Question

The nurse is assessing a client taking hydrocortisone for Addison's disease. Which question is most appropriate for the nurse to ask to monitor for a common complication of therapy?

Answer 1

Correct Answers:

"Have you noticed any changes in your vision?"

Rationale :

⭐ Hydrocortisone therapy is a glucocorticoid replacement for Addison’s disease that mimics the effects of cortisol. While essential, long-term or high-dose therapy suppresses the immune response, making the client more susceptible to infections.

⭐ Asking about recent infections (even mild ones) helps the nurse monitor for immunosuppression, which is a common and serious complication of glucocorticoid therapy.

⭐ Early recognition of infections is critical, since the inflammatory response is blunted in these clients, and infections may progress quickly without typical warning signs like fever.

⭐ Other complications of glucocorticoid therapy include hyperglycemia, osteoporosis, fluid retention, and GI irritation, but infection risk is one of the highest-priority concerns during assessment

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Answer 2

Correct Answers:

Injecting the medication subcutaneously as prescribed

Rationale :

🔷 Epoetin alfa is a synthetic form of erythropoietin used to treat anemia in chronic kidney disease by stimulating red blood cell production in the bone marrow.

🔷 The correct route of administration is subcutaneous (preferred) or slow IV infusion depending on the prescription. Subcutaneous injection provides a more sustained absorption and better effect.

🔷 The vial should not be shaken or vigorously agitated, as this can denature the protein and reduce its effectiveness. Instead, it should be gently swirled if needed.

🔷 The nurse should monitor hemoglobin levels regularly to prevent overcorrection. Therapy is typically held or reduced if hemoglobin exceeds 11 g/dL to decrease the risk of thromboembolic events, stroke, or hypertension.

🔷 Epoetin alfa is never given as an IV push; when given IV, it must be administered slowly to avoid adverse reactions.

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Answer 3

Correct Answers:

Verify the client's kidney function results before the scan is performed

Rationale :

🔹 Metformin is excreted by the kidneys, and when combined with iodinated contrast, there is a risk of acute kidney injury and lactic acidosis, a rare but life-threatening complication.

🔹 The nurse must verify kidney function tests (BUN, creatinine, eGFR) before the procedure. If renal function is impaired, metformin is usually withheld before and for 48 hours after contrast exposure until kidney function is reassessed.

🔹 Administering metformin before the scan is unsafe, as impaired renal clearance may increase the risk of drug accumulation.

🔹 Clients should be encouraged to hydrate, not restrict fluids, since fluids help flush contrast dye through the kidneys.

🔹 While glucose monitoring is important in diabetic clients, the priority related to contrast administration is ensuring renal safety, not immediate glucose checks.

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Answer 4

Correct Answers:

Take with a full glass of water or juice

Rationale :

🍊 Ferrous sulfate is best absorbed in an acidic environment, so taking it with water or orange juice (vitamin C) enhances absorption.

🍊 It should not be taken with milk, eggs, or antacids, as calcium and alkaline substances interfere with iron absorption and reduce its effectiveness.

🍊 Enteric-coated or sustained-release tablets should never be crushed, since this alters absorption and increases the risk of gastric irritation.

🍊 Clients should also be taught that iron may cause dark stools, constipation, or GI upset, and to increase fiber and fluids to reduce constipation.

🍊 For best results, iron should be taken on an empty stomach if tolerated, but with food if GI upset occurs.

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Answer 5

Correct Answers:

The client reports fasting blood glucose levels between 90 and 110 mg/dL

Rationale :

💠 Glimepiride is a sulfonylurea that lowers blood glucose by stimulating the pancreas to release insulin and increasing insulin sensitivity in peripheral tissues.

💠 The desired therapeutic effect is achieving and maintaining fasting blood glucose levels within the target range (<100 mg/dL is normal, but values between 90–110 mg/dL show effective control for type 2 diabetes).

💠 Dizziness and tremors suggest hypoglycemia, a potential side effect of sulfonylureas, not a therapeutic outcome.

💠 Weight gain may occur with glimepiride, but it is an adverse effect, not evidence of treatment effectiveness.

💠 Stable blood glucose levels help prevent both acute complications (hypoglycemia, hyperglycemia) and long-term complications (retinopathy, nephropathy, neuropathy).

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Answer 6

Correct Answers:

3

Rationale :

Calculate daily dose:

25 mg/kg/day × 18 kg = 450 mg/day.

Divide into 3 doses (TID):

450 mg/day ÷ 3 = 150 mg per dose.

Use the concentration to find mL:

250 mg in 5 mL ⇒ 50 mg/mL.

150 mg ÷ 50 mg/mL = 3 mL per dose.

Round as instructed: already a whole number → 3 mL.

