NCLEX PN ARCHER REVIEW

NCLEX PN ARCHER REVIEW

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NCLEX PN ARCHER REVIEW

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ARCHER CAT EXAM 1

75 terms Natasha_smiths23 Preview Adult Health - Archer Review (1/8) - ...201 terms FutureRN2000Preview Mark K 518 term hai The nurse is caring for a client exhibiting signs of poor muscle coordination, stooped posture, and slow movements. Which medication is most likely to cause these symptoms?Haloperidol

Rationale:

Haloperidol is a typical antipsychotic that may adversely cause extrapyramidal side effects (EPS). These effects include akathisia, dystonia, pseudo-parkinsonism, and/or tardive dyskinesia. Tardive dyskinesia is an adverse effect that occurs with antipsychotics and has an onset of months to years while on the medication.While reviewing the morning labs of your client, you see the following results from their thyroid panel. What diagnosis does the nurse suspect?

TSH: 7 mU/L

T4: 1.0 mcg/dL

T3: 2.0 ng/dL

Hypothyroidism

Rationale:

Hypothyroidism would be manifested with an increased thyroid-stimulating hormone level and decreased T4 and T3, as shown in these labs.Because of the increased TSH level, the thyroid gland is tricked into thinking that there is enough thyroid hormone already in the body and does not secrete more. The decreased T3 and T4 levels cause hypothyroidism symptoms, such as weight gain and fatigue.

The nurse reinforces teaching to a client with hypertension about the newly prescribed furosemide. Which of the following should the nurse include in the teaching?Take this medication in the early part of the day

Rationale:

Furosemide is a loop diuretic and may be indicated for conditions such as heart failure or hypertension. The client should be instructed to take this medication in the earlier part of the day to avoid nocturia.The nurse is assessing a 7-month-old infant. At this age, which of the following reflexes would the nurse expect to no longer be present? Select all that apply.Rooting Moro Palmar Tonic neck

Rationale:

The Rooting reflex should disappear by 3-4 months of age. It occurs when the infants turn their face toward stimulation (such as stroking their cheek) and make sucking (rooting) motions with the mouth. This reflex helps to ensure successful feeding.The Moro reflex should disappear by 5-6 months of age. This reflex is a response to a sudden loss of support. When support is removed, the infant spreads out the arms and cries.The Palmar reflex should disappear by 2-3 months of age. When an object is placed in an infant's hand, and the palm is stroked, the fingers will close reflexively.The tonic neck reflex disappears around 4 months of age. This reflex is elicited by turning the infant's head to one side and is considered positive if the infant extends the extremities on the side that the head is turned toward, and flexes the extremities on the opposite side.The nurse is caring for a client with diabetes mellitus. Which of the following laboratory data requires follow-up? Select all that apply.Hemoglobin A1C 8.5% [< 5.7%] Creatinine 1.9 mg/dL [0.6-1.2 mg/dL] BUN 25 mg/dL [10-20 mg/dL] Proteinuria

Rationale:

The client's hemoglobin A1C is elevated as the therapeutic goal for a client with diabetes is to attain less than 7%. This elevated level is causing the client to experience an insult to the kidneys, which is evident by the increased BUN (normal 10-20 mg/dL) and creatinine (normal 0.6-1.2 mg/dL). Finally, proteinuria is further evidence that this client is experiencing diabetic nephropathy.The nurse is caring for the following assigned clients. Which client should the nurse follow up with first?A client requesting diphenhydramine after starting an intravenous antibiotic.

Rationale:

A client requesting diphenhydramine following the initiation of an antibiotic requires immediate follow-up because the client could be experiencing an allergic reaction ranging from mild to severe. Thus, the nurse should quickly follow-up with this client.

