ATI Custom PNU 119 Exam 3

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.

Explanation:

Correct Answer: (C) Administer the regular dose of lithium.

The therapeutic range for lithium is 0.6–1.2 mEq/L for maintenance therapy (up to 1.5 mEq/L during acute manic episodes). A level of 1.2 mEq/L falls within the upper end of the therapeutic maintenance range, indicating the medication is at an effective and safe level. The nurse should administer the regular prescribed dose and continue routine monitoring.

Why Other Options are Incorrect:

A. Contact the laboratory to repeat the lithium level — Repeating the level is unnecessary as 1.2 mEq/L is within the established therapeutic range. Repeat testing would only be warranted if there were signs of toxicity or if the result appeared inconsistent with the clinical picture.

B. Obtain an ECG and institute seizure precautions — These interventions are indicated for lithium toxicity, which typically occurs at levels above 1.5 mEq/L. A level of 1.2 mEq/L does not indicate toxicity.

D. Contact the provider to prescribe an increased dose of lithium — Increasing the dose is not warranted when the level is already at the therapeutic maximum for maintenance therapy. Increasing it could push the client into toxic range.

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.

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.

Explanation:

Correct Answer: (B) "He seems to be getting a lot more bumps and bruises lately."

Increased bruising is a serious warning sign of carbamazepine-induced bone marrow suppression, which can lead to thrombocytopenia and aplastic anemia — both potentially life-threatening conditions. This statement requires immediate priority attention as it suggests a dangerous hematologic adverse effect that must be evaluated and reported to the provider without delay.

Why Other Options are Incorrect:

A. "He only sleeps about 5 hours each night." — While adequate sleep is important, especially for seizure management, this is not an immediately life-threatening concern compared to signs of bone marrow suppression.

C. "He has not been eating as much lately." — Decreased appetite can be a mild side effect of carbamazepine but does not represent an immediate safety threat requiring priority intervention.

D. "He takes his medication between meals with water." — Carbamazepine can actually be taken with food to reduce GI upset, so this warrants some correction, but it is not a priority safety concern compared to signs of hematologic toxicity.

Explanation:

Correct Answer: (A) "St. John's wort may improve symptoms of depression."

St. John's wort (Hypericum perforatum) is the most widely studied herbal supplement for mental health. It is believed to work similarly to antidepressants by inhibiting the reuptake of serotonin, dopamine, and norepinephrine. Multiple clinical studies have shown it to be effective in improving mild to moderate depression symptoms, making this the most accurate and evidence-supported statement about its use.

Why Other Options are Incorrect:

B. "St. John's wort may stimulate the immune system." — Immune stimulation is associated with echinacea, not St. John's wort. This is an inaccurate claim about St. John's wort's mechanism or primary use.

C. "St. John's wort may improve overall energy." — While improved mood from treating depression may indirectly increase energy, St. John's wort is not recognized or indicated specifically as an energy-enhancing supplement.

D. "St. John's wort may enhance memory and cognition." — Memory enhancement and cognitive improvement are associated with ginkgo biloba, not St. John's wort.

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.

Explanation:

Correct Answer: (B) Increased effects of oral anticoagulants.

Garlic, ginger root, and ginkgo biloba all possess antiplatelet and anticoagulant properties. When taken alongside oral anticoagulants such as warfarin or aspirin, these three herbal supplements significantly potentiate the anticoagulant effect, increasing the risk of serious and potentially life-threatening bleeding complications. This is one of the most clinically significant and well-documented drug-herb interaction categories nurses must educate clients about.

Why Other Options are Incorrect:

A. Decreased absorption of other medications — Decreased drug absorption is primarily associated with antacids, fiber supplements, or binding agents like cholestyramine, not with garlic, ginger, or ginkgo biloba.

C. Decreased effects of oral contraceptives — Reduced oral contraceptive effectiveness is associated with enzyme-inducing substances such as St. John's wort and rifampin, not with the three herbal supplements listed here.

D. Increased effects of antidepressant medications — Potentiation of antidepressants, particularly serotonin syndrome risk, is associated with St. John's wort due to its serotonergic activity, not with garlic, ginger root, or ginkgo biloba.

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.