Medication and Blood Products

The patient with severe psoriasis has been prescribed methotrexate. The nurse instructs the patient to schedule which follow-up tests? Select all that apply.   

The patient who has been prescribed methotrexate for the treatment of severe psoriasis has received medication teaching. Which statements indicate the teaching was effective? Select all that apply.

The 62-year-old patient reports erectile dysfunction and states, “I’ve been treating it with herbal remedies prescribed by my naturopathic doctor". Which conditions, if found in the patient’s medical history, prompt the nurse to counsel the patient against these herbal remedies? Select all that apply.  

The patient with high cholesterol reports forgoing the prescribed statin medication for an herbal remedy. The nurse assesses the patient for which adverse effects? Select all that apply. 

The nurse counsels which women against the use of black cohosh as an herbal supplement?  

During a routine physical, the patient states, “I feel more comfortable taking herbal remedies than prescription medications for my high blood pressure.” Which response by the nurse is most important?  

The nurse is helping to recruit patients for a study about the effectiveness of a new delivery system for somatropin. The nurse filters the records for patients with which conditions? Select all that apply.

The patient with short stature associated with Noonan syndrome is being considered for somatropin injections. The nurse ensures which test is performed before therapy is started? 

The nurse places a call to the provider that the 74-year-old patient’s potassium level is 7.1 mEq/dL. The nurse is prepared to answer which questions from the provider? Select all that apply.  

The patient is started on subcutaneous heparin injections 7500 units q12h for deep vein thrombosis prophylaxis at 0900. When does the nurse plan to obtain the activated partial thromboplastin time (aPTT) to determine effectiveness of therapy?  

The patient is receiving a continuous heparin infusion that started at 0000 for the treatment of a deep vein thrombosis in the leg. Prior to the initiation of therapy, the patient’s activated partial thromboplastin time (aPTT) level was 35 seconds. The aPTT level drawn at 0800 was found to be 70 seconds. The nurse reports this information to the provider and advocates for which intervention?  

The patient who was started on warfarin sodium for the treatment of atrial fibrillation has reached steady state with the current dose. Which instruction is most important to give the patient?

The patient on bowel rest has been prescribed 10% dextrose total parenteral nutrition at 50 mL/h, intravenous lipids 3 grams/kg/day, and 10 mg intravenous famotidine every other day. Which information in the patient’s chart prompts the nurse to contact the provider? 

The patient with chronic alcoholism begins parenteral nutrition (PN) at a rate of 50 mL/h for treatment of severe malnutrition. Four hours after the infusion begins, the patient’s urine output increases from 40 mL/h to 200 mL/h. The nurse contacts the provider to request which order?  

The patient is receiving parenteral nutrition while NPO for a bowel obstruction. Review the patient’s lab results and decide which change to the parenteral nutrition the nurse clarifies with the provider.   Blood urea nitrogen = 34 mg/dL   Serum Creatinine = 2.1 mg/dL  Potassium = 6.1 mEq/dL  Sodium = 131 mEq/dL  Chloride = 100 mEq/dL  Bicarbonate = 18 mEq/dL

The patient had an unsealed radiation source instilled into the uterus on Tuesday. On Friday, the patient has an episode of incontinence and requires a full linen change. How does the nurse dispose of the soiled linens? 

The nurse is caring for the patient who is at the nadir for bone marrow suppression. Which order does the nurse clarify with the provider?  

The patient’s activated partial thromboplastin time (aPTT) is 138 seconds. Review the chart to determine the most important question for the charge nurse to ask the bedside nurse.

Which intervention is most important for the 38-week-gestation neonate who was antenatally diagnosed with hypoplastic left heart syndrome and born 2 hours ago?  

The nurse in a tertiary medical center with attached pediatric hospital is caring for the 28-year-old gravida 3 para 2 woman who is 40-weeks pregnant and presents to the labor and delivery unit 1 hour after spontaneous rupture of membranes. Patient had good prenatal care, an amniotic fluid index of 12, and pregnancy is complicated only by the antenatal diagnosis of fetal single ventricle anatomy.  Labor is progressing well and the fetus is tolerating contractions well with moderate variability in fetal heart tones. The nurse is most concerned with having which item in the delivery room? 

The nurse assesses the patient being treated for bipolar disorder for which signs of toxicity?  

During a routine physical, the 58-year-old patient reports aching chest pain that occurs only when doing yardwork or heavy cleaning. However, it does not occur every time he is performing these chores. He denies regular exercise and reports a sedentary lifestyle. The nurse anticipates providing which instruction to the patient related to the patient's new prescription for this condition?   

The 15-year-old patient attempted suicide by ingesting an entire bottle of her father’s metoprolol. She is found unresponsive by emergency medical services and is intubated due to an inability to manage her own airway. Upon arrival to the emergency department, her blood pressure is 49/32 mmHg, heart rate is 24 bpm, and the pulse oximeter reads 82%. An 18-gauge peripheral IV is placed in the left antecubital vein and a 22-gauge IV is placed in the right antecubital vein. Which interventions are included in care? Select all that apply.  

