Exam 2 Flashcards by Sarahi Lawson

A 58 year old patient with type 2 diabetes takes Glipizide (Glucotrol) 5 mg by mouth daily, which has always well controlled the diabetes. However, recently the patient’s fasting blood glucose has measured between 200 and 220 mg/dL. Which of the following medications may have been added to the patient’s regimen that would explain the increased blood glucose?

Prednisone (Deltasone)

Causes severe hyperglycemia

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When assessing a patient who has Cushing’s syndrome from chronic use of glucocorticoids, the nurse associates which of the following with this disorder?

Buffalo Hump
Mood changes
Moon face
Elevated blood glucose

Cushing’s syndrome results from excess levels of exogenous glucocorticoids which are frequently used in treating a variety of disorders. These effects result in manifestations such as redistribution of fat to the face and belly, excess blood sugar, mood changes, and weight gain,

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Which instructions should the nurse provide when teaching a patient to mix and inject regular insulin and NPH insulin in the same syringe?

“You will need to gently rotate the NPH vial before drawing up the insulin.”
“Rotate subcutaneous injection sites each day among the arm, thigh, and abdomen.”
“Draw up the clear regular insulin first, followed by the cloudy NPH insulin.”

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A nurse is caring for a patient who is NPO for surgery scheduled at 1000. He routinely receives 30 units of Humulin 70/30 every morning at 0700. What is the appropriate nursing action in this situation?

Contact the physician for a pre-surgery insulin order.

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Which manifestations should a nurse investigate first when monitoring a patient who is taking levothyroxine (Synthroid)?

Tachycardia

Excess amount of levothyroxine may cause a drug induced thyrotoxicosis, a condition of profound excessive thyroid activity. Tachycardia is the priority assessment, because it can lead to severe cardiac dysfunction. (Remember - the ABCs!) Tremors, insomnia, and irritability are other symptoms of thyroid excess and should be assessed after tachycardia.

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The peak of insulin is when the medication is at maximum strength and patient is at highest risk for hypoglycemia.

True

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The nurse is discussing with the patient how metformin (Glucophage) works to manage blood sugar. What is the best explanation for the use of this drug?

It decreases the amount of glucose made in the liver.

Metformin works to decrease blood sugars by decreasing the amount of glucose made in the liver, decreasing intestinal absorption of glucose, and promoting the use of peripherally stored glucose.

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The parent of high school child with Type 1 diabetes asks the nurse if the child can participate in sports. The nurse responds to the parent stating:

“Yes they can. Make sure the child has a snack to eat prior to playing sports because hypoglycemia is more likely to occur.”

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The nurse should caution the client with diabetes mellitus who is taking a sulfonylurea that alcoholic beverages should be avoided while taking these drugs because they can cause which of the following?

Disulfiram like reaction

use of etoh with sulfonyureas can cause the antabuse like reactions - vomiting, headache, etc…

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A patient is being discharged after having an upper endoscopy procedure and has been diagnosed with gastritis with biopsies taken from the stomach to rule out H. Pylori. The patient asks what the treatment to get rid of H. Pylori is. What is the best response by the nurse?

Antibiotics
PPIs (proton pump inhibitors)
Bismuth subsalicylate

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A patient is taking famotidine. What information should the nurse teach the patient about this drug?

The drug should be administered for 4-8 weeks
The drug should be administered separately from iron by at least 1 hour.
Smoking should be avoided while taking this drug.

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The nurse is caring for a patient taking diphenoxylate an antidiarrheal drug. The patient is an EMT and asks about the atropine in the medication and why it is in this medication combination. What is the correct response by the nurse?

Its adverse effects limit abuse of the drug.

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Slowing down intestinal motility with drugs in uncomplicated diarrhea can ____ traveler’s diarrhea.

Prolong

Since it’s a bacteria, slowing the motility will prolong it.

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What is the most important teaching the nurse can provide regarding bulk forming laxatives?

