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Bundle for CPNRE Exam verified 2022
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Cpnre questions and correct answers 2022
Which of the following medicationsmay predispose the client to hearing loss? a. Aspirin—ototoxic b. Ampicillin c. Demerol d. Tylenol a. Aspirin—ot... [Show More] otoxic The typical acute asthmatic attackis usually due to a combination of bronchial spasm bronchial edema and the presenceof mucoid secretions in the bronchial lumen. The client with asthma was givenmucomyst for which of the following reasons? a. Todecrease the viscosity of secretions. b. Toencourage the movement of the secretions in the bronchi. c. To stimulate the cough reflex. d. Todilate the bronchi. a. Todecrease the viscosity of secretions. 3. Most asthmatic attacks respond toEpinephrine (Adrenalin) and it may be used as a therapeutic agent in the treatment of some allergicconditions because it: a. Improves cardiac output due to itspositive inotropic effect. b. Actsas a hypertensive agent elevating BP. c. Dilatesthe bronchi. d. Antagonizeshistamine. c. Dilatesthe bronchi. 4. A 78-year-old-client is taking acombination of 3 drugs: Lasix Digoxin and Isordil. Which of the followingwill be a desired accumulative effect of the drugs? a. Constipation b. Weight loss = lasix (diuretic)digoxin (improves cardiac output) isordil (vasodilator) c. Postural hypotension d. Dizziness b. Weight loss = lasix (diuretic),digoxin (improves cardiac output), isordil (vasodilator) 5. Propanolol (Inderal) is used in thetreatment of clients with a. heart block. b. asthma. c. hyperthyroid.—beta-blocker d. pulmonaryedema c. hyperthyroid.—beta-blocker 6. Which of the following types of insulin is administered IV and during emergency? a. NPH b. Regular insulin c. PZI d. Combinationof Regular and NPH b. Regular insulin 7. A manic-depressive client was placed on MAO inhibitor therapy. Which of the following foods will not be appropriate for the client? a. Fatty foods b. Coffee and tea c. Salty foods d. Vegetables b. Coffee and tea 8. A client who is suffering from Osteoarthritis is given Naprosyn (Naproxen) and asked the nurse "How does this drug help me"? The PN's appropriate response would be: a. "It relieves your spasm." b. "It prevents demineralization of your bones." c. "It strengthens bone structures." d. "It relieves discomfort." d. "It relieves discomfort." 9. A client is receiving Kayexalate (Sodium Polystyrene). Which of the following statements indicates that the client understands the teaching given? a. "My stool will be hard." b. "It will lessen the bacteria in my stomach." c. "It will decrease the serum K⁺ level in my blood." d. "It will decrease the Ca⁺⁺level in my blood." ... c. "It will decrease the serum K⁺ level in my blood." 10. All of these infants attended an infant care class with their mothers. Who among these babies can be given an oral polio vaccine? a. Annie 5 months old who finished her 120 ml formula an hour ago. b. Ronnie 3 months old who upon arriving to the clinic vomited 2X. c. Jocelyn 6 months with oral thrush. d. Larry 6 months teething and drooling., a. Annie 5 months old, who finished her 120 ml formula an hour ago. 11. While the client is receiving Heparin therapy which of these should be readily available? a. Vitamin K b. Protamine Sulfate c. Calcium Gluconate d. Magnesium Sulfate, b. Protamine Sulfate 12. Why Prednisone dosage is decreased gradually and not abruptly? a. Triggers the adrenal cortex to release ACTH to function normally. b. Costicosteroid suppression. c. Adrenal insufficiency. d. GI irritation. c. Adrenal insufficiency. ... ... 13. Butch is started on Disulfiram (Antabuse) as a part of his treatment for alcoholism. He will continue thismedication at home. Which of the following is contraindicated while Butch istaking Disulfiram? a. Elixir of Terpin Hydrate b. Coated Aspirin c. Bicarbonate of Soda d. Antihistamine a. Elixir of Terpin Hydrate 14. The nurse will anticipate which ofthe following effects when administering Epinephrine to the client who isexperiencing anaphylactic shock? a. Brochoconstriction and positive inotropic effect. b. Bronchoconstriction and negative inotropic effect. c. Bronchodilation and positive inotropic effect. d. Bronchodilation and negative inotropic effect. c. Bronchodilation and positive inotropic effect. 15. Which of the following is a potential side effect of Elavil? a. Dizziness upon getting up. b. Diuresis c. Potential addiction to the drug. d. Mental confusion a. Dizziness upon getting up. 16. The nurse on the day shift receives a report which says "IV solution to be absorbed is 500 ml". The IV is infusing at 75 ml/hr. At the end of the shift at 3:30 PM which of the following amount should be reported to the incoming shift as IV to be absorbed? a. 100 ml b. 300 ml c. 600 ml d. 900 ml d. 900 ml 17. A client with schizophrenia paranoid type was placed on Haldol therapy due to her agitation. Which of the following is a manifestation of the side effect of major tranquilizer like Haldol? a. Unstable gait b. Extra pyrimidal side effects c. Constipation d. Nausea b. Extra pyrimidal side effects 18. The client who is taking Haldol is placed on drug therapy to counteract the side effects of Haldol which drug is appropriate? a. Cogentin b. Antacid c. Vit. K d. Benadryl a. Cogentin 19. To prevent the side effect of Decadron it must be taken with a. fluids. b. crackers. GI irritation c. empty stomach. d. high fiber diet. b. crackers. GI irritation 20. Which of the following indicates that Cogentin is effective? a. The client has improved ability to concentrate. b. The client has decreased tremors. c. The client's BP is decreased. d. The client appears more relax and less agitated. b. The client has decreased tremors. [Show Less]
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CPNRE : Pharmacology with complete solution rated A+
