Med surg exam (Antelope valley college)
Total Questions : 75
Showing 25 questions, Sign in for moreA patient is prescribed long-acting insulin (glargine) for basal control of blood glucose. Which statement by the nurse is correct when educating the patient?
Explanation
A. This insulin does not peak like short-acting insulin; glargine provides a consistent release of insulin without a peak effect.
B. Long-acting insulin is not meant to be taken with meals, as it provides basal control and is typically taken once daily, not with each meal.
C. This statement is correct; glargine provides a steady level of insulin over 24 hours, helping to maintain consistent blood glucose levels throughout the day and night.
D. Long-acting insulin is usually administered once daily, so stating that it must be given three times a day is incorrect.
A postsurgical client has been receiving morphine by patient-controlled analgesia for 2 days. What action by the nurse best addresses potential adverse effects?
Explanation
A. Administering a stool softener is essential as opioids like morphine commonly cause constipation, and this proactive measure helps mitigate that adverse effect.
B. While auscultating the lungs is important to monitor respiratory function, it does not specifically address a common adverse effect of morphine.
C. Encouraging active range of motion exercises can help prevent complications from immobility but does not directly address the most common adverse effect of morphine.
D. Applying calf compressors can help prevent deep vein thrombosis, but it is not the most effective action for addressing the specific adverse effects of morphine use.
The nurse is administering an antibiotic to a client with a diagnosis of cellulitis of the left leg. Which client condition would have the greatest effect on the drug's distribution?
Explanation
A. Hypertension can affect drug distribution to some extent due to altered perfusion but is not the most significant factor impacting distribution, especially for a local condition like cellulitis.
B. Liver dysfunction primarily affects the metabolism and clearance of drugs rather than their distribution, although it may indirectly influence distribution by altering protein binding.
C. Peripheral vascular disease significantly impacts blood flow to the extremities, which can hinder the distribution of the antibiotic to the affected area (the left leg) where the cellulitis is present, leading to reduced drug efficacy.
D. Diverticulitis disease primarily affects the gastrointestinal system and would not directly influence the distribution of an antibiotic used to treat cellulitis in the leg.
The nurse would contact the health care provider before administering an adrenergic drug to a client who is also taking which drug?
Explanation
A. Antibiotics do not typically interact with adrenergic drugs in a way that would necessitate contacting the healthcare provider before administration.
B. MAO inhibitors can cause significant interactions with adrenergic drugs, potentially leading to hypertensive crises due to increased norepinephrine levels. Therefore, the nurse should contact the healthcare provider to assess the risks before administering an adrenergic agent.
C. Diuretics may affect fluid and electrolyte balance, but they do not pose a direct interaction risk with adrenergic drugs that would require prior consultation with the healthcare provider.
D. Analgesics do not have a significant interaction with adrenergic drugs that would warrant contacting the healthcare provider, as they are used for pain management and can often be safely administered together.
The nursing instructor has been teaching about antivirals, actions, and effects. The instructor realizes that a student needs further instruction when the student makes which statement?
Explanation
A. This statement is accurate as antiviral drugs primarily reduce the severity and duration of viral infections but do not prevent transmission to others.
B. The statement that "antivirals are the cure for viral infections" is incorrect, as most antivirals manage symptoms or reduce viral load rather than completely curing the infection, indicating a need for further instruction.
C. This statement is correct; following prescribed application guidelines for topical antivirals is essential to avoid skin irritation or decreased efficacy.
D. This statement is also correct, as using gloves or a finger cot is recommended to prevent contamination and protect the healthcare worker from exposure while applying topical antivirals.
A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?
Explanation
A. Performing a blood sugar analysis is important, but in the case of sudden symptoms such as weakness, shakiness, and dizziness, it is crucial to act quickly to address the potential hypoglycemia without delay.
B. Having the client drink a 4-ounce glass of orange juice is the most appropriate initial response as it provides a quick source of glucose to alleviate symptoms of hypoglycemia, which is a common concern in clients with type 1 diabetes experiencing these symptoms.
C. Administering 1 ampule of 50% dextrose intravenously is an effective treatment for hypoglycemia but is typically reserved for severe cases where the patient is unable to consume oral glucose or is unconscious.
D. Administering 10 units of regular insulin subcutaneously would exacerbate the problem by lowering blood sugar further and is contraindicated in a patient experiencing hypoglycemic symptoms.
A client is receiving opioid therapy. The nurse should be alert to the possibility that which could occur if the client receives an opioid agonist-antagonist?
