RN Adolescents EAQ
The nurse is caring for a client with burns receiving opioid analgesics and who is
sedated. Which medications should the nurse anticipate to be prescribed by the
primary healthcare provider to overcome this side effect of the opioid analgesics?
A: Pregabalin
A: Gabapentin
Lorazepam
Morphine
Midazolam - ANSWER: Pregabalin and gabapentin are adjuvant analgesics used to
overcome the side effects caused by opioid analgesics.
Morphine is an opioid analgesic used in the treatment of pain that can cause
sedation.
Lorazepam and midazolam are anxiolytic agents used to inhibit anxiety.
After an anterior fossa craniotomy, a client is placed on controlled mechanical
ventilation. To ensure adequate cerebral blood flow, which action should the nurse
take?
Monitor serum carbon dioxide levels routinely. - ANSWER: Carbon dioxide levels
must be maintained since carbon dioxide can cause vasodilation, increasing
intracranial pressure, and decreasing blood flow. The fluid may be cerebrospinal
fluid; clearing the ear may cause further damage. Because of manipulation during a
craniotomy, anticonvulsants are given prophylactically to prevent seizures. Elevating
the head of the bed 30 degrees will not increase cerebral blood flow.
What should the nurse emphasize when providing discharge instructions for a client
with the diagnosis of Addison disease?
Continue steroid replacement therapy. - ANSWER: Clients with Addison disease must
take glucocorticoids regularly to enable them to adapt physiologically to stress and
to prevent an addisonian crisis, a medical emergency similar to shock. Activity is
permitted as tolerated. Sodium should be taken as desired because hyponatremia
frequently occurs from diminished mineralocorticoid secretion. Frequent visits to a
healthcare provider are not necessary after control has been established.
A client who has cancer of the sigmoid colon is to have an abdominoperineal
resection with a permanent colostomy. Before surgery a low-residue diet is
prescribed. What is the nurse's explanation for the necessity of this diet?
, Reduce the amount of stool in the large bowel - ANSWER: This diet is low in fiber;
after digestion and absorption there is only a small amount of residue to be
eliminated. This diet does not promote peristalsis; the products of digestion remain
in the intestine longer, and flatus is increased. Although a low-residue diet is less
irritating, this is not the primary reason for its use before surgery. Antimicrobials
such as neomycin are given to lower the bacterial count in the gastrointestinal tract.
While assessing a client during an ophthalmic pupillary physical examination, the
primary healthcare provider observes a noticeable difference in the size of pupils in
the client. Which term should the nurse use to describe this condition?
Anisocoria - ANSWER: A noticeable difference in the size of the pupils of the clients is
known as anisocoria, a normal condition in about 5% of people. The normal diameter
of the pupil is between 3 and 5 mm; clients with hyperopia have smaller pupils with
a diameter of less than 3 mm. Mydriasis is the process of pupillary dilation. Arcus
senilis is an opaque bluish-white ring within the outer edge of the cornea caused by
the presence of fat deposits.
In order to ensure a quality specimen and an accurate test result, which instruction
should the nurse give a client who is scheduled to undergo urine endocrine testing?
"Store the urine specimen in a cooler with ice." - ANSWER: The urine specimen that
is collected for endocrine testing should be stored in a cooler with ice to prevent
bacterial growth in the specimen. The nurse should instruct the client to start the
urine collection after emptying the bladder. The client should be instructed not to
store the urine specimen in a home refrigerator with other food and drinks as it
could lead to cross-contamination. The client should be instructed to refrain from
saving the urine specimen that begins the collection because the timing for urine
collection starts from after the initial voiding specimen.
The primary healthcare provider suspects pituitary gland dysfunction in a female
client. Which diagnostic test would the primary healthcare provider suggest to the
client?
Prolactin test - ANSWER: A prolactin test is used to detect pituitary gland dysfunction
that causes amenorrhea. Therefore the primary healthcare provider would suggest
that the client have a prolactin test to determine if the client does or does not have
any pituitary gland dysfunction. Estradiol is tested to determine functioning of the
ovaries. In men, the estradiol test is used to detect testicular tumors. The Sims-
Huhner test is used to evaluate the hostility of the cervix for passage of sperm from
the vagina into the uterus. The Papanicolaou (Pap) test detects malignancies,
particularly cervical cancer.
A healthcare provider schedules a paracentesis. What should the nurse instruct the
client to do to prepare for the procedure?
