Milestone Exam 1 Questions and Answers 100% Pass

Milestone Exam 1 Questions and Answers 100% Pass Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. The nurse will develop an immediate plan of care based on which finding? A.Severe acute anaphylactic response B.Side reaction that should resolve C.Idiosyncratic reaction D.Cumulative drug response A Rationale: Anaphylaxis related to penicillin can cause a life-threatening allergic response characterized by bronchospasm, laryngeal edema, and a precipitous drop in blood pressure. This client's ingestion of penicillin and presenting clinical picture indicate the client is having an acute reaction with respiratory difficulty. Options B, C, and D are other physiologic responses to medications, but immediate action is required for a potential loss of airway, breathing, and circulation. Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect? A.Beneficial response or cure for disease B.Behavioral or psychotropic responses C.Malingering or drug-seeking behaviors D.Psychological response to inert medication D Rationale:The placebo effect is a response in the client that is caused by the psychological impact of taking an inert drug that has no biochemical properties. A placebo effect can be therapeutic, negative, or ineffective but provides no cure or benefit to the client's progress. The placebo effect may evoke behavioral changes but does not affect neurochemical psychotropic changes. Malingering and drug seeking are behaviors that a client exhibits to obtain treatment for nonexistent disorders or obtain prescription medications. A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my child a half-ounce." The nurse sees that the bottle contains loperamide. What is the next nursing action? A.Tell the mother never to give this drug to her toddler. B.Ask if any other siblings have experienced diarrhea. C.Take the child's oral and tympanic temperatures. D.Ask the mother when the child last voided. D Rationale: Determining when the child last voided is most important because urine output is decreased with dehydration and an 18-month-old with a 3-day history of diarrhea could be severely dehydrated. Although the manufacturer states that loperamide should not be given to a child younger than 2 years except under the direction of a health care provider, option A is not the best answer for this question. In addition, loperamide causes an anticholinergic effect of urinary retention. Data obtained in options B and C are not as high a priority as option D in this situation. A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A.Verify the expiration date. B.Obtain the client's blood pressure. C.Determine the client's history of adverse reactions. D.Review the client's medical record for a change in drug route. B Rationale:To determine the most accurate response to antihypertensive therapy, baseline blood pressures should be obtained before an antihypertensive drug is administered and should be compared with orthostatic vital signs to determine whether any side effects are occurring. Although options A, C, and D are required nursing actions prior to giving any drug, the therapeutic response should be determined before another dose is administered. A client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole. Which instruction is most important for the nurse to include in this client's teaching plan? A.Avoid alcohol consumption. B.Complete the medication regimen. C.Use a barrier contraceptive method. D.Treat partner(s) concurrently. A Rationale:Clients should be instructed to avoid alcohol and products containing alcohol while taking metronidazole because of the possibility of a disulfiram-like reaction. Option B helps prevent the development of metronidazole-resistant T. vaginalis. To prevent reinfection, clients should abstain from sexual contact or use a barrier contraceptive while taking metronidazole, and their partner(s) should be treated concurrently. The most important instruction for client well-being is option A. A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? A.Antiretroviral medications decrease the efficacy of the TB drugs. B.Multiple drugs prevent the development of resistant organisms. C.Duration of the medication regimen is shortened. D.Potential adverse drug reactions are minimized. B A multidrug regimen is prescribed for a client with HIV and TB to prevent the development of resistance of the tubercle bacilli. Although antitubercular medications can inhibit some antiretrovirals, a multidrug regimen is needed to inhibit the proliferation of the virulent tubercle bacilli. The duration of antitubercular therapy is typically 6 to 9 months and is not shortened by the use of multiple medications. A client who is receiving HIV and TB therapy is at an increased risk of adverse reactions because of the complex medication regimens and complications secondary to immunosuppression. Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A.Gain in weight B.Increase in urine output C.Improved gastric motility D.Decrease in blood pressure B Rationale:Intropin activates dopamine receptors in the kidney and dilates blood vessels to improve renal perfusion, so an increase in urine output indicates an increase in glomerular filtration caused by increased arterial blood pressure. Option A is related to fluid retention but is not an indicator of a therapeutic response to dopamine therapy. Option C is not related to the vasopressor effect of dopamine therapy. Dopamine increases cardiac output, which increases a client's blood pressure, not option D. A 21-year-old female client is receiving tetracycline for acne. Which client teaching should the nurse include? A.Oral contraceptives may not be effective. B.Drinking cranberry juice will promote healing. C.Breast tenderness may occur as a side effect. D.The urine will turn a red-orange color. A Rationale:Certain antibiotics, such as tetracycline, decrease the effectiveness of oral contraceptives. Options B, C, and D do not convey accurate information related to client teaching about this medication. An 80-year-old client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which finding requires immediate nursing action? A.The client is drowsy and complains of pruritus. B.Pupils are 3 mm; PERRLA. C.The area around the sutures is reddened and swollen. D.Respirations decrease to 10 breaths/min. D Rationale:Hydromorphone is an opioid agonist-analgesic of opiate receptors that inhibits ascending pathways and can cause respiratory depression. Older adults are more sensitive to opioids so the "start low and go slow" approach should be taken. Option A lists common side effects of opioids, particularly the opiates, which are usually harmless and often transient. Option B is within the normal range (2 to 6 cm). The suture site may be red and swollen as an inflammatory response, but no action is required if the skin around the incision is a normal color and temperature. The nurse has completed diabetic teaching for a client who was newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A."Regular insulin can be stored at room temperature for 30 days." B."My legs, arms, and abdomen are all good sites to inject