UWORLD 2024 QUESTION RATIONALES Flashcards

Constipation is an expected long-term side effect of opioid use; clients will not develop tolerance to this side effect. It is important to teach aggressive preventive measures such as defecate when the urge is felt, drink 2-3 L of fluid/day, high-fiber diet, and exercise. Simultaneous use of a stool softener and a stimulant is also recommended. Constipation is a side effect of _____ use.

_____ is a morphine-like opioid medication. Opioid medications bind to opioid receptors in the intestine, which slows peristalsis and increases water absorption, leading to constipation.

The half-life of naloxone (Narcan) is shorter than most narcotics. When naloxone is used to reverse the effects of narcotics, the nurse must monitor the client to ensure that the client does not fall again into excessive sedation and/or respiratory depression. The half-life of naloxone is _____ than most narcotics.

NSAIDs can cause myocardial infarction, stroke, and hypertension and can exacerbate heart failure. NSAIDs also decrease the effectiveness of diuretics and antihypertensives. Clients with preexisting cardiovascular disease (eg, hypertension) should avoid ibuprofen or use it cautiously at a low dose and only for a short time. NSAIDs can exacerbate _____ failure.

Nausea and vomiting are expected side effects when opioid pain medications are initiated. However, tolerance develops quickly and persistent nausea is rare. Nausea and vomiting are decreased when the client lies still in a flat position. Anti-emetics may be needed initially. Nausea and vomiting are side effects of _____ medications.

Sedation should be monitored closely following administration of opioids because oversedation can quickly escalate to fatal respiratory depression. Falling asleep in conversation indicates that the client is oversedated. Sedation is a critical side effect of _____ administration.

Long-acting controlled-release opioid drugs for chronic pain require regularly scheduled dosing to maintain a therapeutic drug level. Immediate-release opioids may be required for breakthrough pain. Long-term opioid use leads to tolerance and physical dependence; higher doses are eventually required for therapeutic effect. Long-acting opioids require _____ dosing.

The most serious adverse effect to morphine administration is respiratory depression. Sedation precedes respiratory depression; therefore, the nurse should monitor the client's level of consciousness and notify the health care provider if the client becomes sedated. The most serious adverse effect of morphine is _____ depression.

The topical analgesic capsaicin relieves minor peripheral pain (eg, osteoarthritis, neuralgia) with regular use. Local irritation (burning, stinging, erythema) is quite common. The client should wait at least 30 minutes before washing the affected area to ensure adequate absorption. Capsaicin is used to relieve _____ pain.

Orthostatic hypotension occurs when the compensatory mechanism fails due to autonomic dysfunction, volume depletion, or cardiac pump failures, increasing the client's risk for falls. If the client experiences dizziness when standing, the nurse should assist the client to a sitting position to prevent the client from falling. Orthostatic hypotension increases the risk of _____.

When providing care for a client prescribed patient-controlled analgesia (PCA), the nurse should assess pain on a regular and as-needed basis. The nurse should also reinforce previous teaching and evaluate the client's knowledge regarding proper PCA pump use. The nurse should regularly assess _____ in PCA use.

NSAIDs (eg, ibuprofen, naproxen) are nephrotoxic and should be avoided in clients with chronic kidney disease. NSAIDs are _____ and should be avoided in chronic kidney disease.

Factors that increase risk for opioid-related respiratory depression include advanced age, underlying pulmonary disease, recent surgery, concurrent use of other sedating medications, history of smoking, obesity, opiate-naive status, and snoring/sleep apnea. Advanced age increases the risk of _____ depression with opioids.

Opioid analgesics are effective for managing postoperative pain, which encourages participation in deep breathing exercises. When administering an opioid analgesic, the nurse should assist with ambulation, administer stool softeners to prevent constipation, and monitor the client's respiratory status. Opioid analgesics help manage _____ pain.

All NSAIDs (eg, indomethacin, ibuprofen, naproxen) are associated with gastrointestinal toxicity, kidney injury, exacerbation of fluid overload/hypertension, and bleeding risk. They should be used at the lowest dose and for the shortest period possible. NSAIDs are associated with _____ toxicity.

If a client is experiencing oversedation from opioids, the nurse should immediately administer naloxone, assess the client's respiratory rate, continue to stimulate the client, and notify the health care provider. In case of opioid oversedation, the nurse should administer _____.

