HLTH 314 exam with correct answers 2024

A client is about to undergo a diagnostic bowel procedure. The nurse expects which drug to be used to induce total cleansing of the bowel? a. Docusate sodium (Colace) b. Lactulose c. Mineral Oil d. Polyethylene glycol (GoLYTELY) - answers-D Response Feedback: Polyethylene glycol (goLYTELY) is an osmotic laxative used for diagnostic and surgical bowel prep, such as colonoscopies, to ensure visualization of the bowels. The other options are incorrect. When administering a laxative to a client, which assessment is important to monitor? a. Temperature b. Blood pressure c. Fluid and electrolyte status d. White blood cell count - answers-C Response Feedback: The use of all laxatives can cause electrolyte imbalances and changes in fluid output. Patients can be at risk for dehydration. Blood pressure, temperature, and white blood cell count are not directly impacted by laxative use. A client has excessive and painful gas after surgery. The nurse checks the medication orders and prepares to administer which drug for this problem? a. Aluminum hydroxide with magnesium (Maalox) b. Famotidine (Pepcid) c. Calcium carbonate (Tums) d. Simethicone (Mylicon) - answers-D Response Feedback: Simethicone is an antiflatulence medication that alters the elasticity of mucus-coated gas bubbles and breaks them into smaller ones. The other answers are incorrect. A client is receiving an aluminum-containing antacid. The nurse will inform the patient to watch for which possible adverse effect? a. Diarrhea b. Constipation c. Tachycardia d. Headache - answers-B Response Feedback: Aluminum-based antacids have a constipating effect as well as an acid-neuralizing capability. The other options are incorrect. The nurse anticipates which laxative to be ordered for her patient with hepatic encephalopathy? a. Psyllium (Metamucil) b. Bisacodyl (Dulcolax) c. Lactulose d. Magnesium Citrate - answers-C Response Feedback: Lactulose is an osmotic laxative that also reduces blood ammonia levels; elevated blood ammonia levels are seen in hepatic encephalopathy. The other answers are incorrect. A client wants to prevent problems with constipation and asks the nurse for advice about which type of laxative to use. The nurse answers with what class of laxative that is the most safe to use on a long-term basis? a. Emollient laxatives b. Osmotic laxatives c. Bulk-forming laxatives d. Stimulant laxatives - answers-C Response Feedback: Bulk-forming laxatives are the only laxatives recommended for long-term use. They are the most gentle on your body and generally are not associated with electrolyte disturbances, fluid loss, absorption issues, or dependence. Stimulant laxatives are the most likely of all the laxative classes to cause dependence and can be harsh (can cause increased cramping) to the GI tract. Lubricants/emollient laxatives can cause increased fluid loss and impair the absorption of vitamins A, D, E, & K. Osmotic laxatives can cause increased electrolyte disturbances and fluid losses. A client is taking omeprazole (Prilosec) for the treatment of gastroesophageal reflux disease (GERD). The nurse will include which teaching statement about this medication? a. "It is best to take this medication on an empty stomach, 30-60 minutes before meals." b. "Take this medication after your first meal of the day" c. "Do not drive or operate heavy machinery while taking this medication, as it may cause drowsiness" d. "This medication may cause rebound hyperacidity" - answers-A Response Feedback: Omeprazole (Prilosec) is a proton pump inhibitor (PPI). PPIs work best on an empty stomach as they allow the medication's maximum effect to inhibit the production of gastric acid by working directly on the parietal cells of the stomach. PPIs do not cause drowsiness. Antacids cause rebound hyperacidity, not PPIs. A client who has been taking cimetidine (Tagamet) for hyperacidity calls the nurse to say that the medication has not been effective. The nurse reviews the client's history and notes which factor may be influencing the effectiveness of the drug? a. He takes cimetidine at night before bed b. He smokes a pack of cigarettes per day c. He drinks a glass of water with each dose d. He takes an antacid 4 hours after his cimetidine dose - answers-B Response Feedback: Smoking may impair the absorption of H2 antagonists. H2 blockers are often taken at bedtime to suppress the nighttime production of acid. Antacids should be spaced out by 2 hours as they can affect the absorption and