Download NURS396 Test: Pharmacology, Advance Directives, and Clinical Indicators and more Exams Nursing in PDF only on Docsity!
NURS396 TEST WITH COMPLETE SOLUTIONS
A nurse is caring for a client with pulmonary tuberculosis who is to receive several antitubercular medications. Which of the first-line antitubercular medications is associated with damage to the eighth cranial nerve?
Isoniazid (INH)
Rifampin (Rifadin)
Streptomycin
Ethambutol (Myambutol) - ANSWER Correct: 3 Streptomycin
Rationale: Streptomycin is ototoxic and can cause damage to the eighth cranial nerve, resulting in deafness. Assessment for ringing or roaring in the ears, vertigo, and hearing acuity should be made before, during, and after treatment. Isoniazid does not affect the ear; however, blurred vision and optic neuritis, as well as peripheral neuropathy, may occur. Rifampin does not affect hearing; however, visual disturbances may occur. Ethambutol does not affect hearing; however, visual disturbances may occur.
A client who is to have brain surgery has a signed advance directive in the medical record. In what situation should this document be used?
Discharge planning is not covered by insurance.
Client cannot consent to his or her own surgery.
Postoperative complications occur that require additional treatment.
In case of the client's death, there will be directions about which client's belongings are to be given to family members. - ANSWER Correct 2
Rationale: Advance directives allow clients to designate another person to consent to procedures if they are unable to do so. Advance directives are not related to insurance. No information suggests the client cannot consent to treatment. Directions for distribution of belongings should be stipulated in a will, not in an advance directive.
What clinical indicators should the nurse expect a client with hyperkalemia to exhibit? Select all that apply.
Tetany
Seizures
Diarrhea
Weakness
- Dysrhythmia - ANSWER Correct, 3.4.
Rationale: Tetany is caused by hypocalcemia. Seizures caused by electrolyte imbalances are associated with low calcium or sodium levels. Because of potassium's role in the sodium/potassium pump, hyperkalemia will cause diarrhea, weakness, and cardiac dysrhythmias.
A health care provider prescribes transdermal fentanyl (Duragesic) 25 mcg/hr every 72 hours. During the first 24 hours after starting the fentanyl, what is the most important nursing intervention?
Titrate the dose until pain is tolerable.
Manage pain with oral pain medication.
Assess the client for anticholinergic side effects.
Instruct the client to take the medication with food. - ANSWER Correct: 2
Rationale: It takes 24 hours to reach the peak effect of transdermal fentanyl (Duragesic). Oral pain medication may be necessary to support client comfort until the fentanyl reaches its peak effect. The nurse needs to administer the dose of transdermal fentanyl exactly as prescribed by the health care provider. This is associated with tricyclic antidepressants, not transdermal fentanyl. A transdermal medication is administered through the skin via a patch applied to the skin, not via the gastrointestinal tract.
To minimize the side effects of the vincristine (Oncovin) that a client is receiving, what does the nurse expect the dietary plan to include?
Low in fat
High in iron
High in fluids
Low in residue - ANSWER Correct: 3
Rationale: A common side effect of vincristine is a paralytic ileus that results in constipation. Preventative measures include high-fiber foods and fluids that exceed minimum requirements. These will keep the stool bulky and soft, thereby promoting evacuation. Low in fat, high in iron, and low in residue dietary plans will not provide the roughage and fluids needed to minimize the constipation associated with vincristine.
A plan of care for a client newly diagnosed with type 1 diabetes includes teaching how to self-administer insulin, adjust insulin dosage, select appropriate food on the prescribed diet, and test the serum for glucose. The client demonstrates achievement of these skills and is discharged five days following admission. What is the legal implication in this situation?
orders, with the goal of providing correct medications ...
First indication of digoxin toxicity is... - ANSWER nausea and loss of appetite.
Later indications of digoxin toxicity is... - ANSWER yellow vision.
The nurse administers 2 units of salt-poor albumin to a client with portal hypertension and ascites. The nurse explains to the client that the purpose of the albumin is to:
Provide nutrients.
Increase protein stores.
Elevate the circulating blood volume.
