NCLEX-RN Practice Quiz Test Bank #10 (75 Questions)

NCLEX-RN Practice Quiz Test Bank #10 (75 Questions) 1. 1. Question The nurse should visit which of the following clients first? o A. The client with diabetes with a blood glucose of 95mg/dL o B. The client with hypertension being maintained on Lisinopril o C. The client with chest pain and a history of angina o D. The client with Raynaud’s disease Incorrect Correct Answer: C. The client with chest pain and a history of angina The client with chest pain should be seen first because this could indicate a myocardial infarction. Despite many advances in treatment, acute MI still carries a mortality rate of 5-30%; the majority of deaths occur prior to arrival to the hospital. In addition, within the first year after an MI, there is an additional mortality rate of 5% to 12%. The overall prognosis depends on the extent of heart muscle damage and ejection fraction. • Option A: The client in answer A has blood glucose within normal limits. The diagnosis of T1DM is usually through a characteristic history supported by elevated serum glucose levels (fasting glucose greater than 126 mg/dL, random glucose over 200 mg/dL, or hemoglobin A1C (HbA1c exceeding 6.5%) with or without antibodies to glutamic acid decarboxylase (GAD) and insulin. • Option B: The client in this option is maintained on blood pressure medication. Pharmacological therapy consists of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), diuretics (usually thiazides), calcium channel blockers (CCBs), and beta-blockers (BBs), which are instituted taking into account age, race, and comorbidities such as presence of renal dysfunction, LV dysfunction, heart failure, and cerebrovascular disease. JNC-8, ACC, and ESC/ ESH have their separate recommendations for pharmacological management. • Option D: The client in answer D is in no distress. In Raynaud phenomenon, blood-flow restriction occurs during cold temperatures and emotional stress. Specifically, in Raynaud phenomenon, there is vasoconstriction of the digital arteries and cutaneous arterioles. 2. 2. Question A client with cystic fibrosis is taking pancreatic enzymes. The nurse should administer this medication: • A. Once per day in the morning • B. Three times per day with meals • C. Once per day at bedtime • D. Four times per day Incorrect Correct Answer: B. Three times per day with meals Pancreatic enzymes should be given with meals for optimal effects. These enzymes assist the body in digesting needed nutrients. Chronic, supportive therapy for patients with CF includes regular pancreatic enzymes, fat-soluble vitamins (A, D, E, K), mucolytics, bronchodilators, antibiotics, and anti-inflammatory agents. • Option A: A new class of medications known as CFTR modulator therapies is designed to correct the dysfunction by improving production, intracellular processing, or function of the CFTR protein caused by the mutated gene. Each medication is targeted at a specific dysfunction caused by a specific gene mutation. • Option C: Individuals with CF are encouraged to consume a high-fat diet with supplemental fat-soluble vitamins to compensate for malabsorption. Additionally, patients living with CF are encouraged to consume a high-calorie diet to maintain a healthy weight and combat chronic inflammation and frequent infections that are commonly encountered. • Option D: According to the Cystic Fibrosis Foundation, women should consume 2500 to 3000 calories a day, while men should consume 3000 to 3700 calories a day. Those living in hot climates or who participate in activities that cause sweating are encouraged to consume additional sodium in their diet. 3. 3. Question Cataracts result in the opacity of the crystalline lens. Which of the following best explains the functions of the lens? • A. The lens controls stimulation of the retina. • B. The lens orchestrates eye movement. • C. The lens focuses light rays on the retina. • D. The lens magnifies small objects. Incorrect Correct Answer: C. The lens focuses light rays on the retina. The lens allows light to pass through the pupil and focus light on the retina. The lens is a curved structure in the eye that bends light and focuses it for the retina to help you see images clearly. The crystalline lens, a clear disk behind the iris, is flexible and changes shape to help you see objects at varying distances. • Option A: Retinal tissue is stimulated by light but also responds to mechanical disturbances. Flashing lights usually are caused by separation of the posterior vitreous. As the vitreous gel separates from the retina, it stimulates the retinal tissue mechanically, resulting in the release of phosphenes and the sensation of light. • Option B: Because only a small portion of the retina, the fovea, is actually employed for distinct vision, it is vitally important that the motor apparatus governing the direction of gaze be extremely precise in its operation, and rapid. • Option D: The lens works much like a camera lens, bending and focusing light to produce a clear image. The crystalline lens is a convex lens that creates an inverted image focused on the retina. The brain flips the image back to normal to create what you see around you. In a process called accommodation, the elasticity of the crystalline lens allows you to focus on images at far distances and near with minimal disruption. 4. 4. Question A client who has glaucoma is to have miotic eye drops instilled in both eyes. The nurse knows that the purpose of the medication is to: • A. Anesthetize the cornea • B. Dilate the pupils • C. Constrict the pupils • D. Paralyze the muscles of accommodation Incorrect Correct Answer: C. Constrict the pupils Miotic eye drops constrict the pupil and allow aqueous humor to drain out of the Canal of Schlemm. Pilocarpine is a muscarinic acetylcholine agonist that is effective in the treatment and management of acute angle-closure glaucoma and radiation-induced xerostomia. Although not a first-line treatment for glaucoma, it is useful as an adjunct medication in the form of ophthalmic drops. • Option A: The cornea and conjunctiva can be anesthetized by drops of any of the local anesthetics. Bupivacaine, for example, is effective as an eyedrop. Bupivacaine is a potent local anesthetic with unique characteristics from the amide group of local anesthetics, first discovered in 1957. Local anesthetics are used in regional anesthesia, epidural anesthesia, spinal anesthesia, and local infiltration. Local anesthetics generally block the generation of an action potential in nerve cells by increasing the threshold for electrical excitation. • Option B: The eye doctor may dilate the pupils with a special medication called a mydriatic, so they can see the inside of the eye during a slit lamp test. Typically, mydriasis reverses within 4 to 8 hours. However, it may take 24 hours for the mydriatic effect to wear off in some individuals. Weaker strength may cause mydriasis with little cycloplegia. • Option D: Scopolamine ophthalmic is an anticholinergic agent that blocks constriction of sphincter muscle of iris and ciliary body muscle, which, in turn, results in mydriasis (dilation) and cycloplegia (paralysis of accommodation). Scopolamine competitively inhibits G-protein coupled post-ganglionic muscarinic receptors for acetylcholine and acts as a nonselective muscarinic antagonist, producing both peripheral antimuscarinic properties and central sedative, antiemetic, and amnestic effects. 5. 