efficacy of other drugs. A glass of water is recommended with any medication administration to ensure the drug reaches the stomach. A client asks the nurse about the difference between diphenoxylate with atropine (Lomotil) and the over-the-counter (OTC) drug loperamide (Imodium). Which response by the nurse is correct? a. "Lomotil works faster than Imodium" b. "Imodium does not cause physical dependence" c. "Lomotil is only available in suppository form." d. "Imodium is a natural antidiarrheal drug" - answers-B Response Feedback: Although both Immodium and Lomotil exhibit some of the characteristics of the opiate class which has known physical dependence complications, the physical dependence on loperamide (Immodium) has not been reported. Lomotil, however, does have a risk for abuse and dependence and is a Schedule V class drug. Alao, atropine is an added agent to diphenoxylate as an abuse-deterrent because in large doses it can cause dry mouth, tachycardia, abdominal pain, and blurred vision and it does augment the antimotility effects. These meds are administered orally and the other options are incorrect. After starting an oral antidiabetic drug (OAD) for type 2 diabetes mellitus (DM) four months earlier, a client presents for a follow-up examination. Which laboratory test evaluates the adherence to the antidiabetic therapy over the past few months? a. Hemoglobin level b. Serum insulin level c. Hemoglobin A1C level d. Fingerstick fasting blood glucose level - answers-C Response Feedback: The hemoglobin A1C level reflects the client's adherence to the oral antidiabetic drug for the past several months (along with lifestyle modifications). Goal HgbAIC is 7%. The other options are incorrect. Professor Reddington hates giving lispro (Humalog), a rapid-acting insulin, because of its onset of effect within which time frame? a. 1 hour b. 2 to 4 hours c. 1 to 2 hours d. 5-15 minutes - answers-D Response Feedback: The onset of action for rapid-insulin lispro (Humalog) is 5-15 minutes with a peak of 1-2 hours and a duration of 3-5 hours. Clients must eat after administration of any rapid-acting insulins or hypoglycemia can occur. The other answers are incorrect. The nurse is teaching a client about self-administration of insulin. What content is important to include? a. It is important to use the injection site that is the most accessible b. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first c. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first d. If two different insulins are ordered, they need to be given in separate injections - answers-C Response Feedback: Mixing of insulins may be ordered and certain insulins (Regular + NPH) can be mixed in the same insulin syringe. When mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first before the cloudy (NPH) insulin (CLEAR BEFORE CLOUDY or RN). It is important to rotate injection sites to avoid the buildup of fatty tissue which leads to malabsorption of the injected insulin. The nurse is teaching a review class about diabetes mellitus. Which statement by the nurse is correct? a. "Basal-bolus insulin dosing is the preferred method of treatment for DM type 1." b. "Oral antidiabetic drugs can never be combined with each other" c. "Pediatric patients cannot take insulin" d. "Patients with type 2 diabetes will never need insulin" - answers-A Response Feedback: Basal-Bolus insulin dosing is the preferred method of treatment for DM type 1 as it mimics a healthy pancreas by delivering basal insulin constantly as a basal and then as needed as a bolus (before meals or snacks). The basal insulin is a long-acting insulin (insulin glargine) and the bolus insulin is rapid-acting (insulin lispro or insulin aspart) or short-acting like regular insulin. Patients with type 2 diabetes may require insulin in certain situations (especially with elevated HgbA1C or blood glucose levels) or as their disease progresses. Pediatric patients with DM type 1 will need insulin along with close morning. Many oral antidiabetic drugs can be combined, often with Metformin, for maximum therapy. A 75-year-old client with type 2 diabetes has recently been placed on acarbose (Precose), an alpha-glucosidase inhibitor. She asks the nurse when the best time would be to take this medication. What is the nurse's best response? a. "It does not matter what time of day you take this medication" b. "Take this medication in the evening with a snack" c. "This medication needs to be taken within 30 minutes of eating" d. "Take this medication with