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Pharmacology (NUR 3145)
Santa Fe College
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1 medication prescribed for this patient would you want to clarify? Azithromycin (due to pt’s heart condition)
2 intervention and stopping fluids and giving a small dose of Lasix, the patient became a little responsive. ABG labs results came back, the results are as follows: pH 7, PaCO2 38, PAO2 89, HCO3 17. Is there a sign of acid base imbalance in these values? Yes
What type of acid base imbalance would this be? Metabolic Acidosis
- A COPD patient is admitted with hypoxemia due to V/Q mismatch. The nurse is anticipating the delivery system that will be used to provide oxygen. What type of oxygen flow would you provide for this patient?
low levels of oxygen either via nasal cannula or using a face mask at 24% to 32%
oxygen.
4 trauma patient who has acute heart failure has not gotten out of bed and has not being using his incentive spirometry became very restless. Vital signs reveals signs of decrease cardiac output (low BP, bradycardic with thready pulse). A chest X-ray reveals pneumonia. What would be the priority intervention for this patient? Intubate
5 patient presents with liver injury due to history of Tylenol misuse. On arrival the patient is unconscious. After giving him 3 liters of IV fluids, the nurse did an assessment. The findings were bilateral 2+ pedal edema, BP 160/90, HR 115. What would be the priority assessment the nurse should do next? Assess lung sounds
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6 patient is found to have fluids in the lungs due to bronchiectasis and requires postural drainage 3X daily.
What would be some essential teaching essential teaching necessary for this patient about postural drainage? Three hours after meals to allow food to digest- to prevent aspiration, use of pillows to position client, give bronchodilator (albuterol) before procedure, percuss over a towel (or a pillow case) to ensure it does not feel uncomfortable
- A patient presents to the ED with complaints of the heart feeling fluttering. The MD orders for the patient to be placed on telemetry.
Looking at the strip, how would you calculate the HR?
Count up the QRS complex and multiply by 10 (for 6 second strips)
- the patient is diagnosed with atrial flutter. What are the clinical manifestations the patient would present with?
It is associated with CAD, hypertension, mitral valve disorders, pulmonary
embolism, chronic lung disease, cor pulmonale, cardiomyopathy,
hyperthyroidism, and the use of drugs such as digoxin, quinidine, and
epinephrine (page 765)
- Where on the body should the electrodes be placed?
Upper leads (white & black) on clavicle line, lower leads (green & red) right below rib cage, and brown lead on the right of sternum
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EVAR requires adequate vessel supplies to the graft and because the pt’s aneurysm has been ruptured, he has to have open abdominal repair
- Aneurysm often goes undetected until they dissect. Who is a high risk for a aortic dissection?
Pts with Turner syndrome, high blood pressure, heart problems, Marfan syndrome
- A nurse is teaching a patient at risk for peripheral artery disease. What preventative measure should the nurse teach the patient?
Maintain ideal weight, prevent injury to extremities, walk daily, avoid standing for long periods
- A patient who was diagnosed with MI develops constipation from the medication for pain management. What should the nurse teach the patient regarding constipation?
Avoid straining when passing stool
The patient with MI is being treated for constipation with Polyethylene glycol (Macrogol, PEG). What should the nurse monitor for that could be a harmful effect on the patient? Diarrhea → electrolyte imbalance → dysrhythmia (monitor heart rhythm)
A patient is diagnosed with atrial fibrillation and was discharged on digoxin 4 days ago. The family brought the patient to the ED very lethargic with complains of vomiting and diarrhea. The patient is placed on the monitor, the HR is 50. A digoxin level reveal 2 mg/ml.
What should the nurse do? Hold the prescribed digoxin
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- A patient in a motor vehicle accident was admitted to the ICU with multiple fractures. She has fracture to rib 3 through 5 and they are fracture in more than one part.
What type of chest injury would this be? Flail chest
the patient is diagnosed with flail chest. What would be priority management for this patient? Clear airway of secretions
There is no visual blood loss but internal blood loss is suspected what assessment findings would be priority?
Low BP, bruising, rapid pulse, slow capillary refill
- A patient has been brought to the ED after falling in an ice pond. What monitoring is necessary while the patient is being re-warm?
EKG monitoring
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- What are some factors to consider to determine the survival status of a burnt patient?
% of burn, age, general health, pre existing conditions, type of burn (i, inhalation burn), depth of burn (severity)
- the patient is at high risk for weight loss due to inadequate intake thus we would expect the patient to
Low energy (?) Body will break down fat to provide energy.
