NR I293 IFinal IExam IReview.
1) A Inurse Iis Iassessing Ia Iclient Iwho Iis Itaking Ilevothyroxine. IThe Inurse Ishould Irecognize Ithat Iwhich Iof Ithe Ifollowing
Ifindings Iis Ia Imanifestation Iof Ilevothyroxine Ioverdose?
a) Insomnia
i) Rationale: ILevothyroxine Ioverdose Iwill Iresult Iin Imanifestations Iof Ihyperthyroidism, Iwhich Iinclude
IInsomnia, Itachycardia, Iand Ihyperthermia.
b) Constipation
i) Rationale: IConstipation Iis Ia Imanifestation Iof Ihypothyroidism Iand Iindicates Ian Iinadequate Idose Iof
Ilevothyroxine.
c) Drowsiness
i) Rationale: IDrowsiness Iis Ia Imanifestation Iof Ihypothyroidism Iand Iindicates Ian Iinadequate Idose Iof
Ilevothyroxine.
d) Hypoactive Ideep-tendon Ireflexes
i) Rationale: IHypoactive Ideep-tendon Ireflexes Iare Imanifestations Iof Ihypothyroidism Iand Iindicate Ian
Iinadequate Idose Iof Ilevothyroxine.
2) A Inurse Iis Ireviewing Ithe Imedical Irecord Iof Ia Iclient Iwho Ihas Ibeen Ion Ilevothyroxine Ifor Iseveral Imonths. IWhich Iof Ithe
Ifollowing Ifindings Iindicates Ia Itherapeutic Iresponse Ito Ithe Imedication?
a) Decrease Iin Ilevel Iof Ithyroxine I(T4)
i) Rationale: IIf Ithe Idose Iof Ithis Imedication Ihas Ibeen Iadequate, Ithe Inurse Ishould Isee Ian Iincrease Iin Ithe IT4.
b) Increase Iin Iweight
i) Rationale: IIf Ithe Idose Iof Ithis Imedication Ihas Ibeen Iadequate, Ithe Inurse Ishould Isee Ia Idecrease Iin Iweight, Ias
Ihypothyroidism Icauses Ia Idecrease Iin Imetabolism Iwith Iweight Igain.
c) Increase Iin Ihr Iof Isleep Iper Inight
i) Rationale: IIf Ithe Idose Iof Ithis Imedication Ihas Ibeen Iadequate, Ithe Inurse Ishould Isee Ia Idecrease Iin Ithe Ihr Iof
Isleep Iper Inight, Ias Ihypothyroidism Icauses Isluggishness Iwith Iincreased Ihr Iof Isleep.
d) Decrease Iin Ilevel Iof Ithyroid Istimulating Ihormone I(TSH).
i) Rationale: IIn Ihypothyroidism, Ithe Inonfunctioning Ithyroid Igland Iis Iunable Ito Irespond Ito Ithe ITSH, Iand Ino
Iendogenous Ithyroid Ihormones Iare Ireleased. IThis Iresults Iin Ian Ielevation Iof Ithe ITSH Ilevel Ias Ithe Ianterior
Ipituitary Icontinues Ito Irelease Ithe ITSH Ito Istimulate Ithe Ithyroid Igland. IAdministration Iof Iexogenous Ithyroid
Ihormones, Isuch Ias Ilevothyroxine, Iturns Ioff Ithis Ifeedback Iloop, Iwhich Iresults Iin Ia Idecreased Ilevel Iof ITSH.
3) A Inurse Iis Ireviewing Ithe Imedication Ilist Ifor Ia Iclient Iwho Ihas Ia Inew Idiagnosis Iof Itype I2 Idiabetes Imellitus. IThe Inurse
Ishould Irecognize Iwhich Iof Ithe Ifollowing Imedications Ican Icause Iglucose Iintolerance?
a) Ranitidine
i) Serum Icreatinine Ilevels
b) Guafenesin
i) Drowsiness Iand Idizziness
c) Prednisone
i) Glucose Iintolerance Iand Ihyperglycemia, Ipatient Imight Irequire Iincreased Idosage Iof Ihypoglycemic Imed.
d) Atorvastatin
i) Thyroid Ifunction Itests.