They should be taken with 8oz of water or juice.

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What directive should be included in instruction administration of bisacodyl tablets?

You should not take antacids within 1 hour of taking the laxative.

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When collecting a medication history from a patient with primary open-angle glaucoma, the nurse identified several drugs that could exacerbate glaucoma. Which drug possesses a priority concern for this particular patient?

Prednisone a corticosteroid

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The nurse is demonstrating to the patient of a 2 yo child how to administer ear drops. What is a correct statement?

Pull down and back on the ear
Position the child’s ear with the affected ear up.

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What is the most common side effect/adverse reaction associated with prostaglandin analogues for the treatment of glaucoma?

Change in the color of the iris.

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A child is treated four times during the summer for external ear infections or “swimmer’s ear”. The nurse teaches the family to prevent these infections by….

Using custom-fitted earplugs.

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A client has been started on prednisone (Deltasone) for bronchitis to decrease inflammation. What time frame would be best to take it?

With meals to avoid GI upset.

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Which drugs should be used with caution when tanking a glucocorticoid?

NSAIDs
Aspirin
Potassium wasting diuretics.

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A patient taking (Dia Beta) asks about drug interactions while taking a sulfonylurea. What would be the correct response by the nurse?

Antacids
Anticonvulsants
Aspirin
cimetidine

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Insulin glargine is a long-acting insulin. What statement best describes insulin glargine?

Is safe because hypoglycemia cannot occur.
It is available in a prefilled cartridge insulin pen.
Some patients complain of pain at the injection site.

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Which intravenous (IV) fluid would be most appropriate for treating an isotonic volume depletion?

0.9% sodium chloride

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The nurse is teaching a patient who has a new prescription for spironolactone (Aldactone). Which statement by the patient indicates that the teaching was effective?

“I will avoid salt substitutes as they are high in potassium.”

The nurse is caring for a patient newly diagnosed with hypertension. Blood Pressure readings over the past 8 hours have been 0800- 164/93 mmHg, 1200- 158/90 mmHg, & 1600- 166/94 mmHg. The HCP prescribes a no added salt diet and plans to start the patient on hydrochlorothiazide (HCTZ) 25 mg. What action is MOST important for the nurse to take before administering this drug?

Check the patients serum potassium level

The nurse is explaining about the differences between 1st generation antihistamines such as diphenhydramine (Benadryl) and 2nd generation antihistamines such as loratidine (Claritin). Which of the following is correct regarding 2nd generation antihistamines?

They cause less central nervous system sedation.

A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan?

High-dose albuterol [Proventil] via nebulizer treatment

Which finding in a patient who has been taking phenylephrine [Neosynephrine] nasal spray every 2 hours for several days would indicate that the patient has developed an adverse effect?

Worsening of congestion and stuffiness

A child with an ear infection is prescribed liquid amoxicillin 20 mg/kg Q 8 hours. The patient weighs 12 kgs. How many milligrams of amoxicillin will the nurse give with each dose?

240 mg 20 mg/kg x 12 kg = 240 mg

The patient has a serum potassium level of 6.3 mEq/L. What clinical manifestation would the nurse expect to assess in this patient?

Bradycardia A 6.3 K level is hyperkalemia. While symptoms may vary, high levels of potassium can have a depressant effect on the heart, so watch for slowing of the rate or evidence of a heart block.

The nurse is preparing to administer a transfusion of packed red blood cells. What is the most appropriate intravenous fluid to hang as a maintenance infusion and to flush the IV line?

Normal saline (NS) Only one compatible with blood products

The nurse is caring for a patient with acute heart failure with severe pulmonary edema who requires urgent diuresis. The nurse will expect the provider to order a diuretic from which drug class?

Loop Loop diuretics are a potent class of diuretic and usually the class of choice when rapid diuresis is needed.

The nurse is administering loperamide to a patient with diarrhea. What assessment is essential for the nurse to perform?