- What early intervention would be important to prevent stomach ulcers?
Proton pump inhibitors (PPIs), early feeding (enterally)
- A patient is admitted with full thickness burn who is at risk for scarring and contracture.
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*What can the nurse teach the patient to minimize this? Be active as best as they can
what does the care entail in the acute phase? Wound care, nutritional support, infection prevention
Assessment of the urine output over 24 hours has shown increase. What should the nurse do? Monitor and document (diuresis- normal finding for this phase)
Which patient is at highest risk for life threatening complication after burn injuries? Inhalation burn pt
SHOCK
What orders should you clarify for this patient in cardiogenic shock? IV bolus (?)
What are stages of shock? Identify the signs and symptoms of each stage Inital, compensatory, progressive, irreversible (know the stages)
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The patient is not responding to treatment. What would be a finding that indicates there is multiple organ dysfunction syndrome? Thrombocytopenia (low platelet)
What would you anticipate to be the management for a patient that had developed MODS? Stress ulcer prevention for GI: PPIs, tube feeding Kidney: dialysis Adequate perfusion: maintain fluid volume
NEUROGENIC SHOCK-SPINAL CORD INJURY
A patient admitted to the unit is not able to feel his arms or legs. The MD suspects spinal cord injury (SCI). How do we open the airway for a suspect SCI? Jaw thrust maneuver
What would be a priority complication that the nurse should monitor for? Pulmonary embolism (PE)
What would be an indication that this complication is present? Shortness of breath; pain, redness, swelling and warm to touch at lower extremity
What teachings should be provided for the patient/family? Everything would be slow→ low BP, teach about the importance of blood pressure meds for maintaining BP; the pt/family should be made aware that it would be difficult for pt to maintain adequate body temp due to poikilothermia
NEURO
- The neuro assessment reveals the GCS of 5. What is priority management for this patient? Intubate
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- The patient is observed to have fluids leaking from the ear. What is priority management for this patient?
monitor ventriculostomy for ICP alterations (?)
- A patient with a intracranial bleed went for a burr hole procedure. The patient returns to the unit. What is the priority assessment should the nurse conduct on arrival?
Assess for pain, assess surgical dressing for drainage, discoloration
- The patient with a ventriculostomy presents with oliguria and a high specific gravity. Identify the complication the patient is experiencing.
SIADH complications: fluid overload →I&O, fluid restriction, diuretics
- a patient presents with polyuria and a low specific gravity. Identify complications the patient is experiencing.
What management is important for this patient?
Diabetes Insipidus: working IV access for hydration and electrolyte replacement
- A patient is brought in after falling and hitting the head. On assessment the nurse find the patient having ipsilateral (On the same side, as opposed to contralateral) pupil dilatation. What diagnosis would you expect for this patient?
hematoma→ herniation on the same side of injury→ paralysis of oculomotor
nerve (CN III)
- How can the nurse ensure that the ventriculostomy system is calibrating accurately? Ensure ventriculostomy transducer is at tragus level
- A nurse is providing teaching for a patient is diagnosed with homonymous hemianopsia. What should this teaching include?
place things on unaffected side
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Following an acute myocardial infarction (AMI), a patient ambulates in the hospital hallway. When the nurse is evaluating the patient’s response to the activity, which assessment data would indicate that the exercise level should be decreased?
Correct Answer:
Heart rate increases from 66 to 92 beats/minute.
- Question 3 0 out of 2 points
When caring for a client with acute chest pain, which laboratory results requires the most immediate action?
Correct Answer: Troponin I of 1. mcg/L
- Question 4 2 out of 2 points
A nurse is caring for a client with a dysrhythmia. The nurse is identifying the rhythm.
What type of dysrhythmia would the nurse classify as most life threatening? Correct Answer:
Ventricular tachycardia
- Question 5 2 out of 2 points
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NS is ordered to infuse 300 mL over 3 hours. Drip factor is 20 gtts/mL. How many gtts per minute? Round to the nearest whole number. Write only the number not the units.
Correct Answer:
Evaluation Method Correct Answer Case Sensitivity Exact Match 33
- Question 6 2 out of 2 points
A nurse is admitting a client with multiple burns to the intensive care unit. What assessment data is most important for the nurse to include when planning care for the client?
Recent alcohol or drug use.