4) A Inurse Iis Icaring Ifor Ia Iclient Ireceiving Imydriatic Ieye Idrops. IWhich Iof Ithe Ifollowing Iclinical Imanifestations Iindicates Ito
Ithe Inurse Ithat Ithe Iclient Ihas Ideveloped Ia Isystemic Ianticholinergic Ieffect?
a) Seizures
b) Tachypnea
c) Constipation
i) Mydriatic Ieye Idrops Ican Icause Isystemic Ianticholinergic Ieffects Isuch Ias Iconstipation, Idry Imouth,
Iphotophobia, Iand Itachycardia.
d) Hypothermia
,5) A Inurse Iis Icaring Ifor Ia Iclient Iwho Ihas Iheart Ifailure Iand Iis Ireceiving IIV Ifurosemide. IThe Inurse Ishould Imonitor Ithe Iclient Ifor Iwhich
of Ithe Ifollowing Ielectrolyte Iimbalances?
I
a) Hypernatremia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihyponatremia.
b) Hyperuricemia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihyperuricemia. IThe Inurse Ishould
instruct Ithe Iclient Ito Inotify Ithe Iprovider Ifor Iany Itenderness Ior Iswelling Iof Ithe Ijoints.
I
c) Hypercalcemia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihypocalcemia.
d) Hyperchloremia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihypochloremia.
6) A Inurse Iis Italking Ito Ia Iclient Iwho Iis Itaking Ia Icalcium Isupplement Ifor Iosteoporosis. IThe Iclient Itells Ithe Inurse Ishe Iis
Iexperiencing Iflank Ipain. IWhich Iof Ithe Ifollowing Iadverse Ieffects Ishould Ithe Inurse Isuspect?
a) Renal Istones
7) A Inurse Iis Icaring Ifor Ia Iclient Iwho Iis Iprescribed Iwarfarin Itherapy Ifor Ian Iartificial Iheart Ivalve. IWhich Iof Ithe Ifollowing
Ilaboratory Ivalues Ishould Ithe Inurse Imonitor Ifor Ia Itherapeutic Ieffect Iof Iwarfarin?
a) Hemoglobin
b) Prothrombin Itime I(PT)
i) Rationale: IThis Itest Iis Iused Ito Imonitor Iwarfarin Itherapy. IFor Ia Iclient Ireceiving Ifull
Ianticoagulant Itherapy,should Itypically Ibe Iapproximately Itwo Ito Ithree Itimes Ithe Inormal Ivalue,
Idepending Ion ItheIindication Ifor Itherapeutic Ianticoagulation.
c) Bleeding Itime
d) Activated Ipartial Ithromboplastin Itime I(aPTT)
8) A Inurse Iis Ipreparing Ito Iadminister Ia Idose Iof Ilactulose Ito Ia Iclient Iwho Ihas Icirrhosis. IThe Iclient Istates, I"I Idon't Ineed Ithis
Imedication. II Iam Inot Iconstipated." IThe Inurse Ishould Iexplain Ithat Iin Iclients Iwho Ihave Icirrhosis, Ilactulose Iis Iused Ito
Idecrease Ilevels Iof Iwhich Iof Ithe Ifollowing Icomponents Iin Ithe Ibloodstream?
a) Glucose
, b) Ammonia
i) Rationale: ILactulose, Ia Idisaccharide, Iis Ia Isugar Ithat Iworks Ias Ian Iosmotic Idiuretic. IIt Iprevents
Iabsorption Iof Iammonia Iin Ithe Icolon. IAccumulation Iof Iammonia Iin Ithe Ibloodstream, Iwhich Ioccurs
IinIpathologic Iconditions Iof Ithe Iliver, Isuch Ias Icirrhosis, Imay Iaffect Ithe Icentral Inervous Isystem,
Icausing Ihepatic Iencephalopathy Ior Icoma.