The nurse is assessing a 6-year-old client with asthma. Which of the following findings is of highest concern?Silent chest

Rationale:

Silent chest is the assessment finding of most concern. This refers to the inability to auscultate any lung sounds. There is complete obstruction of the client's airway, and therefore the inability to move air. When complete obstruction occurs, this is a medical emergency. This assessment finding is of most concern because the client has lost their airway.The nurse is caring for a client with newly prescribed zolpidem. The nurse understands that this medication is indicated for which condition?Insomnia

Rationale:

Zolpidem is a non-benzodiazepine indicated in the treatment of insomnia.NGN The nurse is caring for a 47-year-old male in the outpatient clinic Orders Discharge home Schedule a follow-up appointment in four weeks Sertraline 50 mg PO Daily Clonidine 0.1 mg PO Daily Zolpidem 5 mg PO, PRN insomnia The nurse reviews the orders and formulates a teaching plan for the newly prescribed medications For each medication, select the appropriate option for drug classification and client teaching that should be reinforced Clonidine - alpha2-adrenergic agonist This medication may cause you to become dizzy or tired.Sertraline - selective serotonin reuptake inhibitor Diarrhea is a common side effect of this medication.Zolpidem - Hypnotic Do not take this medication with alcohol

Rationale:

Clonidine is indicated in the treatment of hypertension. The medication may be administered as a pill or transdermal patch for seven days. It should not be abruptly discontinued because of the risk of rebound hypertension due to a catecholamine surge. Clonidine has a sedative effect, and the client should not take this medication with alcohol or while driving/performing tasks requiring a high degree of concentration.Sertraline is a potent, selective serotonin reuptake inhibitor. Sertraline is indicated in treating anxiety, obsessive-compulsive, and depressive disorders. SSRIs typically cause gastrointestinal distress once they are started and may be lessened by taking the medication with food.Zolpidem is a non-benzodiazepine sedative-hypnotic indicated in the treatment of insomnia. This medication should not be taken with alcohol or other CNS depressants because of the risk of respiratory depression.

The LPN is reinforcing education regarding advance directives with the client. Which of the following statements are not true regarding advance directives? Select all that apply.Only one physician must determine when a client is unable to make medical decisions for himself.Advance directives must be reviewed and re-signed every ten years to remain valid.An advance directive is legally valid in every state, no matter which state it was initially created.

Rationale:

Once a client arrives at a hospital, physicians will need to evaluate the client and implement the advance directive, if necessary. Two physicians, not one are required to determine whether a client cannot make decisions for themself.Advance directives do not expire and remain in effect until they are changed. It is not true that they need to be signed every ten years to stay valid.Some states do not honor advance directives created in other states. So, if a client moves, he/she should check with his/her new state policies on the topic.The nurse is assessing a male client taking prescribed risperidone. Which of the following findings would indicate the client is having an adverse effect?gynecomastia

Rationale:

Risperidone is an atypical (second-generation) antipsychotic indicated in treating disorders such as schizophrenia, autism with behavioral disturbances, delusional disorder, and bipolar disorder. Risperidone is notorious for causing increased prolactin levels. This increase in prolactin levels may cause a client to develop gynecomastia and/or galactorrhea.The emergency department (ED) nurse cares for a client with severe intrabdominal bleeding. The client has tachycardia, hypotension, and a thready pulse. The nurse anticipates the primary healthcare provider (PHCP) will prescribe which blood product?Packed red blood cells (PRBCs)

Rationale:

The client is experiencing intraabdominal bleeding with manifestations confirming shock. The client will need to have the blood volume replaced with emergent surgery. Type-specific PRBCs would be preferred; however, if the client is critical, O-negative blood may be transfused.When preparing to change the linens on the bed of a client who has a draining sacral wound infected by MRSA, which PPE should the nurse plan to use?Select all that apply.Gloves & Gown

Rationale:

A gown and gloves should be used when coming in contact with linens that may be contaminated by wound secretions. Approximately half of all MRSA infections are acquired in the hospital. One-fourth is associated with having received health care, but onset is in the community; the remainder is considered community-acquired. Due to aggressive health care emphasis on preventing MRSA transmission using standard and contact precautions, rates have decreased but are still unacceptably high. More Americans die each year from MRSA than from AIDS.