the first bite of your meal" - answers-D Response Feedback: Alpha-glucosidase inhibitors should be taken with the first bite of the meal, as it works in the intestines to directly affect the glucose absorption of that meal. This prevents excessive postprandial blood glucose elevations. Sulfonylureas should be taken within 30 minutes of a meal or hypoglycemia could occur. The other options are incorrect. When teaching about hypoglycemia, the nurse will make sure that the client is aware of the early signs of hypoglycemia, including which of these? a. Nausea and diarrhea b. Confusion and sweating c. Fruity, acetone odor to the breath d. Hypothermia and seizures - answers-B Response Feedback: Early symptoms of hypoglycemia include the central nervous system (CNS) manifestations of confusion, irritability, tremor, fatigue, tachycardia, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect. When teaching a client who is starting metformin (Glucophage), which instruction by the nurse is correct? a. "If you are hospitalized or need a computed tomography (CT) scan we will need to hold or discontinue your metformin dose" b. "Take metformin with the first bite of your meal" c. "Take metformin within 30 minutes of your meal" d. "Take metformin only if your blood glucose level is above 150 mg/dL" - answers-A Response Feedback: Metformin is contraindicated with iodinated contrast dye used in many computed tomography (CT) scans (and some MRIs) due to the increased risk of lactic acidosis. Sulfonylureas need to be taken within 30 minutes of a meal. Alpha-glucosidase inhibitors need to be taken with the first bite of your meal. Metformin is taken daily or BID (twice a day) standing and not in relation to individual blood glucose levels. The nurse is reviewing a client's medication list and notes that empagliflozin (Jardiance) is ordered. The nurse educates the patient on what potential adverse effect that could occur? a. Blurry vision b. Genital fungal infection and urinary tract infection (UTI) c. Hypertension d. Hypoglycemia - answers-B Response Feedback: Empagliflozin (Jardiance) is a Sodium-Glucose Co-Transporter 2 (SGLT2) inhibitor that works on the kidneys to reduce glucose reabsorption and reduce blood glucose by the elimination of glucose in the urine (glucosuria). Glucosuria facilitates genital fungal infection and UTIs, as glucose (sugar) helps candida (yeast) grow and thrive. There is no hypoglycemia risk because there is NO stimulation of insulin release or effect on the pancreas. Hypertension and blurry vision are incorrect. A client with diabetes is starting a long-acting insulin, insulin glargine (Lantus). The nurse makes what correct statement? a. "Insulin glargine (Lantus) peaks at 6 hours, so it needs to be taken twice a day" b. "This insulin has no peak and is dosed once daily" c. "It is important you take this insulin 30 minutes before your meals" d. "This medication should be drawn up using a millimeter syringe and subcutaneous needle" - answers-B Response Feedback: Insulin glargine (Lantus) is (usually) a once-daily insulin injection with a duration of 24 hours and NO peak. It does not have to be given before or with meals. All insulins are drawn up with a subcutaneous needle in an insulin syringe dosed with units, not millimeters! A client is taking a glipizide (Glucotrol), a sulfonylurea medication, for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during teaching, the nurse will include information about which of these effects? (Select all that apply) a. Hypoglycemia b. Hypotension c. Weight gain d. Peripheral edema e. Nausea - answers-A, C, E Response Feedback: The most common adverse effect of sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight possibly because sulfonylureas work by stimulating the beta cells in the pancreas to release more insulin. The increased insulin levels may lead to enhanced storage of calories in the form of fat, contributing to weight gain. GI disturbances such as nausea/vomiting/diarrhea also occur. A client is taking both cyclobenzaprine (Flexeril) and oxycodone after undergoing spinal surgery. Which is a priority assessment to be completed by the nurse when taking this drug regime? a. Bowel sounds b. Heart rate c. Muscle strength d. Level of consciousness - answers-D A client is taking a 10-day corticosteroid taper to help with the irritating inflammation from their cerebral subarachnoid hemorrhage. The nurse educates the client on what adverse effects that may occur with taking a corticosteroid? (Select