthesis, especially in the irst 4E to 8A hours post-op. +he other assessments are not o concern.

A client has bilateral 5nee pain rom osteoarthritis. 7n addition to ta5ing the prescribed non-steroidal anti-in lammatory drug -/)A7$#, the nurse should instruct the client to A# start a regular eBercise program rest the 5nees as much as possible to &# decrease in lammation '# a%oid oods high in citric acid $# 5eep the legs ele%ated when sitting Review Information* +he correct answer is A* start a regular eBercise program A regular eBercise program is bene icial in treating osteoarthritis. 7t can restore sel -esteem and impro%e physical unctioning.

Question #
3ou are caring or a hypertensi%e client with a new order or captopril -'apoten#. Which in ormation should the nurse include in client teaching" A# A%oid green lea y %egetables &# Restrict luids to ;999cc1day '# A%oid the use o salt substitutes $# +a5e the medication with meals Review Information* +he correct answer is '* A%oid the use o salt substitutes 'aptopril can cause an accumulation o potassium or hyper5alemia. 'lients should a%oid the use o salt substitutes, which are generally potassium-based.

Question 11
A client in respiratory distress is admitted with arterial blood gas results o * ,G 8.:9H ,=A IE, ,'=A :4H and G'=: ;J. +he nurse determines that the client is in A# metabolic acidosis &# metabolic al5alosis '# respiratory acidosis $# respiratory al5alosis Review Information* +he correct answer is A* metabolic acidosis +hese lab %alues indicate metabolic acidosis* the ,G is low, ,'=A is normal, and bicarbonate le%el is low.

Question "
A client is scheduled or an intra%enous pyelogram -7.,#. A ter the contrast material is inFected, which o the ollowing client reactions should be reported immediately" A# (eeling warm

Question 12
A woman with a AE wee5 pregnancy is on the way to the emergency department by ambulance with a tentati%e diagnosis o abruptio placenta. Which should the nurse do first when the woman arri%es" A# administer oBygen by mas5 at ;99K

Question 1$

&# start a second 7. with an ;E gauge cannula '# chec5 etal heart rate e%ery ;I minutes insert urethral catheter with hourly urine $# outputs Review Information* +he correct answer is A* administer oBygen by mas5 at ;99K Administering oBygen in this situation would increase the circulating oBygen in the mothers circulation to the etuss circulation. +his action will minimi2e complications.

eBplain that the purpose o this test is to determine* +he presence o anemia o ten associated A# with $iabetes +he oBygen carrying capacity o the client4s &# red cells +he a%erage blood glucose or the past A-: '# months $# +he client4s ris5 or cardiac complications Review Information* +he correct answer is '* +he a%erage blood glucose or the past A-: months &y testing the portion o the hemoglobin that absorbs glucose, it is possible to determine the a%erage blood glucose o%er the li e span o the red cell, ;A9 days.

mitral %al%e regurgitation and mitral stenosis since her teenage years. $uring the admission assessment, the nurse should as5 the client i as a child she had A# measles &# rheumatic e%er '# hay e%er $# encephalitis Review Information* +he correct answer is &* rheumatic e%er 'lients that present with mitral stenosis o ten ha%e a history o rheumatic e%er or bacterial endocarditis.

Question 13
3ou are caring or a client with deep %ein thrombosis who is on Geparin 7.. +he latest A,++ is I9 seconds. 7 the laboratory normal range is ;L-A4 seconds, you would anticipate A# maintaining the current heparin dose increasing the heparin as it does not appear &# therapeutic. '# gi%ing protamine sul ate as an antidote. repeating the blood test ; hour a ter gi%ing $# heparin. Review Information* +he correct answer is A* maintaining the current heparin dose +he range or a therapeutic A,++ is ;.I-A times the control. +here ore the client is recei%ing a therapeutic dose o Geparin.

Question 1! Question 15
An E9 year-old client is admitted with a diagnosis o malnutrition. 7n addition to physical assessments, which o the ollowing lab tests should be closely monitored" A# ?rine protein &# ?rine creatinine '# )erum calcium $# )erum albumin Review Information* +he correct answer is $* )erum albumin )erum albumin is a %aluable indicator o protein de iciency and, later, nutritional status in adults. A normal reading or an elders serum albumin is between :.9-I.9 g1dl. Which o these clients should the charge nurse assign to the registered nurse -R/#" A IL year-old with atrial ibrillation A# recei%ing digoBin A L9 year-old client with '=,$ on oBygen &# at A M1min A A4 year-old post-op client with type ; '# diabetes in the process o discharge An E9 year-old client reco%ering A4 hours $# post right hip replacement Review Information* +he correct answer is '* A A4 year-old post-op client with type ; diabetes in the process o discharge $ischarge teaching must be done by an R/. ,ractical nurses -,/s# or unlicensed assisti%e personnel -?A,s# can rein orce education a ter the R/ does the initial teaching.