5. Question A client with a severe corneal ulcer has an order for Gentamicin gtt. q 4 hours and Neomycin 1 gtt q 4 hours. Which of the following schedules should be used when administering the drops? • A. Allow 5 minutes between the two medications. • B. The medications may be used together. • C. The medications should be separated by a cycloplegic drug. • D. The medications should not be used in the same client. Incorrect Correct Answer: A. Allow 5 minutes between the two medications. When using eye drops, allow 5 minutes between the two medications. Antibiotic eye drops are prescribed by a doctor to treat bacterial eye infections. They work by killing the bacteria (microscopic organism) that entered the eye and caused the infection. • Option B: Allow 5 minutes interval before administering the next eyedrops. Take the full course, don’t stop early/without consulting your doctor, even if things seem better. Antibiotic eye drops usually help symptoms get better after three days. Call your doctor if your symptoms don’t go away. • Option C: It is not necessary to use a cycloplegic with these medications. Eye infections cause redness, tearing and drainage (yellow-green pus or watery), and can be highly contagious. A certain type of eye infection—a bacterial eye infection—may need treatment with a medicine called an antibiotic eye drop. • Option D: These medications can be used by the same client. Don’t use anyone else’s prescription. Don’t keep unused prescriptions around to use later. Ask your ophthalmologist or pharmacist if it’s OK to keep the drops in the refrigerator. When the drops are cold it might be easier to feel the drop when it hits the eye, so you can tell where it has landed. 6. 6. Question The client with color blindness will most likely have problems distinguishing which of the following colors? • A. Orange • B. Violet • C. Red • D. White Incorrect Correct Answer: B. Violet Clients with color blindness will most likely have problems distinguishing violets, blues, and green. The most common forms are protanopia and deuteranopia, conditions arising from loss of function of one of the cones, leading to dichromic vision. Protanopia is the loss of L cones (red) resulting in green-blue vision only. Deuteranopia is the loss of M cones (green) resulting in red-blue vision only. • Option A: Color vision results from the combination of signals from three visual pigment types within cones: that of red, green, and blue, which correspond to cone types L, M, and S (RGB-LMS). Those colors correspond to the wavelengths of peak light absorption intensities of the modified chromophores. L cones have peak absorptions at 555 nm to 565 nm, M cones at 530 nm to 537 nm, and S cones at 415 nm to 430 nm. • Option C: Similar to above, but not as severe in its symptoms, is the condition anomalous trichromatic vision (tritanomaly), where all three cones are present but the color vision is aberrant. The two common forms, protanomaly, and deuteranomaly result in L or M cones, respectively, being replaced with a cone of intermediate spectral tuning. Both are X-linked and occur in 7% of males. • Option D: In addition to disorders of proper color recognition, many diseases in vision display phototransduction defects affecting many portions of the signal pathway and its regulation. Here, not only is color vision function lessened but scotopic (low-light, rod-associated) vision as well. 7. 7. Question The client with a pacemaker should be taught to: • A. Report ankle edema • B. Check his blood pressure daily • C. Refrain from using a microwave oven • D. Monitor his pulse rate Incorrect Correct Answer: D. Monitor his pulse rate The client with a pacemaker should be taught to count and record his pulse rate. Pacemakers are adjustable artificial electrical pulse generators, frequently emitting a pulse with a duration between 0.5 and 25 milliseconds with an output of 0.1 to 15 volts, at a frequency up to 300 times per minute. The cardiologist or pacemaker technologist will be able to interrogate and control the pacing rate, the pulse width, and the voltage, whether the device is temporary or permanent. • Option A: Ankle edema is a sign of right-sided congestive heart failure. Although this is not normal, it is often present in clients with heart disease. If the edema is present in the hands and face, it should be reported. The pacing and CRT are associated with complications. The majority of complications occur in the hospital or during the first 6 months. Lead complications are the main reason for the re-implantation of the pacemaker and CRT devices. Other complications include, but are not limited to infections, hematoma formation, pericardial effusion or tamponade, pneumothorax, coronary sinus dissection, or perforation. Some old pacemakers are not MRI safe. • Option B: Checking the blood pressure daily is not necessary for these clients. Patients who eventually require permanent pacemaker implantation often present with symptoms of dizziness, lightheadedness, fatigue, syncope, or lack of exercise tolerance. Frequently, these symptoms arise from bradyarrhythmias and patients will have sinus node dysfunction or atrioventricular (AV) conduction defects. • Option C: The client with a pacemaker can use a microwave oven, but he should stand about 5 feet from the oven while it is operating. There are some areas where the indications for a pacemaker are clear, but there are few areas where clinical judgment and expertise plays a greater role. Although the guidelines attempt to define practices that meet the needs of most patients, the ultimate decision for the patient should be based on the particular patient presenting the scenario, clinician judgment, and discussion with the patient about risks and benefits of the procedure. 8. 8. Question The client with enuresis is being taught regarding bladder retraining. The nurse should advise the client to refrain from drinking after: • A. 1900 • B. 1200 • C. 1000 • D. 0700 Incorrect Correct Answer: A. 1900 Clients who are being retrained for bladder control should be taught to withhold fluids after about 7 p.m., or 1900. If you go to the toilet too frequently “just in case,” you might end up making the overactive bladder symptoms worse, because the bladder is then “trained” to send a signal that you need to urinate as soon as there is only a small amount of urine in it. • Option B: It is important to go to the toilet at regular intervals so that your bladder gets used to a certain frequency. A voiding (bathroom visit) schedule can be helpful here. Bladder training programs often recommend that, once you have emptied your bladder first thing in the morning and perhaps again after breakfast, you try to keep the intervals between bathroom visits as regular as possible. • Option C: Even if you have a very strong urge to go to the bathroom, it usually only lasts a few minutes and then dies down again. You can practice not emptying your bladder as soon as you feel the need to go. Going to the bathroom calmly and at a slow pace rather than rushing to get there can help too. • Option D: You can try to wait longer between trips to the bathroom, but do so at a slow pace and without any stress. A voiding schedule can be helpful here too. You can use it to remember, for example, that you want to try to wait 5 minutes before emptying your bladder in the first few days, and then keep this up for about half a week. You can then lengthen that “waiting period” to 10, 15 and finally 20 minutes. 9. 9. Question Which of the following diet instructions should be given to the client with recurring urinary tract infections? • A. Increase intake of meats. • B. Avoid citrus fruits. • C. Perform peri care with hydrogen peroxide. • D. Drink a glass of cranberry juice every day. Incorrect Correct Answer: D. Drink a glass of cranberry juice every day. Cranberry juice is more alkaline and, when metabolized by the body, is excreted with acidic urine. Bacteria do not grow freely in acidic urine. A 2003 study that included 324 women found that frequently drinking freshly squeezed, 100% juice — especially berry juice, as well as consuming fermented dairy products like yogurt, was associated with a decreased risk of UTI occurrence • Option A: Increasing intake of meats is not associated with urinary tract infections, so answer A is incorrect. Red meat and other animal proteins have high potential renal acid loads (PRALs), meaning that they make urine more acidic. Conversely, fruits and vegetables have low PRALs, making urine less acidic. • Option B: The client does not have to avoid citrus fruits. The aforementioned study in 4,145 men and women showed that citrus juice intake was associated with a 50% reduction in lower urinary tract symptoms in men only • Option C: Peri care should be done, but hydrogen peroxide is drying. Other factors claimed to increase the chances of developing a UTI include wearing tight underwear, hot tub use, not urinating after sex, and douching, although strong evidence to support these claims is lacking. 