The 1-year-old with sickle cell disease is in crisis following gastroenteritis. While hospitalized, the patient abruptly exhibits seizures, decreased level of consciousness, right-sided facial asymmetry when crying, coughing and sputtering during a bottle feeding, and decreased movement of the right leg and arm. The nurse contacts the provider and prepares to provide which initial interventions? Select all that apply.  

The 8-year-old male patient presents complaining of warm, painful, swollen joints with decreased range of motion. Upon assessment, he is pale and tachycardic. The parent reports easy bruising and frequent nosebleeds. Which does the nurse most anticipate administering? 

The 12-year-old child who weighs 35 kg with hemophilia B is brought to the emergency department with signs of increased intracranial pressure after being hit in the head at a baseball game. The nurse prepares to carry out which order?  

The patient with β-thalassemia major exhibits complications of therapy. The nurse prepares to provide which intervention? 

The patient receiving chemotherapy for breast cancer develops a fever of 39.8°F and heart rate of 121 bpm. Within hours, the blood pressure drops from 128/89 mmHg to 91/54 mmHg, capillary refill time increases to 5 seconds, and urine output drops to less than 0.5 mL/kg/hour. Right-sided weakness, slurring of the words, and confusion occurs rapidly and subsides within 2 hours. Hemoptysis is also noted and the gums are oozing. Multiple transfusions are ordered. Which blood product does the nurse administer first?

The nurse overhears a colleague preparing a dose of naltrexone. The nurse offers to assist and ensures the colleague takes which actions? Select all that apply.  

The 58-year-old patient presents to the clinic for a follow-up appointment. Upon assessment, the nurse notes expiratory wheezes across all lung fields. Review the patient’s chart to determine the most likely cause of this new symptom.

The nurse reviews the patient’s chart and advocates for which intervention?

The nurse is planning care for the 78-year-old patient with recurrent fecal impaction. The patient has prostate cancer that has metastasized to the bone. In addition to palliative chemotherapy, the patient receives a fentanyl transdermal patch and intravenous hydromorphone. The patient is neutropenic and thrombocytopenic. The nurse works with the provider to plan which intervention to manage the opioid-induced constipation and subsequent fecal impaction? 

The 11-month-old, previously healthy infant is brought to the emergency department after becoming increasingly lethargic over the past 24 hours. The infant’s vital signs are notable for a temperature of 40.8°C, heart rate 138 bpm, respiratory rate 31, and blood pressure 84/50 mmHg. Upon assessment, the nurse notes sensitivity to light and sound, bulging anterior fontanelle, and significant resistance to turning the head. Place the interventions in the correct order.  

The 36-hour-old neonate who was born at 37 weeks gestation to a G3P2 mother has yet to pass meconium. The baby was born by cesarean section due to refractory preeclampsia with severe features. The mother reports the baby has been breastfeeding well after a slow first 12 hours. Upon assessment, the baby appears well with good tone and responsiveness. The baby’s anus is patent and the abdomen is soft and rounded; bowel sounds present. The mother denies emesis in the baby. An abdominal x-ray is obtained, which is normal. The nurse informs the mother that which test will be performed next? 

The 68-year-old patient is admitted after 3 days of extremely foul-smelling watery diarrhea with a temperature of 37.8°C, heart rate 122 bpm, and blood pressure 96/50 mmHg. The patient’s recent medical history is significant for being treated 2 weeks ago for a diverticulitis flare-up. Upon assessment, the patient is pale, diaphoretic, and has a tense, distended abdomen that he does not guard with palpation. Lab studies reveal an elevated creatinine (1.9 mg/dL), high white blood cell count (20,000 cells/mL), and normal hemoglobin and hematocrit. Which medication does the nurse administer without further discussion with the provider? 

The nurse is caring for a 57-year-old woman who is intubated and sedated in the post-anesthesia care unit following a radical hysterectomy. The patient remained stable throughout the 6 hour surgery during which she experienced a 2 L blood loss. The nurse has emptied the patient’s indwelling catheter every hour for the 3 hours the patient has been in the PACU with the following volumes: 54 mL, 23 mL, 12 mL, and 5 mL. Her heart rate is 112 bpm, oxygen saturation is 99%, and blood pressure is 82/54mmHg. The patient received maintenance fluids during the procedure and no blood transfusions. How many liters of isotonic fluid does the nurse anticipate administering to the patient during the postoperative period? Enter your response using a whole number. 

The patient with acquired immunodeficiency syndrome who has been noncompliant with highly active antiretroviral therapy (HAART) presents to the emergency department with a productive cough, fever, night sweats, and weight loss. The patient’s chest x-ray reveals diffuse infiltrates bilaterally and the CD4 count is 182 cells/µL. Which question by the nurse is most important?  