Question 1" Question 14

A client newly diagnosed with +ype 7 $iabetes 0ellitus as5s the purpose o the test measuring glycosylated hemoglobin. +he nurse should

Question 1
A LL year-old client is admitted or mitral %al%e replacement surgery. +he client has a history o

+he nurse discusses nutrition with a pregnant woman who is iron de icient and ollows a %egetarian diet. +he selection o which oods indicates the woman has learned sources o iron" A# 'ereal and dried ruits

&# Whole grains and yellow %egetables '# Mea y green %egetables and oranges $# (ish and dairy products Review Information* +he correct answer is A* 'ereal and dried ruits &oth o these oods would be a good source o iron.

rest Review Information* +he correct answer is '* D3ou ha%e the right to change your mind. 3ou seem anBious. 'an we tal5 about it"D +his response indicates ac5nowledgment o the clients rights and the opportunity or the client to clari y and %entilate concerns. A ter this, i the client continues to re use, the pro%ider should be noti ied. Review Information* +he correct answer is A* 7ncreasing iber inta5e to A9-:9 grams daily +he incorporation o high iber into the diet is an e ecti%e way to promote bowel elimination in the elderly.

Question 1#
A client diagnosed with gouty arthritis is admitted with se%ere pain and edema in the right oot. When the nurse de%elops a plan o care, which inter%ention should be included" A# high protein diet &# salicylates '# hot compresses to a ected Foints $# inta5e o at least :999cc1day Review Information* +he correct answer is $* inta5e o at least :999cc1day (luid inta5e should be increased to pre%ent precipitation o urate in the 5idneys.

Question 21
A male client is admitted with a spinal cord inFury at le%el '4. +he client as5s the nurse how the inFury is going to a ect his seBual unction. +he nurse would respond A# D/ormal seBual unction is not possible.D D)eBual unctioning will not be impaired at &# all.D '# D<rections will be possible.D $# D<Faculation will be normal.D Review Information* +he correct answer is '* D<rections will be possible.D &ecause they are a re leB reaction, erections can be stimulated by stro5ing the genitalia.

Question 23
+he unlicensed assisti%e personnel -?A,# reports to the nurse that a client with cirrhosis who had a paracentesis yesterday has become more lethargic and has musty smelling breath. A critical assessment or increasing encephalopathy is A# monitor the client4s clotting status &# assess upper abdomen or bruits '# assess or lap-li5e tremors o the hands $# measure abdominal girth changes Review Information* +he correct answer is '* assess or lap-li5e tremors o the hands A client with cirrhosis o the li%er who de%elops subtle changes in mental status and has a musty odor to the breath is at ris5 or de%eloping more ad%anced signs o encephalopathy.

Question 2$
=ne hour be ore the irst treatment is scheduled, the client becomes anBious and states he does not wish to go through with electrocon%ulsi%e therapy. Which response by the nurse is most appropriate" D7ll go with you and will be there with you A# during the treatment.D D3oull be asleep and wont remember &# anything.D D3ou ha%e the right to change your mind. '# 3ou seem anBious. 'an we tal5 about it"D D7ll call the health care pro%ider to noti y $# them o your decision.D

Question 22
An EA year-old client complains o chronic constipation. +o impro%e bowel unction, the nurse should first suggest A# 7ncreasing iber inta5e to A9-:9 grams daily &# $aily use o laBati%es A%oidance o binding oods such as cheese '# and chocolate $# 0onitoring a balance between acti%ity and

Question 24
A client is admitted with a diagnosis o nodal bigeminy. +he nurse 5nows that the atrio%entricular -A.# node has an intrinsic rate o A# L9-;99 beats1minute &# ;9-:9 beats1minute '# 49-89 beats1minute $# A9-I9 beats1minute

Question 2!
Review Information* +he correct answer is '* 4989 beats1minute +he intrinsic rate o the A. node is within the range o 49-89 beats per minute. +he nurse is teaching a client with chronic renal ailure -'R(# about medications. +he client !uestions the purpose o aluminum hydroBide -AmphoFel# in her medication regimen. What is the best eBplanation or the nurse to gi%e the client about the therapeutic e ects o this medication" A# 7t decreases serum phosphate &# 7t will reduce serum calcium '# AmphoFel increases urine output +he drug is ta5en to control gastric acid $# secretion
Review Information* +he correct answer is A* 7t decreases serum phosphate Aluminum binds phosphates that tend to accumulate in the patient with chronic renal ailure due to decreased iltration capacity o the 5idney. Antacids such as AmphoFel are commonly used to accomplish this. Review Information* +he correct answer is A* Reduce %ascularity o the thyroid ,otassium iodide solution, or Mugol44s solution may be used preoperati%ely to reduce the si2e and %ascularity o the thyroid gland.

Question 25
A client is admitted or a possible pacema5er insertion. What is the intrinsic rate o the heart4s own pacema5er" A# :9-I9 beats1minute &# L9-;99 beats1minute '# A9-L9 beats1minute $# J9-;99 beats1minute Review Information* +he correct answer is &* L9;99 beats1minute +his is the intrinsic rate o the )A node.

