C28 retake UW Flashcards
A laboring client reports nausea and dizziness 20 minutes after epidural placement. The nurse notes a blood pressure of 88/49 mm Hg and late decelerations on the fetal heart rate monitor. Which medication should the nurse anticipate administering?
a. IV calcium gluconate
b. IV ephedrine
c. IV hydralazine
d. Subcutaneous terbutaline
b. IV ephedrine
The oncology clinic nurse is reviewing laboratory results for a client who is scheduled to receive the second infusion of a second cycle of cisplatin today. Which finding is a priority for the nurse to report to the health care provider to administer the medication? Click the exhibit
a. Creatinine 2.4
b. Platelets 62,000
c. Potassium 3.4
d. WBC 3100/mm3
a. Creatinine 2.4
A client with allergic rhinitis has received a new prescription for nasal spray. Which of the following instructions should the nurse provide to the client? Select all that apply.
a. “Before first use, prime the bottle of nasal spray with several pumps until a spray is noted.”
b. “Gently blow your nose prior to administering the spray to clear your nasal passages.”
c. “Insert the nasal spray tip into the nostril, pointing slightly out and away from the septum.”
d. “Occlude one nostril with your finger and sniff with the other while depressing the nozzle.”
e. “Position yourself with your head tilted back to direct the medication into your sinuses.”
a. “Before first use, prime the bottle of nasal spray with several pumps until a spray is noted.”
b. “Gently blow your nose prior to administering the spray to clear your nasal passages.”
c. “Insert the nasal spray tip into the nostril, pointing slightly out and away from the septum.”
d. “Occlude one nostril with your finger and sniff with the other while depressing the nozzle.”
The nurse is providing discharge education for a client diagnosed with tuberculosis and prescribed rifampin and isoniazid. Which client statement indicates a need for further instruction?
a. “I cannot have my usual glass of red wine with dinner while taking these medications.”
b. “I should not worry if I develop a rash after starting these medications.”
c. “I will call the clinic if I develop abdominal pain, nausea, and vomiting”
d. “I will notify the health care provider if my skin starts to look yellow.”
b. “I should not worry if I develop a rash after starting these medications.”
The nurse is reinforcing education to a client who has a new prescription for clozapine. Which statement best indicates that teaching has been effective?
a. “I may experience loose stools when taking this medication.”
b. “I will follow up with my health care provider in 3 months.”
c. “This medication may cause me to lose weight.”
d. “When standing up from a chair, I should rise slowly.”
d. “When standing up from a chair, I should rise slowly.”
The nurse at an outpatient mental health clinic is reviewing telephone messages left by several clients. Which client should the nurse call back first?
a. A client taking haloperidol who reports anxiety and an intense need to constantly move
b. A client taking lithium who reports fine hand tremors and frequent urination
c. A client taking methylphenidate who reports insomnia and appetite suppression
d. A client taking olanzapine who reports fever and muscle stiffness
d. A client taking olanzapine who reports fever and muscle stiffness
A client reports facial, neck, and chest flushing and itching after receiving IV vancomycin administered over 45 minutes. Which action by the nurse is essential to prevent this reaction from recurring?
a. Administer prescribed prophylactic diphenhydramine
b. Check the client’s serum vancomycin peak and trough levels
c. Infuse the medication at a slower rate, over at least 1 hour
d. Request that the health care provider lower the vancomycin dose
c. Infuse the medication at a slower rate, over at least 1 hour
The nurse reviews the vital signs and prescribed medications for a client with an acute kidney injury and a past medical history of hypertension, heart failure, and osteoarthritis. Based on the history, prescriptions, and data, for which reason should the nurse contact the health care provider? Click the exhibit button for additional information. Exhibit Medical administration record Allergies: No known drug allergies Medications: Metoprolol: 12.5 mg orally, daily, Furosemide: 40 mg orally, twice daily, Celecoxib: 100 mg orally, twice daily, Normal saline: Infuse continuously at 50 mL/hr
a. To clarify the celecoxib prescription
b. To clarify the furosemide prescription
c. To request an increase in the metoprolol dose
d. To request an increase in the normal saline infusion rate
a. To clarify the celecoxib prescription
The nurse is teaching a client who was newly prescribed methotrexate (chemotherapy). Which instructions are appropriate for the nurse to discuss with the client? Select all that apply.
