Adams, Pharmacology for Nurses: A Pathophysiologic Approach, 5/E Chapter 25,100% COREECT

Type: MCMA The nurse practitioner conducts education for home-health nurses who care for geriatric patients. Many of the patients abuse laxatives, so the nurse practitioner focuses the education on problems that can be caused by chronic laxative use. The nurse practitioner evaluates that learning has occurred when the nurses make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The kidneys and GI tract keep electrolytes in narrow balance, where they must be." 2. "Electrolytes carry electricity in the body and must stay in balance." 3. "The electrolytes can be replaced by eating the right foods." 4. "The most important electrolytes are sodium, potassium, and magnesium." 5. "Laxatives can lower the level of potassium, necessary for proper heart function." Correct Answer: 1,2,3,5 Rationale 1: Levels of electrolytes in body fluids are maintained within very narrow ranges, primarily by the kidneys and GI tract. Rationale 2: Small, inorganic molecules possessing a positive or negative charge are called electrolytes. These ions are able to conduct electricity. Rationale 3: As electrolytes are lost due to normal excretory functions, they must be replaced by adequate intake, otherwise electrolyte imbalances will result. Rationale 4: The most important electrolytes are sodium, potassium, and calcium, not magnesium. Rationale 5: Chronic use of laxatives can result in fluid imbalance and hypokalemia. Cardiac arrest is a possible consequence of hypokalemia. Global Rationale: Small, inorganic molecules possessing a positive or negative charge are called electrolytes. These ions are able to conduct electricity. Chronic use of laxatives can result in fluid imbalance and hypokalemia. Cardiac arrest is a possible consequence of hypokalemia. Levels of electrolytes in body fluids are maintained within very narrow ranges, primarily by the kidneys and GI tract. As electrolytes are lost due to normal excretory functions, they must be replaced by adequate intake, otherwise electrolyte imbalances will result. The most important electrolytes are sodium, potassium, and calcium, not magnesium. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-4 Explain the importance of electrolyte balance in the body. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 362 Question 2 Type: MCSA The patient is receiving sodium bicarbonate intravenously (IV) for correction of acidosis secondary to diabetic coma. The nurse assesses cyanosis, slow respirations, and irregular pulse. What is the nurse's priority action? 1. Increase the rate of the infusion and continue to assess the patient for symptoms of acidosis. 2. Decrease the rate of the infusion and continue to assess the patient for symptoms of alkalosis. 3. Continue the infusion; the patient is still in acidosis. 4. Stop the infusion and notify the physician; the patient is in alkalosis. Correct Answer: 4 Rationale 1: The patient is not in acidosis, and the infusion should not be increased. Rationale 2: Slowing the infusion is not sufficient. Rationale 3: patient is not in acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid. Rationale 4: The patient receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The patient's symptoms indicate alkalosis so infusion must be stopped and the physician notified. Global Rationale: The patient receiving sodium bicarbonate is prone to alkalosis; monitor for cyanosis, slow respirations, and irregular pulse. The patient's symptoms indicate alkalosis so infusion must be stopped and the physician notified. The patient is not in acidosis; symptoms of acidosis include lethargy, confusion, CNS depression leading to coma, and a deep, rapid respiration rate that indicates an attempt by the lungs to rid the body of excess acid. The patient is not in acidosis, so the infusion must be stopped, not increased. The infusion must be stopped, not decreased, as the patient is in alkalosis. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-6 Discuss common causes of alkalosis and acidosis and the medications used to treat these conditions. MNL Learning Outcome: 11.1.4 Correlate the characteristics of acid-base disorders, pharmacotherapy, and nursing management. Page Number: 370 Question 3 Type: MCMA The nurse cares for a patient in the emergency department who was just severely burned. The wife of the patient asks the nurse, "Why does he need those intravenous infusions (IVs)?" What are the best responses by the nurse that indicates the primary reasons for intravenous infusions (IVs) with a burned patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "So we have an open line for resuscitation in case his heart stops." 2. "So he can receive his antibiotics." 3. "So we can keep his blood pressure stable." 4. "So we can be sure he keeps enough blood volume." 5. "So we can rapidly administer his pain medications." Correct Answer: 3,4 Rationale 1: Cardiac resuscitation is not a primary reason for intravenous (IV) fluid replacement. Rationale 2: Antibiotic therapy is not a primary reason for intravenous (IV) fluid replacement. Rationale 3: Net loss of fluids from the body can result in dehydration and shock. Intravenous (IV) fluid therapy is used to maintain blood pressure. Rationale 4: Net loss of fluids from the body can result in dehydration and shock. Intravenous (IV) fluid therapy is used to maintain blood volume. Rationale 5: Administration of analgesics is not a primary reason for intravenous (IV) fluid replacement. Global Rationale: Net loss of fluids from the body can result in dehydration and shock. Intravenous (IV) fluid therapy is used to maintain blood volume and support blood pressure. Antibiotic therapy is not a primary reason for intravenous (IV) fluid replacement. Cardiac resuscitation is not a primary reason for intravenous (IV) fluid replacement. Administration of analgesics is not a primary reason for intravenous (IV) fluid replacement. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-1 Describe conditions for which intravenous fluid therapy may be indicated. MNL Learning Outcome: 11.1.1 Examine etiology, pathophysiology, and clinical manifestations of fluid imbalance. Page Number: 360 Question 4 Type: MCSA The physician orders a hypertonic crystalloid solution for the patient in critical care who has cerebral edema. The nurse hangs a bag of a hypotonic solution. What will the priority assessment by the nurse include? 1. Headache, irritability, and decreasing level of consciousness 2. Nausea, projectile vomiting, and pinpoint pupils 3. Confusion, hallucinations, and agitation 4. Hypertension, headache, and nausea Correct Answer: 1 Rationale 1: A hypotonic solution will cause a fluid shift out of the plasma into the tissues and cells in the intracellular compartment. This will increase cerebral edema. Headache, irritability, and decreasing level of consciousness are signs of cerebral edema. Rationale 2: Projectile vomiting and pinpoint pupils are not classical signs of cerebral edema. Rationale 3: Confusion, hallucinations, and agitation are not classical signs of cerebral edema. Rationale 4: Hypertension and nausea are not classical signs of cerebral edema. Global Rationale: A hypotonic solution will cause a fluid shift out of the plasma into the tissues and cells in the intracellular compartment. This will increase cerebral edema. Headache, irritability, and decreasing level of consciousness are signs of cerebral edema. Confusion, hallucinations, and agitation are not classical signs of cerebral edema. Hypertension and nausea are not classical signs of cerebral edema. Projectile vomiting and pinpoint pupils are not classical signs of cerebral edema. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-2 Explain how changes in the osmolality or tonicity of a fluid can cause water to move between fluid compartments. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 359 Question 5 Type: MCSA The patient is dehydrated but has a normal blood pressure. The new medical intern orders normal serum albumin intravenously (IV) for this patient. What is the best evaluation by the nurse regarding this order? 1. It is a correct and valid order. 2. The intern should have ordered 5% dextrose in normal saline. 3. The intern should have ordered 0.45% NaCl. 4. The intern should have ordered 0.9% NaCl. Correct Answer: 3 Rationale 1: Normal serum albumin is a hypertonic solution; the patient requires a hypotonic solution. Rationale 2: 5% dextrose in normal saline is a hypertonic solution; the patient requires a hypotonic solution. Rationale 3: 0.45% NaCl is a hypotonic solution. This will cause fluid to shift from plasma to the tissues and cells in the intravascular compartment. Hypotonic solutions are indicated for patients who are dehydrated with normal blood pressure. Rationale 4: 0. 0.9% NaCl is an isotonic solution; the patient requires a hypotonic solution. Global Rationale: 0.45% NaCl is a hypotonic solution. This will cause fluid to shift from plasma to the tissues and cells in the intravascular compartment. Hypotonic solutions are indicated for patients who are dehydrated with normal blood pressure. Normal serum albumin is a hypertonic solution; the patient requires a hypotonic solution. 5% dextrose in normal saline is a hypertonic solution; the patient requires a hypotonic solution. 0.9% NaCl is an isotonic solution; the patient requires a hypotonic solution. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-3 Compare and contrast the use of colloids and crystalloids in intravenous therapy. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 361 Question 6 Type: MCSA The patient has been running in a long-distance marathon on a very warm day. The patient complains of dizziness and nausea and is taken to the hospital where she becomes lethargic. The serum sodium level is 125 mEq/L. What will be the best plan of the nurse? 1. Prepare to encourage the patient to drink fluids. 2. Prepare to administer normal saline intravenous (IV). 3. Prepare to administer 0.45% NaCl. 4. Prepare to provide a diet high in NaCl. Correct Answer: 2 Rationale 1: The patient requires intravenous (IV) fluids at this point, not oral fluids. Rationale 2: Hyponatremia is a serum sodium level less the 135 mEq/L. Hyponatremia caused by sodium loss may be treated with intravenous (IV) fluids containing salt, such as normal saline. Rationale 3: 0.45% NaCl is a hypotonic solution and will further lower the serum sodium. Rationale 4: Feeding the patient is not indicated. Global Rationale: Hyponatremia is a serum sodium level less the 135 mEq/L. Hyponatremia caused by sodium loss may be treated with intravenous (IV) fluids containing salt, such as normal saline. 0.45% NaCl is a hypotonic solution and will further lower the serum sodium. The patient requires intravenous (IV) fluids at this point, not oral fluids. The patient requires intravenous (IV) fluids at this point, not foods high in NaCl. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-5 Explain the pharmacotherapy of sodium and potassium imbalances. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 364 Question 7 Type: MCSA The patient has a potassium level of 5.9 mEq/L. The nurse is administering glucose and insulin. The patient's wife says, "He doesn't have diabetes, why is he getting insulin?" What is the best response by the nurse? 1. "Insulin will cause his extra potassium to go into his cells and lower the blood level." 2. "Insulin lowers his blood sugar levels and this is how the extra potassium is excreted." 3. "Insulin is safer than giving laxatives such as Kayexalate." 4. "Insulin will help his kidneys excrete the extra potassium." Correct Answer: 1 Rationale 1: Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells. Rationale 2: Serum potassium is lowered by entering the cells; this is not controlled by serum glucose. Rationale 3: Giving insulin to decrease serum potassium levels is not considered a safer method than giving Kayexalate. Rationale 4: Insulin does not promote renal excretion of potassium. Global Rationale: Serum potassium levels may be temporarily lowered by administering glucose and insulin, which cause potassium to leave the extracellular fluid and enter cells. Giving insulin to decrease serum potassium levels is not considered a safer method than giving Kayexalate. Insulin does not promote renal excretion of potassium. Serum potassium is lowered by entering the cells; this is not controlled by serum glucose. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-5 Explain the pharmacotherapy of sodium and potassium imbalances. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 365 Question 8 Type: Hot Spot In order to explain the importance of hydration, the nurse shows this diagram to a group of high school athletes. The nurse would indicate that which fluid component holds fluid composing 40% of total body weight? 1. A 2. B 3. C 4. D Answer: 3 Rationale: The cells make up the intracellular fluid compartment, which holds fluid equal to 40% of body weight. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-2 Explain how changes in the osmolality or tonicity of a fluid can cause water to move between fluid compartments. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 359 Question 9 Type: MCSA The patient receives dextran 40 (Gentran 40). The patient experiences tachycardia, dyspnea, and a cough. What is the best evaluation by the nurse? 1. The drug caused an interaction with another drug the patient receives. 2. The patient experienced impending kidney failure. 3. The patient is allergic to the drug. 4. The drug was infused too rapidly. Correct Answer: 4 Rationale 1: There is no information in the question that the patient is receiving another drug. Rationale 2: The patient's symptoms do not indicate kidney failure. Rationale 3: An allergy would be manifested by urticaria. Rationale 4: Fluid overload will be caused by a rate of infusion that is too rapid. Signs of fluid overload include tachycardia, peripheral edema, distended neck veins, dyspnea, and cough. Global Rationale: Fluid overload will be caused by a rate of infusion that is too rapid. Signs of fluid overload include tachycardia, peripheral edema, distended neck veins, dyspnea, and cough. An allergy would be manifested by urticaria. There is no information in the question that the patient is receiving another drug. The patient's symptoms do not indicate kidney failure. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 362 Question 10 Type: MCSA The physician orders potassium chloride (KCl) intravenous (IV) for the patient. The nurse administers this drug intravenous (IV) push. What will be the most likely outcome for this patient? 1. The patient will most likely experience cardiac arrest. 2. The patient will not experience adverse effects if the push was given slowly. 3. The patient will most likely experience tissue necrosis at the injection site. 4. The patient will most likely experience renal failure. Correct Answer: 1 Rationale 1: Potassium chloride (KCl) must never be administered intravenous (IV) push, as bolus injections can overload the heart and cause cardiac arrest. Rationale 2: Potassium chloride must never be administered via intravenous (IV) push, even if slowly, as cardiac arrest may result. Rationale 3: Although tissue necrosis may occur, this is not the primary concern. Rationale 4: Renal failure is not the most concerning outcome of administering potassium chloride intravenous (IV) push. Global Rationale: Potassium chloride (KCl) must never be administered intravenous (IV) push, as bolus injections can overload the heart and cause cardiac arrest. Potassium chloride must never be administered via intravenous (IV) push, even if slowly, as cardiac arrest may result. Cardiac failure, not renal failure, is the most likely outcome of administering potassium chloride intravenous (IV) push. Although tissue necrosis may occur, this is not the primary concern. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse's role in therapy. Page Number: 366 Question 11 Type: MCSA The physician orders potassium chloride (KCl) for the patient who has a nasogastric (NG) tube. What will the nurse plan to do prior to the administration of this drug? 1. Dilute the drug prior to administration through the nasogastric (NG) tube. 2. Flush the nasogastric (NG) tube with Coca-Cola before and after administration. 