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NURS 323 Final questions with key
solutions. GET IT 100%
Your patient having an acute MI is allergic to aspirin. What do you as the nurse anticipate that the physician will prescribe that will serve the same purpose? a. Clopidogrel (Plavix) b. Warfarin (Coumadin) c. Rivaroxaban (Xarelto)
d. Dabigatran etexilate (Pradaxa) - CORRECT ANSWER -a. Clopidogrel (Plavix)
What will the nurse observe in order to monitor for adverse reactions of heparin therapy? Select all that apply a. CBC b. PTT c. PT/INR d. S/S of bleeding
e. LFTs - CORRECT ANSWER -a, b, and d
Which drug is used as a mucolytic as well as for tylenol overdoses? a. Guaifenesin (Mucinex) b. Acetylcysteine (Mucomyst) c. Dextromethorphan (Robitussin)
d. Pseudoephedrine (Sudafed) - CORRECT ANSWER -b. Acetylcysteine
(Mucomyst) What drug is appropriate to administer in order to relieve symptoms of an acute asthma attack? a. Salmeterol (Serevent Diskus) b. Albuterol (Proventil) c. Tiotropium (Spiriva)
d. Theophylline - CORRECT ANSWER -b. Albuterol (Proventil)
Your patient on Dilaudid PCA pump is sleeping but grimacing in his sleep. His wife tells you she presses the button when he grimaces in his sleep. What do you say to her? a. "That is totally fine!" b. "If you put it in his hand while he is sleeping and press his finger on the button, that is fine. Otherwise it is not allowed"
c. "Only he can press the button"
d. "Only the doctors and nurses can press the button" - CORRECT ANSWER -c.
"Only he can press the button" Which class of antidepressants has dietary restrictions related to tyramine in order to prevent hypertensive crisis? a. TCA b. MAOI c. SSRI
d. SNRI - CORRECT ANSWER -b. MAOI
Your patient on a diuretic was recently started on Lithium. What major concern do you have related to the administration of both of these drugs together? a. Hyperkalemia and Lithium Toxicity b. Hypernatremia and Lithium Toxicity c. Hyponatremia and Lithium Toxicity
d. Hypokalemia and Lithium Toxicity - CORRECT ANSWER -c. Hyponatremia
and Lithium Toxicity The reversal agent for benzos is a. Omarion b. Romereon c. Romazicon
d. Romahromahma - CORRECT ANSWER -c. Romazicon
A patient with deep vein thrombosis receiving an intravenous (IV) heparin infusion asks the nurse how this medication works. What is the nurse's best response? a. Heparin prevents the activation of vitamin K and thus blocks synthesis of some clotting factors. b. Heparin suppresses coagulation by helping antithrombin perform its natural functions. c. Heparin works by converting plasminogen to plasmin, which in turn dissolves the clot matrix. d. Heparin inhibits the enzyme responsible for platelet activation and aggregation within
vessels. - CORRECT ANSWER -b. Heparin suppresses coagulation by helping
antithrombin perform its natural functions. Rationale: Heparin is an anticoagulant that works by helping antithrombin inactivate thrombin and factor Xa, reducing the production of fibrin and thus decreasing the formation of clots.
The nurse is caring for a patient who takes warfarin [Coumadin] for prevention of deep vein thrombosis. The patient has an international normalized ratio (INR) of 1.2. Which action by the nurse is most appropriate? a. Administer intravenous (IV) push protamine sulfate. b. Continue with the current prescription. c. Prepare to administer vitamin K.
d. Call the healthcare provider to increase the dose. - CORRECT ANSWER -d.
