NRSG 2010 AQ MED SURG DRUGS QUESTIONS AND ANSWERS
Quiz: Medical-Surgical Drugs Correct Answers: 7 3029479603 Confidence: Just a guess Stats Issue with
... [Show More] this question? 4.
The provider prescribes one unit of packed red blood cells to be administered to a client. To ensure the client's safety, which measure should the nurse take during administration of blood products? Correct1
Stay with client during first 15 minutes of infusion. 2 Flush packed red blood cells with 5% dextrose and 0.45% normal saline. 3 Discontinue the intravenous catheter if a blood transfusion reaction occurs. 4
Administer the red blood cells through a percutaneously inserted central catheter line with a 20-gauge needle.
The nurse should remain with the client for the first 15 to 30 minutes. Any severe reaction usually occurs with the infusion of the first 50 mL of blood. Blood components are viscous, requiring a large needle to be used for venous access. A 20-gauge needle is not used to access a central catheter line. Normal saline is the solution to administer with blood productions. Lactated Ringer and dextrose in water are not used for infusion because of hemolysis.
75%of students nationwide answered this question correctly. View Topics 3029691363 Confidence: Just a guess Stats Issue with this question? 8.A client who takes daily megadoses of vitamins is hospitalized with joint pain, loss of hair, yellow
pigmentation of the skin, and an enlarged liver due to vitamin toxicity. What type of toxicity does the
nurse suspect?
Correct1
Retinol (vitamin A)
2
Thiamine (vitamin B1)
3
Pyridoxine (vitamin B6)
4
Ascorbic acid (vitamin C)
These adaptations, as well as anemia, irritability, pruritus, and an enlarged spleen, occur with vitamin A
toxicity. Excess thiamine is excreted in the urine and rarely, if ever, causes toxicity; an excessive dose may
elicit an allergic reaction in some individuals. Excess vitamin C (ascorbic acid) does not cause these
adaptations or toxicity; however, vitamin C may cause diarrhea or renal calculi. Pyridoxine (vitamin B6) is
relatively nontoxic, and excess amounts are excreted in the urine.
STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all
exams is not realistic, but scoring an 85% may be a better goal.
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10.
A client with diabetes asks how exercise will affect insulin and dietary needs. What information does the
nurse share about insulin and exercise?
Correct1
"Exercise increases the need for carbohydrates and decreases the need for insulin."
2
"Exercise increases the need for insulin and increases the need for carbohydrates."3
"Regular physical activity decreases the need for insulin and decreases the need for carbohydrates."
4
"Intensive physical activity decreases the need for carbohydrates but does not affect the need for
insulin."
Exercise increases the uptake of glucose by active muscle cells without the need for insulin;
carbohydrates are needed to supply energy for the increased metabolic rate associated with exercise.
The need for insulin is decreased.
Test-Taking Tip: Being emotionally prepared for an examination is key to your success. Proper use of
resources over an extended period of time ensures your understanding and increases your confidence
about your nursing knowledge. Your lifelong dream of becoming a nurse is now within your reach! You
are excited, yet anxious. This feeling is normal. A little anxiety can be good because it increases
awareness of reality; but excessive anxiety has the opposite effect, acting as a barrier and keeping you
from reaching your goal. Your attitude about yourself and your goals will help keep you focused, adding
to your strength and inner conviction to achieve success.
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12.
A client with a new diagnosis of type 1 diabetes is told that lifelong insulin will be needed. The client
becomes agitated and says, "I am scared of shots. If that is my only option, I’ll just have to go into a coma
and die!" What is the nurse’s best response?
Correct1
"Injections are not the only option available for insulin."
2
"It won’t be so bad; you will get used to it if you will only try."
3
"This is one of those times when you need to act like an adult."
4"Clients have the right to refuse treatment, but I need you to sign this form that removes us from liability
for your decision."
An insulin nasal spray was approved by the Food and Drug Administration (FDA) in 2014 and is available
for clients who do not want insulin injections. The nurse should use therapeutic communication in
interacting with clients. Intimidating the client by suggesting that actions are childlike and suggesting
that the client’s concerns are not significant are not therapeutic responses. The nurse’s primary concern
should be for the client’s well-being, not protection from liability.