Maintenance drug therapy after a pulmonary embolus typically includes administration of oral anticoagulants such as factor Xa inhibitors (eg, apixaban). NSAIDs (eg, indomethacin) increase the risk of bleeding when used concurrently with apixaban therapy. The nurse should question initiation of apixaban therapy in the context of NSAID use. Apixaban is a type of _____ inhibitor.

Ventricular septal defect (VSD) is an opening between the ventricles, which results in shunting of oxygenated blood from the left to right ventricle and can lead to heart failure. Grunting during feeding in clients with a VSD is indicative of cardiac compromise and decreased oxygenation. VSD involves an opening between the _____.

Elevated CVP can indicate fluid volume overload. The nurse should recognize clinical signs such as crackles in lungs, jugular venous distension, and peripheral edema as evidence of fluid volume overload. Elevated CVP indicates _____ overload.

Hypercyanotic, or 'tet,' spells usually occur during stressful or painful procedures and with hunger, crying, and feeding. Providing a calm environment, reducing hunger with small meals, keeping the infant warm, and preventing periods of excessive crying can help prevent hypercyanotic episodes. Hypercyanotic spells occur during _____ procedures.

ACE inhibitors (eg, captopril, enalapril, lisinopril) have a low incidence of serious adverse effects except for angioedema, which causes rapid swelling of the lips, tongue, throat, face, and larynx and should be immediately reported to the health care provider. More common adverse effects of ACE inhibitors include dry cough, orthostatic hypotension, and hyperkalemia. ACE inhibitors can cause _____, a serious adverse effect.

Clonidine is a very potent antihypertensive medication. Abrupt discontinuation of the medication can result in serious rebound hypertension; therefore, clonidine should be tapered over 2-4 days for client safety. Common side effects of clonidine include dizziness, drowsiness, and dry mouth. Clonidine is a potent _____ medication.

The nurse should teach the client that incisional pain from thoracotomy incisions between the ribs may be very painful after MIDCAB surgery. The nurse should encourage the client to take pain medication before the pain is too intense. The client should also be instructed to cough, breathe deeply while splinting the chest with a pillow, and use the incentive spirometer routinely to reduce the incidence of postop complications. Pain from thoracotomy incisions is _____ after MIDCAB surgery.

Findings concerning for impaired perfusion (eg, peripheral artery disease) include skin temperature cool to touch, decreased palpable lower extremity pulses, and delayed capillary refill. These findings require immediate follow-up to prevent further disease progression. Impaired perfusion is indicated by _____ skin temperature.

Chronic venous insufficiency occurs when incompetent valves in the lower extremities cannot prevent the backflow of blood, which leads to edema and pain that improves with elevation (due to increased venous return). Peripheral artery disease (PAD) refers to a narrowing of the arteries, resulting in decreased perfusion. Clinical manifestations of PAD include decreased leg hair, decreased peripheral pulses, and skin temperature cool to touch. Chronic venous insufficiency leads to _____ and pain.

Peripheral artery disease (PAD) is characterized by impaired perfusion, particularly to the lower extremities. Without intervention (eg, lifestyle changes, surgical revascularization), PAD progressively worsens, and clients can develop ischemic pain at rest, nonhealing ulcers, gangrene, and tissue necrosis. PAD is characterized by impaired _____ to the lower extremities.

Management of peripheral artery disease is aimed at cardiovascular risk factor modification and treatment of claudication symptoms. Expected interventions include antihypertensive, lipid-lowering, and antiplatelet medications; hyperglycemia monitoring and treatment; and gradual increase in exercise to promote collateral circulation and distal tissue perfusion. Management of PAD includes _____ risk factor modification.

Home management of peripheral artery disease (PAD) focuses on symptom management and lifestyle modifications to prevent worsening PAD, such as incorporating more fruits and vegetables into the diet; inspecting the feet daily for wounds; and exercising regularly with light physical activity, stopping if ischemic pain develops, and gradually increasing intensity. Home management of PAD focuses on _____ modifications.

Varenicline is a partial nicotine agonist that is a smoking cessation aid. Clients taking varenicline should be taught that smoking cigarettes is permissible while on the medication, sleep disturbances may occur, significant changes in behavior or mood should be reported to the health care provider, and varenicline can be combined with other forms of nicotine replacement if needed. Varenicline is a _____ agonist.