Call the healthcare provider to increase the dose. Rationale: An INR in the range of 2 to 3 is considered the level for warfarin therapy. For a level of 1.2, the nurse should contact the healthcare provider to discuss an order for an increased dose. A patient presents to the emergency department with symptoms of acute myocardial infarction. After a diagnostic workup, the healthcare provider prescribes a 15-mg IV bolus of alteplase (tPA), followed by 50 mg infused over 30 minutes. In monitoring this patient, which finding by the nurse most likely indicates an adverse reaction to this drug? a. Urticaria, itching, and flushing b. Blood pressure of 90/50 mm Hg c. Decreasing level of consciousness
d. Potassium level of 5.5 mEq/L - CORRECT ANSWER -c. Decreasing level of
consciousness Rationale: The greatest risk with this drug is bleeding, with intracranial bleeding being the greatest concern. A decreasing level of consciousness indicates intracranial bleeding. Alteplase does not cause an allergic reaction or hypotension. Thrombolytic agents, such as alteplase, do not typically cause an elevated potassium level. The nurse knows that which statement is accurate for enoxaparin [Lovenox]? a. It equally reduces the activity of thrombin and factor Xa. b. It has selective inhibition of factor Xa and no effect on thrombin. c. It reduces the activity of factor Xa more than the activity of thrombin. d. It has a lower bioavailability and shorter half-life than unfractionated heparin. -
CORRECT ANSWER -c. It reduces the activity of factor Xa more than the activity
of thrombin. Rationale: Enoxaparin acts primarily on factor Xa and also, but to a lesser degree, on thrombin. Unfractionated heparin equally reduces the action of thrombin and factor Xa. Low-molecular-weight (LMW) heparins, such as enoxaparin, have greater bioavailability and a longer half-life than unfractionated heparin.
A patient is being discharged from the hospital on warfarin [Coumadin] for deep vein thrombosis prevention. Which instructions should the nurse include in the patient's discharge teaching plan? (Select all that apply.) a. Wear a medical alert bracelet. b. Check all urine and stool for discoloration. c. Do not start any new medication without first talking to your healthcare provider. d. Enteric-coated aspirin and any aspirin products can be used unless they cause a gastrointestinal ulcer. e. No laboratory or home monitoring of international normalized ratio (INR) is required
after the first 6 months. - CORRECT ANSWER -a, b, and c
Rationale: Advise the patient to wear some form of identification (eg, Medic Alert bracelet) to alert emergency personnel to warfarin use. Bleeding is a major complication of warfarin therapy. Inform patients about the signs of bleeding, which include discolored urine or stools. Inform patients that warfarin is subject to a large number of potentially dangerous drug interactions. Instruct them to avoid all prescription and nonprescription drugs that have not been specifically approved by the prescriber. A patient is receiving continuous heparin infusion for venous thromboembolism treatment. Which laboratory results should the nurse monitor? (Select all that apply.) a. Platelets b. Vitamin K c. Prothrombin time (PT) d. International normalized ratio (INR)
e. Activated partial thromboplastin time (aPTT) - CORRECT ANSWER -a and e
Rationale: To reduce the risk of heparin-induced thrombocytopenia (HIT), platelet counts should be monitored. Heparin therapy is monitored by measuring the laboratory test activated partial thromboplastin time (aPTT). A patient diagnosed with a pulmonary embolism is receiving a continuous heparin infusion at 1000 units/hr. Of which findings should the nurse immediately notify the healthcare provider? (Select all that apply.) a. aPTT of 65 seconds b. aPTT of 40 seconds c. Nosebleeds d. aPTT of 100 seconds
e. Platelet count of 300,000/mcL - CORRECT ANSWER -b, c, and d
Rationale: If the normal value of the aPTT is 40 seconds, the goal is to achieve a therapeutic range of a factor of 1.5 to 2 (60 to 80 seconds). Because 40 seconds is too short (increases the risk for clotting) and 100 seconds is too long (increases the risk for
Rationale: Morphine can cause urinary hesitancy and urinary retention. If bladder distention or inability to void is noted, the prescriber should be notified. Urinary catheterization may be required. Morphine acts as a cough suppressant and an antidiarrheal. A patient admitted to the hospital with a diagnosis of pneumonia asks the nurse, "Why am I receiving codeine? I don't have any pain." The nurse's response is based on the knowledge that codeine also has which effect? a. Immunostimulant b. Antitussive c. Expectorant
d. Decongestant - CORRECT ANSWER -b. Antitussive
A patient takes oxycodone [OxyContin] 40 mg PO twice daily for the management of chronic pain. Which intervention should be added to the plan of care to minimize the gastrointestinal adverse effects? a. The patient should take an antacid with each dose. b. The patient should eat foods high in lactobacilli. c. The patient should take the medication on an empty stomach.