Acetaminophen (Tylenol) 1. Antipyretic 2. Analgesic *Can cause liver damage in excessive amounts or known liver disease ASA (EC ASA) 1. Anti-inf... [Show More] lammatory 2. Anti-pyretic 3. Analgesic *do not administer in children under 12 years of age = Rye's Syndrome** *can cause bleeding tendencies* *baby ASA-preventative for heart disease* Amlodipine Ca Channel blocker (decrease BP, heart rate) *may cause gingival hyperplasia Atenolol and other "olol" Beta blocker (decreases BP, heart rate) *teach patient to rise slowly-orthostatic hypotension* Atorvastatin, Simvastatin (Zocor) cholesterol lowering drugs **need to be given in evenings as that is when cholesterol is manufactured the greatest** *watch liver enzymes* calcium carbonate calcium supplement *watch calcium levels* Carbamazepine (Tegretol) Anticonvulsant *decreases CNS excitement* Watch for CNS depression!!! Cefazolin (Ancef) "anti-Infectives" Antibiotic *Adverse effects-GI signs & symptoms Dalteparin Sodium (Fragmin) Anticoagulant (LMWH) Hydromorphone (Dilaudid) Narcotic analgesic *used for moderate to severe pain* Watch for signs and symptoms of CNS depression Histamine 2 Antagonist (H2 blocker) Inhibits release of histamine, which reduces gastric acids Treatment for GERD, PUD Glyburide (Metformin) oral hypoglycemic agent *must check AQ check/blood sugar prior to administration* *watch for S&S of hypoglycemia* Furosemide (Lasix) Loop diuretic Decrease blood volume *watch for signs of dehydration and "hypokalemia* *should be administered in morning* Ferrous Gluconate (IRON) May cause black tarry stools, constipation *check hgb levels* Given for anemia (IRON cont.)*should be taken with straw if in liquid preparation*-stains teeth *can cause GI upset, therefore taken with meals Dimenhydrinate (Gravol) -Class: Antiemetic -EMS Indications: Nausea and vomiting as a result of vertigo, motion sickness, and narcotic administration -Adult Dosage: 50 mg SIVP/IM Repeat: q 4 hours Patients 65 years of age or older, 25 mg SIVP/IM q 15 minutes to a total maximum of 50 mg Contraindications: Hypersensitivity to dimenhydrinate, diphenhydramine, or propylene glycol; Narrow angle glaucoma; Patients who have ingested large quantities of depressants (including alcohol) *Preferred antiemetic in treatment of nausea and vomiting associated with vertigo or motion sickness **Monitor patient carefully - goal is to provide symptom management without overmedicating Administer IM injections in the lateral quad (vastus lateralis) muscle Diltiazem Cardizem Ca channel blocker TX: Hypertension Docusate Sodium—(colace) stool softener Digoxin (Lanoxin) Anti-Arrhythmic, cardiac glycoside **Apical heart rate is to be taken for one full minute If less than 60—hold med. Contact doctor/prescriber Dexamethasone (Decadron) Corticosteroid—decrease inflammation **careful for adverse effects: "cushings-like" Can cause IMMUNOSUPPRESSION --protect from infections-- MUST BE WEANED!!! Morphine Sulfate narcotic Analgesic for moderate to severe pain *check respirations—adverse effect respiratory depression* Levothyroxine (Synthroid) Treatment for hypothyroidism *adverse effects Hyperthyroidism* Mannitol (Osmitrol) Osmotic diuretics. Pull fluid back into the vascular and extravascular space by increasing serum osmolality to promote osmotic changes. Used to prevent renal failure related to hypovolemia. Decrease intracranial pressure related to cerebral edema. Decrease intraocular pressure. Meperidine (Demerol) Narcotic Analgesic, Pain [moderate to severe] (black box: potential addiction, abuse, misuse) Rapid-acting insulin analogues (clear) • Insulin aspart (NovoRapid®) • Insulin glulisine (Apidra®) • Insulin lispro (Humalog®) *Bolus (prandial) insulins Onset 10 - 15 min = Insulin aspart (NovoRapid®) 10 - 15 min = Insulin glulisine (Apidra®) 10 - 15 min = Insulin lispro (Humalog®) Peak 1 - 1.5 h= Insulin aspart (NovoRapid®) 1 - 1.5 h = Insulin glulisine (Apidra®) 1 - 2 h = Insulin lispro (Humalog®) Duration 3 - 5 h= Insulin aspart (NovoRapid®) 3 - 5 h = Insulin glulisine (Apidra®) 3.5 - 4.75 h = Insulin lispro (Humalog®) Short-acting insulins (clear) • Humulin®-R • Novolin® ge Toronto Onset 30 min Peak 2 - 3 h Duration 6.5 h Intermediate-acting (cloudy) • Humulin® -N • Novolin® ge NPH Onset 1 - 3 h Peak 5 - 8 h Duration Up to 18 h Long-acting insulin (clear) • Insulin detemir (Levemir®) • Insulin glargine (Lantus®) • Insulin glargine U300 (Toujeo®) Onset 90 min = Insulin detemir (Levemir®) 90 min = Insulin glargine (Lantus®) Up to 6 h = Insulin glargine U300 (Toujeo®) Peak Not applicable Duration Up to 24h (detemir 16-24 h) = Insulin detemir (Levemir®) Up to 24h (glargine 24 h) = Insulin glargine (Lantus®) Up to 30 h = Insulin glargine U300 (Toujeo®) Premixed insulins Premixed regular insulin -NPH (cloudy) • Humulin® 30/70 • Novolin® ge 30/70, 40/60, 50/50 Premixed insulin analogues (cloudy) • Biphasic insulin aspart (NovoMix® 30) • Insulin lispro/lispro protamine (Humalog®Mix25 and Mix50) ... ... Lisinopril (Hydrochlorothiazide) ACE inhibitor Antihypertensive Must check BP prior to administration Lorazepam (ATIVAN) Antianxiety, Anticonvulsant [Show Less]
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CPNRE exam correctly answered latest update 2022/2023
Which is an adverse effect of digoxin? bradycardia What does TKVO mean? To keep vein open Mr. Singh is experiencing asthma and acut... [Show More] e shortness of breath and wheezing, whats the first thing you should do? Administer rescue inhaler Which of the following is most important when performing a preoperative assessment? physical assessment Which of the following would be elicit the best information about a patients pain? Describe your pain to me (open ended) The practical nurses scope of practice is determined by legislation and regulatory and licensure requirments Intentional torts Assault Battery Invasion of privacy False imprisonment Battery the intentional touching of a person without his or her consent Unintentional torts Negligence is a failure to take the care that a reasonable nurse in similar circumstances would have taken. Examples of activities that nurses may be charged with - theft of narcotics - theft of client or agency property - assisted suicide - criminal negligence Common negligence acts medication errors, intravenous therapy errors that result in phlebitis or infiltrations, burns caused by equipment, falls, failure to use aseptic technique, failure to report, failure to monitor a patients condition, failure to notify a physician Principles of accountability for nurses - responsible and accountable for their decisions and actions - engage in self reflection and continuous learning to maintain and enhance competence - accountable and responsible for assessing their individual fitness to practice. - practical nurses demonstrate and apply knowledge of the distinction between ethical responsible and legal rights Code of nursing ethics - being accountable for ones actions - upholding the patients rights to privacy and confidentiality - providing care that maintains pt dignity - respect at all times - promoting integrity by providing safe, competent, and ethical nursing care - evaluating ones work and maintaining competency A professional relationship is created through the nurses application of knowledge, communication theory, understanding of human behaviour, and commitment to ethical behaviour. Four phases of the nurse client relationship Pre-interaction: Gathering information; assessing one's feelings, fears, and anxieties about working with a particular client Orientation: nurse and client become acquainted. Goal is to establish trust. Working: Goal is to promote client change Termination: Evaluate goal attainment; and ensure therapeutic closure -penia reduced amount Best approach to conflict resolution collaboration The