Gastric assessment

Which outcome assessment is essential to monitor for in the patient taking diphenoxylate with atropine?

Decrease in gastric motility

What should the nurse teach the patient about the reason for administering multiple medications for relief of nausea and vomiting?

Combination therapy blocks different vomiting pathways.

What instruction is most important for the nurse to teach a patient who is taking an anticholinergic agent to treat nausea and vomiting?

“Brush your teeth and gargle to help with dryness in your mouth.”

The patient is prescribed tetracycline as part of the treatment for acne. Which patient education information takes priority?

Drink plenty of water.

A patient is prescribed lorazepam and a glucocorticoid during chemotherapy treatments. What is the nurse’s best action?

Administer the medications and assess the patient for relief.

In developing a plan of care for a patient receiving an antihistamine antiemetic agent, which is the priority nursing diagnosis?

Fluid volume deficit related to nausea and vomiting

Which nursing intervention is a priority before administering magnesium hydroxide to a patient?

Assess renal function. Adequate renal function is needed to excrete excess magnesium.

A patient complains of constipation and requires a laxative. In providing teaching for this patient, the nurse reviews the common causes of constipation, including which cause?

Poor dietary habits

A patient who has constipation is prescribed a bisacodyl suppository. Which explanation will the nurse use to explain the action of bisacodyl?

Acts on smooth intestinal muscle to gently increase peristalsis

The nurse is administering difenoxin with atropine to a patient. Which should be included in the patient teaching regarding this medication?

Caution the patient to avoid laxative abuse. Record the frequency of bowel movements. Caution the patient against taking sedatives concurrently. Encourage the patient to increase fluids. Instruct the patient to avoid this drug if he or she has narrow-angle glaucoma.

A patient comes to the office with a chief complaint of hair loss and peeling skin. The nurse notes many vitamins and minerals are on the medication list. The patient reports using vitamins to treat liver disease. The patient’s complaint may be caused by an excess of which vitamin or mineral?

Vitamin A

The nurse routinely includes health teaching about vitamins to patients. Vitamin D has a major role in which process?

Regulating calcium and phosphorous metabolism

The nurse is doing preconception counseling with a patient. The patient asks why she must take folic acid (folate) during pregnancy. What is the nurse’s response?

Folic acid prevents neural tube defects in the developing fetus.

A prenatal patient tells the nurse that she is not taking vitamins because she heard that vitamins may cause damage to the fetus. What is the nurse’s best response?

Megadose of vitamins can be harmful in the first trimester.

A patient asks the nurse for information about fat-soluble vitamins. What is the nurse’s best response?

Fat-soluble vitamins are excreted slowly in urine.

A patient complains of night blindness. The nurse correctly recommends which foods?

Fortified milk and eggs

A patient diagnosed with alcoholism has questions about his medications. The nurse correctly explains that alcoholism can be associated with deficiency of which vitamin?

B (B-complex)

Which vitamin plays a major role in regulating calcium and phosphorus absorption?

Vitamin D

A patient takes iron on a daily basis. Which comment from the patient suggests the need for health teaching related to iron?

I will take the tablet before I go to bed.

The nurse is determining a patient’s gastric residual before administering an enteral feeding; the last feeding was 240 mL. The patient will be discharged on enteral feedings. It is important to include in the teaching plan that a residual of more than which amount would indicate delayed gastric emptying (based on the last feeding)?

150 mL

The nurse is reviewing the plan of care for a patient receiving enteral therapy. What is the most common complication of enteral therapy?

Diarrhea

Which is appropriate nursing care for a patient receiving total parenteral nutrition (TPN) in an acute care setting?

Monitor patient’s blood glucose level. Measure patient’s fluid intake and output closely. Monitor the TPN insertion site for erythema.

A patient has been on TPN for 1 month, and there is an order to discontinue TPN tomorrow. The nurse contacts the health care provider because sudden interruption of TPN therapy may cause which condition?