Question 2#
A client with testicular cancer has had an orchiectomy. ,rior to discharge the client eBpresses his ears related to his prognosis. Which principle should the nurse base the response on" +esticular cancer has a cure rate o J9K with A# early diagnosis +esticular cancer has a cure rate o I9K with &# early diagnosis 7ntensi%e chemotherapy is the treatment o '# choice $# +esticular cancer is usually atal
Review Information* +he correct answer is A* +esticular cancer has a cure rate o J9K with early diagnosis With aggressi%e treatment and early detection1diagnosis the cure rate is J9K.

Question 2
A client is diagnosed with gastroesophageal re luB disease -><R$#. +he nurse4s instruction to the client regarding diet should be to A# a%oid all raw ruits and %egetables &# increase inta5e o mil5 products '# decrease inta5e o atty oods $# ocus on : a%erage si2e meals a day Review Information* +he correct answer is '* decrease inta5e o atty oods ><R$ may be aggra%ated by a atty diet. A diet low in at would decrease the symptoms o ><R$. =ther agents which should also be decreased or a%oided are* cigarette smo5ing, ca eine, alcohol, chocolate, and meperidine -$emerol#.

Question 2"
+he client with goiter is treated with potassium iodide preoperati%ely. What should the nurse recogni2e as the purpose o this medication" A# Reduce %ascularity o the thyroid &# 'orrect chronic hyperthyroidism '# $estroy the thyroid gland unction $# &alance en2ymes and electrolytes

Question 3$
+he nurse is caring or clients o%er the age o 89. +he nurse is aware that when gi%ing medications to older clients, it is %est to A# start low, go slow &# a%oid stopping a medication entirely a%oid drugs with side e ects that impact '# cognition

$# re%iew the drug regimen yearly

Review Information* +he correct answer is A* start low, go slow $ue to physiological changes in the elderly, as well as conditions such as dehydration, hyperthermia, immobility and li%er disease, the e ecti%e metabolism o drugs may decrease. As a result, drugs can accumulate to toBic le%els and cause serious ad%erse reactions. Review Information* +he correct answer is &* 'ompleting the ull course o medications 7n order or antibiotic therapy to be e ecti%e in eradicating an in ection, the client must compete the entire course o prescribed therapy. When indings subside, stopping the medication early may lead to recurrence or subse!uent drug resistance.

Review Information* +he correct answer is '* $eeply or :-4 seconds +he client should be instructed to breath in the medication or :-4 seconds in order to recei%e the correct dosage o medication.

Question 35 Question 33 Question 31

+he nurse enters the room o a client diagnosed with '=,$. +he clients s5in is pin5, and respirations are E per minute. +he clients oBygen is running at L liters per minute. What should be the nurses first action" A# 'all the health care pro%ider &# ,ut the client in (owlers position '# Mower the oBygen rate $# +a5e the %ital signs Review Information* +he correct answer is '* Mower the oBygen rate 7n clients diagnosed with '=,$, the dri%e to breathe is hypoBia. 7 oBygen is deli%ered at too high o a concentration, this dri%e will be eliminated and the clients depth and rate o respirations will decrease. +here ore the irst action should be to lower the oBygen rate. A II year-old woman is ta5ing ,rednisone and aspirin -A)A# as part o her treatment or rheumatoid arthritis. Which o the ollowing would be an appropriate inter%ention or the nurse" A# Assess the pulse rate ! 4 hours &# 0onitor her le%el o consciousness ! shi t '# +est her stools or occult blood $iscuss iber in the diet to pre%ent $# constipation
Review Information* +he correct answer is '* +est her stools or occult blood &oth ,rednisone and A)A can lead to >7 bleeding, there ore monitoring or occult blood would be appropriate.

A ter surgery, a client with a nasogastric tube complains o nausea. What action would the nurse ta5e" A# 'all the health care pro%ider &# Administer an antiemetic '# ,ut the bed in (owlers position $# 'hec5 the patency o the tube Review Information* +he correct answer is $* 'hec5 the patency o the tube An indication that the nasogastric tube is obstructed is a clients complaint o nausea. /asogastric tubes may become obstructed with mucus or sediment.

Question 32
A client has an order or antibiotic therapy a ter hospital treatment o a staph in ection. Which o the ollowing should the nurse emphasi2e" A# )cheduling ollow-up blood cultures &# 'ompleting the ull course o medications '# .isiting the pro%ider in a ew wee5s $# 0onitoring or signs o recurrent in ection

Question 34
A client is prescribed an inhaler. Gow should the nurse instruct the client to breathe in the medication" A# As !uic5ly as possible &# As slowly as possible '# $eeply or :-4 seconds $# ?ntil hearing whistling by the spacer

Question 3
A 8A year-old client is admitted or possible dehydration. +he nurse 5nows that older adults are particularly at ris5 or dehydration because they ha%e A# an increased need or eBtra%ascular luid &# a decreased sensation o thirst '# an increase in diaphoresis $# higher metabolic demands

$# ;9 minutes
Review Information* +he correct answer is &* a decreased sensation o thirst +he elderly ha%e a reduction in thirst sensation causing them to consume less luid. =ther ris5 actors may include ear o incontinence, inability to drin5 luids independently and lac5 o moti%ation.

