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What assessment finding would indicate the patient's left-sided heart failure is worsening?
- A. Increased jugular venous pressure.
- B. Liver enlargement.
- C. Increased pulse rate.
- D. Increased crackles in lung fields.
Correct Answer: D
Rationale: The correct answer is D: Increased crackles in lung fields. Worsening left-sided heart failure causes fluid to accumulate in the lungs, leading to crackles on auscultation. Increased jugular venous pressure (A) is more indicative of right-sided heart failure. Liver enlargement (B) is a sign of congestive hepatomegaly, common in right-sided heart failure. Increased pulse rate (C) may indicate heart failure exacerbation but is not specific to left-sided failure. Therefore, choice D is the best indicator of worsening left-sided heart failure.
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A geriatric patient received a narcotic analgesic before leaving the post-anesthesia care unit to return to the regular unit. What is the priority nursing action for the nurse receiving the patient on the regular unit?
- A. Administer a non-steroidal anti-inflammatory drug.
- B. Put side rails up and place bed in the lowest position.
- C. Encourage fluids.
- D. Create a restful dark environment.
Correct Answer: B
Rationale: The correct answer is B: Put side rails up and place bed in the lowest position. This is the priority nursing action as the geriatric patient who received a narcotic analgesic may experience drowsiness or confusion, increasing the risk of falls. By putting up the side rails and lowering the bed, the nurse is ensuring the patient's safety and preventing falls. Administering a non-steroidal anti-inflammatory drug (choice A) is not the priority as the patient's safety should be addressed first. Encouraging fluids (choice C) and creating a restful dark environment (choice D) are important but not as crucial as ensuring the patient's immediate safety.
What is the responsibility of the nurse related to the patient's drug therapy? Select all that apply.
- A. Teaching the patient how to cope with therapy to ensure the best outcome.
- B. Altering the drug regime to optimize the outcome.
- C. Evaluating the effectiveness of therapy.
- D. Providing therapy as well as medications.
- E. Recommending over-the-counter medications to treat adverse effects of prescription drug therapy.
Correct Answer: A,C
Rationale: The correct answers are A and C. A nurse's responsibility related to a patient's drug therapy includes teaching the patient how to cope with therapy for optimal outcomes (A) and evaluating the effectiveness of the therapy (C). Teaching the patient ensures they understand how to take medications correctly and manage any side effects. Evaluating effectiveness allows for adjustments in the treatment plan if needed. Choices B, D, and E are incorrect. B - altering the drug regime should be done by the prescribing healthcare provider, not the nurse. D - providing therapy is beyond the scope of a nurse's responsibilities, as they focus on administering medications and supporting the patient. E - recommending over-the-counter medications falls under the purview of a pharmacist or physician, not a nurse.
What drug would the nurse administer to treat a patient diagnosed with bronchospasm associated with chronic obstructive pulmonary disease (COPD)?
- A. Glycopyrrolate.
- B. Ipratropium.
- C. Atropine.
- D. Flavoxate.
Correct Answer: B
Rationale: The correct answer is B: Ipratropium. Ipratropium is an anticholinergic bronchodilator that helps relax the muscles in the airways, making it effective in treating bronchospasm in COPD. Glycopyrrolate (A) is also an anticholinergic but not commonly used for bronchospasm. Atropine (C) is not typically used for COPD-related bronchospasm. Flavoxate (D) is a urinary antispasmodic and not indicated for bronchospasm.
The nurse is caring for a patient with Parkinson's Disease. While writing the care plan for the patient, what would be an appropriate diagnosis?
- A. Constipation related to dopaminergic effects.
- B. Risk for injuries related to CVS effects and PVD.
- C. Risk for injury related to CVS effects and incidence of orthostatic hypotension.
- D. Diarrhea related to dopaminergic effects.
Correct Answer: C
Rationale: The correct answer is C, "Risk for injury related to CVS effects and incidence of orthostatic hypotension." This is the most appropriate diagnosis for a patient with Parkinson's Disease because they are at increased risk for falls due to cardiovascular (CVS) effects such as orthostatic hypotension, which can lead to dizziness and falls. This diagnosis addresses the specific risk factor associated with Parkinson's Disease and focuses on preventing potential injuries.
Choice A, "Constipation related to dopaminergic effects," is incorrect as constipation is a common symptom in Parkinson's Disease but does not directly relate to the risk of injury.
Choice B, "Risk for injuries related to CVS effects and PVD," is incorrect because it includes peripheral vascular disease (PVD) which is not typically associated with Parkinson's Disease.
Choice D, "Diarrhea related to dopaminergic effects," is also incorrect as diarrhea is not a common symptom or risk factor for patients with Parkinson's Disease.
A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor's best response?
- A. They compete with serotonin for muscarinic acetylcholine receptor sites.
- B. They increase norepinephrine at the neuromuscular junction.
- C. They block nicotinic receptors.
- D. They act to block the effects of the parasympathetic nervous system.
Correct Answer: D
Rationale: The correct answer is D: They act to block the effects of the parasympathetic nervous system. Anticholinergic agents inhibit the action of acetylcholine, the primary neurotransmitter of the parasympathetic nervous system. By blocking muscarinic acetylcholine receptors, these agents reduce parasympathetic stimulation, leading to effects such as decreased salivation, decreased GI motility, and pupil dilation.
Choice A is incorrect because anticholinergic agents do not compete with serotonin for receptor sites; they primarily target acetylcholine receptors. Choice B is incorrect as anticholinergic agents do not directly affect norepinephrine levels at the neuromuscular junction. Choice C is incorrect because anticholinergic agents primarily target muscarinic receptors, not nicotinic receptors.