Test-Taking Tip: If you are unable to answer a multiple-choice question immediately, eliminate the
alternatives that you know are incorrect and proceed from that point. The same goes for a multiple-
response question that requires you to choose two or more of the given alternatives. If a fill-in-the-blank
question poses a problem, read the situation and essential information carefully and then formulate your
response.
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14.
A client who is receiving phenytoin to control a seizure disorder questions the nurse regarding this
medication after discharge. How will the nurse respond?
Correct1
"Antiseizure drugs will probably be continued for life."
2
"Phenytoin prevents any further occurrence of seizures."
3
"This drug needs to be taken during periods of emotional stress."
4
"Your antiseizure drug usually can be stopped after a year's absence of seizures."
Seizure disorders usually are associated with marked changes in the electrical activity of the cerebral
cortex, requiring prolonged or lifelong therapy. Seizures may occur despite drug therapy; the dosage may
need to be adjusted. A therapeutic blood level must be maintained through consistent administration ofthe drug irrespective of emotional stress. Absence of seizures will probably result from medication
effectiveness rather than from correction of the pathophysiologic condition.
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17.
A client develops thrombophlebitis in the right calf. Bed rest is prescribed, and an IV of heparin is
initiated. What drug action will the nurse include when describing the purpose of this drug to the client?
Correct1
Prevents extension of the clot
2
Reduces the size of the thrombus
3
Dissolves the blood clot in the vein
4
Facilitates absorption of red blood cells
Heparin interferes with activation of prothrombin to thrombin and inhibits aggregation of platelets.
Heparin does not reduce the size of a thrombus. Heparin does not dissolve blood clots in the veins.
Heparin does not facilitate the absorption of red blood cells.
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23.A client reports nausea, vomiting, and seeing a yellow light around objects. A diagnosis of hypokalemia is
made. Upon a review of the client's prescribed medication list, the nurse determines that what is the
likely cause of the clinical findings?
Correct1
Digoxin (Lanoxin)
2
Furosemide (Lasix)
3
Propranolol (Inderal)
4
Spironolactone (Aldactone)
These are signs of digitalis toxicity, which is more likely to occur in the presence of hypokalemia.
Although furosemide most likely contributed to the hypokalemia, the client's symptoms are consistent
with digitalis toxicity. Although propranolol can cause nausea, vomiting, and blurred vision, the presence
of hypokalemia and yellow vision are more suggestive of digitalis toxicity. A side effect of spironolactone
is hyperkalemia, not hypokalemia.
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A client with cancer of the thyroid is scheduled for a thyroidectomy. What should the nurse teach the
client?
Incorrect1
The dietary intake of carbohydrates must be restricted.
Correct2
Thyroxine replacement therapy will be required indefinitely.
3
Chemotherapy may be used in conjunction with the surgery.
4
A tracheostomy requires an alternative means of communication.
Thyroxine is given postoperatively to suppress thyroid-stimulating hormone (TSH) and prevent
hypothyroidism. Increased intake of carbohydrates and proteins is needed because of the increased
metabolic activity associated with hyperthyroidism. Chemotherapy is uncommon; radiation may be used
to eradicate remaining tissue. A tracheostomy is not planned; it is needed only in an emergency related
to respiratory distress.Test-Taking Tip: Being prepared reduces your stress or tension level and helps you maintain a positive
attitude.
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2.
A client who had abdominal surgery is receiving patient-controlled analgesia intravenously to manage
pain. The pump is programmed to deliver a basal dose and bolus doses that can be accessed by the
client, with a lock-out time frame of 10 minutes. The nurse assesses use of the pump during the last hour
and identifies that the client attempted to self-administer the analgesic 10 times. Further assessment
reveals that the client is experiencing pain still. What should the nurse do first?
Incorrect1
Monitor the client's pain level for another hour.
Correct2
Determine the integrity of the intravenous delivery system.
3
Reprogram the pump to deliver a bolus dose every 8 minutes.
4
Arrange for the client to be evaluated by the healthcare provider.
Initially, integrity of the intravenous system should be verified to ensure that the client is receiving
medication. The intravenous tubing may be kinked or compressed or the catheter may be dislodged.