Review Information* +he correct answer is &* I minutes 7t is necessary to apply pressure to the area or I minutes to pre%ent bleeding and the ormation o hematomas.

Questions are numbered by the order in which they appeared in the test. * Represents the correct answer.

Question 1
An older adult client is to recei%e and antibiotic, gentamicin. What diagnostic inding indicates the client may ha%e di icult eBcreting the medication" A# Gigh gastric pG &# Gigh serum creatinine '# Mow serum albumin $# Mow serum blood urea nitrogen Review Information* +he correct answer is &* Gigh serum creatinine An ele%ated serum creatinine indicates reduced renal unction. Reduced renal unction will delay the eBcretion o many medications.

Question 3!
?pon admission to an intensi%e care unit, a client diagnosed with an acute myocardial in arction is ordered oBygen. +he nurse 5nows that the ma&or reason that oBygen is administered in this situation is to A# saturate the red blood cells &# relie%e dyspnea '# decrease cyanosis $# increase oBygen le%el in the myocardium
Review Information* +he correct answer is $* increase oBygen le%el in the myocardium AnoBia o the myocardium occurs in myocardial in arction. =Bygen administration will help relie%e dyspnea and cyanosis associated with the condition but the maFor purpose is to increase the oBygen concentration in the damaged myocardial tissue.

Question 3#
A client recei%ing chemotherapy has de%eloped sores in his mouth. Ge as5s the nurse why this happened. What is the nurses best response" A# D7t is a sign that the medication is wor5ing.D &# D3ou need to ha%e better oral hygiene.D D+he cells in the mouth are sensiti%e to the '# chemotherapy.D $# D+his always happens with chemotherapy.D Review Information* +he correct answer is '* D+he cells in the mouth are sensiti%e to the chemotherapy.D +he epithelial cells in the mouth are %ery sensiti%e to chemotherapy due to their high rate o cell turno%er.

Question 4$
A client with testicular cancer is scheduled or a right orchiectomy. +he nurse 5nows that an orchiectomy is the A# surgical remo%al o the entire scrotum &# surgical remo%al o a testicle '# dissection o related lymph nodes $# partial surgical remo%al o the penis Review Information* +he correct answer is &* surgical remo%al o a testicle +he a ected testicle is surgically remo%ed along with its tunica and spermatic cord. Q&A-Ran'om (1

Question 2
A client is admitted to the hospital with indings o li%er ailure with ascites. +he health care pro%ider orders spironolactone -Aldactone#. What is the pharmacological e ect o this medication" A# ,romotes sodium and chloride eBcretion &# 7ncreases aldosterone le%els '# $epletes potassium reser%es $# 'ombines sa ely with antihypertensi%es Review Information* +he correct answer is A* ,romotes sodium and chloride eBcretion )pironolactone promotes sodium and chloride eBcretion while sparing potassium and decreasing aldosterone le%els. 7t had no e ect on ammonia

Question 3"
An arterial blood gases test -A&># is ordered or a con used client. +he respiratory therapist draws the blood and then as5s the nurse to apply pressure to the area so the therapist can ta5e the specimen to the lab. Gow long should the nurse apply pressure to the area" A# : minutes &# I minutes '# E minutes

le%els.

Question 3
A client with tuberculosis is started on Ri ampin. Which one o the ollowing statements by the nurse would be appropriate to include in teaching" D3ou may notice* A# an orange-red color to your urine.D your appetite may increase or the irst &# wee5.N it is common to eBperience occasional sleep '# disturbances.D i you ta5e the medication with ood, you $# may ha%e nausea.D
Review Information* +he correct answer is A* an orangered color to your urine.D $iscoloration o the urine and other body luids may occur. 7t is a harmless response to the drug, but the patient needs to be aware it may happen.

Review Information* +he correct answer is '* As5 about prior eBperience with similar clients +he irst step in delegation is to determine the !uali ications o the person to whom one is delegating. &y as5ing about the ,/44s prior eBperience with similar clients1tas5s, the R/ can determine whether the ,/ has the re!uisite eBperience to care or the assigned clients.

Review Information* +he correct answer is $* D)how me what you ha%e learned about emptying your pouch.D 0ost adult learners obtain s5ills by participating in the acti%ities. AnBiety about discharge can be causing the client to orget that they ha%e mastered the s5ill o emptying the pouch. +he client should show the nurse how the pouch is emptied.

Question 5
Which o the ollowing assessments by the nurse would indicate that the client is ha%ing a possible ad%erse response to the isonia2id -7/G#" A# )e%ere headache &# Appearance o Faundice '# +achycardia $# $ecreased hearing
Review Information* +he correct answer is &* Appearance o Faundice 'lients recei%ing 7/G therapy are at ris5 or de%eloping drug induced hepatitis. +he appearance o Faundice may indicate that the client has li%er damage.

