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The HCP prescribes a second antihypertensive medication for the client who has poorly controlled BP on one medication. If prescribed, which medication combination should the nurse question?
- A. Atenolol and metoprolol
- B. Metolazone and valsartan
- C. Captopril and furosemide
- D. Bumetanide and diltiazem
Correct Answer: A
Rationale: A: The nurse should question this medication combination. When two medications are used to treat hypertension, each should be from different drug classifications. Atenolol (Tenormin) and metoprolol (Lopressor) are both beta-adrenergic blockers and have the same general mechanism of action. B: Metolazone (Zaroxolyn) is a thiazide-like diuretic, and valsartan (Diovan) is an ARB. C: Captopril (Capoten) is an ACE inhibitor, and furosemide (Lasix) is a loop diuretic. D: Bumetanide (Bumex) is a loop diuretic, and diltiazem (Cardizem) is a calcium channel blocker.
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The client taking imipramine is preparing for a summer vacation. Which information should the nurse include when planning client education regarding imipramine? Select all that apply.
- A. Drink additional fluids and add extra fiber to the diet
- B. Stop imipramine if experiencing any unpleasant side effects.
- C. Avoid alcohol, which can cause an additive depressant effect.
- D. Request an “as needed†sleeping pill in the event of insomnia.
- E. Wear sunglasses, protective clothing, and sunscreen while outdoors.
Correct Answer: A,C,E
Rationale: TCAs such as imipramine (Tofranil) may cause constipation, CNS depression when combined with alcohol, and photosensitivity. Increasing fluids and fiber, avoiding alcohol, and using sun protection are appropriate.
Which of the following injuries, if demonstrated by a client entering the Emergency Department, is the highest priority?
- A. open leg fracture
- B. open head injury
- C. stab wound to the chest
- D. traumatic amputation of a thumb
Correct Answer: C
Rationale: A stab wound to the chest might result in lung collapse and mediastinal shift that, if untreated, could lead to death. Treatment of an obstructed airway or a chest wound is a higher priority than hemorrhage. The principle of ABC (airway, breathing, and circulation) prioritizes care decisions.
Why must the nurse be careful not to cut through or disrupt any tears, holes, bloodstains, or dirt present on the clothing of a client who has experienced trauma?
- A. The clothing is the property of another and must be treated with care.
- B. Such care facilitates repair and salvage of the clothing.
- C. The clothing of a trauma victim is potential evidence with legal implications.
- D. Such care decreases trauma to the family members receiving the clothing.
Correct Answer: C
Rationale: Trauma in any client, living or dead, has potential legal and/or forensic implications. Clothing, patterns of stains, and debris are sources of potential evidence and must be preserved. Nurses must be aware of state and local regulations that require mandatory reporting of cases of suspected child and elder abuse, accidental death, and suicide. Each Emergency Department has written policies and procedures to assist nurses and other health care providers in making appropriate reports. Physical evidence is real, tangible, or latent matter that can be visualized, measured, or analyzed. Emergency Department nurses can be called on to collect evidence. Health care facilities have policies governing the collection of forensic evidence. The chain of evidence custody must be followed to ensure the integrity and credibility of the evidence. The chain of evidence custody is the pathway that evidence follows from the time it is collected until is has served its purpose in the legal investigation of an incident.
The factor that most determines drug distribution is:
- A. vascular perfusion of the tissue or organ.
- B. salt form.
- C. drug interactions.
- D. steady state.
Correct Answer: A
Rationale: Drugs are distributed via the circulatory system. Adequate perfusion is necessary for distribution of a drug. The other choices are not as dependent on adequate perfusion.
The test used to differentiate sickle cell trait from sickle cell disease is:
- A. sickle cell preparation
- B. peripheral smear
- C. sickledex
- D. hemoglobin electrophoresis
Correct Answer: D
Rationale: Hemoglobin electrophoresis identifies the specific hemoglobin types, distinguishing sickle cell trait (HbAS) from sickle cell disease (HbSS).