NSG 555/ NSG555 Final Exam – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A

NSG 555/ NSG555 Final Exam – Nurse Practitioners in Primary Care II Review| Wilkes (Latest 2026/ 2027 Update) 100% Verified Questions & Answers | Grade A A client on in the hospital has a leg that is immobilized in traction. Which observation by the nurse indicates that the client understands actions to take to prevent muscle atrophy? -The patient adducts the affected leg every 2 hours -The patient rolls the affected leg away from the body's midline twice per day -The patient performs isometric exercises to the affected extremity three times a day -The patient asks the nurse to add a 5-lb (2-3kg) weight to the traction for 35 min a day The patient performs isometric exercises to the affected extremity three times a day The nurse is caring for a client who is 30 years of age with a fracture of the right femur and left tibia. Both legs have casts. The nurse assesses the following: Respiration's are 35 per minute, rapid and shallow Presence of faint expiratory wheeze Cough that produces thin pink sputum The client is yelling at the nurse and wants to be released from the hospital. His behavior unlike that previously reported by other nurse who have cared for him. The last dose of pain medication was administered three hours ago. What should be the nurse's first action: -Cut slits in the top of the casts -Administer pain medication -Notify the healthcare provider (HCP) -Obtain a chest x-ray Notify the healthcare provider (HCP) Which client statement identifies a knowledge deficit about cast care? "I will elevate the cast above my heart initially" "I will exercise my joints above and below the cast." "I will apply ice for 10 minutes to control edema for the first 24 hours." "I can pull out cast padding to scratch inside the cast." "I can pull out cast padding to scratch inside the cast." After teaching the client about the use of traction, which statement made by the patient about the purpose of the traction indicates the client needs additional teaching? - "I can move up and down in bed if I need to" -"Traction will help align my injured bone" -"Traction will provide constant pull" -"Traction will help reduce muscle spasms" "I can move up and down in bed if I need to" The nurse should instruct the client with a cast to avoid. (Select all that apply) - Direct pressure on the cast during the drying period - Allowing dirt to get inside the cast -! Washing the cast with bleach -Using a coat hanger to scratch a itch inside the cast - Storing M&Ms inside my cast for a snack later - Direct pressure on the cast during the drying period - Allowing dirt to get inside the cast -! Washing the cast with bleach -Using a coat hanger to scratch a itch inside the cast - Storing M&Ms inside my cast for a snack later Braces and splints are the same thing True False False The nurse develops a teaching plan for a patient needing a hinged knee brace for an injury sustained after a fall. Which statement made by the patient indicates effective teaching? -"I can use any type of powder under the brace to absorb perspiration" -"I will apply lotion and thick layers of clothing before putting my brace on" - "I need to wear the brace until my recheck but I can take it off to look at my skin" -"I will tighten the brace as tight as I can make it" - "I need to wear the brace until my recheck but I can take it off to look at my skin" During the nurse's morning assessment, a patient has an absent peripheral distal pulse and pain at rest after a splint was placed. What should the nurse do first? -Request that a venous Doppler exam be ordered -Remove the splint until the provider makes their rounds -Administer the ordered one time dose of pain medication -Notify the healthcare provider (HCP) immediately Notify the healthcare provider (HCP) immediately The patient has sustained a complex fracture and is brought to the hospital. What treatment should the nurse anticipate being ordered? (Select all that apply) -Consult for possible orthopedic surgery -Apply a flexible brace for long-term use until healed -Apply a stabilizing splint and assess neurovascular status after placement - IV analgesic pain management -Consult for possible orthopedic surgery -Apply a stabilizing splint and assess neurovascular status after placement -IV analgesic pain management Which information should the nurse include in the teaching session when preparing a client for a cast? (Select all that apply) - Signs and symptoms of appropriate pain control -Skin checks initially and aftercare -When and how they can remove their cast -Explain the procedure -Signs and symptoms of appropriate pain control -Skin checks initially and aftercare -Explain the procedure Of the patients listed below, who is at higher risk for developing rheumatoid arthritis(RA)? (Select all that apply) - Adults between the peak age of 30 to 50 years old - Older adults with degenerative joint disease - Adults who are of female gender - Adults who play sports and have had surgery due to injury - Adults who have osteoarthritis - Adults between the peak age of 30 to 50 years old - Adults who are of female gender The nurse teaches a client about heat and cold treatments to manage arthritis pain. Which statement indicates that the client still has a knowledge deficit? - A "I can use heat and cold as often as I want" - "What heat, I should apply it for no longer than 20 minutes at a time" - "Heat-producing liniments can be used with other heat devices" - "Ten to fifteen minutes per application is the maximum time for cold application" - "Heat-producing liniments can be used with other heat devices" Rheumatoid arthritis has numerous medication treatment options. Which medication listed below can be indicated for RA patients? (Select all that apply) - Monoclonal antibody that target B cells - Interleukin-6 (IL-6) blocker - Tumor necrosis factor inhibitor - Antibiotic (minocycline) - Gold preparations - Folic Acid - Monoclonal antibody that target B cells - Interleukin-6 (IL-6) blocker - Tumor necrosis factor inhibitor - Antibiotic (minocycline) - Gold preparations After teaching a patient with RA about measures to conserve energy in activities of daily living involving the small joints, which activity observed by the nurse indicates the need for additional teaching? - Pushing with palms when rising from a chair - Holding