Respiratory HW Qs

Question 1

Which action would be the most appropriate way for the nurse to evaluate a child’s understanding of how to use an inhaler?
A. Asking questions about using the inhaler
B. Having the child demonstrate inhaler use
C. Explaining how the inhaler will be used at home
D. Having the child tell the nurse about the technique that was learned

Answer 1

B. Having the child demonstrate inhaler use

Question 2

A client with chronic obstructive pulmonary disease prepares to take a medication that is delivered via a nebulizer. Which instruction would the nurse provide when teaching about use of the nebulizer?
A. ‘Hold your breath, spray the medication into your mouth, then inhale deeply.’
B. ‘Depress the canister as you inhale deeply, then hold your breath for at least 10 seconds.’
C. ‘Seal your lips around the mouthpiece and breathe in and out, taking slow, deep breaths.’
D. ‘Inhale the medication from the nebulizer, remove the mouthpiece to exhale and then repeat.’

Answer 2

C. ‘Seal your lips around the mouthpiece and breathe in and out, taking slow, deep breaths.’

Question 3

List in order the steps the nurse teaches the client to follow when using a metered-dose inhaler (MDI).
1.
Shake the inhaler for 30 seconds.
2.
Exhale slowly and deeply to empty the air from the lungs.
3.
Hold the inhaler upright in the mouth.
4.
Start breathing in and press down on the inhaler once.

Answer 3

1.
Shake the inhaler for 30 seconds.
2.
Exhale slowly and deeply to empty the air from the lungs.
3.
Hold the inhaler upright in the mouth.
4.
Start breathing in and press down on the inhaler once.

Question 4

Which goal is the priority for a client with asthma who has a prescription for an inhaled bronchodilator?
A. Is able to obtain pulse oximeter readings
B. Demonstrates use of a metered-dose inhaler
C. Knows the health care provider’s office hours
D. Can identify triggers that may cause wheezing

Answer 4

B. Demonstrates use of a metered-dose inhaler

Question 5

Which method would the nurse recommend when teaching the client with asthma how to determine if an inhaler is empty?
A. Track the number of doses taken.
B. Taste the medication when sprayed into the air.
C. Shake the canister.
D. Place the canister in water to see if it floats.

Answer 5

A. Track the number of doses taken.

Question 6

The nurse provides instructions about how to use a metered-dose inhaler (MDI) to a client with chronic obstructive pulmonary disease. The nurse concludes that additional teaching is needed when the client demonstrates which technique?
A. Places the tip of the inhaler just past the lips
B. Holds the inspired breath for at least 3 seconds
C. Activates the inhaler during inspiration
D. Inhales rapidly with the lips sealed around the nebulizer opening

Answer 6

D. Inhales rapidly with the lips sealed around the nebulizer opening

Question 7

Which intervention would the nurse implement for a client admitted for an exacerbation of asthma?
A. Determine the client’s emotional state.
B. Give prescribed medications to promote bronchiolar dilation.
C. Provide education about the effect of a family history.
D. Encourage the client to use an incentive spirometer routinely.

Answer 7

B. Give prescribed medications to promote bronchiolar dilation.

Question 8

A nurse is teaching an 80-year-old client how to use a metered dose inhaler. The nurse is concerned that the client is unable to coordinate the release of the medication during the inhalation phase. Which intervention should improve the delivery of the medication?
A. Ask a family member to assist the client with the inhaler.
B. Request a home health nurse to visit the client at home.
C. Use nebulized treatments at home instead.
D. Add a spacer device to the inhaler canister.

Answer 8

D. Add a spacer device to the inhaler canister.

Question 9

The nurse is teaching the client how to properly use a dry powder capsule inhaler. How should the nurse instruct the client to use this type of inhaler?
A. Shake inhaler before putting it in mouth
B. Seal lips tightly around mouthpiece and inhale rapidly and deeply
C. Rinse mouthpiece in hot soapy water after using
D. Breathe in medicine slowly and deeply for about 3-5 seconds

Answer 9

B. Seal lips tightly around mouthpiece and inhale rapidly and deeply

Question 10

The nurse is teaching a school-aged child and family members about the use of inhalers prescribed for asthma. Which statement made by a family member indicates an understanding of the nurse’s instructions?
A. “We will keep a chart of daily peak flow meter results.”
B. “We can rely on our child’s self-report of symptoms.”
C. “Monitoring our child’s pulse rate is not necessary.”
D. “Skin color changes in our child is an early warning sign for airway constriction.”

Answer 10

A. “We will keep a chart of daily peak flow meter results.”

Question 11

The nurse is educating a client about how to use a metered-dose inhaler with spacer. Place each step in the correct order by entering the numbers in order.
1.
Breathe out slowly
2.
Breathe in deeply
3.
Release the medication into the spacer
4.
Remove the mouthpiece from the lips
5.
Hold breath for 10 seconds

Answer 11

3.
Release the medication into the spacer
2.
Breathe in deeply
4.
Remove the mouthpiece from the lips
5.
Hold breath for 10 seconds
1.
Breathe out slowly

Question 12

The nurse administers albuterol to a 4-year-old child. Which intervention would assist the nurse in evaluating the effectiveness of this medication?
A. Auscultate breath sounds.
B. Collect a sputum sample.
C. Conduct a neurological examination.
D. Palpate chest excursion.

Answer 12

A. Auscultate breath sounds.

Question 13

The nurse administers albuterol to a child with asthma. Which common side effect would the nurse monitor for in the child?
A. Flushing
B. Dyspnea
C. Tachycardia
D. Hypotension

Answer 13

C. Tachycardia

Question 14

A client is prescribed albuterol to relieve severe asthma. Which adverse effects will the nurse instruct the client to anticipate? Select all that apply. One, some, or all responses may be correct.
A. Tremors
B. Lethargy
C. Palpitations
D. Bronchoconstriction
E. Decreased pulse rate

Answer 14

A. Tremors
C. Palpitations

Question 15

A client prescribed albuterol tablets reports nausea every evening with the 9:00 p.m. dose. Which action should the nurse perform to alleviate this side effect?
A. Change the time of the dose.
B. Hold the 9 p.m. dose.
C. Administer the dose with a snack.
D. Offer an antiemetic with the dose.

Answer 15

C. Administer the dose with a snack.

Question 16

The nurse is providing teaching to the client prescribed albuterol for the management of asthma. The nurse is including reportable side effects in the teaching plan. Which of the following side effects is the priority?
A. Nervousness
B. Headache
C. Palpitations
D. Muscle aches

Answer 16

C. Palpitations

Question 17

The nurse is teaching a pediatric client and family about prescribed albuterol sulfate extended-release tablets. Which statement should be included?
A. If you cannot swallow the tablet, it is ok to chew it
B. Rinse your mouth after taking this medication
C. This medication can cause restlessness
D. Oral albuterol can cause an increase in urination

Answer 17

C. This medication can cause restlessness

Question 18

The nurse is educating a client with end stage chronic obstructive pulmonary disease (COPD) about medication management. Which statement by the client indicates an understanding of the teaching?
A. “I will use the albuterol in the nebulizer before my other inhalers each morning.”
B. “I can use my tiotropium inhaler if I get short of breath.”
C. “I will only use the fluticasone inhaler on the days I am really out of breath.”
D. “The side effects of these medications will be less severe because I’m not taking them by mouth.”

