Exit Exam

Question 1

Leadership Styles and what they look like

Answer 1

Authoritative: more dictatorship
Democratic: everyone gets input
Laissez-faire: laid back, hands off

Question 2

What are some examples of reportable incidents?

Answer 2

Medication errors, procedure/treatment errors, equipment-related injuries/errors, needlestick injuries, client falls/injuries, visitor/volunteer injuries, threat made to client or staff, and loss of property (dentures, jewelry, etc)

Question 3

What are the five rights of delegation?

Answer 3

Right person, right task, right circumstances, right direction and communication, right supervision and evaluation

Question 4

What is within the scope of practice of an AP?

Answer 4

Perform basic hygiene care and grooming, report to LPN or RN, provide assistance with ADLs (nutrition, elimination, mobility), take vitals, calculate I&O, maintain safe environment, perform noninvasive and nonsterile skills

Question 5

What is within the scope of practice of an LPN?

Answer 5

Meets health needs for clients, cares for clients who are stable with an expected outcome, reinforce teaching, contributes to care plan through discussion of problems/findings, calculate and monitor IV flow rates, administer IVPB

Question 6

What are religious practices for Buddhism? (birth, death, diet, health)

Answer 6

Birth: reincarnation, contraception is acceptable
Death: calm environment, chanting, monk delivers last rights, organ donation encouraged, cremation is common
Dietary: many are vegetarian, avoid alcohol
Health: peaceful environment to practice meditation and prayer, refuse care on holy day

Question 7

What are religious practices for Catholicism? (birth, death, diet, health)

Answer 7

Birth: contraception/abortion/sterilization are prohibited, baptism is required
Death: Priest administers last rights, organ donation is acceptable, suicide may prevent burial in Catholic cemetery
Diet: abstain from meat on Ash Wednesday and Fridays during Lent
Health: want a priest during hospitalization, communion and confession to aid healing, wear cross or display religious statues

Question 8

What are religious practices for Christian Science? (birth, death, diet, health)

Answer 8

Birth: abortion is prohibited, home births
Death: unlikely to prolong life with medical care, organ donation discouraged
Diet: abstain from alcohol
Health: Medication and blood products avoided, healing ministers practice spiritual healing

Question 9

What are religious practices for Hinduism? (birth, death, diet, health)

Answer 9

Birth: contraception is acceptable, abortion prohibited, no circumcision, child named at 10 days old
Death: Reincarnation, natural death is traditional, may want to lie on floor while dying, thread placed on neck/wrist, organ donation accepted, cremation preferred
Diet: vegetarian encouraged, abstain from beef and pork, right hand for eating and left for hygiene, fasting several days a year
Health: personal hygiene is important, future lives are influenced by how one faces illness/disability/death

Question 10

What are religious practices of Islam (Muslim)? (birth, death, diet, health)

Answer 10

Birth: contraception accepted, abortion under certain circumstances, prayer in infant’s ear at birth, circumcision customary
Death: confess sins before death, placed facing Mecca (east), organ donation and autopsy sometimes okay, bathing with burial within 24 hr, cremation prohibited
Diet: Ramadan is fasting during 9th lunar month, Halal (lawful) meats from animals slaughtered during prayer ritual, Haram (prohibited) includes pork/gelatin/alcohol/fanged animals
Health: may pray 5 times a day, privacy during prayer, women are very modest and may refuse male HCW

Question 11

What are religious practices of Judaism? (birth, death, diet, health)

Answer 11

Birth: abortion permitted, circumcision at 8 days old, Orthodox Jewish males not allowed in delivery room
Death: autopsy discouraged, organ donation permitted, death companion at all times, bathing and burial within 24 hr, cremation prohibited
Diet: food is kosher, milk and meat cannot be served together, pork and shellfish prohibited, fasting on Yom Kippur
Health: saving life overrides religious obligation, prayers of well being, anything to ease suffering is encouraged, Orthodox Jews refrain from electrical appliances on Sabbath

