NCLEX RN Practice Question # 546-551

The nurse is assessing a client with Addison’s disease. The nurse expects to note which of the following?

1. Anorexia
2. Weight gain
3. Yellow skin coloration
4. A craving for sweets

Addison’s disease

Description

Hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids)
Can be primary or secondary
The condition is fatal if left untreated.

Interventions

Monitor vital signs, particularly blood pressure, weight, and intake and output.
Monitor white blood cell (WBC) count, blood glucose, and potassium, sodium, and calcium levels.
Administer glucocorticoid or mineralocorticoid medications as prescribed.
Observe for addisonian crisis caused by stress, infection, trauma, or surgery.

Client education

Avoid individuals with an infection.
Diet: High protein and high carbohydrate, normal sodium intake
Avoid strenuous exercise and stressful situations.
Need for lifelong glucocorticoid therapy
Avoid over-the-counter medications.
Wear a Medic-Alert bracelet.
Signs and symptoms of complications such as underreplacement and overreplacement of hormones

The nurse is administering a doxorubicin IV push to a client with breast cancer. Which of the following should the nurse explain is to be expected during therapy with this drug?

1. Burning at the IV site during administration
2. Red-colored urine
3. Permanent alopecia
4. Teeth discoloration

ANTITUMOR ANTIBIOTIC MEDICATIONS

Description

Interfere with DNA and RNA synthesis
Cell cycle phase–nonspecific medications

Side effects

Nausea and vomiting
Fever
Bone marrow depression
Rash
Alopecia
Stomatitis
Gonadal suppression
Hyperuricemia
Vesication (blistering of tissue at IV site)
Daunorubicin (DaunoXome) may cause congestive heart failure and dysrhythmias.
Doxorubicin (Adriamycin, Doxil) and idarubicin (Idamycin) may cause cardiotoxicity, cardiomyopathy,
and electrocardiographic changes (Dexrazoxane [Zinecard] may be administered with doxorubicin to reduce cardiomyopathy).
Pulmonary toxicity can occur with bleomycin (Blenoxane).

Interventions:

Refer to general interventions section under Antineoplastic Medications.

Withhold medication if the platelets are lower than 75,000/mm3 or the neutrophil count is lower than 2000/mm3, and notify physician (this may vary depending on antitumor antibiotic agent and agency policy).
Assess results of pulmonary function tests.
Monitor for electrocardiographic changes.
Assess lung sounds for crackles.
Assess for signs of congestive heart failure, including dyspnea, crackles, peripheral edema, and weight gain.
Assess results of chest radiography and renal and liver function studies.

A client is leaving the clinic with a new prescription for lisinopril. Which of the following suggestions can the nurse make to minimize one of the major effects of lisinopril?

1. Eat fruits and vegetables high in iron.
2. Rise slowly from a lying to a sitting position.
3. Increase fluid intake.
4. Avoid aspirin-containing drugs.

IMPORTANT WARNING:

Do not take lisinopril if you are pregnant. If you become pregnant while taking lisinopril, call your doctor immediately. Lisinopril may harm the fetus.

Why is this medication prescribed?

Lisinopril is used alone or in combination with other medications to treat high blood pressure. It is used in combination with other medications to treat heart failure. Lisinopril is also used to improve survival after a heart attack. Lisinopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly and the heart can pump blood more efficiently.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys, and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

The nurse is administering a drug by Z-track and must follow the proper technique. Place the following steps in the appropriate order. All options must be used.

1. Withdraw the needle.
2. Administer the drug intramuscularly (IM) in the dorsogluteal site.
3. Release the skin.
4. Displace the skin lateral to the injection site.

Administering a Z-Track Injection

Wash your hands with soap and warm water.

This will help to prevent potential infection. Be sure to thoroughly scrub between fingers, on the backs of hands, and under fingernails. The Centers for Disease Control and Prevention (CDC) recommends lathering for 20 seconds – the time it takes to sing the “Happy Birthday” song twice.

Gather the necessary supplies:

needle and syringe with medication
alcohol pads
gauze
puncture-resistant container to discard the used needles and syringe (typically a red, plastic “sharp’s container”)
bandages

Clean the injection site.

Clean the injection site with an alcohol pad to minimize the possibility of infection. Allow the area to air dry for a few minutes.

Relax the muscle to be injected.

Get into a comfortable position so that your muscle is as relaxed as possible. This may be lying down on your stomach or bending over a chair or counter, or sitting (if self-injecting into your thigh).

Prepare the syringe with medication.

Remove the cap. If the vial is multi-dose, take a note about when the vial was first opened. The rubber stopper should be cleaned with an alcohol swab.

Draw air into the syringe. Draw back the plunger to fill the syringe with air up to the dose that you will be injecting. This is done because the vial is a vacuum and you need to add an equal amount of air to regulate the pressure. This makes it easier to draw the medication into the syringe. Don’t worry; if you forget this step, you can still get the medication out of the vial.

Insert air into the vial. Remove the cap from the needle and push the needle through the rubber stopper at the top of the vial. Inject all the air into the vial. Be careful to not touch the needle to keep it clean.

Withdraw the medication. Turn the vial and syringe upside down so the needle points upward. Then pull back on the plunger to withdraw the correct amount of medication.

Remove any air bubbles. Tap the syringe to push any bubbles to the top and gently depress the plunger to push the air bubbles out.

Insert the needle. Use one hand to pull downward on your skin and fatty tissue. Hold it firmly about an inch away (2.54 cm) from the muscle. In the other hand, hold the needle at a 90-degree angle and insert it quickly and deeply enough to penetrate your muscle.

A client is admitted for pulmonary embolism and is receiving heparin 1,500 units/hour IV. In case of a serious bleeding reaction, the nurse has which of the following drugs readily available?

1. Vitamin K
2. Protamine sulfate
3. Promethazine hydrochloride
4. Protamine

PULMONARY EMBOLISM

Description:

An embolus blocking the pulmonary artery and disrupting blood flow to one or more lobes of the lung.

Assessment

Sudden dyspnea
Sudden sharp chest or upper abdominal pain
Cyanosis
Tachycardia
A drop in blood pressure

Interventions

Notify the physician immediately because pulmonary embolism may be life-threatening and requires emergency action.
Monitor vital signs.
Administer oxygen and medications as prescribed.