Quick safety check:

– Dose equals the ordered 25 mg/kg/day when summed over 3 doses (3 mL × 3 = 9 mL/day → 9 mL × 50 mg/mL = 450 mg/day ✅).

– Typical TID interval: every 8 hours.

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Answer 7

Correct Answers:

"Carry a fast-acting carbohydrate snack with you at all times."

Rationale :

🔷 Insulin lowers blood glucose; if meals, activity, or timing don’t perfectly match the dose, hypoglycemia can occur unexpectedly.

🔷 Keeping a fast-acting carbohydrate (≈15 g) on hand (e.g., glucose tablets, 120–150 mL juice, regular soda, glucose gel) allows immediate correction of low sugar.

🔷 Liquids or glucose tablets are absorbed quickly and predictably, making them superior to candy with fat/protein that slows absorption.

🔷 Teach the “15–15 rule”: take ~15 g rapid carb, recheck in 15 minutes, repeat if still <70 mg/dL, then follow with a longer-acting carb if the next meal is far off.

🔷 Also advise carrying medical ID and recognizing early symptoms (shaking, sweating, hunger, confusion) for prompt self-treatment.

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Answer 8

Correct Answers:

Cosyntropin

Rationale :

🔷 Cosyntropin is synthetic ACTH (1–24) used in the ACTH stimulation test to diagnose adrenocortical insufficiency.

🔷 Procedure: obtain baseline cortisol (± ACTH), administer 250 mcg IV/IM cosyntropin, then recheck cortisol at 30 and 60 minutes.

🔷 A normal adrenal responds with a clear cortisol rise (commonly to ≥18–20 μg/dL or by ≥7 μg/dL over baseline), indicating intact adrenal reserve.

🔷 Little/no rise supports primary adrenal insufficiency; a blunted/variable rise may indicate secondary/tertiary (pituitary/hypothalamic) insufficiency depending on chronicity.

🔷 Minimize confounders: schedule testing in the morning, and avoid recent exogenous glucocorticoids that cross-react with assays when possible.

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Answer 9

Correct Answers:

"During pregnancy, chemotherapeutic agents should be avoided if possible."

Rationale :

🔶 Most chemo drugs are teratogenic, especially during the 1st trimester (organogenesis), increasing risks of miscarriage and congenital anomalies.

🔶 When treatment is unavoidable, some regimens may be used in the 2nd/3rd trimester under oncology–maternal-fetal medicine co-management, but none are considered categorically “safe.”

🔶 Methotrexate is a folate antagonist and contraindicated in pregnancy (abortifacient/major malformations).

🔶 Tamoxifen exposure in pregnancy has been linked to fetal anomalies; it is not considered safe.

🔶 Doxorubicin (anthracycline) has been used after the first trimester in select cases, but it is not “safe”—it carries fetal and maternal risks and requires specialist oversight.

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Answer 10

Correct Answers:

New-onset confusion and tremors

Rationale :

🔷 Epoetin alfa can precipitate hypertension and rapidly rising hemoglobin/hematocrit, predisposing to stroke or hypertensive encephalopathy—often presenting with new neurologic changes (confusion, tremor, headache, seizures).

🔷 Neurologic symptoms after starting or titrating an ESA are a red-flag adverse effect that warrants immediate BP check, neuro assessment, and provider notification.

🔷 The highest risks occur when Hb rises quickly or exceeds targets; ESAs are generally adjusted to keep Hb ≤11 g/dL to limit thromboembolic events.

🔷 Hemoglobin 10.2 g/dL with stable vitals reflects an expected therapeutic response, not toxicity.

🔷 Slight pallor/low appetite or mild joint pain/fatigue are nonspecific and typically not serious in this context.

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Exam 4 - Modules 7 and 8

No.

1 :
The nurse is assessing a client taking hydrocortisone for Addison's disease. Which question is most appropriate for the nurse to ask to monitor for a common complication of therapy?

2 :
The nurse is preparing to administer epoetin alfa to a client with chronic kidney disease and anemia. Which action by the nurse demonstrates correct medication administration?
Laboratory Reference Ranges: Hemoglobin 12-15 g/dL

3 :
A client taking metformin for type 2 diabetes is scheduled for a contrast-enhanced CT scan in the morning. Which nursing action is appropriate to include in the client's plan of care?

4 :
What education should the nurse teach a client taking ferrous sulfate?

5 :
The nurse is caring for a client with type 2 diabetes mellitus who has recently started taking glimepiride. Which finding indicates the medication is having the desired effect? Laboratory Reference Ranges: Fasting blood glucose: < 100 mg/dL

6 :
A pediatric client weighing 18 kg has been prescribed amoxicillin 25 mg/kg/day in three divided doses. The available concentration is amoxicillin 250 mg/5 mL. How many mL should the nurse administer dose? Round the answer to the nearest whole number.