Question !
A post-operati%e client is admitted to the postanesthesia reco%ery room -,A'?#. +he anesthetist reports that malignant hyperthermia occurred during surgery. +he nurse recogni2es that this complication is related to what actor" A# Allergy to general anesthesia &# ,re-eBisting bacterial in ection '# A genetic predisposition $# )elected surgical procedures Review Information* +he correct answer is '* A genetic predisposition 0alignant hyperthermia is a rare, potentially atal ad%erse reaction to inhaled anesthetics. +here is a genetic predisposition to this disorder.

Question 4
+he nurse has Fust recei%ed report on a group o clients and plans to delegate care o se%eral o the clients to a practical nurse -,/#. +he first thing the R/ should do be ore the delegation o care is ,ro%ide a time- rame or the completion o A# the client care Assure the ,/ that the R/ will be a%ailable &# or assistance As5 about prior eBperience with similar '# clients Re%iew the speci ic procedures uni!ue to the $# assignment

Question
+he nurse is caring or a client who is 4 days postop or a trans%erse colostomy. +he client is ready or discharge and as5s the nurse to empty his colostomy pouch. What is the best response by the nurse" D3ou should be emptying the pouch A# yoursel .D DMet me demonstrate to you how to empty &# the pouch.D DWhat ha%e you learned about emptying '# your pouch"D D)how me what you ha%e learned about $# emptying your pouch.D

Question "
Which o the ollowing laboratory results would suggest to the emergency room nurse that a client admitted a ter a se%ere motor %ehicle crash is in acidosis" A# Gemoglobin ;I gm1dl &# 'hloride ;99 m<!1M '# )odium ;:9 m<!1M $# 'arbon dioBide A9 m<!1M Review Information* +he correct answer is $* 'arbon dioBide A9 m<!1M )erum carbon dioBide is an indicator o acid-base status. +his inding would indicate acidosis.

Question 11 Question #
+he nurse is teaching a school-aged child and amily about the use o inhalers prescribed or asthma. What is the best way to e%aluate e ecti%eness o the treatments" A# Rely on child4s sel -report &# ?se a pea5- low meter '# /ote s5in color changes $# 0onitor pulse rate
Review Information* +he correct answer is &* ?se a pea5- low meter +he pea5 lowmeter, i used correctly, shows e ecti%eness o inhalants.

A client on telemetry begins ha%ing premature %entricular beats -,.&s# at ;A per minute. 7n re%iewing the most recent laboratory results, which would re!uire immediate action by the nurse" A# 'alcium J mg1dl &# 0agnesium A.I mg1dl '# ,otassium A.I m<!1M $# ,++ 89 seconds Review Information* +he correct answer is '* ,otassium A.I m<!1M +he patient is at ris5 or %entricular dysrhythmias when the potassium le%el is low.

<Bploring eelings with the %erbally aggressi%e client helps to put angry eelings into words and then to engage in problem sol%ing.

Question 13
A ;A year-old child is admitted with a bro5en arm and is told surgery is re!uired. +he nurse inds him crying and unwilling to tal5. What is the most appropriate response by the nurse" A# >i%e him pri%acy +ell him he will get through the surgery with &# no problem '# +ry to distract him $# 0a5e arrangements or his riends to %isit
Review Information* +he correct answer is A* >i%e him pri%acy A ;A year-old child needs the opportunity to eBpress his emotions pri%ately.

Question 1$
+he nurse is pro%iding care to a newly a hospitali2ed adolescent. What is the maFor threat eBperienced by the hospitali2ed adolescent" A# ,ain management &# Restricted physical acti%ity '# Altered body image $# )eparation rom amily
Review Information* +he correct answer is '* Altered body image +he hospitali2ed adolescent may see each o these as a threat, but the maFor threat that they eel when hospitali2ed is the ear o altered body image, because o the emphasis on physical appearance during this de%elopmental stage.

Question 12
A client has Fust been diagnosed with breast cancer. +he nurse enters the room and the client tells the nurse that she is stupid. What is the most therapeutic response by the nurse" A# <Bplore what is going on with the client Accept the clients statement without &# comment +ell the client that the comment is '# inappropriate $# Mea%e the client4s room Review Information* +he correct answer is A* <Bplore what is going on with the client

Question 14
A nurse is assigned to care or a comatose diabetic on 7. insulin therapy. Which tas5 would be most appropriate to delegate to an unlicensed assisti%e personnel -?A,#" A# 'hec5 the client4s le%el o consciousness &# =btain the regular blood glucose readings '# $etermine i special s5in care is needed Answer !uestions rom the client4s spouse $# about the plan o care
Review Information* +he correct answer is &* =btain the

$# /eutrophil percent
regular blood glucose readings +he ?A, can sa ely obtain blood glucose readings, which are routine tas5s. Review Information* +he correct answer is &* Question this medication dose &upropion -Wellbutrin# should be started at ;99mg &7$ or three days then increased to ;I9mg &7$. When used or depression, it may ta5e up to our wee5s or results. 'ommon side e ects are dry mouth, headache, and agitation. $oses should be administered in e!ually spaced time increments throughout the day to minimi2e the ris5 o sei2ures. Review Information* +he correct answer is A* Gemoglobin Gemoglobin should be in a therapeutic range o approBimately ;9 g1dl -;99gM#. D+his le%el is low enough to oster the patient44s own erythropoiesis without enlarging the spleen.D -Mewis, p. 844#