3. Flush the nasogastric (NG) tube with normal saline before and after administration. 4. There is no particular preparation prior to administration. Correct Answer: 1 Rationale 1: Liquid forms of potassium chloride (KCl) must be diluted prior to administration through a nasogastric (NG) tube to decrease gastrointestinal (GI) distress. Rationale 2: Flushing the tube with Coca-Cola is an outdated practice and should not be done. Rationale 3: Flushing the tube before and after administration of the drug is important, but the drug must still be diluted to decrease gastrointestinal (GI) distress. Rationale 4: There is a preparation that must occur. Global Rationale: Liquid forms of potassium chloride (KCl) must be diluted prior to administration through a nasogastric (NG) tube to decrease gastrointestinal (GI) distress. There is a preparation; the drug must be diluted to decrease gastrointestinal (GI) distress. Flushing the tube with Coca-Cola is an outdated practice and should not be done. Flushing the tube before and after administration of the drug is important, but the drug must still be diluted to decrease gastrointestinal (GI) distress. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse's role in therapy. Page Number: 366 Question 12 Type: MCSA The patient has overdosed on aspirin. In the emergency department, the physician orders sodium bicarbonate. A family member says to the nurse, "I thought that was for stomach ulcers." What is the best response by the nurse? 1. "It will prevent excessive bleeding from the stomach." 2. "It will change the pH of the blood to neutralize the aspirin." 3. "It will change the urine so the kidneys can get rid of the aspirin quickly." 4. "It will help the liver break down the aspirin more quickly." Correct Answer: 3 Rationale 1: Sodium bicarbonate is not given to prevent bleeding when a patient has overdosed on aspirin. Rationale 2: Sodium bicarbonate is not given to neutralize blood pH when a patient has overdosed on aspirin. Rationale 3: Sodium bicarbonate makes the urine more basic, which aids in the renal excretion of acidic drugs such as aspirin. Rationale 4: Sodium bicarbonate is not given to enhance liver enzymes when a patient has overdosed on aspirin. Global Rationale: Sodium bicarbonate makes the urine more basic, which aids in the renal excretion of acidic drugs such as aspirin. Sodium bicarbonate is not given to prevent bleeding when a patient has overdosed on aspirin. Sodium bicarbonate is not given to neutralize blood pH when a patient has overdosed on aspirin. Sodium bicarbonate is not given to enhance liver enzymes when a patient has overdosed on aspirin. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse's role in therapy. Page Number: 370 Question 13 Type: MCSA The patient receives normal serum albumin. What are the priority assessments by the nurse? 1. Blood pressure and urinary output 2. Urinary output and pupil response 3. Blood pressure and level of pain 4. Urinary output and nausea or vomiting Correct Answer: 1 Rationale 1: During fluid replacement therapy, the nurse must assess for fluid volume deficit and fluid volume excess. This is commonly done by assessment of blood pressure and urinary output. Rationale 2: Pupil response is not a priority assessment. Rationale 3: Level of pain is not a priority assessment. Rationale 4: Nausea or vomiting is not the priority assessment. Global Rationale: During fluid replacement therapy, the nurse must assess for fluid volume deficit and fluid volume excess. This is commonly done by assessment of blood pressure and urinary output. Level of pain is not a priority assessment. Pupil response is not a priority assessment. Nausea or vomiting is not the priority assessment. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationship between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-9 Use the nursing process to care for patients receiving pharmacotherapy for fluid balance, electrolyte, and acid-base disorders. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 362 Question 14 Type: MCSA What is a priority outcome when a patient receives dextran 40 (Gentran 40)? 1. The patient will immediately report any ototoxicity. 2. The patient will immediately report any diarrhea. 3. The patient will immediately report any hiccoughs. 4. The patient will immediately report any itching or flushing. Correct Answer: 4 Rationale 1: Ototoxicity is not a sign of an allergic reaction so is not the priority. Rationale 2: Diarrhea is not a sign of an allergic reaction so is not the priority. Rationale 3: Hiccoughs are not a sign of an allergic reaction so are not the priority. Rationale 4: A small percentage of patients are allergic to dextran 40 (Gentran 40), with urticaria being the most common sign. The most important outcome is for the patient to report any allergic symptoms. Global Rationale: A small percentage of patients are allergic to dextran 40 (Gentran 40), with urticaria being the most common sign. The most important outcome is for the patient to report any allergic symptoms. Diarrhea is not a sign of an allergic reaction so is not the priority. Ototoxicity is not a sign of an allergic reaction so is not the priority. Hiccoughs are not a sign of an allergic reaction so are not the priority. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: V.A.4 Delineate general categories of errors and hazards in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-8 For each of the drug classes listed in Drugs at a Glance, know representative drug examples, and explain their mechanisms of action, primary action, and important adverse effects. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 362 Question 15 Type: MCSA The nurse provides group education to active adolescents about sodium replacement after exercising outdoors. What is the best information to include? 1. Have extra salt with your breakfast on days you exercise outdoors. 2. It is best to avoid exercising outdoors in the summer. 3. You should take one salt tablet for every 2 hours spent outside. 4. Water is the best fluid replacement after exercising. Correct Answer: 4 Rationale 1: Increasing salt intake prior to exercising is not necessary. Rationale 2: There is no need to avoid exercising. Rationale 3: Salt tablets can increase the risk of hypernatremia. Rationale 4: Heat-related problems can be best avoided by consuming adequate amounts of water. Global Rationale: Heat-related problems can be best avoided by consuming adequate amounts of water. Salt tablets can increase the risk of hypernatremia. There is no need to avoid exercising as long as enough water is consumed to avoid dehydration. Increasing salt intake prior to exercising is not necessary. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationship between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-9 Use the nursing process to care for patients receiving pharmacotherapy for fluid balance, electrolyte, and acid-base disorders. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 363 Question 16 Type: MCSA Intravenous therapy would be indicated if 1. hypertension were present. 2. fluid intake were greater than 2500 mL/day. 3. intake and output were deregulated. 4. constipation were present. Correct Answer: 3 Rationale 1: Hypertension would not require IV therapy. Rationale 2: Fluid intake of 2500 mL/day is the average intake for adults. Rationale 3: Intake and output imbalance would require IV therapy to treat dehydration or shock and correct fluid imbalance. Rationale 4: Constipation might indicate lack of fluid but would not require IV. Global Rationale: Intake and output imbalance would require IV therapy to treat dehydration or shock and correct fluid imbalance. Hypertension would not require IV therapy. Fluid intake of 2500 mL/day is the average intake for adults. Constipation might indicate lack of fluid but would not require IV. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-1 Describe conditions for which intravenous fluid therapy may be indicated. MNL Learning Outcome: 11.1.1 Examine etiology, pathophysiology, and clinical manifestations of fluid imbalance. Page Number: 360 Question 17 Type: MCMA A patient who is hyperkalemic reports being constipated. Which advice should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. “Drinking more water may help.” 2. “Prune juice is an effective laxative.” 3. “You should add fruits and vegetables to your diet.” 4. “Walking may stimulate your bowel function.” 5. “Use salt substitutes to reduce your sodium level.” Correct Answer: 1,4 Rationale 1: Adding fluids may relieve constipation. Water is a safe fluid for this patient. Rationale 2: Prunes are high in potassium and should be avoided by this patient. Rationale 3: Many fruits and vegetables are high in potassium. If the nurse wishes to provide this instruction, more specifics are indicated as to which fruits and vegetables are safe. Rationale 4: Exercise, such as walking, may stimulate the bowels. Rationale 5: Salt substitutes are often potassium salt based and should be avoided by this patient. Global Rationale: Adding fluids may relieve constipation. Water is a safe fluid for this patient. Exercise, such as walking, may stimulate the bowels. Many fruits and vegetables are high in potassium. If the nurse wishes to provide this instruction, more specifics are indicated as to which fruits and vegetables are safe. Prunes are high in potassium and should be avoided by this patient. Salt substitutes are often potassium salt based and should be avoided by this patient. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-7 Describe the nurse’s role in the pharmacologic management of fluid balance, electrolyte, and acid-base disorders. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 367 Question 18 Type: MCMA Dextran 40 (Gentran 40) has been prescribed for nonemergency infusion. The nurse should plan to take which actions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Start the infusion no faster than 240 mg/min. 2. Monitor the patient’s vital signs continuously during administration. 3. Monitor for signs of anaphylaxis. 4. Teach the patient to avoid use of any over-the-counter herbal products. 5. Discard any portion of the infusion that is not used. Correct Answer: 1,2,3,5 Rationale 1: Nonemergency infusion should not be faster than 240 mg/min. In an emergency the rate is increased to 1.2 to 2.4 g/min. Rationale 2: Hypertension may occur, so vital signs must be continuously monitored. Rationale 3: Some patients are anaphylactic to this drug. Rationale 4: There is no known herbal or food interaction with this drug. Rationale 5: There is no preservative in this preparation, so unused portions must be discarded. Global Rationale: Nonemergency infusion should not be faster than 240 mg/min. In an emergency the rate is increased to 1.2 to 2.4 g/min. Hypertension may occur, so vital signs must be continuously monitored. Some patients are anaphylactic to this drug. There is no preservative in this preparation, so unused portions must be discarded. There is no known herbal or food interaction with this drug. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-7 Describe the nurse’s role in the pharmacologic management of fluid balance, electrolyte, and acid-base disorders. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 362 Question 19 Type: MCSA Hyponatremia is marked by a serum sodium level less than 1. 137 mEq/mL. 2. 140 mEq/mL. 3. 133 mEq/mL. 4. 145 mEq/mL. Correct Answer: 3 Rationale 1: 137 is normal. Rationale 2: 140 is normal. Rationale 3: 135 indicates a hyponatremic state. Rationale 4: Normal serum sodium range is 135–145 mEq/L. Global Rationale: 133 indicates a hyponatremic state. Normal serum sodium range is 135–145 mEq/L. Cognitive Level: Remembering Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-5 Explain the pharmacotherapy of sodium and potassium imbalances. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 364 Question 20 Type: MCSA Which condition is a sign of hypokalemia? 1. Constipation 2. Hypertension 3. Muscle weakness 4. Weight gain Correct Answer: 3 Rationale 1: Diarrhea, not constipation, will occur. Rationale 2: Hypertension is usually not a sign of hypokalemia. Rationale 3: Muscle weakness can occur, since muscle fibers are very sensitive to changes in potassium. Rationale 4: Weight gain is usually not a sign of hypokalemia. Global Rationale: Muscle weakness can occur, since muscle fibers are very sensitive to changes in potassium. Diarrhea, not constipation, will occur. Hypertension is usually not a sign of hypokalemia. Weight gain is usually not a sign of hypokalemia. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 25-5 Explain the pharmacotherapy of sodium and potassium imbalances. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 365 Question 21 Type: MCSA Buffers are chemicals that help maintain normal body pH. The two primary buffers in the body are 1. sodium and calcium ions. 2. sodium and bicarbonate ions. 3. bicarbonate and phosphate ions. 4. potassium and phosphate ions. Correct Answer: 3 Rationale 1: Sodium and calcium are not buffers. Rationale 2: Sodium is not a buffer in maintaining normal body pH. Rationale 3: Bicarbonate and phosphate are the two primary buffers of pH balances. Rationale 4: Potassium and phosphate are not the two primary buffers. Global Rationale: Bicarbonate and phosphate are the two primary buffers of pH balances. Sodium and calcium are not buffers. Potassium and phosphate are not the two primary buffers. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-6 Discuss common causes of alkalosis and acidosis and the medications used to treat these conditions. MNL Learning Outcome: 11.1.4 Correlate the characteristics of acid-base disorders, pharmacotherapy, and nursing management. Page Number: 368 Question 22 Type: MCSA Potential causes for respiratory alkalosis include 1. hypotension. 2. hypertension. 3. hypoventilation. 4. hyperventilation. Correct Answer: 4 Rationale 1: Hypotension is unrelated. Rationale 2: Hypertension is unrelated. Rationale 3: Hypoventilation is associated with respiratory acidosis. Rationale 4: Hyperventilation occurs with respiratory alkalosis. Global Rationale: Hyperventilation occurs with respiratory alkalosis. Hypoventilation is associated with respiratory acidosis. Blood pressure alterations are unrelated. Cognitive Level: Understanding Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-6 Discuss common causes of alkalosis and acidosis and the medications used to treat these conditions. MNL Learning Outcome: 11.1.4 Correlate the characteristics of acid-base disorders, pharmacotherapy, and nursing management. Page Number: 369 Question 23 Type: MCMA The nurse is caring for a group of patients on a medical-surgical unit. For which patients would the nurse anticipate the need for intravenous fluid therapy to correct fluid depletion? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A patient suffering from constipation 2. A patient exhibiting nausea and vomiting following a surgical procedure 3. A patient with a severe burn 4. A patient with congestive heart failure with edema to the lower extremities and rales 5. A patient with uncontrolled diabetic ketoacidosis Correct Answer: 2,3,5 Rationale 1: A patient who is suffering from constipation will not need intravenous fluid due to fluid depletion. A patient with diarrhea may require intravenous fluid due to fluid depletion. Rationale 2: A patient exhibiting nausea and vomiting may require intravenous fluid to avoid dehydration. Rationale 3: A patient with a severe burn will often require intravenous fluid due to fluid depletion that occurs from fluid shifts. Rationale 4: A patient with congestive heart failure retains fluid and will be on fluid restrictions. Rationale 5: A patient with uncontrolled diabetic ketoacidosis often requires intravenous fluid administration for fluid depletion. Global Rationale: A patient exhibiting nausea and vomiting may require intravenous fluid to avoid dehydration. A patient with a severe burn will often require intravenous fluid due to fluid depletion that occurs from fluid shifts. A patient with uncontrolled diabetic ketoacidosis often requires intravenous fluid administration for fluid depletion. A patient who is suffering from constipation will not need intravenous fluid due to fluid depletion. A patient with diarrhea may require intravenous fluid due to fluid depletion. A patient with congestive heart failure retains fluid and will be on fluid restrictions. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-1 Describe conditions for which intravenous fluid therapy may be indicated. MNL Learning Outcome: 11.1.1 Examine etiology, pathophysiology, and clinical manifestations of fluid imbalance. Page Number: 360 Question 24 Type: FIB A nurse is caring for a patient receiving intravenous fluid therapy for dehydration. The nurse knows that the osmolarity or tonicity of a fluid causes water to move to a different compartment. The nurse is caring for a patient who weighs 40 kg. The osmolality of the body fluids for this patient is between 11,000 and _____ milliosmoles. Standard Text: Correct Answer: 11,800 Rationale: The normal osmolality of body fluids ranges from 275 to 295 milliosmoles per kilogram (mOsm/kg). Global Rationale: The normal osmolality of body fluids ranges from 275 to 295 milliosmoles per kilogram (mOsm/kg). Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-2 Explain how changes in the osmolality or tonicity of a fluid can cause water to move between fluid compartments. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 359 Question 25 Type: MCMA The nurse is reviewing the tonicity of the different intravenous fluids on the medical-surgical unit in preparation for an educational presentation. Which fluids are considered to be isotonic and appropriate in the treatment of fluid loss due to a surgical procedure? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. 5% dextrose in lactated Ringer’s 2. 0.9% sodium chloride (NS) 3. 0.45% sodium chloride 4. Lactated Ringer’s 5. 5% dextrose in water Correct Answer: 2,4,5 Rationale 1: 5% dextrose in lactated Ringer’s is a hypertonic solution and is not appropriate for the treatment of fluid loss due to a surgical procedure. Rationale 2: 0.9% sodium chloride (NS) is an isotonic solution and is appropriate for the treatment of fluid loss due to a surgical procedure. Rationale 3: 0.45% sodium chloride is a hypotonic solution and is not appropriate in the treatment of fluid loss due to a surgical procedure. Rationale 4: Lactated Ringer’s is an isotonic solution that is appropriate to treat fluid loss caused by a surgical procedure. Rationale 5: 5% dextrose in water is an isotonic solution that is appropriate to treat fluid loss caused by a surgical procedure. Global Rationale: 0.9% sodium chloride (NS) is an isotonic solution and is appropriate for the treatment of fluid loss due to a surgical procedure. Lactated Ringer’s is an isotonic solution that is appropriate to treat fluid loss caused by a surgical procedure. 5% dextrose in water is an isotonic solution that is appropriate to treat fluid loss caused by a surgical procedure. 5% dextrose in lactated Ringer’s is a hypertonic solution and is not appropriate for the treatment of fluid loss due to a surgical procedure. 0.45% sodium chloride is a hypotonic solution and is not appropriate in the treatment of fluid loss due to a surgical procedure. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 25-3 Compare and contrast the use of colloids and crystalloids in intravenous therapy. MNL Learning Outcome: 11.1.2 Compare various intravenous fluids used to regulate fluid balance and the nurse’s role in therapy. Page Number: 361 Question 26 Type: MCMA The nurse is caring for a patient with severe electrolyte imbalances that have occurred as a result of kidney failure. The nurse knows that this patient is at risk for what disorders as a result of this electrolyte imbalance? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Fluid retention 2. Muscle spasms 3. Fractures 4. High cholesterol 5. Depression Correct Answer: 1,2,3 Rationale 1: Electrolytes are responsible for membrane permeability and water balance. An electrolyte imbalance, especially too much sodium, can result in fluid retention. Rationale 2: Electrolytes are essential for muscle contractions. An imbalance in electrolytes can result in muscle spasms. Rationale 3: Electrolytes are essential for bone growth and remodeling and may place a patient at risk for fractures, especially when there is an imbalance of calcium. Rationale 4: There is no indication that electrolyte imbalances result in high cholesterol. Rationale 5: There is no indication that electrolyte imbalances result in depression. Global Rationale: Electrolytes are responsible for membrane permeability and water balance. An electrolyte imbalance, especially too much sodium, can result in fluid retention. Electrolytes are essential for muscle contractions. An imbalance in electrolytes can result in muscle spasms. Electrolytes are essential for bone growth and remodeling and may place a patient at risk for fractures, especially when there is an imbalance of calcium. There is no indication that electrolyte imbalances result in high cholesterol or depression. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 25-4 Explain the importance of electrolyte balance in the body. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 362 Question 27 Type: MCMA The nurse is caring for a patient with a pH of 7.32. Which medications would be appropriate to administer to a patient with this condition? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Oral bicarbonate 2. Sodium chloride 3. Sodium citrate 4. Potassium chloride 5. Ammonium chloride Correct Answer: 1,3 Rationale 1: Oral bicarbonate is an agent used to treat acidosis. Rationale 2: Sodium chloride is an agent used to treat alkalosis. Rationale 3: Sodium citrate is an agent used to treat acidosis. Rationale 4: Potassium chloride is an agent used to treat alkalosis. Rationale 5: Ammonium chloride is an agent used to treat alkalosis. Global Rationale: Oral bicarbonate is an agent used to treat acidosis. Sodium citrate is an agent used to treat acidosis. Sodium chloride is an agent used to treat alkalosis. Potassium chloride is an agent used to treat alkalosis. Ammonium chloride is an agent used to treat alkalosis. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research. NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-6 Discuss common causes of alkalosis and acidosis and the medications used to treat these conditions. MNL Learning Outcome: 11.1.4 Correlate the characteristics of acid-base disorders, pharmacotherapy, and nursing management. Page Number: 369 Question 28 Type: MCMA A patient has been prescribed potassium chloride (KCl). The patient states, “This is sure a big pill.” What nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Have the patient sit straight up to attempt to swallow the pill. 2. Crush the tablet and put it in a soft food for the patient to swallow. 3. Have the patient chew the tablet. 4. Consult with the prescriber about an alternative drug form. 5. Have the patient take the pill at the beginning of a meal. Correct Answer: 1,4,5 Rationale 1: The patient should sit straight up when swallowing this pill to prevent choking and to prevent esophagitis. Rationale 2: The pill should not be crushed. Rationale 3: The patient should not chew the tablet. Rationale 4: Alternative forms of potassium are available and may be better for this patient. Rationale 5: KCl should be taken with food to prevent gastric upset. Global Rationale: The patient should sit straight up when swallowing this pill to prevent choking and to prevent esophagitis. Alternative forms of potassium are available and may be better for this patient. KCl should be taken with food to prevent gastric upset. The pill should not be crushed. The patient should not chew the tablet. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-7 Describe the nurse’s role in the pharmacologic management of fluid balance, electrolyte, and acid-base disorders. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 366 Question 29 Type: MCMA A nurse providing medication education about loop diuretics advises patients to avoid eating licorice. What is the nurse’s rationale for this statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Licorice causes acid-base imbalances. 2. Licorice can cause potassium loss. 3. Licorice can cause sodium retention. 4. Licorice can cause gastric irritation. 5. Licorice causes renal absorption of calcium. Correct Answer: 2,3 Rationale 1: Licorice does not cause acid-base imbalance. Rationale 2: Licorice can cause potassium loss. Rationale 3: Licorice can cause sodium retention. Rationale 4: Licorice does not cause gastric irritation. Rationale 5: Licorice does not cause renal absorption of calcium. Global Rationale: Licorice can cause potassium loss and sodium retention. It does not cause acid-base imbalance, gastric irritation, or renal absorption of calcium. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-7 Describe the nurse’s role in the pharmacologic management of fluid balance, electrolyte, and acid-base disorders. MNL Learning Outcome: 11.1.4 Correlate the characteristics of acid-base disorders, pharmacotherapy, and nursing management. Page Number: 367 Question 30 Type: MCMA A patient who has a potassium level of 5.9 mEq/L will be given oral polystyrene sulfonate (Kayexalate). What nursing actions are necessary? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Monitor for onset of action of this drug in an hour. 2. Administer sorbitol concurrently. 3. Repeat the dose in 4 hours if needed. 4. Mix the dose with a high sugar liquid. 5. Follow the dose with an enema. Correct Answer: 1,2,3 Rationale 1: Polystyrene sulfonate (Kayexalate) has an onset of action of 1 hour. Rationale 2: Sorbitol or another laxative is administered concurrently to promote rapid evacuation of potassium. Rationale 3: The dose may be repeated in 4 hours if indicated. Rationale 4: There is no need to mix the dose with a high sugar liquid. Rationale 5: This drug may be given rectally, but there is no indication to use both routes of delivery. Global Rationale: Polystyrene sulfonate (Kayexalate) has an onset of action of 1 hour. Sorbitol or another laxative is administered concurrently to promote rapid evacuation of potassium. The dose may be repeated in 4 hours if indicated. There is no need to mix the dose with a high sugar liquid. This drug may be given rectally, but there is no indication to use both routes of delivery. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care. AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 25-7 Describe the nurse’s role in the pharmacologic management of fluid balance, electrolyte, and acid-base disorders. MNL Learning Outcome: 11.1.3 Compare various electrolytes used to maintain fluid balance and the nurse’s role in therapy. Page Number: 365