Shadow Health Questions Answered 100% correct 2023

Shadow Health Questions Answered 100% correct 2023 A patient has been given a new prescription for warfarin. Which statement indicates the need for additional teaching? - I will use a soft toothbrush while taking this medication - I can eat moderate amounts of foods with vitamin K on a regular basis - I should report unusual bleeding to my doctor - I can keep taking a daily aspirin to protect against heart disease (Correct Response) - I can keep taking a daily aspirin to protect against heart disease Aspirin increases the effect of warfarin and may cause a higher risk of bleeding; the patient should not take aspirin while on warfarin therapy. All other statements are consistent with safe use of warfarin. What is the nurse's priority assessment for a patient receiving heparin treatment? - Assess for elevated liver enzymes - Assess for inflammation at the injection site - Assess for bruising or unusual bleeding - Assess aPTT levels - Assess for bruising or unusual bleeding While all options are relevant assessments, bruising or unusual bleeding can be a life threatening adverse effect of heparin treatment, and therefore needs to be the nurse's priority. A patient who has been receiving oxycodone therapy for chronic pain reports no relief after a 10mg dose. The patient is exhibiting: - Opioid addiction - Opioid tolerance - Drug-seeking behaviour - Paradoxical CNS stimulation - Opioid tolerance Prolonged use of opioid therapy can lead to tolerance, where a patient requires a higher dose of the drug to achieve an analgesic effect. Which meal choice exhibits a lack of understanding of atorvastatin's drug-food interactions? - Orange juice, banana, and toast - Grapefruit juice and yogurt - Orange juice, bacon, and eggs - Coffee and croissant - Grapefruit juice and yogurt Grapefruit juice is contraindicated for patients on statin therapy and it may increase drug levels in the blood and increase the likelihood of rhabdomyolysis. None of the other choices interact harmfully with atorvastatin. Which statement indicates that the patient understood the nurse's discharge information about his albuterol inhaler? - I should use this inhaler five minutes after my beclomethasone inhaler - I should use this inhaler regularly to manage my asthma - I should use this inhaler when I am having an acute attack - I should use this inhaler to reduce inflammation in my airways - I should use this inhaler when I am having an acute attack Inhaled albuterol is a rescue medication that reduces bronchoconstriction that is present during acute attacks; it has no effect on inflammation. A patient is taking promethazine for nausea and oxycodone for pain. What is the nurse's priority assessment? - Assess for breakthrough pain - Assess sedation level - Assess for constipation - Assess for dizziness - Assess sedation level The nurse must assess sedation level as the additive sedative effect when promethazine and oxycodone are administered together can lead to life-threatening respiratory depression. The other side effects do not pose immediate risk and are therefore lower-priority assessments. Which information is essential to include when educating the patient about clindamycin? - Clindamycin is primarily bacteriostatic - Clindamycin should be continued even when feeling better - Clindamycin can be given to patients with penicillin sensitivities - Clindamycin can cause a harmless bitter taste - Clindamycin should be continued even when feeling better To resolve the infection and prevent the development of resistant pathogens, it is important that the patient understands she must take an entire course of antibiotics even if she is feeling better. A patient with a penicillin allergy needs antibiotic treatment. Which antibiotic choice would require close monitoring for hypersensitivity due to cross sensitivity? - vancomycin - azithromycin - cefazolin - levofloxacin - cefazolin Cefazolin is a cephalosporin, which is a family of antibiotics that has a high risk of cross-sensitivity in patients with penicillin allergies. A patient has been receiving 40mg of pravastatin daily. The nurse should closely monitor for which of the following: - Muscle pain - Dizziness - Blurred vision - Hypoglycemia - Muscle pain Muscle pain can be an indicator of rhabdomyolysis, which is a potentially life-threatening adverse effect of pravastatin. A patient's primary care doctor has prescribed a potassium supplement. This is most likely to counter the effects of which drug? - furosemide - metoprolol - apixaban - oxybutynin - furosemide Furosemide is a diuretic that can cause potassium loss, so a potassium supplement can help to avoid hypokalemia. The other drugs do not have a significant effect on potassium levels. A patient with angina has been given isosorbide mononitrate. Which of the following symptoms could indicate that the patient is experiencing an adverse reaction to the drug? - hypertension - tachycardia - dry mouth - fatigue - tachycardia Tachycardia is an adverse reaction associated with isosorbide mononitrate. A diabetic patient who has