Question 15
+he clinic nurse is discussing health promotion with a group o parents. A mother is concerned about Reye4s )yndrome, and as5s about pre%ention. Which o these demonstrates appropriate teaching" A# D7mmuni2e your child against this disease.D &# D)ee5 medical attention or serious inFuries.D '# DReport eBposure to this illness.D $# DA%oid use o aspirin or %iral in ections.D Review Information* +he correct answer is $* DA%oid use o aspirin or %iral in ections.D +he lin5 between aspirin use and Reye44s )yndrome has not been con irmed, but e%idence suggests that the ris5 is su iciently gra%e to include the warning on aspirin products.

Question 1# Question 1!
A : year-old child has tympanostomy tubes in place. +he child4s parent as5s the nurse i he can swim in the amily pool. +he %est response rom the nurse is D3our child should not swim at all while the A# tubes are in place.D D3our child may swim in your own pool but &# not in a la5e or ocean.D D3our child may swim i he wears ear '# plugs.D $# D3our child may swim anywhere.D
Review Information* +he correct answer is '* D3our child may swim i he wears ear plugs.D Water should not enter the ears. 'hildren should use ear plugs when bathing or swimming and should not put their heads under the water.

+he nurse is eBplaining the e ects o cocaine abuse to a pregnant client. Which o the ollowing must the nurse understand as a basis or teaching" 'ocaine use can cause etal growth A# retardation +he drug has been lin5ed to neural tube &# de ects /ewborn withdrawal generally occurs '# immediately a ter birth &reast eeding promotes positi%e parenting $# beha%iors
Review Information* +he correct answer is A* 'ocaine use can cause etal growth retardation 'ocaine is %asoconstricti%e, and this e ect in the placental %essels causes etal hypoBia and diminished growth. =ther ris5s o continued cocaine use during pregnancy include preterm labor, congenital abnormalities, altered brain de%elopment and subse!uent beha%ioral problems in the in ant.

Question 1
+he nurse is caring or a client with a new order or bupropion -Wellbutrin# or treatment o depression. +he order reads OWellbutrin ;8I mg. &7$ B 4 days.N What is the appropriate action" A# >i%e the medication as ordered &# Question this medication dose '# =bser%e the client or mood swings $# 0onitor neuro signs re!uently

Question 1"
A nurse has administered se%eral blood trans usions o%er : days to a ;A year-old client with +halassemia. What lab %alue should the nurse monitor closely during this therapy" A# Gemoglobin &# Red &lood 'ell 7ndices '# ,latelet count

Question 2$
+he eeling o trust can %est be established by the nurse during the process o the de%elopment o a nurse-client relationship by which o these characteristics" A# Reliability and 5indness &# $emeanor and sincerity

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'# Gonesty and consistency $# )ympathy and appreciati%eness Review Information* +he correct answer is '* Gonesty and consistency 'haracteristics o a trusting relationship include respect, honesty, consistency, aith and caring.

years is best.D D=nce a woman reaches I9, she should ha%e '# a mammogram yearly.D D3early mammograms are ad%ised or all $# women o%er :I.D
Review Information* +he correct answer is '* D=nce a woman reaches I9, she should ha%e a mammogram yearly.D +he American 'ancer )ociety recommends a screening mammogram by age 49, e%ery ; - A years or women 494J, and e%ery year rom age I9. 7 there are amily or personal health ris5s, other assessments may be recommended.

other clients" D3our team here thin5s it4s good or you to A# spend time with others.D D7t is important or you to participate in &# group acti%ities.D D'ome with me so you can paint a picture to '# help you eel better.D D'ome play 'hinese 'hec5ers with >loria $# and me.D
Review Information* +he correct answer is $* D'ome play 'hinese 'hec5ers with >loria and me.D +his gradually engages the client in interactions with others in small groups rather than large groups. 7n addition, ocusing on an acti%ity is less anBiety-pro%o5ing than unstructured discussion. +he statement is an eBample o a positi%e beha%ioral eBpectation.

Question 21
A client is recei%ing and 7. antibiotic in usion and is scheduled to ha%e blood drawn at ;*99 pm or a Dpea5D antibiotic le%el measurement. +he nurse notes that the 7. in usion is running behind schedule and will not be competed by ;*99. +he nurse should* A# /oti y the client4s health care pro%ider &# )top the in usion at ;*99 pm '# Reschedule the laboratory test $# 7ncrease the in usion rate Review Information* +he correct answer is '* Reschedule the laboratory test 7 the antibiotic in usion will not be completed at the time the pea5 blood le%el is due to be drawn, the nurse should as5 that the blood sampling time be adFusted

Question 23
7n discharge teaching, the nurse should emphasi2e that which o these is a common side e ect o clo2apine -'lo2aril# therapy" A# $ry mouth &# Rhinitis '# $ry s5in $# <Btreme sali%ation Review Information* +he correct answer is $* <Btreme sali%ation A signi icant number o clients recei%ing 'lo2apine -'lo2aril# therapy eBperience eBtreme sali%ation.