d. The patient should increase fluid and fiber in the diet. - CORRECT ANSWER -
d. The patient should increase fluid and fiber in the diet. The nurse is teaching a patient with cancer about a new prescription for a fentanyl [Sublimaze] patch, 25 mcg/hr, for chronic back pain. Which statement is the most appropriate to include in the teaching plan? a. "You will need to change this patch every day, regardless of your pain level." b. "This type of pain medication is not as likely to cause breathing problems." c. "With the first patch, it will take about 24 hours before you feel the full effects." d. "Use your heating pad for the back pain. It will also improve the patch's
effectiveness." - CORRECT ANSWER -c. "With the first patch, it will take about
24 hours before you feel the full effects." Rationale: Full analgesic effects can take up to 24 hours to develop with fentanyl patches. Most patches are changed every 72 hours. Fentanyl has the same adverse effects as other opioids, including respiratory depression. Patients should avoid exposing the patch to external heat sources, because this may increase the risk of toxicity. Which agent is most likely to cause serious respiratory depression as a potential adverse reaction? a. Morphine [Duramorph]
b. Pentazocine [Talwin] c. Hydrocodone [Lortab]
d. Nalmefene [Revex] - CORRECT ANSWER -a. Morphine [Duramorph]
The nurse is working on a postoperative unit in which pain management is part of routine care. Which statement is the most helpful in guiding clinical practice in this setting? a. At least 30% of the U.S. population is prone to drug addiction and abuse. b. The development of opioid dependence is rare when opioids are used for acute pain. c. Morphine is a common drug of abuse in the general population. d. The use of PRN (as needed) dosing provides the most consistent pain relief without
risk of addiction. - CORRECT ANSWER -b. The development of opioid
dependence is rare when opioids are used for acute pain. A nurse administers naloxone [Narcan] to a postoperative patient experiencing respiratory sedation. What undesirable effect would the nurse anticipate after giving this medication? a. Drowsiness b. Tics and tremors c. Increased pain
d. Nausea and vomiting - CORRECT ANSWER -c. Increased pain
Rationale: Naloxone reverses the effects of narcotics. Although the patient's respiratory status will improve after administration of naloxone, the pain will be more acute A patient with chronic pain has a fentanyl patch applied to his right shoulder. The patient reports that his arm hurts and he requests a warm pack to apply to the area. Which statement by the nurse is correct? a. "Putting a warm pack on the area where the fentanyl patch is located could accelerate fentanyl release." b. "Your arm probably hurts because of the fentanyl patch." c. "I can remove your patch and reapply it after you are done with the warm pack."
d. "The fentanyl patch is heat resistant, so I will get you a warm pack." - CORRECT
ANSWER -a. "Putting a warm pack on the area where the fentanyl patch is located
could accelerate fentanyl release." The nurse knows that local anesthetics stop axonal conduction by blocking what? a. Potassium channels in the axonal membrane b. Sodium channels in the axonal membrane c. Calcium channels in the axonal membrane
d. Vertigo and nausea/vomiting - CORRECT ANSWER -c. Excitation followed by
depression Rationale: Local anesthetics can cause CNS excitation followed by depression when large enough amounts are absorbed in the system. This can lead to drowsiness, loss of consciousness, and death. The nurse is explaining differential sensitivity to the nursing student with regard to the use of local anesthetics. The nurse explains that which perception is lost first? a. Pain b. Cold c. Warmth
d. Touch - CORRECT ANSWER -a. Pain
Rationale: Although local anesthetics can block traffic in all neurons, blockade develops more rapidly in some neurons than in others. Specifically, small, nonmyelinated neurons are blocked more rapidly than large, myelinated neurons. Because of this differential sensitivity, some sensations are blocked sooner than others. Specifically, perception of pain is lost first, followed in order by perception of cold, warmth, touch, and deep pressure. The healthcare provider orders topical benzocaine spray for a 1-year-old child with a sunburn. Which action should the nurse take? a. Question the order for benzocaine. b. Question the order for further directions. c. Teach the parent about application of the spray.
d. Apply the spray to the child. - CORRECT ANSWER -a. Question the order for
benzocaine. Rationale: Topical benzocaine can cause methemoglobinemia, a blood disorder in which hemoglobin is modified such that it cannot release oxygen to tissues. Because of this risk, topical benzocaine should not be used in children under the age of 2 years. Which of the following statements about cocaine is true? a. Cocaine causes intense vasoconstriction. b. Cocaine has no medicinal applications. c. Cocaine is a poor local anesthetic.