repeat back method consists of identification, situation, background, assessment, recommendations, repeat back before consent, patients need to receive full disclosure of all details of the procedure. Can practical nurses obtain consent for surgery? no because they are not conducting the surgery, but may be a witness consent can be verbal, written, and implicit Example of implicit consent; client lifting leg for wound care Cno practice standard for resuscitation is based on these ethical values - respect for ones well-being - client choice - privacy and confidentiality - respect for life - maintaining comittments - truthfulness and fairness medication treatment is used for dx, treatment, cure, relief, and prevention Idiosyncratic reactions are unpredictable and occur when an individual overreaction from the medication or has a different reaction from the norm. After a medication is taken it breaks down in the body and is absorbed, distributed, metabolized, and excreted 10 rights of medication administration right medication, right dose, right client, right route, right time, right documentation, right reason, right to refuse, right client education, right evaluation oral medications given by mouth. easiest route , most common, and has the slowest, most prolonged effect sublingual medications placed under the tongue and should not be swallowed. parenteral medications injected into the body tissues. The four main sites are: - intradermal, subcutaneous (only for volumes of 0.5-1ml) - intramuscular (for volumes up to 3ml) - IV inhalation route used to administer medications through nasal passages, orally, by endotracheal tube or via tracheostomy The nursing process 1. assessment [Show Less]
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CPNRE Exam Prep correctly answered to pass
What questions should the practical nurse ask a family member of a 75 yr old male new admission with Mid-stage Alzheimer's to obtain the most relevant info... [Show More] for updating a care plan? 1. Do you have any help at home 2. Are your children worried about their father 3. What help does Mr. Robichaud require each day 4. How frequently are you able to visit 3. What help does Mr. Robichaud require each day. (This information is critical in the development of a personalized care plan.) The resident son, asks the practical nurse whether he can participate in his father's daily care when he is available. What should the nurse do? 1. Invite the son to come and play cards with his father 2. Encourage the son to spend his days off with his father 3. Reassure the son that the fathers daily care is being provided by the health care team 4. Question son about what part of his father's care he would like to be a part of 4. Question son about what part of his father's care he would like to be a part of Practical nurse witnesses resident fall to the floor. He does not appear visibly injured, but becomes aggressive when practical nurse tries to assess him. What should the practical nurse do? 1. Reassure the resident and request assistance with a mechanical lift 2. Stay with him and ask the nurse-in-charge to contact the primary care contact 3. Wait until the resident becomes calm and complete the assessment of his injuries 4. Call for assistance, reassure the resident and provide necessary care 4. Call for assistance, reassure the resident and provide necessary care Practical nurse is helping orientate a new employee, an unregulated health worker. Practical nurse watches the UCP (unregulated care provider) helping a resident at mealtimes and notices she appears uncomfortable. What should the nurse do? 1. Suggest that the UCP share her concerns with other employees 2. Partner the UCP with a more experienced unregulated health worker 3. Invite the UCP to attend information sessions on Alzheimers disease 4. Ask the UCP how she feels about caring for clients with Alzheimer's disease 4. Ask the UCP how she feels about caring for clients with Alzheimer's disease A 68 yr old in the medical unit following an MI has a history of type 2 diabetes mellitus and has orders for IV 0.9% NaCl at 30mL/h, oxygen PRN, oral hypoglycemic daily, nitroglycerin transdermal patch (Nitro-Dur) 0.4mg daily and nitroglycerin 0.3mg sublingual PRN for chest discomfort. While watching the pt's back during AM care the PN notices a reddened area on his sacrum. What is proper documentation of the PN's assessment finding? 1. Small reddened area noted over sacrum 2. Reddened area over sacrum the size of a grape 3. Reddened area over sacrum 3cm in diameter, skin intact 4. Skin over sacral area appears reddened 3. Reddened area over sacrum 3cm in diameter, skin intact A 68 yr old in the medical unit following an MI has a history of type 2 diabetes mellitus and has orders for IV 0.9% NaCl at 30mL/h, oxygen PRN, oral hypoglycemic daily, nitroglycerin transdermal patch (Nitro-Dur) 0.4mg daily and nitroglycerin 0.3mg sublingual PRN for chest discomfort. When administering the oral hypoglycemic pill, he states " that doesn't look like the pill I take at home." What should the PN do? 1. Reassure the pt that this is the correct med order by the physician 2. Reassure the pt that this is the correct med although it may look different 3. Re-check the Dr's orders and the home medication history 4. RE-check the pharmacy label before giving the med 3. Re-check the Dr's orders and the home medication history A 68 yr old in the medical unit following an MI has a history of type 2 diabetes mellitus and has orders for IV 0.9% NaCl at 30mL/h, oxygen PRN, oral hypoglycemic daily, nitroglycerin transdermal patch (Nitro-Dur) 0.4mg daily and nitroglycerin 0.3mg sublingual PRN for chest discomfort. The PN is preparing to admin the pt's nitroglycerin patch. What would be the best place to apply the patch? 1. Lower leg 2. Upper arm 3. Lumbar area 4. Upper thigh 2. Upper arm A 68 yr old in the medical unit following an MI has a history of type 2 diabetes mellitus and has orders for IV 0.9% NaCl at 30mL/h, oxygen PRN, oral hypoglycemic daily, nitroglycerin transdermal patch (Nitro-Dur) 0.4mg daily and nitroglycerin 0.3mg sublingual PRN for chest discomfort. The 2nd day on the medical unit, the pt develop diarrhea and begins vomiting. The Dr orders the IV rate to increase to 150mL/h. 2 hrs later the PN notices that he is dyspneic and his RR is 32 breaths/min. The PN auscultates his chest and notes adventitious sounds throughout. What should the PN do? 1. Discontinue the IV infusion and notify the physician 2. Reassess the IV rate and encourage deep breathing and coughing exercises 3. Maintain the IV infusion at 150mL/h and notify the physician 4. Notify the physician and anticipate a decrease in the IV rate 4. Notify the physician and anticipate a decrease in the IV rate A 68 yr old in the medical unit following an MI has a history of type 2 diabetes mellitus and has orders for IV 0.9% NaCl at 30mL/h, oxygen PRN, oral hypoglycemic daily, nitroglycerin transdermal patch (Nitro-Dur) 0.4mg daily and nitroglycerin 0.3mg sublingual PRN for chest discomfort. On the fourth day on the medical unit, the pt reports that he has chest discomfort and SOB. The PN notes that he is pale, and his skin is cool and clammy . Most appropriate sequence of interventions? 