A client is taking several prescribed oral medications for treatment of congestive heart failure. He tells the nurse, "I'm going to take these at breakfast". Which response by the nurse is most appropriate?
"Let's look at each medication to determine the best time to take it"
"That depends on what you eat for breakfast"
"That's a great idea so you won't forget any medications"
"What time do you usually have breakfast?"
In addition to less efficient renal excretion, what other physical change in aging may lead to a need to reduce medication dosage in an elderly client?
Increased rate of drug absorption
Decreased total body fluid proportionate to body mass
Decreased efficiency in drug distribution
Increased rate of drug metabolism by the liver
A nurse is administering medication to a hospitalized client. Which of the following is the most accurate way to assure that the right patient gets the medication?
Ask the client, "are you Dale Jones?"
Check the client's identification band
Check the client's room number and bed assignment
Ask the client why he or she is getting the medication
A client asks, "what's the difference between Advil and ibuprofen?" The nurse responds by saying which of the following?
"There is no difference between them"
"Advil and ibuprofen are two different drugs with similar effects"
"This question should be answered by your doctor"
"If you doctor orders Advil, you should not substitute any other medication"
The nurse would expect the dose of morphine for a postoperative patient to be higher than usual for the patient's size and age is prescribed for a patient who routinely uses:
alprazolam (Xanax)
ethanol (Alcohol)
oxycodone (OxyContin)
temazepam (Restoril)
The decreased lean body mass common in the elderly is likely to affect:
absorption of drugs
distribution of drugs
metabolism of drugs
elimination of drugs
Which of the following is an example of a primary prevention measure?
Participating in cardiac rehabilitation
Getting an annual physical examination
Avoiding excessive sun exposure
Practicing monthly self-breast examinations
An older adult client who experiences several adverse effects of medications could benefit from:
Reduced drug dosages
Nursing home placement
Increased drug dosages at less frequent intervals
More frequent physician visits
One day after surgery, the nurse inspects the client's incision. Which of the following is evidence of a local inflammatory response?
Clear yellow drainage from the surgical wound
Redness and warmth around the incision
Pallor at the suture line
Brown exudate at the wound edges
Which is the best way to increase client compliance with a medication regimen?
Give all the instructions at least three times
Encourage the client to hire a visiting nurse
Use a medication organizer
Devise the simplest schedule possible
Which of the following provides the best rationale for encouraging a client with a wound to consume a diet high in vitamin C?
Restoration of the inflammatory response
Enhancement of oxygen transport
Reduction of edema
Increased protein synthesis
The nurse is concerned about urinary retention in a client who has not voided for 8 hours since undergoing surgery. Which assessment finding is most likely?
The nurse will be unable to palpate the bladder
The bladder will be smooth to palpation
The nurse can palpate the bladder at the symphysis pubis
The bladder will be felt at the umbilicus
A client who has had surgery has a poor cough effort due to incisional pain. He has crackles in his lower lobes bilaterally. Which of the following non-pharmacological interventions would be most effective in dealing with this problem?
Increasing fluids to 2500cc/day
Using incentive spirometry every 2 hours
Suctioning the client every 2 hours
Splinting the abdominal incisional
The client is ordered to have morphine sulfate 2 mg IV every 6 minutes via PCA pump. However, the client has refused to take the medication. Which of the following actions by the nurse is most appropriate?
Pushing the PCA pump button for him
Calling the physician to request medication by mouth
Giving the medication in an intramuscular injection
Exploring why he does not want to take the medication
A nurse is evaluating a client for a post-operative infection. Which of the following signs is most indicative of an infection?
Presence of an indwelling foley catheter
Rectal temperature of 37.8 C (100 F)
Productive cough with yellow mucous
White blood cell count of 8,000/mm^3
A client is at risk for hypovolemia in the postoperative period. Which of the following would insure the most accurate monitoring of fluid balance?
Measuring and recording intake and output
Monitoring skin turgor for tenting
Assessing the vital signs every hour hours
Checking the lungs for crackles
Which member of the healthcare team is responsible for obtaining informed consent from a client prior to a surgical procedure?
