ATI Custom PNU 119 Exam 3
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Free ATI Custom PNU 119 Exam 3 Questions
A nurse is reinforcing teaching for a client who is depressed and has a prescription for fluoxetine 20 mg PO twice daily. The nurse should identify that which of the following statements by the client demonstrates an understanding of the teaching?
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"I can stop taking this medication if I'm feeling better after the first month."
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"I should avoid eating cheese while taking this medication."
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"I'll take my second dose of this medicine at bedtime."
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"I'll need to report weight loss or gain to my provider while taking this medication."
Explanation
Explanation:
Correct Answer: (D) "I'll need to report weight loss or gain to my provider while taking this medication."
Fluoxetine, an SSRI antidepressant, is known to cause changes in appetite and body weight — both weight loss (more common initially) and weight gain (with long-term use). Reporting these changes to the provider is important for monitoring the client's overall health, nutritional status, and medication effectiveness, demonstrating accurate understanding of the drug's side effect profile.
Why Other Options are Incorrect:
A. "I can stop taking this medication if I'm feeling better after the first month." — Fluoxetine must never be stopped abruptly. Discontinuing antidepressants without tapering can cause discontinuation syndrome and relapse of depression. Clients should continue taking the medication as prescribed and only stop under provider guidance.
B. "I should avoid eating cheese while taking this medication." — Avoiding tyramine-rich foods such as aged cheese is a requirement for MAOIs (monoamine oxidase inhibitors), not SSRIs like fluoxetine. This statement reflects a misunderstanding of medication class requirements.
C. "I'll take my second dose of this medicine at bedtime." — Fluoxetine is activating and can cause insomnia and nervousness. Taking a dose at bedtime can interfere with sleep. It is generally recommended to take fluoxetine doses in the morning or early afternoon to minimize sleep disturbances.
The nurse is caring for a patient taking tobramycin for recurrent conjunctivitis (pink eye). The nurse should monitor which laboratory test while the patient is being treated?
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WBC and Platelets
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BUN and Creatinine
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AST and ALT
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PT and INR
Explanation
Explanation:
Correct Answer: (B) BUN and Creatinine.
Tobramycin is an aminoglycoside antibiotic that carries a significant risk of nephrotoxicity (kidney damage). BUN (Blood Urea Nitrogen) and creatinine are the primary indicators of renal function. Regular monitoring of these values throughout tobramycin therapy is essential to detect early signs of kidney injury and prevent permanent renal damage. Ototoxicity is another major concern and audiologic monitoring may also be warranted.
Why Other Options are Incorrect:
A. WBC and Platelets — These are hematologic markers used to assess infection and bleeding risk. While useful in general clinical monitoring, they are not the priority laboratory tests specific to tobramycin toxicity.
C. AST and ALT — AST and ALT are liver function tests. Tobramycin is primarily nephrotoxic, not hepatotoxic, making these not the priority lab values to monitor during tobramycin therapy.
D. PT and INR — PT and INR measure coagulation function and are monitored for clients on anticoagulation therapy such as warfarin. They are not relevant to tobramycin administration.
A nurse is caring for a client who is postoperative and receiving fentanyl via patient controlled analgesia. The client has a prescription for naloxone. The nurse understands that the purpose of naloxone is which of the following?
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To treat nausea
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To suppress respiratory secretions
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To treat urinary retention
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Block the effects of opioids on the central nervous system
Explanation
Explanation:
Correct Answer: (D) Block the effects of opioids on the central nervous system.
Naloxone is a pure opioid antagonist that competitively binds to opioid receptors in the CNS, rapidly reversing the effects of opioids such as fentanyl. It is prescribed as a reversal agent for opioid-induced respiratory depression, the most life-threatening complication of opioid therapy. By displacing opioids from their receptors, naloxone restores normal respiratory drive within minutes of administration.
Why Other Options are Incorrect:
A. To treat nausea — Naloxone is not an antiemetic. Opioid-induced nausea is managed with medications such as ondansetron or promethazine, not naloxone.
B. To suppress respiratory secretions — Suppression of respiratory secretions is associated with anticholinergic medications such as atropine or glycopyrrolate, not naloxone.
C. To treat urinary retention — While opioids can cause urinary retention, naloxone is not prescribed specifically for this purpose. Urinary retention is managed through catheterization or by reducing the opioid dose.