1. Assess vital signs & blood glucose, then apply oxygen 2. Apply oxygen, assess vital signs and then assess blood glucose 3. Assess vital signs, apply oxygen, and then give sublingual nitroglycerin 4. Apply oxygen, assess vital signs and provide a warm blanket 3. Assess vital signs, apply oxygen, and then give sublingual nitroglycerin 13 yr old female hospitalized with vomiting and generalized stomach pain. Her parents worry about recent changes in behavior and depressed mood. Pt tells PN her stomach hurts because she is making herself vomit. Asks PN not to tell parents, how should PN respond? 1. Tell the pt that the PN is only obliged to report vomiting if it occurs during her hospitalization 2. Remind the pt that clients have the right to determine what information is documented and reported 3. Explain to the pt that information is shared with the health care team to provide appropriate care 4. Reassure the pt that her stomach pains will subside if she stops vomiting and her condition improves 3. Explain to the pt that information is shared with the health care team to provide appropriate care 13 yr old female hospitalized with vomiting and generalized stomach pain. Her parents worry about recent changes in behavior and depressed mood. In accordance with the nursing care plan, the PN sits with the pt while she eats her meals and accompanies her to the bathroom. Today, the PN notices the females facecloths are missing from the bathroom. What action should the PN take? 1. Discuss the issue of lost facecloths, search the room when the pt is out of her room and document appropriately 2. Ask the pt where the facecloths are, ask her to return them and chart the missing facecloths 3. Ask the pt where the facecloths are and chart the suspicion that they are being used to hide uneaten food 4. Discuss the issue of lost facecloths with the pt and document appropriate information 4. Discuss the issue of lost facecloths with the pt and document appropriate information 13 yr old female hospitalized with vomiting and generalized stomach pain. Her parents worry about recent changes in behavior and depressed mood. The pt is concerned about her weight. She exercise and makes food choices based on not wanting to become fat. She says that she does not feel like eating. What should the nurse do? 1. Design a diet in consultation with the dietitian and ensure that it is balanced, contains variety and has the requisite caloric intake. 2. Ask the pt what she likes and dislikes, have her mother bring in food, and obtain and record her daily weight to demonstrate progress. 3. Include the pt in goal-setting for healthy weight, have her maintain a food and fitness journal, and obtain & record her weight weekly. 4. Promote a healthy lifestyle, the importance of stress management and nutritional teaching with peer support groups 3. Include the pt in goal-setting for healthy weight, have her maintain a food and fitness journal, and obtain & record her weight weekly. 75 yr old pt with tuberculosis, and has been placed on isolation precautions since being admitted to the hospital. Which action best indicates that the practical nurse knows how to collect sputum specimen from the pt? 1. Keep the specimen at room temperature and send to the laboratory for analysis 2. Collect the specimen in a clean, light occlusive container 3.Instruct the pt to use mouthwash prior to specimen collection 4. Teach the pt to deep breath and cough prior to expectoration 4. Teach the pt to deep breath and cough prior to expectoration 75 yr old pt with tuberculosis, and has been placed on isolation precautions since being admitted to the hospital. While in the pt room doing routine care, what is the most crucial health information about TB that the practical nurse should provide to the pt? 1. His contacts do not need to worry about contracting TB 2. He must comply with medication protocol on discharge 3. He should follow a well-balanced diet 4. His fluid intake should ensure adequate hydration 2. He must comply with medication protocol on discharge 75 yr old pt with tuberculosis, and has been placed on isolation precautions since being admitted to the hospital. What would offer the best protection to the PN when providing direct care to the pt? 1. A mask 2. Sterile gloves 3. A gown 4. Goggles 1. A mask A pt, 68 years old, has chronic renal failure. She has been on peritoneal dialysis for the past 2 years. Her daughter brought her to the Emergency Department last night with a fever. Infection of her peritoneal dialysis catheter is suspected. The pt is started on IV therapy what complication is most likely to occur bc of renal failure? 1. Infiltration 2. Fluid Overload 3. Dehydration 4. Urinary retention 2. Fluid Overload [Show Less]
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CPNRE Practice Questions and answers graded A+ already passed
The nurse is administering heparin via the subcutaneous route. Which intervention should the nurse implement? a. Prepare the medication using a 25-gauge... [Show More] , ½ inch needle b. After injecting the needle, aspirate and observe for blood c. After removing the needle, massage the area gently d. Administer the medication in the client's "love handles" Prepare the medication using a 25-gauge, ½ inch needle Knowledge: The nurse should NOT aspirate for blood when administering heparin because this can damage surrounding tissue and cause bruising. The nurse should not massage after injecting heparin because this may cause bruising or bleeding. Heparin is administered in the abdomen at least 2 inches from umbilicus-best practice. The nurse is administering morning medications on a medical floor. Which medication should the nurse administer first? a. Regular insulin sliding scale to an elderly client diagnosed with Type 1 diabetes mellitus b. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus c. Morphine, a narcotic analgesic, to a client diagnosed with AIDS d. Lasix, a diuretic, to a client with hypertension a. Regular insulin sliding scale to an elderly client diagnosed with Type 1 diabetes mellitus b. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus (can be administered within the 30-minute acceptable time frame) c. Morphine, a narcotic analgesic, to a client diagnosed with AIDS -pain medication is a priority, but it can be administered after the sliding scale d. Lasix, a diuretic, to a client with hypertension- can be administered within the 30-minute acceptable time frame Regular insulin is administered prior to meals; therefore, this medication should be administered. Critical Thinking Which data would indicate that the antibiotic therapy has been successful for a client diagnosed with bacterial pneumonia? a. The client's hematocrit is within normal range b. The client is expectorating thick green sputum c. The client's lung sounds are clear to ausculatation d. The client has complaints of pleuritic chest pain. a. The client’s hematocrit is within normal range- does not indicate client response b. The client is expectorating thick green sputum- symptom of pneumonia c. The client’s lung sounds are clear to ausculatation d. The client has complaints of pleuritic chest pain.— symptom of pneumonia The symptoms of pneumonia includes crackles and wheezes, rhonchi in the lung fields. Clear lungs indicate an improvement in the pneumonia and that the medication is effective. Application The nurse is administering Humalog at 0730 to a client diagnosed with Type 1 diabetes. Which intervention should the nurse implement? a. Ensure the client eats at least 90% of the lunch tray b. Do not administer unless the breakfast tray is in the client's room c. Check the client's blood glucose level 1 hour after receiving the insulin d. Have 50% dextrose in water at the bedside for emergency use. a. Ensure the client eats at least 90% of the lunch tray—insulin will not be working 4-5 hours after being administered b. Do not administer unless the breakfast tray is in the client’s room c. Check the client’s blood glucose level 1 hour after receiving the insulin—glucose level should be checked prior to administering d. Have 50% dextrose in water at the bedside for emergency use.—this is administered when a client is unconscious secondary to hypoglycemia, and should not be kept at the bedside. Orange juice or some form of simple glucose can be kept at the bedside. Application: The insulin peaks in 15-20 minutes after being administered; therefore, the meal should be at the bedside prior to administering this medication The client has a severe anaphylactic reaction to insect bites. What priority discharge intervention should the nurse discuss with the client? a. Wear an insect repellent on exposed skin b. Keep prescribed antihistamines on their person c. Keep an EpiPen in the refrigerator at all times d. Wear a MedicAlert identification bracelet a. Wear an insect repellent on exposed skin —appropriate intervention, but if the client has an insect bite, the repellent will not prevent anaphylaxis, therefore, not priority intervention b. Keep prescribed antihistamines on their person —used with anaphylaxis, but it takes at least 30 minutes to work, therefore not a priority medication c. Keep an EpiPen in the refrigerator at all times —keeping medication in the refrigerator does not allow it to be available to the client at all times. d. Wear a MedicAlert identification bracelet Application: Bracelet indicates the client is at risk for an anaphylactic reaction; therefore, this is the priority intervention. The client's mother contacts the clinic regarding medication administration stating, "My daughter cannot swallow this capsule. It's too large." Investigation reveals that the medication is a capsule marked SR. The nurse should instruct the mother to: a. Open the capsule and mix the medication with apple sauce b. Crush the medication and administer it with a glass of liquid c. Call the pharmacist and request a change to a different medication d. Stop the medication and inform the physician d. Stop the medication and inform the physician Application: SR means sustained released. These medications cannot be altered. In answers A and B, crushing or opening the capsule is not allowed. The best response would be to inform the prescriber (the doctor) immediately The client calls the nursing station and requests pain medication. When the nurse enters the room with the narcotic medication, the nurse finds the client laughing and talking with visitors. Which action should the nurse administer first? a. Administer the client's prescribed pain medication b. Assess the client's perception of pain on a 1-10 scale c. Wait until the visitors leave to administer any medication d. Check the MAR to see if there is a nonnarcotic medication ordered a. Administer the client’s prescribed pain medication —should not administer pain medication until after assessing the client’s pain b. Assess the client’s perception of pain on a 1-10 scale c. Wait until the visitors leave to administer any medication —should assess client whether the client has visitors or not d. Check the MAR to see if there is a nonnarcotic medication ordered —nurse should assess the client’s pain first Application: first action is to always assess the client in pain to determine if client is having a complication that requires medical intervention rather than PRN medication. The client in hypovolemic shock is receiving normal saline by rapid intravenous infusion. Which assessment data would warrant immediate intervention by the nurse? a. The client's blood pressure is 89/48 b. The client's pulse oximeter reading is 95% c. The client's lung sounds are clear bilaterally d. The client's urine output is 120 mL in 3 hours a. The client’s blood pressure is 89/48 b. The client’s pulse oximeter reading is 95% --normal finding c. The client’s lung sounds are clear bilaterally—normal finding d. The client’s urine output is 120 mL in 3 hours—normal finding Application: low blood pressure reading for a client in hypovolemic shock. A B/P less than 90/60 warrants intervention by the nurse and indicates that fluid resuscitation is not effective. Which intervention should the nurse implement when administering a medication via the intradermal route? a. Insert the needle with the bevel up at 15-degree angle in the skin b. Prepare the medication in a 3-mL syringe using a 23-gauge 1-inch needle c. Bunch the skin between the thumb and index finger of the nondominant hand d. Quickly inject the medication as to not form a wheal or bleb a. Insert the needle with the bevel up at 15-degree angle in the skin b. Prepare the medication in a 3-mL syringe using a 23-gauge 1-inch needle —wrong syringe (need tuberculin syringe), wrong gauge, and wrong needle c. Bunch the skin between the thumb and index finger of the nondominant hand---skin should be spread taut, not bunched d. Quickly inject the medication as to not form a wheal or bleb—medication should be injected slowly to form a wheal or bleb Knowledge: A is the correct way to administer intradermal medication The charge nurse is observing the primary nurse administering otic drops to a 2-year-old child by pulling down and back on the auricle. Which action should the charge nurse take? a. Stop the primary nurse and ask the nurse to step out of the room b. Demonstrate inserting the otic drops by pulling up and