, Empty the bladder before the procedure. - ANSWER: Emptying the bladder before a
paracentesis prevents its accidental puncture during the procedure. No bowel
preparation is indicated. The client may eat and drink as tolerated. A low soapsuds
enema two hours before the procedure is not indicated for a paracentesis.
Nasogastric (NG) tube irrigations are prescribed for a client after abdominal surgery.
The nurse instills 30 mL of saline solution, and 10 mL is returned. How should the
nurse proceed?
Record 20 mL as intake - ANSWER: This 20 mL must be accounted for in the intake
and output, either by including it as intake or by subtracting it from the total gastric
drainage. High suction may lead to adherence of mucosa to the tube and potential
injury. Repositioning the nasogastric tube is unnecessary. Return of 10 mL indicates
patency; more frequent irrigations are not indicated.
A nurse is caring for a client who underwent a cervical biopsy. The nurse finds that
the client has a body temperature of 100° F, increased abdominal pain, and
increased drainage that is foul-smelling. Which action is priority?
Report the client's condition to the primary healthcare provider - ANSWER: A client
who underwent a cervical biopsy may have a body temperature of 100° F, increased
abdominal pain, and foul-smelling drainage due to infection. The nurse should report
these findings regarding the client's condition to the primary healthcare provider to
prevent sepsis. Analgesics may reduce the pain in the client, but not the other
symptoms. Placing the client in the lithotomy position will not provide adequate
comfort. The client should not douche the genital area for about two weeks after a
cervical biopsy.
When preparing discharge teaching for a client who had a kidney transplant, in
addition to a corticosteroid, the nurse expects what other medications to be
prescribed to prevent kidney rejection?
Furosemide and sirolimus
Cefazolin and methotrexate
Methylprednisolone and phenytoin
Tacrolimus and mycophenolate mofetil - ANSWER: A: Tacrolimus and mycophenolate
mofetil
Standard triple therapy includes a corticosteroid prednisone (methylprednisolone),
an antimetabolite (mycophenolate), and a calcineurin inhibitor (tacrolimus and
cyclosporine). Although sirolimus is used for immunosuppression, furosemide is a
diuretic. Neither of these medications are immunosupressives. Cefazolin is an
antibiotic, and methotrexate is a folic acid antagonist used in cancer chemotherapy.
The nurse is caring for a client with burns receiving opioid analgesics and who is
sedated. Which medications should the nurse anticipate to be prescribed by the
primary healthcare provider to overcome this side effect of the opioid analgesics?
A: Pregabalin
A: Gabapentin
Lorazepam
Morphine
Midazolam - ANSWER: Pregabalin and gabapentin are adjuvant analgesics used to
overcome the side effects caused by opioid analgesics.
Morphine is an opioid analgesic used in the treatment of pain that can cause
sedation.
Lorazepam and midazolam are anxiolytic agents used to inhibit anxiety.
After an anterior fossa craniotomy, a client is placed on controlled mechanical
ventilation. To ensure adequate cerebral blood flow, which action should the nurse
take?
Monitor serum carbon dioxide levels routinely. - ANSWER: Carbon dioxide levels
must be maintained since carbon dioxide can cause vasodilation, increasing
intracranial pressure, and decreasing blood flow. The fluid may be cerebrospinal
fluid; clearing the ear may cause further damage. Because of manipulation during a
craniotomy, anticonvulsants are given prophylactically to prevent seizures. Elevating
the head of the bed 30 degrees will not increase cerebral blood flow.
What should the nurse emphasize when providing discharge instructions for a client
with the diagnosis of Addison disease?
Continue steroid replacement therapy. - ANSWER: Clients with Addison disease must
take glucocorticoids regularly to enable them to adapt physiologically to stress and
to prevent an addisonian crisis, a medical emergency similar to shock. Activity is
permitted as tolerated. Sodium should be taken as desired because hyponatremia
frequently occurs from diminished mineralocorticoid secretion. Frequent visits to a
healthcare provider are not necessary after control has been established.
A client who has cancer of the sigmoid colon is to have an abdominoperineal
resection with a permanent colostomy. Before surgery a low-residue diet is
prescribed. What is the nurse's explanation for the necessity of this diet?
, Reduce the amount of stool in the large bowel - ANSWER: This diet is low in fiber;
after digestion and absorption there is only a small amount of residue to be
eliminated. This diet does not promote peristalsis; the products of digestion remain
in the intestine longer, and flatus is increased. Although a low-residue diet is less
irritating, this is not the primary reason for its use before surgery. Antimicrobials
such as neomycin are given to lower the bacterial count in the gastrointestinal tract.