10. 10. Question The physician has prescribed NPH insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs? • A. "I will make sure I eat breakfast within 2 hours of taking my insulin." • B. "I will need to carry candy or some form of sugar with me all the time." • C. "I will eat a snack around three o'clock each afternoon." • D. "I can save my dessert from supper for a bedtime snack." Incorrect Correct Answer: C. “I will eat a snack around three o’clock each afternoon.” NPH insulin peaks in 8–12 hours, so a snack should be offered at that time. It is on the list of essential medicines of the world health organization (WHO).NPH insulin is FDA-approved in the adult and pediatric population for the control of type 1 and type 2 diabetes mellitus. It is currently the most widely used basal insulin that simulates the physiological basal insulin action. Basal insulin provides a constant supply of insulin in the body that is necessary for glucose regulation despite fasting, such as between meals and overnight. • Option A: NPH insulin onsets in 90–120 minutes, so answer A is incorrect. American Diabetes Association guidelines recommend NPH insulin dose of 0.4 to 1.0 units/kg/day subcutaneously for the management of type 1 diabetes mellitus. A higher dose is necessary during medical illness and puberty. A dose of 0.1 to 0.2 units/kg/day subcutaneously is recommended in type 2 diabetes mellitus depending on body weight and the patient’s hyperglycemia. • Option B: NPH insulin is time-released and does not usually cause sudden hypoglycemia. NPH insulin is an isophane suspension of human insulin and categorized as an intermediate-acting insulin. It helps increase the cellular intake of glucose in the liver, adipose tissue, and skeletal muscles. It acts as basal insulin and stimulates the liver to promote hepatic glycogen synthesis, fatty acid metabolism for lipoprotein synthesis. • Option D: The client should eat a bedtime snack. NPH cannot classify as ideal basal insulin. It shows much variability in its absorption and action after subcutaneous injection. This situation leads to fluctuations in blood glucose control and causes hypoglycemic episodes. For this reason, it requires meticulous monitoring, including fasting blood glucose, and changes in HbA1c values. 11. 11. Question The nurse is caring for a 30-year-old male admitted with a stab wound. While in the emergency room, a chest tube is inserted. Which of the following explains the primary rationale for insertion of chest tubes? • A. The tube will allow for equalization of the lung expansion. • B. Chest tubes serve as a method of draining blood and serous fluid and assist in re inflating the lungs. • C. Chest tubes relieve pain associated with a collapsed lung. • D. Chest tubes assist with cardiac function by stabilizing lung expansion. Incorrect Correct Answer: B. Chest tubes serve as a method of draining blood and serous fluid and assist in re inflating the lungs. Chest tubes work to reinflate the lung and drain serous fluid. Physicians use a chest tube to create negative pressure in the chest cavity and allow re-expansion of the lung. It helps remove air (pneumothorax), blood (hemothorax), fluid (pleural effusion or hydrothorax), chyle (chylothorax), or purulence (empyema) from the intrathoracic space. • Option A: The tube does not equalize the expansion of the lungs. There are other uses for a thoracostomy tube that are not as common and rarely indicated. Typically for a tension pneumothorax needle decompression occurs first and chest tube placement quickly follows after the patient stabilizes from decompression. • Option C: Pain is associated with the collapse of the lung, and insertion of chest tubes is painful. A chest tube, also known as a thoracostomy tube, is a flexible tube that can be inserted through the chest wall between the ribs into the pleural space. • Option D: This is not the primary rationale for performing chest tube insertion. Thoracostomy tubes are commonly made from PVC or silicone. They range from 6 French to 40 French. The majority are fenestrated along the sides of the insertion end, and the tubes have a radiopaque stripe. After placement, the distal end of the tube is connected to a pleur-evac system. There are three chambers of a pleur-evac: suction chamber, water seal chamber, and the collection chamber. The water seal chamber acts as a one-way valve allowing air to escape from gravity, but not to re-enter the thoracic cavity. 12. 12. Question A client who delivered this morning tells the nurse that she plans to breastfeed her baby. The nurse is aware that successful breastfeeding is most dependent on the: • A. Mother’s educational level • B. Infant’s birth weight • C. Size of the mother’s breast • D. Mother’s desire to breastfeed Incorrect Correct Answer: D. Mother’s desire to breastfeed Success with breastfeeding depends on many factors, but the most dependable reason for success is desire and willingness to continue breastfeeding until the infant and mother have time to adapt. Breastfeeding is an important part of a newborn’s life. Breastfeeding or lactation provides total nutritional and emotional dependency of the baby on the mother. The strong emotional bonding between the mother-child dyad is needed for successfully prolong breastfeeding. • Option A: Baby and maternal factors can influence this bonding. Skin-to-skin contact in the first 2 hours after birth is essential for successful initiation of lactation. The breast crawl, soon after birth, while the baby is alert will initiate the bonding, and it will be an assurance by giving comfort and calm to the mother. The breast crawl is when the baby is placed on the mother’s abdomen after birth; the baby finds its way to the breast to suckle. • Option B: Successful breastfeeding factors related to the baby include proper latching, alertness of the baby, rooting reflex, and active sucking reflex. Although lactation is a natural process, the mother needs support and education for proper positioning and latching. The ability of the baby to empty the breast will determine the subsequent milk volume. • Option C: Maternal factors like pain, anxiety, emotional instability, among others should be addressed before and after delivery. Lactation consultants or knowledgeable nurses can also be helpful with initiating of breastfeeding. 13. 13. Question The nurse is monitoring the progress of a client in labor. Which finding should be reported to the physician immediately? • A. The presence of scant bloody discharge • B. Frequent urination • C. The presence of green-tinged amniotic fluid • D. Moderate uterine contractions Incorrect Correct Answer: C. The presence of green-tinged amniotic fluid Green-tinged amniotic fluid is indicative of meconium staining. This finding indicates fetal distress. Amniotic fluid should be clear, or straw tinged with small vernix particles in the fluid. Brown or green staining of the fluid indicates the passage of meconium. Because the fetus swallows amniotic fluid in utero, meconium can be present in the infant’s oropharynx at delivery. During delivery, if meconium-stained amniotic fluid is noted, a neonatal resuscitation team should be promptly involved • Option A: In the third trimester, bleeding is concerning for placental abruption, placenta previa, or labor. Each of these pathologies has its entry discussing its presentation and pathophysiology. Although bleeding in pregnancy is not considered “normal,” it is common, affecting about one in three pregnancies. • Option B: An increased urge to urinate can be a result of the baby’s head dropping into the pelvis. The low position of the baby’s head puts even more pressure on the urinary bladder, so many women approaching labor might feel a frequent need to urinate. • Option D: Although precisely determining when labor starts may be inexact, labor is generally defined as beginning when contractions become strong and regularly spaced at approximately 3 to 5 minutes apart. Throughout pregnancy, women may experience painful contractions that do not lead to cervical dilation or effacement, referred to as false labor. 