Critical Care Comprehensive Exam 1

1. A client with asthma receives a prescription for high blood pressure during a

clinic visit. Which prescription should the nurse anticipate the client to receive that

is least likely to exacerbate asthma?

A. Carteolol (Ocupress).

B. Propranolol hydrochloride (Inderal).

C. Pindolol (Visken). Incorrect

D. Metoprolol tartrate (Lopressor). Correct

The best antihypertensive agent for clients with asthma is metoprolol (Lopressor)

(C), a beta2 blocking agent which is also cardioselective and less likely to cause

bronchoconstriction. Pindolol (A) is a beta2 blocker that can cause

bronchoconstriction and increase asthmatic symptoms. Although carteolol (B) is a

beta blocking agent and an effective antihypertensive agent used in managing

angina, it can increase a client's risk for bronchoconstriction due to its nonselective

beta blocker action. Propranolol (D) also blocks the beta2 receptors in the lungs,

causing bronchoconstriction, and is not indicated in clients with asthma and other

obstructive pulmonary disorders.

2. A male client who has been taking propranolol (Inderal) for 18 months tells the

nurse that the healthcare provider discontinued the medication because his blood

pressure has been normal for the past three months. Which instruction should the

nurse provide?

A. Obtain another antihypertensive prescription to avoid withdrawal

symptoms.

B. Stop the medication and keep an accurate record of blood pressure.

C. Report any uncomfortable symptoms after stopping the medication.

D. Ask the healthcare provider about tapering the drug dose over the next

week. Correct

Although the healthcare provider discontinued the propranolol, measures to prevent

rebound cardiac excitation, such as progressively reducing the dose over one to two

weeks (C), should be recommended to prevent rebound tachycardia, hypertension,

and ventricular dysrhythmias. Abrupt cessation (A and B) of the beta-blocking agent

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may precipitate tachycardia and rebound hypertension, so gradual weaning should

be recommended. (D) is not indicated.

3. A client who is taking clonidine (Catapres, Duraclon) reports drowsiness. Which

additional assessment should the nurse make?

A. Has the client experienced constipation recently?

B. Did the client miss any doses of the medication?

C. How long has the client been taking the medication? Correct

D. Does the client use any tobacco products?

Drowsiness can occur in the early weeks of treatment with clonidine and with

continued use becomes less intense, so the length of time the client has been on

the medication (A) provides information to direct additional instruction. (B, C, and

D) are not relevant.

4.ID: 6974873590

The nurse is preparing to administer atropine, an anticholinergic, to a client who is

scheduled for a cholecystectomy. The client asks the nurse to explain the reason for

the prescribed medication. What response is best for the nurse to provide?

A. Provide a more rapid induction of anesthesia.

B. Induce relaxation before induction of anesthesia.

C. Decrease the risk of bradycardia during surgery. Correct

D. Minimize the amount of analgesia needed postoperatively.

Atropine may be prescribed preoperatively to increase the automaticity of the

sinoatrial node and prevent a dangerous reduction in heart rate (B) during surgical

anesthesia. (A, C and D) do not address the therapeutic action of atropine use

perioperatively.

5.ID: 6974876286

An 80-year-old client is given morphine sulphate for postoperative pain. Which

concomitant medication should the nurse question that poses a potential

development of urinary retention in this geriatric client?

A. Antacids.

B. Tricyclic antidepressants. Correct

C. Nonsteroidal antiinflammatory agents.

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D. Insulin.

Drugs with anticholinergic properties, such as tricyclic antidepressants (C), can

exacerbate urinary retention associated with opioids in the older client. Although

tricyclic antidepressants and antihistamines with opioids can exacerbate urinary

retention, the concurrent use of (A and B) with opioids do not. Nonsteroidal

antiinflammatory agents (D) can increase the risk for bleeding, but do not increase

urinary retention with opioids (D).

6.ID: 6974873559

A client with osteoarthritis is given a new prescription for a nonsteroidal

antiinflammatory drug (NSAID). The client asks the nurse, "How is this medication

different from the acetaminophen I have been taking?" Which information about the

therapeutic action of NSAIDs should the nurse provide?

A. Are less expensive.

B. Provide antiinflammatory response. Correct

C. Increase hepatotoxic side effects.

D. Cause gastrointestinal bleeding.

Nonsteroidal antiinflammatory drugs (NSAIDs) have antiinflammatory properties (B),

which relieves pain associated with osteoarthritis and differs from acetaminophen, a

non-narcotic analgesic and antipyretic. (A) does not teach the client about the

medication's actions. Although NSAIDs are irritating to the gastrointestinal (GI)

system and can cause GI bleeding (C), instructions to take with food in the stomach

to manage this as an expected side effect should be included, but this does not

answer the client's question. Acetaminophen is potentially hepatotoxic (D), not

NSAIDs.

7.ID: 6974876262

A client with cancer has a history of alcohol abuse and is taking acetaminophen

(Tylenol) for pain. Which organ function is most important for the nurse to monitor?

A. Cardiorespiratory.

B. Liver. Correct

C. Sensory.

D. Kidney.

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Acetaminophen and alcohol are both metabolized in the liver. This places the client

at risk for hepatotoxicity, so monitoring liver (A) function is the most important

assessment because the combination of acetaminophen and alcohol, even in

moderate amounts, can cause potentially fatal liver damage. Other non-narcotic

analgesics, such as n onsteroidal anti-inflammatory drugs (NSAIDs), are more likely

to promote adverse renal effects (B). Acetaminophen does not place the client at

risk for toxic reactions related to (C or D).

8.ID: 6974875110

The nurse obtains a heart rate of 92 and a blood pressure of 110/76 prior to

administering a scheduled dose of verapamil (Calan) for a client with atrial flutter.

Which action should the nurse implement?

A. Give intravenous (IV) calcium gluconate.

B. Withhold the drug and notify the healthcare provider.

C. Administer the dose as prescribed. Correct

D. Recheck the vital signs in 30 minutes and then administer the dose.

Verapamil slows sinoatrial (SA) nodal automaticity, delays atrioventricular (AV)

nodal conduction, which slows the ventricular rate, and is used to treat atrial flutter,

so (A) should be implemented, based on the client's heart rate and blood pressure.

(B and C) are not indicated. (D) delays the administration of the scheduled dose.

9.ID: 6974873583

A client is admitted to the hospital with a diagnosis of Type 2 diabetes mellitus and

influenza. Which categories of illness should the nurse develop goals for the client's

plan of care?

A. One chronic and one acute illness. Correct

B. Two acute illnesses.

C. One acute and one infectious illness. Incorrect

D. Two chronic illnesses.

The plan of care should include goals that are specific for chronic and acute

illnesses. Adult-onset diabetes is a life-long chronic disease, whereas influenza is an

acute illness with a short term duration (C). (A, B, and D) do not include the correct

duration categories for this situation.

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