The 48-year-old patient is brought via ambulance to the emergency room after being found unresponsive by her son. She has a prescription for transdermal fentanyl patches for treatment of cancer pain related to her breast cancer that has metastasized to her pelvis. The patient’s heart rate is 72 bpm, respiratory rate is 4 breaths per minute, and her oxygen saturation is 88%. Her arterial blood gas results are: pH 7.21, PaCO₂ 72 mmHg, PaO₂ 74, HCO₃¯ 23. A thorough assessment reveals 2 fentanyl patches on the patient’s skin. The nurse advocates for which initial action?  

The nurse is preparing the otherwise healthy 54-year-old patient for a right knee replacement surgery and checks to see if the patient is allergic to which medication? 

The 23-year-old patient is brought to the emergency department after contacting emergency services to report profound weakness that started in his feet and worsened and spread cranially over the past few days. He reports severe diarrhea after a camping trip a week ago. Upon assessment, strength, sensation, and deep tendon reflexes are significantly reduced, with the lower extremities more severely affected than his upper extremities. There is increased protein in the cerebrospinal fluid found after a lumbar puncture. The patient begins taking more shallow breaths and becomes confused. The patient is intubated and mechanically ventilated. Once the patient is stable, the nurse anticipates administering which medication? 

The 75-year-old patient presents to the emergency department complaining of a severe headache that is localized behind the right eye. The patient is nauseous and vomits upon standing. While wearing glasses, the visual acuity is 20/25 in the left eye and 20/110 in the right (records show it is normally also 20/25 corrected). Her left pupil is equal, round, and reactive to light and accommodation; it is measured at 3 mm. Her right pupil reacts only minimally to light and measures at 5 mm; it is round. The provider palpates the eye and reports that it is tense. Her heart rate is 102 bpm and blood pressure is 118/84 mmHg. The nurse anticipates providing which intervention first?  

The 38-year-old patient who strictly adheres to a vegan diet complains of weakness and tingling in her lower extremities. She retains the strength in her lower extremities but proprioception is decreased.  Her complete blood count reveals a megaloblastic anemia. Which statement by the nurse is most appropriate? 

The patient with well-controlled chronic obstructive pulmonary disorder presents with a 3 day history of increased cough with sputum production, fever, and malaise. Upon assessment, breath sounds are clear after coughing and the patient appears to breathe comfortably with no retractions or nasal flaring. His chest x-ray is clear and his screening complete blood count is largely normal, with exception of a white blood cell count of 16. The nurse anticipates the provider to order which medication(s)? Select all that apply. 

The 7-year-old child is being evaluated for attention deficit or learning disability. The child’s teachers report a lack of attention to detail and an inability to follow direction. The child’s parents report issues at home, too – not doing what is asked and not remembering what has been said. While being evaluated, the child begins to blink rapidly for 20 seconds. Once the episode ends, the child does not remember what happened or the purpose of the appointment. The nurse prepares education for the parents about which medication? 

The 7-year-old child is being evaluated for attention deficit or learning disability. The child’s teachers report a lack of attention to detail and an inability to follow direction. The child’s parents report issues at home, too – not doing what is asked and not remembering what has been said. While being evaluated, the child begins to blink rapidly for 20 seconds. Once the episode ends, the child does not remember what happened or the purpose of the appointment. The nurse educates the parents about which adverse effects of first line therapy? Select all that apply.  

The nurse clarifies which order for the patient admitted with cellulitis caused by methicillin-resistant staphylococcus aureus?   

The 24-year-old patient presents with flu-like symptoms and a diffuse maculopapular rash across her chest, trunk, and palms of the hands. Upon palpation, cervical lymph nodes are enlarged. The patient uses intravenous drugs and reports having unprotected sex. The patient’s labs are notable for negative HIV test, positive human chorionic gonadotropin test, and positive rapid plasma reagin test. The patient reports a history of anaphylaxis with penicillin administration. The nurse educates the patient about which treatment? 

The patient is brought to the emergency department after sudden onset slurring of the words, confusion, and right-sided weakness that started 3 hours ago. Aspirin was given by emergency response. He has a history of diabetes mellitus, hypertension, and hyperlipidemia for which he is compliant with therapy. He smokes 2 packs of cigarettes per day. Upon assessment, the patient’s temperature is 37.4°C, heart rate is 118 bpm, and blood pressure is 204/118 mmHg.  A stat computed tomography (CT) scan shows an area of hyperechogenicity on the left side of the brain. The nurse prepares to provide which medication?  

The patient with cirrhosis is admitted with severe confusion, ascites, and jaundice. He has gained 10 kg in 2 weeks. He has been coughing blood and his stool is dark and tarry. Therapeutic paracentesis results are concerning for infection.  The nurse anticipates the patient to report not taking which medications that are ordered? Select all that apply.  

The 71-year-old previously healthy patient is admitted to the hospital for dehydration after 3 days of malaise and productive cough with green sputum. Right lower lobe consolidation is noted on x-ray. Leukocytosis is revealed by a complete blood count. Vitals are notable for a temp of 40.4°C, heart rate of 122 bpm, respiratory rate of 22, and blood pressure of 104/62 mm Hg. Oxygen saturation is 84% on room air, but improves to 100% with 2L 100% FiO2 via nasal cannula. The nurse prepares to administer which medications? Select all that apply.