N368 Final Chapters 30-34 NCLEX

Question 1

Superinfections are an adverse effect commonto all antibiotic therapy. The best description of a superinfection is:
1 An initial infection so overwhelming that it requires multiple antimicrobial agents to treat successfully.
2 Bacterial resistance that creates infections difficult to treat and often resistant to multiple drugs.
3 Infections requiring high-dose antimicrobial therapy with increased chance of organ toxicity.
4 The overgrowth of normal body flora or of opportunistic organisms no longer held in check by normal, beneficial flora.

Answer 1

The overgrowth of normal body flora or of opportunistic organisms no longer held in check by normal, beneficial flora.

Question 2

A patient has been discharged with a prescription for penicillin. Discharge instructions include that:
Penicillins can be taken while breast-feeding.
The entire prescription must be finished.
All penicillins can be taken without regard to eating.
Some possible side effects include abdominal pain and constipation.

Answer 2

The entire prescription must be finished

Question 3

A patient has been prescribed tetracycline. When providing information regarding this drug, the nurse would be correct in stating that tetracycline:
Is classified as a narrow-spectrum antibiotic and only treats a few infections
Is used to treat a wide variety of disease processes
Has been identified to be safe during pregnancy
Is contraindicated in children younger than 8 years

Answer 3

Is contraindicated in children younger than 8 years

Question 4

Important information to include in the patient’s education regarding taking fluoroquinolones is that:
The drug can cause discoloration of teeth.
Fluid intake should be decreased to prevent urine retention.
This drug is primarily given orally because it is absorbed in the GI tract.
A serious side effect is hearing loss.

Answer 4

A serious side effect is hearing loss.

Question 5

discontinued..””

Answer 5

It is critical to continue therapy for at least 6 to 12

Question 6

A 32-year-old female has been started on ampicillin for a severe UTI. Before sending her home with this prescription, the nurse will:
Teach her to wear sunscreens.
Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course.
Assess for hearing loss.
Recommend taking the pill with some antacid to prevent GI upset.

Answer 6

Ask her about oral contraceptive use and recommend an alternative method for the duration of the ampicillin course.

Question 7

Teaching for a patient redceiving a prescription for ciprofloxacin (Cipro) should include (Select all that apply):

1. Report unusual heel, lower leg or calf pain or difficulty walking.
2. Avoid taking the medicine with milk products and antacids.
3. Limit vitamin C, both dietary and oral vitamin forms.
4. Take her pill with an antihistamine to avoid side effects.

Answer 7

1. Report unusual heel, lower leg or calf pain or difficulty
   walking.
2. Avoid taking the medicine with milk products and
   antacids.

Question 8

On discharge of the patient, the nurse discusses types of over-the-counter NSAID medications that are available. The nurse knows that which of the following OTC medications is often used for pain and fever but is not classified as an NSAID?
Aspirin 
Ibuprofen 
Acetaminophen 
Motrin

Answer 8

Acetaminophen

Question 9

While educating the patient about glucocorticoids, the nurse would instruct the patient to contact the health care provider immediately if:
There is a decrease of 2 lb in weight. 
There is an increase in appetite. 
There is any diarrhea. 
There is any difficulty breathing.

Answer 9

There is any difficulty breathing

Question 10

The nurse is admitting a patient with rheumatoid arthritis. The patient has been taking glucocorticoids for an extended period of time. During the assessment, the nurse observes that the patient has a very round moon-shaped face, bruising, and an abnormal contour of the shoulders. What does the nurse conclude based on these findings?
These are normal reactions with the illness.
These are probably birth defects.
These are symptoms of myasthenia gravis.
These are symptoms of adverse drug effects from the corticosteroids.

Answer 10

These are symptoms of adverse drug effects from the corticosteroids.

Question 11

A 24-year-old patient reports taking acetaminophen (Tylenol) fairly regularly for headaches. The nurse knows that a patient who consumes excess acetaminophen per day or regularly consumes alcoholic beverages should be observed for:
Hepatic toxicity
Renal damage 
Thrombotic effects 
Pulmonary damage

Answer 11

Hepatic toxicity

Question 12

The nurse is counseling a mother regarding antipyretic choices for her 8-year-old daughter. When asked why aspirin is not a good drug to use, the nurse bases her answer on her knowledge that aspirin:
Is not as good an antipyretic as is acetaminophen
May increase fever in children under age 10
May produce nausea and vomiting
Increases the risk of Reye’s syndrome in children under 18 with viral infections

Answer 12

Increases the risk of Reye’s syndrome in children under 18 with viral infections

Question 13

A 55-year-old female patient is receiving cyclosporine (Neoral, Sandimmune) after a heart transplant. The patient exhibits a white blood cell count of 12,000 cells/mm3, a sore throat, fatigue, and a low-grade fever. The nurse suspects: 
Transplant rejection
Heart failure 
Dehydration 
Infection

Answer 13

Infection

Question 14

Which of the following statements by a client taking cy- closporin (Neoral, Sandimmune) would indicate the need for more teaching by the nurse?