The primary nurse
The surgeon
The nurse at the physician's office
The surgeon's assistant
The nurse inadvertently gives the client a double dose of the medication. Who should be notified first?
The client
The prescriber
The nurse's lawyer
The nursing supervisor
Of the following clients, who is at the greatest risk for developing wound infection?
One who requires frequent pain medication
One who is 25 lbs. overweight
One who walks shortly after surgery
One who is 10 lbs. underweight
A client had surgery two hours ago. Vital signs at that time were BP 140/74, P 82, R 16, skin warm and dry. Vitals signs are now BP 110/62, P 102, R 22, skin cool. Which of the following should the nurse do first?
Re-checking of vital signs to verify they are correct
Evaluate the head of the bed to help the client breath more effectively
Check the client's urine output for more than 30mL/hour
Administer pain medication
Which of the following is a form of secondary prevention?
Getting a tetanus booster
Losing 10 pounds
Getting mammograms and pap smears regularly
Having physical therapy for low back pain
Which nursing action may help decrease the anxiety of a pre-operative client?
Encouraging her to sleep until it is time for surgery
Reassuring her that she will be fine and has no need to worry
Spending time with her and answering all of her questions
Teaching her how to avoid postoperative complications
Regular use of which of the following places a surgical client at increased risk for bleeding?
Ginseng
Omega 3 fatty acids
Echinacea
Kava kava
A client is experiencing confusion in the immediate post-operative period. Which of the following assessments is most essential to determine the reason for confusion?
airway status
cardiac rhythm
level of anxiety
body temperature
The nurse is caring for a client post-operatively. Which of the following indicates that the client has a compromised airway?
The client states he is anxious
The client rates his pain a 6 out of 10
His pulse oximetry reading is 90%
His skin is cool and clammy
In reviewing the chart of a patient about to undergo general anesthesia, which of the following is the greatest risk factor?
He expresses anxiety about the upcoming procedure
He ate a snack two hours ago
He smokes and states his last cigarette was 6 hours ago
He has a history of hypertension controlled by diet
Which of the following instructions should be included in the medication teaching for an older adult who has back pain who is prescribed an opioid with codeine?
Check your breathing rate three times a day
Increase your intake of fiber and fluids
Limit taking the medication unless pain is severe
Avoid taking the medication more than twice a day
The nurse is preparing to administer Clarinex (desloratadine) to an adult with seasonal allergies. The order reads 15mg once/day but the acceptable dose is 5mg/day. What should the nurse do next?
Hold the medication and check the original order
Call the prescriber
Ask the client if this is his usual dose
Administer the dose because it was prescribed
A patient is taking lovastatin (Mevacor) for cholesterol control. She asks what might happen if she takes the medication with grapefruit juice. The nurse replies:
"The medication will not get to its site of action"
"You may build up toxic levels of the medication"
"The liver can be damaged"
"The medication cannot be absorbed properly"
Before administering acetaminophen (Tylenol) the nurse reviews the patient's lab results. Which of the following is the nurse specifically looking for?
Alterations in BUN and creatinine
Low potassium level
Elevated AST and ALT levels
Low hemoglobin and hematocrit
Warfarin sodium (Coumadin) is a highly protein bound drug. When the nurse gives this medication to a client with a low serum protein level, which of the following responses is expected?
More intense drug response and greater risk for bleeding
Less intense drug response and greater risk for bleeding
More intense drug response and less risk for bleeding
Less intense drug response and less risk for bleeding
A client develops a rash after receiving the medication Oxycodone. The prescriber discontinues the oxycodone and orders diphenhydramine (Benadryl). The nurse must be alert for which drug-drug interaction?
Confusion
Fever
Hypotension
Urinary retention
A client is scheduled for an elective surgical procedure. He tells the nurse that he usually takes gingko biloba to help his memory but he hasn't taken it for three days. What action should the nurse take?
Document this information in the chart
Notify the nurse anesthetist immediately
Request a stat electrocardiogram and chest x-ray
Determine how long the client has taken the gingko
The client has had a general anesthetic for an exploratory laparotomy. The nurse notes that there is no antiemetic medication ordered for post-op care. Which action should the nurse take?
Ask the anesthesiologist if the client was nauseated during surgery
Tell the client to report any nausea
Contact the surgeon and request an order for an antiemetic
Give the client sips of ginger ale to reduce nausea
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 knowledge that codeine also has what effect?
Immunostimulant
Antitussive
Anti-infective
Immunosuppressant
The nurse is walking in the hallway with a client who had surgery yesterday. The client is receiving morphine sulfate via a patient controlled analgesia system. The client complains of nausea. Of the following, which should the nurse do first?
Administer the anti-nausea medication
Assist the client to sit down
Get an emesis basin
Walk the client back to his room
A patient who has received morphine sulfate becomes becomes slightly disoriented. If this effect is due to the morphine, which intervention by the nurse would be most likely to reverse this adverse effect?
Assist the patient to walk
Instruct the patient to change positions slowly
Instruct the patient to take slow, deep breaths
Keep the room well lit
The caregiver of a patient calls to report, "My mother just took her first dose of the prescribed opioid and became very nauseated." Select the nurse's best response:
"She is probably allergic to the agent and should discontinue it now"
"If the nausea is not as bad as the pain, she should continue the opioid as prescribed"
"This is generally a temporary effect and is lessened by keeping still"
"Try cutting the dose in half and take the medication on an empty stomach"
A nurse suspects that a patient is still in pain because of non-adherance to the opioid regimen. Which physical sign would help confirm this suspicion?
Dilated pupils
Constricted pupils
Slow respiration
While reviewing discharge instructions, a patient asks the nurse why the oral dose of the opioid is so much higher than the intravenous dose was. Select the nurse's best response.
"When patients go home, they need higher doses of medication"
"The oral form of the drug passes through the liver, and a lot is metabolized before it can achieve the desired effect"
"When the physician converted the dosages, there was an error in calculation"
"The doses should be the same. The physician must think your pain is not well controlled"
Select the most accurate description of physical dependence.
It is a state in which larger doses are required to produce the same response formerly produced by a smaller dose.
It is a state in which an individual will seek and use the drug despite physical, psychological, or social harm
It is a state in which pain is undertreated and the patient appears to be drug seeking
It is a state in which an abstinence syndrome will occur if the drug is abruptly discontinued
In the emergency department a nurse assesses a stuporous patient who is suspected of overdosing on opioids. The nurse should prepare to administer which agent if the patient becomes comatose or develops respiratory depression?
Flumazenil (Romazicon)
Naloxone (Narcan)
Atropine
Vitamin K
A patient who has been taking opioids for 2 years is preparing to stop. How should the nurse instruct the patient to discontinue the opioids after prolonged use?
Stop the agents abruptly
Continue a very low dose for 3-6 months
Taper slowly over 7-10 days
Switch to an equianalgesic dose of another opioid and then discontinue
While caring for an unconscious client, the nurse knows that:
The patient will not feel pain
Any noxious stimulus should be treated as potentially painful
If pain is perceived the client will always have an observable change in behavior
Pain is best assessed by asking a family member
Which of the following are commonly experienced side effects associated with administration of opioid analgesics? (select all that apply)
Constipation
Pupillary dilation
Slowed respiratory rate
Rapid pulse
Headache
Drowsiness
Increased blood pressure
Dry mouth
Nursing practice should be guided by which of the following principles of pain management?
Pain medication should be used only as needed when pain becomes severe
Nurses should give pain medication at the first sign of pain using a large enough dose to obtain relief
It is best to begin with a very small dose, adding more as needed for relief
Medication should be given no more frequently than every four hours to avoid overdose
Which of the following factors have the most significant effect on a client's response to pain medications? (select all that apply)
Age
Gender
Body mass index
Time of day medication is given
Nutritional status
Generic substitution
An 80 year-old woman is brought to the health center for the first time by her 64 year-old daughter. Which of the following approaches by the nurse would be most appropriate at the time?
Ask the daughter whether the client has any urgent needs or problems
Obtain a health history from the client herself
Interview the client and daughter together so that pertinent information can be obtained
Refer the client for an interdisciplinary comprehensive geriatric assessment since she will have multiple needs