14. 14. Question The nurse is measuring the duration of the client’s contractions. Which statement is true regarding the measurement of the duration of contractions? • A. Duration is measured by timing from the beginning of one contraction to the beginning of the next contraction. • B. Duration is measured by timing from the end of one contraction to the beginning of the next contraction. • C. Duration is measured by timing from the beginning of one contraction to the end of the same contraction. • D. Duration is measured by timing from the peak of one contraction to the end of the same contraction. Incorrect Correct Answer: C. Duration is measured by timing from the beginning of one contraction to the end of the same contraction. Duration is measured from the beginning of one contraction to the end of the same contraction. Duration is timed from when you first feel a contraction until it is over. This time is usually measured in seconds. • Option A: This refers to frequency. Frequency is timed from the start of one contraction to the start of the next. It includes the contraction as well as the rest period until the next contraction begins. Option B: We do not measure from the end of one contraction to the beginning of the next contraction. Contractions are considered regular when the duration and frequency are stable over a period of time. An example is contractions lasting 60 seconds and coming five minutes apart for an hour. • Option D: Duration is not measured from the peak of the contraction to the end, as stated in D. Contractions that are lasting longer and getting closer together are considered to be progressing. Over the course of labor, contractions get longer, stronger, and closer together. 15. 15. Question The physician has ordered an intravenous infusion of Pitocin for the induction of labor. When caring for the obstetric client receiving intravenous Pitocin, the nurse should monitor for: • A. Maternal hypoglycemia • B. Fetal bradycardia • C. Maternal hyperreflexia • D. Fetal movement Incorrect Correct Answer: B. Fetal bradycardia The client receiving Pitocin should be monitored for decelerations. It is essential to monitor patient fluids (both intake and outtake) while administering oxytocin, as well as the frequency of uterine contractions, patient blood pressure, and heart rate of the unborn fetus. • Option A: Oxytocin is primarily used by the obstetrician and the labor and delivery nurses. Healthcare workers who do prescribe this hormone should be familiar with its side effects. An inappropriate dosage of oxytocin can lead to dangerous tachycardia, arrhythmias, and myocardial ischemia. High dosages of oxytocin can cause uterine rupture, hypertonicity, and spasms. • Option C: If oxytocin is given in doses too large or even slowly during 24 hours, the medication can exhibit an antidiuretic effect resulting in extreme water intoxication. This excessive dosing can result in coma, seizures, and even death in the mother. • Option D: When oxytocin is given to women who are in the first or second stages of labor, or to women to cause induction of labor, uterine rupture, as well as maternal subarachnoid hemorrhages, maternal death, and even fetal death, can result. 16. 16. Question A client with diabetes visits the prenatal clinic at 28 weeks gestation. Which statement is true regarding insulin needs during pregnancy? • A. Insulin requirements moderate as the pregnancy progresses. • B. A decreased need for insulin occurs during the second trimester. • C. Elevations in human chorionic gonadotropin decrease the need for insulin. • D. Fetal development depends on adequate insulin regulation. Incorrect Correct Answer: D. Fetal development depends on adequate insulin regulation. Fetal development depends on adequate nutrition and insulin regulation. Significant alterations in maternal metabolism during pregnancy ensure a continuous supply of nutrients to the fetus. Glucose is the primary energy source for the fetus. In early pregnancy, increases in maternal insulin sensitivity enable the storage of energy and nutrients. • Option A: Insulin requirements do not moderate as the pregnancy progresses. To counteract insulin resistance and achieve adequate metabolic control in late pregnancy, the dose of insulin may need to be increased. Understanding insulin requirements in pregnant women with type 1 diabetes would help them to maintain tight glycemic control. • Option B: Insulin needs to increase during the second and third trimesters. In late pregnancy, maternal insulin resistance develops due to increases in pregnancy-related hormones, such as progesterone, human placental lactogen and prolactin, as well as inflammatory cytokines, such as tumor necrosis factor-?. These changes facilitate the supply of glucose toward the fetus. • Option C: Elevated human chorionic gonadotropin elevates insulin needs, not decreases them. Insulin dose prior to pregnancy was associated with pre-pregnancy body weight, BMI, and HbA1c levels before pregnancy and in the first trimester. Insulin dose prior to pregnancy was higher in patients with male infants than patients with female infants. 17. 17. Question A client in the prenatal clinic is assessed to have a blood pressure of 180/96. The nurse should give priority to: • A. Providing a calm environment • B. Obtaining a diet history • C. Administering an analgesic • D. Assessing fetal heart tones Incorrect Correct Answer: A. Providing a calm environment A calm environment is needed to prevent seizure activity. Any stimulation can precipitate seizures. Establish measures to lessen likelihood of seizures; i.e., keep the room quiet and dimly lit, limit visitors, plan and coordinate care, and promote rest. Lessens environmental factors that may stimulate irritable cerebrum and cause a convulsive state. • Option B: Obtaining a diet history should be done later. Determine patient’s nutritional status, condition of hair and nails, and height and pregravid weight. Establishes guidelines for determining dietary needs and educating the patient. Malnutrition may be a contributing factor to the onset of PIH, specifically when the client follows a low-protein diet, has insufficient caloric intake, and is overweight or underweight by 20% or more before conception. • Option C: Administering an analgesic is not indicated because there is no data in the stem to indicate pain. MgSO4 a CNS depressant, decreases acetylcholine release, blocks neuromuscular transmission, and prevents seizures. It has a transient effect of lowering BP and increasing urine output by altering vascular response to pressor substances. Although IV administration of MgSO4 is easier to regulate and reduces the risk of a toxic reaction, some facilities may still use the IM route if continuous surveillance is not possible and/or if appropriate infusion apparatus is not available. • Option D: Assessing the fetal heart tones is important, but this is not the highest priority in this situation as stated in answer D. Assess for signs of impending eclampsia: hyperactivity of deep tendon reflexes (3+ to 4+), ankle clonus, decreased pulse and respirations, epigastric pain, and oliguria (less than 50 ml/hr). 18. 