ATI Custom PNU 119 Exam 3

Explanation:

Correct Answer: (B) Monitor the client for black, tarry stools.

Clopidogrel is an antiplatelet medication that inhibits platelet aggregation to prevent blood clots. A significant adverse effect is GI bleeding. Black, tarry stools (melena) are a classic sign of upper GI bleeding and must be monitored closely, as they indicate digested blood passing through the GI tract — a potentially serious complication requiring immediate provider notification.

Why Other Options are Incorrect:

A. Administer the medication with each meal — Clopidogrel can be taken with or without food. While food may help reduce stomach upset, it is not required to be given with every meal as a standard nursing action.

C. Initiate contact precautions — Contact precautions are implemented for clients with communicable infections or multi-drug resistant organisms. Clopidogrel therapy does not require contact precautions.

D. Have suction equipment at the bedside — Suction equipment is indicated for clients at risk for aspiration or airway compromise, not specifically for clients receiving antiplatelet therapy like clopidogrel.

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: (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.

Explanation:

Correct Answer: (A) "This medication adheres to the ulcer and protects it from gastric acid."

Sucralfate is a cytoprotective agent that works locally in the GI tract. In the acidic environment of the stomach, sucralfate forms a viscous, paste-like substance that binds to proteins at the ulcer site, creating a protective barrier over the ulcer crater. This barrier shields the damaged mucosa from further injury by gastric acid, pepsin, and bile, allowing the ulcer to heal. It is most effective when taken on an empty stomach 1 hour before meals.

Why Other Options are Incorrect:

B. "This medication prevents gastric acid secretion in the stomach." — This describes the mechanism of proton pump inhibitors (e.g., omeprazole) or H2 blockers (e.g., ranitidine), not sucralfate. Sucralfate does not affect acid production.

C. "This medication neutralizes gastric acid after it is secreted." — This describes the mechanism of antacids such as aluminum hydroxide or calcium carbonate. Sucralfate does not neutralize acid.

D. "This medication kills the bacteria which cause ulcers." — Eradication of Helicobacter pylori bacteria requires antibiotic therapy such as clarithromycin and amoxicillin combined with a proton pump inhibitor. Sucralfate has no antimicrobial properties.

Explanation:

Correct Answer: (A) Doxycycline

Doxycycline is contraindicated in children under 8 years of age because it binds to calcium in developing teeth and bones, causing permanent yellow-gray-brown tooth discoloration and potential disruption of bone growth. For a 5-year-old with Lyme disease, the nurse should question this order and expect an alternative antibiotic to be prescribed.

Why Other Options are Incorrect:

B. Amoxicillin — Amoxicillin is actually the first-line recommended treatment for Lyme disease in children under 8 years old and is safe for this age group.

C. Cephalexin — Cephalexin is a cephalosporin antibiotic that is safe for use in young children and would not require questioning.

D. Azithromycin — Azithromycin is considered an alternative treatment option for Lyme disease in pediatric patients who are allergic to penicillin and is safe for use in young children.

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.

Explanation:

Correct Answer: (C) "Watch for drowsiness and light-headedness while taking alprazolam."

Alprazolam is a benzodiazepine that enhances the effect of GABA in the CNS, producing anxiolytic and sedative effects. CNS depression manifesting as drowsiness, sedation, and light-headedness is one of its most common and predictable adverse effects. Clients must be warned not to drive or operate heavy machinery until they know how the medication affects them, and to take precautions to prevent falls.

Why Other Options are Incorrect:

A. "Stop taking alprazolam right away if you experience abdominal discomfort." — Alprazolam should never be stopped abruptly. Sudden discontinuation of benzodiazepines can cause severe withdrawal symptoms including seizures, rebound anxiety, and autonomic instability. Any dose changes must be done gradually under provider supervision.

B. "This medication has a low risk for physical dependence." — This statement is false and dangerous. Alprazolam carries a high risk of physical and psychological dependence, even at therapeutic doses. It is a Schedule IV controlled substance and clients must be counseled about this risk.

D. "Drinking alcohol decreases the effectiveness of alprazolam." — This is incorrect and potentially dangerous misinformation. Alcohol is also a CNS depressant and combining it with alprazolam produces an additive CNS depressant effect, significantly increasing the risk of respiratory depression, over-sedation, and death. Alcohol should be completely avoided.

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.

Explanation:

Correct Answer: (C) Echinacea can decrease effects of immunosuppressant medications.

Echinacea stimulates the immune system by enhancing the activity of macrophages and T-lymphocytes. This immune-stimulating effect directly opposes the action of immunosuppressant medications such as corticosteroids, cyclosporine, and methotrexate, significantly reducing their therapeutic effectiveness. This is a clinically important drug-herb interaction that clients taking immunosuppressants must be informed about.

Why Other Options are Incorrect:

A. Echinacea can cause damage to the liver — Hepatotoxicity is not a well-established adverse effect of echinacea at recommended doses. Kava and comfrey are herbal supplements more strongly associated with liver damage.

B. Echinacea interacts with benzodiazepines to increase drowsiness — Echinacea does not have a documented clinically significant interaction with benzodiazepines that increases sedation. This interaction is more relevant to herbs such as valerian or kava.

D. Echinacea significantly reduces manifestations of common cold and influenza — While echinacea is widely used and marketed for cold and flu prevention, clinical evidence remains inconsistent and does not definitively support that it significantly reduces symptoms. This statement overstates the evidence.