Answer 18

A. “I will use the albuterol in the nebulizer before my other inhalers each morning.”

Question 19

The nurse is reinforcing the correct use of a metered-dose inhaler (MDI) for a client newly-diagnosed with asthma. The client asks, “how will I know the canister is empty?” What is the best response by the nurse?
A. “Contact your pharmacy to find out when to obtain a refill.”
B. “Drop the canister in water to observe if it floats.”
C. “Count the number of doses as the inhaler is used.”
D. “Shake the canister and listen for any fluid movement.”

Answer 19

C. “Count the number of doses as the inhaler is used.”

Question 20

The nurse is teaching a client diagnosed with asthma about the medication albuterol. Which statement by the nurse demonstrates appropriate teaching?
A. “Call your doctor’s office if you need to use the drug more often.”
B. “Use this medication at bedtime to promote rest.”
C. “Use this medication after other asthma inhalers.”
D. “Discontinue the inhaler if you feel dizzy.”

Answer 20

A. “Call your doctor’s office if you need to use the drug more often.”

Question 21

The nurse is teaching a client with asthma about albuterol. How should the nurse best describe the action of this medication?
A. “The medication is given to reduce secretions that block airways.”
B. “The medication will help to relax smooth muscles in the airways.”
C. “The medication will stimulate the respiratory center in the brain.”
D. “The medication will help to prevent pneumonia.”

Answer 21

B. “The medication will help to relax smooth muscles in the airways.”

Question 22

The nurse is preparing to administer an albuterol nebulizer treatment to a patient with asthma. Which assessment finding should be brought to the health care provider’s attention prior to administering the medication?
A. Temperature of 101°F (38.3°C)
B. Heart rate of 116 bpm
C. Respiratory rate of 28
D. Lower extremity edema

Answer 22

B. Heart rate of 116 bpm

Question 23

The nurse is providing discharge education to a client with moderate persistent asthma. The nurse should instruct the client to administer which medication first?
A. Bronchodilator
B. Glucocorticoid
C. Anticholinergic
D. Mast cell stabilizer

Answer 23

A. Bronchodilator

Question 24

A client with a history of asthma is admitted for a minor surgical procedure. Preoperatively, the peak flow is measured at 480 liters/minute. Postoperatively, the client reports chest tightness and the peak flow is now 200 liters/minute. What should the nurse do first?
A. Notify both the surgeon and primary care provider
B. Repeat the peak flow reading in 30 minutes
C. Administer the PRN dose of albuterol
D. Apply oxygen at two liters per nasal cannula

Answer 24

C. Administer the PRN dose of albuterol

Question 25

The nurse is evaluating the effectiveness of therapy for a client who received albuterol via nebulizer during an acute episode of shortness of breath due to asthma. Which finding is the best indicator that the therapy was effective?
A. Accessory muscle use has decreased.
B. Oxygen saturation is greater than 90%.
C. Respiratory rate is 16 breaths/minute.
D. No wheezes are audible.

Answer 25

B. Oxygen saturation is greater than 90%.

Question 26

Upon admission to the emergency center, an adult client with acute status asthmaticus is prescribed this series of medications. In which order should the nurse administer the prescribed medications? (Arrange from first to last.)
A. Prednisone (Deltasone) orally.
B. Gentamicin (Garamycin) IM.
C. Albuterol (Proventil) puffs.
D. Salmeterol (Serevent Diskus).

Answer 26

C. Albuterol (Proventil) puffs.
D. Salmeterol (Serevent Diskus).
A. Prednisone (Deltasone) orally.
B. Gentamicin (Garamycin) IM.

Question 27

A health care provider prescribes metaproterenol for a client. For which therapeutic effect would the nurse monitor the client?
A. Induced sedation
B. Relaxed bronchial spasm
C. Decreased blood pressure
D. Productive cough

Answer 27

B. Relaxed bronchial spasm

Question 28

Which intervention would the nurse implement for a client admitted for an exacerbation of asthma?
A. Determine the client’s emotional state.
B. Give prescribed medications to promote bronchiolar dilation.
C. Provide education about the effect of a family history.
D. Encourage the client to use an incentive spirometer routinely.

Answer 28

B. Give prescribed medications to promote bronchiolar dilation.

Question 29

While receiving an adrenergic beta 2 agonist medication for asthma, the client complains of palpitations, chest pain, and a throbbing headache. Which nursing action is the most appropriate?
A. Withhold the medication and notify the health care provider.
B. Tell the client that these are expected side effects from the medicine.
C. Give instructions to breathe slowly and deeply for several minutes.
D. Explain that the effects are temporary and will subside as medication tolerance.

Answer 29

A. Withhold the medication and notify the health care provider.

Question 30

The nurse is preparing to discharge a client who presented to the emergency room for an acute asthma attack. The nurse notes that upon discharge the health care provider has prescribed theophylline 300 mg orally to be taken daily at 9:00 AM. The nurse will teach the client to take the medication on which schedule?
A. One hour before or 2 hours after eating
B. At bedtime
C. At the specific time prescribed
D. Daily until symptoms are gone

Answer 30

C. At the specific time prescribed

Question 31

A client with chronic obstructive pulmonary disease (COPD) is receiving aminophylline 25 mg/hour intravenously (IV). Which finding would be associated with side effects of this medication?
A. Flushing and headache
B. Restlessness and palpitations
C. Decreased urine volume
D. Pruritus

Answer 31

B. Restlessness and palpitations

Question 32

The nurse is providing education to the client prescribed montelukast for the treatment of asthma. What medication should the nurse instruct the client to avoid?
A. Ibuprofen
B. Prednisone
C. Amoxicillin
D. Formoterol

Answer 32

A. Ibuprofen

Question 33

Which response to fludrocortisone will the nurse teach a client with adrenal insufficiency to report? Select all that apply. One, some, or all responses may be correct.
A. Edema
B. Rapid weight gain
C. Fatigue in the afternoon
D. Unpredictable changes in mood
E. Increased frequency of urination

Answer 33

A. Edema
B. Rapid weight gain

Question 34

Which explanation would the nurse provide for administering prednisone to a client with an exacerbation of colitis?
A. The client will be protected from getting an infection.
B. Symptoms associated with the colitis will decrease slowly over time.
C. Although the medication causes anorexia, weight loss may not occur.
D. Although the medication decreases intestinal inflammation, it will not cure the colitis.

Answer 34

D. Although the medication decreases intestinal inflammation, it will not cure the colitis.

Question 35

Which instruction will the nurse include when performing discharge teaching to a client now receiving hydrocortisone by mouth after stabilization of an acute adrenal insufficiency?
A. “Eat a diet high in sodium.”
B. “Take the medication with food.”
C. “Maintain the same dose indefinitely.”
D. “Eliminate a dose if side effects occur.”

Answer 35

B. “Take the medication with food.”

Question 36

Which information would the nurse provide when administering the first dose of prednisone prescribed to a client with an exacerbation of colitis?
A. “Prednisone protects you from getting an infection.”
B. “The medication may cause weight loss by decreasing your appetite.”
C. “Prednisone is not curative but does cause a suppression of the inflammatory process.”
D. “The medication is relatively slow in precipitating a response but is effective in reducing symptoms.”

Answer 36

C. “Prednisone is not curative but does cause a suppression of the inflammatory process.”

Question 37

Which side effect of prolonged cortisone therapy for adrenal insufficiency would the nurse teach the client and family to expect? Select all that apply. One, some, or all responses may be correct.
A. Oliguria
B. Anorexia
C. Weakness
D. Moon face
E. Weight gain
F. Nervousness

Answer 37

C. Weakness
D. Moon face
E. Weight gain

Question 38

The nurse teaches a client about cortisone therapy. Which statements made by the client indicate the need for further teaching? Select all that apply. One, some, or all responses may be correct.
A. ‘I should take 3 tablets at a time.’
B. ‘I should take the tablet twice a week.’
C. ‘I should take the tablet on an empty stomach.’
D. ‘I should take the tablet with a meal.’