18. Question A primigravida, age 42, is 6 weeks pregnant. Based on the client’s age, her infant is at risk for: • A. Down syndrome • B. Respiratory distress syndrome • C. Turner’s syndrome • D. Pathological jaundice Incorrect Correct Answer: A. Down syndrome The client who is age 42 is at risk for fetal anomalies such as Down syndrome and other chromosomal aberrations. The risk of chromosome abnormalities is higher. Babies born to older mothers have a higher risk of certain chromosome problems, such as Down syndrome. • Option B: Risk factors for respiratory distress syndrome include prematurity, maternal diabetes, cesarean delivery, and asphyxia. The mother will more likely have a low birth weight baby and a premature birth. Premature babies, especially those born earliest, often have complicated medical problems. • Option C: Turner’s syndrome is a genetic disorder. Turner syndrome results from a deletion or the non-functioning of one X chromosome in females. About half of the population with Turner syndrome have monosomy X (45,XO). The other 50% of the population has a mosaic chromosomal component (45,X with mosaicism). Option D: Premature infants are at most risk for pathological jaundice because they develop higher levels of bilirubin. The risk of pregnancy loss — by miscarriage and stillbirth — increases as you get older, perhaps due to pre-existing medical conditions or fetal chromosomal abnormalities. Research suggests that the decrease in the quality of your eggs, combined with an increased risk of chronic medical conditions such as high blood pressure and diabetes, could increase your risk of miscarriage. Ask your health care provider about monitoring your baby’s well-being during the last weeks of pregnancy. 19. 19. Question A client with a missed abortion at 29 weeks gestation is admitted to the hospital. The client will most likely be treated with: • A. Magnesium sulfate • B. Calcium gluconate • C. Dinoprostone (Prostin E.) • D. Bromocriptine (Parlodel) Incorrect Correct Answer: C. Dinoprostone (Prostin E.) The client with a missed abortion will have induction of labor. Prostin E. is a form of prostaglandin used to soften the cervix. Prostaglandin E2 (PGE2), also known by the name dinoprostone, is a naturally occurring compound that is involved in promoting labor, though it is also present in the inflammatory pathway. Prostaglandin E2 is FDA approved for cervical ripening for the induction of labor in patients for which there is a medical indication for induction. • Option A: Magnesium sulfate is used for preterm labor and preeclampsia. Magnesium sulfate is a naturally occurring mineral used to control low blood levels of magnesium. Magnesium injection is also used for pediatric acute nephritis and to prevent seizures in severe pre-eclampsia, eclampsia, or toxemia of pregnancy. • Option B: Calcium gluconate is the antidote for magnesium sulfate. Calcium gluconate is typically administered intravenously (IV) or orally in the treatment of hypocalcemia, cardiac arrest, or cardiotoxicity due to hyperkalemia or hypermagnesemia. Calcium gluconate has also been used off-label in the management of ?-blocker toxicity, calcium-channel blocker (CCB) toxicity, magnesium toxicity, and hydrofluoric acid burns. • Option D: Pardel is a dopamine receptor stimulant used to treat Parkinson’s disease. Bromocriptine is also used as an early treatment for PD to delay the onset of the use of levodopa, ultimately delaying the likely dyskinesia and motor fluctuations that occur with chronic use. 20. 20. Question A client with preeclampsia has been receiving an infusion containing magnesium sulfate for a blood pressure that is 160/80; deep tendon reflexes are 1 plus, and the urinary output for the past hour is 100mL. The nurse should: • A. Continue the infusion of magnesium sulfate while monitoring the client’s blood pressure • B. Stop the infusion of magnesium sulfate and contact the physician • C. Slow the infusion rate and turn the client on her left side • D. Administer calcium gluconate IV push and continue to monitor the blood pressure Incorrect Correct Answer: A. Continue the infusion of magnesium sulfate while monitoring the client’s blood pressure The client’s blood pressure and urinary output are within normal limits. The only alteration from normal is the decreased deep tendon reflexes. The nurse should continue to monitor the blood pressure and check the magnesium level. The therapeutic level is 4.8–9.6mg/dL. Magnesium levels must be monitored frequently by checking serum levels every 6 to 8 hours or clinically by following patellar reflexes or urinary output. • Option B: Do not stop the infusion. If serum concentration levels are low, a proper dose of magnesium sulfate can be given parenterally to replete low serum concentrations with recommended follow up laboratory testing. • Option C: There is no need to stop the infusion at this time or slow the rate. If patients exhibit signs and symptoms of hypermagnesemia, the recommendation is to discontinue magnesium sulfate products immediately. If the patient consumed magnesium sulfate orally, then the use of magnesium-free enemas or cathartics can be useful in removing excess magnesium from the GI tract. • Option D: Calcium gluconate is the antidote for magnesium sulfate, but there is no data to indicate toxicity. Patients should receive parenteral doses of calcium gluconate to help alleviate symptoms, but continued doses may be necessary as the calcium provides temporary improvement. IV hydration should also occur if clinically appropriate. 21. 21. Question Which statement made by the nurse describes the inheritance pattern of autosomal recessive disorders? • A. An affected newborn has unaffected parents. • B. An affected newborn has one affected parent. • C. Affected parents have a one in four chance of passing on the defective gene. • D. Affected parents have unaffected children who are carriers. Incorrect Correct Answer: C. Affected parents have a one in four chance of passing on the defective gene. Autosomal recessive disorders can be passed from the parents to the infant. If both parents pass the trait, the child will get two abnormal genes and the disease results. Parents can also pass the trait to the infant. Patients affected with autosomal recessive (AR) diseases have a disease allele on each chromosome. The pattern of individuals affected with an AR disease can be traced through a family to determine which individuals are carriers and which individuals are likely to become impacted. • Option A: To have an affected newborn, the parents must be carriers. The easiest way to determine the inheritance pattern of a disorder in a family is by looking at a pedigree. Autosomal recessive diseases typically affect both females and males equally. Autosomal recessive patterns manifest by skipping generations as the affected are usually children of unaffected carriers. • Option B: Both parents must be carriers. The most common situation of an autosomal recessive disease occurs when the parents are each carrier or heterozygous (Dd). Children of carrier parents have a 25% chance of inheriting the disorder. This value is obtained by using the Punnett square model used in genetics. • Option D: The parents might have affected children. Each parent has a 50% chance of passing on the disease allele. Using the multiplication rule of probability, there is a 50% chance that the father passes on his disease allele and a 50% chance that the mother passes on her disease allele; 50% x 50% = 25%. So with the mating of carrier parents, there is a 25% chance that the child will be affected, a 50% chance that the child would be a carrier, and 25% chance that they would be homozygous dominant and unaffected. 22. 