Question Answered step-by-step EVENING A When treating hypertension with two medications, they should both be of different drug classifications. Atenolol and Metoprolol are both beta-adrenergic blockers. This means that both drugs have the same mechanism of action and would be ineffective.B Both medications are of different classes, therefore this would be an effective drug combination. Metolazone is a thiazide diuretic and Valsartan is an angiotensin II receptor blocker (ARB). The nurse would not question this order since they are both of different drug classes.C The nurse should not question this order because both drugs have different mechanisms of action. Captopril is an angiotensin converting enzyme inhibitor (ACE inhibitor) and Furosemide is a loop diuretic. Since both medications are of different classes, this combination is effective.D Bumetanide is a loop diuretic and Diltiazem is a calcium channel blocker. Both medications are of different classes, therefore have different mechanisms of action. The nurse should not question this order since the medication combination is effective.• What financial value conflicts might patients have with respect to this issue?• What financial value conflicts might healthcare providers have with respect to this issue?• What financial value conflicts might insurance companies have with respect to this issue?• What financial value conflicts might other stakeholders have with respect to this issue?• Why is it important to understand these value conflicts when making decisions related to health policy?• How might the competition between these financial value conflicts affect both stakeholders’ influence on the issue and how stakeholders are impacted by the issue itself?1. A nurse is caring for a client diagnosed with end stage renal disease.  The client is 6 feet tall and weighs 180 pounds.  The client’s total serum protein is 5.8g/dL.  An assessment by the nurse reveals 2+ edema.  The nurse determines that the client’s edema is most likely the result of which of the following? 2. Increased capillary hydrostatic pressure3. Decreased plasma oncotic pressure4. Increased capillary permeability 5. Decreased serum electrolytes RationalesA  B  C  D  1. Which electrolyte imbalance should be the priority concern for a nurse when assessing a client diagnosed with acute renal failure? 2. hypercalcemia3. hyperphosphatemia4. hyperkalemia5. hypernatremia RationalesA  B  C  D  1. A client is hypotensive.  A nurse closely monitors the client’s electrolytes because the nurse knows that renin is released in response to decreased blood flow to the kidneys.  Which electrolytes are dependent on the renin angiotensin-aldosterone system and should be closely monitored? 2. Sodium, potassium, and chloride3. Sodium, chloride, and calcium4. Calcium, phosphate and magnesium 5. Magnesium, potassium and sodium RationalesA  B  C  D  1. A client diagnosed with cardiomyopathy is hyponatremic as a result of fluid volume overload.  A fluid restriction of 800mL/24 hours is ordered by the physician.  Which action by the nurse is most appropriate? 2. Provide ice chips and refill the cup every 4 hours3. Encourage the client to perform mouth care when feeling thirsty4. Offer sugary lozenges for the client to hold in their mouth5. Replenish the client’s water every 2 hours telling them to only take sips RationalesA  B  C  D  1. What assessment findings should prompt a nurse to conclude that interventions have been effective for a 90-year-old client with hypernatremia?2. Lethargy and paresthesias3. Muscle cramps and spasms4. Restlessness and agitation 5. Decreased body temperature and shivering RationalesA  B  C  D  1. A nurse admits a client diagnosed with polycystic kidney disease.  The client is experiencing dull flank pain, nocturia, and diluted urine with a low specific gravity.  A nurse is reviewing orders written by the nurse practitioner.  Which orders should the nurse question?  Choose all that apply.  2. Increase fluid intake to 2 L a day3. Restrict sodium intake to 500 mg a day 4. Initiate referral for genetic counseling5. Lisinopril 2.5mg daily for hypertension 6. Metoprolol 12.mg a day BID RationalesA  B  C  D  E  1. A nurse evaluates that a client is in the recovery phase of acute renal failure.  Achievement of which outcomes supports the nurse’s conclusion?  Choose all that apply. 2. Increased urine specific gravity3. Increased serum creatinine level 4. Decreased serum potassium 5. Absence f nausea and vomiting 6. Absence of muscle twitching RationalesA  B  C  D  E  1. A nurse is concerned that a client receiving peritoneal dialysis may be experiencing peritonitis.  Which finding noted on the nurse’s assessment supported this concern? 2. Abdominal numbness3. Cloudy dialysis output4. Radiating sternal pain5. Decreased white blood cell count RationalesA  B  C  D  1. A nurse is assessing a patient who is 24 hour post GI hemorrhage.  