my insulin." C."I will always carry hard candies to treat hypoglycemic reactions." D."When I exercise, I should plan to increase my insulin dosage." D Exercise helps facilitate the entry of glucose into the cell, so increasing insulin doses with exercise would place the client at high risk for a hypoglycemic reaction. Options A, B, and C reflect accurate statements about the use of insulin and management of hypoglycemic reactions. To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, what is the best nursing action? A.Ask the client about the onset of any dizziness since taking the medication. B.Measure the client's blood pressure while the client is lying, sitting, and then standing. C.Compare the client's blood pressure before and after the client takes the medication. D.Interview the client about any past or recent history of high blood pressure. C Rationale:Therapeutic effects are the expected or predictable physiologic responses to a medication. An antihypertensive medication is administered to lower blood pressure, so to determine if the therapeutic effect has been achieved, the nurse should compare the client's blood pressure before and after the client takes the medication. Options A and B provide data related to the side effect of hypotension, which may occur following the administration of an antihypertensive medication. Option D provides useful data but does not evaluate the medication's effectiveness. Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A.Report vaginal itching or discharge. B.Take the medication at 0800, 1500, and 2200 hours. C.Protect skin from natural and artificial ultraviolet light. D.Avoid driving until response to medication is known. E.Take with an antacid tablet to prevent nausea. F.Use a nonhormonal method of contraception if sexually active. A,C,DF Rationale:Adverse effects of tetracyclines include superinfections, photosensitivity, and decreased efficacy of oral contraceptives. Therefore, the client should report vaginal itching or discharge (A), protect the skin from ultraviolet light (C), and use a nonhormonal method of contraception (F) while on the medication. Minocycline is known to cause dizziness and ataxia, so until the client's response to the medication is known, driving (D) should be avoided. Tetracyclines should be taken around the clock (B) but exhibit decreased absorption when taken with antacids, so (E) is contraindicated. In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A.Hypotension B.Hyperkalemia C.Hypocalcemia D.Seizures A Nifedipine reduces peripheral vascular resistance and nitrates produce vasodilation, so concurrent use of nitrates with nifedipine can cause hypotension with the initial administration of these agents. Options B, C, and D are not side effects of this treatment regimen. The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time? A.Decrease the oral secretions. B.Reduce the child's anxiety. C.Potentiate the opioid effects. D.Prevent possible peritonitis. A Rationale:Atropine sulfate, an anticholinergic agent, is given to decrease oral secretions during a surgical procedure. Options B, C, and D are not actions of anticholinergic agents. The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? A.Avoid ingesting any alcohol or acetaminophen. B.Schedule a follow-up visit for a liver biopsy in 1 month. C.Activities that are strenuous should be avoided. D.Notify the health care provider of any increase in appetite. A Rationale:Combining hepatotoxic drugs, such as acetaminophen and alcohol, increases the risk of liver damage, so option A is an important discharge instruction. Although clients who receive hepatotoxic drugs should be screened for any changes in serum liver function test (LFT) results, option B is not indicated. Rest is advantageous during an infectious process, but activity restriction is unnecessary. A client who is receiving a hepatotoxic drug should report any hepatotoxic symptoms, such as jaundice, dark urine, or light-colored stools, but an increased appetite does not need medical attention. The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given? A.5 minutes after subcutaneous administration B.30 minutes after subcutaneous administration C.1 to 2 hours after administration D.At any time because of a flat peak of action A Rationale:Insulin aspart is a very rapidly acting insulin, with an onset of 5 to 15 minutes. Insulin aspart should be administered when the client's tray is available. Insulin aspart peaks in 45 minutes to 1½ hours and has a duration of 3 to 4 hours. The client should have eaten to ensure absorption of the meal so that serum glucose levels will coincide with the peak. Insulin glargine has a flat peak of action and is usually given at bedtime. A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan? A.Take one tablet every 3 minutes, up to five tablets. B.Take one tablet at the onset of angina and stop the activity. C.Replace nitroglycerin tablets yearly to maintain freshness. D.Allow 30 minutes for a tablet to provide relief from angina. B Rationale:Nitroglycerin tablets should be taken at the onset of angina, and the client should stop activity and rest. One tablet can be taken every 5 minutes, up to three doses. Nitroglycerin should be replaced every 3 to 6 months, not every 12 months. Nitroglycerin should provide relief in 5 minutes, not 30 minutes. During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely? A.Liver enzyme levels B.Blood urea nitrogen (BUN) level C.Serum electrolyte levels D.Complete blood count (CBC) A Rationale:The client receiving isoniazid is at risk for the development of hepatitis; therefore, liver function test results should be monitored carefully during drug therapy. Options B, C, and D are not specific indicators of liver function, so they are not monitored closely during isoniazid therapy. During the initial nursing assessment history, the client reports taking tetracycline hydrochloride for urethritis. Which concurrent medication will the nurse report to the health care provider? A.Sucralfate B.Hydrochlorothiazide C.Acetaminophen D.Phenytoin A Sucralfate is used to treat duodenal ulcers and will bind with tetracycline hydrochloride, inhibiting this antibiotic's absorption. Options B, C, and D have no drug interaction properties that prohibit concurrent use with tetracycline hydrochloride. A client with viral influenza is receiving vitamin C, 3000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? A.Change the acetaminophen to ibuprofen. B.Change the elixir to an injectable route. C.Decrease the dose of vitamin C. D.Begin treatment with an antibiotic. C Diarrhea is an adverse effect of high doses of vitamin C, so the nurse should anticipate a reduction in the dose of vitamin C. Acetaminophen does not cause diarrhea and is not available in an injectable form. Because the client has a viral infection, option D will not be beneficial. A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client? A.Isoniazid B.Carvedilol C.Acyclovir D.Griseofulvin A Rationale:Isoniazid is the drug of choice for treatment of clients with positive skin tests for tuberculosis. Options B, C, and D are not the drugs used for treatment of TB.