Hypoglycemia

A patient is receiving TPN at home. The visiting nurse assists the family with the care plan, which includes changing the TPN solution and tubing. What is the recommended initial frequency for changing the tubing?

Every 24 hours

The nurse is reviewing the care plan with a patient using enteral nutrition (EN). Which interventions by the nurse are appropriate for this strategy?

Check the continuous route for gastric residual every 2 to 4 hours. Elevate the bed to a 30- to 45-degree angle before administering EN. Report absent bowel sounds to the health care provider.

The nurse is to administer enteral medications to a patient who cannot swallow and is receiving continuous enteral feedings. Which is correct concerning administration of the enteral medications?

Dilute liquid medications before administering through the feeding tube.

A patient is taking oral acetazolamide, a carbonic anhydrase inhibitor, to decrease intraocular pressure. When providing drug education, which side effect would the nurse advise the patient to anticipate?

Increased urine output

The ophthalmologist asks the nurse to prepare to assist in the administration of tetracaine, fluorescein stain, and atropine for a diagnostic eye examination. Before assisting in the procedure, it is most important for the nurse to inform the ophthalmologist if the patient has a history of which condition?

Angle-closure glaucoma

When collecting a medication history from a patient with primary open-angle glaucoma, the nurse identifies several drugs that could exacerbate glaucoma. Which drug poses a priority concern for this particular patient?

Prednisone, a corticosteroid

A patient is taking famotidine. What information should the nurse teach the patient about this drug?

The drug should be administered for 4 to 8 weeks. The drug must be administered separately from iron by at least 1 hour. Smoking should be avoided while taking this drug. Foods high in vitamin B12 should be increased in the diet.

When a patient complains of pain accompanying a peptic ulcer, why should the nurse give an antacid?

Antacids neutralize hydrochloric acid and reduce pepsin activity.

A patient is taking famotidine to inhibit gastric secretions. Which side effects of famotidine will the nurse teach the patient?

Dizziness Headaches Erectile dysfunction

A patient is taking levothyroxine. For which adverse effect would the nurse monitor?

Tachycardia

The nurse is administering prednisone to a newly admitted patient who is taking multiple other drugs. The nurse would consider which drug interaction with prednisone?

Potassium-wasting diuretics increase potassium loss, resulting in hypokalemia. Risk for gastrointestinal bleeding and ulceration increases when drug is taken with aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs). The action of prednisone is decreased when taken with phenytoin because phenytoin increases glucocorticoid metabolism. Risk for dysrhythmias and digitalis toxicity increase when drug is taken with cardiac glycosides.

A patient is diagnosed with type 2 diabetes mellitus. The nurse is aware that which statement is true about this patient?

Heredity and obesity are major causative factors.

Antidiabetic drugs are designed to control signs and symptoms of diabetes mellitus. The nurse primarily expects a decrease in which?

Blood glucose

A patient is to receive insulin before breakfast, and the time of breakfast tray delivery is variable. The nurse knows that which insulin should not be administered until the breakfast tray has arrived and the patient is ready to eat?

Lispro

A patient is receiving a daily dose of NPH insulin at 7:30 a.m. The nurse expects the peak effect of this drug to occur at what time?

5:00 p.m.

A nurse is teaching a patient how to recognize symptoms of hypoglycemia. Which symptoms should be included in the teaching?

Headache Nervousness Sweatin

A patient is newly diagnosed with type 1 diabetes mellitus and requires daily insulin injections. Which instructions should the nurse include in the teaching of insulin administration?

Instruct the patient about the necessity for compliance with prescribed insulin therapy. Instruct the patient in the care and handling of the insulin container and syringe.

Three days after a patient’s total colectomy and ileostomy, he has a nasogastric tube for continuous suction and a Foley catheter for continuous drainage. The night nurse reports a high output from the ileostomy. The patient’s pulse is irregular, and he reports muscle weakness and leg cramping. Based on this situation, the nurse would correctly suspect what type of imbalance?

