Shadow health comprehensive assessment: Updated
Solution
A patient has been given a new prescription for warfarin. Which statement indicates
the need for additional teaching?
- I will use a soft toothbrush while taking this medication
- I can eat moderate amounts of foods with vitamin K on a regular basis
- I should report unusual bleeding to my doctor
- I can keep taking a daily aspirin to protect against heart disease (Correct Response)
- ANSWER- I can keep taking a daily aspirin to protect against heart disease
Aspirin increases the effect of warfarin and may cause a higher risk of bleeding; the
patient should not take aspirin while on warfarin therapy. All other statements are
consistent with safe use of warfarin.
What is the nurse's priority assessment for a patient receiving heparin treatment?
- Assess for elevated liver enzymes
- Assess for inflammation at the injection site
- Assess for bruising or unusual bleeding
- Assess aPTT levels - ANSWER- Assess for bruising or unusual bleeding
While all options are relevant assessments, bruising or unusual bleeding can be a life
threatening adverse effect of heparin treatment, and therefore needs to be the
nurse's priority.
A patient who has been receiving oxycodone therapy for chronic pain reports no
relief after a 10mg dose. The patient is exhibiting:
- Opioid addiction
- Opioid tolerance
- Drug-seeking behaviour
- Paradoxical CNS stimulation - ANSWER- Opioid tolerance
Prolonged use of opioid therapy can lead to tolerance, where a patient requires a
higher dose of the drug to achieve an analgesic effect.
Which meal choice exhibits a lack of understanding of atorvastatin's drug-food
interactions?
- Orange juice, banana, and toast
- Grapefruit juice and yogurt
- Orange juice, bacon, and eggs
- Coffee and croissant - ANSWER- Grapefruit juice and yogurt
, Grapefruit juice is contraindicated for patients on statin therapy and it may increase
drug levels in the blood and increase the likelihood of rhabdomyolysis. None of the
other choices interact harmfully with atorvastatin.
Which statement indicates that the patient understood the nurse's discharge
information about his albuterol inhaler?
- I should use this inhaler five minutes after my beclomethasone inhaler
- I should use this inhaler regularly to manage my asthma
- I should use this inhaler when I am having an acute attack
- I should use this inhaler to reduce inflammation in my airways - ANSWER- I should
use this inhaler when I am having an acute attack
Inhaled albuterol is a rescue medication that reduces bronchoconstriction that is
present during acute attacks; it has no effect on inflammation.
A patient is taking promethazine for nausea and oxycodone for pain. What is the
nurse's priority assessment?
- Assess for breakthrough pain
- Assess sedation level
- Assess for constipation
- Assess for dizziness - ANSWER- Assess sedation level
The nurse must assess sedation level as the additive sedative effect when
promethazine and oxycodone are administered together can lead to life-threatening
respiratory depression. The other side effects do not pose immediate risk and are
therefore lower-priority assessments.
Which information is essential to include when educating the patient about
clindamycin?
- Clindamycin is primarily bacteriostatic
- Clindamycin should be continued even when feeling better
- Clindamycin can be given to patients with penicillin sensitivities
- Clindamycin can cause a harmless bitter taste - ANSWER- Clindamycin should be
continued even when feeling better
To resolve the infection and prevent the development of resistant pathogens, it is
important that the patient understands she must take an entire course of antibiotics
even if she is feeling better.
A patient with a penicillin allergy needs antibiotic treatment. Which antibiotic choice
would require close monitoring for hypersensitivity due to cross sensitivity?
- vancomycin
- azithromycin
Solution
A patient has been given a new prescription for warfarin. Which statement indicates
the need for additional teaching?
- I will use a soft toothbrush while taking this medication
- I can eat moderate amounts of foods with vitamin K on a regular basis
- I should report unusual bleeding to my doctor
- I can keep taking a daily aspirin to protect against heart disease (Correct Response)
- ANSWER- I can keep taking a daily aspirin to protect against heart disease
Aspirin increases the effect of warfarin and may cause a higher risk of bleeding; the
patient should not take aspirin while on warfarin therapy. All other statements are
consistent with safe use of warfarin.
What is the nurse's priority assessment for a patient receiving heparin treatment?
- Assess for elevated liver enzymes
- Assess for inflammation at the injection site
- Assess for bruising or unusual bleeding
- Assess aPTT levels - ANSWER- Assess for bruising or unusual bleeding
While all options are relevant assessments, bruising or unusual bleeding can be a life
threatening adverse effect of heparin treatment, and therefore needs to be the
nurse's priority.
A patient who has been receiving oxycodone therapy for chronic pain reports no
relief after a 10mg dose. The patient is exhibiting:
- Opioid addiction
- Opioid tolerance
- Drug-seeking behaviour
- Paradoxical CNS stimulation - ANSWER- Opioid tolerance
Prolonged use of opioid therapy can lead to tolerance, where a patient requires a
higher dose of the drug to achieve an analgesic effect.
Which meal choice exhibits a lack of understanding of atorvastatin's drug-food
interactions?
- Orange juice, banana, and toast
- Grapefruit juice and yogurt
- Orange juice, bacon, and eggs
- Coffee and croissant - ANSWER- Grapefruit juice and yogurt
, Grapefruit juice is contraindicated for patients on statin therapy and it may increase
drug levels in the blood and increase the likelihood of rhabdomyolysis. None of the
other choices interact harmfully with atorvastatin.
Which statement indicates that the patient understood the nurse's discharge
information about his albuterol inhaler?
- I should use this inhaler five minutes after my beclomethasone inhaler
- I should use this inhaler regularly to manage my asthma
- I should use this inhaler when I am having an acute attack
- I should use this inhaler to reduce inflammation in my airways - ANSWER- I should
use this inhaler when I am having an acute attack
Inhaled albuterol is a rescue medication that reduces bronchoconstriction that is
present during acute attacks; it has no effect on inflammation.
A patient is taking promethazine for nausea and oxycodone for pain. What is the
nurse's priority assessment?
- Assess for breakthrough pain
- Assess sedation level
- Assess for constipation
- Assess for dizziness - ANSWER- Assess sedation level
The nurse must assess sedation level as the additive sedative effect when
promethazine and oxycodone are administered together can lead to life-threatening
respiratory depression. The other side effects do not pose immediate risk and are
therefore lower-priority assessments.
Which information is essential to include when educating the patient about
clindamycin?
- Clindamycin is primarily bacteriostatic
- Clindamycin should be continued even when feeling better
- Clindamycin can be given to patients with penicillin sensitivities
- Clindamycin can cause a harmless bitter taste - ANSWER- Clindamycin should be
continued even when feeling better
To resolve the infection and prevent the development of resistant pathogens, it is
important that the patient understands she must take an entire course of antibiotics
even if she is feeling better.
A patient with a penicillin allergy needs antibiotic treatment. Which antibiotic choice
would require close monitoring for hypersensitivity due to cross sensitivity?
- vancomycin
- azithromycin