The assessment findings include a BUN of 40 and a creatinine level of 0.8 mg/dL.  After reviewing the assessment the nurse should do which of the following?  2. Immediately call the physician to report the results3. Monitor urine output as this may be a sign of kidney failure4. Document the findings and continue to monitor the client 5. Encourage the client to limit their protein intake RationalesA  B  C  D  1. A nurse is performing a helath history on a client during a clinic visit.  Which client statement should be most concerning to the nurse because it could be a symptom of esophageal cancer? 2. ” I have been  having a lot of indigestion lately.”3. “When I eat meat t seems to get stuck halfway down.”4. “I have been waking up at night with chest pain.”5. “I have been gaining a lot of weight lately even though I have not changed my diet.” RationalesA  B  C  D  1. A client is hospitalized for conservative treatment of cirrhosis.  As part of the collaborative plan of care, a nurse would anticipate?2. monitoring the client’s blood sugar3. maintaining NPO status4. administering antibiotics5. encouraging frequent ambulation RationalesA  B  C  D  1. A nurse is beginning client care and has been assigned 4 patients.  Which patient should the nurse plan to assess first? 2. A 50 year old client who has chronic pancreatitis and is reporting a pain level of 6 out of 10 on a numeric scale.3. A 47 year old patient with esophageal varices who has influenza and has a bad cough 4. A 60 year old patient who had an open cholecystectomy 15 hours ago and has been stable overnight5. A 54 year old with cirrhosis and jaundice who is reporting itching RationalesA  B  C  D  1. A nurse is assessing a client diagnosed with acute diverticulitis.  Which finding should make the nurse suspect that the client has an intestinal perforation? 2. Elevated white blood cells3. Temperature of 1014. Absent bowel sounds5. Abdominal pain RationalesA  B  C  D  1. A nurse is working with a client to update the client’s asthma action plan.  The nurse knows that this action plan should include information on:2. medication adjustments that should be made if peak flow is less than 50% normal3. timeline for allergy skin testing4. the best methods for chest physiotherapy5. plan to come to the ED if an asthma attack occurs RationalesA  B  C  D  1. Which finding should a nurse expect when completing an assessment on a client with chronic bronchitis?2. Minimal sputum with heavy cough3. Pink frothy sputum4. Barrel chest5. Stridor on expiration RationalesA  B  C  D  1. A client with chronic obstructive pulmonary disease is in the third postoperative day following a right sided thoracotomy. During the day shift, the client has required 10L of oxygen by mask to keep their saturations above 88%.  Based on this information which action should be taken by the next nurse?2. Work to wean O2 down to 3L by mask3. Call respiratory therapy for a nebulizer treatment4. Check respiratory rate and notify the physician on call 5. Administer dose of ordered pain medication RationalesA  B  C The night shift nurse should check the client’s respiratory rate and report abnormal findings to the physician. Although uncommon, clients with COPD on high flow oxygen can lose their respiratory drive.D  1. A patient’s nurse practitioner prescribes lisinopril to treat their hypertension.  The patient returns to the clinic for a follow-up appointment.  A nurse should evaluate the client for adverse effects by asking the client if they are experiencing which of the following?2. muscle weakness3. bleeding gums4. persistent cough5. petechiae RationalesA  B  C  D  1. A health care provider adds a second medication for blood pressure control for a client whose blood pressure has not been well controlled with one antihypertensive medication.  If the health care provider orders the following medication combinations which combination would the nurse question? 2. Atenolol (Tenormin) and metoprolol (Lopressor)3. Metolazone (Zaroxolyn) and valsartan (Diovan)4. Captopril (Capoten) and furosemide (Lasix)5. Bumetanide (Bumex) and diltiazem (Cardizem) Rationales1. A nurse is assessing a client who is taking atorvastatin.  For which manifestation should e the nurse specifically assess?2. Constipation and hemorrhoids3. Muscle pain and weakness4. Fatigue and dysrhythmias5. Flushing and postural hypotension RationalesA  B  C  D  1. A client is neutropenic following treatment for acute lymphocytic leukemia and is now experiencing hypotension, tachycardia, and an elevated temperature.  Because an infection is suspected the provider is notified.  Which order should be the nurse’s priority?2. portable chext x-ray3. urine and blood cultures4. Vancomycin (Vancocin) 1gm IV every 12 hours5. Filgrastim (Neupogen) 10mg/kg subcutaneously daily RationalesA  B  C  D  •  Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