Question 12

What are religious practices of The Church of Jesus Christ of Latter Day Saints? (birth, death, diet, health)

Answer 12

Birth: contraception at discretion of couple, abortion under certain circumstances, infants not baptized
Death: organ donation and autopsy permitted, life continues after death
Diet: alcohol/coffee/tea prohibited, fasting once a month
Health: herbal remedies in addition to medical care, blessings with anointed oil

Question 13

What are religious practices of Seventh-Day Adventist? (birth, death, diet, health)

Answer 13

Birth: abortion acceptable, opposed to infant baptism
Death: autopsy and organ donation acceptable
Diet: vegetarian encouraged, alcohol/coffee/tea prohibited
Health: medical intervention and divine healing, prayer and anointing may be performed

Question 14

1 mg=? mcg
1 g=? mg
1 kg=? g
1 kg=? lbs
30 mL=? oz
1 L=? mL
5 mL=? tsp
15 mL=? tbsp
1 tbsp=? tsp

Answer 14

1 mg=1000 mcg
1 g=1000 mg
1 kg=1000 g
1 kg=2.2 lbs
30 mL=1 oz
1 L=1000 mL
5 mL=1 tsp
15 mL=1 tbsp
1 tbsp=3 tsp

Question 15

When are peak levels usually drawn? (oral, IM, IV)
When is a trough level usually drawn?

Answer 15

Oral: 1-2 hours
IM: 1 hour
IV: 30 minutes
Trough: 15 minutes before next scheduled dose

Question 16

Care and Maintenance of TPN

Answer 16

Monitor daily weights, I&), blood sugar Q4-6, signs of infection. Change IV tubing and fluid Q24 h. If TPN is unavailable administer D10.
TPN is hypertonic solution with dextrose, protein, electrolytes, minerals, etc to promote nutrition

Question 17

Antidotes
Acetaminophen
Benzodiazepine
Curare
Cyanide Poisoning
Digitalis
Ethylene poisoning
Heparin/enoxaparin
Iron
Lead
Magnesium sulfate
Narcotics
Warfarin

Answer 17

Acetaminophen: acetylcysteine
Benzodiazepine: flumazenil
Curare: edrophonium
Cyanide Poisoning: methylene blue
Digitalis: digoxin immune FAB
Ethylene poisoning: fomepizole
Heparin/enoxaparin: protamine sulfate
Iron: deferoxamine
Lead: succimer
Magnesium sulfate: calcium gluconate 10%
Narcotics: naloxone
Warfarin: phytonadione (vitamin K)

Question 18

Therapeutic Drug Levels
Aminophylline
Carbamazepine
Digoxin
Gentamicin
Lidocaine
Lithium
Magnesium sulfate
Phenobarbital
Phenytoin
Salicylate
Theophylline
Tobramycin

Answer 18

Aminophylline: 10-20 mcg/mL
Carbamazepine: 5-12 mcg/mL
Digoxin: 0.8-2.0 ng/mL
Gentamicin: 5-10 mcg/mL
Lidocaine: 1.5-5.0 mcg/mL
Lithium: 0.4-1.4 mEq/L
Magnesium sulfate: 4-8 mg/dL
Phenobarbital: 10-40 mcg/mL
Phenytoin: 10-20 mcg/mL
Salicylate: 100-250 mcg/mL
Theophylline: 10-20 mcg/mL
Tobramycin: 5-10 mcg/mL

Question 19

Trough Drug Levels
Gentamicin
Tobramycin
Vancomycin

Answer 19

Gentamicin: 1-2 mcg/mL
Tobramycin: 1-2 mcg/mL
Vancomycin: 15-20 mcg/mL

Question 20

Toxic Drug Levels
Acetaminophen
Aminophylline
Amitriptyline
Digoxin
Lidocaine
Magnesium sulfate
Methotrexate
Phenobarbital
Phenytoin
Salicylate
Theophylline