c) Potassium
d) Bicarbonate
9) A Inurse Iis Ieducating Ia Igroup Iof Iclients Iabout Ithe Icontraindications Iof Iwarfarin Itherapy. IWhich Iof Ithe Ifollowing
Istatements Ishould Ithe Inurse Iinclude Iin Ithe Iteaching?
a) "Clients Iwho Ihave Iglaucoma Ishould Inot Itake Iwarfarin."
b) "Clients Iwho Ihave Irheumatoid Iarthritis Ishould Inot Itake Iwarfarin."
c) "Clients Iwho Iare Ipregnant Ishould Inot Itake Iwarfarin."
i) Rationale: IWarfarin Itherapy Iis Icontraindicated Iin Ithe Ipregnant Iclient Ibecause Iit Icrosses Ithe Iplacenta
Iand Iplaces Ithe Ifetus Iat Irisk Ifor Ibleeding.
d) "Clients Iwho Ihave Ihyperthyroidism Ishould Inot Itake Iwarfarin."
10) A Inurse Iis Iteaching Ia Iclient Iwho Itakes Iwarfarin Idaily. IWhich Iof Ithe Ifollowing Istatements Iby Ithe Iclient Iindicates Ia Ineed Ifor Ifurther
Iteaching?
a) "I Ihave Istarted Itaking Iginger Iroot Ito Itreat Imy Ijoint Istiffness."
i) Rationale: IGinger Iroot Ican Iinterfere Iwith Ithe Iblood Iclotting Ieffect Iof Iwarfarin Iand Iplace Ithe Iclient Iat Irisk Ifor
Ibleeding. IThis Istatement Iindicates Ithe Iclient Ineeds Ifurther Iteaching.
b) "I Itake Ithis Imedication Iat Ithe Isame Itime Ieach Iday."
i) Rationale: IThe Iclient Ishould Itake Iwarfarin Iat Ithe Isame Itime Ieach Iday Ito Imaintain Ia Istable Iblood Ilevel.
c) "I Ieat Ia Igreen Isalad Ievery Inight Iwith Idinner."
i) Rationale: IGreen Ileafy Ivegetables Iare Ia Igood Isource Iof Ivitamin IK, Iwhich Ican Iinterfere Iwith Ithe Iclotting Ieffects Iof
Iwarfarin. IClients Iwho Iare Itaking Iwarfarin Ido Inot Ineed Ito Irestrict Idietary Ivitamin IK Iintake Ibut Irather Ishould Imaintain Ia
Iconsistent Iintake Iof Ivitamin IK Iin Iorder Ito Icontrol Ithe Itherapeutic Ieffect Iof Ithe Imedication.
d) "I Ihad Imy IINR Ichecked Ithree Iweeks Iago.
i) " IRationale: IClients Iwho Ihave Ibeen Itaking Iwarfarin Ifor Imore Ithan I3 Imonths Ishould Ihave Itheir IINR Ilevel Ichecked Ievery
I2 Ito I4 Iweeks.
11) A Ipatient Iis Istarting Iwarfarin I(Coumadin) Itherapy Ias Ipart Iof Itreatment Ifor Iatrial Ifibrillation. IThe Inurse Iwill
Ifollow Iwhich Iprinciples Iof Iwarfarin Itherapy? I(Select Iall Ithat Iapply.)
a) Teach Iproper Isubcutaneous Iadministration
b) Administer Ithe Ioral Idose Iat Ithe Isame Itime Ievery Iday
c) Assess Icarefully Ifor Iexcessive Ibruising Ior Iunusual Ibleeding
d) Monitor Ilaboratory Iresults Ifor Ia Itarget IINR Iof I2 Ito I3
e) Monitor Ilaboratory Iresults Ifor Ia Itherapeutic IaPTT Ivalue Iof I1.5 Ito I2.5 Itimes Ithe Icontrol Ivalue
12) Atorvastatin Ican Ielevate ILFT
a) Baseline Itotal Icholesterol, ILDL Iand IHDL Ilevel, Itriglycerides, Iand Iliver Iand Irenal Ifunction Itest Iobtained Iand Ithen
Imonitored Iperiodically Ithroughout Itreatment
1) A Inurse Iis Iassessing Ia Iclient Iwho Iis Itaking Ilevothyroxine. IThe Inurse Ishould Irecognize Ithat Iwhich Iof Ithe Ifollowing
Ifindings Iis Ia Imanifestation Iof Ilevothyroxine Ioverdose?