back on the auricle c. Take no action because this is the correct way to administer the ear drops d. Allow the nurse to administer the otic drops and then discuss the technique with the nurse a. Stop the primary nurse and ask the nurse to step out of the room b. Demonstrate inserting the otic drops by pulling up and back on the auricle—correct way for adults c. Take no action because this is the correct way to administer the ear drops d. Allow the nurse to administer the otic drops and then discuss the technique with the nurse Knowledge: This is the correct way to administer eardrops to a child younger than 3. This is done because of the short Eustachian tube of a child. The charge nurse need take no action The nurse prepared 2 mg of morphine for a client who is complaining of pain. When the nurse enters the room the client tells the nurse, "I don't want to take a shot. I would like to have a pain pill." Which action should the nurse take? a. Explain that the medication must be administered because it has been drawn up b. Ask another nurse to watch the medication being wasted into the sink c. Place the syringe in the sharps container in the client's room— d. Notify the pharmacy that a narcotic was not administered to the client a. Explain that the medication must be administered because it has been drawn up —client has the right to refuse medication; therefore; the nurse cannot force the client to take the med. b. Ask another nurse to watch the medication being wasted into the sink c. Place the syringe in the sharps container in the client’s room—legally the nurse must have someone witness the narcotic being wasted d. Notify the pharmacy that a narcotic was not administered to the client—does not need to be notified Application: Correct procedure as per CNO medication standards of practice The nurse is preparing to adminster 3 mL of a medication intramuscularly to an adult client in the clinic. Which muscle is the best site to administer the medication? a. The deltoid muscle b. The dorsogluteal muscle c. The ventrogluteal muscle d. The vastus lateralis muscle a. The deltoid muscle —1-2 mL max. at this site, muscle is small b. The dorsogluteal muscle— not recommended because the sciatic nerve may be injured if landmarking is improper c. The ventrogluteal muscle d. The vastus lateralis muscle— can be used, but is more painful Knowledge: site of choice is C, free of major nerves and adipose tissue to ensure medication goes in the muscle. It is also a larger mass of muscle. The nurse is administering medications through a gastrostomy tube (GT). Which intervention should the nurse implement first? a. Place the crushed pills in the gastrostomy tube. b. Flush the gastrostomy with at least 30 mL of tap water c. Use the plunger to push the medication into the GT d. Clamp the gastrostomy tube closed. a. Place the crushed pills in the gastrostomy tube.—Not first intervention b. Flush the gastrostomy with at least 30 mL of tap water c. Use the plunger to push the medication into the GT- not first intervention d. Clamp the gastrostomy tube closed.— performed after medication is administered Knowledge: Nurse should first flush the GT with tap water to ensure it is patent before putting any medication into the GT. The charge nurse is making rounds on the clients and notices the primary nurse left a medication cup with three tablets at the client's bedside. Which action should the charge nurse implement? a. Administer the client's medications b. Remove the medication cup from the room c. Request the primary nurse come to the room d. Leave the cup at the bedside and talk to the primary nurse a. Administer the client’s medications—charge nurse cannot administer without verifying medications against MAR b. Remove the medication cup from the room c. Request the primary nurse come to the room—charge nurse should not correct the primary nurse in front of client d. Leave the cup at the bedside and talk to the primary nurse Application: The nurse should take the medication cup back to the medication room and discuss this situation with the primary nurse. Medications should never be left at the bedside. 1. The client in end-stage renal disease is receiving oral Kayexalate. Which assessment data indicates the medication is not effective? a. The client's serum potassium level is 5.8 mEq/L b. The client's serum sodium level is 135 mEq/L c. The client's serum postassium level is 4.2 mEq/L d. The client's serum sodium level is 147 mEq/L a. The client’s serum potassium level is 5.8 mEq/L b. The client’s serum sodium level is 135 mEq/L —does not alter sodium levels (not used for this) c. The client’s serum postassium level is 4.2 mEq/L—normal level d. The client’s serum sodium level is 147 mEq/L (see above) Application: Kayexalate is a medication used to decrease potassium levels. A is an elevated level, therefore, medication is not effective. Which of the following interventions would be a priority in the plan of care for the person with pulmonary emphysema? (Select all that apply) a. Low flow oxygen via face mask b. Intravenous aminophylline c. Maintain hydration status d. Intravenous ampicillin therapy b. Intravenous aminophylline c. Maintain hydration status Application Question: Since emphysema is a chronic disorder, the patient will be required to wear oxygen continuously, therefore nasal canula is the best way to deliver the low levels of oxygen. Aminophylline is a bronchodilator used as maintenance therapy. Hydration is necessary, but not overhydration. Ampicillin therapy is not considered a typical intervention in the management of emphysema. The practical nurse enters Mrs. Stem's room to administer the 0800 Hours insulin dose. Mrs. Stem states , "That is not my usual dose of insulin. " How should the nurse respond to Mrs. Stem? a. "Let me check the medication order again and I'll be back in a few minutes." b. "I'll check with my colleague, who is right here to see if this is the right dose." c. "I saw your insulin order about 1 hour ago and this what the physician ordered." d. "Mrs. Stem, I know what I am doing and you should trust me, this is the correct dose." a. “Let me check the medication order again and I’ll be back in a few minutes.” APPLICATION QUESTION--According to the CNO compendium –medication standards---YOU SHOULD ALWAYS CHECK/VALIDATE ANY MEDICATION /ORDER THAT THE PATIENT THEMSELVES QUESTIONS. “BEST PRACTICE” Mrs. Soh, 65 years old, is 3 days postoperative. She is experiencing nausea and vomiting. What should the nurse do? a. Place bed in semi-Fowler's (45 degrees) b. Document client condition c. Auscultate bowel sounds d. Provide a glass of water c. Auscultate bowel sounds CRITICAL THINKING QUESTION--. Yes, you will document this event, but you would manage the patient first in this case. Complete an assessment, then intervene. Bowel sounds are one aspect of an assessment