Explanation
A. An increased risk for CNS depression is not typically associated with opioid agonist-antagonists; instead, these medications may produce a ceiling effect on sedation compared to full agonists.
B. Respiratory depression is more commonly associated with full opioid agonists rather than agonist-antagonists. Agonist-antagonists can sometimes counteract respiratory depression caused by full agonists.
C. Opioid withdrawal symptoms can occur when a client who is dependent on full agonist opioids is given an agonist-antagonist, as these medications can displace the agonist from receptors, leading to withdrawal.
D. Hypotension is a possible side effect of opioids but is not a specific concern with the use of agonist-antagonists in the context of opioid therapy.
An older adult client with hypertension has recently been prescribed a beta-adrenergic blocker and a thiazide diuretic. When educating the client about preventing and managing adverse effects, the nurse will provide which instruction?
Explanation
A. Changing positions slowly is critical for older adults taking beta-adrenergic blockers and diuretics to prevent orthostatic hypotension, which can lead to lightheadedness or dizziness.
B. Reducing fluid intake is not advisable, as thiazide diuretics can lead to dehydration, and maintaining adequate fluid intake is essential for overall health and to avoid excessive urinary output.
C. Identifying and eliminating high-potassium foods is unnecessary unless there is a specific indication of hyperkalemia, particularly since thiazide diuretics do not typically cause potassium retention, and beta-blockers are not potassium-specific.
D. Expecting blood pressure to increase before it decreases is misleading; clients should see a gradual reduction in blood pressure with proper medication adherence, and any sudden increases should be reported.
When caring for a patient who has been admitted for his heart failure, the nurse observes that the patient is experiencing bradycardia. Which drug should be administered to patients who develop bradycardia?
Explanation
A. Atropine is an anticholinergic medication that increases heart rate by blocking vagal effects on the heart, making it the first-line treatment for symptomatic bradycardia.
B. Cholestyramine is a bile acid sequestrant used to lower cholesterol levels and does not have any effects on heart rate.
C. Inamrinone is a phosphodiesterase inhibitor used in heart failure for inotropic support but is not specifically indicated for bradycardia management.
D. Milrinone is also a phosphodiesterase inhibitor used for heart failure but does not address bradycardia directly.
A patient taking magnesium citrate as an osmotic laxative reports abdominal cramping and diarrhea. What should the nurse recommend?
Explanation
A. Increasing fluid intake may not alleviate the cramping and diarrhea, which are common side effects of magnesium citrate.
B. Abdominal cramping and diarrhea are expected side effects of magnesium citrate, and the patient can continue the medication unless symptoms become severe.
C. Discontinuing the medication should not be recommended unless the side effects are intolerable or the patient experiences severe reactions.
D. Switching to a different type of laxative is unnecessary unless the patient has contraindications to magnesium citrate or develops severe side effects.
A client diagnosed with type 1 diabetes suddenly reports feeling weak, shaky, and dizzy. What should be the nurse's initial response?
Explanation
A. Performing a blood sugar analysis is important, but in the case of sudden symptoms such as weakness, shakiness, and dizziness, it is crucial to act quickly to address the potential hypoglycemia without delay.
B. Having the client drink a 4-ounce glass of orange juice is the most appropriate initial response as it provides a quick source of glucose to alleviate symptoms of hypoglycemia, which is a common concern in clients with type 1 diabetes experiencing these symptoms.
C. Administering 1 ampule of 50% dextrose intravenously is an effective treatment for hypoglycemia but is typically reserved for severe cases where the patient is unable to consume oral glucose or is unconscious.
D. Administering 10 units of regular insulin subcutaneously would exacerbate the problem by lowering blood sugar further and is contraindicated in a patient experiencing hypoglycemic symptoms.
A client began taking hydrochlorothiazide 1 week ago and is reporting occasional dizziness when standing up quickly from sitting or lying. What is the nurse's best action?
Explanation
A. While assessing potassium levels is important for clients on diuretics, the immediate concern is the client's dizziness, which indicates a potential issue with blood pressure.
B. Teaching the client about the potential for orthostatic hypotension caused by hydrochlorothiazide and instructing them on safety measures (e.g., standing up slowly) is crucial to prevent falls and address the dizziness.
C. Bed rest is not necessary; the client should be educated about managing dizziness instead.
D. Withholding the medication is not warranted unless directed by a healthcare provider; the focus should be on safety education.
A client with acute joint inflammation tells the nurse, "I've been taking acetaminophen as it's ordered on the bottle, but my swelling and inflammation doesn't seem to be getting better." What should the nurse teach the client?