a) Insomnia
i) Rationale: ILevothyroxine Ioverdose Iwill Iresult Iin Imanifestations Iof Ihyperthyroidism, Iwhich Iinclude
IInsomnia, Itachycardia, Iand Ihyperthermia.
b) Constipation
i) Rationale: IConstipation Iis Ia Imanifestation Iof Ihypothyroidism Iand Iindicates Ian Iinadequate Idose Iof
Ilevothyroxine.
c) Drowsiness
i) Rationale: IDrowsiness Iis Ia Imanifestation Iof Ihypothyroidism Iand Iindicates Ian Iinadequate Idose Iof
Ilevothyroxine.
d) Hypoactive Ideep-tendon Ireflexes
i) Rationale: IHypoactive Ideep-tendon Ireflexes Iare Imanifestations Iof Ihypothyroidism Iand Iindicate Ian
Iinadequate Idose Iof Ilevothyroxine.
2) A Inurse Iis Ireviewing Ithe Imedical Irecord Iof Ia Iclient Iwho Ihas Ibeen Ion Ilevothyroxine Ifor Iseveral Imonths. IWhich Iof Ithe
Ifollowing Ifindings Iindicates Ia Itherapeutic Iresponse Ito Ithe Imedication?
a) Decrease Iin Ilevel Iof Ithyroxine I(T4)
i) Rationale: IIf Ithe Idose Iof Ithis Imedication Ihas Ibeen Iadequate, Ithe Inurse Ishould Isee Ian Iincrease Iin Ithe IT4.
b) Increase Iin Iweight
i) Rationale: IIf Ithe Idose Iof Ithis Imedication Ihas Ibeen Iadequate, Ithe Inurse Ishould Isee Ia Idecrease Iin Iweight, Ias
Ihypothyroidism Icauses Ia Idecrease Iin Imetabolism Iwith Iweight Igain.
c) Increase Iin Ihr Iof Isleep Iper Inight
i) Rationale: IIf Ithe Idose Iof Ithis Imedication Ihas Ibeen Iadequate, Ithe Inurse Ishould Isee Ia Idecrease Iin Ithe Ihr Iof
Isleep Iper Inight, Ias Ihypothyroidism Icauses Isluggishness Iwith Iincreased Ihr Iof Isleep.
d) Decrease Iin Ilevel Iof Ithyroid Istimulating Ihormone I(TSH).
i) Rationale: IIn Ihypothyroidism, Ithe Inonfunctioning Ithyroid Igland Iis Iunable Ito Irespond Ito Ithe ITSH, Iand Ino
Iendogenous Ithyroid Ihormones Iare Ireleased. IThis Iresults Iin Ian Ielevation Iof Ithe ITSH Ilevel Ias Ithe Ianterior
Ipituitary Icontinues Ito Irelease Ithe ITSH Ito Istimulate Ithe Ithyroid Igland. IAdministration Iof Iexogenous Ithyroid
Ihormones, Isuch Ias Ilevothyroxine, Iturns Ioff Ithis Ifeedback Iloop, Iwhich Iresults Iin Ia Idecreased Ilevel Iof ITSH.
3) A Inurse Iis Ireviewing Ithe Imedication Ilist Ifor Ia Iclient Iwho Ihas Ia Inew Idiagnosis Iof Itype I2 Idiabetes Imellitus. IThe Inurse
Ishould Irecognize Iwhich Iof Ithe Ifollowing Imedications Ican Icause Iglucose Iintolerance?
a) Ranitidine
i) Serum Icreatinine Ilevels
b) Guafenesin
i) Drowsiness Iand Idizziness
c) Prednisone
i) Glucose Iintolerance Iand Ihyperglycemia, Ipatient Imight Irequire Iincreased Idosage Iof Ihypoglycemic Imed.
d) Atorvastatin
i) Thyroid Ifunction Itests.
