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NCLEX-PN Exam Questions - Part 108
1. A client has been taking a drug (Drug A) that is highly metabolized by the cytochrome p-450 system. He has been on this medication for 6 months. At this time, he is started on a second medication (Drug B) that is an inducer of the cytochrome p-450 system. You should monitor this client for:
A) increased therapeutic effects of Drug A.
B) increased adverse effects of Drug B.
C) decreased therapeutic effects of Drug A.
D) decreased therapeutic effects of Drug B.
2. Ten-year-old Jackie is admitted to the hospital with a medical diagnosis of Rheumatic Fever. She relates a history of 'a sore throat about a month ago.' Bed rest with bathroom privileges is prescribed. Which of the following nursing assessments should be given the highest priority when assessing Jackies condition?
A) her response to being hospitalized
B) the presence of a macular rash on her trunk
C) her cardiac status
D) the presence of polyarthritis and pain in her joints
3. A 21-year-old college student has just learned that she contracted genital herpes from her sexual partner. After completing the initial history and assessment, the nurse has data concerning areas pertinent to the disease. The data is likely to include all but which of the following?
A) voiding patterns
B) characteristics of lesions
C) vaginal discharge
D) prior history of varicella
4. A client has been admitted in septic shock. Her nursing care plan includes the diagnosis High Risk for Injury (related to clotting disorder). Based on this diagnosis, all the following are appropriate entries in the nursing care plan except:
A) obtain an order for a stool softener.
B) administer packed RBCs, if ordered.
C) encourage the client to rinse her mouth with mouthwash and scrub her teeth with an oral sponge.
D) dress venipuncture sites immediately to prevent infection.
5. A person using over-the-counter nasal decongestant drops who reports unrelieved and worsening nasal congestion should be instructed to:
A) switch to a stronger dose of the medication.
B) discontinue the medication for a few weeks.
C) continue taking the same medication, but use it more frequently.
D) use a combination of medications for better relief.
A) increased therapeutic effects of Drug A.
B) increased adverse effects of Drug B.
C) decreased therapeutic effects of Drug A.
D) decreased therapeutic effects of Drug B.
2. Ten-year-old Jackie is admitted to the hospital with a medical diagnosis of Rheumatic Fever. She relates a history of 'a sore throat about a month ago.' Bed rest with bathroom privileges is prescribed. Which of the following nursing assessments should be given the highest priority when assessing Jackies condition?
A) her response to being hospitalized
B) the presence of a macular rash on her trunk
C) her cardiac status
D) the presence of polyarthritis and pain in her joints
3. A 21-year-old college student has just learned that she contracted genital herpes from her sexual partner. After completing the initial history and assessment, the nurse has data concerning areas pertinent to the disease. The data is likely to include all but which of the following?
A) voiding patterns
B) characteristics of lesions
C) vaginal discharge
D) prior history of varicella
4. A client has been admitted in septic shock. Her nursing care plan includes the diagnosis High Risk for Injury (related to clotting disorder). Based on this diagnosis, all the following are appropriate entries in the nursing care plan except:
A) obtain an order for a stool softener.
B) administer packed RBCs, if ordered.
C) encourage the client to rinse her mouth with mouthwash and scrub her teeth with an oral sponge.
D) dress venipuncture sites immediately to prevent infection.
5. A person using over-the-counter nasal decongestant drops who reports unrelieved and worsening nasal congestion should be instructed to:
A) switch to a stronger dose of the medication.
B) discontinue the medication for a few weeks.
C) continue taking the same medication, but use it more frequently.
D) use a combination of medications for better relief.