While assessing a client during an ophthalmic pupillary physical examination, the
primary healthcare provider observes a noticeable difference in the size of pupils in
the client. Which term should the nurse use to describe this condition?
Anisocoria - ANSWER: A noticeable difference in the size of the pupils of the clients is
known as anisocoria, a normal condition in about 5% of people. The normal diameter
of the pupil is between 3 and 5 mm; clients with hyperopia have smaller pupils with
a diameter of less than 3 mm. Mydriasis is the process of pupillary dilation. Arcus
senilis is an opaque bluish-white ring within the outer edge of the cornea caused by
the presence of fat deposits.
In order to ensure a quality specimen and an accurate test result, which instruction
should the nurse give a client who is scheduled to undergo urine endocrine testing?
"Store the urine specimen in a cooler with ice." - ANSWER: The urine specimen that
is collected for endocrine testing should be stored in a cooler with ice to prevent
bacterial growth in the specimen. The nurse should instruct the client to start the
urine collection after emptying the bladder. The client should be instructed not to
store the urine specimen in a home refrigerator with other food and drinks as it
could lead to cross-contamination. The client should be instructed to refrain from
saving the urine specimen that begins the collection because the timing for urine
collection starts from after the initial voiding specimen.
The primary healthcare provider suspects pituitary gland dysfunction in a female
client. Which diagnostic test would the primary healthcare provider suggest to the
client?
Prolactin test - ANSWER: A prolactin test is used to detect pituitary gland dysfunction
that causes amenorrhea. Therefore the primary healthcare provider would suggest
that the client have a prolactin test to determine if the client does or does not have
any pituitary gland dysfunction. Estradiol is tested to determine functioning of the
ovaries. In men, the estradiol test is used to detect testicular tumors. The Sims-
Huhner test is used to evaluate the hostility of the cervix for passage of sperm from
the vagina into the uterus. The Papanicolaou (Pap) test detects malignancies,
particularly cervical cancer.
A healthcare provider schedules a paracentesis. What should the nurse instruct the
client to do to prepare for the procedure?
, Empty the bladder before the procedure. - ANSWER: Emptying the bladder before a
paracentesis prevents its accidental puncture during the procedure. No bowel
preparation is indicated. The client may eat and drink as tolerated. A low soapsuds
enema two hours before the procedure is not indicated for a paracentesis.
Nasogastric (NG) tube irrigations are prescribed for a client after abdominal surgery.
The nurse instills 30 mL of saline solution, and 10 mL is returned. How should the
nurse proceed?
Record 20 mL as intake - ANSWER: This 20 mL must be accounted for in the intake
and output, either by including it as intake or by subtracting it from the total gastric
drainage. High suction may lead to adherence of mucosa to the tube and potential
injury. Repositioning the nasogastric tube is unnecessary. Return of 10 mL indicates
patency; more frequent irrigations are not indicated.
A nurse is caring for a client who underwent a cervical biopsy. The nurse finds that
the client has a body temperature of 100° F, increased abdominal pain, and
increased drainage that is foul-smelling. Which action is priority?
Report the client's condition to the primary healthcare provider - ANSWER: A client
who underwent a cervical biopsy may have a body temperature of 100° F, increased
abdominal pain, and foul-smelling drainage due to infection. The nurse should report
these findings regarding the client's condition to the primary healthcare provider to
prevent sepsis. Analgesics may reduce the pain in the client, but not the other
symptoms. Placing the client in the lithotomy position will not provide adequate
comfort. The client should not douche the genital area for about two weeks after a
cervical biopsy.
When preparing discharge teaching for a client who had a kidney transplant, in
addition to a corticosteroid, the nurse expects what other medications to be
prescribed to prevent kidney rejection?
Furosemide and sirolimus
Cefazolin and methotrexate
Methylprednisolone and phenytoin
Tacrolimus and mycophenolate mofetil - ANSWER: A: Tacrolimus and mycophenolate
mofetil
Standard triple therapy includes a corticosteroid prednisone (methylprednisolone),
an antimetabolite (mycophenolate), and a calcineurin inhibitor (tacrolimus and
cyclosporine). Although sirolimus is used for immunosuppression, furosemide is a
diuretic. Neither of these medications are immunosupressives. Cefazolin is an
antibiotic, and methotrexate is a folic acid antagonist used in cancer chemotherapy.