of peristalsis. This will help determine if the intestines are functioning, and rule out bowel obstruction or other disorders. A 19-year-old with acute asthma has come into the E.R in acute respiratory distress. His breath rate is 44 breaths/minute. Which of the following interventions should the nurse anticipate first? a. Obtain a complete health history b. Administer bronchodilator via nebulizer c. Provide emotional support to the client d. Apply a cardiac monitor to the client b. Administer bronchodilator via nebulizer Critical Thinking Question: Follow Protocol ABC’s First, then Nursing Process. In this case, it is an emergency, therefore we follow ABC’s. The patient is experiencing an acute asthma attack, we will administer bronchodilator to open up the airway. Once the acute phase is over, we can consider the other interventions. Which one of the following best describes the concept of Routine Precautions (formerly Standard Precautions? a. It is a method of infection control used only when the client tests positive for a communicable disease. b. It is a method of sterilization that is followed in emergency and high-risk clinical situations. c. It is a process where soiled articles are separated from clean hospital supplies. d. It is a system of generic infection control practices for all clients. d. It is a system of generic infection control practices for all clients. KNOWLEDGE QUESTION--BEST DESCRIPTION—THE OTHER RESPONSES ARE FALSE Mrs. Albiani, 72 years old, has pneumonia. What assessment should the nurse expect to find during auscultation? a. Wheezing b. Tactile fremitus c. Crackles d. Hyperresonance c. Crackles KNOWLEDGE QUESTION—HYPERRESONANCE IS DUE TO EXCESSIVE AIR ACCUMULATION IN LUNGS. WHEEZING IS DUE TO NARROWED AIRWAY—WHICH COULD DEVELOP LATER WITH ILLNESS, SECONDARY TO THE BUILD UP OF SECRETIONS. What action is best when the nurse observes that a client's drug dosage for an antihypertensive medication is twice the recommended dose for that medication? a. Take the client's vital signs before proceeding with administration b. Take the client's blood pressure every 1-2 hours c. Check with the client to determine how long she has been taking the medication. d. Re-check the dosage on the physician's order sheet. d. Re-check the dosage on the physician’s order sheet. CRITICAL THINKING--Always, Always recheck or verify dosages that are over the recommendation, or are inaccurate. AS PER CNO MEDICATION STANDARDS IN COMPENDIUM Mr. Harrison, 29 years old, is experiencing anxiety following a diagnosis of testicular cancer. What should the nurse do? a. Ask him if he is concerned about not having children b. Encourage him to verbalize his feelings c. Suggest that he talk to his significant other. d. Refer him to a testicular cancer support group. b. Encourage him to verbalize his feelings APPLICATION QUESTION--NURSES ARE ABLE TO LISTEN ANY EXPRESSION OF FEELINGS, IT IS WITHIN THEIR SCOPE OF PRACTICE, THEREFORE, YOU DO NOT NEED TO REFER THIS BOUT OF ANXIETY TO SOMEONE ELSE. A—NON-THERAPEUTIC AT THIS TIME. Ben is a frail, 18-year-old client who is in the end stages of AIDS. He has open areas on his upper and lower extremities. He is having severe persistent pain and is due to receive morphine sulfate (Morphine) 10 mg subcutaneously. Which of the following nursing interventions best applies when the nurse prepares to administer morphine to Ben? a. Inject the morphine in the upper abdomen using a ½ inch needle at 45 degrees. b. Inject the morphine in the upper arm using a 1 inch needle at 45 degrees c. Contact the pharmacist and ask if morphine can be absorbed subcutaneously d. Call the physician and request an alternative route for morphine a. Inject the morphine in the upper abdomen using a ½ inch needle at 45 degrees. CRITICAL THINKING QUESTION—OPEN AREAS ARE LOCATED ON UPPER EXTREMITIES, THEREFORE, DO NOT USE THOSE SITES, 45 DEGREE ANGLE IS BEST FOR UNDERNOURISHED PATIENTS. HE HAS SEVERE PAIN, THEREFORE NEEDS INTERVENTION. A CONSIDERATION FOR THE FUTURE IS POSSIBLY INVESTIGATING FOR A LONGER RELEASE/DURATION PAIN MEDICATION. The nurse is asked by a colleague to witness the wastage of two narcotic tablets that have fallen on the floor. After co-signing the narcotic sheet, the practical nurse sees the colleague put the two tablets in a uniform pocket. Which action must the nurse take? a. Report and document the incident b. Encourage the colleague to attend a self-help group for professionals c. Ignore the incident and observe for further occurrences d. Telephone the discipline committee of the regulatory body. a. Report and document the incident APPLICATION QUESTION---AS PER CNO STANDARDS---CANNOT IGNORE INCIDENT, FOLLOW DUE PROCESS—AT THIS POINT DISCIPLINE COMMITTEE IS NOT THE INITIAL PERSON OF CONTACT, A IS BEST PRACTICE. An elderly male client with alcoholism states that he is thinking of committing suicide and asks that this information be kept confidential. Which one of the following responses is most appropriate for the nurse to make? a. "For your own safety, I have to report this immediately." b. "You are not really serious about this?" c. "Have you spoken to your physician about this?" d. "Are you drinking more now?" a. “For your own safety, I have to report this immediately.” AS PER STANDARDS OF PRACTICE---CONFIDENTIALITY IS TO BE MAINTAINED, WITH THE EXCEPTION OF—HARM TO ONESELF, OR HARM TO ANOTHER. B---MINIMIZES THE EXPRESSION, NON THERAPEUTIC, C—PASSES THE RESPONSIBILITY OFF.---APPLICATION QUESTION The practical nurse is asked to set up an IV infusion of 1,000 ml normal saline for a client. Which one of the following actions is the first responsibility of the nurse? a. Explaining the procedure to the client b. Teaching the client about IV/infusion therapy c. Verifying the physician's order the client d. Assembling the equipment at the client's bedside c. Verifying the physician’s order the client AS PER MEDICATION STANDARDS OF PRACTICE. THIS IS THE FIRST RESPONSIBILITY PRIOR TO PROCEEDING WITH THE PROCEDURE. APPLICATION QUESTION [Show Less]
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CPNRE: Upper Gastrointestinal questions solved 2022