A nurse caring for a client who has a new prescription for atenolol. For which of the following adverse effects should the nurse monitor the client?
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Anemia
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Neutropenia
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Hypokalemia
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Bradycardia
Explanation
Explanation:
Correct Answer: (D) Bradycardia.
Atenolol is a cardioselective beta-1 adrenergic blocker used to treat hypertension, angina, and cardiac arrhythmias. By blocking beta-1 receptors in the heart, it reduces heart rate and myocardial contractility. A primary and expected adverse effect is bradycardia (heart rate below 60 beats per minute). The nurse should assess the apical pulse before each dose and withhold the medication if the heart rate falls below 60 bpm, notifying the provider.
Why Other Options are Incorrect:
A. Anemia — Anemia is not a recognized adverse effect of atenolol. It is more commonly associated with medications such as chemotherapy agents or certain antibiotics that affect bone marrow production.
B. Neutropenia — Neutropenia (low white blood cell count) is not an adverse effect of beta-blocker therapy. It is more commonly associated with certain antithyroid medications, chemotherapy, or clozapine.
C. Hypokalemia — Hypokalemia is primarily associated with diuretics, particularly loop and thiazide diuretics, not beta-blockers. Atenolol does not significantly affect potassium levels.
Which of the following actions should the nurse take when administering IV therapy?
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Ensure the IV site is clean, dry, intact, patent and free from any signs of infection, infiltration or phlebitis.
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Avoid using an infusion pump for IV administration to prevent complications.
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Administer IV medications as quickly as possible to ensure rapid therapeutic effects.
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Use a small gauge needle for IV insertion to minimize discomfort for the client.
Explanation
Explanation:
Correct Answer: (A) Ensure the IV site is clean, dry, intact, patent and free from any signs of infection, infiltration or phlebitis.
Before administering any IV therapy, assessing the IV site is a fundamental and non-negotiable nursing responsibility. A clean, intact, and patent site free from redness, swelling, warmth, or pain ensures the medication enters the bloodstream correctly and prevents serious complications such as infection, infiltration into surrounding tissue, or phlebitis.
Why Other Options are Incorrect:
B. Avoid using an infusion pump for IV administration — Infusion pumps are actually strongly recommended and often required for IV therapy to ensure precise flow rates and prevent over- or under-infusion, particularly with high-alert medications.
C. Administer IV medications as quickly as possible — Rapid IV administration can cause serious adverse effects including cardiac arrhythmias, toxicity, and anaphylaxis. Medications must be administered at the prescribed rate.
D. Use a small gauge needle for IV insertion — While smaller gauge needles cause less discomfort, the appropriate gauge is selected based on the type of fluid or medication being administered, the client's vein size, and clinical need — not solely for comfort.
A nurse is caring for a client who has gastroesophageal disease and a prescription for metoclopramide. For which of the following adverse effects should the monitor?
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Sedation
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Hypertension
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Blurred vision
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Urinary retention
Explanation
Explanation:
Correct Answer: (A) Sedation
Metoclopramide is a dopamine antagonist used to treat gastroesophageal reflux and gastroparesis. One of its most common adverse effects is sedation, as it crosses the blood-brain barrier and affects central dopamine receptors. Nurses must monitor for drowsiness, fatigue, and other CNS depressant effects, particularly when clients are performing activities that require alertness.
Why Other Options are Incorrect:
B. Hypertension — Metoclopramide does not commonly cause hypertension. It may occasionally affect blood pressure, but this is not a primary or notable adverse effect to monitor.
C. Blurred vision — Blurred vision is not a recognized significant adverse effect of metoclopramide. This side effect is more commonly associated with anticholinergic medications.
D. Urinary retention — Urinary retention is an anticholinergic side effect. Metoclopramide has prokinetic, not anticholinergic properties, so urinary retention is not an expected adverse effect.
A nurse is preparing to administer methylergonovine IM for a client who had a vaginal delivery earlier that day. The nurse should explain to the client that this medication will help prevent which of the following?
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Postpartum hemorrhage
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Hypertension
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Thromboembolic events
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Postpartum infection
Explanation
Explanation:
Correct Answer: (A) Postpartum hemorrhage.
Methylergonovine is an ergot alkaloid that causes sustained uterine contraction (uterotonic effect). It is administered after delivery to promote uterine tone and reduce the risk of postpartum hemorrhage, which occurs when the uterus fails to contract adequately (uterine atony) after birth. It is one of the primary medications used to manage and prevent excessive postpartum bleeding.
Why Other Options are Incorrect:
B. Hypertension — Methylergonovine actually causes vasoconstriction and can elevate blood pressure. It is contraindicated in clients with hypertension, making this the opposite of a therapeutic goal.
C. Thromboembolic events — Methylergonovine does not prevent blood clots. Anticoagulants such as heparin or low molecular weight heparin are used for thromboembolic prophylaxis in the postpartum period.
D. Postpartum infection — Methylergonovine has no antimicrobial properties and does not prevent postpartum infection. Antibiotics are used for infection prevention and treatment.
A nurse is reviewing laboratory data from a client who has pulmonary embolism and is receiving IV heparin. Which of the following findings should the nurse report to the provider?
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Platelets 74,000/mm³
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Partial thromboplastin time (PTT) 75 seconds
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Hematocrit 45%
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White blood cell count 8,000/mm³
Explanation
Explanation:
Correct Answer: (A) Platelets 74,000/mm³
A platelet count of 74,000/mm³ is critically below the normal range of 150,000–400,000/mm³ and is a hallmark finding of Heparin-Induced Thrombocytopenia (HIT), a serious and potentially life-threatening complication of heparin therapy. This must be reported to the provider immediately, as continued heparin use in HIT can paradoxically increase the risk of thrombosis.
Why Other Options are Incorrect:
B. Partial thromboplastin time (PTT) 75 seconds — For a client receiving therapeutic IV heparin, the goal PTT is typically 60–100 seconds (1.5 to 2.5 times the normal value of approximately 30–40 seconds). A PTT of 75 seconds falls within the therapeutic range and does not require provider notification.
C. Hematocrit 45% — A hematocrit of 45% falls within the normal range (male: 42–52%, female: 37–47%) and does not require reporting.
D. White blood cell count 8,000/mm³ — A WBC of 8,000/mm³ is within the normal range of 5,000–10,000/mm³ and does not indicate any concern.
A nurse is caring for an older adult client who has cancer and is receiving opioids for pain relief. The client has a new prescription for docusate PO daily. When collecting data from the client, which of the following therapeutic effects of docusate should the nurse expect?
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Relief from nausea
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Relief from constipation
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Decreased cancer pain
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Decreased drowsiness
Explanation
Explanation:
Correct Answer: (B) Relief from constipation.
Docusate is a stool softener that works by drawing water and fat into the stool, making it softer and easier to pass. Opioid analgesics, commonly used for cancer pain management, are well-known to cause opioid-induced constipation by reducing GI motility. Docusate is routinely prescribed alongside opioids specifically to prevent and relieve this expected adverse effect.
Why Other Options are Incorrect:
A. Relief from nausea — Docusate has no antiemetic properties and is not indicated for the treatment of nausea. Antiemetics such as ondansetron or promethazine are used for this purpose.
C. Decreased cancer pain — Docusate is a stool softener with no analgesic properties whatsoever. It has no effect on pain management.
D. Decreased drowsiness — Docusate does not affect alertness or sedation. Opioid-induced drowsiness is managed through dose adjustment or medication changes, not stool softeners.
A nurse is collecting data on a client who has a prescription for morphine. The nurse should recognize that which of the following data is a priority to obtain before administering this medication?
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Blood pressure
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Apical heart rate
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Respiratory rate
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Temperature
Explanation
Explanation:
Correct Answer: (C) Respiratory rate
Morphine is an opioid analgesic whose most dangerous and potentially fatal adverse effect is respiratory depression. Before administering morphine, the nurse must assess the client's respiratory rate, as a rate below 12 breaths per minute is a contraindication to administration. Monitoring respiratory status is the top priority to prevent life-threatening opioid-induced respiratory suppression.
Why Other Options are Incorrect:
A. Blood pressure — While morphine can cause hypotension, particularly orthostatic hypotension, blood pressure monitoring is a secondary concern compared to the critical risk of respiratory depression.
B. Apical heart rate — Morphine can cause bradycardia, but this is less immediately life-threatening than respiratory depression and is therefore not the priority assessment before administration.
D. Temperature — Temperature has no direct clinical relevance to the safe administration of morphine and is not a standard pre-administration assessment for this medication.
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