Explanation
A. Acetaminophen is primarily an analgesic and antipyretic; it does not have anti-inflammatory properties, so it will not reduce swelling or inflammation.
B. While some medications may take time to show effects, this is not applicable to acetaminophen regarding inflammation, as it does not address that symptom.
C. Although acetaminophen is used for pain relief, saying it has only clinical use for pain is misleading; it is not effective for inflammation.
D. Monitoring for bleeding is important for medications that can affect coagulation, such as NSAIDs, but acetaminophen does not typically cause this risk.
A patient on warfarin is found to have an INR of 5.0. What is the most appropriate action by the nurse?
Explanation
A. An INR of 5.0 indicates a significantly increased risk of bleeding, and administering vitamin K is the appropriate antidote for reversing the effects of warfarin. This is a critical intervention to restore coagulation.
B. Increasing the dose of warfarin is inappropriate in this scenario because the INR is already elevated; it would further increase bleeding risk.
C. While heparin can be used for anticoagulation, it is not appropriate to administer it while the INR is dangerously high without reversing the warfarin first.
D. Continuing warfarin is unsafe at this INR level due to the high risk of bleeding; monitoring for symptoms without intervention is not adequate care.
A client asks, "Why is my prescription being switched from furosemide to spironolactone?" What is the nurse's best response?
Explanation
A. Spironolactone is a potassium-sparing diuretic, meaning it helps retain potassium while promoting sodium and water excretion. This makes it advantageous for clients who may be at risk for hypokalemia with furosemide, which can lead to significant potassium loss.
B. This statement is incorrect; spironolactone causes less potassium loss compared to furosemide, making it a better option for those needing to maintain potassium levels.
C. This statement is misleading; spironolactone does promote diuresis but does not cause greater water losses than furosemide.
D. This is incorrect; while spironolactone does promote sodium excretion, it does not do so to a greater extent than furosemide, which is a more potent diuretic.
A nurse is instructing a colleague on how an antimicrobial produces a therapeutic effect. What should be included in the nurse's teaching?
Explanation
A. While historical context is useful, the development of antimicrobials primarily began in the early 20th century, notably with penicillin discovered by Alexander Fleming in 1928.
B. This statement is incorrect; fluoroquinolones primarily inhibit bacterial DNA synthesis rather than directly affecting the cell wall.
C. Selective toxicity is a principle of antimicrobial action but does not directly explain how a specific antimicrobial works therapeutically.
D. Penicillin specifically interferes with the synthesis of the bacterial cell wall, leading to cell lysis and death of the bacteria, which is a fundamental mechanism of action for this antibiotic.
Which of the following is a common side effect of antiplatelet therapy with medications such as clopidogrel?
Explanation
A. Hypertension is not a common side effect of antiplatelet therapy; rather, it may be managed or monitored during treatment.
B. Gastrointestinal bleeding is a well-documented side effect of antiplatelet medications like clopidogrel, as they inhibit platelet aggregation and can increase bleeding risk.
C. Hyperglycemia is not typically associated with antiplatelet therapy; it is more commonly related to corticosteroids or certain diabetic medications.
D. Tachycardia is not a common side effect of antiplatelet therapy; cardiovascular effects are usually related to the management of existing conditions.
When researching information about a drug, the nurse finds that the drug tightly binds to protein. The nurse would interpret this to mean that the drug will:
Explanation
A. A drug that binds tightly to protein is typically released slowly, not quickly, as it remains bound in circulation.
B. Tight binding to proteins usually results in a prolonged duration of action since the drug is released gradually into the bloodstream, leading to sustained therapeutic effects.
C. Drugs that bind tightly to protein are generally not excreted quickly; they remain in circulation longer due to the binding.
D. While toxicity can occur with any drug, tight protein binding does not inherently lead to toxicity; it primarily affects the pharmacokinetics of the drug.
A male client is concerned with the inability to have an erection and asks for medication to help with this problem. Which information in the client's medication record would contraindicate the client from being prescribed medication for this condition?
Explanation
A. Nitroglycerin is contraindicated with erectile dysfunction medications such as sildenafil (Viagra) because both can cause significant drops in blood pressure when used together, potentially leading to severe cardiovascular complications.
B. Furosemide is a diuretic and does not have a direct contraindication with erectile dysfunction medications, although it may contribute to electrolyte imbalances.
C. Verapamil is a calcium channel blocker that does not directly contraindicate the use of erectile dysfunction medications but should be monitored for potential interactions affecting heart rate and blood pressure.