Question 25
+he mother o a 4 month-old in ant as5s the nurse about the dangers o sunburn while they are on %acation at the beach. Which o the ollowing is the best ad%ice about sun protection or this child" D?se a sunscreen with a minimum sun A# protecti%e actor o ;I.D DApplications o sunscreen should be &# repeated e%ery ew hours.D DAn in ant should be protected by the '# maBimum strength sunscreen.D D)unscreens are not recommended in $# children younger than L months.D
Review Information* +he correct answer is $* D)unscreens are not recommended in children younger than L months.D 7n ants under L months o age should be 5ept out o the sun or shielded rom it. <%en on a cloudy day, the in ant can be sunburned while near water. A hat and light protecti%e clothing should be worn.

Question 22
A IA year-old post menopausal woman as5s the nurse how re!uently she should ha%e a mammogram. What is the nurse4s best response" D3our doctor will ad%ise you about your A# ris5s.D &# D?nless you had pre%ious problems, e%ery A

Question 24
A client was admitted to the psychiatric unit or se%ere depression. A ter se%eral days, the client continues to withdraw rom the other clients. Which o these statements by the nurse would be the most appropriate to promote interaction with

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Question 2
A client has had a positi%e reaction to puri ied protein deri%ati%e -,,$#. +he client as5s the nurse what this means. +he nurse should indicate that the client has A# acti%e tuberculosis &# been eBposed to mycobacterium tuberculosis '# ne%er had tuberculosis ne%er been in ected with mycobacterium $# tuberculosis Review Information* +he correct answer is &* been eBposed to mycobacterium tuberculosis +he ,,$ s5in test is used to determine the presence o tuberculosis antibodies and a positi%e result indicates that the person has been eBposed to mycobacterium tuberculosis. Additional tests are needed to determine i acti%e tuberculosis is present.

&# Mi%er unction '# 0ental status $# Gemoglobin Review Information* +he correct answer is '* 0ental status +he elderly are at ris5 or de%eloping con usion when ta5ing cimetidine, a drug that interacts with many other medications.

responses. 'lients recei%ing cyclosporin are at ris5 or in ection.

Question 3$
A client with paranoid thoughts re uses to eat because o the belie that the ood is poisoned. +he a))ro)riate statement at this time for the nurse to say is DGere, 7 will pour a little o the Fuice in a A# medicine cup to drin5 it to show you that it is =P.D D+he ood has been prepared in our 5itchen &# and is not poisoned.D DMet4s see i your partner could bring ood '# rom home.D D7 you don4t eat, 7 will ha%e to suggest or $# you to be tube ed.D Review Information* +he correct answer is '* DMet44s see i your partner could bring ood rom home.D Reassurance is ine ecti%e when a client is acti%ely delusional. +his option a%oids both arguing with the client and agreeing with the delusional premise. =ption $ o ers a logical response to a primarily a ecti%e concern. When the clients condition has impro%ed, gentle negation o the delusional premise can be employed.

Question 2"
A J year-old is ta5en to the emergency room with right lower !uadrant pain and %omiting. When preparing the child or an emergency appendectomy, what must the nurse eBpect to be the child4s greatest ear" A# 'hange in body image &# An un amiliar en%ironment '# ,ercei%ed loss o control $# >uilt o%er being hospitali2ed Review Information* +he correct answer is '* ,ercei%ed loss o control (or school age children, maFor ears are loss o control and separation rom riends1peers.

Question 2#
+he nurse is planning care or a client who is ta5ing cyclosporin -/eoral#. What would be an appropriate nursing diagnosis or this client" A# Alteration in body image &# Gigh ris5 or in ection '# Altered growth and de%elopment $# 7mpaired physical mobility Review Information* +he correct answer is &* Gigh ris5 or in ection 'yclosporin -/eoral# inhibits normal immune

Question 31
A client has many delusions. As the nurse helps the client prepare or brea5 ast the client comments D$ont waste good ood on me. 7m dying rom this disease 7 ha%e.D +he appropriate response would be D3ou need some nutritious ood to help you A# regain your weight.D

Question 2!
+he nurse administers cimetidine -+agamet# to a 8J year-old male with a gastric ulcer. Which parameter may be a ected by this drug, and should be closely monitored by the nurse" A# &lood pressure

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D/one o the laboratory reports show that you ha%e any physical disease.D D+ry to eat a little bit, brea5 ast is the most '# important meal o the day.D D7 5now you belie%e that you ha%e an $# incurable disease.D &# Review Information* +he correct answer is $* D7 5now you belie%e that you ha%e an incurable disease.D +his response does not challenge the clients delusional system and thus orms an alliance by pro%iding reassurance o desire to help the client.