a. Avoid drinking alcohol
b. Avoid yearly influenza vaccine injection
c. Do not take this drug with dairy products
d. Stop taking this drug if you become pregnant
e. Watch for signs and symptoms of infection
a. Avoid drinking alcohol
d. Stop taking this drug if you become pregnant
e. Watch for signs and symptoms of infection
The nurse is conducting a staff education conference about alteplase infusions for clients with acute ischemic stroke. Which of the following statements by attendees indicate a proper understanding? Select all that apply.
a. “I will assess for a decrease in level of consciousness, visual changes, and severe headache during the infusion.”
b. “ I will notify the healthcare provider if a clients blood pressure is greater than 185/110 mm Hg prior to administration”
c. “If clients become tachycardic and hypotensive during therapy, I will perform a full assessment to identify possible bleeding.”
d. “Invasive procedures and subcutaneous and IM injections should be avoided, if possible, during the infusion.”
e. “Two nurses must calculate and verify the dosage, infusion rate, and IV pump setting before initiating alteplase infusions.
a. “I will assess for a decrease in level of consciousness, visual changes, and severe headache during the infusion.”
c. “If clients become tachycardic and hypotensive during therapy, I will perform a full assessment to identify possible bleeding.”
d. “Invasive procedures and subcutaneous and IM injections should be avoided, if possible, during the infusion.”
e. “Two nurses must calculate and verify the dosage, infusion rate, and IV pump setting before initiating alteplase infusions.
The nurse is educating a client with ascites from liver cirrhosis who has IV albumin scheduled for administration immediately after a paracentesis. Which statement by the client indicates a correct understanding of the teaching?
a. “Albumin helps to decrease the roundness of my abdomen.”
b. “Albumin stops my hands from flapping when I hold my arms out.”
c. “I need albumin so I can breathe easier when I’m lying down.”
d. “I receive albumin to keep my blood pressure from getting too low.”
d. “I receive albumin to keep my blood pressure from getting too low.”
The nurse is assessing a client who has preeclampsia. The client received a loading dose of 6g magnesium sulfate IV and is now receiving magnesium sulfate IV continuously. Which assessment finding should cause the nurse to suspect magnesium toxicity?
a. Blood pressure of 160/100 mm Hg
b. Respirations of 14/min
c. Serum magnesium level of 8.7 mEq/L (4.4 mmol/L)
d. Urine output of 160 mL over the past 4 hours
c. Serum magnesium level of 8.7 mEq/L (4.4 mmol/L)
The nurse is educating a client at 37 weeks gestation who has preeclampsia with severe features about magnesium sulfate therapy. Which statement by the client indicates a need for further education about magnesium sulfate?
a. “I am receiving magnesium sulfate to prevent my blood pressure from being too high.”
b. “It will be necessary to continue this medication for several hours after giving birth.”
c. “Magnesium sulfate will help prevent me from having a seizure.”
d. “This medication may make me feel hot, tired, and weak.”
a. “I am receiving magnesium sulfate to prevent my blood pressure from being too high.”