Hypokalemia

A patient is receiving intravenous (IV) potassium supplements. What is the most important nursing implication when administering this drug?

It is diluted with IV fluids and delivered by infusion pump.

A patient is receiving 10 mEq of potassium chloride in 100 mL of normal saline intravenously (IV) to infuse over 1 hour via infusion pump. The patient has a 22-gauge peripheral IV in his right forearm and reports pain at the insertion site; the nurse notes that the site is reddened, warm, and tender to the touch. Which action would the nurse take?

Stop the infusion, and discontinue the IV immediately.

The health care provider orders a hypertonic crystalloid IV solution for a 70-year-old patient. Which solution will the nurse hang?

. 5% dextrose in 0.9% sodium chloride (NaCl)

A patient has hypernatremia. Which components are appropriate to include in the Clinical Judgment [Nursing Process] plan of care?

Instruct patient on seizure precautions. Keep appointments for laboratory tests. Explain the meaning of fluid restriction. Instruct patient on how to read food labels.

A patient is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance?

Hypokalemia

A patient is taking hydrochlorothiazide 50 mg/day and digoxin 0.25 mg/day. The nurse plans to monitor the patient for which potential electrolyte imbalance?

Hypokalemia

The nurse knows that which statement is correct regarding nursing care of a patient receiving hydrochlorothiazide?

Administer ordered potassium supplements. Monitor serum potassium and uric acid levels. Assess blood pressure before administration. Notify the health care provider if a patient has had oliguria for 24 hours.

A patient has heart failure, and a high dose of furosemide is ordered. What suggests a favorable response to furosemide?

Respiratory rate decreases from 28/min to 20/min, and the depth increases.

What should the nurse do when a patient is taking furosemide?

Assess blood pressure before administration.

For the patient taking a diuretic, a combination such as triamterene and hydrochlorothiazide may be prescribed. The nurse realizes that this combination is ordered for which purpose?

To maintain serum potassium level

The patient has been receiving spironolactone 50 mg/day for heart failure. The nurse should closely monitor the patient for which condition?

Hyperkalemia

A patient tells the nurse that he has started to take an over-the-counter antihistamine, diphenhydramine. In teaching about side effects, what is most important for the nurse to tell the patient?

Avoid driving a motor vehicle until stabilized on the drug.

A patient has been prescribed guaifenesin. The nurse understands that the purpose of the drug is to accomplish what?

Loosen bronchial secretions so coughing can eliminate them

The nurse is teaching a patient about diphenhydramine. Which instructions should the nurse include in the patient’s teaching plan?

Avoid alcohol and other central nervous system depressants. Notify a health care provider if confusion or hypotension occurs. Use sugarless candy, gum, or ice chips for temporary relief of dry mouth. Avoid handling dangerous equipment or performing dangerous activities until stabilized on the medication.

A patient with chronic obstructive pulmonary disease is taking the leukotriene antagonist montelukast. The nurse is aware that this medication is given for which purpose?

Maintenance treatment of asthma

The nurse is caring for a patient who has increased intraocular pressure. The provider has ordered levobunolol 0.5% ophthalmic solution. The nurse will perform a thorough health history to make sure the patient does not have a history of which condition?

Asthma

The nurse is administering timolol (Timoptic) eye drops to a patient who has glaucoma. To prevent bradycardia, the nurse will perform which action?

Apply pressure to the lacrimal ducts.

The parent of a toddler asks the nurse what can be done to prevent otitis media. What will the nurse recommend?

Keep the child’s immunizations up to date.

A nurse is teaching a client who has a new prescription for Brimonidine ophthalmic drops and wears soft contact lenses. Which of the following instructions should the nurse include in the teaching?

You should remove your contacts before instilling this medication

A nurse is teaching a client about preventing otitis externa. Which of the following instructions should the nurse include?

Tip the head to the side to remove water from the ears after showering.

Exam 2 Flashcards

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