1. “I will report any reduction 111 urine output to my physician.5
2. “I will wash my hands frequently.”
3. cc I will take my blood pressure at home every day”
4. I will take my cyclosporine at breakfast with a glass of grapefruit juice.”

Answer 14

Answer: 4
Rationale: Grapefruit juice increases cyclosporine levels 50% to 200%, resulting in drug toxicity. Hand washing is important to pre- vent infection. Renal toxicity and hypertension are adverse effects of cyclosporine therapy. Cognitive Level: Analysis. Nursing Process: As- sessment. Clie?itNeed: Physiological Integrity.

Question 15

The nurse should monitor a transplant patient for the major adverse effect of cyclosporine (Neoral, Sandimmune) therapy by assessing which lab test?
CBC 
Serum creatinine
Liver enzymes 
Electrolytes

Answer 15

Serum creatinine

Question 16

The nurse would question an order for immunostimulant
therapy if the patient had which of the following conditions?
(Select all that apply. )
1. Pregnancy
2. renal disease
3. Infection
4. Liver disease
5. Metastatic cancer

Answer 16

Pregnancy
Renal disease
Liver disease
Metastatic cancer

Question 17

The type of immunity achieved through the administration of a vaccine is called:
Active immunity 
Passive immunity
Titer 
Vaccine

Answer 17

Active Immunity

Question 18

After interviewing her mother, which of the following responses may indicate a possible contraindication for giving this preschooler a live vaccine (e.g., MMR) at this visit and would require further exploration by the nurse?
Her cousin has the flu.
The mother has just finished her series of hepatitis B vaccines.
Her arm got really sore after her last tetanus shot.
They are caring for her grandmother who has just finished her second chemotherapy treatment for breast cancer.

Answer 18

They are caring for her grandmother who has just finished her second chemotherapy treatment for breast cancer.

Question 19

Which of the following mechanisms is the most important regulator of fluid intake?
Thirst 
Electrolytes 
Renin-angiotensin 
Kidneys

Answer 19

Thirst

Question 20

Which of the following nursing interventions is most important when caring for a patient receiving a plasma volume expander?
Assess the patient for deep vein thrombosis
Observe for signs of fluid overload
Encourage fluid intake
Monitor arterial blood gases

Answer 20

Observe for signs of fluid overload

Question 21

The patient’s serum sodium value is 149 mEq/L Which of
the following nursing interventions is most appropriate
for this patient? (Select all that apply.)
1. Encourage the patient to eat a low-salt diet
2. Administer a 0.45% NaCl IV solution.
3. Hold all doses of glucocortroids.
4. Notify the health care provider.
5. Have patient drink as much water as possible.

Answer 21

Encourage the patient to eat a low-salt diet

Notify the health care provider.

Question 22

The patient complains of muscle cramping in the calves, paresthesia of the toes, and the sensation of the heart skipping a beat. These symptoms may indicate which one of the following imbalances?
Hypernatremia 
Hypercalcemia 
Hypoglycemia 
Hyperkalemia

Answer 22

Hyperkalemia

Question 23

A patient will be sent home on diuretic therapy and will need to increase the amount of potassium in the diet. What food choices would the nurse suggest be added?
Liver, red meats, lettuce 
Apples, pears, celery, onions 
Bananas, tomatoes, beans, fresh meats 
Potato chips, licorice, rice, corn

Answer 23

Bananas, tomatoes, beans, fresh meats

Question 24

The nurse weighs the patient and finds that there has been a weight gain of 1.5 kg since the previous day. What would be the nurse’s next highest priority?
Check with the patient to see if there have been any dietary changes in the last few days.
Assess the patient for signs of edema and BP for possible hypertension.
Contact dietary to change the patient’s diet to reduced sodium.
Request a diuretic from the patient’s provider.

Answer 24

Assess the patient for signs of edema and BP for possible hypertension.

Question 25

Which of the following actions by the nurse is most important when caring for a patient with renal disease?
Identify medications that have the potential for nephrotoxicity.
Check the specific gravity of the urine daily.
Eliminate potassium-rich foods from the diet.
Encourage the patient to void every 4 hours.