Continued monitoring will result in the client experiencing unnecessary pain. The nurse may not
reprogram the pump to deliver larger or more frequent doses of medication without a healthcare
provider's prescription. The healthcare provider should be notified if the system is intact and the client is
not obtaining relief from pain. The prescription may have to be revised; the basal dose may be increased,
the length of the delay may be reduced, or another medication or mode of delivery may be prescribed.
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3.
A client has been admitted with severe edema and hypertension. Intravenous furosemide has been
prescribed. Which subjective clinical manifestations lead the nurse to suspect that the furosemide is
infusing too rapidly? Select all that apply.
Incorrect1
Hunger
Correct2
Tinnitus
Correct3
Weakness
Correct4
Leg cramps
5
Excess salivation
Tinnitus is a central nervous system side effect of furosemide. Weakness and leg cramps result from
hypokalemia caused by an overload of furosemide. Nausea and anorexia, not hunger, are side effects of
dehydration that may occur with an overload of furosemide. Dry mouth, not salivation, results from
dehydration caused by an overload of furosemide.
Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning,
take a high-powered snack with you to eat 20 minutes before the examination. The brain works best
when it has the glucose necessary for cellular function.
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5.;
A client is receiving heparin sodium intravenously at 1500 units/hour. The concentration in the bag is
25,000 units/500 milliliters. The nurse determines that how many milliliters will infuse during the nurse's
8-hour shift? Record your answer using a whole number. ___ mL
The ordered rate is 1500 u/hr. The available concentration is 25,000 u in 500 mL. Make the necessary
conversions and use dimensional analysis to determine the appropriate rate in mL/h. The ratio and
proportion method is not appropriate for this situation.
7601121476
Test-Taking Tip: When taking the NCLEX exam, an on-screen calculator will be available for you to
determine your response, which you will then type in the provided space.
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6.
Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands
that the drug is being used primarily for which of its properties?
Incorrect1
Analgesic
2
Antipyretic
Correct3
Antiinflammatory
4
AntiplateletThe antiinflammatory action of aspirin reduces joint inflammation. Aspirin reduces fever, but this is not
the rationale for prescribing it for clients with rheumatoid arthritis. Aspirin does not preserve bone
integrity. Flexion contractures are prevented by exercise, not aspirin.
STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go
ahead and guess. You have studied for the test and you know the material well. You are not making a
random guess based on no information. You are guessing based on what you have learned and your best
assessment of the question.
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7.
A client is to receive total parenteral nutrition (TPN) via a central venous access device/catheter. What
information about this treatment would the nurse recognize as accurate?
Incorrect1
The jugular vein is the most commonly used catheter insertion site.
Correct2
The TPN may be administered intermittently rather than continuously.
3
The client will experience a moderate amount of pain during the procedure.
4
Catheter placement must be confirmed by fluoroscopy before the TPN is initiated.
Although the central venous catheter remains in situ, total parenteral nutrition does not have to infuse
continuously. Continuous versus intermittent administration depends on the health care provider's
prescription. Placement of the tube after the procedure is verified by x-ray, not fluoroscopy. The
subclavian veins are used most often; the jugular vein is too close to hair-growing areas, which increases
the possibility of sepsis, and neck movements may interfere with maintaining placement of the catheter.
Although a feeling of pressure may be experienced, it is not a painful procedure.
STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals.39%of students nationwide answered this question correctly.
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9.
A nurse is teaching an older adult client about managing chronic pain with acetaminophen. Which client
statement indicates that the teaching is effective?
Incorrect1
"I can drink beer with this, but not wine."
2
"I need to limit my intake of acetaminophen to 650 mg a day."
3
"I should take an emetic if I accidentally overdose on the acetaminophen."
Correct4
"I have to be careful about which over-the-counter cold preparations I take when I have a cold."
Many over-the-counter cold preparations contain acetaminophen; the amount of acetaminophen in cold
preparations must be taken into consideration when the total amount of acetaminophen taken daily is
calculated. A typical single dose is 650 mg a day for adults. Acetaminophen should not exceed 3 to 4 g a
day, with a lower dose preferred in older adults. An emetic is contraindicated because it may reduce the
client's ability to tolerate oral acetylcysteine, the antidote for acetaminophen toxicity. Alcohol of any
type, when taken with acetaminophen, increases the risk of liver injury.