Question Answered step-by-step EVENING A When treating hypertension with two medications, they should both be of different drug classifications. Atenolol and Metoprolol are both beta-adrenergic blockers. This means that both drugs have the same mechanism of action and would be ineffective.B Both medications are of different classes, therefore this would be an effective drug combination. Metolazone is a thiazide diuretic and Valsartan is an angiotensin II receptor blocker (ARB). The nurse would not question this order since they are both of different drug classes.C The nurse should not question this order because both drugs have different mechanisms of action. Captopril is an angiotensin converting enzyme inhibitor (ACE inhibitor) and Furosemide is a loop diuretic. Since both medications are of different classes, this combination is effective.D Bumetanide is a loop diuretic and Diltiazem is a calcium channel blocker. Both medications are of different classes, therefore have different mechanisms of action. The nurse should not question this order since the medication combination is effective.• What financial value conflicts might patients have with respect to this issue?• What financial value conflicts might healthcare providers have with respect to this issue?• What financial value conflicts might insurance companies have with respect to this issue?• What financial value conflicts might other stakeholders have with respect to this issue?• Why is it important to understand these value conflicts when making decisions related to health policy?• How might the competition between these financial value conflicts affect both stakeholders’ influence on the issue and how stakeholders are impacted by the issue itself?1. A nurse is caring for a client diagnosed with end stage renal disease.  The client is 6 feet tall and weighs 180 pounds.  The client’s total serum protein is 5.8g/dL.  An assessment by the nurse reveals 2+ edema.  The nurse determines that the client’s edema is most likely the result of which of the following? 2. Increased capillary hydrostatic pressure3. Decreased plasma oncotic pressure4. Increased capillary permeability 5. Decreased serum electrolytes RationalesA  B  C  D  1. Which electrolyte imbalance should be the priority concern for a nurse when assessing a client diagnosed with acute renal failure? 2. hypercalcemia3. hyperphosphatemia4. hyperkalemia5. hypernatremia RationalesA  B  C  D  1. A client is hypotensive.  A nurse closely monitors the client’s electrolytes because the nurse knows that renin is released in response to decreased blood flow to the kidneys.  Which electrolytes are dependent on the renin angiotensin-aldosterone system and should be closely monitored? 2. Sodium, potassium, and chloride3. Sodium, chloride, and calcium4. Calcium, phosphate and magnesium 5. Magnesium, potassium and sodium RationalesA  B  C  D  1. A client diagnosed with cardiomyopathy is hyponatremic as a result of fluid volume overload.  A fluid restriction of 800mL/24 hours is ordered by the physician.  Which action by the nurse is most appropriate? 2. Provide ice chips and refill the cup every 4 hours3. Encourage the client to perform mouth care when feeling thirsty4. Offer sugary lozenges for the client to hold in their mouth5. Replenish the client’s water every 2 hours telling them to only take sips RationalesA  B  C  D  1. What assessment findings should prompt a nurse to conclude that interventions have been effective for a 90-year-old client with hypernatremia?2. Lethargy and paresthesias3. Muscle cramps and spasms4. Restlessness and agitation 5. Decreased body temperature and shivering RationalesA  B  C  D  1. A nurse admits a client diagnosed with polycystic kidney disease.  The client is experiencing dull flank pain, nocturia, and diluted urine with a low specific gravity.  A nurse is reviewing orders written by the nurse practitioner.  Which orders should the nurse question?  Choose all that apply.  2. Increase fluid intake to 2 L a day3. Restrict sodium intake to 500 mg a day 4. Initiate referral for genetic counseling5. Lisinopril 2.5mg daily for hypertension 6. Metoprolol 12.mg a day BID RationalesA  B  C  D  E  1. A nurse evaluates that a client is in the recovery phase of acute renal failure.  Achievement of which outcomes supports the nurse’s conclusion?  Choose all that apply. 2. Increased urine specific gravity3. Increased serum creatinine level 4. Decreased serum potassium 5. Absence f nausea and vomiting 6. Absence of muscle twitching RationalesA  B  C  D  E  1. A nurse is concerned that a client receiving peritoneal dialysis may be experiencing peritonitis.  Which finding noted on the nurse’s assessment supported this concern? 2. Abdominal numbness3. Cloudy dialysis output4. Radiating sternal pain5. Decreased white blood cell count RationalesA  B  C  D  1. A nurse is assessing a patient who is 24 hour post GI hemorrhage.  