packages close to the body - Sliding objects - Carrying a laundry basket with clinched fingers and fists - Carrying a laundry basket with clinched fingers and fists A 25-year old client taking Hydroxychloroquine for RA reports difficulty seeing out of the left eye. What does this finding indicate? - Development of a cataract - Possible retinal degeneration - Part of the disease process - A coincidental occurrence - Possible retinal degeneration After teaching the patient with severe RA about prescribed methotrexate, which statement indicates the need for further teaching? - "I will continue to take my melatonin for sleep" - "I must not drink any alcohol while I am taking this drug cause it could affect my liver" - "I should brush my teeth after every meal to prevent thrush" - "I will continue taking my birth control pills" - "I will continue to take my melatonin for sleep" A client with RA is taking high doses of nonsteroidal anti-inflammatory medications. The nurse should instruct the client to: - Don't stop taking the medication suddenly; the dose needs to be decreased gradually - Take prescribed medications with food to lessen the likelihood of an upset stomach - Use mouthwash to rinse the mouth after taking this medication - Do not drive if constipation occurs - Take prescribed medications with food to lessen the likelihood of an upset stomach The most important person in the interprofessional team is the Nurse. - True - False - False A client with RA tells the nurse "I know it is important to exercise my joints so that I will not lose mobility, but the joints are so stiff and painful that exercising is difficult." Which response by the nurse would be most appropriate? - "you are probably exercising too much when you exercise 10 minutes a day. Decrease your exercise to every other day." -"Tell the healthcare provider about your symptoms. Maybe your analgesic medication can be increased to more than the max dose." - "Stiffness and pain are part of the disease. Learn to cope by focusing on activities that you enjoy and stop worrying about it." -"Take a warm tub bath or shower before exercising. This may help with your discomfort." -"Take a warm tub bath or shower before exercising. This may help with your discomfort." A patient is in acute pain phase of RA causing moderate pain. What symptoms would correlate with these RA symptoms? (select all that apply) - Pain rated 1 out of 10 on a pain scale - Stiffness in the hands lasting longer than 60 minutes - Loss of joint function - Tender hand joints - Stiffness in the hands lasting longer than 60 minutes - Loss of joint function - Tender hand joints A client in the hospital has a leg that is immobilized in traction. Which observation by the nurse indicates that the client understands actions to take to prevent muscle atrophy? -The patient adducts the affected leg every 2 hours -The patient rolls the affected leg away from the body's midline twice per day - The patient performs isometric exercises to the affected extremity three times a day -The patient asks the nurse to add a 5-lb (2-3kg) weight to the traction for 35 min a day - The patient performs isometric exercises to the affected extremity three times a day The nurse is caring for a client who is 30 years of age with a fracture of the right femur and left tibia. Both legs have casts. The nurse assesses the following: Respiration's are 35 per minute, rapid and shallow Presence of faint expiratory wheeze Cough that produces thin pink sputum The client is yelling at the nurse and wants to be released from the hospital. His behavior unlike that previously reported by other nurse who have cared for him. The last dose of pain medication was administered three hours ago. What should be the nurse's first action: - Cut slits in the top of the casts - Administer pain medication - Notify the healthcare provider (HCP) - Obtain a chest x-ray - Notify the healthcare provider (HCP) Which client statement identifies a knowledge deficit about cast care? - "I will elevate the cast above my heart initially" - "I will exercise my joints above and below the cast." - "I will apply ice for 10 minutes to control edema for the first 24 hours." - "I can pull out cast padding to scratch inside the cast." - "I can pull out cast padding to scratch inside the cast." After teaching the client about the use of traction, which statement made by the patient about the purpose of the traction indicates the client needs additional teaching? - "I can move up and down in bed if I need to" - "Traction will help align my injured bone" - "Traction will provide constant pull" - "Traction will help reduce muscle spasms" - "I can move up and down in bed if I need to" The nurse should instruct the client with a cast to avoid. (Select all that apply) - Direct pressure on the cast during the drying period - Allowing dirt to get inside the cast - Washing the cast with bleach - Using a coat hanger to scratch a itch inside the cast - Storing M&Ms inside my cast for a snack later - Direct pressure on the cast during the drying period - Allowing dirt to get inside the cast - Washing the cast with bleach - Using a coat hanger to scratch a itch inside the cast - Storing M&Ms inside my cast for a snack later Braces and splints are the same thing - True - False - False The nurse develops a teaching plan for a patient needing a hinged knee brace for an injury sustained after a fall. Which statement made by the patient indicates effective teaching? - "I can use any type of powder under the brace to absorb perspiration" - "I will apply lotion and thick layers of clothing before putting my brace on" - "I need to wear the brace until my recheck but I can take it off to look at my skin" - "I will tighten the brace as tight as I can make it" - "I need to wear the brace until my recheck but I can take it off to look at my skin" During the nurse's morning assessment, a patient has an absent peripheral distal pulse and pain at rest after a splint was placed. What should the nurse do first? - Request that a venous Doppler exam be ordered - Remove the splint until the provider makes their rounds - Administer the ordered one time dose of pain medication - Notify the healthcare provider (HCP) immediately -Notify the healthcare provider (HCP) immediately The patient has sustained a complex fracture and is brought to the hospital. What treatment should the nurse anticipate being ordered? (Select all that apply) - Consult for possible orthopedic surgery - Apply a flexible brace for long-term use until healed - Apply a stabilizing splint and assess neurovascular status after placement - IV analgesic pain management - Consult for possible orthopedic surgery - Apply a stabilizing splint and assess neurovascular status after placement - IV analgesic pain management Which information should the nurse include in the teaching session when preparing a client for a cast? (Select all that apply) - Signs and symptoms of appropriate pain control - Skin checks initially and aftercare - When and how they can remove their cast - Explain the procedure - Signs and symptoms of appropriate pain control - Skin checks initially and aftercare - Explain the procedure A patient who is admitted to a burn unit is hypovolemic. A new nurse asks an experienced nurse about the patient's condition. Which response if made by the experienced nurse is most appropriate? A. ) "Blood loss from burned tissue is the most likely cause of hypovolemia." B.) "Third spacing of fluid into fluid-filled vesicles is usually the cause of hypovolemia." C.) "The usual cause of hypovolemia is evaporation of fluid from denuded body surfaces." D.) "Increased capillary permeability causes fluid shifts out of blood vessels and results in hypovolemia. " D.) "Increased capillary permeability causes fluid shifts out of blood vessels and results in hypovolemia. " CASE STUDY: §Lane is a 25 y.o. transitioning FTM who fell from the roof while cleaning solar panels and struck a hot charcoal grill. He lacerated his left leg and his clothes caught fire. §Lane works as roofer. He smokes 1 PPD and drinks beer three times a week with his buddies. §Lane was taken to the ED by ambulance. §His burns were estimated to be partial and full thickness over his face, neck, trunk, right upper arm, and left leg. §What actual and potential risk factors might affect Lane's recovery? •FTM- Female to male • type of burn(s) Lane likely have? •Thermal burns •Possible smoke inhalation from burning clothing • Degree of burns? second and third degree •Using the Rule of Nines, estimate the percent of total body surface that has been burned. =36% •Risk factors: •His smoking might affect his lungs and ability to heal. •His drinking may be an issue as well. Why? Poor nutrition •The fact that he has upper and lower body burns may affect his ability for self-care, as well as ability to return to work. CASE STUDY §Two large-bore IVs are started. §An indwelling urinary catheter is inserted into the bladder. §By using the Lund-Browder chart, Lane's total body surface area affected is 46%. §What places Lane at risk for an inhalation injury? §What are your nursing goals for his care? §Lane's breathing is stable on 100% humidified oxygen. §He is taken to OR for debridement of burns of his trunk and arm. •In what phase of a burn injury would he be classified? Because the burn occurred in the last 24 hours, he is classified in the emergent phase. •What are the priorities of care for him? Priorities: (1) airway, (2) breathing, (3) circulation, (4) fluids, (5) wound care. •The burns on his face and neck. •Primary nursing concerns during the emergent phase are: •Monitoring for hypovolemic shock •Monitoring for edema formation •What is the next step in wound care for Lane? •What is his biggest risk? Infection CASE STUDY §Lane reports severe pain (9 on a 0-to-10 scale) over his face and leg. §He appears very anxious and expresses fear regarding his healing and future. §Lane reports slight difficulty swallowing and his voice is hoarse. §He is able to swallow ice chips without difficulty. §Lane begins to diurese and his facial and body edema subside. §He is taken to OR again for further debridement and skin grafting. •What medications would you anticipate for his care? O2, antibiotics, pain medications, IV hydration When monitoring initial fluid replacement for the patient with 40% TBSA deep partial-thickness and full-thickness burns, which finding is of most concern to the nurse? a.Serum K+ of 4.5 mEq/L b.Urine output of 35 mL/hr c.Decreased bowel sounds d.Blood pressure of 86/72 mm Hg d.Blood pressure of 86/72 mm Hg Adequacy of fluid replacement is assessed by urine output and cardiac parameters. Urine output should be 0.5 to 1 mL/kg/hr. Mean arterial pressure should be 65 mm Hg, systolic BP 90 mm Hg, and heart rate 120 beats/min. A blood pressure of 86/72 indicates inadequate fluid replacement. However, the MAP is calculated at 77 mm Hg. During the emergent phase of burn injury, the nurse assesses for the presence of hypovolemia. In burn patients, hypovolemia occurs primarily as a result of a.Blood loss from injured tissue. b.Third spacing of fluid into fluid-filled vesicles. c.Evaporation of fluid from denuded body surfaces. d.Capillary permeability with fluid shift to the interstitium. Answer D Hypovolemic shock is caused by a massive shift of fluids out of the blood vessels as a result of increased capillary permeability. Water, sodium, and plasma proteins move into interstitial spaces and other surrounding tissue. A patient is to undergo skin grafting with the use of cultured epithelial autografts for full thickness burns. The nurse explains to the patient that this treatment involves a.Shaving a split-thickness layer of the patient's skin to cover the burn wound. b.Using epidermal growth factor to cultivate cadaver skin for temporary wound coverage. c.Growing small specimens of the patient's skin into sheets to use as permanent skin coverage. d.Exposing animal skin to growth factors to decrease antigenicity so it can be used for permanent wound coverage. Answer C Cultured epithelial autograft (CEA) is a method of obtaining permanent skin from a person with limited available skin for harvesting. CEA is grown from biopsy specimens obtained from the patient's own unburned skin. The nurse answers a patient's call light and finds the patient sitting up in bed and requesting pain medication. What will the nurse do first? ◦ A.Check the orders and give the patient the requested pain medication. B.Provide comfort measures to the patient. C.Assess the patient's pain and pain level. D.Evaluate the effectiveness of previous pain medications. Answer C Rationale: The nurse should always assess a patient before any intervention. Although the nurse will check the orders and possibly give the medication (and possibly even perform the actions in responses B and D), the first priority is assessment. The patient's medication administration record lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse's coworker suggests giving the medications via IV because the patient is NPO. What will the nurse do? ◦ A.Give the medications PO with a small sip of water. B.Give the medications via the IV route because the patient is NPO. C.Hold the medications until after the test is completed. D.Call the health care provider to clarify the instructions. Answer D Rationale: The dosage for the IV route would not be the same as for the PO route. Holding the medications may cause drug levels to drop and result in seizure activity and giving the medications PO without consent may alter the test results. The nurse must never assume the route of medication administration and should consult the physician for clarification of the orders. NEVER give another route than ordered. The physician must be notified and order obtained for a new route. A nurse makes an error when administering medications to a patient. Which action by the nurse requires the supervising nurse to intervene? ◦ A.The nurse completes an incident report. B.The nurse informs the prescriber of the error. C.The nurse documents adverse effects to the medication error. D.The nurse records completion of an incident report in the medical record. Answer D If there is a medication error, the nurse should complete an incident report with the entire event, surrounding circumstances, therapeutic response, adverse effects, and notification of the prescriber described in detail. However, the nurse should not record completion of an incident report in the medical record. A patient is prescribed ibuprofen 200 mg PO every 4 hours as needed for pain. The pharmacy sends up enteric-coated tablets, but the patient refuses the tablets, stating that she cannot swallow pills. What will the nurse do? A.Crush the tablets and mix them with applesauce or pudding. B.Call the pharmacy and ask for the liquid form of the medication. C.Call the pharmacy and ask for the IV form of the medication. D.Encourage the patient to try to swallow the tablets. Answer B The liquid form is appropriate because it is also given via the oral route. Enteric-coated tablets should not be crushed, and the patient should not be forced to take the tablets. This medication does not have an IV form, but even if it did, the routes cannot be changed without a health care provider's order. The nurse is preparing to administer a transdermal patch to a patient and finds the patient already has a medication patch on his right upper chest. What will the nurse do? A.Remove the old medication patch and notify the health care provider. B.Apply the new patch without removing the old one. C.Remove the old patch and apply the new patch in the same spot. D.Remove the old patch and apply the new patch to a different, clean area. Answer D Transdermal drugs should be placed on alternating sites, on a clean and nonirritating area, and only after the previously applied patch has been removed. The nurse is giving a medication that has a high first-pass effect. The health care provider has changed the route from PO to IV. What can the nurse expect with the IV dose? A.The IV dose will be higher because of the first-pass effect. B.The IV dose will be lower because of the first-pass effect. C.The IV dose will be the same as the PO dose. D.The rate of IV infusion must be faster due to first-pass effect. Answer B The first-pass effect is the metabolism of a drug before it becomes systemically available, and it reduces the bioavailability of the drug. This primarily occurs with oral medications. Therefore, IV doses need to be lower than PO doses because of the first-pass effect. A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route? u A.IV B.IM C.Subcutaneous D.PO Parenteral routes result in the fastest absorption and therefore also the fastest effects. Teratogenic known to have potential to cause developmental defects in the embryo or fetus. •Examples of teratongenic meds: diazepam (cleft lip), Isotretinoin for acne (neural tube defects), hormones (large clitoris and fused labia) mutagenic causing changes, or mutations, in DNA •Mutagens- charcoal BBQ, decaf coffee "A mutagen is a chemical or physical agent that has the ability to change our genetic code in a harmful way. The change in the genetic code is called a mutation, and throughout our lifetime we actually accumulate many mutations within our cells. And our body has the ability to recognize and repair these mutations. However, if some of these mutations escape repair, they can cause a normal cell to be transformed to become a tumor cell. Therefore, mutations are actually associated with the development of cancer." carcinogenic effect cancer causing When teaching a pregnant woman about the use of drugs during pregnancy, which statement will the nurse include? A.Exposure of the fetus to drugs is most detrimental during the second trimester of pregnancy. B.Pregnant women must never take drugs to control high blood pressure. C.Drug transfer to a fetus is most likely to occur during the last trimester of pregnancy. D.A fetus is at greatest risk for drug-induced developmental defects during the second trimester of pregnancy. Answer C Rationale: Drug transfer to the fetus is most likely to occur during the last trimester of pregnancy. Exposure of a fetus to drugs is most detrimental during the first trimester of pregnancy, and fetuses are at greatest risk for drug-induced developmental defects during the first trimester of pregnancy. Pregnant women need to take medications to control situations such as high blood pressure. CASE STUDY Jing is a 7-month-old male who is being admitted for pneumonia on a combined adult and pediatric medical unit. The nurse assigned has little pediatric experience and has sought the advice of the experienced charge nurse. - What age-related considerations should the nurse consider when preparing medications for Jing? The nurse must consider the age and weight of the child for safe medication administration. A 6 month-old cannot swallow pills therefore, liquid preparation of medications must be available. High risk medications should be verified by a second RN. Pediatric medications have safe ranges and these should be calculated for all medications. If the drug dose raises concerns or varies from the safe range, contact the prescriber immediately. The nurse will have to consider how to safely administer the medication. Oral syringes are common methods to instill the medication in the mouth of the young child. Note: Some facilities require all pediatric medications to be double checked by a second RN. CASE STUDY The nurse reviews the prescriber's orders and notes the following: Administer acetaminophen 10 mg/kg/dose every 4 hours for fever greater than 102.6 temporal. What important data would the nurse need to verify? The nurse needs to verify an accurate weight. Children of this age should be weighed nude or with as little clothing as possible (diaper and t-shirt). The weight should be calculated in kilograms. The nurse caring for a pediatric patient calculates the safe range for the prescribed medication. Based on the nurse's calculations, the dose ordered exceeds the high limit. What is the nurse's next action? A.Contact the prescriber immediately. B.Administer only half the ordered dose. C.Proceed with administration of the prescribed dose. D.Contact pharmacy to substitute the prescribed medication with one that will calculate in the safe range. Answer A The nurse should contact the prescriber immediately and before administering the medications. Giving only half the prescribed dose is making a prescribed order which is not within the scope of practice for the nurse. Pharmacy cannot make treatment changes without the direction of the prescriber. What does the nurse identify as a pharmacokinetic change that occurs in older adults? A.Gastric pH is more acidic. B.Fat content is decreased because of increased lean body mass. C.There is increased production of proteins by the liver. D.The number of intact nephrons is decreased. Answer D In older adults, the gastric pH is less acidic because of a gradual reduction in the production of hydrochloric acid in the stomach, fat content is increased because of decreased lean body mass, and there is decreased production of proteins by the aging liver and reduced protein intake. It is correct that the number of intact nephrons decreases in older adults. Which of the following statements regarding African Americans' responses to antihypertensive medication therapy is true? § A.African Americans respond better to diuretics than to beta blockers. B.African Americans do not respond to diltiazem. C.Single-drug therapy is effective for African Americans. D.Hypertension is uncommon in the African-American population. Answer A African Americans respond less effectively to beta blockers. African Americans respond best to calcium channel blockers, especially diltiazem. African Americans respond less effectively to single-drug therapy. A research group is conducting an investigational drug study on a promising new drug for osteoporosis. It has been difficult to find research participants who meet the criteria. Just before the conclusion of the study, four participants approach the researchers and express their desire to withdraw from the study. What is the researcher's priority intervention? A.Inform them that they waited too long to withdraw from the study. B.Explore with them the reasons for withdrawing from the study. C.Acknowledge that they can withdraw at any time from the study. D.Request that they try to remain with the study until it is completed. Answer C The researcher may try to find the reasons for withdrawal and request that the participants try to remain with the study, but the individuals must know that their participation is truly voluntary and that they can quit the study at any time. Autonomy authority to take charge and make decisions with professional knowledge Beneficence Doing good or causing good to be done; kindly action Justice fairness Negligence careless neglect, often resulting in injury Nonmaleficence duty to do no harm Veracity truthfulness A nurse does not notice that a patient's IV site is swollen, red, painful, and warm to touch nor that the IV has quit infusing properly. What ethical principle does this involve? A.Breach of duty B.Duty C.Causation D.Damage Answer A Refer to Teamwork and Collaboration: Legal and Ethical Principles: Elements of Liability for Nursing Malpractice box on page 58 in the textbook. A nurse has been asked to participate in an elective procedure that violates the nurse's personal ethical principles. What is the nurse's best action? § A.Refuse to participate. B.Ask to switch assignments with another nurse. C.Speak to the manager or supervisor. D.Perform the procedure. Answer C The nurse has a right to refuse to participate in any treatment or aspect of patient care that violates the nurse's personal ethical principles. However, this should be done without deserting the patient. The matter should be discussed with the manager or supervisor so that a change in assignment can be approved. In a 2006 IOM study, it was estimated that some form of medication error resulted in harm to how many patients? A.400,000 B.800,000 C.1 million D.1.5 million Answer D In a 2006 IOM study, it was estimated that some form of medication error resulted in harm to 1.5 million patients per year, including 400,000 in hospitals and up to 800,000 in long-term care settings. What is the most common point in the process at which medications errors occur? • A.Prescribing B.Dispensing C.Administering D.Monitoring Answer A Nearly 50% of preventable errors occur at the point of prescribing. The next most common error point is administration of medications. The nurse is administering a drug that has been ordered as follows: "Give 10 mg on odd numbered days and 5 mg on even-numbered days." When the date changes from May 31 to June 1, what should the nurse do? A.Give 10 mg because June 1 is an odd-numbered day. B.Hold the dose until the next odd-numbered day. C.Change the order to read: "Give 10 mg on even-numbered days and 5 mg on odd-numbered days." D.Consult the prescriber to verify that the dose should alternate each day, no matter whether the day is odd or even numbered. Answer D Although option C seems reasonable, the nurse does not have prescriptive authority to change the order. Therefore, the prescriber should be consulted to verify the order, which can be written in clearer terms. The other options would result in a change in the alternating dose schedule. The nursing student realizes that she has given a patient a double dose of an antihypertensive medication. The tablet was supposed to be cut in half, but the student forgot and administered the entire tablet. The patient's blood pressure just before the dose was 146/98 mm Hg. What should the student nurse do first? A.Notify the patient's physician. B.Notify the clinical faculty. C.Take the patient's blood pressure. D.Continue to monitor the patient. Answer B The patient's blood pressure will need to be monitored, but it was just taken, and the medication dose will not have an immediate effect. The student should notify the clinical instructor immediately. A 58-year-old man is taking OTC antacids for relief of indigestion. He tells the nurse that he consumes at least one bottle a week and has done so for more than 1 month because "it works for me." What is the nurse's primary concern? A.This self-treatment is expensive. B.This self-treatment may be delaying treatment of a more serious problem. C.This self-treatment may be the best treatment of his indigestion. D.The long-term use of antacids may make the indigestion worse. Answer B Normally, over-the-counter medications should be used only for short-term treatment of common minor illnesses. Their use may postpone effective management of chronic disease states and may delay treatment. The nurse associates use of which OTC medication with the development of hepatotoxicity? ● A.Acetylsalicylic acid (Aspirin) B.Ibuprofen (Motrin) C.Pseudoephedrine (Sudafed) D.Acetaminophen (Tylenol) Answer D Acetaminophen (Tylenol) is associated with the development of hepatotoxicity. A patient tells the nurse that he wants to stop taking his antilipemic drugs and start taking garlic to lower his cholesterol. What is the nurse's best reply? A."That decision is up to you." B."You have every right to switch to herbal remedies." C."You should not go against what the doctor has prescribed for you." D."Let's explore the evidence that supports the use of garlic to lower your cholesterol." Answer D The nurse can provide patient education regarding potential risks and adverse drug reactions that are possible with herbal products. A group of student nurses have been assigned to provide teaching at Senior Center on use of herbs and dietary products. A client informs tells the students, "I have high blood pressure and hardening of my arteries. My doctor gave me pills, but my daughter added herbs because they are natural and totally safe." The student nurses understand the use of herbal products in patients with cardiovascular disease has what significance? Herbal products can increase bleeding risk with warfarin, potentiate digoxin toxicity, increase the effects of antihypertensive agents, and cause heart block or dysrhythmias. A client tells the student nurse that she is seeing her HCP because she has been feeling, "Down in the dumps" and that she has been taking a serotonergic drug. The client tells the student nurse that she wants to start taking St. John's wort because her partner heard this herb will help her depression get better faster. The student nurse bases his response on the fact that using St. John's wort with serotonergic drugs has what effect? Use of St. John's wort with serotonergic drugs may lead to serotonin syndrome. Patients should inform their health care providers of all OTC medications as well as herbal and dietary supplements they are taking. A client tells the student nurse that she would like to start taking gingko. Before starting this herb, it is most important for the student nurse to ask the patient if she is taking which type of medication? Use of gingko may increase risk of bleeding in patients who are taking anticoagulants such as warfarin and heparin as well as antiplatelet drugs such as aspirin and clopidogrel. The nurse is caring for a patient who is suffering from chronic obstructive pulmonary disease. He coughs frequently and produces a thick white sputum. During auscultation, the stethoscope should be placed: A.Over the scapula to enhance adventitious lung sounds B.So that it is barely touching the skin to avoid auditory artifact C.Over the left lung fields first D.In one position long enough to hear an entire inhalation-exhalation set Correct Answer: D Rationale: Always avoid bones during auscultation. The diaphragm should be firmly pressed against the skin. When auscultating the lungs, the nurse should compare side to side. Sean is a 10-year-old male child who attends a local middle school. He has two siblings in his home. All of his immunizations are up to date. He has a history of eczema and chickenpox. His favorite activities are baseball and basketball. He loves to go to the movies with his best friend, Josh. His father smokes inside the home. Sean has recently had a hospitalization for asthma. Subjective data: Complains of increased shortness of breath, especially with exercise. Mother says he seems to be using the inhaler more. Mother admits to not having a lot of knowledge regarding inhaler usage. Objective data: Vital signs: T 98.0; P 61; R 17. Height: 4 ft 5 in. Weight 85 lb. Lungs: Clear on auscultation, no wheezing present. Heart: RRR, no murmurs present. Questions: A.What risk factors does Sean have for asthma? B.What measures might help to prevent asthma exacerbation? C.What should the nurse do in this clinical situation? Risk factors present for asthma are: 1.Living in a home with a relative who smokes. 2.Having a history of eczema. 3.Having a recent hospitalization for asthma. What measures might have helped prevent asthma? 1. Instruct parent on importance of child living in a smoke-free environment. 2.Instruct parent and child to learn what his "triggers" are. Triggers may include dust, pollen, or exercise. 3.Keep rescue inhalers close by at all times. Appropriate actions in this situation are: 1. Assess for patient and familial understanding of teaching. 2.Include his siblings in the proposed interventions and plan. 3.Assess for medicine compliance. §If a patient becomes hypotensive, which of the following will help maintain adequate glomerular pressure? A.Dilation of collecting tubule B.Dilation of efferent arteriole C.Constriction of ureters D.Constriction of efferent arteriole D Remember that the afferent arteriole brings blood to the glomerulus and the efferent arteriole takes blood away from the glomerulus. A patient is scheduled for cystometrography. Which instructions will the nurse provide to the patient about this procedure? a. The patient will urinate into a specialized toilet to measure the voiding pressure. b. Water will be instilled into the bladder through a catheter to assess bladder tone. c. The patient will urinate into a container to measure the time and volume of urine excretion. d. The bladder will be filled with contrast media, and fluoroscopic images will be taken during voiding. Answer: B Rationale: Cystometrography is an evaluation of bladder tone, sensations of filing, and bladder stability. Water or saline is instilled into the bladder through a urinary catheter. The nurse is caring for a patient who has just undergone a cystoscopy. Which assessment finding necessitates an immediate intervention by the nurse? a. Back pain b. Bright red urine c. Urinary frequency d. Burning on urination Answer: B Rationale: Bright red urine is not expected after a cystoscopy. Burning on urination, pink-tinged urine, and urinary frequency are expected effects. When percussing the kidneys for tenderness, the nurse should: § A.Start tapping at the level of T1. B.Tap in the costal angle. C.Use the direct or indirect method of percussion. D.Know whether the patient has a history of cholelithiasis. Correct Answer: C Rationale: The costovertebral angle is at the level of the 12th rib, not at T1 (which is the base of the neck). The costal angle is over the stomach anteriorly. Cholelithiasis is not related. oKarthic, a 24 y.o. man, c/o a loss of appetite and occasional lower sternal chest pain shortly after each meal. He reports his symptoms began about 7 months ago. He is 180 cm (5' 11") and weighs 86 kg (190 pounds). He states he smokes ½ PPD. oBesides chest pain after meals, Karthic says he has heartburn multiple times a week and occasionally brings up a bitter liquid into his mouth. oKarthic also has a Hx of asthma. He reports needing his inhaler "more than usual." •What questions would you ask him to explore causative factors? •History of hiatal hernia, swallowing difficulties •Diet history: look for caffeine, alcohol, chocolate ingestion •What medications is he taking? •Does he smoke? •What are his height and weight? •Explore his clinical symptoms further: •Are there certain foods or fluids that cause the heartburn? •What does he do to relieve it? •How does his asthma relate to his GI symptoms? •Pressure changes in chest and ABD aggrevate GERD oKarthic was scheduled for an endoscopy to evaluate his symptoms. oThe results indicate he has acute esophagitis as well as Barrett's esophagus. He is being discharged today.He expresses concern about what lifestyle changes may be necessary to prevent recurrences or complications •What are potential complications related to these findings: •Dysphagia •Esophageal cancer •Perforation of the esophagus After the nurse teaches a patient with gastroesophageal reflux disease (GERD) about recommended dietary modifications, which statement by the patient indicates that the teaching has been effective? a."I can have a glass of low-fat milk at bedtime." b."I will have to eliminate all spicy foods from my diet." c."I will have to use herbal teas instead of caffeinated drinks." d."I should keep something in my stomach all the time to neutralize the excess acids." Answer C Patients with gastroesophageal reflux disease should avoid foods (such as tea and coffee) that decrease lower esophageal pressure. Patients should also avoid milk, especially at bedtime, as it increases gastric acid secretion. Patients may eat spicy foods, unless these foods cause reflux. Small, frequent meals help prevent overdistention of the stomach, but patients should avoid late evening meals and nocturnal snacking. Andy is a 30 y.o. man admitted to the hospital with general fatigue, lack of appetite, headaches, and jaundice. He reports his symptoms became progressive during the past few days. One month ago, he was in Mexico, where he ate a lot of seafood and local food. He confides in you that he had sex with a prostitute while in Mexico. The HCP suspects Andy may have acute hepatitis. For what other manifestations would you assess? Nausea/vomiting, RUQ tenderness, Reduced sense of taste and smell Also: urine color, peri area itching/discharge, protection used, jaundice present, amount of weight loss Andy's physical assessment reveals hepatomegaly and splenomegaly. His urine is also dark-colored (icteric) What diagnostic tests would you expect the health care provider to order? Laboratory results show ◦Hemoglobin 12 g/dL ◦Bilirubin (direct) 5.6 mg/dL ◦Bilirubin (indirect) 3.4 mg/dL ◦Alkaline phosphatase 600 U/mL ◦AST 1200 U/mL ◦ALT 1510 U/mL ◦Urine positive for bilirubin Additional laboratory results show ◦Anti-HAV IgM positive ◦Anti-HAV IgG negative ◦HBsAg negative ◦Anti-HBs negative ◦Anti-HCV negative ◦Anti-HDV negative What type of hepatitis does Andy have? How did he get infected? What interventions would you expect the health care provider to order? 1.He receives a diagnosis of hepatitis A. 2.It was probably contracted through contaminated food in Mexico because of poor hygiene, improper food handling, crowded situations, and poor sanitary conditions. 3.Interventions: no specific treatment- rest, manage nausea, avoid ETOH/certain meds Dana is a 36 y.o. woman admitted from the ED with a Dx of hepatic encephalopathy. Review of medical records indicate a diagnosis of fatty liver disease at age 28 and cirrhosis at age 32. She accepts treatment only during crises. What else would you look for in Dana's past medical history that might be a precipitating factor in her liver disease? For what late clinical manifestations of cirrhosis would you assess? •Past medical records: Diet type, ETOH consumption, S/S heart failure SOB, fatigue, weakness, edema, arrhythmia, tachycardia, persistent cough, pink tinged sputum, previous ABD girth measurement, jaundice •Late clinical manifestations: Jaundice, peripheral edema, ascites, skin lesions, hematologic problems , endocrine problems , and peripheral neuropathies, liver becomes smaller, nodular hematemesis vomiting blood •Bright red •coffee-ground—contact with HCl acid; digested blood melena Black tarry stool from upper GI source A plaster splint is applied with an elastic bandage to the leg of a patient with a fractured tibia in