The nurse is reviewing the chart of a client with heart failure. Which prescription should the nurse clarify with the health care provider? Click the exhibit button for additional information. Laboratory results
Sodium139 mEq/L (139 mmol/L) Potassium 3.4 mEq/L (3.4 mmol/L) Creatinine 1.0 mg/dL (88.4 µmol/L) BUN19 mg/dL (6.78 mmol/L) Vital signs Temperature 99 F (37.2 C) Blood pressure 132/93 mm Hg Heart rate 61/min Respirations 22/min SpO2 96%
a. Atorvastatin 40 mg PO once daily
b. Captopril 25 mg PO three times daily
c. Furosemide 20 mg PO twice daily
d. Spironolactone 25 mg PO once daily
c. Furosemide 20 mg PO twice daily
The nurse is caring for a client with end-stage liver disease. The client has become increasingly confused and is now somnolent. The nurse receives several new prescriptions. Which prescription should the nurse administer first?
a. Furosemide 20 mg IV push
b. Lactulose enema 30 g in 500 mL sterile water
c. Pantoprazole 40 mg IV push
d. Rifaximin 550 mg via nasogastric tube
b. Lactulose enema 30 g in 500 mL sterile water
The labor and delivery nurse plans to care for several clients admitted for medically indicated labor inductions. The nurse recognizesI’m that administration of dinoprostone gel for cervical ripening is appropriate for which client?
a. Client with a history of cesarean birth due to breech presentation, Bishop score of 6
b. Client with insulin-controlled gestational diabetes, Bishop score of 3 - this one
c. Client with late decelerations on fetal heart rate monitor, Bishop score of 10
d. Client with poorly controlled chronic hypertension, Bishop score of 9
c. Client with late decelerations on fetal heart rate monitor, Bishop score of 10
The community health nurse is hosting an influenza vaccination clinic. Which client can safely receive the intranasal live attenuated influenza vaccine?
a. 6-year-old client receiving aspirin therapy for Kawasaki disease
b. 12-year-old client who has a mild egg allergy
c. 18-year-old client who is pregnant at 8 weeks gestation
d. 25-year-old client who is neutropenic after chemotherapy
b. 12-year-old client who has a mild egg allergy
The registered nurse is supervising a student nurse who is administering influenza vaccines at a community clinic. Which action by the student nurse indicates a correct understanding about influenza vaccines?
a. Advises a client that no influenza vaccine is available for those with egg allergies
b. Asks a client to stay 30 minutes after receiving vaccination to observe for adverse reactions
c. Offers to administer an IM influenza vaccine to a client diagnosed with HIV
d. Tells a client that June through August is an optimal time to receive the influenza vaccine
c. Offers to administer an IM influenza vaccine to a client diagnosed with HIV
The nurse is administering influenza vaccinations to clients at a community health fair. For which client would it be appropriate to administer the intranasal live attenuated influenza vaccine?
a. 23-year-old client who is at 25 weeks gestation
b. 32-year-old client with a kidney transplant
c. 48-year-old client with a total knee replacement
d. 80-year-old client with Alzheimer disease
c. 48-year-old client with a total knee replacement
The nurse is caring for a client with rheumatoid arthritis who is being treated with tofacitinib. Which client statement requires immediate follow up?
a. Even though my TB test was negative, I may need another soon
b. I am scheduled to have my intranasal flu vaccine tomorrow morning
c. I will call my health care provider if I developed a fever
d. I will continue to have my blood cell levels checked frequently
b. I am scheduled to have my intranasal flu vaccine tomorrow morning
The clinic nurse is preparing to teach a client about newly prescribed sucralfate for the treatment of a duodenal ulcer. Which statement is the priority for the nurse to include in the teaching?
a. “Drink plenty of fluids because this medication may cause constipation.”
b. “If the tablet is difficult to swallow, it can be broken and dissolved in water.”
c. “Some people experience dry mouth and drowsiness with this medication.”
d. “This medication should be taken 1 hour before meals and at bedtime.”
d. “This medication should be taken 1 hour before meals and at bedtime.”
The nurse is reviewing the medical record of a newly admitted client with severe ulcerative colitis and a productive cough. Which prescription should the nurse clarify with the health care provider? Click the exhibit button for additional information.