D. Acetaminophen is a pain reliever and does not pose a contraindication for erectile dysfunction medications.
A clinic nurse has been assigned a 49-year-old female client who has a history of diabetes. A recent diagnosis of hypertension has been made, and the client has been prescribed a hydrochlorothiazide and metoprolol. The client will be scheduled to return to the clinic once a month for the next 6 months. A priority action by the nurse will be to:
Explanation
A. While dietary intake is important, especially regarding sodium and fluid balance, it is not the highest priority compared to monitoring blood pressure.
B. Monitoring the client's blood pressure is essential to evaluate the effectiveness of the prescribed antihypertensive medications and to ensure the client is within the target range for managing her hypertension.
C. Weighing the client is important for monitoring fluid retention, especially with hydrochlorothiazide, but it is secondary to direct blood pressure monitoring.
D. Monitoring the respiratory rate is generally less critical in this scenario unless there are specific concerns related to medication side effects or respiratory conditions.
A patient receiving heparin therapy develops bruising and bleeding gums. What should the nurse suspect and what is the appropriate action?
Explanation
A. Bruising and bleeding gums are not indicative of an allergic reaction, which would typically present with different symptoms such as rash, itching, or swelling. Administering antihistamines would not address the underlying issue.
B. The development of bruising and bleeding gums in a patient on heparin therapy suggests a bleeding complication, which is a known risk of anticoagulation therapy. The nurse should notify the healthcare provider to assess the situation and possibly adjust treatment or perform further evaluations.
C. While hypersensitivity reactions can occur with medications, the symptoms presented here are more aligned with bleeding complications than with hypersensitivity. Discontinuing heparin without consulting the provider could put the patient at risk for thromboembolic events.
D. The symptoms do not indicate an infection; therefore, initiating antibiotic therapy would not be appropriate in this context.
A client diagnosed with hyperlipidemia has been taking atorvastatin for several months. How can the therapeutic effect of the medication be determined?
Explanation
A. While resting heart rate and blood pressure are important for overall cardiovascular health, they do not specifically assess the effectiveness of atorvastatin in lowering lipid levels.
B. Reviewing laboratory blood work results, particularly lipid panels, is essential to determine the therapeutic effect of atorvastatin, as it directly measures changes in cholesterol levels (such as LDL and total cholesterol).
C. Assessing exercise tolerance and activities of daily living can provide insight into overall health and well-being but does not specifically evaluate the impact of atorvastatin on lipid levels.
D. A focused cardiac assessment is beneficial for understanding cardiovascular health but is not specific for measuring the effectiveness of lipid-lowering therapy with atorvastatin.
The nurse is caring for a client who is taking a bronchodilator. In what disease process should bronchodilators be used cautiously?
Explanation
A. Liver failure does not have a direct contraindication with bronchodilators, though careful monitoring is needed.
B. Renal failure is not a direct contraindication for bronchodilator use; however, kidney function can affect drug metabolism and clearance.
C. Respiratory failure may necessitate bronchodilator therapy rather than caution, especially in conditions like COPD or asthma where bronchodilators are crucial for management.
D. Heart failure requires caution with bronchodilators because they can lead to increased heart rate and blood pressure, potentially exacerbating heart failure symptoms or leading to arrhythmias.
The nurse is teaching a patient with type 2 diabetes about intermediate-acting insulin (NPH). Which of the following statements by the patient indicates a need for further teaching?
Explanation
A. The patient’s statement about the peak of NPH insulin being 6-12 hours is correct; it is important to know when to monitor for hypoglycemia.
B. Taking NPH before breakfast is appropriate, as it is typically given in the morning to provide coverage for meals throughout the day.
C. The duration of NPH insulin lasting for 12-18 hours is accurate, which is crucial for understanding how long the patient can expect blood glucose control.
D. NPH insulin should not be taken right before meals as it does not act quickly enough to cover immediate carbohydrate intake. Rapid-acting insulin is typically used for that purpose, indicating a need for further teaching.
In discussing the safe use of drugs in the institutional setting, what duty is performed by the nurse? (Select all that apply.)
Explanation
A. Administering drugs is a fundamental duty of the nurse, ensuring that medications are given safely and according to protocols.
B. Monitoring clients for drug effects is crucial for assessing the effectiveness of medications and identifying any adverse reactions or complications.
C. Prescribing drugs is not a duty performed by nurses, as this responsibility typically falls under the purview of licensed practitioners such as physicians or nurse practitioners.
D. Evaluating clients for toxic effects is part of the nurse's responsibility to ensure patient safety and to respond to any signs of medication toxicity.
E. Educating clients/caregivers about drugs is a vital role for nurses, as it helps patients understand their medications and the importance of adherence to prescribed regimens.
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