d. Cocaine has no CNS effects. - CORRECT ANSWER -a. Cocaine causes
intense vasoconstriction. The healthcare provider orders lidocaine injection SC before a skin biopsy. Which action should the nurse take?
a. Question the order for further instructions. b. Administer the lidocaine. c. Refuse to administer the lidocaine.
d. Suggest the use of procaine. - CORRECT ANSWER -a. Question the order for
further instructions. Rationale: The nurse should question the order for further instructions, including the dose to be administered, the location, and the use of epinephrine. The nurse should not administer, refuse to administer, or suggest the use of another medication without further information The nurse is caring for a postoperative patient who had spinal anesthesia with bupivacaine. The nurse knows to monitor for which possible adverse effects? (Select all that apply.) a. Hypotension b. Headache c. Nausea/vomiting d. Urinary retention
e. Tachycardia - CORRECT ANSWER -a, b, and d
Rationale: The most significant adverse effect of spinal anesthesia is hypotension. Autonomic blockade may disrupt function of the intestinal and urinary tracts, causing fecal incontinence and either urinary incontinence or urinary retention. Spinal anesthesia frequently causes headache. Nausea/vomiting and tachycardia are not expected adverse effects of spinal anesthesia with bupivacaine. The perioperative nurse is caring for a patient receiving Isoflurane [Forane]. The nurse understands that this medication will be excreted by the body through which organ system? a. Kidneys b. Liver c. Lungs
d. Circulation - CORRECT ANSWER -c. Lungs
Rationale: Inhaled anesthesia is excreted by the lungs A patient is receiving isoflurane [Forane]. Which physical assessment finding is the most likely to be a potential adverse effect of this drug? a. Blood glucose level of 180 mg/dL b. Blood urea nitrogen (BUN) level of 22 mg/dL c. Respiratory rate (RR) of 28 breaths per minute
Rationale: Malignant hyperthermia is a rare but potentially fatal reaction that can be triggered by all inhalation anesthetics except nitrous oxide. Predisposition to the reaction is genetic A nurse notices that one of the anesthesiologists returns from the staff lounge every day in a brief state of euphoria after her break. The nurse speaks to the unit manager, because she is concerned about abuse of which of these medications? a. Clonidine b. Propofol c. Midazolam
d. Lorazepam - CORRECT ANSWER -b. Propofol
The student nurse prepares to administer ketamine to a patient. The supervising nurse questions this administration for which patient? a. A 6-year-old boy with an allergy to lidocaine b. A 55-year-old female with a history of hypertension c. A 40-year-old male with a history of bipolar disorder
d. A 12-month-old with a history of burns - CORRECT ANSWER -c. A 40-year-
old male with a history of bipolar disorder Rationale: Because of its potential for adverse psychologic effects, ketamine should generally be avoided in patients with a history of psychiatric illness. Succinylcholine [Anectine] is contraindicated in a patient with which condition? a. Diabetes mellitus b. Hyperthyroidism c. Chronic obstructive pulmonary disease (COPD)
d. Major burns during the emergent phase - CORRECT ANSWER -d. Major
burns during the emergent phase Rationale: Succinylcholine promotes the release of potassium from tissues. Significant hyperkalemia is most likely to develop in patients with major burns during the emergent phase The nurse understands that tubocurarine and other neuromuscular (NM) blockers cannot be given by mouth. What is the rationale for this statement? a. They carry a positive charge. b. They compete with acetylcholine (ACh) for binding sites. c. They cause muscle relaxation.
d. They interact with potassium. - CORRECT ANSWER -a. They carry a positive
charge. Rationale: The inability to cross membranes makes parenteral administration necessary What is essential for the nurse to confirm before starting vecuronium [Norcuron] as a continuous intravenous infusion? a. The patient has been intubated and is on mechanical ventilation. b. A Foley catheter has been inserted. c. Hourly blood glucose levels have been ordered.
