Nokea
An LPN is tasked with checking the narcotic count on a medical surgical unit. Which statement by the LPN requires further investigation?
- A. I need a witness when I waste the leftover narcotics in the client's PCA pump.
- B. I am going to check the facility's policy for how to dispose of this controlled substance.
- C. I left the narcotics box unlocked after confirming the beginning of shift count was correct.
- D. The end of shift narcotics count is incorrect and needs to be reported.
Correct Answer: C
Rationale: Narcotics should be locked and kept in a secure place during the shift.
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The nurse is receiving a report from an ER nurse about a client. Which of the following statements requires additional follow-up?
- A. The client said they have been taking aspirin, but I'm not sure for how long or how much.
- B. The client frequently takes antacids, but they have not taken any in the last three days.
- C. The client stopped taking ibuprofen after developing gastric ulcers.
- D. The client takes Antabuse and has stopped using mouthwash.
Correct Answer: A
Rationale: Aspirin can have an impact on the patient's bleeding risk, so the amount and frequency is important to know. Antacids can change the gastric pH and impact medication absorption, so the nurse should note when they are last taken. Ibuprofen can cause or exacerbate gastric ulcers. Clients who take Antabuse should avoid alcohol in all forms, including avoiding over-the-counter cough medication and mouthwash.
The client taking paroxetine telephones the mental health clinic nurse and states, “Since I started taking St. John's wort, I have had a high fever and muscle stiffness, and I am sweating a lot.†Which statement is most appropriate?
- A. You may have the flu; call your primary provider to make an appointment.
- B. Take ibuprofen, drink fluids, and rest; call tomorrow if the symptoms worsen.
- C. Could you have doubled up on your medication, taking more than prescribed?
- D. You should be taken to the emergency department right away to be evaluated.
Correct Answer: D
Rationale: Fever, muscle stiffness (rigidity), and diaphoresis are symptoms of serotonin syndrome, a potentially fatal condition that may occur with concurrent use of St. John's wort and paroxetine (Paxil). The client should be taken to the ED.
The nurse is to administer vancomycin to the client diagnosed with sepsis. The client is to have a peak and trough level completed on this dose of vancomycin. Which action should the nurse initiate first?
- A. Determine if the trough level has already been drawn on the client.
- B. Check drug compatibilities before infusing into an existing IV line.
- C. Evaluate the client's culture and sensitivity (C&S) report results.
- D. Calculate the rate at which the vancomycin should be infused.
Correct Answer: A
Rationale: A: A trough level must be drawn before vancomycin (Vancocin) is administered. This is the first action because if the trough level has not been drawn, it will delay the vancomycin dose and could result in a medication error. B: Checking medication compatibilities is important, but this can be completed while the laboratory is obtaining the trough level. C: Checking C&S report results is important, but this can be completed while the laboratory is obtaining the trough level. D: Calculating the administration rate is important, but this can be completed while the laboratory is obtaining the trough level.
A nurse teaching a patient with COPD pulmonary exercises should do which of the following?
- A. Teach pursed-lip breathing techniques.
- B. Encourage repetitive heavy lifting exercises that will increase strength.
- C. Limit exercises based on respiratory acidosis.
- D. Take breaks every 10-20 minutes with exercises.
Correct Answer: A
Rationale: Pursed-lip breathing will help decrease the volume of air expelled by increased bronchial airways.
The child with CF is receiving albuterol. Which response should the nurse expect if albuterol is achieving the desired therapeutic effect?
- A. Increased heart rate
- B. Improved weight gain
- C. Fewer hospitalizations
- D. Fewer adventitious lung sounds
Correct Answer: D
Rationale: A: Albuterol may increase HR, but this is not the desired therapeutic effect. B: Weight should not be affected by albuterol. C: The use of a bronchodilator has not been demonstrated to decrease hospitalization frequency. D: The desired therapeutic effect of a bronchodilator such as albuterol (Proventil) is a reduction in adventitious (abnormal) breath sounds.