Answer 20

Acetaminophen: greater than 250 mcg/mL
Aminophylline: greater than 20 mcg /mL
Amitriptyline: greater than 500 ng/mL
Digoxin: greater than 2.4 ng/mL
Lidocaine: greater than 5 mcg/mL
Magnesium sulfate: greater than 9 mg/mL
Methotrexate: greater than 10 mcmol over 24 hours
Phenobarbital: greater than 40 mcg/mL
Phenytoin: greater than 30 mcg/mL
Salicylate: greater than 300 mcg/mL
Theophylline: greater than 20 mcg/mL

Question 21

Angiotensin-Converting Enzyme (ACE) inhibitors medications, action, therapeutic use, precautions, side effects, nursing interventions

Answer 21

Medications: captopril, enalapril, enalaprilat (IV), fosinopril, lisinopril
Action: blocks conversion of angiotensin to angiotensin 2
Therapeutic Use: hypertension, heart failure, MI, diabetic neuropathy
Side/Adverse Effects: persistent nonproductive cough, angioedema, hypotension, don’t use in second and third semester of pregnancy
Nursing Interventions: captopril should be taken 1 hour before meals, monitor blood pressure, monitor for angioedema and promptly administer 0.5 mL epinephrine subq

Question 22

Angiotensin 2 Receptor Blockers (ARBS) medications, action, therapeutic use, side effects, nursing interventions

Answer 22

Medications: losartan, valsartan, irbesartan
Action: selectively block the binding of angiotensin 2 to AT1 receptors found in tissues
Therapeutic Use: hypertension, heart failure, MI, diabetic neuropathy
Side/Adverse Effects: angioedema, hypotension, don’t use in second and third semester of pregnancy
Nursing Interventions: monitor blood pressure, monitor for angioedema and promptly administer 0.5 mL epinephrine subq

Question 23

Calcium Channel Blockers medications, action, therapeutic use, precautions, side effects, nursing interventions

Answer 23

Medications: nifedipine, verapamil, diltiazem, amlodipine
Action: slows movement of calcium into smooth-muscle cells, resulting in arterial dilation and decreased blood pressure
Therapeutic Use: angina, hypertension, verapamil and diltiazem may be used for atrial fibrillation, atrial flutter, or SVT
Precautions: use cautiously in clients taking digoxin and beta blockers, contraindicated for clients who have heart failure/heart failure/bradycardia, do not consume grapefruit juice (toxic effects)
Side/Adverse Effects: constipation, reflex tachycardia, peripheral edema, toxicity
Nursing Interventions: do not crush or chew sustained-release tablets, administer IV over 2-3 minutes, slowly taper dose if discontinuing, monitor heart rate and blood pressure

Question 24

Alpha Adrenergic Blockers (Sympatholytics) medications, action, therapeutic use, precautions, side effects, nursing interventions

Answer 24

Medications: prazosin, doxazosin mesylate
Action: selectively inhibit alpha1 adrenergic receptors resulting in peripheral arterial and venous dilation that lowers blood pressure
Therapeutic Use: primary hypertension, doxazosin mesylate may be used in treatment of BPH
Precautions: increased risk of hypotension and syncope if given with other antihypertensives, beta blockers, or diuretics. NSAIDs may decrease the effect of prazosin
Side/Adverse Effects: dizziness, fainting
Nursing Interventions: monitor heart rate and blood pressure, take medication at bedtime to minimize effects of hypotension, notify prescriber of adverse reactions, consult prescriber before taking any OTC medication

Question 25

Centrally Acting Alpha Agonists medications, action, therapeutic use, precautions, side effects, nursing interactions