22. Question A pregnant client, age 32, asks the nurse why her doctor has recommended a serum alpha fetoprotein. The nurse should explain that the doctor has recommended the test: • A. Because it is a state law • B. To detect cardiovascular defects • C. Because of her age • D. To detect neurological defects Incorrect Correct Answer: D. To detect neurological defects Alpha fetoprotein is a screening test done to detect neural tube defects such as spina bifida. Alpha-fetoprotein (AFP) is a plasma protein produced by the embryonic yolk sac and the fetal liver. AFP levels in serum, amniotic fluid, and urine functions as a screening test for congenital disabilities, chromosomal abnormalities, as well as some other adult occurring tumors and pathologies. • Option A: The test is not mandatory, as stated in answer A. Patients having amniocentesis must be duly counseled about the procedure, as well as, the associated risks. There is a risk of obstetric mishap following amniocentesis; a miscarriage can happen in less than 1% of cases. Some other very rare complications of amniocentesis are preterm labor, infection (amnionitis), iatrogenic trauma, or injury to the developing fetus or mother. • Option B: It does not indicate cardiovascular defects. Maternal blood AFP levels often as part of triple (AFP, Estriol, and hCG) or quadruple (AFP, implies Estriol, hCG and Inhibin A) screening test for birth defects. Levels are usually interpreted for age, race, weight, and gestational age. The elevated levels imply a significant risk of having birth defects, hence, further evaluation may be required to assess the level of risk. • Option C: The mother’s age has no bearing on the need for the test, so answer C is incorrect. A significant number of patients with elevated maternal AFP do not develop birth defects, but there may be an increased risk of obstetric complications like premature rupture of membrane, placenta accreta, increta, and packet. 23. 23. Question A client with hypothyroidism asks the nurse if she will still need to take thyroid medication during the pregnancy. The nurse’s response is based on the knowledge that: • A. There is no need to take thyroid medication because the fetus’s thyroid produces a thyroid-stimulating hormone. • B. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy. • C. It is more difficult to maintain thyroid regulation during pregnancy due to a slowing of metabolism. • D. Fetal growth is arrested if thyroid medication is continued during pregnancy. Incorrect Correct Answer: B. Regulation of thyroid medication is more difficult because the thyroid gland increases in size during pregnancy. During pregnancy, the thyroid gland triples in size. This makes it more difficult to regulate thyroid medication. During pregnancy, there are increased metabolic needs of the maternal body resulting in changes in thyroid physiology. These changes in thyroid physiology reflect in altered thyroid function tests. • Option A: There could be a need for thyroid medication during pregnancy. The serum TSH concentration is the initial and most reliable measure of thyroid function during pregnancy. As elaborated above, there are physiologic changes in TSH levels during pregnancy which warrants close monitoring of TSH levels. As per the latest American Thyroid Association (ATA) guidelines, serum TSH levels during pregnancy should be defined using population and trimester-specific based reference ranges. • Option C: The thyroid function does not slow. When population and trimester-specific normal ranges are not available, the ATA guidelines recommend reducing the lower limit of TSH by 0.4 mU/L and the upper limit by 0.5 mU/L. It would correspond to the TSH reference range of 0.1 to 4.0 mU/L during the first trimester with a gradual return of TSH towards the non-pregnant normal range during second and third trimesters. • Option D: Fetal growth is not arrested if thyroid medication is continued. There is an increase in iodine requirement during pregnancy due to an increase in maternal thyroid hormone production as well as an increase in renal iodine clearance. Along with the above two factors, there is also a fetal iodine requirement; therefore, dietary iodine requirements are higher during pregnancy. 24. 24. Question The nurse is responsible for performing a neonatal assessment on a full-term infant. At 1 minute, the nurse would expect to find: • A. An apical pulse of 100 • B. An absence of tonus • C. Cyanosis of the feet and hands • D. Jaundice of the skin and sclera Incorrect Correct Answer: C. Cyanosis of the feet and hands Cyanosis of the feet and hands is acrocyanosis. This is a normal finding 1 minute after birth. Acrocyanosis is bluish discoloration around the mouth and extremities, with the remaining area pink. It is a benign finding often seen in healthy newborns and is common in the initial days of life due to initial peripheral vasoconstriction. This is managed by routine newborn care. The routine newborn care management which involves pulse oximetry and screening of congenital heart disease (CHD). • Option A: An apical pulse should be 120–160. The next step would be cardiac auscultation, making a note of the rate, rhythm, and quality of sounds. Heart sounds should have a single first heart sound and second split heart sound. Neonatal murmurs on the first day of life are common and are usually transient. • Option B: The baby should have muscle tone, making answer B incorrect. A neurological exam should include a more thorough assessment of tone & level of alertness than the initial inspection. Tone can be assessed by holding up the newborn under the bilateral axilla. • Option D: Jaundice immediately after birth is pathological jaundice and is abnormal. Pathologic jaundice may occur in the first 24 hours of life and is characterized by a rapid rate of rising in the bilirubin level more than 0.2 mg/dl per hour or 5 mg/dl per day. 25. 25. Question A client with sickle cell anemia is admitted to the labor and delivery unit during the first phase of labor. The nurse should anticipate the client’s need for: • A. Supplemental oxygen • B. Fluid restriction • C. Blood transfusion • D. Delivery by Caesarean section Incorrect Correct Answer: A. Supplemental oxygen Clients with sickle cell crises are treated with heat, hydration, oxygen, and pain relief. The supply of extra oxygen with oxygen therapy may be beneficial for some patients with sickle cell disease. But the use of oxygen therapy in sickle cell disease is controversial because high levels of oxygen are known to suppress the formation of new red blood cells. Oxygen therapy is, therefore, only recommended when oxygen levels drop below a critical threshold. • Option B: Fluids are increased, not decreased. Vaso-occlusive crisis is treated with vigorous intravenous hydration and analgesics. Intravenous fluids should be of sufficient quantity to correct dehydration and to replace continuing loss, both insensible and due to fever. Normal saline and 5% dextrose in saline may be used. Treatment must be in an inpatient setting. • Option C: Blood transfusions are usually not required. Transfusions are not needed for the usual anemia or episodes of pain associated with SCD. Urgent replacement of blood is often required for sudden, severe anemia due to acute splenic sequestration, parvovirus B19 infection, or hyperhemolytic crisis. Transfusions are helpful in acute chest syndrome, perioperatively, and during pregnancy. • Option D: The client can deliver vaginally. Although activity is unrestricted, patients may not be able to tolerate vigorous exercise or exertion. Patients with avascular necrosis of the femur may not be able to tolerate weightbearing and may be restricted to bed rest. Patients with chronic leg ulcers may need to restrict activity that involves raising the legs. 26. 