GERD the backwards flow of gastrointestinal contents into the esophagus GERD nursing interventions diet: restrict spicy and acidic and fatty foods... [Show More] , eat 4-6 meals a day, avoid bedtime snacks, eat slowly and chew thoroughly lifestyle: elevate HOC by 8-12 inches for sleep, stop smoking, monitor/avoid alcohol, weight reduction drug therapy: antacids, histamine blockers Hiatal Hernia portion of the stomach enters into the esophagus through an opening or hiatus in diaphragm types of hernias Sliding (stomach slides into thoracic cavity when supine and into abd cavity when standing upright) Paraesophageal: esophageal junction stays in place but fundus and greater curvature of stomach roll up through diaphragm manifestations of a hiatal hernia heart burn post meals and lying, dysphagia (difficulty swallowing) Gastritis Acute: rapid onset usually caused by dietary indiscretion (spicy, contaminated) Chronic: prolonged inflammation caused by benign or malignant ulcers of the stomach of H. pylori manifestations of gastritis acute: abd discomfort, headache, n/v, hiccupping chronic: epigastric discomfort, anorexia, heart burn after eating, intolerance to some foods, sour taste in mouth, n/v peptic ulcer disease erosion of GI mucosa resulting from digestive action of HCl acid and pepsin types of peptic ulcers acute: superficial erosion, minimal inflammation, short duration and resolves quickly when identified chronic: muscular wall erosion with formation of fibrous tissue. Long duration. Destroyers of mucosal barriers H.pylori, aspirin, NSAIDs, corticosteroid, lifestyle factors (alcohol, coffee, smoking) manifestations of peptic ulcers pain in epigastrium 1-2 hours after meals and 2-5 hours post meals in duodenal ulcers (food aggravates pain)= antacids gastric outlet obstruction manifestations ulcer hx, pain progressing to generalized upper abd discomfort, vomitting is common, pain worsens at the end of the day, relief by burping, constipation is common complaint, loud peristalsis, stomach is grossly dilated gastric outlet acute nursing interventions treat symptoms, provide regular mouth care, cleanse and lubricate nares for NG tube, VS hourly, I/O gastric outlet complications perforation and hemorrhage j tube this is inserted into the jejunum g tube this is intserted into the stomach nursing care for J/G tubes pt teaching and prep, tube insertion, confirming placement, securing the tube, monitoring the placement, monitoring the patient, maintaining tube function, oral and nasal care, monitoring/preventing and managing complications and tube removal [Show Less]
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Lab Values for CPRNE question & answer 2022
Hemoglobin Female 12-16 Male 14-18 RBC 4-6 BILLION WBC 5,000-10,000 Potassium (K) 3.5-5.5 Sodium (Na) 135-145 Cap ... [Show More] refill normal time less than 2 seconds Cholesterol 140-200 PH 7.35-7.45 [Show Less]
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CPRNE Study Cards correctly answered 2022
Examples of Therapeutic Communication - Introducing self and title, as well as length of relationship - Address client by name/preferred title - Give cl... [Show More] ient time/opportunity to explain self and listen to them - Informing client information with be shared with health care team - Awareness of body language interpretation by client - Accommodate for communication styles (language) - Assess clients knowledge, beliefs and wishes to find best care plan - Listen to concerns of family and significant others - Consider client preference when promoting advocacy - Providing information to promote client choice - Recognizing that all behaviors have meaning - Refraining from self disclosure - Reflecting on interactions - Discuss throughout plans to meet needs after termination of relationship Examples of Client Centered Care - Making the clients goals, wishes and preferences that basis of the care plan - Understanding clients limitations and needs for nursing assistance - Discuss clients expectations, and how realistic it is regarding health and available resources - Recognizing client well being is affected by establishing and maintaining relationship - Recognize biases and feelings established through life that could affect relationship - Acknowledging and managing stress - Engaging client in evaluating the nursing care - Committing to availability - Requesting therapeutic transfer of care if relationship does not evolve Examples of Maintaining Boundaries - Helping clients understand when requests are beyond limits of boundaries - Following care plan aiming to clients needs - Make sure any action that could be seen as crossing boundaries is in care plan (having coffee with mental health client may be appropriate) - Nurse does not interfere with personal relationships - Abstaining from disclosing personal information - Continually clarifying his/her role in situation - Coexisting relationships do not interfere - Consult with health care team when it is unclear if boundaries have been crossed - Goals are made to meet the needs of the client and not the nurse - Consider cultural value of the context of maintaining boundaries When do you accept a gift? When refusal will harm the nurse-client therapeutic relationship - Consider that the gift was not solicited by the nurse, the client is mentally competent, and the clients intent of offering the gift When can you give a gift? - The client knows the nurses want nothing in return - Does not change the dynamic of the relationship - No potential for negative feelings Examples of Protecting Client from Abuse - Always intervene and report - Intervene when the client feels abused - Intervening and reporting health care team members abusing clients - Not entering friendship, romantic, sexual or personal relationship with the client - Not engaging in behaviors that may be perceived as violent/abusive - Not neglecting basic needs - Not accepting POA positions and other positions of power over the client When can you enter a personal relationship with a client after termination of nurse-client relationship? - When determined that relationship with not have negative impact on future care for client - Client is clear that relationship is no longer therapeutic - The relationship is not based off of therapeutic relationship previously established Warning Signs of Boundary Crossing - Spending extra time - Changing client assignments to care for client - Feeling health care team doesn't understand the relationship - Disclosing personal information - Dressing differently when seeing the client - Thinking about client away from work - Feeling guarded when questions are asked about client - Spending off duty time with client - Ignoring agency policies for client - Keep secrets with client, away from health care team - Client is only willing to speak with you What do you do if you see a colleague crossing boundaries with a client? 1. Assess and address the colleague regarding what was observed, how the behavior was perceived, the impact on the client, and the College practice standard 2. ^^ if not possible, address the colleague's supervisor by putting concerns in writing with date, time, witnesses and type of client identification (file number) 3. ^^ if not possible, report to next highest authority or College 4. If ABUSE, the nurse must intervene and report any incident of unsafe practice to employer 5. ALWAYS inform the clients right to inform police What is fast acting insulin used for? Control blood sugar during meals, snack [Show Less]
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