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11.A client with a seizure disorder is receiving phenytoin and phenobarbital. What client statement
indicates that the instructions regarding the medications are understood?
Incorrect1
"I will not have any seizures with these medications."
2
"These medicines must be continued to prevent falls and injury."
Correct3
"Stopping the drugs can cause continuous seizures and I may die."
4
"By my staying on the medicines I will prevent postseizure confusion."
Sudden withdrawal of antiepileptic medication can cause status epilepticus. It is important to take
medication as prescribed to lessen the frequency of seizures; there is no guarantee that seizures will
stop. Medication may or may not eliminate the seizures; stress may precipitate a seizure. Antiepileptics
are not prescribed to prevent falls and injury. Although seizures may occur while the client is taking the
medications, the medications do not stop postseizure confusion.
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13.
A client with an intractable infection is receiving vancomycin. Which laboratory blood test result should
the nurse report?
Incorrect1
Hematocrit: 45%
2
Calcium: 9.0 mg/dL (2.25 mmol/L)
3
White blood cells (WBC): 10,000 mm3 (10 X 109/L)
Correct4Blood urea nitrogen (BUN): 30 mg/dL (10.2 mmol/L)
Vancomycin is a nephrotoxic medication. An elevated BUN can be an early sign of toxicity. The BUN of a
healthy adult is 10 to 20 mg/dL (3.6-7.1 mmol/L). This hematocrit is expected in a healthy adult; the
range is from 40 to 52. The expected range of the WBC count is 5,000 to 10,000 mm3 (5-10 X 109/L) for a
healthy adult. This calcium level is within the expected range of 9.0 to 10.5 (2.25-2.75 mmol/L) for a
healthy adult.
Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong
answer. Example: If you are being asked to identify a diet that is specific to a certain condition, your
knowledge about that condition would help you choose the correct response (e.g., cholecystectomy =
low-fat, high-protein, low-calorie diet).
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15.
Which nursing interventions are important when caring for clients receiving IV digoxin? Select all that
apply.
Correct1
Monitor the heart rate closely
Correct2
Check the blood levels of digoxin
3
Administer the dose over 1 minute
Correct4
Monitor the serum potassium level
5
Give the drug with other infusing medications
Bradycardia or other dysrhythmias may occur; therefore, the heart rate and rhythm should be
monitored. ECG monitoring should be continuous. The digoxin level is checked before administration toavoid toxicity. A low serum potassium level when digoxin is administered can contribute to toxicity.
Digoxin should be given over a 5-minute period through a Y-tube or three-way stopcock. There are many
syringe, Y-site, and additive incompatibilities; the manufacturer recommends that digoxin not be
administered with other drugs.
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Neomycin is prescribed for a client with cirrhosis. What should the nurse explain is the reason for taking
this medication?
Incorrect1
Prevents an infection
2
Limits abdominal distention
3
Minimizes intestinal edema
Correct4
Reduces the blood ammonia level
Reducing the blood ammonia level decreases the effect of bacterial activity on blood and wastes in the
gastrointestinal tract. Although neomycin is an aminoglycoside antimicrobial, it is not administered to
prevent infection. Neomycin has little or no effect on intestinal edema. Neomycin does not reduce
abdominal distention.
STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have
adequately studied and really know the material, start looking in the mirror each time you pass one and
say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several
times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be
able to perform much better during the test period. This technique really works for students who are
adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for
performing skills in clinical as well, as long as you have practiced the skill sufficiently.
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A client who had a femoropopliteal bypass graft is receiving clopidogrel postoperatively. What should the nurse teach the client related to the medication? Incorrect1 Eliminate grapefruit from the diet 2 Eat more roughage if constipation occurs Correct3
Report any occurrence of multiple bruises 4 Take the medication on an empty stomach
Clopidogrel is a platelet aggregation inhibitor that decreases the probability of clots forming where the graft was placed, but it also increases bleeding tendencies when the dosage is excessive. Clopidogrel does not interact with grapefruit, which is permitted on the diet. Diarrhea, not constipation, is more likely to occur with clopidogrel. Clopidogrel should be taken with food to decrease the side effects of gastric discomfort, diarrhea, and gastrointestinal bleeding.
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