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Nursing Principles 3
| Question | Answer |
|---|---|
| A nurse is reviewing a patient's medication profile and notes that the patient is taking clopidogrel which is an anticoagulant. Medical history reveals chronic pain syndrome and recent cardiac stenting. Which additional medication present on the medicatio | 325 mg ASA |
| A nurse is performing a nutrition assessment of a patient with cardiac disease. Which food selection is high in antioxidants? | Dark chocolate |
| A nursing student is reviewing the concept of first-pass metabolism. For a critically ill patient,which medication route would be preferred based on this concept? | Parenteral |
| A nurse is reviewing mixing of insulin preparations. Which subcutaneous medication order requires immediate action? | Lantus insulin 12 units with NPH 2 units |
| A nurse is reviewing an order for administration of medication via subcut route. Which finding indicates that the nurse should contact the health-care provider (HCP) for clarification? | 5 mL of solution is to be administered. |
| A nurse reviews a serum level of a medication that is below the therapeutic range. What action would the nurse anticipate that the health-care provider (HCP) will take based on the reported findings? | Increase the dosage of the medication. |
| An older patient with hip pain reports that continuous heat has been the most effective means of relieving pain. After confirming that the patient has an order for heat therapy, which method should the nurse select? | Aquathermia K-pad |
| A nurse is preparing to administer oral medication to a patient who has dysphagia. Which type of oral medication form would the nurse anticipate that the health-care provider (HCP) will order? | Orally disintegrating tablet |
| A cooling blanket is being used to treat a patient with hyperthermia. Which priority assessment should the nurse include in the plan of care for this patient? | Vital signs |
| A middle-aged female patient is being treated for anemia. In reviewing the patient's medical history, the nurse notes that the patient currently takes several supplements, including peppermint oil, melatonin, ginseng, and valerian. Based on the patient's | Peppermint oil |
| A nurse is providing medications to a patient who is currently receiving continuous tube feeding via gastrostomy tube. The patient has a dose of phenytoin due. Which is the nurse's best course of action? | Stop the tube feeding for at least 1 hour before administration. |
| A patient wants to use a nutritional approach to managing cardiac health. Which suggestion should the nurse make to help improve health outcomes for this patient? | Increase intake of fruits and vegetables. |
| A nurse is preparing to administer a vaccine injection to a patient who is very nervous. What method should the nurse implement to decrease the patient's anxiety? | Ask the patient about what activities they like to do. |
| A patient with chronic pain reports that pretending to be lying on a beach with the sun warming the legs helps relieve the chronic hip and leg pain caused by arthritis. Which nonpharmacological method is this patient using to control pain? | Guided imagery |
| A patient who has pain rated as a 7 on a scale from 1 to 10 continues to have pain despite having medication 2 hours ago. Which response should the nurse make when the patient requests additional medication? | “Let me reposition you and rub your back to help relieve the pain.” |
| A patient reports having a sore jaw and tooth pain in the mornings. Which sleep disorder should the nurse suspect this patient has? | Bruxism |
| A patient reports feeling pain “only when I move.” Which type of pain is this patient experiencing? | Deep somatic |
| A nurse is called to the room of a patient who is receiving an IV antibiotic. The patient is flushed, anxious, and short of breath. Which should the nurse do first? | Stop the IV infusion. |
| A nursing student is practicing how to administer injections in the clinical simulation lab. Which finding indicates that additional instruction is needed? | Place syringe on counter after removing from packaging. |
| A nurse is preparing to administer medications through a feeding tube. The patient is receiving continuous enteral therapy. Which priority action is indicated? | Flush the tube before and after medication administration. |
| While injecting insulin into the patient, the nurse rotates injection sites around the abdomen. Which is the nurse trying to prevent? Select all that apply. | Lipohypertrophy |
| A nurse is providing meperidine to a patient who reports postsurgical pain 8 of 10. The order is for 50 mg to be orally administered in tablet form every 4 hours, but each tablet contains 100 mg. Which is the best action for the nurse to take? | Administer half the tablet to the patient and dispose of the other half in a chemical waste container with another licensed nurse as a witness, recording the narcotic drug wastage on the narcotic record and having the witness cosign. |
| A nurse is evaluating use of cold therapy for a muscular injury sustained by a 28-year-old patient during a sporting activity. Which priority assessment should the nurse perform? | Assess for edema. |
| A nurse has prepared medication to be dispensed to a patient. What nursing action cannot be delegated to an unlicensed assistive personnel (UAP) as it relates to medication administration? | Giving medication to patient |