4) A Inurse Iis Icaring Ifor Ia Iclient Ireceiving Imydriatic Ieye Idrops. IWhich Iof Ithe Ifollowing Iclinical Imanifestations Iindicates Ito
Ithe Inurse Ithat Ithe Iclient Ihas Ideveloped Ia Isystemic Ianticholinergic Ieffect?
a) Seizures
b) Tachypnea
c) Constipation
i) Mydriatic Ieye Idrops Ican Icause Isystemic Ianticholinergic Ieffects Isuch Ias Iconstipation, Idry Imouth,
Iphotophobia, Iand Itachycardia.
d) Hypothermia
,5) A Inurse Iis Icaring Ifor Ia Iclient Iwho Ihas Iheart Ifailure Iand Iis Ireceiving IIV Ifurosemide. IThe Inurse Ishould Imonitor Ithe Iclient Ifor Iwhich
of Ithe Ifollowing Ielectrolyte Iimbalances?
I
a) Hypernatremia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihyponatremia.
b) Hyperuricemia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihyperuricemia. IThe Inurse Ishould
instruct Ithe Iclient Ito Inotify Ithe Iprovider Ifor Iany Itenderness Ior Iswelling Iof Ithe Ijoints.
I
c) Hypercalcemia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihypocalcemia.
d) Hyperchloremia
i) Rationale: IThe Inurse Ishould Imonitor Ithe Iclient Iwho Iis Ireceiving IIV Ifurosemide Ifor Ihypochloremia.
6) A Inurse Iis Italking Ito Ia Iclient Iwho Iis Itaking Ia Icalcium Isupplement Ifor Iosteoporosis. IThe Iclient Itells Ithe Inurse Ishe Iis
Iexperiencing Iflank Ipain. IWhich Iof Ithe Ifollowing Iadverse Ieffects Ishould Ithe Inurse Isuspect?
a) Renal Istones
7) A Inurse Iis Icaring Ifor Ia Iclient Iwho Iis Iprescribed Iwarfarin Itherapy Ifor Ian Iartificial Iheart Ivalve. IWhich Iof Ithe Ifollowing
Ilaboratory Ivalues Ishould Ithe Inurse Imonitor Ifor Ia Itherapeutic Ieffect Iof Iwarfarin?
a) Hemoglobin
b) Prothrombin Itime I(PT)
i) Rationale: IThis Itest Iis Iused Ito Imonitor Iwarfarin Itherapy. IFor Ia Iclient Ireceiving Ifull
Ianticoagulant Itherapy,should Itypically Ibe Iapproximately Itwo Ito Ithree Itimes Ithe Inormal Ivalue,
Idepending Ion ItheIindication Ifor Itherapeutic Ianticoagulation.
c) Bleeding Itime
d) Activated Ipartial Ithromboplastin Itime I(aPTT)
8) A Inurse Iis Ipreparing Ito Iadminister Ia Idose Iof Ilactulose Ito Ia Iclient Iwho Ihas Icirrhosis. IThe Iclient Istates, I"I Idon't Ineed Ithis
Imedication. II Iam Inot Iconstipated." IThe Inurse Ishould Iexplain Ithat Iin Iclients Iwho Ihave Icirrhosis, Ilactulose Iis Iused Ito
Idecrease Ilevels Iof Iwhich Iof Ithe Ifollowing Icomponents Iin Ithe Ibloodstream?
a) Glucose
, b) Ammonia
i) Rationale: ILactulose, Ia Idisaccharide, Iis Ia Isugar Ithat Iworks Ias Ian Iosmotic Idiuretic. IIt Iprevents
Iabsorption Iof Iammonia Iin Ithe Icolon. IAccumulation Iof Iammonia Iin Ithe Ibloodstream, Iwhich Ioccurs
IinIpathologic Iconditions Iof Ithe Iliver, Isuch Ias Icirrhosis, Imay Iaffect Ithe Icentral Inervous Isystem,
Icausing Ihepatic Iencephalopathy Ior Icoma.
