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During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis?
- A. Brain
- B. Bone
- C. Liver
- D. Mediastinum
Correct Answer: C
Rationale: Rectal adenocarcinoma commonly metastasizes to the liver via the portal vein and lymphatics, making it the most likely next site.
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A child diagnosed with ADHD is to receive a total of 20 mg of dextroamphetamine daily in two divided doses. The dextroamphetamine on hand is supplied in 5-mg tablets. How many tablet(s) should the nurse administer for the morning dose?
Correct Answer: 2
Rationale: Calculation: 20 mg daily/ 2 doses = 10 mg per dose; 10 mg/ 5 mg/tablet = 2 tablets.
The client admitted for inpatient treatment of an anxiety disorder has been taking fluoxetine for the past 9 months. The HCP prescribes a new antianxiety medication and discontinues fluoxetine. What is the nurse's most appropriate intervention?
- A. Monitor the client closely for dizziness and lethargy due to discontinuation syndrome.
- B. Teach the client relaxation measures to use while adjusting to the new antianxiety drug.
- C. Call the HCP to question whether fluoxetine should be iżtapered rather than discontinued.
- D. Reassure the client that there is little risk of adverse effects when discontinuing fluoxetine.
Correct Answer: D
Rationale: Because of its long half-life, there is a relatively low risk of adverse effects when discontinuing fluoxetine (Prozac). The client should be reassured and taught about the change of antianxiety medication.
The client is prescribed varenicline for smoking cessation. The nurse concludes that varenicline is being prescribed primarily for its antagonistic effect. Which statement describes this effect?
- A. Gets readily absorbed into the bloodstream for rapid effectiveness
- B. Demonstrates a high degree of attractiveness for a specific receptor
- C. Blocks receptors in the brain that produce the pleasurable effects of smoking
- D. Stimulates receptors stimulated by smoking, producing similar pleasurable effects.
Correct Answer: C
Rationale: Varenicline (Chantix) functions as an antagonist, blocking receptors to reduce the pleasurable effects of smoking.
The client with CRF is receiving epoetin alfa. Which finding should indicate to the nurse that the action of the medication has been effective?
- A. Urine output increased to 30 mL per hour
- B. Hemoglobin 12 g/dL and hematocrit 36%
- C. BP 110/70 mm Hg and heart rate 68 bpm
- D. Reports an increased energy level and less fatigue
Correct Answer: B
Rationale: A: Epoetin alfa does not have an effect on urine output or BP. B: Epoetin alfa stimulates erythropoiesis, or the production of RBCs. It is used in treating anemias associated with decreased RBC production, such as in renal failure. Hgb and Hct are used to evaluate the medication's effectiveness. The target Hgb for the client with CRF is 12 g/dL. C: Epoetin alfa does not have an effect on BP or HR. D: The client may report increased energy and less fatigue because of the increased Hgb levels, but these findings are not used to evaluate the medication's action.
The initial treatment regimen of isoniazid, rifampin, and ethambutol is prescribed for the adolescent who has a positive tuberculin skin test. The client confides that she thinks she may be pregnant and asks if she should be taking these medications. Which rationale should be the basis for the nurse's response?
- A. These drugs cross the placental barrier, and treatment should be withheld until the postpartum period.
- B. The medications should be taken, but the diagnosis is an indication for termination of the pregnancy.
- C. The medications should be postponed because the risk for hepatitis is greatly increased in the intrapartum period.
- D. The medications should be taken; untreated TB represents a far greater hazard to the pregnant woman and her fetus.
Correct Answer: D
Rationale: A: The medications do not cross the placental barrier, so treatment should not be withheld. B: Administering antituberculosis medications would not be an indication for termination of pregnancy because the medications are safe during pregnancy. C: The risk of hepatitis is slightly increased with the use of antituberculosis medications in pregnant women; however, the benefits of treatment strongly outweigh postponement of treatment. D: Infants born to women with untreated TB may be of lower birth weight, but rarely would the infant acquire congenital TB. Isoniazid (Nydrazid), rifampin (Rifadin), and ethambutol (Myambutol) are all considered safe for use in pregnancy.