1. Right Answer: C
Explanation: Drug B induces the cytochrome p-450 enzyme system of the liver, thus increasing the metabolism of Drug A. Therefore, Drug A is broken down faster and exerts decreased therapeutic effects. Drug A is metabolized faster, thus reducing, not increasing, its therapeutic effect. Inducing the cytochrome p-450 system does not increase the adverse effects of Drug B. Drug B induces the cytochrome p-450 system but is not metabolized faster. Thus, the therapeutic effects of Drug B are not decreased. Pharmacological Therapies
2. Right Answer: C
Explanation: Monitoring cardiac status is of the highest priority. Permanent cardiac damage can result from rheumatic fever. The second priority is assessing the clients joints for the presence of polyarthritis and accompanying pain. Physiological Adaptation
3. Right Answer: D
Explanation: The other choices are common reasons for which clients with herpes seek care. Physiological Adaptation
4. Right Answer: D
Explanation: Firm, direct pressure should be applied to venipuncture sites for 37 minutes before final dressing because of the clotting abnormality. Septic shock is a systemic infection of the bloodstream producing clinical manifestations warm, flushed skin; high urine output; tachycardia; edema; respiratory problems; restlessness; altered level of consciousness; life-threatening form of shock. Physiological Adaptation
5. Right Answer: B
Explanation: Prolonged use of decongestant drops (3 to 5 days) can lead to rebound congestion, which is relieved by discontinuing the medication for 2 to 3 weeks. Nasal congestion results from dilation of nasal blood vessels due to infection, inflammation, or allergy. With this dilation, there is a transudation of fluid into the tissue spaces, resulting in swelling of the nasal cavity. Nasal decongestants (sympathomimetic amines) stimulate the alphaadrenergic receptors, producing vascular constriction (vasoconstriction) of the capillaries within the nasal mucosa. The result is shrinking of the nasal mucous membranes and a reduction in fluid secretion(runny nose). Decongestants can make a client jittery, nervous, or restless. These side effects decrease or disappear as the body adjusts to the drug. When nasal decongestants are used for longer than 5 days, instead of the nasal membranes constricting, vasodilation occurs, causing increased stuffy nose and nasal congestion. The nurse should emphasize the importance of limiting the use of nasal sprays and drops. As with any alpha-adrenergic drug (for example, decongestants), blood pressure and blood glucose levels can increase. These drugs are contraindicated and should only be used with extreme caution for clients with hypertension, cardiac disease, hyperthyroidism, and diabetes mellitus. Physiological Adaptation
Explanation: Drug B induces the cytochrome p-450 enzyme system of the liver, thus increasing the metabolism of Drug A. Therefore, Drug A is broken down faster and exerts decreased therapeutic effects. Drug A is metabolized faster, thus reducing, not increasing, its therapeutic effect. Inducing the cytochrome p-450 system does not increase the adverse effects of Drug B. Drug B induces the cytochrome p-450 system but is not metabolized faster. Thus, the therapeutic effects of Drug B are not decreased. Pharmacological Therapies
2. Right Answer: C
Explanation: Monitoring cardiac status is of the highest priority. Permanent cardiac damage can result from rheumatic fever. The second priority is assessing the clients joints for the presence of polyarthritis and accompanying pain. Physiological Adaptation
3. Right Answer: D
Explanation: The other choices are common reasons for which clients with herpes seek care. Physiological Adaptation
4. Right Answer: D
Explanation: Firm, direct pressure should be applied to venipuncture sites for 37 minutes before final dressing because of the clotting abnormality. Septic shock is a systemic infection of the bloodstream producing clinical manifestations warm, flushed skin; high urine output; tachycardia; edema; respiratory problems; restlessness; altered level of consciousness; life-threatening form of shock. Physiological Adaptation
5. Right Answer: B
Explanation: Prolonged use of decongestant drops (3 to 5 days) can lead to rebound congestion, which is relieved by discontinuing the medication for 2 to 3 weeks. Nasal congestion results from dilation of nasal blood vessels due to infection, inflammation, or allergy. With this dilation, there is a transudation of fluid into the tissue spaces, resulting in swelling of the nasal cavity. Nasal decongestants (sympathomimetic amines) stimulate the alphaadrenergic receptors, producing vascular constriction (vasoconstriction) of the capillaries within the nasal mucosa. The result is shrinking of the nasal mucous membranes and a reduction in fluid secretion(runny nose). Decongestants can make a client jittery, nervous, or restless. These side effects decrease or disappear as the body adjusts to the drug. When nasal decongestants are used for longer than 5 days, instead of the nasal membranes constricting, vasodilation occurs, causing increased stuffy nose and nasal congestion. The nurse should emphasize the importance of limiting the use of nasal sprays and drops. As with any alpha-adrenergic drug (for example, decongestants), blood pressure and blood glucose levels can increase. These drugs are contraindicated and should only be used with extreme caution for clients with hypertension, cardiac disease, hyperthyroidism, and diabetes mellitus. Physiological Adaptation
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