Response Feedback: Any recent alcohol or drug use is important to assess for as this could lead to further complications with care. The client’s educational level does not need to be included within the plan of care at this time. The insurance carrier should not affect the type of care the client receives. The presences of smoke alarms in the home is important to include with discharging clients however at this time it is not the most important information to include in the plan of care.
- Question 7 2 out of 2 points
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Petechiae
Response Feedback: Petechiae is a sign of hematological dysfunction, meaning that more than just cardiac dysfunction is present. Dyspnea is a sign consistent with cardiogenic shock. Pallor is a compensatory measure consistent with cardiogenic shock. Hypotension is a compensatory measure consistent with cardiogenic shock.
- Question 10 2 out of 2 points
An emergency room nurse assesses a client who was rescued from a home fire. The client suddenly develops a loud, brassy cough. Which action should the nurse take first?
Answers:
Apply oxygen and continuous pulse oximetry.
Provide small quantities of ice ships and sips of water. Request a prescription for an antitussive medication. Ask the respiratory therapist to provide humidified air.
Response Feedback: Brassy cough and wheezing are some of the signs seen with inhalation injury. The first action by the nurse is to give the client oxygen. Clients with possible inhalation injury also need continuous pulse oximetry. Ice chips and humidified room air will not help the problem, and antitussives are not warranted.
- Question 11 2 out of 2 points
A nurse is caring for four clients in the neurologic intensive care unit. After receiving the hand-off report, which client should the nurse see FIRST?
Correct Answer:
Client with a Glasgow Coma Scale score that was 10 and is now 8
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Question 12
0 out of 2 points
A client is admitted to the cardiac unit with a diagnosis of acute chest pain related to myocardial infarction. Which nursing action(s) are most helpful in ensuring adequate oxygenation to the myocardium? [Select all that apply].
a. Increase oral fluids
b. Administer oxygen
c. Monitor pedal pulses
d. Decrease client’s activity
e. Provides a safe environment
Question 13
2 out of 2 points
A client is in the hospital after suffering a myocardial infarction and has bathroom privileges. The nurse assists the client to the bathroom and notes the client’s O2 saturation to be 95%, pulse 88 beats/min, and respiratory rate 16 breaths/min after returning to bed. What action by the nurse is best?
Correct Answer:
Allow continued bathroom privileges.
Question 14
0 out of 2 points
A nurse is admitting a client on the neurologic unit for manifestations of a hemorrhagic stroke. What assessment findings would require the nurse’s immediate action?
Correct Answer:
Seizure-type activity
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- Question 18 2 out of 2 points
A nurse is transporting a non-English speaking client to the radiology department for a computed topography scan (CT) after the client fell from 20 feet. The client is currently intubated. What information would be MOST IMPORTANT to provide to the technologist performing the scan?
Correct Answer:
The interpreter is with the client to aid in translation
Question 19
2 out of 2 points
A nurse is giving a presentation to a community group about preventing atherosclerosis.
Which of the following should the nurse include as a modifiable risk factor for this disorder? (Select all that apply.)
Correct Answers:
Hypercholesterolem
ia Hypertension
Obesity
Smokin
g
Question 20
2 out of 2 points
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A client comes to the emergency department via ambulance to report severe radiating chest pain and shortness of breath. The client appears restless, frightened, and slightly cyanotic. The provider prescribes oxygen by nasal cannula at 4 L/min stat, cardiac enzyme levels, IV fluids, and a 12-lead ECG. Which action should the nurse take first?
Correct Answer:
Initiate oxygen therapy.
Question 21
2 out of 2 points
A clinic nurse is assessing a client with a history of a myocardial infarction for an annual health visit. What assessment data would the nurse follow up on in regards to the possibility of heart failure?
Correct Answer:
Client states they get short of breath walking to their mailbox
- Question 22 2 out of 2 points
A nurse cares for a client with a burn injury who presents with drooling and difficulty swallowing. Which action should the nurse take FIRST?
Answers: Assess the level of consciousness and pupillary reactions. Ascertain the time food or liquid was last consumed.
Auscultate breath sounds over the trachea and bronchi. Measure abdominal girth and auscultate bowel sounds.
Response Feedback: Inhalation injuries are present in 7% of clients admitted to burn centers. Drooling and difficulty swallowing can mean that the client is about to lose his or
AHFinal
Course: Pharmacology (NUR 3145)
University: Santa Fe College
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