The assessment findings include a BUN of 40 and a creatinine level of 0.8 mg/dL.  After reviewing the assessment the nurse should do which of the following?  2. Immediately call the physician to report the results3. Monitor urine output as this may be a sign of kidney failure4. Document the findings and continue to monitor the client 5. Encourage the client to limit their protein intake RationalesA  B  C  D  1. A nurse is performing a helath history on a client during a clinic visit.  Which client statement should be most concerning to the nurse because it could be a symptom of esophageal cancer? 2. ” I have been  having a lot of indigestion lately.”3. “When I eat meat t seems to get stuck halfway down.”4. “I have been waking up at night with chest pain.”5. “I have been gaining a lot of weight lately even though I have not changed my diet.” RationalesA  B  C  D  1. A client is hospitalized for conservative treatment of cirrhosis.  As part of the collaborative plan of care, a nurse would anticipate?2. monitoring the client’s blood sugar3. maintaining NPO status4. administering antibiotics5. encouraging frequent ambulation RationalesA  B  C  D  1. A nurse is beginning client care and has been assigned 4 patients.  Which patient should the nurse plan to assess first? 2. A 50 year old client who has chronic pancreatitis and is reporting a pain level of 6 out of 10 on a numeric scale.3. A 47 year old patient with esophageal varices who has influenza and has a bad cough 4. A 60 year old patient who had an open cholecystectomy 15 hours ago and has been stable overnight5. A 54 year old with cirrhosis and jaundice who is reporting itching RationalesA  B  C  D  1. A nurse is assessing a client diagnosed with acute diverticulitis.  Which finding should make the nurse suspect that the client has an intestinal perforation? 2. Elevated white blood cells3. Temperature of 1014. Absent bowel sounds5. Abdominal pain RationalesA  B  C  D  1. A nurse is working with a client to update the client’s asthma action plan.  The nurse knows that this action plan should include information on:2. medication adjustments that should be made if peak flow is less than 50% normal3. timeline for allergy skin testing4. the best methods for chest physiotherapy5. plan to come to the ED if an asthma attack occurs RationalesA  B  C  D  1. Which finding should a nurse expect when completing an assessment on a client with chronic bronchitis?2. Minimal sputum with heavy cough3. Pink frothy sputum4. Barrel chest5. Stridor on expiration RationalesA  B  C  D  1. A client with chronic obstructive pulmonary disease is in the third postoperative day following a right sided thoracotomy. During the day shift, the client has required 10L of oxygen by mask to keep their saturations above 88%.  Based on this information which action should be taken by the next nurse?2. Work to wean O2 down to 3L by mask3. Call respiratory therapy for a nebulizer treatment4. Check respiratory rate and notify the physician on call 5. Administer dose of ordered pain medication RationalesA  B  C The night shift nurse should check the client’s respiratory rate and report abnormal findings to the physician. Although uncommon, clients with COPD on high flow oxygen can lose their respiratory drive.D  1. A patient’s nurse practitioner prescribes lisinopril to treat their hypertension.  The patient returns to the clinic for a follow-up appointment.  A nurse should evaluate the client for adverse effects by asking the client if they are experiencing which of the following?2. muscle weakness3. bleeding gums4. persistent cough5. petechiae RationalesA  B  C  D  1. A health care provider adds a second medication for blood pressure control for a client whose blood pressure has not been well controlled with one antihypertensive medication.  If the health care provider orders the following medication combinations which combination would the nurse question? 2. Atenolol (Tenormin) and metoprolol (Lopressor)3. Metolazone (Zaroxolyn) and valsartan (Diovan)4. Captopril (Capoten) and furosemide (Lasix)5. Bumetanide (Bumex) and diltiazem (Cardizem) Rationales1. A nurse is assessing a client who is taking atorvastatin.  For which manifestation should e the nurse specifically assess?2. Constipation and hemorrhoids3. Muscle pain and weakness4. Fatigue and dysrhythmias5. Flushing and postural hypotension RationalesA  B  C  D  1. A client is neutropenic following treatment for acute lymphocytic leukemia and is now experiencing hypotension, tachycardia, and an elevated temperature.  Because an infection is suspected the provider is notified.  Which order should be the nurse’s priority?2. portable chext x-ray3. urine and blood cultures4. Vancomycin (Vancocin) 1gm IV every 12 hours5. Filgrastim (Neupogen) 10mg/kg subcutaneously daily RationalesA  B  C  D  •  Health Science Science Nursing Share QuestionEmailCopy link Comments (0)