7 :
The nurse is educating a client who has been prescribed insulin for type 2 diabetes. Which instruction should the nurse include to help prevent hypoglycemia?
Laboratory Reference Ranges: Blood glucose 70-100 mg/dL

8 :
The nurse is assessing a client with suspected adrenocortical insufficiency. Which medication should the nurse anticipate being used for diagnostic testing?

9 :
A new graduate nurse asks their preceptor which chemotherapeutic agents are safe to use during pregnancy? Which response by the preceptor is correct?

10 :
The nurse is caring for a client with chronic kidney disease who is receiving epoetin alfa to treat anemia. Which new assessment finding should the nurse recognize as a potential serious adverse effect of the medication?
Normal Lab Reference Ranges Hemoglobin 11.7-15.5 g/dL

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Exam 4 - Modules 7 and 8

No.

1 : The nurse is assessing a client taking hydrocortisone for Addison's disease. Which question is most appropriate for the nurse to ask to monitor for a common complication of therapy?

2 : The nurse is preparing to administer epoetin alfa to a client with chronic kidney disease and anemia. Which action by the nurse demonstrates correct medication administration?Laboratory Reference Ranges: Hemoglobin 12-15 g/dL

3 : A client taking metformin for type 2 diabetes is scheduled for a contrast-enhanced CT scan in the morning. Which nursing action is appropriate to include in the client's plan of care?

4 : What education should the nurse teach a client taking ferrous sulfate?

5 : The nurse is caring for a client with type 2 diabetes mellitus who has recently started taking glimepiride. Which finding indicates the medication is having the desired effect? Laboratory Reference Ranges: Fasting blood glucose: < 100 mg/dL

6 : A pediatric client weighing 18 kg has been prescribed amoxicillin 25 mg/kg/day in three divided doses. The available concentration is amoxicillin 250 mg/5 mL. How many mL should the nurse administer dose? Round the answer to the nearest whole number.

7 : The nurse is educating a client who has been prescribed insulin for type 2 diabetes. Which instruction should the nurse include to help prevent hypoglycemia?Laboratory Reference Ranges: Blood glucose 70-100 mg/dL

8 : The nurse is assessing a client with suspected adrenocortical insufficiency. Which medication should the nurse anticipate being used for diagnostic testing?

9 : A new graduate nurse asks their preceptor which chemotherapeutic agents are safe to use during pregnancy? Which response by the preceptor is correct?

10 : The nurse is caring for a client with chronic kidney disease who is receiving epoetin alfa to treat anemia. Which new assessment finding should the nurse recognize as a potential serious adverse effect of the medication?Normal Lab Reference Ranges Hemoglobin 11.7-15.5 g/dL

1 :
The nurse is assessing a client taking hydrocortisone for Addison's disease. Which question is most appropriate for the nurse to ask to monitor for a common complication of therapy?

2 :
The nurse is preparing to administer epoetin alfa to a client with chronic kidney disease and anemia. Which action by the nurse demonstrates correct medication administration?
Laboratory Reference Ranges: Hemoglobin 12-15 g/dL

3 :
A client taking metformin for type 2 diabetes is scheduled for a contrast-enhanced CT scan in the morning. Which nursing action is appropriate to include in the client's plan of care?

4 :
What education should the nurse teach a client taking ferrous sulfate?

5 :
The nurse is caring for a client with type 2 diabetes mellitus who has recently started taking glimepiride. Which finding indicates the medication is having the desired effect? Laboratory Reference Ranges: Fasting blood glucose: < 100 mg/dL

6 :
A pediatric client weighing 18 kg has been prescribed amoxicillin 25 mg/kg/day in three divided doses. The available concentration is amoxicillin 250 mg/5 mL. How many mL should the nurse administer dose? Round the answer to the nearest whole number.

7 :
The nurse is educating a client who has been prescribed insulin for type 2 diabetes. Which instruction should the nurse include to help prevent hypoglycemia?
Laboratory Reference Ranges: Blood glucose 70-100 mg/dL

8 :
The nurse is assessing a client with suspected adrenocortical insufficiency. Which medication should the nurse anticipate being used for diagnostic testing?

9 :
A new graduate nurse asks their preceptor which chemotherapeutic agents are safe to use during pregnancy? Which response by the preceptor is correct?

10 :
The nurse is caring for a client with chronic kidney disease who is receiving epoetin alfa to treat anemia. Which new assessment finding should the nurse recognize as a potential serious adverse effect of the medication?
Normal Lab Reference Ranges Hemoglobin 11.7-15.5 g/dL