d. A nasogastric tube is in place for suction. - CORRECT ANSWER -a. The
patient has been intubated and is on mechanical ventilation. Rationale: Vecuronium [Norcuron], an NM blocking agent, can cause respiratory arrest. Therefore the nurse must ensure that the patient has an established airway and assisted oxygenation and ventilation before starting the continuous IV infusion. Which condition is an indication for the use of succinylcholine [Anectine]? a. Pain relief after major surgery b. Loss of consciousness during surgery c. Facilitation of endotracheal intubation
d. Relief of status epilepticus - CORRECT ANSWER -c. Facilitation of
endotracheal intubation The nurse is caring for a patient receiving inhalant anesthesia and succinylcholine [Anectine]. The patient develops muscle rigidity and a temperature of 105°F. Which nursing action is essential? a. Prepare to administer dantrolene [Dantrium]. b. Administer normal saline at 50 mL/hr. c. Administer morphine sulfate to relieve pain.
d. Prepare for intubation and mechanical ventilation. - CORRECT ANSWER -a.
Prepare to administer dantrolene [Dantrium]. The following statements about neuromuscular blockers are true except: a. they cannot be absorbed by the GI tract. b. they easily cross the placenta. c. they cannot cross the blood-brain barrier.
d. they have no effect on the CNS. - CORRECT ANSWER -b. they easily cross
the placenta. What is the primary effect of neuromuscular blockers?
A nurse is teaching a patient about montelukast [Singulair]. Which statement by the patient would indicate that the nurse's teaching was effective? a. "I'll take a dose as soon as I feel short of breath and start to cough." b. "While taking this medicine, I may be able to reduce my steroid medication." c. "This is the priority medication for preventing exercise-induced asthma symptoms." d. "If I have nosebleeds or excessive bruising, I'll stop the medication immediately." -
CORRECT ANSWER -b. "While taking this medicine, I may be able to reduce my
steroid medication." Rationale: Combining montelukast with an inhaled glucocorticoid medication can improve asthma symptoms and thus may allow a reduction in the glucocorticoid dosage. Which outcome should a nurse establish as a priority for a patient taking an oral glucocorticoid for long-term treatment of asthma? a. Increases the daily intake of vitamin D and calcium. b. Records daily peak expiratory flow rates. c. Supplements additional doses at times of stress.
d. Uses alternate-day therapy to reduce adverse effects. - CORRECT
ANSWER -c. Supplements additional doses at times of stress.
Rationale: Adrenal suppression can be profound with oral glucocorticoid use. It is a priority that patients take supplemental oral or intravenous doses at times of stress; failure to do so can be fatal. A nurse teaches a patient with chronic obstructive pulmonary disease (COPD) about the adverse effects of tiotropium [Spiriva]. Which behavior by the patient would indicate that the teaching has been effective? a. Combines tiotropium with an antacid. b. Sucks on hard candy as needed. c. Prevents constipation with a stool softener.
d. Wears long sleeves and a wide-brim hat. - CORRECT ANSWER -b. Sucks on
hard candy as needed. Rationale: Spiriva is an anticholinergic medication. A common side effect is dry mouth. Using a stepwise approach to managing asthma, a nurse teaches a patient who is at step 1 to use albuterol MDI [Proventil] at which of these times? a. Whenever needed (PRN) as a quick-relief agent b. Twice daily combined with an inhaled glucocorticoid c. Only with a long-acting beta2 agonist (LABA)
d. If nighttime awakenings occur more than 2 days a week - CORRECT
ANSWER -a. Whenever needed (PRN) as a quick-relief agent
A patient is admitted to the emergency department with acute severe exacerbation of asthma. Which drug should the nurse anticipate will be included in the treatment plan? a. Oral theophylline [Elixophyllin] b. Subcutaneous omalizumab [Xolair] c. Inhaled mometasone furoate [Asmanex]
d. High-dose albuterol [Proventil] via nebulizer treatment - CORRECT
ANSWER -d. High-dose albuterol [Proventil] via nebulizer treatment
Which are advantages of a dry-powder inhaler (DPI) over a metered-dose inhaler (MDI)? (Select all that apply.) a. More of the drug is delivered to the lungs and less to the oropharynx. b. Use of a spacer is not necessary. c. Less propellant is needed to deliver the medication. d. Less hand-lung coordination is required.
e. DPIs pose no environmental risk. - CORRECT ANSWER -a, b, d, and e
Which instruction should be included in the teaching for a patient for whom fluticasone propionate [Flovent] MDI has been ordered? a. "Gargle after using your inhaler." b. "Take the medication immediately at the onset of an attack." c. "Take your albuterol first, followed by the Flovent 5 minutes later." d. "Make sure you monitor your fingerstick blood glucose level each morning." -
CORRECT ANSWER -a. "Gargle after using your inhaler."