| A nurse finds a sleeping patient difficult to arouse to provide routine prescribed medications. Which stage of sleep was this patient most likely in? | Stage IV |
| A patient has been using a TENS unit for one hour to help relieve back pain. Which action should the nurse take after removing the unit from the patient? | Assess pain level. |
| A nurse is providing care for a 32-year-old with suspected bowel obstruction who is receiving intramuscular injections of narcotic pain medication. The patient states, “I hate shots. Why can't I just take a pill?” How should the nurse best respond? | “We want to avoid giving you medication that you have to digest.” |
| Which of the following shows the use of integrative health care? | A patient controls hypertension with prescription medication, dietary changes, and yoga. |
| A home health nurse (HHN) is visiting a patient who has sitz baths ordered after a hemorrhoidectomy. Which observation requires immediate action if observed by the HHN? | Cold tap water is being used. |
| A nurse is caring for a patient who crushes medications and administers them via a gastrostomy tube. Which medication could safely be included in the patient's plan of care? | Chewable antacids |
| A nurse is using a prefilled syringe to administer a patient's medication. Which action should not be included in the administration process? | Recap once administered. |
| A patient has been prescribed enteric-coated aspirin therapy but has difficulty swallowing and requires medication to be crushed and mixed in applesauce for administration. What action should the nurse take next? | Contact health-care provider (HCP) |
| A 62-year-old patient in the clinic asks for a prescription refill for lorazepam. Which action should the nurse take next? | Schedule an appointment with the health-care provider (HCP) to discuss refill. |
| A patient asks about chiropractic medicine and whether it would be a good choice to help relieve body aches and pain. What is the best nursing response? | “This specialty of medicine may prove to be helpful.” |
| A hospital dietitian conducts an in-service about the Ornish diet. The dietitian teaches that patients who adhere to this diet can expect what? | Reverse heart disease without drugs or surgery. |
| A patient with a sprained wrist is prescribed cold therapy. Which should the nurse explain about this treatment as compared to heat therapy? | “Cold therapy decreases swelling and pressure on nearby nerves, which helps decrease pain.” |
| While caring for a patient who recently took a new anticonvulsant medication, a nurse would contact the health-care provider (HCP) immediately if the patient reports which of the following? | Shortness of breath |
| A nurse is using a commercial gel pack to apply moist heat therapy to treat a patient's backache. Which step is essential in the application process for this type of equipment? | Use protective barrier between gel pack and patient's skin. |
| Nurses verifying the narcotic count at the end of the shift note a discrepancy. What action should the nurses take next? | Follow hospital policy and procedure. |
| A patient complains of nausea. What type of herbal therapy would the nurse identify that would help decrease nausea? | Ginger |
| A patient complaining of persistent shoulder pain is in the clinic for evaluation. Upon examination, vital signs are stable, and the patient appears angry that no one can help. How would the nurse interpret these findings? | Chronic pain pattern |
| A nurse is planning to administer medication to a patient. Which nursing action could lead to an increased likelihood of a medication error? | Using bed assignment as patient identification |
| While being admitted to the unit, a patient reports, “I'm allergic to Vicodin; it makes me sick to my stomach.” Which is the best action for the nurse to take? | Record Vicodin under allergies, along with the patient's reported symptoms. |
| A nursing instructor is observing actions of nursing students in the laboratory setting as they prepare to administer an intramuscular injection. Which observation warrants immediate action? | Student pulls off the needle cover with their teeth. |
| A patient with chronic rheumatoid arthritis is in the clinic for a yearly checkup. The nurse is performing a pain assessment. What type of pain designation would the nurse expect the patient to have? | Deep somatic |
| A nurse is preparing to reconstitute a medication in a multiple-dose vial. What is the most essential step in this process? | Instilling the accurate amount of diluent into the vial |
| A nurse is inspecting a patient's IV site and finds the surrounding skin area slightly warm to the touch. What is the next action the nurse should take? | Stop the infusion, remove the IV, and apply warm compress to the site. |
| A nurse is reviewing a patient's medication profile and finds that the patient is taking gabapentin following a motor vehicle accident (MVA) in which injuries were sustained. Medical history is negative for disease. How should the nurse interpret this fin | The medication is used to treat pain from MVA. |
| A nurse is monitoring a diabetic patient who has a fingerstick glucose level of 450 mg/dL. What is the next action the nurse should take? | Contact health-care provider (HCP). |
| A patient has been prescribed new blood pressure medication and reports feeling dizzy at times but that the feeling goes away. How should the nurse document this finding? | Side effect |
Created by:
Kfayia