ATI Custom PNU 119 Exam 3
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Free ATI Custom PNU 119 Exam 3 Questions
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?
- Postpartum hemorrhage
- Hypertension
- Thromboembolic events
- 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 caring for a client who has asthma and is taking fluticasone. For which of the following adverse effects should the nurse monitor that requires immediate followup?
- Hypoglycemia
- Hypertension
- Oral candidiasis
- Polyuria
Explanation
Explanation:
Correct Answer: (C) Oral candidiasis.
Fluticasone is an inhaled corticosteroid used for asthma management. The moist, steroid-rich environment it creates in the oropharynx promotes the overgrowth of Candida albicans, leading to oral candidiasis (thrush). This is a well-known and clinically significant adverse effect that requires prompt identification and treatment. Clients must be instructed to rinse their mouth and gargle with water after each use to reduce this risk.
Why Other Options are Incorrect:
A. Hypoglycemia — Inhaled corticosteroids like fluticasone can actually cause mild elevations in blood glucose, not hypoglycemia. Hypoglycemia is not an expected adverse effect of this medication.
B. Hypertension — Systemic corticosteroid use can cause hypertension, but inhaled fluticasone has minimal systemic absorption at standard therapeutic doses and is not significantly associated with hypertension.
D. Polyuria — Polyuria is associated with conditions such as diabetes insipidus or hyperglycemia from systemic corticosteroids, not from inhaled fluticasone at standard doses.
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?
- Anemia
- Neutropenia
- Hypokalemia
- 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.
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?
- WBC and Platelets
- BUN and Creatinine
- AST and ALT
- 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 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 caring for a client who has gastroesophageal disease and a prescription for metoclopramide. For which of the following adverse effects should the monitor?
- Sedation
- Hypertension
- Blurred vision
- 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 collecting data from a client who has heart failure, prior to the administration of furosemide. For which of the following findings should the nurse withhold the medication?
- Serum potassium level of 4.8 mEq/L
- Serum sodium level of 140 mEq/L
- Serum sodium level of 138 mEq/L
- Serum potassium level of 2.8 mEq/L
Explanation
Explanation:
Correct Answer: (D) Serum potassium level of 2.8 mEq/L.
The normal serum potassium range is 3.5–5.0 mEq/L. A potassium level of 2.8 mEq/L indicates significant hypokalemia. Since furosemide is a potassium-wasting loop diuretic, administering it to a client who is already hypokalemic would further deplete potassium levels, placing the client at serious risk for life-threatening cardiac arrhythmias, muscle weakness, and respiratory compromise. The nurse must withhold the dose and notify the provider immediately.
Why Other Options are Incorrect:
A. Serum potassium level of 4.8 mEq/L — This falls within the normal range of 3.5–5.0 mEq/L and does not contraindicate furosemide administration.
B. Serum sodium level of 140 mEq/L — This is within the normal sodium range of 135–145 mEq/L and does not require withholding the medication.
C. Serum sodium level of 138 mEq/L — This is also within the normal sodium range and is not a reason to withhold furosemide.
A nurse is collecting data from a client who has been taking omeprazole for the past 4 weeks. The nurse determines that the medication is effective when the client reports relief from which of the following symptoms?
- Nausea
- Acid indigestion
- Diarrhea
- Headache
Explanation
Explanation:
Correct Answer: (B) Acid indigestion.
Omeprazole is a proton pump inhibitor (PPI) that works by irreversibly blocking the hydrogen-potassium ATPase enzyme system in the stomach's parietal cells, thereby reducing gastric acid production. It is primarily indicated for conditions caused by excess stomach acid, including GERD, peptic ulcer disease, and acid indigestion. Relief from acid indigestion directly confirms the medication is working as intended.
Why Other Options are Incorrect:
A. Nausea — While nausea can be associated with GI conditions, it is not the primary therapeutic target of omeprazole and does not confirm the drug's effectiveness.
C. Diarrhea — Diarrhea is not an acid-related symptom that omeprazole is designed to treat. In fact, diarrhea can be an adverse effect of omeprazole itself, particularly with long-term use.
D. Headache — Headache is a potential adverse effect of omeprazole, not a symptom it is intended to relieve. Relief of headache would not indicate the medication's therapeutic effectiveness.
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?
- Platelets 74,000/mm³
- Partial thromboplastin time (PTT) 75 seconds
- Hematocrit 45%
- 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 reinforcing teaching with a client who has a new prescription for codeine. Which of the following information should the nurse include in the teaching?
- Limit alcohol intake to 12 oz daily.
- Diarrhea is an expected adverse effect.
- Change positions slowly.
- Take on an empty stomach to prevent nausea.
Explanation
Explanation:
Correct Answer: (C) Change positions slowly.
Codeine, like all opioid analgesics, can cause orthostatic hypotension — a sudden drop in blood pressure upon standing. Clients should be instructed to change positions slowly, moving from lying to sitting to standing gradually, to prevent dizziness, lightheadedness, and falls.
Why Other Options are Incorrect:
A. Limit alcohol intake to 12 oz daily — Alcohol should be completely avoided, not merely limited, while taking codeine. Both alcohol and codeine are CNS depressants, and combining them significantly increases the risk of respiratory depression and sedation.
B. Diarrhea is an expected adverse effect — This is incorrect. Codeine, as an opioid, causes constipation, not diarrhea. Opioids slow GI motility, and clients should be counseled to increase fluid and fiber intake and use stool softeners as needed.
D. Take on an empty stomach to prevent nausea — Codeine should actually be taken with food or milk to reduce GI upset and nausea, not on an empty stomach.
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