Question 33
+he nurse is beginning nutritional counseling1teaching with a pregnant woman. What is the initial step in this interaction" +each her how to meet the needs o sel and A# her amily <Bplain the changes in diet necessary or &# pregnant women Question her understanding and use o the '# ood pyramid 'onduct a diet history to determine her $# normal eating routines Review Information* +he correct answer is $* 'onduct a diet history to determine her normal eating routines Assessment is always the irst step in planning teaching or any client. A thorough and accurate history is essential or gathering the needed in ormation.

&# reduce ammonia le%els '# stimulate peristalsis $# control portal hypertension Review Information* +he correct answer is &* reduce ammonia le%els Mactulose bloc5s the absorption o ammonia rom the >7 tract and secondarily stimulates bowel elimination.

Question 35
+he nurse is teaching a client about the toBicity o digoBin. Which one o the ollowing statements made by the client to the nurse indicates more teaching is needed" A# D7 may eBperience a loss o appetite.D &# D7 can eBpect occasional double %ision.D '# D/ausea and %omiting may last a ew days.D D7 must report a bounding pulse o LA $# immediately.D Review Information* +he correct answer is $* D7 must report a bounding pulse o LA immediately.D )low heart rate is related to increased cardiac output and an intended e ect o digoBin. +he ideal heart rate is abo%e L9 &,0 with digoBin. +he client needs urther teaching.

Question 32
A client tells the R/ she has decided to stop ta5ing sertraline -Qolo t# because she doesnt li5e the nightmares, seB dreams, and obsessions shes eBperiencing since starting on the medication. What is an appropriate response by the nurse" D7t is unsa e to abruptly stop ta5ing any A# prescribed medication.D D)ide e ects and bene its should be &# discussed with your health care pro%ider.D D+his medication should be continued '# despite unpleasant symptoms.D D0any medications ha%e potential side $# e ects.D Review Information* +he correct answer is A* D7t is unsa e to abruptly stop ta5ing any prescribed medication.D Abrupt withdrawal may occasionally cause serotonin syndrome, consisting o lethargy, nausea, headache, e%er, sweating and chills. A slow withdrawal may be prescribed with sertraline to a%oid di22iness, nausea, %omiting, and diarrhea.

Question 34
A client diagnosed with cirrhosis is started on lactulose -'ephulac#. +he main purpose o the drug or this client is to A# add dietary iber

Question 3
A client is to begin ta5ing (osamaB. +he nurse must emphasi2e which o these instructions to the client when ta5ing this medication" D+a5e (osamaB A# on an empty stomach.D

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&# a ter meals.D '# with calcium.D $# with mil5 A hours a ter meals.D
Review Information* +he correct answer is A* on an empty stomach.D (osamaB should be ta5en irst thing in the morning with LE ounces o plain water at least :9 minutes be ore other medication or ood. (ood and luids -other than water# greatly decrease the absorption o (osamaB. +he client must also be instructed to remain in the upright position or :9 minutes ollowing the dose to acilitate passage into the stomach and minimi2e irritation o the esophagus.

Question 3"
+he nurse is caring or a client with asthma who has de%eloped gastroesophageal re luB disease -><R$#. Which o the ollowing medications prescribed or the client may aggra%ate ><R$" A# Anticholinergics &# 'orticosteroids '# Gistamine bloc5er $# Antibiotics Review Information* +he correct answer is A* Anticholinergics An anticholinergic medication will decrease gastric emptying and the pressure on the lower esophageal sphincter.

most li5ely to be displayed" A# Ambi%alence, dependence, demanding &# $enial, proFection, regression '# 7ntellectuali2ation, rationali2ation, repression $# 7denti ication, assimilation, withdrawal Review Information* +he correct answer is &* $enial, proFection, regression Gelplessness and hopelessness may contribute to regressi%e, dependent beha%ior which o ten occurs at any age with hospitali2ation. $enying or minimi2ing the seriousness o the illness is used to a%oid acing the worst situation. Recall that denial is the initial step in the process o wor5ing through any loss.

Question 3!
+he nurse is caring or a ;9 year-old child who has Fust been diagnosed with diabetes insipidus. +he parents as5 about the treatment prescribed, %asopressin. A What is priority in teaching the child and amily about this drug" +he child should carry a nasal spray or A# emergency use +he amily must obser%e the child or &# dehydration ,arents should administer the daily '# intramuscular inFections +he client needs to ta5e daily inFections in $# the short-term Review Information* +he correct answer is A* +he child should carry a nasal spray or emergency use $iabetes insipidus results rom reduced secretion o the antidiuretic hormone, %asopressin. +he child will need to administer daily inFections o %asopressin, and should ha%e the nasal spray orm o the medication readily a%ailable. A medical alert tag should be worn.

Question 3#
A client is recei%ing a nitroglycerin in usion or unstable angina. What assessment would be a priority when monitoring the e ects o this medication" A# &lood pressure &# 'ardiac en2ymes '# <'> analysis $# Respiratory rate Review Information* +he correct answer is A* &lood pressure )ince an e ect o this drug is %asodilation, the client must be monitored or hypotension.

Question 4$
+he nurse assesses the use o coping mechanisms by an adolescent ; wee5 a ter the client had a motor %ehicle accident resulting in multiple serious inFuries. Which o these characteristics are

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