all that apply) a. CNS depression b. Hypertension c. Insomnia d. Increased stomach acid e. Hyperglycemia - answers-B, C, D, and E Response Feedback: Corticosteroids have many short-term adverse effects, which include hypertension, tachycardia, hyperglycemia, insomnia, leucocytosis, acne, impotence/sexual dysfunction, fluid retention, increased appetite, weight gain, changes in mood, and increased stomach acid with dyspepsia. Corticosteroids do not cause CNS depression. A 38-year-old man has come into the urgent care center with severe hip pain after falling from a ladder at work. He says he has taken a lot of pain pills over the past few hours but cannot remember how many he has taken. He hands the nurse an empty bottle of acetaminophen (Tylenol). The nurse is aware that the most serious toxic effect of acute acetaminophen overdose is which condition? a. Renal failure b. Central nervous system depression c. Tachycardia d. Hepatotoxicity - answers-D Hepatotoxicity is the most serious acute toxic effect of an acute overdose of acetaminophen (Tylenol). The other options are incorrect. A client had abdominal surgery this morning. The patient is groggy but complaining of severe pain around the incision. What is the most important assessment data to consider before the nurse administers a dose of intravenous (IV) morphine sulfate to the patient? a. The patient's heart rate b. The patient's respiratory rate c. The appearance of the incision d. The date of the patient's last bowel movement - answers-B Response Feedback: One of the most serious adverse effects of opioids, such as morphine, is respiratory depression. The nurse must assess the respiratory rate before administering an opioid. The other options are important assessments but not directly related to morphine administration. A client will be discharged with a 1-week supply of an opioid analgesic for pain management after knee surgery. The nurse will include which information in the teaching plan? a. The importance of taking the drug only when the pain becomes severe b. The importance of taking the drug on an empty stomach c. How to prevent constipation d. How to prevent dehydration due to diarrhea - answers-C Response Feedback: Gastrointestinal (GI) adverse effects, such as nausea, vomiting, and especially CONSTIPATION are the most common adverse effects associated with opioid analgesics. Physical dependence usually occurs in patients undergoing long-term treatment. Diarrhea is not an effect of opioid analgesics. Taking the dose with food may help minimize GI upset. A client with chronic back pain is applying a lidocaine patch at 8 am. What time will he remove the lidocaine patch? A. He does not need to remove the lidocaine patch, it can stay in place until it naturally falls off b. He will remove the lidocaine patch when the pain is improved c. He will remove the lidocaine patch at 8 am the next day (24hrs) d. He will remove the lidocaine patch at 8 pm (12hrs) - answers-D Response Feedback: Lidocaine patches should be left in place for no more than 12 hours; if the patch is applied at 8 am then it should be removed at 8 pm the same day. The other answers are incorrect. A client is taking ibuprofen (Motrin) routinely for shoulder pain they experience after walking their large, misbehaved, dog every day. The nurse recommends taking omeprazole (Prilosec) and says which correct statement to the client regarding why? A. "Taking omeprazole will help protect your stomach while you are taking a non-steroidal anti-inflammatory drug (NSAID)" b. "Taking omeprazole will help potentiate the analgesic effects of ibuprofen" c. "Taking omeprazole will help protect your liver while you are taking a non-steroidal anti-inflammatory drug (NSAID)" d. "Taking omeprazole will help with the constipating effects of taking an opioid drug" - answers-A Response Feedback: Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID) can irritate the stomach lining, potentially leading to gastritis or the formation of ulcers, especially when used for long-term therapy. Taking omeprazole, a proton pump inhibitor (PPI) can help protect the stomach from excessive acid secretion and decrease the risk of gastric ulcer formation. Acetaminophen can cause hepatic toxicity, not NSAIDs, and omeprazole has no role in protecting the liver. Omeprazole also has no role in potentiating analgesic effect and is not constipating. A client is taking gabapentin (Neurontin), an anticonvulsant, but the nurse notes that there is no history of seizures