Exhibit 1: Vital Signs: Temperature: 101 F (38.3 C), Blood pressure 102/60 mm Hg, Heart rate: 110/min, Respirations: 26/min
Exhibit 2: Hematocrit: 27%, Hemoglobin: 9 g/dL (90 g/L), WBC: 14,000/mm3 (14.0 x 10%/L)
a. Ferrous sulfate
b. Infliximab
c. Metronidazole
d. Sulfasalazine
b. Infliximab
The nurse is caring for a client receiving tamoxifen therapy following a mastectomy for breast cancer. Which statement by the client requires priority follow-up?
a. “I am walking more each day to work out the cramping in my right leg.”
b. “I have noticed that I feel irritable and moody more often than before.”
c. “I no longer enjoy sexual intercourse because my vagina is very dry.”
d. “I wake up with my pajamas soaked with sweat 2 or 3 times each night.”
a. “I am walking more each day to work out the cramping in my right leg.”
A client with diabetic ketoacidosis is receiving continuous IV insulin. What possible adverse effect will the nurse monitor for as result of IV insulin
a. Elevated liver enzymes
b. Elevated pancreatic enzymes
c. Hypokalemia
d. Hyponatremia
c. Hypokalemia
The nurse is talking to a client during a follow-up clinic visit after initiation of warfarin therapy a month ago. Which of the following client statements indicate a need for further teaching?
Select all that apply.
a. “I bought and have been using my new soft-bristled toothbrush and electric razor.”
b. “I have decreased the amount of leafy green vegetables I eat every day since my last visit.”
c. “I have been using over-the-counter ibuprofen when I get headaches or joint pain.”
d. “I started using garlic and ginger to season my foods instead of using table salt.”
e. “I talked to my boss about how I will need to be absent periodically for routine blood work.”
b. “I have decreased the amount of leafy green vegetables I eat every day since my last visit.” = not supposed to change your diet
c. “I have been using over-the-counter ibuprofen when I get headaches or joint pain.”
d. “I started using garlic and ginger to season my foods instead of using table salt.”
The nurse is educating a client about safety measures to implement for newly prescribed clopidogrel. Which statement by the client indicates a need for additional instruction?
a. “I need to stop taking the Gingko biloba that I use for my memory.”
b. “I should remind my dentist about this medication at each visit.”
c. “I take ibuprofen instead of acetaminophen for minor aches and pains.”
d. “I will begin monitoring my bowel movements for any changes in color.”
c. “I take ibuprofen instead of acetaminophen for minor aches and pains.”
The nurse reinforces teaching about a continuous subcutaneous insulin infusion pump for a 12-year-old client with type 1 diabetes mellitus. Which statement by the client indicates appropriate understanding of teaching?
a. “I can get rid of my insulin syringes now that I use the insulin infusion pump.”
b. “I will get my parents to help me change the infusion site once a week.”
c. “It is important to subtract my basal insulin rate from the bolus doses at meals.”
d. “The insulin infusion pump continuously delivers small doses of insulin.”
d. “The insulin infusion pump continuously delivers small doses of insulin.”
The nurse is reinforcing teaching to a client with gastroesophageal reflux disease who has been prescribed esomeprazole capsules. Which instruction is the priority for the nurse to include in the teaching plan?
a. “Avoid taking NSAIDs because they can increase the risk for gastric irritation.”
b. “Call the clinic to see the health care provider if you develop diarrhea, abdominal cramps, or fever.”
c. “If it is easier to swallow, you may open the capsules and sprinkle the pellets onto apple sauce.”
d. “Prioritize eating foods that are rich in magnesium, such as nuts and whole grains.”
b. “Call the clinic to see the health care provider if you develop diarrhea, abdominal cramps, or fever.”
The clinic nurse is assessing the effectiveness of pancrelipase therapy for a client with cystic fibrosis. Which client statement requires follow-up related to pancrelipase therapy?
a. “I have been having several formed bowel movements each day.”
b. “I have been taking my pancrelipase with each meal and snack.”
c. “I have gained approximately 4 pounds during the last 2 months.”
d. “I have had increased stomach cramps and gas the past 3 days.”
d. “I have had increased stomach cramps and gas the past 3 days.”
