ATI LPN
LPN Pharmacology
1. A client with deep vein thrombosis (DVT) is receiving anticoagulant therapy. The nurse should reinforce with the client the importance of reporting which potential side effect?
- A. Nausea
- B. Headache
- C. Gingival bleeding
- D. Dizziness
Correct answer: C
Rationale: The correct answer is C, 'Gingival bleeding.' Gingival bleeding is a common side effect of anticoagulant therapy. Anticoagulants work by prolonging the time it takes for blood to clot, which can lead to bleeding issues, including gingival bleeding. Nausea, headache, and dizziness are not typically associated with anticoagulant therapy. Since bleeding, including gingival bleeding, can be a serious side effect that requires medical attention, the client should be educated on reporting it promptly to their healthcare provider.
2. A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following findings should the nurse report to the provider?
- A. Blood glucose level of 120 mg/dL
- B. White blood cell count of 8,000/mm³
- C. Temperature of 37.2°C (99°F)
- D. Daily weight increase of 0.45 kg (1 lb)
Correct answer: D
Rationale: The correct answer is D. A sudden weight increase may indicate fluid retention, a complication of TPN therapy that should be reported. Options A, B, and C are within normal ranges and do not directly relate to TPN therapy complications. A blood glucose level of 120 mg/dL is normal, a white blood cell count of 8,000/mm³ is within the normal range, and a temperature of 37.2°C (99°F) is also normal.
3. Which of the following techniques should be used to insert an indwelling urinary catheter for a female client?
- A. Use sterile technique.
- B. Insert the catheter 2-3 inches into the urethra.
- C. Inflate the balloon after insertion.
- D. Lubricate the catheter tip before insertion.
Correct answer: D
Rationale: Lubricating the catheter tip before insertion is crucial for female urinary catheterization. This step helps reduce discomfort for the patient and facilitates smooth catheter insertion into the urethra. Using sterile technique maintains asepsis during the procedure, inserting the catheter 2-3 inches ensures proper placement, and inflating the balloon after insertion secures the catheter in place without causing trauma. Proper technique is fundamental for patient comfort, preventing infection, and ensuring the success of the catheterization procedure.
4. A client with a history of myocardial infarction (MI) is being discharged with a prescription for nitroglycerin sublingual tablets. Which instruction should the nurse reinforce?
- A. Store the tablets in a cool, dry place away from light.
- B. Take a tablet every 5 minutes if chest pain occurs.
- C. Place the tablets under the tongue for sublingual absorption.
- D. Take the tablets without water for faster effect.
Correct answer: A
Rationale: The correct answer is A. Nitroglycerin tablets are light and moisture-sensitive, so they should be stored in a cool, dry place away from light to maintain their effectiveness. Option B advises taking a tablet every 5 minutes, which may lead to overdose as this frequency is too high. Option C emphasizes the correct administration route for sublingual tablets. Option D is incorrect as water is not needed for the tablets to take effect.
5. What is the first action when a client who is admitted with schizophrenia reports hearing voices telling them to harm themselves?
- A. Administer antipsychotic medication
- B. Ask the client what the voices are saying
- C. Distract the client with another activity
- D. Call the healthcare provider
Correct answer: B
Rationale: The correct first action when a client with schizophrenia reports hearing voices telling them to harm themselves is to ask the client what the voices are saying. This is important to assess the content of the hallucinations and determine if there is any immediate danger or suicidal intent. Administering antipsychotic medication without knowing the content of the voices or the level of danger could be inappropriate and potentially harmful. Distracting the client with another activity may not address the underlying issue of the hallucinations commanding harm. Calling the healthcare provider can be done after assessing the situation and gathering information from the client.
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