Answer 38

A. ‘I should take 3 tablets at a time.’
B. ‘I should take the tablet twice a week.’
C. ‘I should take the tablet on an empty stomach.’

Question 39

A child recovering from a severe asthma attack is given oral prednisone 15 mg twice daily. Which intervention would be a priority for the nurse?
A. Having the child rest as much as possible
B. Checking the child’s eosinophil count daily
C. Preventing exposure of the child to infection
E. Offering sips of water when administering the medication

Answer 39

C. Preventing exposure of the child to infection

Question 40

The nurse is teaching the parents of a child prescribed a high dose of oral prednisone for asthma. Which information is critical for the nurse to include when teaching about this medication?
A. It protects against infection.
B. It should be stopped gradually.
C. An early growth spurt may occur.
D. A moon-shaped face will develop.

Answer 40

B. It should be stopped gradually.

Question 41

A child with nephrotic syndrome has been receiving prednisone for 1 week. Which information in the child’s record indicates to the nurse that the medication has been effective? Select all that apply. One, some, or all responses may be correct.
A. Weight loss
B. Lower blood pH
C. Decreased lethargy
D. Increased urine output
E. Decreased blood pressure

Answer 41

A. Weight loss
C. Decreased lethargy
D. Increased urine output

Question 42

Which complication is an adverse effect of cortisone therapy?
A. Hypoglycemia
B. Severe anorexia
C. Anaphylactic shock
D. Behavioral changes

Answer 42

D. Behavioral changes

Question 43

A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. Which reason would the nurse include in a response to this question?
A. Lubricates the joint
B. Reduces inflammation
C. Provides physiotherapy
D. Prevents ankylosis of the joint

Answer 43

B. Reduces inflammation

Question 44

Hydrocortisone is prescribed for a client with Addison’s disease. Which response is a therapeutic effect of this medication?
A. Supports a better response to stress
B. Promotes a decrease in blood pressure
C. Decreases episodes of shortness of breath
D. Controls an excessive loss of potassium

Answer 44

A. Supports a better response to stress

Question 45

The nurse is caring for a client who is scheduled for a bilateral adrenalectomy. Which medication would the nurse expect to be prescribed for this client?
A. Methimazole
B. Regular insulin
C. Pituitary extract
D. Hydrocortisone

Answer 45

D. Hydrocortisone

Question 46

Which effect explains the purpose for gradual dosage reduction of glucocorticoids such as dexamethasone?
A. Builds glycogen stores in the muscles
B. Produces antibodies by the immune system
C. Allows the increased intracranial pressure to return to normal
D. Promotes return of cortisone production by the adrenal glands

Answer 46

D. Promotes return of cortisone production by the adrenal glands

Question 47

A client has refused prescribed cortisone. The nurse continues to administer the cortisone while evading the client’s questions. When the client later discovers that cortisone continued to be administered, the client decides to sue the nurse. Which elements must be considered in a legal action? Select all that apply. One, some, or all responses may be correct.
A. Clients have a right to refuse treatment.
B. Nurses are required to answer clients truthfully.
C. The health care provider should have been notified.
D. The client had insufficient knowledge to make such a decision.
E. Legally prescribed medications are administered despite a client’s objections.

Answer 47

A. Clients have a right to refuse treatment.
B. Nurses are required to answer clients truthfully.
C. The health care provider should have been notified.

Question 48

Dexamethasone has been prescribed for a client after a craniotomy for a brain tumor. Which physiological response is responsible for this medication’s therapeutic effect?
A. Reduced cell growth
B. Reduced cerebral edema
C. Increased renal reabsorption
D. Increased response to sedation

Answer 48

B. Reduced cerebral edema

Question 49

A female client receiving cortisone therapy for adrenal insufficiency expresses concern that she is developing facial hair. How would the nurse respond?
A. ‘It is just another sign of adrenal insufficiency.’
B. ‘This side effect will disappear after therapy.’
C. ‘This is not important as long as you are feeling better.’
D. ‘The medication contains a hormone that causes male characteristics.’

Answer 49

D. ‘The medication contains a hormone that causes male characteristics.’

Question 50

A client with systemic lupus erythematosus is taking prednisone. Which foods would the nurse encourage the client to eat while receiving treatment to prevent hypokalemia?
A. Broccoli
B. Oatmeal
C. Fried rice
D. Cooked carrots

Answer 50

A. Broccoli

Question 51

Which side effect would the nurse assess for in a child receiving prednisone?
A. Alopecia
B. Anorexia
C. Weight loss
D. Mood changes

Answer 51

D. Mood changes

Question 52

Which nursing assessment is important for a school-age child undergoing long-term steroid therapy?
A. Monitoring pulse for irregularities
B. Testing of stools for occult blood
C. Inspection of urine for mucous threads
D. Check of oral mucous membranes for ulcers

Answer 52

B. Testing of stools for occult blood

Question 53

The client who was admitted with exacerbation of ulcerative colitis has developed hyperglycemia. The client who was admitted with exacerbation of ulcerative colitis has developed hyperglycemia. Which medication that the client was prescribed most likely caused this adverse drug effect?
A. Dicyclomine
B. Acetaminophen
C. Prednisone
D. Diphenoxylate/atropine

Answer 53

C. Prednisone

Question 54

The nurse is preparing a client with rheumatoid arthritis (RA) for discharge to an assisted living facility. Which statement about the prescribed oral glucocorticoid is correct?
A. “The medication will reverse the joint deterioration of RA.”
B. “You will be taking the medication for several years.”
C. “It is normal to experience some memory loss or hallucinations.”
D. “The medication will be gradually tapered off over 5 to 7 days.”

Answer 54

D. “The medication will be gradually tapered off over 5 to 7 days.”

Question 55

A child is prescribed fluticasone after an acute asthma attack. Which instruction would the nurse give the family about the administration of this medication?
A. ‘Fluticasone needs to be taken with food or milk.’
B. ‘Fluticasone is primarily used to treat acute asthma attacks.’
C. ‘The child should suck on hard candy to help relieve dry mouth.’
D. ‘Watch for white patches in the mouth and report to the health care provider.’

Answer 55

D. ‘Watch for white patches in the mouth and report to the health care provider.’

Question 56

A health care provider prescribes dexamethasone for a client with head trauma. The nurse recognizes that it reduces swelling in the brain by which process?
A. Acts as a hyperosmotic diuretic
B. Increases resistance to infection
C. Reduces the inflammatory response of tissues
D. Decreases the formation of cerebrospinal fluid

Answer 56

C. Reduces the inflammatory response of tissues

Question 57

A client is receiving dexamethasone to treat acute exacerbation of asthma. For which side effect would the nurse monitor the client?
A. Hyperkalemia
B. Liver dysfunction
C. Orthostatic hypotension
D. Increased blood glucose

Answer 57

D. Increased blood glucose

Question 58

A beclomethasone inhaler would be prescribed for which purpose?
A. Prevents atelectasis
B. Decreases inflammation
C. Relaxes smooth muscle in the airways
D. Reduces bacteria in the respiratory tract

Answer 58

B. Decreases inflammation

Question 59

When a client is receiving dexamethasone for adrenocortical insufficiency, which action would the nurse take to monitor for an adverse effect of the medication?
A. Auscultate for bowel sounds.
B. Assess deep tendon reflexes.
C. Culture respiratory secretions.
D. Measure blood glucose levels.

Answer 59

D. Measure blood glucose levels.

Question 60

Which action would the nurse perform when administering fluticasone propionate to a client with asthma? Select all that apply. One, some, or all responses may be correct.
A. Assessing heart rate and rhythm
B. Monitoring liver function blood tests
C. Rinsing the oral cavity with water after use
D. Obtaining blood glucose levels before meals
E. Giving stool softeners to prevent constipation

Answer 60

C. Rinsing the oral cavity with water after use

Question 61

The nurse admits a client with tumor-induced spinal cord compression. Which medication should the nurse anticipate to be prescribed to offer the best palliative treatment for this client?
A. Morphine sulfate.
B. Ibuprofen.
C. Amitriptyline.
D. Dexamethasone.

Answer 61

D. Dexamethasone.

Question 62

The nurse is educating a client on self-administration of a fluticasone inhaler. What statement indicates an understanding of the teaching?
A. I will rinse my mouth with water after using the inhaler
B. Disinfectant wipes can be used to clean the spacer
C. I need to wait 15 minutes between puffs
D. This inhaler should be used before the others

Answer 62

A. I will rinse my mouth with water after using the inhaler

Question 63

A nurse is teaching a client with asthma about the correct use of the fluticasone inhaler. Which statement, if made by the client, would indicate that the teaching was effective?
A. “The inhaler can be used when I feel short of breath.”
B. “If I forget a dose, I will double the next dose.”
C. “I should rinse my mouth after using the inhaler.”
D. “I should not use a spacer with my inhaler.”

Answer 63

C. “I should rinse my mouth after using the inhaler.”

Question 64

The nurse is providing discharge education to a client newly diagnosed with chronic obstructive pulmonary disease. The client is prescribed the diskus inhaler fluticasone propionate and salmeterol. The client asks, “How will I know when the inhaler is empty?” How should the nurse respond?
A. Shake the canister to detect any fluid movement
B. The number of doses that remain will be on the inhaler
C. Drop the canister in water to observe floating
D. Estimate how many doses are usually in the canister

Answer 64

B. The number of doses that remain will be on the inhaler

Question 65

Which symptom would the nurse expect to decrease in response to corticosteroid therapy prescribed for a client with multiple sclerosis?
A. Emotional lability
B. Muscular contractions
C. Pain in the extremities
D. Visual impairment

Answer 65

D. Visual impairment

Question 66

Which statement regarding mealtime administration by a client who has arthritis and is prescribed corticosteroid medication indicates that the teaching was effective?
A. “This will decrease gastric irritation.”
B. “This will serve as a reminder to take the medication.”
C. “The presence of food will enhance absorption.”
D. “The medication is ineffective in an acid medium.”

Answer 66

A. “This will decrease gastric irritation.”

Question 67

Which times for the medication schedule would a nurse teach when corticosteroid therapy is prescribed for a client with an exacerbation of ulcerative colitis?
A. At bedtime with a snack
B. Three times a day with meals
C. In the early morning with food
D. One hour before or 2 hours after eating

Answer 67

C. In the early morning with food

Question 68

Which action is the primary purpose of a topical steroid application to a basal cell carcinoma surgical site?
A. Preventing infection of the wound
B. Increasing fluid loss from the skin
C. Reducing inflammation at the surgical site
D. Limiting itching around the area of the lesion

Answer 68

C. Reducing inflammation at the surgical site

Question 69

Which intervention would the nurse anticipate providing teaching on when a client presents with extensive lesions caused by psoriasis?
A. Advising sunscreen and special clothing
B. Topical application of steroids
C. Potassium permanganate baths
D. Debridement of necrotic plaques

Answer 69

B. Topical application of steroids

Question 70

Which action will a nurse take when a male client receiving prolonged steroid therapy complains of always being thirsty and urinating frequently?
A. Have the client assessed for an enlarged prostate.
B. Obtain a urine specimen from the client to test for ketonuria.
C. Perform a finger stick to test the client’s blood glucose level.
D. Assess the client’s lower extremities for the presence of pitting edema.

Answer 70

C. Perform a finger stick to test the client’s blood glucose level.

Question 71

A 6-year-old child with asthma is prescribed an inhaled corticosteroid. The nurse would conclude the mother understands teaching about the medication side effects when the mother makes which statement?
A. ‘I’ll watch for frequent urination.’
B. ‘I’ll check for white patches in the mouth.’
C. ‘I’ll be alert for short episodes of not breathing.’
D. ‘I’ll monitor for an increased blood glucose level.’

Answer 71

B. ‘I’ll check for white patches in the mouth.’

Question 72

A child who has nephrotic syndrome is prescribed steroid therapy. Which explanation would the nurse give the parents regarding the goal of this treatment?
A. Prevents infection
B. Stimulates diuresis
C. Provides hemopoiesis
D. Reduces blood pressure

Answer 72

B. Stimulates diuresis

Question 73

A child undergoing prolonged steroid therapy takes on a cushingoid appearance. The nurse would expect to find which of these manifestations during further assessment? Select all that apply. One, some, or all responses may be correct.
A. Truncal obesity
B. Thin extremities
C. Increased linear growth
D. Loss of hair on the body
E. Decreased blood pressure

Answer 73

A. Truncal obesity
B. Thin extremities

Question 74

A client with myasthenia gravis is to receive immunosuppressive therapy with corticosteroids. Which mechanism of action assures the nurse that this therapy will be effective?
A. Inhibits the breakdown of acetylcholine at the neuromuscular junction
B. Stimulates the production of acetylcholine at the neuromuscular junction
C. Decreases the production of autoantibodies that attack acetylcholine receptors
D. Promotes the removal of autoantibodies that impair the transmission of impulses
Rationale

Answer 74

C. Decreases the production of autoantibodies that attack acetylcholine receptors

Question 75

A client is scheduled for a craniotomy to remove a brain tumor. To prevent the development of cerebral edema after surgery, the nurse anticipates the use of medications from which class?
A. Glucocorticoids
B. Anticholinergics
C. Anticonvulsants
D. Antihypertensives

Answer 75

A. Glucocorticoids

Question 76

Long-term corticosteroid therapy has been initiated for a client with myasthenia gravis who experiences inadequate symptomatic control with pyridostigmine bromide. Which action is important for the nurse to take?
A. Request a high-sodium diet.
B. Establish protective isolation.
C. Decrease the client’s total daily fluid intake.
D. Monitor the client for an exacerbation of symptoms.

Answer 76

D. Monitor the client for an exacerbation of symptoms.

Question 77

A client receiving corticosteroid therapy states, ‘I have difficulty controlling my temper, which is so unlike me, and I don’t know why this is happening.’ How will the nurse respond?
A. Tell the client it is nothing to worry about.
B. Reassure that everyone does this at times.
C. Instruct the client to attempt to avoid situations that cause irritation.
D. Inquire about mood swings.

Answer 77

D. Inquire about mood swings.

Question 78

A client who recently started receiving oral corticosteroids for a severe allergic reaction is instructed that the dosage will be reduced gradually until all medication is stopped at the end of 2 weeks. Which reason would the nurse provide for this gradual reduction in dosage?
A. Discontinuing the medication too fast will cause the allergic reaction to reappear.
B. Slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed.
C. The health care provider is attempting to determine the minimal dose that will be effective for the allergy.
D. Sudden cessation of the medication will cause development of serious side effects, such as moon face and fluid retention.

Answer 78

B. Slow reduction of the medication will prevent a physiological crisis because the adrenal glands are suppressed.

Question 79

A client is admitted to the hospital for an adrenalectomy. Before the client’s replacement steroid therapy is regulated fully, the nurse will monitor the client for which complication?
A. Hypotension
B. Hypokalemia
C. Hypernatremia
D. Hyperglycemia

Answer 79

A. Hypotension

Question 80

A client who is on long-term corticosteroid therapy after an adrenalectomy is admitted to the surgical intensive care unit after being involved in a motor vehicle crash. Which statement is an important concern for client safety?
A. The dosage of steroids will have to be tapered down slowly to prevent acute adrenal crisis.
B. Steroid therapy will need to be increased to avert a life-threatening crisis.
C. Osteoporosis secondary to long-term corticosteroids increases fracture risk.
D. The client is at risk for Cushing syndrome if taking long-term corticosteroid

Answer 80

B. Steroid therapy will need to be increased to avert a life-threatening crisis.

Question 81

Immediately after a bilateral adrenalectomy, a client is receiving corticosteroids that are to be continued after discharge from the hospital. Which statement by the client indicates to the nurse that additional education is needed?
A. ‘I need to have periodic tests of my blood for glucose.’
B. ‘I am glad that I only have to take the medication once a day.’
C. ‘I must take the medicine with meals.’
D. ‘I should tell my health care provider if I am overly restless or have trouble sleeping.’

Answer 81

B. ‘I am glad that I only have to take the medication once a day.’

Question 82

Which information from the client’s history would the nurse identify as a risk factor for developing osteoporosis?
A. Takes estrogen therapy
B. Receives long-term steroid therapy
C. Has a history of hypoparathyroidism
D. Engages in strenuous physical activity

Answer 82

B. Receives long-term steroid therapy

Question 83

A client with rheumatoid arthritis has been taking a corticosteroid medication for the past year. Prolonged use of corticosteroids puts this client at increased risk for which complication?
A. Decreased white blood cells
B. Increased C-reactive protein
C. Increased sedimentation rate
D. Decreased serum glucose levels

Answer 83

A. Decreased white blood cells

Question 84

A client is scheduled for an adrenalectomy. Which action would the nurse expect in the plan of care?
A. Provide a low-protein diet.
B. Administer parenteral corticosteroids.
C. Collect a preoperative 24-hour urine specimen.
D. Withhold all medications 48 hours before surgery.

Answer 84

B. Administer parenteral corticosteroids.

Question 85

A client is scheduled for a bilateral adrenalectomy. Which rationale describes why steroids are administered to the client?
A. To foster accumulation of glycogen in the liver
B. To increase the inflammatory action to promote healing
C. To facilitate urinary excretion of salt and water after surgery
D. To compensate for sudden lack of these hormones after surgery

Answer 85

D. To compensate for sudden lack of these hormones after surgery

Question 86

A client is admitted to the hospital for an adrenalectomy. When teaching the client about the prescribed medications, which advice will the nurse emphasize?
A. Medication therapy will be given in conjunction with insulin.
B. Once regulated, the dosage will remain the same for life.
C. Medications will need to be held for surgery or other invasive procedures.
D. Salt intake may have to be restricted.

Answer 86

D. Salt intake may have to be restricted.

Question 87

A male client receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. Which is the nurse’s initial action?
A. Have the client assessed for an enlarged prostate.
B. Obtain a urine specimen from the client to test for ketonuria.
C. Perform a finger stick to test the client’s blood glucose level.
D. Assess the client’s lower extremities for the presence of pitting edema.

Answer 87

C. Perform a finger stick to test the client’s blood glucose level.

Question 88

A client presents with extensive lesions caused by psoriasis. Which intervention would the nurse anticipate providing teaching on?
A. Advising sunscreen and special clothing
B. Topical application of steroids
C. Potassium permanganate baths
D. Debridement of necrotic plaques

Answer 88

B. Topical application of steroids

Question 89

The nurse provides client teaching on the administration of a topical steroid application to a basal cell carcinoma surgical site. The nurse evaluates the teaching as effective when the client identifies which action as the primary purpose of the medication?
A. Preventing infection of the wound
B. Increasing fluid loss from the skin
C. Reducing inflammation at the surgical site
D. Limiting itching around the area of the lesion

Answer 89

C. Reducing inflammation at the surgical site

Question 90

A pediatric client is prescribed an intravenous infusion of methylprednisolone. Which clinical manifestation requires immediate intervention during administration of the initial dose?
A. Polyuria
B. Tinnitus
C. Drowsiness
D. Hypotension

Answer 90

A. Polyuria

Question 91

A client is receiving methylprednisolone 40 mg IV daily. The nurse should monitor which laboratory value closely?
A. Serum glucose.
B. Serum calcium.
C. Red blood cells.
D. Serum potassium.

Answer 91

A. Serum glucose.

Question 92

The nurse is teaching a client about newly prescribed inhaled budesonide. The nurse should teach the client to report which finding to the healthcare provider?
A. Rounded face
B. Bradycardia
C. Increased thirst
D. Cough

Answer 92

C. Increased thirst

Question 93

A client is started on long-term corticosteroid therapy for an autoimmune disorder. Which statement by the client indicates the need for more teaching by the nurse?
A. “For 1 week each month I will stop taking the medication.”
B. “I will keep a record of my weight each week.”
C. “The medication needs to be taken with food.”
D. “I will be sure to eat foods that are high in potassium.”

Answer 93

A. “For 1 week each month I will stop taking the medication.”

Question 94

The client has been treated with long-term glucocorticoid therapy. While completing the physical assessment, which finding should the nurse expect?
A. Jaundice
B. Peripheral edema
C. Buffalo hump
D. Increased muscle mass

Answer 94

C. Buffalo hump

Question 95

Which increased risk would the nurse consider when assessing a client with diabetes who is receiving long-term corticosteroid therapy and is admitted with leg ulcers?
A. Weight loss
B. Hypoglycemia
C. Decreased blood pressure
D. Inadequate wound healing

Answer 95

D. Inadequate wound healing

Question 96

Which outcome would the nurse expect when caring for a child receiving adrenocorticosteroid therapy?
A. Accelerated wound healing
B. Development of hyperkalemia
C. Increased antibody production
D. Suppressed inflammatory process

Answer 96

D. Suppressed inflammatory process

Question 97

The nurse is caring for a child undergoing chemotherapy for acute lymphoid leukemia. The parents ask why the child needs prednisone. Which response by the nurse would be correct?
A. ‘It decreases inflammation.’
B. ‘It suppresses the production of lymphocytes.’
C. ‘It increases appetite and a sense of well-being.’
D. ‘It may decrease skin irritation and edema.’

Answer 97

A. ‘It decreases inflammation.’

Question 98

The nurse is caring for a child receiving prednisone. Which consideration is most important for the nurse to remember when administering adrenocorticosteroid therapy?
A. It suppresses inflammation.
B. It may produce hyperkalemia.
C. Wound healing is accelerated.
D. Antibody production increases.

Answer 98

A. It suppresses inflammation.

Question 99

The nurse is monitoring an older adult client prescribed diphenhydramine for contact dermatitis related to poison ivy exposure. Which finding should be reported to the provider as a potential drug-related side effect?
A. Confusion
B. Hypertension
C. Incontinence
D. Bradypnea

Answer 99

A. Confusion

Question 100

A nurse notes an abrupt onset of confusion in an 85-year-old client. Which newly prescribed medication most likely caused this change in the client’s mental status?
A. Warfarin
B. Metoprolol
C. Pantoprazole
D. Diphenhydramine

Answer 100

D. Diphenhydramine

Question 101

The nurse is evaluating the plan of care for a client with benign prostatic hyperplasia (BPH). For which prescribed medication should the nurse notify the health care provider (HCP)?
A. Diphenhydramine
B. Finasteride
C. Terazosin
D. Metoprolol

Answer 101

A. Diphenhydramine

Question 102

The nurse is caring for a client with a sore throat who developed urticaria after the administration of prescribed antibiotics. The client is now receiving cetirizine. Which finding indicates that the cetirizine is having the intended effect?
A. The client reports less itching.
B. The tonsils are decreasing in size.
C. The client reports less muffled hearing.
D. The pain rating is decreased.

Answer 102

A. The client reports less itching.

Question 103

An adolescent prescribed loratadine 10 mg daily for hay fever is concerned the medication will cause drowsiness during the school day. Which action would the school nurse take?
A. Explain this medication rarely causes drowsiness.
B. Advise to take half a tablet in the morning before school.
C. Suggest skipping the next day’s dose if hay fever is better.
D. Recommend contacting the allergist for a prescription containing a stimulant.

Answer 103

A. Explain this medication rarely causes drowsiness.

Question 104

An adolescent with hay fever has been taking a prescribed first-generation antihistamine every 8 hours for the past 2 days. The adolescent tells the nurse, ‘This medicine is making me sleepy.’ Which response by the nurse would be most appropriate?
A. ‘Take half a tablet before school.’
B. ‘Try omitting the early morning dose.’
C. ‘The drowsiness usually decreases after several days.’
D. ‘I’ll write your teacher a note to explain your inability to concentrate in class while taking this medicine.’

Answer 104

C. ‘The drowsiness usually decreases after several days.’

Question 105

The nurse is administering hydroxyzine to a client. The nurse would monitor the client for which side effect of this medication?
A. Ataxia
B. Drowsiness
C. Vertigo
D. Slurred speech

Answer 105

B. Drowsiness

Question 106

The nurse is caring for an 83-year-old client who is experiencing a sudden onset of confusion. Which medication most likely contributed to this change?
A. Cardiac glycoside
B. Anticoagulant
C. Liquid antacid
D. Antihistamine

Answer 106

D. Antihistamine

Question 107

The nurse is collecting the health history of a client who reports taking over-the-counter pseudoephedrine for nasal congestion. Which statement by the client would require follow-up by the nurse?
A. I take this medication at night before I go to bed
B. I have to use a normal saline nasal spray since I started this medication
C. I avoid drinking beverages with caffeine while taking the medication
D. I chew gum when I take this medication to help with my dry mouth

Answer 107

A. I take this medication at night before I go to bed

Question 108

An adolescent is prescribed phenylephrine nasal spray. The nurse would determine teaching has been effective when the adolescent identifies which complication that may occur if the spray is used more frequently or longer than recommended?
A. Tinnitus
B. Nasal polyps
C. Bleeding tendencies
D. Increased nasal congestion

Answer 108

D. Increased nasal congestion

Question 109

Which effect would the nurse assess a teenager for if more than the recommended dose of oxymetazoline nasal spray is taken?
A. Nasal polyps
B. Ringing in the ears
C. Bleeding tendencies
D. Increased nasal congestion

Answer 109

D. Increased nasal congestion

Question 110

The nurse is providing education to the client with sinusitis who has asked about taking over-the-counter pseudoephedrine. Which of the following statements is appropriate?
A. If you take pseudoephedrine and phenylephrine together, you will get more relief
B. Continue the medication until your congestion resolves
C. Using these kinds of medications may make you jittery and restless
D. It is safe to chew over the counter medications if you have trouble swallowing pills

Answer 110

C. Using these kinds of medications may make you jittery and restless

Question 111

The spouse of a client with an intracranial hemorrhage asks the nurse, ‘Why aren’t they administering an anticoagulant?’ How will the nurse respond?
A. ‘It is not advisable because bleeding will increase.’
B. ‘If necessary, it will be started to enhance circulation.’
C. ‘If necessary, it will be started to prevent pulmonary thrombosis.’
D. ‘It is inadvisable because it masks the effects of the hemorrhage.’

Answer 111

A. ‘It is not advisable because bleeding will increase.’

Question 112

The laboratory report establishes that the client has a warfarin overdose. Which antidote would the nurse anticipate administering?
A. Physostigmine
B. Vitamin K
C. Iron dextran
D. Protamine sulfate

Answer 112

B. Vitamin K

Question 113

Which antidote would the nurse anticipate administering to a client whose laboratory report establishes a warfarin overdose?
A. Physostigmine
B. Vitamin K
C. Iron dextran
D. Protamine sulfate

Answer 113

B. Vitamin K

Question 114

Which statement about appropriate foods to consume when taking warfarin would indicate that the client needs further teaching?
A. “Eggs provide a good source of iron, which is needed to prevent anemia.”
B. “Yellow vegetables are high in vitamin A and should be included in the diet.”
C. “Dark green leafy vegetables are high in vitamin K, so I should eat them more often.”
D. “Milk and other high-calcium dairy products are necessary to counteract bone density loss.”

Answer 114

C. “Dark green leafy vegetables are high in vitamin K, so I should eat them more often.”

Question 115

Which drink would a nurse teach a client on warfarin to avoid?
A. Apple juice
B. Grape juice
C. Orange juice
D. Cranberry juice

Answer 115

D. Cranberry juice

Question 116

Which information would the nurse include when teaching a client about warfarin?
A. Periodic blood testing is necessary.
B. Increase intake of green leafy vegetables.
C. Limit the amount of daily physical activity.
D. It should be continued for minor surgical procedures.

Answer 116

A. Periodic blood testing is necessary.

Question 117

The nurse provides discharge medication education to a client who has a prescription for warfarin. Which client statement indicates to the nurse that teaching was effective?
A. ‘I will avoid taking aspirin and nonsteroidal anti-inflammatory drugs [NSAIDs].’
B. ‘I will need to develop a more sedentary routine.’
C. ‘I will need to have regular complete blood counts to guide warfarin dosage.’
D. ‘Before going to the dentist, I will ask my health care provider for antibiotics.’

Answer 117

A. ‘I will avoid taking aspirin and nonsteroidal anti-inflammatory drugs [NSAIDs].’

Question 118

Which medication is often contraindicated when taking warfarin?
A. Atenolol
B. Ferrous sulfate
C. Chlorpromazine
D. Acetylsalicylic acid

Answer 118

D. Acetylsalicylic acid

Question 119

The international normalized ratio (INR) results of a client receiving warfarin have been variable. Which factor can help the nurse identify the cause of the INR fluctuations?
A. Intake of foods high in potassium
B. Serum glucose level
C. Platelet count
D. Adherence to the prescribed medication regimen

Answer 119

D. Adherence to the prescribed medication regimen

Question 120

Warfarin is prescribed for a client who has been receiving intravenous (IV) heparin for a partial occlusion of the left common carotid artery. The client expresses concern about why both medications are needed at the same time. Which rationale would the nurse include to address the client’s concern?
A. This permits the administration of smaller doses of each medication.
B. Giving both medications allows clot dissolution while preventing new clot formation.
C. Heparin provides anticoagulant effects until warfarin reaches therapeutic levels.
D. Administration of heparin with warfarin provides immediate and maximum protection against clot formation.

Answer 120

C. Heparin provides anticoagulant effects until warfarin reaches therapeutic levels.

Question 121

A client with a partial occlusion of the left common carotid artery is to be discharged while still receiving warfarin. Which adverse effect will the nurse identify as a reason for the client to seek medical consultation? Select all that apply. One, some, or all responses may be correct.
A. Hematuria
B. Hemoptysis
C. Delayed clotting from minor cuts and scrapes
D. Bleeding from gums when brushing teeth
E. Vomiting coffee-ground emesis

Answer 121

A. Hematuria
B. Hemoptysis
E. Vomiting coffee-ground emesis

Question 122

A client is taking warfarin. If an antidote is needed, which agent will be used?
A. Vitamin K
B. Fibrinogen
C. Prothrombin
D. Protamine sulfate

Answer 122

A. Vitamin K

Question 123

The nurse teaches the client about appropriate foods to consume when taking warfarin. The nurse evaluates that the client needs further teaching when the client makes which statement?
A. ‘Eggs provide a good source of iron, which is needed to prevent anemia.’
B. ‘Yellow vegetables are high in vitamin A and should be included in the diet.’
C. ‘Dark green leafy vegetables are high in vitamin K, so I should eat them more often.’
D. ‘Milk and other high-calcium dairy products are necessary to counteract bone density loss.’

Answer 123

C. ‘Dark green leafy vegetables are high in vitamin K, so I should eat them more often.’

Question 124

A client being discharged is prescribed warfarin for the treatment following a pulmonary embolism. Which diagnostic test should the nurse instruct the client to receive once a month?
A. Perfusion scan.
B. Prothrombin Time (PT).
C. Activated partial thromboplastin (aPTT).
D. Serum Coumadin level (SCL).

Answer 124

B. Prothrombin Time (PT).

Question 125

The nurse is caring for a client prescribed warfarin therapy for treatment of persistent atrial fibrillation. Which of the following may potentiate the effect of this medication?
A. St. John wort
B. Estrogen
C. Vitamin K
D. Green tea

Answer 125

D. Green tea

Question 126

A nurse is providing education on activities of daily living to a client taking warfarin. Which statement made by the client indicates further teaching is required?
A. “I will brush my teeth using a soft-bristled toothbrush.”
B. “I will wear a medical alert bracelet on my wrist.”
C. “I will be sure to consume plenty of green leafy vegetables.”
D. “I need to shave using an electric razor.”

Answer 126

C. “I will be sure to consume plenty of green leafy vegetables.”

Question 127

The home health nurse is completing a medication reconciliation of a client who has a new prescription for warfarin. Which medication should the nurse question the healthcare provider about?
A. Aspirin
B. Nifedipine
C. NPH insulin
D. Vitamin D supplement

Answer 127

A. Aspirin

Question 128

The nurse is preparing to administer prescribed warfarin to a client with a mechanical heart valve. Which finding should the nurse report to the healthcare provider?
A. The INR is 3.0.
B. The peripheral IV site has been oozing blood.
C. The aPTT is 30.
D. The client has cola-colored urine.

Answer 128

D. The client has cola-colored urine.

Question 129

The nurse is reinforcing medication interactions with a client who is taking warfarin. Which over-the-counter (OTC) medication should the nurse remind the client to avoid?
A. Diphenhydramine
B. Acetaminophen
C. Naproxen
D. Pantoprazole

Answer 129

C. Naproxen

Question 130

The nurse is reviewing the prothrombin time results for a client who is taking warfarin. The nurse notes the value is 20 seconds. What is an appropriate nursing action?
A. Recognize that this is a therapeutic level.
B. Assess for bleeding gums or IV sites.
C. Notify the primary health care provider immediately.
D. Observe the client for hematoma development.

Answer 130

A. Recognize that this is a therapeutic level.

Question 131

A nurse is reviewing the INR results for caring for a client who had a cerebral vascular accident and is receiving prescribed warfarin. The nurse notes the INR is 5.2. Which finding requires priority follow-up?
A. Gum bleeding
B. Generalized weakness
C. Pharyngitis
D. Anorexia

Answer 131

A. Gum bleeding

Question 132

A client who had surgery is discharged on warfarin. Which statement by the client is incorrect and indicates a need for further teaching?
A. “I will report any bruises or unusual bleeding.”
B. “I know I must avoid crowds.”
C. “I plan on using an electric razor for shaving.”
D. “I will keep all laboratory appointments.”

Answer 132

B. “I know I must avoid crowds.”

Question 133

The nurse is teaching a client about precautions while taking warfarin. The nurse should instruct the client to avoid foods with excessive amounts of which nutrient?
A. Calcium
B. Vitamin E
C. Iron
D. Vitamin K

Answer 133

D. Vitamin K

Question 134

A client is being discharged with a prescription for warfarin. Which information is most important to be included in the nurse’s discharge teaching?
A. Take acetaminophen for minor pain
B. Use a soft toothbrush
C. Avoid eating leafy green vegetables
D. Report nose or gum bleeding

Answer 134

D. Report nose or gum bleeding

Question 135

The nurse has provided instructions to a client on the use of warfarin. Which statement by the client requires further teaching?
A. “If I become constipated, I can take laxatives containing magnesium salts.”
B. “If I develop a headache, I should take ibuprofen to help my pain.”
C. “If I develop an itchy rash, I will use a cream with diphenhydramine.”
D. “If I catch a cold, I will use guaifenesin to make my cough better”

Answer 135

B. “If I develop a headache, I should take ibuprofen to help my pain.”

Question 136

Which substance does vitamin K contributes to the formation of?
A. Bilirubin
B. Prothrombin
C. Thromboplastin
D. Cholecystokinin

Answer 136

B. Prothrombin

Question 137

A client with chronic liver disease reports, ‘My gums have been bleeding spontaneously.’ The nurse identifies small hemorrhagic lesions on the client’s face. The nurse concludes that the client needs which additional supplement?
A. Bile salts
B. Folic acid
C. Vitamin A
D. Vitamin K

Answer 137

D. Vitamin K

Question 138

Which vitamin is essential for the synthesis of prothrombin by the liver?
A. B 12
B. C
C. D
D. K

Answer 138

D. K

Question 139

The surgeon prescribes vitamin K before surgery. The nurse recognizes that this is prescribed because vitamin K contributes to the formation of which substance?
A. Bilirubin
B. Prothrombin
C. Thromboplastin
D. Cholecystokinin

Answer 139

B. Prothrombin

Question 140

A client is being discharged with a prescription for warfarin. The client asks “May I take aspirin with this medication? It helps my arthritis.” Which response by the nurse is appropriate to address the client’s concern?
A. “Use about half the recommended dose of aspirin.”
B. “When you take the aspirin, do not take the warfarin that day.”
C. “Avoid aspirin because it can increase the bleeding effects of warfarin.”
D. “Take the warfarin in the morning and the aspirin at night.”

Answer 140

C. “Avoid aspirin because it can increase the bleeding effects of warfarin.”

Question 141

A client is being discharged with a prescription for warfarin. The client asks “May I take aspirin with this medication? It helps my arthritis.” Which response by the nurse is appropriate to address the client’s concern?
A. “Use about half the recommended dose of aspirin.”
B. “When you take the aspirin, do not take the warfarin that day.”
C. “Avoid aspirin because it can increase the bleeding effects of warfarin.”
D. “Take the warfarin in the morning and the aspirin at night.”

Answer 141

C. “Avoid aspirin because it can increase the bleeding effects of warfarin.”

Question 142

A nurse is educating a client about the use of warfarin at home. The nurse should reinforce the need for the client to monitor which of the following?
A. Extended exposure to outdoor sunlight
B. Consistent intake of foods high in vitamin K
C. Avoidance of public transportation and large groups of people
D. Limit of strenuous physical exercise

Answer 142

B. Consistent intake of foods high in vitamin K

Question 143

A client who is 34 weeks gestation is diagnosed with a pulmonary embolism. Which of these medications should the nurse plan to administer?
A. Oral low-dose aspirin
B. Oral warfarin
C. Intravenous heparin
D. Subcutaneous enoxaparin

Answer 143

C. Intravenous heparin

Question 144

To prevent excessive bruising when administering subcutaneous heparin, which technique will the nurse employ?
A. Administer the injection via the Z-track technique.
B. Avoid massaging the injection site after the injection.
C. Use 2 mL of sterile normal saline to dilute the heparin.
D. Inject the medication into the vastus lateralis muscle in the thigh.