26. Question A client with diabetes has an order for ultrasonography. Preparation for an ultrasound includes: • A. Increasing fluid intake • B. Limiting ambulation • C. Administering an enema • D. Withholding food for 8 hours Incorrect Correct Answer: A. Increasing fluid intake Before ultrasonography, the client should be taught to drink plenty of fluids and not void. Drink water and do not go to the toilet until after the scan – this may be needed before a scan of the unborn baby or the pelvic area. A full bladder is very important for the ultrasound exam. Empty the bladder 90 minutes before exam time, then consume one 8-ounce glasses of fluid (water, milk, coffee, etc.) about an hour before exam time. • Option B: There is no restriction for ambulation before ultrasound. Most ultrasound scans last between 15 and 45 minutes. They usually take place in a hospital radiology department and are performed either by a radiologist or a sonographer. • Option C: Enema is not necessary during an ultrasound. In some cases, you may also be given an injection of a harmless substance called a contrast agent before the scan, as this can make the images clearer. • Option D: The client should withhold voiding, not food, before an ultrasound. Avoid eating or drinking for several hours before the scan – this may be needed before a scan of your digestive system, including the liver and gallbladder. 27. 27. Question An infant who weighs 8 pounds at birth would be expected to weigh how many pounds at 1 year? • A. 14 pounds • B. 16 pounds • C. 18 pounds • D. 24 pounds Incorrect Correct Answer: D. 24 pounds By 1 year of age, the infant is expected to triple his birth weight. Between six months and one year, weight gain slows down a little. Most babies double their birth weight by five to six months of age and triple it by the time they are a year old. By one year, the average weight of a baby girl is approximately 19 pounds 10 ounces (8.9 kg), with boys weighing about 21 pounds 3 ounces (9.6 kg). • Option A: During the first few days of life, it’s normal for both breastfed and bottle-fed newborns to lose weight. A bottle-fed baby may lose up to 5% of his body weight, and an exclusively breastfed newborn can lose up to 10%. • Option B: On average, babies gain about one pound each month for the first six months. The average weight at six months is about 16 pounds 2 ounces (7.3 kg) for girls and 17 pounds 8 ounces (7.9 kg) for boys. • Option C: Most infants will gain about a pound over their birth weight by month one. At this age, infants are not as sleepy, they begin developing a regular feeding pattern, and they have a stronger suck during feedings. 28. 28. Question A pregnant client with a history of alcohol addiction is scheduled for a nonstress test. The nonstress test: • A. Determines the lung maturity of the fetus • B. Measures the activity of the fetus • C. Shows the effect of contractions on the fetal heart rate • D. Measures the neurological well-being of the fetus Incorrect Correct Answer: B. Measures the activity of the fetus A nonstress test is done to evaluate periodic movement of the fetus. Prenatal non-stress test, popularly known as NST, is a method used to test fetal wellbeing before the onset of labor. A prenatal non-stress test functions in overall antepartum surveillance with ultrasound as a part or component of the biophysical profile. The presence of fetal movements and fetal heart rate acceleration is the most critical feature of the non-stress test. • Option A: It is not done to evaluate lung maturity as in answer A. It is usually estimated by examination of the amniotic fluid, obtained by transabdominal amniocentesis, for lecithin, lecithin/sphingomyelin (L/S) ratio. The Lecithin-to-Sphingomyelin Ratio (L/S ratio) is one of several methods for clinicians to assess fetal lung maturation. This biochemical test was first introduced in the 1970s, where a sample of amniotic fluid was collected via amniocentesis to determine the risk of the neonate developing respiratory distress syndrome (RDS). • Option C: An oxytocin challenge test shows the effect of contractions on fetal heart rate. The oxytocin challenge test (OCT) is a form of antenatal fetal monitoring that is being utilized by obstetricians to assess fetal well-being. Uterine contractions may lower the fetal oxygen supply by decreasing the blood circulation in the intervillous spaces of the placenta. • Option D: Nonstress test does not measure neurological well-being of the fetus. Advances in technology over the past decade have enabled researchers to investigate directly the functional development of the fetal brain through two emerging techniques: functional magnetic resonance imaging (fMRI) and fetal magnetoencephalography (MEG). 29. 29. Question A full-term male has hypospadias. Which statement describes hypospadias? • A. The urethral opening is absent. • B. The urethra opens on the dorsal side of the penis. • C. The penis is shorter than usual. • D. The urethral meatus opens on the underside of the penis. Incorrect Correct Answer: D. The urethral meatus opens on the underside of the penis. Hypospadias is a congenital abnormality in which the urethral meatus is on the underside of the penis. Hypospadias is an anatomical congenital malformation of the male external genitalia. It is characterized by abnormal development of the urethral fold and the ventral foreskin of the penis that causes abnormal positioning of the urethral opening. • Option A: Urethral agenesis is the absence of the urethral opening. Urethral atresia is a rare urethral malformation, which is not compatible with life unless the urachus open in the umbilicus, an alternative communication between the bladder and rectum exists in a form of congenital fistula, or a prenatal placement of a vesico-amniotic shunt established. Terminal renal failure and multiple reconstructive operations have to be expected in the course of the disease. • Option B: The urethral opening is located ventrally, not dorsally, in hypospadias. In hypospadias, the external urethral meatus may present various degrees of malpositioning and may be found with associated penile curvature. Depending on the location of the defect, patients may have an additional genitourinary malformation. • Option C: Penis shorter than usual is not a characteristic of a patient with hypospadias. Key features include a glandular groove and a dorsal hood of the foreskin but in almost all cases the prepuce is incomplete ventrally. In addition, the urethral meatus is usually in an abnormal location. If the infant has a complete foreskin, the hypospadias may become obvious after circumcision. 30. 30. Question A gravida 3 para 2 is admitted to the labor unit. Vaginal exam reveals that the client’s cervix is 8 cm dilated, with complete effacement. The priority nursing diagnosis at this time is: • A. Alteration in coping related to pain • B. Potential for injury related to precipitate delivery • C. Alteration in elimination related to anesthesia • D. Potential for fluid volume deficit related to NPO status Incorrect Correct Answer: A. Alteration in coping related to pain Transition is the time during labor when the client loses concentration due to intense contractions. Assess nature and amount of vaginal show, cervical dilation, effacement, fetal station, and fetal descent. Cervical dilation should be approximately 1.2 cm/hr in the nullipara and 1.5 cm/hr in the multipara; vaginal show increases with a fetal descent. Choice and timing of medication is affected by the degree of dilation and contractile pattern. • Option B: Potential for injury related to precipitate delivery has nothing to do with the dilation of the cervix, so answer B is incorrect. Monitor uterine activity manually and/or electronically, noting frequency, duration, and intensity of contraction. The uterus is susceptible to possible rupture if a hypertonic contractile pattern develops spontaneously or in response to oxytocin administration. Placental separation and hemorrhage can also occur if contraction persists. • Option C: Encourage periodic attempts to void, at least every 1–2 hr. Pressure of the presenting part on the bladder often reduces sensation and interferes with complete emptying. Regional anesthesia (especially in conjunction with IV fluid infusion and use of Stadol) also may contribute to voiding difficulties/bladder distension. • Option D: Monitor for signs and symptoms of excess fluid loss or shock (i.e., check BP, pulse, sensorium, skin color, and temperature). Hemorrhage associated with fluid loss greater than 500 ml may be manifested by increased pulse, decreased BP, cyanosis, disorientation, irritability, and loss of consciousness. 