Answer 25

Identify medications that have the potential for nephrotoxicity.

Question 26

The patient admitted for congestive heart failure (CHF) is receiving digoxin (Lanoxin) and furosemide (Lasix). Which of the following laboratory levels should the nurse carefully monitor?
Potassium 
Creatinine 
Calcuim 
Sodium

Answer 26

Potassium

Question 27

Which of the following clinical manifestations may indicate the patient is experiencing hypokalemia?
Hypertension 
Polydipsia 
Cardiac dysrhythmias 
Diarrhea

Answer 27

Cardiac dysrhythmias

Question 28

Which of the following medications must be used with caution in patients with a history of CHF? 
Acetazolamide (Diamox) 
Mannitol (Osmitrol) 
Bumetanide (Bumex) 
Ethacrynic acid (Edecrin)

Answer 28

Mannitol (Osmitrol)

Question 29

The nurse recognizes which of the disorders as a cause of
chronic renal failure? (select all that apply. )
1. chronic urinary tract infections
2. Diabetes mellitus
3. Congenital malformation
4. Hypertension
5. Hypotension

Answer 29

Diabetes mellitus Hypertension

Question 30

A patient with a history of CHF will be started on the potassium-sparing diuretic, spironolactone (Aldactone). Which of the following drug groups should not be used, or used with extreme caution in patients taking potassium-sparing diuretics?
NSAIDs 
Corticosteroids 
Loop diuretics 
ACE inhibitors or ARBs

Answer 30

ACE inhibitors or ARBs

Question 31

“A patient has been diagnosed with tuberculosis. While his
medicine is being administered, he asks questions regarding his treatment. What teaching should the nurse supply
to this patient! (Select all that apply. )
1. It is critical to continue therapy for at least 6 to 12”

2. “Two or more drugs may be used to prevent resistance.”
3. “These drugs may be used to prevent tuberculosis also.”
4. “No special precautions are required”
5. “After I month of treatment, the medication will be
   discontinued. .”

Answer 31

“It is critical to continue therapy for at least 6 to 12

months. “
2. “Two or more drugs may be used to prevent resistance.”
3. “These drugs may be used to prevent tuberculosis also.”
4. “No special precautions are required”

Question 32

A client is taking sirolimus (Rapamune) following a liver transplant. On the most recent CBC, the nurse notes a marked 50% decrease in platelets and leukocytes. During the physical assessment, what signs and symptoms should the nurse look for? What are appropriate nursing interventions?

Answer 32

Sirolimus (Rapamune) is an immunosuppressant. The nurse should assess for any signs and symptoms of bleeding or jaundice and infection. The nurse should question the client regarding activities that may cause bleeding. The nurse should also assess for signs and symptoms of liver impairment. The nurse should notify the health- care provider of the laboratory findings and educate the client to re- port any bleeding to the healthcare provider. The client should also report signs and symptoms of infection.

Question 33

A client has been exposed to hepatitis A and has been referred for an injection of gamma globulin. The client is hesitant to get a “shot” and says that his immune system is fine. How should the nurse respond?

Answer 33

The client needs the protection of this passive form of immunity after an exposure to such an illness. The gamma globulin will act as a protective mechanism for 3 weeks while the client is in the window of opportunity for developing hepatitis A. This drug does not stimulate the client’s immune system but will help protect the client from de- veloping the disease. The nurse should inform the client that the shot is far less debilitating than the disease.

Question 34

A client had a renal transplant 6 months ago and is taking cyclosporine (Neoral, Sandimmune) daily. Identify three precautions that the nurse should be aware of when caring for this client.

Answer 34

Cyclosporine is a toxic medication with many serious adverse effects. The nurse must understand that this drug cannot be given with grapefruit juice; clients who take this medication need their kidney function assessed regularly (not because of the kidney trans- plant but because cyclosporine reduces urine output). The nurse also must assess whether this client is taking steroids, which are often given concurrently with cyclosporine, as the serum glucose will need to be monitored regularly.

Question 35

A 72-year-old man with a history of heart failure presents to the emergency department complaining of weakness and pal- pitations. The client has been taking furosemide (Lasix) and digoxin (Lanoxin) at home. His current ECG reveals atrial fib- rillation, and serum electrolyte testing reveals a potassium level of 2.5 mEq/L. The physician orders an IV solution of
1,000 ml of Ringer’s lactate with 40 mEq KC1 to infuse over
8 hours. What are the issues the nurse must consider to safely administer this drug?

Answer 35

Aggressive treatment with loop diuretics is a common cause of hypokalemia. As in this example, hypokalemia can produce a myriad of sequelae including dysrhythmias. KC1 is indicated for clients with low potassium levels and is preferred over other potassium salts be- cause chloride is simultaneously replaced. The nurse administering KC1 must keep in mind several critical concerns to safeguard the client. The primary concern is the risk of potassium intoxication. High plasma concentrations of potassium may cause death through cardiac depression, arrhythmias, or arrest. The signs and symptoms of potassium overdose include mental confusion, weakness, listlessness, hypotension, and ECG abnormalities. In a client with heart disease, cardiac monitoring may be indicated during potassium infusion. Stu- dents should consult their drug handbooks and look up the maxi- mum rates for infusing KC1 in adults and children.
To prevent potassium intoxication, the nurse should carefully reg- ulate the infusion of IV fluids. Most institutions require that any solu- tion containing KG be administered using an infusion pump. Prior to beginning and throughout the infusion, the nurse should assess the client’s renal function (BUN and creatinine levels). A client with di- minished renal function is more likely to develop hyperkalemia.

Question 36

an 18-year-old woman is admitted to the labor and delivery unit for observation with a blood pressure of 186/108 mm Hg. She has 3-41 pitting edema of the lower extremities and states that her hands and face are “swollen.” The CBC reveals an elevated hemoglobin and hematocrit. The certified nurse midwife diagnoses the client with pregnancy-induced hyper- tension and orders an IV of D5LR. In addition, she requests that the nurse “push oral fluids.” The nurse considers whether
the midwife’s order should be questioned. Discuss the appro- priateness of this order.

Answer 36

The student should recognize from an intravascular standpoint that this client is dehydrated despite her appearance. The client’s elevated hematocrit and hemoglobin are indications of her degree of “dehy- dration.” Most pregnant women present with dilution anemia. This client does not. The midwife recognizes the need to increase the in- travascular fluid compartment to promote renal and uterine perfusion.

Question 37

An 84-year-oldwomanhasrecentlyreturnedhomeafterbe- ing admitted to the hospital for persistent nausea and vomit- ing and dehydration. Her past medical history includes gastric reflux, hiatal hernia, GI bleeding, anemia, and coronary artery disease. Her current medication regimen is metoprolol
(Lopressor), 50 mg PO bid; pantoprazole (Protonix), 40 mg PO daily; furosemide (Lasix), 20 mg PO daily; and lactulose, 20 g/30 ml PO at bedtime. Although this client s nausea and vomiting has resolved, she is still at risk for fluid and elec- trolyte imbalances secondary to her medication regimen. Which drug in particular places her at risk for fluid volume deficit, and which electrolyte must be monitored? What assessments should the nurse include?

Answer 37

client does not. The midwife recognizes the need to increase the in- travascular fluid compartment to promote renal and uterine perfusion.

Question 38

A 43-year-old man is diagnosed with hypertension follow- ing an annual physical examination. The client is thin and states that he engages in fairly regular exercise, but he de- scribes his job as highly stressful. He also has a positive family history for hypertension and stroke. The healthcare provider initiates therapy with losartan (Cozaar). After
2 months, the client has noted no appreciable difference in blood pressure values. The healthcare provider switches the client to combination losartan and hydrochloro- thiazide (Hyzaar), which proves to be very effective. Why is the new therapy more effective?

Answer 38

Losartan (Cozaar) is an angiotensin II receptor antagonist com- monly prescribed for hypertension. Because some clients do not re- spond adequately to monotherapy, a drug that offers combined therapy, Hyzaar, is added. ITyzaar combines losartan with hy- drochlorothiazide, a diuretic. This combination decreases blood pres- sure initially by reducing blood volume and arterial resistance. Over time, the diuretic is effective in maintaining the desired change in sodium balance with a resultant decrease in the sensitivity of vessels to norepinephrine. Angiotensin II-receptor antagonists appear to
prevent the hypokalemia associated with thiazide therapy.

Question 39

A 78-year-old woman is admitted to the intensive care unit with a diagnosis of heart failure. The nurse adminis-ters furosemide (Lasix) 40 mg IV push. What assessments should the nurse make to determine the effectiveness of this therapy?

Answer 39

Ifll The nurse should carefully monitor fluid status. Because the pri- mary concern is cardiopulmonary,s condition, a Foley catheter may be inserted to permit the measurement of hourly outputs. Daily weights should be obtained. Edema should be evaluated and documented, as well as status of mu- cous membranes and skin turgor. Because furosemide (Lasix) is a loop diuretic, the nurse would anticipate a rapid and profound diure- sis. Therefore, the nurse should also observe for signs of dehydration and potassium depletion over the course of therapy.

Question 40

A 17-year-old male client is admitted to the ICU following a car-train collision. The client sustained a depressed skull frac- ture and is on a ventilator. Two days after surgery, there are obvio us signs of increasing intracranial pressure. The nurse administers 32 g of a 15% solution of mannitol (Osmitrol) per IV over 30 minutes. The client’s mother asks the nurse to explain why her son needs this drug. What explanation should the nurse offer?

Answer 40

Cerebral edema occurs as a result of the body’s response to an ini- tial head trauma. In this case, the client sustained a skull fracture and underwent the trauma of required surgery. The nurse should explain to the mother that mannitol (Osmitrol) helps reduce swelling or cere- bral edema at the site of her son’s injury. The nurse might explain that the drug helps “pull” water from the site of injury and carry it to the kidneys, where it is eliminated. The client’s mother should under-
stand that the goal of decreasing swelling is to promote tissue recovery. Nurses must be sensitive to the fact that family members may have se- vere emotional reactions to a clients injury and need help to focus on short-term goals for recovery when the long-term prognosis is not known. For additional information on the action or administration of mannitol, students should consult a drug handbook.

Question 41

A 64-year-old diabetic client is on prednisone for rheumatoid arthritis. The client has recently been admitted to the hospital for stabilization of hyperglycemia. What are the nurse’s pri- mary concerns when caring for this client?

Answer 41

his client has many potential problems related to the use of prednisone over a sustained period. The primary current concern is the hyperglycemia—an adverse effect of the prednisone that can become serious when the client is diabetic. Blood pressure must be monitored for potential hypertension, which is related to sodium retention and, therefore, increased water retention caused by the prednisone. The client is also at high risk for infection while on pred- nisone because of suppression of the immune system, also related to the diabetes

Question 42

A 44-year-old client is requesting medication for a painful tendinitis of the elbow. This client has mild hypertension, a history of alcohol abuse, and nutritional deficits. This client has orders for acetaminophen (Tylenol), ibuprofen
(Motrin), and celecoxib (Celebrex). Which one would the nurse give and why?

Answer 42

The nurse should give the client celecoxib (Celebrex) for the el- bow inflammation and pain. This medication should provide ade- quate relief of the symptoms for this client. Ensure that the client is not allergic to sulfa prior to giving this medication. The client should not take acetaminophen (Tylenol) because of related potential liver compromise secondary to alcohol abuse. The client should not take ibuprofen (Motrin) because of the potential for gastric bleeding. The client’s stomach is already at risk because of alcohol abuse, and the chance for bleeding is elevated because of potential liver problems secondary to alcohol abuse.

Question 43

The mother of a 7-year-old child calls the physician s office stating that her daughter has a temperature of 101 °F. She states the child is also complaining of being tired and aachv” all over. The mother asks how much aspirin she
can giver her daughter for her temperature. How should the nurse respond?

Answer 43

The nurse should educate the mother that aspirin and aspirin- containing products should not be given to children younger than age 18. These drugs have been implicated in the development of Reye’s syndrome. Acetaminophen is the antipyretic of choice for treating most fevers. The nurse should also further question the mother re-
garding the length and severity of symptoms.

Question 44

An 18-year-old woman comes to a clinic for prenatal care. She is 8 weeks pregnant. She is healthy and takes no other medica- tion other than low-dose tetracycline for acne. What is a priority of care for this client?

Answer 44

This client should not be on tetracycline (Achromycin) while preg- nant because tetracycline is a category D drug that has teratogenic ef- fects on the fetus. Counseling should be provided for alternative sources of care for her acne as well as for use of drugs when pregnant.

Question 45

A 32-year-old client has a diagnosis of otitis external and the healthcare provider has ordered erythromycin PO. This client has a history of hepatitis B, allergies to sulfa and penicillin, and mild hypertension. Should the nurse give the erythromycin?

Answer 45

No, the nurse should not give the erythromycin. This client has a history of hepatitis B, and this medication is metabolized by the liver. An alternative type of antibiotic should be utilized.

Question 46

A 66-year-old hospitalized client has MRSA in a cellulitis of the lower extremity and is on gentamicin IV. What is a prior- ity for the nurse to monitor in this client?

Answer 46

his medication is typically reserved for more serious infections because of its higher potential for toxicity. Renal function is a priority assessment for this client. The nurse should monitor urine output, urine protein, and serum BUN and creatinine on a regular basis. A secondary priority is hearing assessment, because ototoxicity is common for clients on gentamicin.