c) Potassium
d) Bicarbonate
9) A Inurse Iis Ieducating Ia Igroup Iof Iclients Iabout Ithe Icontraindications Iof Iwarfarin Itherapy. IWhich Iof Ithe Ifollowing
Istatements Ishould Ithe Inurse Iinclude Iin Ithe Iteaching?
a) "Clients Iwho Ihave Iglaucoma Ishould Inot Itake Iwarfarin."
b) "Clients Iwho Ihave Irheumatoid Iarthritis Ishould Inot Itake Iwarfarin."
c) "Clients Iwho Iare Ipregnant Ishould Inot Itake Iwarfarin."
i) Rationale: IWarfarin Itherapy Iis Icontraindicated Iin Ithe Ipregnant Iclient Ibecause Iit Icrosses Ithe Iplacenta
Iand Iplaces Ithe Ifetus Iat Irisk Ifor Ibleeding.
d) "Clients Iwho Ihave Ihyperthyroidism Ishould Inot Itake Iwarfarin."
10) A Inurse Iis Iteaching Ia Iclient Iwho Itakes Iwarfarin Idaily. IWhich Iof Ithe Ifollowing Istatements Iby Ithe Iclient Iindicates Ia Ineed Ifor Ifurther
Iteaching?
a) "I Ihave Istarted Itaking Iginger Iroot Ito Itreat Imy Ijoint Istiffness."
i) Rationale: IGinger Iroot Ican Iinterfere Iwith Ithe Iblood Iclotting Ieffect Iof Iwarfarin Iand Iplace Ithe Iclient Iat Irisk Ifor
Ibleeding. IThis Istatement Iindicates Ithe Iclient Ineeds Ifurther Iteaching.
b) "I Itake Ithis Imedication Iat Ithe Isame Itime Ieach Iday."
i) Rationale: IThe Iclient Ishould Itake Iwarfarin Iat Ithe Isame Itime Ieach Iday Ito Imaintain Ia Istable Iblood Ilevel.
c) "I Ieat Ia Igreen Isalad Ievery Inight Iwith Idinner."
i) Rationale: IGreen Ileafy Ivegetables Iare Ia Igood Isource Iof Ivitamin IK, Iwhich Ican Iinterfere Iwith Ithe Iclotting Ieffects Iof
Iwarfarin. IClients Iwho Iare Itaking Iwarfarin Ido Inot Ineed Ito Irestrict Idietary Ivitamin IK Iintake Ibut Irather Ishould Imaintain Ia
Iconsistent Iintake Iof Ivitamin IK Iin Iorder Ito Icontrol Ithe Itherapeutic Ieffect Iof Ithe Imedication.
d) "I Ihad Imy IINR Ichecked Ithree Iweeks Iago.
i) " IRationale: IClients Iwho Ihave Ibeen Itaking Iwarfarin Ifor Imore Ithan I3 Imonths Ishould Ihave Itheir IINR Ilevel Ichecked Ievery
I2 Ito I4 Iweeks.
11) A Ipatient Iis Istarting Iwarfarin I(Coumadin) Itherapy Ias Ipart Iof Itreatment Ifor Iatrial Ifibrillation. IThe Inurse Iwill
Ifollow Iwhich Iprinciples Iof Iwarfarin Itherapy? I(Select Iall Ithat Iapply.)
a) Teach Iproper Isubcutaneous Iadministration
b) Administer Ithe Ioral Idose Iat Ithe Isame Itime Ievery Iday
c) Assess Icarefully Ifor Iexcessive Ibruising Ior Iunusual Ibleeding
d) Monitor Ilaboratory Iresults Ifor Ia Itarget IINR Iof I2 Ito I3
e) Monitor Ilaboratory Iresults Ifor Ia Itherapeutic IaPTT Ivalue Iof I1.5 Ito I2.5 Itimes Ithe Icontrol Ivalue
12) Atorvastatin Ican Ielevate ILFT
a) Baseline Itotal Icholesterol, ILDL Iand IHDL Ilevel, Itriglycerides, Iand Iliver Iand Irenal Ifunction Itest Iobtained Iand Ithen
Imonitored Iperiodically Ithroughout Itreatment
