Asthma and Respiratory Disorders Practice Problems PDF

## Asthma and Respiratory Disorders **A nurse is caring for a client who has asthma and is prescribed a short-acting** **beta2-agonist. Which of the following should the nurse identify as the expected** **outcome of this medication?** * Reduces the frequency of attacks * **Reverses bronchospasm**...

## Asthma and Respiratory Disorders **A nurse is caring for a client who has asthma and is prescribed a short-acting** **beta2-agonist. Which of the following should the nurse identify as the expected** **outcome of this medication?** * Reduces the frequency of attacks * **Reverses bronchospasm** * Prevents inflammation * Decreases chronic manifestations **Correct Answer:** B. Reverses bronchospasm **The nurse should identify that the expected outcome of a short-acting beta2-** **agonist is reversal of bronchospasm. Short-acting beta2-agonists bind to beta2-** **adrenergic receptors in the lungs, resulting in relaxation of bronchial smooth** **muscles.** **Incorrect Answers:** * Reducing the frequency of attacks of asthma is achieved through the use of long-term control agents such as inhaled corticosteroids and long-acting inhaled beta2-agonists. * Preventing inflammation is achieved through the use of inhaled corticosteroids, not short-acting beta2-agonists. * Decreasing chronic manifestations of asthma is achieved through the use of inhaled corticosteroids and long-acting inhaled beta2-agonists. **A nurse is caring for a client with asthma who has been taking an inhaled** **glucocorticoid and long-acting beta2-agonist combination dry-powdered** **inhaler (DPI) for maintenance therapy. The nurse should identify that** **which of the following is a disadvantage of this medication?** * **Restricted dosage flexibility** * Complicated delivery device * Serious systemic effects * Limited efficacy over time **Correct Answer:** A. Restricted dosage flexibility **The nurse should identify that a disadvantage of an inhaled glucocorticoid and a long-acting beta2-agonist being** **combined is that the dosages of these medications are fixed, so the dose cannot be adjusted.** **Incorrect Answers:** * This combination medication DPI is an easy-to-use device that allows the client to self-administer medication after receiving basic instruction about its use. * This combination medication DPI is delivered locally to the lungs. Systemic effects are mild and generally do not occur. * This combination medication DPI is effective for long-term use for clients who have asthma. **A nurse is planning care for a client with thrombophlebitis who has a** **prescription to receive heparin via continuous IV infusion. Which of the** **following actions should the nurse include in the plan of care?** * **Infuse the heparin using an electronic IV pump** * Administer vitamin K if the client has indications of hemorrhage * Adjust the dosage of heparin based on the client's PT levels * Inform the client that the heparin will dissolve the thrombus **Correct Answer:** A. Infuse the heparin using an electronic IV pump **The nurse should administer heparin using an electronic IV pump, rather than by gravity, to prevent an accidental** **increase or change in the rate of infusion.** **Incorrect Answers:** * The nurse should monitor the client for indications of hemorrhage and administer protamine sulfate as an antidote to heparin if this adverse effect occurs. * The nurse should monitor the client's aPTT levels and adjust the dosage as prescribed. * While thrombolytic medications can dissolve a thrombus, heparin cannot. The nurse should inform the client that heparin prevents enlargement of the thrombus and further clot formation. **A nurse is monitoring a client who has asthma, takes albuterol, and recently started taking propranolol to treat a cardiovascular disorder. The client reports** **that the albuterol has been less effective. Which of the following factors should the nurse identify as a possible explanation for this change?** * Potentiative interaction * **Detrimental inhibitory interaction** * Increased adverse reaction * Toxicity-reducing inhibitory interaction **Correct Answer:** B. Detrimental inhibitory interaction **A detrimental inhibitory interaction can occur with the concurrent use of propranolol and albuterol. When a client takes propranolol and** **albuterol together, propranolol can interfere with albuterol's therapeutic effects.** **Incorrect Answers:** * When a client takes 2 medications, a medication might potentiate the effects of the other. Potentiative interactions can be helpful in increasing or prolonging a medication's therapeutic effects. However, this would not explain a decrease in the effectiveness of a medication. * Detrimental potentiative interactions worsen adverse effects. An example of this effect is warfarin and aspirin, which increase the risk of bleeding when used together. * Some medications reduce the effects of or block the action of another, with a beneficial interaction to reduce toxicity. An example of this effect is the use of naloxone to reverse the effects of an opioid overdose. **A nurse is caring for a client who takes warfarin 2.5 mg PO daily and has an INR of 6.2. The nurse should anticipate a prescription from the provider for which of** **the following medications?** * Protamine sulfate * Fondaparinux * **Vitamin K** * Bivalirudin **Correct Answer:** C. Vitamin K **The nurse should anticipate the provider to prescribe vitamin K for a client who has an INR of 6.2. Vitamin K antagonizes warfarin's actions,** **which can reverse warfarin-induced inhibition of clotting factor synthesis.** **Incorrect Answers:** * Protamine sulfate is an antidote that is administered for severe heparin overdoses. * Fondaparinux is an anticoagulant medication. It would not be administered to a client who is hypercoagulated. * Bivalirudin is an IV anticoagulant. The nurse should recognize that an anticoagulant should not be administered to a client who is hyper- coagulated. **A nurse is teaching a client who has a new prescription for warfarin. Which of the following statements should the nurse identify as an indication that the client** **understands the instructions?** * "I'll use a safety razor to shave each day." * "I'll be sure to eat lots of spinach." * **"I'll avoid contact sports like football."** * "I'll take ibuprofen if I get a headache." **Correct Answer:** C. "I'll avoid contact sports like football." **The most common adverse effect of taking anticoagulants is bleeding. Therefore, the client should avoid any activities that have a high risk** **of causing injury, such as contact sports.** **Incorrect Answers:** * The client should use an electric razor, not a safety razor, to shave. Safety razors contain a sharp blade that could cause bleeding. * Dark green, leafy vegetables are high in vitamin K and can reduce anticoagulation if the client eats an excessive amount. The client should keep vitamin K intake consistent. * The client should not take ibuprofen because NSAIDs interact with anticoagulants to increase their effects and raise the risk of bleeding. Acetaminophen can also increase the risk of bleeding. The client should contact the provider for help with relieving headaches. **A nurse is preparing to administer warfarin to a client who has a new onset of atrial fibrillation. The client asks the nurse, "What should this medication do?"** **Which of the following responses should the nurse make?** * "It helps your heart return to a normal rhythm." * "It dissolves blood clots." * **"It can reduce your risk of having a stroke."** * "It helps to prevent bleeding in atrial fibrillation." * **Correct Answer:** C. "It can reduce your risk of having a stroke." * **The nurse should identify that atrial fibrillation increases the client's risk of having a stroke due to clot formation in the atrium. Warfarin can** * **prevent clot formation when used long-term, which will reduce the client's risk of having a stroke.** * **Incorrect Answers:** * The nurse should identify that conversion of rhythms is not an indication of warfarin because warfarin is anti-coagulant. Other medications such as amiodarone can assist with the conversion of arrhythmias to a normal sinus rhythm. * The nurse should identify that thrombolytic medications dissolve clots. Warfarin is an anticoagulant and cannot dissolve clots. * The nurse should identify that hemorrhage is an adverse effect of warfarin. **A nurse is reviewing the medical record of a client who is receiving hydrochlorothiazide (HCTZ). The nurse should expect to find an improvement in which of** **the following conditions as a result of this medication?** * Gouty arthritis * Dehydration * **Diabetes insipidus** * Hypokalemia **Correct Answer:** C. Diabetes insipidus **A thiazide diuretic such as HCTZ is administered to treat diabetes insipidus. Diabetes insipidus is a condition in which there is an** **overproduction of urine. Thiazides reduce urine production by 30% to 50%.** **Incorrect Answers:** * Gouty arthritis can be an adverse effect of HCTZ due to the retention of uric acid. The nurse should periodically monitor the client's plasma levels of uric acid. * Dehydration can be an adverse effect of thiazide medications such as HCTZ due to the loss of water, sodium, and chlorite. The nurse should weigh the client on a regular basis to monitor for dehydration. * Hypokalemia can be an adverse effect of taking HCTZ due to excessive potassium excretion. The nurse should monitor the client's potassium levels and encourage the client to eat potassium-rich foods. **A nurse is providing discharge teaching to a client who has angina pectoris and a new prescription for verapamil. The client tells the nurse, "My brother takes** **verapamil for high blood pressure. Do you think the provider made a mistake?" Which of the following responses should the nurse make?** * **"Verapamil is used to treat both high blood pressure and angina."** * "You should talk to your provider to make sure the prescription is correct for you." * "Are you concerned that you might have high blood pressure?" * "Your provider has prescribed verapamil so that you will not develop high blood pressure." **Correct Answer:** A. "Verapamil is used to treat both high blood pressure and angina." **Verapamil is a calcium channel blocker that is used for both hypertension and anginal pain because of its ability to dilate arteries and** **decrease afterload.** **Incorrect Answers:** * Telling the client to speak to the provider prolongs the client's concern about the medication. The nurse should deal with the client's concern directly by providing specific information about the medication. * This response does not address the client's concerns directly. The nurse should give the client specific information about the medication rather than minimizing or making assumptions about the client's concerns. * Verapamil is not prescribed to prevent hypertension. **A nurse is assessing a client who takes oral theophylline for chronic bronchitis relief. The nurse should recognize that which of the following findings indicates** **toxicity to theophylline?** * Constipation * **Tremors** * Fatigue * Bradycardia **Correct Answer:** B. Tremors **Theophylline is a xanthine-derivative bronchodilator. An early manifestation of toxicity is CNS stimulation, often seen as tremors. Seizures** **can occur if blood levels continue to rise.** **Incorrect Answers:** * Diarrhea, rather than constipation, is a manifestation of theophylline toxicity. * Theophylline is a CNS stimulant. An increased blood level of theophylline causes restlessness and irritability, not fatigue. Lethargy is more indicative of CNS depression. * Tachycardia, not bradycardia, is an adverse effect associated with theophylline toxicity. **A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse** **identify as being incompatible with theophylline?** * Cromolyn * Albuterol * **Zafirlukast** * Methylprednisolone **Correct Answer:** C. Zafirlukast **The nurse should identify that zafirlukast is a leukotriene receptor antagonist prescribed for asthma maintenance. Concurrent use of** **zafirlukast along with theophylline suppresses the metabolism of theophylline, which can lead to toxicity. Therefore, another medication** **should be used.** **Incorrect Answers:** * Cromolyn is a mast cell stabilizer that decreases inflammation of the airways or nasal passageways. This medication can be taken with theophylline without interaction. * Albuterol sulfate is a beta2-agonist that is used to treat acute bronchospasm. This medication can be prescribed along with the use of theophylline without interaction. * Methylprednisolone is an oral glucocorticoid that can be used for the long-term treatment and management of asthma. This medication decreases inflammation of the airways and can be prescribed with theophylline without interaction. **A nurse is providing teaching to a client who is scheduled to start taking hydrochlorothiazide for hypertension. The nurse instructs the client to eat foods that** **are rich in potassium. Which of the following statements by the client indicates an understanding of the teaching?** * "This medication will not work unless I have enough potassium." * "Potassium will increase the therapeutic effect of my blood pressure medication." * "Potassium will lower my blood pressure." * **"This medication can cause a loss of potassium."** **Correct Answer:** D. "This medication can cause a loss of potassium." **Hydrochlorothiazide can result in hypokalemia caused by excessive potassium excretion from the kidneys. The client should supplement his** **diet with potassium-rich foods to avoid the occurrence of hypokalemia. Foods that are high in potassium include bananas, raisins, baked** **potatoes, pumpkins, and milk.** **Incorrect Answers:** * Potassium does not influence the effectiveness of hydrochlorothiazide. * Potassium does not have a synergistic effect when taken with hydrochlorothiazide. It will not increase the therapeutic effect of an antihypertensive medication. * Potassium does not have an antihypertensive effect. **A nurse is caring for a client who has bronchitis and a prescription for a mucolytic agent. Which of the following findings should the nurse identify as an** **adverse effect of this type of medication?** * Fluid overload * **Bronchospasm** * Electrolyte imbalance * Tachycardia **Correct Answer:** B. Bronchospasm **The nurse should identify that bronchospasm is an adverse reaction to a mucolytic agent. Mucolytic agents such as a hypertonic saline** **solution or acetylcysteine can irritate the airways, resulting in bronchospasm while producing a cough and thinning mucus secretions.** **Incorrect Answers:** * A mucolytic agent such as a hypertonic saline solution or acetylcysteine can be used for thinning secretions as well as producing a cough in a client who has an upper respiratory infection. Fluid overload is not an adverse effect of this type of medication. * Electrolyte imbalance is not an adverse effect of this type of medication. * Some nebulized medications cause tachycardia, such as beta2-agonist bronchodilators. A mucolytic agent does not cause tachycardia. **A nurse is providing teaching to a client with asthma who has a new prescription for a short-acting beta-2 agonist (SABA) bronchodilator. Which of the following** **pieces of information should the nurse share?** * The SABA will provide prolonged control of asthma attacks. * SABAs are also available in an oral form. * The SABA will have to be taken with an inhaled glucocorticoid. * **Notify the provider if the SABA is needed more than twice per week.** **Correct Answer:** D. Notify the provider if the SABA is needed more than twice per week. **SABA bronchodilators are used as a PRN rescue medication to stop an ongoing asthma attack. If the client requires the SABA more than twice** **per week, the provider should be notified because a prescription for a long-acting beta-2 agonist (LABA) might be required. Using a SABA** **more than twice per week can lead to serious adverse effects.** **Incorrect Answers:** * Prolonged control of asthma requires the use of a LABA bronchodilator. LABAs are available in inhaled or oral form. * All oral bronchodilators are long-acting. SABAs are only available as inhaled preparations. * LABA bronchodilators should not be used as monotherapy. LABAs should be combined with an inhaled glucocorticoid. **A charge nurse is teaching a newly licensed nurse about a client who has severe allergy-related asthma and a new prescription for omalizumab. Which of the** **following pieces of information should the charge nurse include to describe the medication's mechanism of action?** * **It reduces the number of immunoglobulin E (IgE) molecules on mast cells.** * It stabilizes the cellular membrane of mast cells. * It decreases the synthesis and release of inflammatory mediators. * It relaxes the smooth muscles by blocking adenosine receptors. ** Correct Answer:** A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells. **The charge nurse should include in the teaching that the mechanism of action of omalizumab reduces the number of IgE molecules on mast** **cells. This limits the ability of allergens to trigger immune mediators that cause bronchospasm.** **Incorrect Answers:** * Stabilizing the cellular membrane of mast cells is the mechanism of action of mast cell stabilizers. * Decreasing the synthesis and release of inflammatory mediators is the mechanism of action of glucocorticoids. * Relaxing smooth muscle by blocking adenosine receptors is the mechanism of action of methylxanthines. **A nurse is caring for a client who is taking diphenhydramine for allergies. The client reports, "I feel sleepy during the day." Which of the following responses** **should the nurse make?** * "You will find that all antihistamines cause sedation." * "You should avoid taking the antihistamine with food." * "The effects of sedation will occur with each dose." * **"You should try antihistamines with non-sedative effects."** **Correct Answer:** D. "You should try antihistamines with non-sedative effects." **The nurse should tell the client to try second-generation antihistamines that have no sedative effect, as these are large molecules with low** **lipid solubility that cannot cross the blood-brain barrier. Diphenhydramine is a first-generation antihistamine and has a common adverse** **effect of sedation.** **Incorrect Answers:** * Diphenhydramine is a first-generation antihistamine and has a common adverse effect of sedation. * The nurse should tell the client to take diphenhydramine with food to decrease gastrointestinal irritation that can cause nausea and vomiting. * Diphenhydramine is a first-generation antihistamine and has a common adverse effect of sedation. However, sedative effects subside after a few days of taking the antihistamine. **A nurse is assessing a client who is experiencing chest pain. Which of the following medications should the nurse expect to administer to suppress the** **aggregation of platelets?** * Nitroglycerin * **Aspirin** * Morphine * Metoprolol **Correct Answer:** B. Aspirin **Aspirin suppresses platelet aggregation, producing an immediate antithrombotic effect. The client should chew the first dose of aspirin to** **allow rapid absorption.** **Incorrect Answers:** * Nitroglycerin is a nitrate that is used to reduce preload and oxygen demand as well as to increase collateral blow in the ischemic heart. * The nurse should identify morphine as a treatment choice for pain. Morphine can also improve hemodynamics by reducing preload. * The nurse should identify metoprolol as a beta-blocker. Beta blockers can be given to a client who is experiencing an ST-elevation myocardial infarction (STEMI) to reduce the client's cardiac pain, the size of the infarction, and the risk of short-term mortality. **A nurse is planning to administer diltiazem via IV bolus to a client who has atrial fibrillation. When assessing the client, the nurse should recognize that which** **of the following findings is a contraindication to administration of diltiazem?** * **Hypotension** * Tachycardia * Decreased level of consciousness * History of diuretic use **Correct Answer:** A. Hypotension **Diltiazem can be a treatment option for essential hypertension. This medication will lower blood pressure and is contraindicated for a client** **who is hypotensive. The nurse should teach the client to self-monitor blood pressure and keep a record of the readings.** **Incorrect Answers:** * Diltiazem and other calcium channel blockers are contraindicated for use in certain conditions where bradycardia is present (e.g. second- or third-degree heart block). It is used to treat tachydysrhythmia such as atrial flutter and fibrillation and supraventricular tachycardia. * A decreased level of consciousness is not a contraindication for diltiazem use. * Diltiazem does not interact with diuretics, and a history of diuretic use is not a contraindication for diltiazem administration. **A nurse is preparing a discharge teaching plan for a 6-year-old client with asthma who has several prescription medications using metered-dose inhalers** **(MDIs). Which of the following interventions should the nurse include in the plan?** * **Add a spacer to each MDI** * Instruct the child to inhale more rapidly than usual when using an MDI * Ask the provider to change the child's medications from inhaled to oral formulations * Administer oxygen by facemask along with the MDI **Correct Answer:** A. Add a spacer to each MDI **MDIs are difficult to use correctly; even when properly used, only a portion of the medication is delivered to the lungs. A spacer applied to an** **MDI can make up for a lack of hand-lung coordination by increasing the amount of medication delivered to the lungs.** **Incorrect Answers:** * A client who uses an inhaler should be taught to inhale the medication slowly over 3 to 5 seconds for maximum effectiveness. * There are advantages to delivering medications for asthma by inhalation, including enhanced therapeutic effects, decreased systemic adverse effects, and quick relief when short-acting bronchodilators are used. Changing the child's medications to oral formulations is not an effective intervention. *Administering oxygen along with inhaled medications does not increase the amount of medication reaching the lungs. In addition, oxygen therapy should be administered on the basis of low oxygen saturation and other assessments. It is not appropriate to administer oxygen by facemask along with the MDI. **A nurse is caring for a client who has a dry nonproductive cough. Which of the following types of medication should the nurse recommend?** * Expectorant * Mucolytic * Bronchodilator * **Antitussive** **Correct Answer:** D. Antitussive **Antitussives suppress the cough reflex.** **Incorrect Answers:** * Expectorants help mobilize secretions. * Mucolytics help liquefy secretions. * Bronchodilators help open air passages. **A nurse is caring for a client who was recently diagnosed with Addison's disease and has been placed on long-term mineralocorticoid therapy with** **fludrocortisone. Which of the following pieces of information should the nurse provide when explaining the purpose of this therapy?** * Mineralocorticoids help the body metabolize carbohydrates, fats, and proteins. * Mineralocorticoids support secondary sexual development. * **Mineralocorticoids maintain electrolyte and fluid balance.** * Mineralocorticoids reduce the risk of cardiac dysrhythmias. **Correct Answer:** C. Mineralocorticoids maintain electrolyte and fluid balance. **Mineralocorticoids (specifically aldosterone) are necessary for the regulation of fluid and electrolyte balance (particularly for sodium,** **potassium, and water). Addison's disease results in a deficiency of cortisol and aldosterone production and requires supplementation with** **glucocorticoids and mineralocorticoids. Fludrocortisone is the only mineralocorticoid available.** **Incorrect Answers:** * Glucocorticoids enhance carbohydrate, fat, and protein metabolism. * Adrenal androgens have minimal effects on the development of secondary sex characteristics and libido maintenance. * Mineralocorticoids, specifically high levels of aldosterone, increase the risk of cardiac dysrhythmias due to the promotion of myocardial fibrosis. **A nurse is planning to administer diphenhydramine 50 mg via IV bolus to a client who is having an allergic reaction. The client has an IV infusion containing a** **medication that is incompatible with diphenhydramine in solution. Which of the following actions should the nurse take?** * Choose an IV port for IV bolus injection of diphenhydramine as near as possible to the client's hanging IV bag * Flush the IV tubing with 2 mL of 0.9% sodium chloride before and after administering diphenhydramine * Allow the IV infusion to keep running while administering the diphenhydramine via IV bolus * **Aspirate to check for IV patency before administering the diphenhydramine** **Correct Answer:** D. Aspirate to check for IV patency before administering the diphenhydramine **It is important to confirm IV patency prior to administering an IV bolus. Some medications cause severe tissue damage when inadvertently** **administered into tissue rather than into a vein.** **Incorrect Answers:** * The nurse should choose the injection port that is nearest to the client to administer an IV bolus injection. * When IV medications are incompatible in solution, the nurse should flush the IV tubing with 10 mL of 0.9% sodium chloride before and after administering the diphenhydramine. * When medications are incompatible, the infusing IV fluids should be stopped by clamping the IV just above the chosen injection port. **A nurse is caring for a client who is taking a prescription for glucocorticoid adrenal replacement medication for the long-term treatment of Addison's disease.** **Which of the following findings indicates that the client is experiencing an adverse effect of the medication?** * Weight loss * Hypotension * Lethargy * **Osteoporosis** **Correct Answer:** D. Osteoporosis **Long-term use of steroid medications such as glucocorticoid medication can inhibit bone growth and result in the adverse effect of** **osteoporosis with long-term treatment.** **Incorrect Answers:** * The nurse should identify that long-term treatment with a glucocorticoid can result in weight gain due to sodium and water retention. * The nurse should identify that long-term treatment with a glucocorticoid can result in hypertension due to sodium and water retention. * The nurse should identify that long-term treatment with a glucocorticoid can result in restlessness, agitation, anxiety, and irritability rather than lethargy. **A nurse is teaching a client who has a new prescription for enteric-coated** **aspirin as stroke prophylaxis. The client asks the nurse why the provider** **prescribed an enteric-coated medication. Which of the following** **responses should the nurse give?** * "The enteric coating allows a lower dosage to be given." * "Enteric-coated medications have better absorption in the body." * **"Enteric-coated medications cause less gastric irritation."** * "The enteric coating provides a steady release of the medication over time." **Correct Answer:** C. "Enteric-coated medications cause less gastric irritation." **Enteric-coated medications do not dissolve until they reach the small intestine, which reduces the risk of gastric** **irritation.** **Incorrect Answers:** * Compared with standard medications, absorption of enteric forms can be variable. Absorption might be delayed, and no absorption of the medication will occur at all if the coating fails to dissolve. Therefore, an enteric coating does not improve absorption. * Sustained-release formulations provide a steady release of a medication over time. **A nurse is caring for a client who has atrial fibrillation and is scheduled for cardioversion. The nurse should anticipate a prescription from the provider for** **which of the following medications for this procedure?** * Amlodipine * **Diltiazem** * Nifedipine * Lidocaine **Correct Answer:** B. Diltiazem **The nurse should anticipate a prescription for diltiazem, which blocks calcium channels in the heart and blood vessels, thereby lowering** **blood pressure. Also, it is an antiarrhythmic medication that is used during cardioversion to treat atrial fibrillation.** **Incorrect Answers:** * Amlodipine is a calcium channel blocker. However, it minimally blocks calcium channels in the heart and is not used to treat arrhythmias. Amlodipine is used to treat hypertension or angina pectoris. * Nifedipine is a calcium channel blocker that minimally blocks calcium channels in the heart and is not used to treat arrhythmias. It is indicated for hypertension or angina pectoris. * Lidocaine is an antidysrhythmic medication used to treat ventricular dysrhythmias. **A nurse is administering subcutaneous epinephrine for a client who is** **experiencing anaphylaxis. The nurse should monitor the client for which** **of the following adverse effects?** * Hypotension * Hyperthermia * Hypoglycemia * **Tachycardia** **Correct Answer:** D. Tachycardia **Adverse effects of epinephrine, an adrenergic agonist, can include tachycardia and dysrhythmi** **stimulation.** **Incorrect Answers:** * Hypertension is an adverse effect of epinephrine. * Hyperthermia is not an adverse effect of epinephrine. * Hyperglycemia is an adverse effect of epinephrine. **A nurse is caring for a client who had a myocardial infarction 2 hours ago** **and is receiving alteplase. Which of the following findings should the** **nurse identify as an adverse effect of receiving this medication?** * **Bleeding** * Increased clot formation * Shortness of breath * Blockage of the central venous catheter **Correct Answer:** A. Bleeding **The nurse should identify that an adverse effect of alteplase is bleeding. Severe bleeding can occur as a result of** **the alteplase-plasminogen complex, which catalyzes the conversion of other plasminogen molecules that digest** **fibrin clots. This action of the medication can contribute to hemorrhage.** **Incorrect Answers:** * Alteplase is a thrombolytic medication used to treat clot formation by dissolving clots. * Alteplase is a thrombolytic medication used to treat pulmonary embolus by dissolving clots in the lungs, allowing the client to breathe more easily. * Alteplase is a thrombolytic medication that can be added in a diluted solution to dissolve any clots blocking the catheter of a central venous device. **A nurse is teaching a client about the proper placement of a nitroglycerin** **patch. Which of the following statements by the client indicates an** **understanding of the teaching?** * "I'll apply the patch over areas of my body with little fatty tissue." * **"I can place the patch on any area of my body without hair."** * "I'll put the patch on the same site as the previous patch." * "I have to apply the patch directly over my heart." **Correct Answer:** B. "I can place the patch on any area of my body without hair." **The nitroglycerin transdermal patch should be applied to skin that is free from hair because hair creates a** **physical barrier to absorption.** **Incorrect Answers:** * Placing the nitroglycerin patch on the same site as a previous patch should be avoided because it can cause skin irritation. * The nitroglycerin patch does not have to be applied directly over the heart. Various topical locations are acceptable. **A nurse is teaching a client who has allergic rhinitis about a new** **prescription for brompheniramine. Which of the following pieces of** **information should the nurse include in the teaching?** * "Report gastrointestinal disturbances immediately." * **"You might find that you develop a dry mouth."** * "You should not experience any central nervous system alterations." * "Increased urinary frequency is an expected effect." **Correct Answer:** B. "You might find that you develop a dry mouth." **A client who takes a first-generation antihistamine such as brompheniramine can experience cholinergic** **blockade effects that can cause drying of mucous membranes in the mouth, nasal passages, and throat. Taking** **frequent sips of liquid or sucking on a hard, sugarless candy can help relieve dry mouth.** **Incorrect Answers:** * A client who takes a first-generation antihistamine such as brompheniramine can experience gastrointestinal disturbance such as nausea, vomiting, loss of appetite, diarrhea, and constipation. These findings do not need to be reported immediately because they are known adverse effects of brompheniramine. * A client who takes a first-generation antihistamine such as brompheniramine can experience central nervous system effects, including dizziness, poor coordination, confusion, and fatigue. **A nurse is caring for a client who has unstable angina. The nurse should** **anticipate a prescription from the provider for which of the following** **medications?** * Epinephrine * **Nitroglycerin** * Lidocaine * Atropine **Correct Answer:** B. Nitroglycerin **The nurse should anticipate a prescription for nitroglycerin, which is indicated for a client who has unstable** **angina. Nitroglycerin is an organic nitrate and a vasodilator that acts by relaxing or preventing spasms in the** **coronary arteries, thereby decreasing the oxygen demand of the heart along with ventricular filling.** **Incorrect Answers:** * Epinephrine is an adrenergic agonist that is used to control superficial bleeding, delay local anesthetic absorption, and treat cardiac arrest and anaphylaxis. * Lidocaine is an antidysrhythmic medication used to treat ventricular dysrhythmias. * Atropine is a muscarinic agonist that is used to treat and manage bradycardia by increasing the heart rate. **A nurse is preparing to administer nitroglycerin topical ointment to a** **client who has angina. Which of the following actions should the nurse** **take?** * Cover the applied ointment with cotton gauze * **Apply the ointment using a dose-measuring applicator** * Apply the ointment using the index finger * Massage the ointment into the client's skin **Correct Answer:** B. Apply the ointment using a dose-measuring applicator **The nurse should apply the ointment using a dose-measuring applicator. This allows the nurse to measure the** **correct dose the client is to receive.** **Incorrect Answers:** * The nurse should cover the ointment that has been applied to the client's skin with plastic wrap. This allows the medication to absorb into the client's skin fully. * The nurse should apply the ointment to the client's skin using gloves and a dose-measuring applicator. Skin that comes into contact with this medication will absorb the medication. * The nurse should avoid massaging or rubbing the ointment into the client's skin, as this will increase the absorption and interfere with the efficacy of the medication. **A nurse is caring for a client who is taking glucocorticoids. The nurse** **should monitor the client for which of the following adverse effects of the** **medication?** * Weight loss * **Peptic ulcer** * Hyperkalemia * Diplopia **Correct Answer:** B. Peptic ulcer **The nurse should monitor this client who is taking glucocorticoids for peptic ulcer disease due to irritation of the** **gastric mucosa. The nurse should periodically check the client's stool for occult blood and instruct the client to** **contact the provider if any black or tarry stools occur.** **Incorrect Answers:** * The nurse should monitor a client taking glucocorticoids for weight gain, not weight loss. * The nurse should monitor a client taking glucocorticoids for hypokalemia, not hyperkalemia. * The nurse should monitor a client taking glucocorticoids for visual complications like cataracts and glaucoma. However, diplopia is not an adverse effect of glucocorticoids. **A nurse is caring for a client who is taking warfarin. Which of the following** **laboratory values should the nurse recognize as an effective response to** **the medication?** * Hct 45% * Hgb 15 g/dL * aPTT 35 seconds * **INR 3.0** **Correct Answer:** D. INR 3.0 **Warfarin is an anticoagulant that prevents thrombus formation in susceptible clients. The INR measures its** **effectiveness. For most clients taking warfarin, an INR of 3.0 indicates effective therapy.** **Incorrect Answers:** * Hct measures the percentage of RBCs in the blood, not the effectiveness of warfarin therapy. * Hgb measures the oxygen-carrying pigment in RBCs, not the effectiveness of warfarin therapy. * The aPTT test monitors the effectiveness of the anticoagulant heparin, not warfarin. **A nurse is caring for a client who has COPD and has been taking fluticasone via inhaler for many years. Which of the following findings should the nurse identify** **as