Divert blood flow away from the liver temporarily. - ANSWER Correct: 3
Rationale: Increasing oncotic pressure increases the client's circulating blood volume; salt-poor albumin pulls interstitial fluid into the blood vessels, restoring blood volume and limiting ascites. Nutrients are provided by total parenteral nutrition, not salt-poor albumin. Salt-poor albumin is not given to increase protein stores. Salt-poor albumin has no effect on diverting blood flow away from the liver.
Study Tip: Remember that intelligence plays a vital role in your ability to learn. However, being smart involves more than just intelligence. Being practical and applying common sense are also part of the learning experience.
A client is scheduled to receive phenytoin (Dilantin) 100 mg orally at 6 PM but is having difficulty swallowing capsules. What method should the nurse use to help the client take the medication?
Sprinkle the powder from the capsule into a cup of water.
Insert a rectal suppository containing 100 mg of phenytoin.
Administer 4 mL of phenytoin suspension containing 125 mg/5 mL.
Obtain a change in the administration route to allow an intramuscular (IM) injection. - ANSWER Correct: 3
Rationale: When an oral medication is available in a suspension form, the nurse can use it for clients who cannot swallow capsules. Use the "Desire over Have" formula to solve the problem. Desire 100 mg = x mL Have 125 mg 5 mL 125x = 500 X = 500 รท 125 X = 4 mL Because a palatable suspension is available, it is a better alternative than opening the capsule. The route of administration cannot be altered without the health care provider's approval. Intramuscular injections should be avoided because of risks for tissue injury and infection.
Before a male client signs an operative consent for an abdominoperineal resection, the nurse verifies that the client understands that surgery likely will result in which outcome?
1)Permanent ileostomy in the jejunum
Permanent colostomy and impotence
Temporary ileostomy and diminished libido
Temporary colostomy in the descending colon - ANSWER Correct: 2
Rationale: Large portions of bowel and rectum are removed; during the perineal portion of the surgery, nerves involved in penile erection often are damaged. An ileostomy will not be performed because the lesion is in the descending colon. A colostomy after an abdominoperineal resection is permanent because the rectum is removed; sexual functioning, not libido, may be affected. The descending colon is removed; the colostomy will be permanent.
A nurse is caring for a client who is experiencing the second (acute) phase of burn recovery. The common client response the nurse expects to identify during this phase of burn recovery is an increase in:
Serum sodium
Urinary output
Hematocrit level
Serum potassium - ANSWER Correct: 2
Rationale: As fluid returns to the vascular system, increased renal flow and diuresis occur. An increase in the serum sodium level (hypernatremia) is not a common response identified during the second (acute) phase of burn recovery. An increase in the hematocrit level indicates hemoconcentration and hypovolemia; in the second phase of burn recovery, hemodilution and hypervolemia occur. During the second phase of burn recovery, potassium moves back into the cells, decreasing serum potassium.
Three days after bariatric surgery, the client puts the call light on and states, "I felt a 'pop' in my belly after I had a coughing spell." The nurse assesses the client's incision site for signs of dehiscence. Which clinical finding supports the nurse's conclusion that the client is experiencing wound dehiscence?
- Loosening of the sutures
determine it cause. Purposeless movements such as tossing and turning or involuntary movements such as a reflexive jerking may indicate pain. Physiological responses such as elevated blood pressure and heart rate are most likely to be absent in the client with chronic pain. Pain is a subjective experience and therefore the nurse has to ask the client directly instead of accepting statement of the family members.
A health care provider prescribes simvastatin (Zocor) 20 mg daily for elevated cholesterol and triglyceride levels for a female client. Which is most important for the nurse to teach when the client initially takes the medication?
Take the medication with breakfast.
Have liver function tests every six months.
Wear sunscreen to prevent photosensitivity reactions.
Inform the health care provider if the client wishes to become pregnant. - ANSWER Correct: 4
Rationale: Simvastatin is contraindicated in pregnancy because it is capable of causing fetal damage (teratogenic). It is a Pregnancy Category X teratogen. Simvastatin should be taken in the evening because most cholesterol is synthesized between 12 midnight and 3:00 AM. Liver function tests should be done at 6 to 12 weeks initially and only then every 6 months. Although wearing sunscreen should be taught, sensitivity reactions are a rare occurrence; it is not as important as an action in another option.