Answer 25

Medications: clonidine, guanfacine HCl, methyldopa Action: stimulate alpha adrenergic receptors (alpha2) in the brain to reduce peripheral vascular resistance, heart rate, and systolic and diastolic blood pressure Therapeutic Use: primary hypertension (may be used in combination with diuretics or other antihypertensives), hypertensive crisis, severe cancer pain (parenteral administration via epidural) Precautions: contraindicated with anticoagulant therapy/hepatic failure, do not give with MAOIs, do not give methyldopa IV with barbiturates or sulfonamides, use cautiously in CVA/MI/DM/major depression/chronic renal failure, do not use during lactation Side/Adverse Effects: dry mouth, drowsiness and sedation (resolves over time), rebound hypertension, black or sore tongue, leukopenia Nursing Interventions: monitor for adverse CNS effects, CBC, heart rate, blood pressure, weight gain, edema, rebound hypertension when discontinued (48 hours). Never skip a dose, take at bedtime to minimize hypotension, notify prescriber of involuntary jerky movements, prolonged dizziness, rash, yellowing of skin

Question 26

Beta Adrenergic Blockers (Sympatholytic) medication, action, precautions, side effects, nursing interventions

Answer 26

Medications: metoprolol, atenolol, metoprolol succinate, propranolol, nadolol, labetalol Action: inhibits stimulation of receptor sites, resulting in decreased excitability, cardiac output, myocardial oxygen demand. Lowers blood pressure by decreasing release of renin in the kidney Therapeutic Use: primary hypertension, angina, tachydysrhythmias, heart failure, MI Precautions: contraindicated in clients who have AV block and sinus bradycardia. Do not administer nonselective beta blockers to clients who have asthma, bronchospasm or heart failure. Propranolol may mask effects of hypoglycemia in clients who have DM. Do not administer labetalol in the same IV as furosemide Side/Adverse Effects: bradycardia, nasal stuffiness, AV block, rebound myocardium excitation if stopped abruptly, bronchospasm Nursing Interventions: administer 1-2 times daily as prescribed, do not discontinue without consulting provider, do not crush or chew extended-release tablets, hold medication and notify provider is systolic blood pressure is less than 100 mmHg or pulse is less than 60, monitor clients who have DM for indications of hypoglycemia

Question 27

Vasodilators medication, action, therapeutic use, precautions, side effects, nursing interventions

Answer 27

Medications: nitroglycerin, enalaprilat, nitroprusside, hydralazine Action: direct vasodilators of arteries and veins resulting in rapid reduction of blood pressure (decreased preload and afterload) Therapeutic Use: hypertensive emergencies Precautions: clients who had hepatic or renal disease, older adults, electrolyte imbalances Side/Adverse Effects: dizziness, headache, profound hypotension, cyanide toxicity, thiocyanate poisoning Nursing Interventions: nitroprusside may not be mixed with any other medications, apply protective cover to container, discard unused fluid after 24 hours, provide continuous ECG and blood pressure monitoring

Question 28

Cardiac Glycoside medication, action, therapeutic use, precautions, side effects, nursing interventions, management of toxicity

Answer 28

Medication: digoxin Action: increase the force and velocity of myocardial contractions to improve stroke volume and cardiac output, slows conduction rate which allows for increased ventricular filling Therapeutic Use: heart failure, atrial fibrillation Precautions: thiazide or loop diuretics increase risk of hypokalemia and precipitate digoxin toxicity, ACE and ARBs increase risk of hyperkalemia, Verapamil increases risk of toxicity Side/Adverse Effects: digoxin toxicity causes GI effects (anorexia, nausea, vomiting, abdominal pain), CNS effects (fatigue, weakness, diplopia, blurred vision, yellow-green or white halos around objects) Nursing Interventions: assess apical pulse for 1 minute before administration, notify provider if HR is less than 60 (adult), 70 (child), or 90 (infant). Monitor for signs of digoxin toxicity, hypokalemia, and hypomagnesemia. Notify provider of any sudden increase in pulse rate that previously had been normal or low, maintain therapeutic digoxin level Management of Toxicity: