ATI Custom PNU 119 Exam 3
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A nurse is assisting with a presentation about caring for clients who are receiving diuretic therapy. The nurse should explain that which of the following medications can put clients at risk for hyperkalemia?
- Spironolactone
- Hydrochlorothiazide
- Furosemide
- Mannitol
Explanation
Explanation:
Correct Answer: (A) Spironolactone.
Spironolactone is a potassium-sparing diuretic that works by antagonizing aldosterone receptors in the collecting ducts of the kidney, blocking sodium reabsorption and potassium excretion. Because potassium is retained rather than excreted, spironolactone places clients at risk for hyperkalemia (elevated potassium levels), which can cause dangerous cardiac arrhythmias and must be closely monitored.
Why Other Options are Incorrect:
B. Hydrochlorothiazide — Hydrochlorothiazide is a thiazide diuretic that promotes potassium excretion, placing clients at risk for hypokalemia (low potassium), not hyperkalemia.
C. Furosemide — Furosemide is a loop diuretic that causes significant potassium wasting through the kidneys, leading to hypokalemia, not hyperkalemia. It is the opposite risk to spironolactone.
D. Mannitol — Mannitol is an osmotic diuretic primarily used to reduce intracranial pressure and treat acute kidney injury. It does not specifically cause hyperkalemia and its primary electrolyte concern relates to fluid shifts rather than potassium retention.
A nurse at a provider's office is reviewing the medication record of a client who has mild dementia. The client's caregiver reports the client takes ginkgo biloba to aid his memory and warfarin for Atrial fibrillation to prevent clots. The nurse should warn the caregiver to monitor for and report which of the following adverse effects?
- Insomnia
- Decreased alertness
- Jaundice (yellowed skin)
- Bleeding gums
Explanation
Explanation:
Correct Answer: (D) Bleeding gums.
Ginkgo biloba has significant antiplatelet and anticoagulant properties of its own. When combined with warfarin, an anticoagulant, the two substances have an additive effect that greatly increases the risk of bleeding. Bleeding gums are an accessible and observable early sign of excessive anticoagulation. Other serious bleeding risks include intracranial hemorrhage and GI bleeding. The caregiver must be educated to monitor for and report any unusual bleeding immediately.
Why Other Options are Incorrect:
A. Insomnia — Insomnia is not a recognized adverse effect of the ginkgo biloba and warfarin combination. It is not related to anticoagulation risk.
B. Decreased alertness — Decreased alertness is not an expected adverse effect of this drug-herb combination. Ginkgo biloba is actually used to improve alertness and cognitive function.
C. Jaundice (yellowed skin) — Jaundice indicates liver dysfunction and is not a primary concern with ginkgo biloba and warfarin combination use. Hepatotoxicity is not a well-established adverse effect of this interaction.
A nurse is reinforcing teaching for a client who has rheumatoid arthritis and a new prescription for aspirin 650 mg orally every 6 hr. The nurse should instruct the client to monitor for which of the following adverse effects of aspirin therapy?
- Insomnia
- Blurred vision
- Constipation
- Bleeding
Explanation
Explanation:
Correct Answer: (D) Bleeding.
Aspirin irreversibly inhibits platelet aggregation by blocking thromboxane A2 synthesis, which impairs the blood's ability to clot. At the therapeutic dose of 650 mg every 6 hours used for rheumatoid arthritis, the risk of GI bleeding, easy bruising, and prolonged bleeding time is significant. Clients should be instructed to watch for signs such as black tarry stools, blood in urine, unusual bruising, or prolonged bleeding from cuts.
Why Other Options are Incorrect:
A. Insomnia — Insomnia is not a recognized adverse effect of aspirin therapy. It is more commonly associated with CNS-stimulating medications.
B. Blurred vision — Blurred vision is not a standard adverse effect of aspirin. While salicylate toxicity at very high doses can affect vision, this is not the primary adverse effect to monitor at therapeutic doses.
C. Constipation — Aspirin does not cause constipation. In fact, GI irritation, nausea, and stomach upset are more common GI complaints associated with aspirin use.
A nurse is collecting data from a client who has hypertension and a prescription for propranolol. A history of which of the following conditions is of concern?
- Migraine
- Depression
- Asthma
- Glaucoma
Explanation
Explanation:
Correct Answer: (C) Asthma.
Propranolol is a non-selective beta-blocker that blocks both beta-1 (cardiac) and beta-2 (pulmonary) adrenergic receptors. Blocking beta-2 receptors in the lungs causes bronchoconstriction, which can trigger severe bronchospasm in clients with asthma or other reactive airway diseases. This makes asthma a significant contraindication and a serious concern when propranolol is prescribed.
Why Other Options are Incorrect:
A. Migraine — Propranolol is actually FDA-approved for migraine prophylaxis. A history of migraines is not a concern and may even be an additional therapeutic benefit.
B. Depression — While beta-blockers have been associated with mood changes, depression alone is not a primary contraindication to propranolol use, though it warrants monitoring.
D. Glaucoma — Propranolol does not worsen glaucoma. Beta-blocker eye drops are actually used to treat certain types of glaucoma by reducing intraocular pressure.
A nurse is collecting data from a client who has a prescription for clindamycin. Which of the following findings should the nurse report to the provider as a potential dangerous side effect?
- Depressed mood
- Nausea
- Headache
- Watery diarrhea
Explanation
Explanation:
Correct Answer: (D) Watery diarrhea.
Watery diarrhea in a client taking clindamycin is a critical warning sign of Clostridioides difficile (C. diff) infection, also known as antibiotic-associated colitis or pseudomembranous colitis. Clindamycin is one of the antibiotics most strongly associated with C. diff because it disrupts the normal gut flora, allowing C. diff to overpopulate and produce toxins that damage the intestinal lining. This can progress to life-threatening toxic megacolon and must be reported to the provider immediately.
Why Other Options are Incorrect:
A. Depressed mood — Depression is not a recognized adverse effect of clindamycin and does not require priority reporting in the context of this medication.
B. Nausea — Nausea is a common, mild GI side effect of many antibiotics including clindamycin. While uncomfortable, it is not a dangerous or immediately reportable finding compared to watery diarrhea.
C. Headache — Headache is a non-specific complaint and not a dangerous adverse effect associated with clindamycin therapy.
A nurse is reinforcing discharge teaching with a client who has a prescription for phenytoin. Which of the following instructions is most important and accurate that the nurse should include in the teaching?
- Alter the phenytoin administration regimen each week.
- Phenytoin turns urine blue.
- Alcohol increases the chance of phenytoin toxicity.
- Switch phenytoin brands with each refill.
Explanation
Explanation:
Correct Answer: (C) Alcohol increases the chance of phenytoin toxicity.
Alcohol interacts significantly with phenytoin metabolism. Acute alcohol consumption inhibits the metabolism of phenytoin, causing its blood levels to rise and increasing the risk of toxicity, which can manifest as nystagmus, ataxia, and altered mental status. This is a critical safety teaching point that directly protects the client from serious harm.
Why Other Options are Incorrect:
A. Alter the phenytoin administration regimen each week — Phenytoin requires a consistent, stable dosing regimen. Altering the schedule can lead to subtherapeutic levels and increased risk of seizures.
B. Phenytoin turns urine blue — This is factually incorrect. Phenytoin can cause a pinkish-red to reddish-brown discoloration of urine, not blue.
D. Switch phenytoin brands with each refill — Clients should never switch between phenytoin brands or between brand and generic formulations without provider guidance, as different formulations have different bioavailability, which can affect seizure control and toxicity risk.
A nurse is collecting data prior to the administration of digoxin. Which of the following findings should the nurse report to the provider?
- Digoxin level of 1.2 ng/mL
- Digoxin level of 1.0 ng/mL
- Digoxin level of 2.0 ng/mL
- Digoxin level of 2.2 ng/mL
Explanation
Explanation:
Correct Answer: (D) Digoxin level of 2.2 ng/mL.
The therapeutic range for digoxin is 0.5–2.0 ng/mL. A level of 2.2 ng/mL exceeds this range and indicates digoxin toxicity, which can cause life-threatening cardiac arrhythmias, bradycardia, nausea, vomiting, visual disturbances (yellow-green halos), and confusion. This finding must be reported to the provider immediately and the dose withheld.
Why Other Options are Incorrect:
A. Digoxin level of 1.2 ng/mL — This falls within the therapeutic range of 0.5–2.0 ng/mL and does not require provider notification. The medication can be safely administered.
B. Digoxin level of 1.0 ng/mL — This also falls within the therapeutic range and is a safe, acceptable level. No provider notification is required.
C. Digoxin level of 2.0 ng/mL — This sits at the upper limit of the therapeutic range. While it warrants close monitoring, it is technically still within the accepted therapeutic window and does not require reporting in the same way that a clearly toxic level does.
A nurse is reinforcing teaching with a client who has a prescription for atorvastatin. Which of the following instructions should the nurse provide?
- GI symptoms are a common adverse effect.
- Report sore throat, hoarseness or cough to your provider.
- This drug can be safely used for patients with liver disease.
- Swallow the tablet with a glass of grapefruit juice.
Explanation
Explanation:
Correct Answer: (A) GI symptoms are a common adverse effect.
Atorvastatin is an HMG-CoA reductase inhibitor (statin) used to lower cholesterol. Gastrointestinal symptoms including nausea, diarrhea, abdominal cramping, and constipation are among the most commonly reported adverse effects of statin therapy. Clients should be informed of this expected side effect and instructed to report any severe or persistent GI symptoms to their provider.
Why Other Options are Incorrect:
B. Report sore throat, hoarseness or cough to your provider — These are adverse effects associated with ACE inhibitors (e.g., lisinopril), not statins. The classic ACE inhibitor cough results from bradykinin accumulation, not from atorvastatin.
C. This drug can be safely used for patients with liver disease — Atorvastatin is actually contraindicated in clients with active liver disease or unexplained persistent elevations in liver enzymes, as it is hepatically metabolized and can worsen hepatic function.
D. Swallow the tablet with a glass of grapefruit juice — Grapefruit juice inhibits the CYP3A4 enzyme system responsible for metabolizing atorvastatin, causing significantly elevated drug plasma levels and dramatically increasing the risk of myopathy and rhabdomyolysis. Clients must be specifically instructed to avoid grapefruit juice.
A nurse is reinforcing teaching with a client who reports motion sickness about using an herbal supplement. The nurse should identify that the client can use which of the following herbal supplements to help control nausea?
- Kava
- Ginger root
- Valerian
- Garlic
Explanation
Explanation:
Correct Answer: (B) Ginger root.
Ginger root has well-documented antiemetic properties and has been used for centuries to manage nausea and vomiting. It works by blocking serotonin receptors in the gut and affecting gastric motility. It is widely recognized as an effective and safe herbal remedy for motion sickness, pregnancy-related nausea, and chemotherapy-induced nausea.
Why Other Options are Incorrect:
A. Kava — Kava is used for its anxiolytic and sedative properties to reduce anxiety and promote relaxation. It has no established use as an antiemetic for motion sickness.
C. Valerian — Valerian is an herbal supplement primarily used to promote sleep and reduce anxiety. It does not have antiemetic properties and is not indicated for nausea or motion sickness.
D. Garlic — Garlic is primarily used for its cardiovascular benefits, including cholesterol reduction and blood pressure management. It has no established role in managing nausea or motion sickness.
A nurse is reinforcing teaching with a 55-year-old client who is experiencing menopause and is prescribed estradiol. The nurse should tell the client that which of the following is a benefit of estradiol therapy in women who are postmenopausal?
- EPT prevents deep-vein thrombosis.
- Estrogen prevents fractures from osteoporosis.
- EPT prevents the occurrence of gallstones.
- Estrogen prevents the development of breast cancer.
Explanation
Explanation:
Correct Answer: (B) Estrogen prevents fractures from osteoporosis.
Estrogen plays a critical role in maintaining bone density by inhibiting osteoclast activity, which breaks down bone tissue. After menopause, estrogen levels drop significantly, accelerating bone loss and increasing the risk of osteoporosis and fragility fractures. Estradiol therapy helps preserve bone mineral density in postmenopausal women, reducing the risk of fractures, particularly of the hip and vertebrae.
Why Other Options are Incorrect:
A. EPT prevents deep-vein thrombosis — This is the opposite of the truth. Estrogen therapy actually increases the risk of deep-vein thrombosis and pulmonary embolism due to its prothrombotic effects on coagulation factors.
C. EPT prevents the occurrence of gallstones — Estrogen therapy is associated with an increased risk of gallstones, not prevention. Estrogen increases cholesterol concentration in bile, promoting gallstone formation.
D. Estrogen prevents the development of breast cancer — Estrogen therapy, particularly combined estrogen-progestin therapy, is associated with an increased risk of breast cancer with long-term use, not prevention.
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