on their medical record. What is the best possible rationale for this medication order? a. The medical record is missing the correct information about the patient's history of seizures b. The medication is helpful for the treatment of multiple sclerosis c. The medication is used for the treatment of neuropathic pain d. The medication is used to reduce the symptoms of Parkinson's disease - answers-C Response Feedback: Gabapentin (Neurontin) is commonly used to treat neuropathic pain. The other options are incorrect. A client is prescribed Buprenorphine (Buprenex) to help with their opioid addiction. This is considered which class of drug? A. Non-opioid b. Agonist-antagonist opioid c. Opioid agonist d. Opioid antagonist - answers-B Response Feedback: Buprenorphine is considered an agonist-antagonist opioid, also known as partial agonist or mixed agonist-antagonist, and is a class of opioid drugs that have both agonist (activating) and antagonist (blocking) properties at the opioid receptors; these drugs are often used to help treat opioid dependence or addiction. Non-opioids are drugs such as non-steroidal anti-inflammatory drugs, acetaminophen, and aspirin. Opioid agonists are drugs such as oxycodone, morphine, fentanyl, and hydromorphone. An opioid antagonist is naloxone, which is often used for opioid overdoses and toxicity. A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct? a. "The full therapeutic effects may not occur for several weeks" b. "Make sure you take this medication with food, or you will not see the full therapeutic effect" c. "This means you may need surgery for full therapeutic effect" d. "Make sure you take this medication at night to correspond with your circadian sleep cycles" - answers-A Response Feedback: Thyroid replacement drugs such as levothyroxine may take up to several weeks to see therapeutic effects. Surgery is not indicated in hypothyroidism but can be a treatment for hyperthyroidism. Levothyroxine should be taken on an empty stomach, as the absorption of levothyroxine can be affected by the presence of food, especially certain minerals and nutrients. Levothyroxine is most effective to take in the morning 30 minutes before breakfast so it will have drug effects early in the day, as it works with the body's metabolism (to increase it) and will be the most effective at that time to help with increased energy etc. A client is diagnosed with a seizure disorder and is started on an antiseizure drug. The nurse includes which correct teaching statements regarding their antiseizure drug regime? SELECT ALL THAT APPLY a. "You will most likely need to take this medication for the rest of your life" b. "It is ok to stop taking the medication if your seizures have stopped" c. "Take this medication at the same time each day" d. "You do not need any bloodwork or monitoring with this medication" e. "If you have a procedure requiring you to be NPO (not having anything by mouth), check with your healthcare provider regarding your antiseizure medication dosage." - answers-A, C, E Response Feedback: Antiseizure drugs are often needed for lifelong therapy for symptomatic treatment of seizure control. It is important to take medications every day as instructed and at the same time so that there are consistent therapeutic drug levels in the body. Always check with your healthcare provider if you are undergoing a procedure that requires you to be NPO, as most antiseizure drugs should still be taken to prevent seizures from occurring during the procedure. Many antiseizure drugs can be monitored with serum drug levels and adverse effects should be monitored by a healthcare professional throughout therapy. Antiseizure medications should never be abruptly stopped for the risk of rebound seizures and status epileptics that could occur. A client calls the nurse and asks why she has a transdermal patch placed behind her ear. She has just returned post-operatively from having surgery to remove a brain tumor. The nurse says what correct response? a. "The patch is an antiinfective so you don't get an infection from surgery" b. "The patch was placed to treat anticipatory nausea that is likely to occur with this type of surgery." c. "The patch is a monitoring device used during your surgery" d. "The patch was placed to help control your heart rate during surgery" - answers-B Response Feedback: A scopolamine transdermal patch is often placed prophylactically behind the ear to treat anticipatory nausea. Brain surgery, especially if near the vomiting center