preparation for open reduction and internal fixation (ORIF). The patient complains of increasing pain in the affected leg and foot that is not relieved by loosening of the elastic bandage. The most appropriate action by the nurse is to te the leg on two pillows. ice over the fracture site. y the health care provider. rm neurovascular assessment of the foot. Answer: D Rationale: Prompt, accurate diagnosis of compartment syndrome is critical. Prevention or early recognition is the key. Regular neurovascular assessments should be performed and documented on all patients with fractures, but especially those with injury of the distal humerus or proximal tibia or soft tissue disruption in these areas. Early recognition and treatment of compartment syndrome is essential to avoid permanent damage to muscles and nerves. One or more of the following six Ps are characteristic of compartment syndrome: (1) paresthesia (numbness and tingling); (2) pain distal to the injury that is not relieved by opioid analgesics and pain on passive stretch of muscle, traveling through the compartment; (3) pressure increases in the compartment; (4) pallor, coolness, and loss of normal color of the extremity; (5) paralysis or loss of function; and (6) pulselessness or diminished/absent peripheral pulses. Carefully assess the location, quality, and intensity of the pain (see Chapter 10). Evaluate the patient's level of pain on a scale of 0 to 10. Pain unrelieved by drugs and out of proportion to the level of injury is one of the first indications of impending compartment syndrome. Pulselessness and paralysis (in particular) are later signs of compartment syndrome. After completion of the neurovascular assessment, the nurse should notify the health care provider immediately of a patient's changing condition. A patient has a severely sprained ankle from a sports injury. What should the nurse teach the patient prior to discharge from the urgent care center? a.Alternate cold and heat for 30 minutes each until symptoms are relieved. b.Apply cold for 20 to 30 minutes with breaks of 10 to 15 minutes during the first 2 days. c.Use continuous cold for the first 24 hours and then continuous heat until the symptoms are relieved. d.Apply continuous heat to the ankle for the first 24 hours and then continuous cold until the symptoms are relieved. Answer: B Rationale: If an injury occurs, immediate care focuses on (1) stopping the activity and limiting movement, (2) applying ice compresses to the injured area, (3) compressing the involved extremity, (4) elevating the extremity, and (5) providing analgesia as necessary. These interventions will decrease local inflammation and pain for most musculoskeletal injuries. Cold (cryotherapy) in several forms can be used to produce hypothermia to the involved part. Physiologic changes that occur in soft tissue as a result of the use of cold include vasoconstriction and reduction in the transmission and perception of nerve pain impulses. These changes result in analgesia and anesthesia, reduction of muscle spasm without changes in muscular strength or endurance, reduction of local edema and inflammation, and reduction of local metabolic requirements. Cold is most useful when applied immediately after the injury has occurred. Ice applications should not exceed 20 to 30 minutes per application, and ice should not be applied directly to the skin. After the acute phase (usually 24 to 48 hours), warm, moist heat may be applied to the affected part to reduce swelling and provide comfort. Heat applications should not exceed 20 to 30 minutes, allowing a "cool-down" time between applications. Alendronate (Fosamax) is prescribed for a patient with osteoporosis. The nurse teaches the patient that drug must be taken with food to prevent GI side effects. osphonates prevent calcium from being taken from the bones. down after taking the drug prevents light-headedness and dizziness. g the drug with milk enhances the absorption of calcium from the bowel. Answer: B Rationale: Alendronate is a bisphosphonate that prevents calcium from being taken from the bones by inhibiting osteoclast-mediated bone resorption. Bisphosphonates should be taken with a full glass of water, 30 minutes before food or other medications, and the patient should remain upright for at least 30 minutes after administration. These precautions aid in drug absorption and decrease gastrointestinal side effects (especially esophageal irritation). Which patient would be at greatest risk for developing osteoporosis? a.A 73-year-old man who has five alcoholic drinks per week and limits sun exposure to prevent recurrence of skin cancer. b.An 84-year-old man who has recently been diagnosed with hypothyroidism and is prescribed levothyroxine (Synthroid). c.A 69-year-old woman who had a renal transplant 5 years ago and has been taking prednisone to prevent organ rejection. d.A 55-year-old woman who recently had a hysterectomy with bilateral salpingo-oophorectomy and refuses estrogen therapy. Answer: C Rationale: Risk factors for osteoporosis include advanced age (65 years), female gender, low body weight, white or Asian ethnicity, current cigarette smoking, nontraumatic fracture, inactive lifestyle, family history of osteoporosis, diet low in calcium or vitamin D deficiency, excessive use of alcohol (2 drinks per day), postmenopausal, including premature or surgical menopause, and long-term use of corticosteroids, thyroid replacements, heparin, long-acting sedatives, or antiseizure medications. Long-term corticosteroid (such as prednisone) use is a major contributor to osteoporosis. The other patients have risk factors for osteoporosis, but the 69-year-old female is at highest risk. When caring for a patient following a lumbar laminectomy, the nurse should a pillow between the patient's legs before turning to the side. te the head of the bed 30 degrees and then turn the patient to the side. the patient to flex the knees and push the heels into the bed during turning. the patient grasp the side rail on the opposite side of the bed to help with turning. Answer: A Rationale: Place pillows between the legs before turning the patient and when in the side-lying position to provide comfort and ensure alignment. Twisting movements are not allowed. Also, the patient's spine will need to be kept in alignment without flexion of the hips by elevating the head of the bed.