A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this
medication. I am not constipated." The nurse should explain that in clients who have cirrhosis,
...
A nurse is preparing to administer a dose of lactulose to a client who has cirrhosis. The client states, "I don't need this
medication. I am not constipated." The nurse should explain that in clients who have cirrhosis, lactulose is used to
decrease levels of which of the following components in the bloodstream?
a) Glucose
b) Ammonia
i) Rationale: Lactulose, a disaccharide, is a sugar that works as an osmotic diuretic. It prevents
absorption of ammonia in the colon. Accumulation of ammonia in the bloodstream, which occurs in
pathologic conditions of the liver, such as cirrhosis, may affect the central nervous system, causing
hepatic encephalopathy or coma.
c) Potassium
d) Bicarbonate
9) A nurse is educating a group of clients about the contraindications of warfarin therapy. Which of the following
statements should the nurse include in the teaching?
a) "Clients who have glaucoma should not take warfarin."
b) "Clients who have rheumatoid arthritis should not take warfarin."
c) "Clients who are pregnant should not take warfarin."
i) Rationale: Warfarin therapy is contraindicated in the pregnant client because it crosses the placenta
and places the fetus at risk for bleeding.
d) "Clients who have hyperthyroidism should not take warfarin."
10) A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further
teaching?
a) "I have started taking ginger root to treat my joint stiffness."
i) Rationale: Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for
bleeding. This statement indicates the client needs further teaching.
b) "I take this medication at the same time each day."
i) Rationale: The client should take warfarin at the same time each day to maintain a stable blood level.
c) "I eat a green salad every night with dinner."
i) Rationale: Green leafy vegetables are a good source of vitamin K, which can interfere with the clotting effects of
warfarin. Clients who are taking warfarin do not need to restrict dietary vitamin K intake but rather should maintain a
consistent intake of vitamin K in order to control the therapeutic effect of the medication.
d) "I had my INR checked three weeks ago.
i) " Rationale: Clients who have been taking warfarin for more than 3 months should have their INR level checked every
2 to 4 weeks.
11) A patient is starting warfarin (Coumadin) therapy as part of treatment for atrial fibrillation. The nurse will
follow which principles of warfarin therapy? (Select all that apply.)
a) Teach proper subcutaneous administration
b) Administer the oral dose at the same time every day
c) Assess carefully for excessive bruising or unusual bleeding
d) Monitor laboratory results for a target INR of 2 to 3
e) Monitor laboratory results for a therapeutic aPTT value of 1.5 to 2.5 times the control value
12) Atorvastatin can elevate LFT
a) Baseline total cholesterol, LDL and HDL level, triglycerides, and liver and renal function test obtained and then
monitored periodically throughout treatment
13) The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication?
a) NSAIDS
i) NSAIDs may be nephrotoxic to a client with acute kidney disease, and should be avoided.
ACE inhibitors are used for treatment of hypertension and to protect the kidneys, especially
in the diabetic client, from progression of kidney disease. Opiates may be used by clients
with kidney disease if severe pain is present; however, excretion may be delayed. Calcium
channel blockers can improve the glomerular filtration rate and blood flow within the kidney.
b) ACE inhibitors
c) Opiates
d) Calcium channel blockers
14) Which of the following are adverse reactions related to the use of CELECOXIB? Select all that apply
a) Rhinitis
b) Neutropenia
c) Oliguria
d) Stomatitis
15) A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be started on intravenous rifampin
therapy. The nurse should instruct the client that this medication can cause which of the following adverse effects?
a) Constipation
b) Black colored stools
c) Staining of teeth
d) Body secretions turning a red-orange color
i) Rationale: Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the
urine, stool, saliva
16) A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused
breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
a) A. Check the client's vital signs.
i) Rationale: It is possible that the client's nausea is secondary to digoxin toxicity. Assess for bradycardia, a
symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's
heart rate is less than 60 bpm.
b) Request a dietitian consult.
c) Suggest that the client rests before eating the meal.
d) Request an order for an antiemetic.
17) A nurse is caring for a client who has difficulty swallowing medications and is prescribed enteric-coated aspirin PO
once daily. The client asks if the medication can be crushed to make it easier to swallow. Which of the following
responses should the nurse provide?
a) "Crushing the medication might cause you to have a stomachache or indigestion.
i) Rationale: The pill is enteric-coated to prevent breakdown in the stomach and decrease the possibility of
GI distress. Crushing destroys protection.
b) "Crushing the medication is a good idea, and I can mix it in some ice cream for you.”
c) "Crushing the medication would release all the medication at once, rather than over time."
d) "Crushing is unsafe, as it destroys the ingredients in the medication."
18) A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client
asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the
nurse give?
a) "It usually takes heparin at least 2 to 3 days to reach a therapeutic blood level."
b) "A pharmacist is the person to answer that question."
c) "Heparin does not dissolve clots. It stops new clots from forming."
i) Rationale: This statement accurately answers the client's question.
d) "The oral medication you will take after this IV will dissolve the clot.
19) A nurse is caring for a client who has bipolar disorder and has been taking lithium for 1 year. Before administering
the medication, the nurse should check to see that which of the following tests have been completed?
a) Thyroid hormone assay
i) Rationale: Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction.
b) Liver function tests:
i) Rationale: LFTs must be monitored before and during valproic acid therapy
c) Erythrocyte sedimentation rate
i) Rationale: This is not a necessary test related to lithium therapy.
d) Brain natriuretic peptide
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