Answer 144

B. Avoid massaging the injection site after the injection.

Question 145

A client develops a deep vein thrombophlebitis in her leg 3 weeks after giving birth and is admitted for anticoagulant therapy. The nurse would anticipate developing a teaching plan for which anticoagulant?
A. Heparin
B. Warfarin
C. Clopidogrel
D. Enoxaparin

Answer 145

A. Heparin

Question 146

After abdominal surgery, a client is prescribed low molecular weight heparin (LMWH). During administration of the medication, the client asks the nurse the reason for the medication. Which is the best response for the nurse to provide the client?
A. This medication is given to prevent blood clot formation.
B. This medication enhances antibiotics to prevent infection.
C. This medication dissolves clots that develop in the legs.
D. This medication enhances the healing of wounds.

Answer 146

A. This medication is given to prevent blood clot formation.

Question 147

The nurse is caring for a client after cardiac surgery who has been prescribed protamine sulfate. Which finding indicates that the treatment is having the intended effect?
A. The international normalized ratio (INR) is trending down.
B. The bleeding from the surgical site has slowed.
C. The client reports decreased chest pain.
D. The respiratory rate is increased.

Answer 147

B. The bleeding from the surgical site has slowed.

Question 148

The nurse is caring for a client who is receiving a continuous intravenous heparin infusion. The client’s most recent activated partial thromboplastin time (aPTT) is 120 seconds. Which medication should the nurse plan to administer?
A. Protamine
B. Naloxone
C. Vitamin K
D. Enoxaparin

Answer 148

A. Protamine

Question 149

A client is prescribed heparin therapy for a deep vein thrombosis (DVT). Which laboratory value should the nurse monitor closely?
A. D-dimer
B Platelet count
C. Activated partial thromboplastin time
D. Bleeding time

Answer 149

C. Activated partial thromboplastin time

Question 150

The nurse is caring for a client who is experiencing excessive bleeding after receiving unfractionated heparin sodium. Which orders should the nurse anticipate from the health care provider? Select all that apply.
A. Administer vitamin K.
B. Obtain prothrombin time (PT)/international normalized ratio (INR).
C. Administer protamine sulfate.
D. Obtain activated partial thromboplastin time (aPTT).
E. Change prescription to enoxaparin.

Answer 150

C. Administer protamine sulfate.
D. Obtain activated partial thromboplastin time (aPTT).

Question 151

A client who has atrial fibrillation with rapid ventricular response is started on a continuous heparin infusion. Which clinical finding enables the nurse to conclude that the heparin therapy is effective?
A. Atrial fibrillation converts to a sinus rhythm.
B. The heart rate is stabilized at 70 to 90 beats per minute.
C. The international normalized ratio (INR) is within normal range.
D. An activated partial thromboplastin time (aPTT) is twice the usual value.

Answer 151

D. An activated partial thromboplastin time (aPTT) is twice the usual value.

Question 152

The health care provider prescribes enoxaparin to be administered subcutaneously. To ensure client safety, which measure would the nurse take when administering this medication?
A. Remove air pocket from the prepackaged syringe before administration.
B. Rub the injection site for 30 seconds after administration.
C. Administer the medication over 2 minutes.
D. Administer in the abdomen area only.

Answer 152

D. Administer in the abdomen area only.

Question 153

A health care provider prescribes enoxaparin 30 mg subcutaneously daily. Which measure would the nurse take when administering this medication?
A. Push over 2 minutes.
B. Administer in the abdomen.
C. Massage site after administration.
D. Remove air pocket from prepackaged syringe before administration.

Answer 153

B. Administer in the abdomen.

Question 154

Enoxaparin 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given for which purpose?
A. To control postoperative fever
B. To provide a constant source of mild analgesia
C. To limit the postsurgical inflammatory response
D. To provide prophylaxis against postoperative thrombus formation

Answer 154

D. To provide prophylaxis against postoperative thrombus formation

Question 155

The nurse is discharging a client who is at risk for venous thromboembolism (VTE). The client is prescribed enoxaparin. Which instruction should the nurse provide to this client?
A. “Notify your health care provider if your stools appear tarry or black.”
B. “You must have your partial thromboplastin time (PTT) checked weekly.”
C. “You should massage the injection site for better absorption.”
D. “An intravenous (IV) catheter will be placed to administer the medication.”

Answer 155

A. “Notify your health care provider if your stools appear tarry or black.”

Question 156

Which statement by a client who had an endarterectomy that is prescribed clopidogrel would cause the nurse to conclude that teaching was effective?
A. “Clopidogrel will limit inflammation around my incision.”
B. “Taking this medication will help prevent further clogging of my arteries.”
C. “The medication will lower the slight fever I have had since surgery.”
D. “I will take this medication to reduce the discomfort I feel at the surgical incision.”

Answer 156

B. “Taking this medication will help prevent further clogging of my arteries.”

Question 157

For the client taking clopidogrel, the nurse will monitor for which adverse effect?
A. Nausea
B. Epistaxis
C. Chest pain
D. Elevated temperature

Answer 157

B. Epistaxis

Question 158

A client who had a femoropopliteal bypass graft is receiving clopidogrel postoperatively. Which instruction will the nurse teach the client related to the medication?
A. Eliminate starches and red meats from the diet.
B. Eat more roughage if constipation occurs.
C. Report any occurrence of multiple bruises.
D. Take the medication on an empty stomach.

Answer 158

C. Report any occurrence of multiple bruises.

Question 159

A client at risk for a stroke has been prescribed clopidogrel. Which information is most important for the nurse to reinforce with the client?
A. “You must take the medication on an empty stomach.”
B. “If you miss a dose, take a double dose the next day.”
C. “You must stop the medication a week before your surgery.”
D. “You must have your lab tests checked weekly.”

Answer 159

C. “You must stop the medication a week before your surgery.”

Question 160

A nurse is assessing a client receiving alteplase for a pulmonary embolism. The client suddenly becomes confused and is unable to follow commands. What action does the nurse take first?
A. Notify the healthcare provider
B. Reorient the client
C. Check the client pupils
D. Stop the infusion

Answer 160

D. Stop the infusion

Question 161

Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Before beginning the infusion, which assessment is the nurse’s priority?
A. Vital signs
B. Electrocardiogram (ECG) monitoring
C. Signs of bleeding
D. Level of chest pain

Answer 161

C. Signs of bleeding

Question 162

The nurse is caring for a client who received tenecteplase to open an occluded coronary artery. Which finding should be of highest concern for the nurse?
A. Epistaxis
B. Bleeding gums
C. Hematemesis
D. Urinary retention

Answer 162

C. Hematemesis

Question 163

The nurse is monitoring a client who is receiving the thrombolytic agent alteplase for treatment of an acute myocardial infarction (AMI). What outcome indicates the client is receiving adequate therapy within the first few hours of treatment?
A. Reduction of ST-segment elevation on a 12-lead ECG
B. Stabilization of blood pressure
C. Absence of cardiac arrhythmias
D. Cardiac enzymes are within normal limits

Answer 163

A. Reduction of ST-segment elevation on a 12-lead ECG