been using insulin to manage her blood glucose levels was admitted to the hospital. Which of her health problems would prompt the nurse to re-evaluate the patient's daily insulin requirements? - hypertension - atrial fibrillation - infection - hypothyroidism - infection Infection can increase the body's insulin needs, whereas the other health conditions do not have a significant impact on insulin need. Which of the following statements by a patient receiving levothyroxine for hypothyroidism suggests the need for additional teaching? - I put an alarm on my phone to remind me to take this at the same time every day. - I crush the tablet in water because I have trouble swallowing the tablet whole. - I take this in the morning because it was keeping me awake when I took it at night. - I take this medication before breakfast with my daily multivitamin. - I take this medication before breakfast with my daily multivitamin. Multivitamins could contain elements that prevent levothyroxine's absorption, including calcium, iron, magnesium, or zinc. Taking the medication at the same time everyday is advised, and morning administration may lessen the risk of insomnia. Crushing levothyroxine tablets does not hinder their efficacy. Thiazide diuretics: (increase/decrease/nothing) - BP - HR - blood volume - peripheral resistance - cardiac output - fluid volume - urination - decrease -nothing - decrease - nothing - nothing - decrease - increase Calcium channel blockers: (increase/decrease/nothing) - BP - HR - blood volume - peripheral resistance - swelling - cardiac output - fluid volume - edema - decrease - nothing - nothing - decrease - increase - nothing - nothing - increase Where is angiotensinogen produced? in the liver Where is renin produced? in the kidneys What is ACE produced by? capillary tissue cells, primarily in the lunges What does angiotensin II stimulate the production of? aldosterone Where is aldosterone secreted? by adrenal cortex What effect does angiotensin II have on blood vessels? vasoconstriction ACE inhibitors: (increase/decrease/nothing) - BP - HR - blood volume - peripheral resistance - swelling - cardiac output - urination - decrease - nothing - decrease - decrease - nothing - nothing - increase Noteworthy side effect of ACE inhibitors: dry cough ARBs: (increase/decrease/nothing) - BP - HR - blood volume - peripheral resistance - swelling - cardiac output - urination - decrease - nothing - decrease - decrease - nothing - nothing - increase Beta-blockers: (increase/decrease/nothing) - BP - HR - blood volume - peripheral resistance - swelling - cardiac output - urination - decrease - decrease - nothing - nothing - decrease - nothing A proper greeting: 1) uses a friendly tone 2) addresses both yourself and the patient by name 3) States your reason for being there The narrowing and broadening of scope in a health history interview occurs in the contexts of: an organized progression through topics related to patient health How to structure a health interview Greeting and identifying data Chief Complaints History of Present Illness (HPI) Family History Personal and Social History Review of Systems Greeting and Identifying Data Greet patient and confirm patients name, age, and gender Chief Complaint(s) Identify symptoms or concerns causing patient to seek care History of Present Illness (HPI) Assess symptoms and patient's thoughts and feelings about illness Medical History Determine allergies, presence and dates of childhood and adult illnesses, chronic health problems, immunization history, and past hospitalizations Family History Determine age and health, or age and cause of death, of parents, sibling, and grandparents, noting the presence of specific illnesses in family (e.g. hypertension, addiction, type II diabetes). Personal and Social History Evaluate education level, family and household dynamics, spiritual practices, personal interests, sleep habits, and lifestyle (e.g. tobacco, alcohol and illicit drug use, sexual history, exercise, and nutrition Review of Systems Assess the presence or absence of common symptoms related to each major body system. To Shape patient interviews Move from open questions to closed questions (shaped like a cone) Open questions "cast a wide net" - allow patients to communicate more generally, and allow them to emphasize their own concerns and priorities Open question examples: How did you injure your elbow? What are your stomachaches like? What prevented you from refilling your prescription? How have you been managing your blood pressure Key Open Question Words "Describe", "Tell me about", "How", "Why" Open Question tips - Ask the patient to elaborate or describe - Convey empathy and avoid judgement - Avoid unnecessary use of medical terminology or jargon - Use concise language to convey a clear meaning. Closed Questions "zoom in" on particulars and refine their understanding of an aspect of patient health Closed Question examples - Has your pain gotten worse? - Are your headaches focused on one side of your head? - Has the medication helped with your heartburn? - When did you start feeling fatigued?