31. 31. Question The client with varicella will most likely have an order for which category of medication? • A. Antibiotics • B. Antipyretics • C. Antivirals • D. Anticoagulants Incorrect Correct Answer: C. Antivirals Varicella is chickenpox. This herpes virus is treated with antiviral medications. In adults, infection tends to be more severe, and treatment with antiviral drugs (acyclovir or valacyclovir) is advised if they can be started within 24 to 48 hours of rash onset. In children, acyclovir decreases symptoms by one day if taken within 24 hours of the start of the rash, but it has no effect on complication rates, and it is not recommended for individuals with normal immune function. • Option A: The pharmacology behind antibiotics includes destroying the bacterial cell by either preventing cell reproduction or changing a necessary cellular function or process within the cell. Antimicrobial agents are classically grouped into 2 main categories based on their in vitro effect on bacteria: bactericidal and bacteriostatic. • Option B: The client might have a fever before the rash appears, but when the rash appears, the temperature is usually gone, so answer B is incorrect. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a drug class FDA-approved for use as antipyretic, anti-inflammatory, and analgesic agents. These effects make NSAIDs useful for the treatment of muscle pain, dysmenorrhea, arthritic conditions, pyrexia, gout, migraines, and used as opioid-sparing agents in certain acute trauma cases. • Option D: The client is not treated with anticoagulants as stated in answer D. Anticoagulants derive their effect by acting at different sites of the coagulation cascade. Some act directly by enzyme inhibition, while others indirectly, by binding to antithrombin or by preventing their synthesis from the liver (vitamin K dependent factors). 32. 32. Question A client is admitted complaining of chest pain. Which of the following drug orders should the nurse question? • A. Nitroglycerin • B. Ampicillin • C. Propranolol • D. Verapamil Incorrect Correct Answer: B. Ampicillin There is no indication for an antibiotic such as Ampicillin. Penicillins had been very effective against S. aureus; in the past, however, S. aureus has become capable of exhibiting resistance against them by producing a penicillin hydrolyzing enzyme – penicillinase. After that, subsequent efforts to overcome this issue and extend the antimicrobial coverage of penicillins, ampicillin was developed. It is also resistant to acid so that it can be administered orally. • Option A: Nitroglycerin is a vasodilatory drug used primarily to provide relief from anginal chest pain. Nitroglycerin has been FDA approved since 2000 and was first sold by Pfizer under the brand name Nitrostat. It is currently FDA approved for the acute relief of an attack or acute prophylaxis of angina pectoris secondary to coronary artery disease. • Option C: B-adrenoceptor antagonists, including propranolol, have been advised to be used for the treatment of heart failure, atrial fibrillation, and coronary artery disease. Furthermore, they have demonstrated to improve mortality and morbidity in those with hypertension that is complicated with heart failure, angina, or any history of previous myocardial infarctions. • Option D: Clients with chest pain can be treated with nitroglycerin, a beta-blocker such as propranolol, or Verapamil. Given as initial treatment in patients with: (1) Non-ST elevation acute coronary syndrome(NSTE-ACS, (2) continuing or frequently recurring ischemia and are unable to use beta-blockers (e.g., contraindication, suffered from unacceptable adverse effects, beta-blockers were insufficient for treatment). 33. 33. Question Which of the following instructions should be included in the teaching for the client with rheumatoid arthritis? • A. Avoid exercise because it fatigues the joints. • B. Take prescribed anti-inflammatory medications with meals. • C. Alternate hot and cold packs to affected joints. • D. Avoid weight-bearing activity. Incorrect Correct Answer: B. Take prescribed anti-inflammatory medications with meals. Anti-inflammatory drugs should be taken with meals to avoid stomach upset. Disease-modifying, anti-rheumatic drugs (DMARDs) are initiated as soon as the diagnosis of rheumatoid arthritis is made. Traditional or conventional DMARD include methotrexate, leflunomide, sulfasalazine, hydroxychloroquine. Biologic DMARDs include TNF (tumor necrosis factor): Adalimumab, Etanercept, Infliximab, Golilumab, Certolizumab. And non-TNF inhibitors: Tocilizumab (Interleukin-6 inhibitor), Abatacept (inhibits T-cell costimulation), Rituximab (anti-B cell). • Option A: Clients with rheumatoid arthritis should exercise, but not to the point of pain. The patient should enroll in an exercise program to recover joint function. An occupational therapy consult can help the patient manage daily living activities. • Option C: Alternating hot and cold is not necessary, especially because warm, moist soaks are more useful in decreasing pain. Provide a variety of comfort measures (eg, application of heat or cold; massage, position changes, rest; foam mattress, supportive pillow, splints; relaxation techniques, diversional activities). • Option D: Weight-bearing activities such as walking are useful but are not the best answer for the stem. Encourage independence in mobility and assist as needed: Allow ample time for activity; provide rest period after activity; reinforce principles of joint protection and work simplification. 34. 34. Question A client with acute pancreatitis is experiencing severe abdominal pain. Which of the following orders should be questioned by the nurse? • A. Meperidine 100 mg IM q 4 hours PRN pain • B. Mylanta 30 ccs q 4 hours via NG • C. Cimetidine 300 mg PO q.i.d. • D. Morphine 8 mg IM q 4 hours PRN pain Incorrect Correct Answer: D. Morphine 8 mg IM q 4 hours PRN pain Morphine is contraindicated in clients with gallbladder disease and pancreatitis because morphine causes spasms of the Sphincter of Oddi. GI obstruction is another important contraindication. It is also considered by many as a contraindication to provide opioids to individuals that have a history of substance misuse, especially if a patient has had a history of abusing opioids. • Option A: Clinicians use meperidine is used for the treatment of moderate to severe pain. It has intramuscular, subcutaneous, intravenous injection, syrup, and tablet forms. In the 20th century, it was the drug of choice amongst the opioids in the management of acute pain by most of the physicians and the management of some patients with chronic pain. • Option B: Antacids are a group of drugs that have been on the market for many years. They were initially first-line defense against peptic ulcer disease; however, the discovery of proton pump inhibitors revolutionized the treatment of peptic ulcer disease. Currently, antacid use is restricted to the relief of mild intermittent gastroesophageal reflux disease (GERD) associated heartburn. • Option C: Cimetidine is ordered for pancreatitis, making answer C incorrect. Cimetidine is a gastric acid reducer used in the short-term treatment of duodenal and gastric ulcers. The drug is effective in managing gastric hypersecretion, and therefore, used for the management of reflux esophagitis disease and in the prevention of stress ulcers. With the development of proton pump inhibitors, such as omeprazole, approved for the same indications, cimetidine is available as an over the counter formulation for the prevention of heartburn or acid indigestion, along with the other H2-receptor antagonists. 35. 35. Question The client is admitted to the chemical dependence unit with