A nurse is planning care for a patient who takes fexofenadine [Allegra] for allergic rhinitis. Which outcome should the nurse anticipate? a. No complaints of dry mouth b. Relief of sneezing and itching c. Use limited to allergy season
d. Absence of rebound congestion - CORRECT ANSWER -b. Relief of sneezing
and itching A nurse is teaching a patient who is to start taking an expectorant. The nurse provides the patient with which of these instructions? a. "Restrict cold fluids to promote reduced mucus production." b. "Take the medication once a day only, usually at bedtime."
d. Effective productive cough - CORRECT ANSWER -c. Respiratory rate of 12 to
24 breaths per minute Rationale: Codeine, an opioid analgesic that acts through the CNS, effectively suppresses the frequency and intensity of cough. However, it also can suppress respiration, and overdose can be fatal. Which instruction should the nurse include in the teaching for a patient prescribed cetirizine [Zyrtec] for seasonal allergic rhinitis? a. "Clean the nasal applicator after use to prevent contamination." b. "Take the medication daily throughout the allergy season." c. "Expect a decrease in your nasal congestion in a day or two."
d. "Take a stool softener daily to avoid the side effect of constipation." - CORRECT
ANSWER -b. "Take the medication daily throughout the allergy season."
Which class of drugs is most effective in preventing and treating seasonal and allergic rhinitis? a. Antitussives b. Oral antihistamines c. Oral sympathomimetics
d. Intranasal glucocorticoids - CORRECT ANSWER -d. Intranasal glucocorticoids
Which medication is indicated for suppression of cough? a. Benzonate [Tessalon] b. Guaifenesin [Mucinex] c. Acetylcysteine [Mucomyst]
d. Fluticasone furoate [Veramyst] - CORRECT ANSWER -a. Benzonate
[Tessalon] Rationale: Tessalon is an antitussive The nurse is monitoring a patient with depression in the early phase of treatment with amitriptyline [Elavil]. Which question is most important for the nurse to ask the patient? a. "Have you noticed dry mouth or blurred vision?" b. "Have you had any changes in your urine function?" c. "When was your last bowel movement?"
d. "Have you had any changes in your mood or anxiety level?" - CORRECT
ANSWER -d. "Have you had any changes in your mood or anxiety level?"
The nurse is planning care for a patient taking imipramine [Tofranil]. Which finding, if present, would most likely be an adverse effect of this drug? a. Blood pressure of 160/90 mm Hg b. Insomnia and diarrhea c. Sedation and dry mouth
d. Tachypnea and wheezing - CORRECT ANSWER -c. Sedation and dry mouth
Rationale: Anticholinergic effects (dry mouth, blurred vision, constipation, tachycardia, urinary retention) and sedation are potential adverse effects of the tricyclic antidepressants (TCAs), such as imipramine [Tofranil]. The nurse is caring for a patient receiving fluoxetine [Prozac] for depression. Which adverse effect is most likely associated with this drug? a. Sexual dysfunction b. Dry mouth c. Orthostatic hypotension
d. Bradycardia - CORRECT ANSWER -a. Sexual dysfunction
The nurse is caring for a patient in the emergency department who reports the onset of agitation, confusion, muscle twitching, diaphoresis, and fever about 12 hours after beginning a new prescription for escitalopram [Lexapro]. Which is the most likely explanation for these symptoms? a. Depressive psychosis b. Serotonin syndrome c. Escitalopram overdose
d. Cholinergic crisis - CORRECT ANSWER -b. Serotonin syndrome
The nurse is preparing to administer phenelzine [Nardil] to a patient with depression. Why is this drug considered a second- or third-line agent in the treatment of depression? a. It increases the risk of suicide in the early phase. b. It is less effective than the tricyclic antidepressants. c. It increases the risk of psychoses and parkinsonism.
d. It has more side effects and drug interactions. - CORRECT ANSWER -d. It
has more side effects and drug interactions. Rationale: Phenelzine [Nardil], a monoamine oxidase inhibitor (MAOI), is considered a second- or third-line treatment because of the risk of triggering hypertensive crisis when the patient eats foods high in tyramine.