or chemoreceptor trigger zone in the brain, can cause increased nausea and vomiting post-operatively. The other answers are incorrect. A client who has AIDS complains of constant nausea, has also lost weight, and is easily fatigued because of his malnourished state. The nurse anticipates an order for which antinausea drug to help with nausea and stimulate his appetite? a. Aprepitant (Emend), a substance P/NK1 receptor antagonist b. Ondansetron (Zofran), a serotonin blocker c. Metoclopramide (Reglan), a prokinetic drug d. Dronabinol (Marinol), a tetrahydrocannabinoid - answers-D Response Feedback: Dronabinol is a tetrahydrocannabinoid that is used for the treatment of nausea and vomiting. It is also used to stimulate appetite and weight gain for those who have diseases such as AIDs; also can be used for cancer patients, pediatrics, and the elderly with poor appetite. The drugs in the other options are used to reduce or prevent nausea and vomiting but are not used to stimulate appetite. A client is experiencing status epilepticus. The nurse prepares to give which priority drug for the treatment of this condition? a. Diazepam (Valium) b. Levetiracetam (Keppra) c. Valproic acid (Depakote) d. Carbamazepine (Tegretol) - answers-A Response Feedback: A benzodiazepine, such as diazepam (Valium), is considered the first-line rescue drug for status epileptics (given intravenously). Loading doses of the antiseizure medications listed may also be given after benzodiazepines have been initially administered. A client inquires why he is not taking phenobarbital for his seizure disorder as his father did. The nurse makes what correct statement? a. "I can ask your healthcare provider to change your medication to phenobarbital" b. "Phenobarbital causes significant CNS depression and is rarely used today" c. "Phenobarbital is more expensive and difficult to find in today's market" d. "Phenobarbital only treats certain types of seizures" - answers-B Response Feedback: Phenobarbital is an older drug that is rarely used today due to the significant CNS and respiratory depression it causes. It also can cause dependence, be habit-forming, and cause rebound seizures if stopped abruptly. The other answers are incorrect. A client is on a chemotherapy regimen in an outpatient clinic and is receiving a chemotherapy drug that is known to be highly emetogenic. The nurse will implement which interventions regarding the pharmacologic management of nausea and vomiting? (Select all that apply) a. Observing carefully for the adverse effects of restlessness and anxiety b. Instructing the patient that the antinausea drugs may cause drowsiness c. Instructing the patient to rise slowly from a sitting or lying position because of possible orthostatic hypotension d. Administering antinausea drugs 30 to 60 minutes before chemotherapy is started e. For best therapeutic effects, medicating for nausea once the symptoms begin f. Giving antinausea drugs at the beginning of the chemotherapy infusion - answers-B, C, D Response Feedback: Antiemetics should be given before any chemotherapy drug is administered, often 30 to 60 minutes before treatment, but not immediately before chemotherapy is administered. Do not wait until the nausea begins. Most antiemetics cause drowsiness, not restlessness and anxiety. Orthostatic hypotension is a possible adverse effect that may lead to injury. A nurse is teaching a client who is starting on propylthiouracil (PTU) for hyperthyroidism. What signs and symptoms should the nurse teach the patient to be aware of when taking this medication? a. Tachycardia, fever, and weight loss b. Immune-mediated skin rashes c. Prolonged QTC d. Drowsiness, constipation, and bradycardia - answers-D Response Feedback: Adverse effects of Propylthiouracil (PTU) that are most commonly seen are the effects of thyroid suppression (i.e., symptoms of hypothyroidism), such as drowsiness, lethargy, bradycardia, weight gain, and constipation. The other answers are incorrect A client is receiving a tube feeding through a gastrostomy and is noted to have a large tube feed residual (500cc) in their stomach. The nurse expects which type of drug will be used to promote gastric emptying? a. Metoclopramide (Reglan) b. Prochlorperazine (Compazine) c. Ondansetron (Zofran) d. Scopolamine patch (Transderm-Scop) - answers-A Response Feedback: Metoclopramide (Reglan) promotes the movement of substances through the gastrointestinal tract and increases gastrointestinal motility. The other answers are incorrect.