Clients with hypertension should be instructed not to take potentially high-risk over-the-counter medications, including high-sodium antacids, appetite suppressants, and cold and sinus preparations, as they can increase blood pressure. Clients with hypertension should avoid high-sodium _____ preparations.

To measure orthostatic BP, the nurse should have the client lie supine for 5-10 minutes and then measure BP and HR. The nurse should then have the client stand for 1 minute, measure BP and HR, and repeat the measurements at 3 minutes. Findings are significant if the systolic BP drops ≥20 mm Hg or the diastolic BP drops ≥10 mm Hg. Orthostatic BP measurement involves checking BP and HR in _____ positions.

When a client taking a diuretic experiences constipation, the nurse must consider the reason for taking the diuretic before offering a recommendation. Increased fluid intake is usually contraindicated in clients with a history of heart failure. The nurse must consider the _____ for taking a diuretic.

Hypertensive crisis is a life-threatening elevation in blood pressure (systolic ≥180 mm Hg and/or diastolic ≥120 mm Hg) that may cause end-organ damage (eg, stroke, kidney injury, heart failure, papilledema). The client's level of consciousness should be monitored, as a decreased level may indicate onset of hemorrhagic stroke. Hypertensive crisis involves a life-threatening elevation in _____ pressure.

If a client is prescribed clopidogrel, the nurse should be concerned about a history of peptic ulcer disease and Ginkgo biloba use. In this situation, the client would be at increased risk for bleeding. This data should be reported to the prescribing health care provider before the client is discharged. Clopidogrel use with Ginkgo biloba increases the risk of _____.

Insertion of central venous access devices in the femoral vein should be avoided if possible due to the high risk for central line-associated bloodstream infections. The femoral vein is a high-risk site for _____ infections.

Metabolic alkalosis is identified by a pH >7.45 with an increased HCO3− and normal (or increased if compensated) PaCO2. Severe vomiting is a common cause due to loss of gastric acid. The nurse should administer an antiemetic and IV fluids. Metabolic alkalosis is identified by a pH greater than _____.

Older adults have an increased risk for dehydration (ie, loss of body fluid) due to reduced thirst response, difficulty obtaining fluids (eg, impaired mobility), and decreased muscle mass (leading to less free water). Clinical manifestations include dry mucous membranes, poor skin turgor, decreased urine output, decreased blood pressure, tachycardia, increased hematocrit, increased urine specific gravity, and increased BUN. Older adults are at increased risk for _____ due to reduced thirst response.

Hypokalemia (serum potassium <3.5 mEq/L [3.5 mmol/L]) is a complication of diuretic therapy with thiazide or loop diuretics (eg, furosemide). Symptoms depend on the severity of the imbalance but can include weakness, fatigue, and muscle cramps. Flaccid paralysis, hyporeflexia, and cardiac dysrhythmias may occur with severe hypokalemia (serum potassium <2.5 mEq/L [2.5 mmol/L]). Hypokalemia is a complication of _____ therapy.

A sucking chest wound indicates a traumatic, or 'open,' pneumothorax and is a medical emergency. Respiratory distress results from inability to expand the lung. The priority action is to apply a sterile occlusive dressing (eg, petroleum gauze) taped on three sides. A sucking chest wound indicates a traumatic _____ and is a medical emergency.

Interventions to help prevent recurrent UTIs in sexually active female clients include avoiding use of feminine perineal products, vaginal douches, and spermicidal contraceptive jelly. Protective factors include wearing cotton underwear, increasing water intake, and voiding immediately after sexual intercourse. To prevent recurrent UTIs, avoid using _____ products.

Symptoms of ovarian cancer are often subtle, and the condition is often not discovered until an advanced stage due to a lack of routine screening guidelines. Clients may present with bloating, early satiety, urinary symptoms (pressure on the bladder), and pelvic pressure. Ovarian cancer symptoms are often _____ and discovered late.

Chronic kidney disease (CKD) is an irreversible condition characterized by a progressive decrease in kidney function that results in decreased glomerular filtration rate. Manifestations of worsening CKD include a persistent metallic taste in the mouth, difficulty with memory and concentration, bilateral crackles in the lungs, loss of appetite, and decreased urine production. CKD is characterized by a progressive decrease in _____ function.

In clients with chronic kidney disease, glomerular filtration rate and serum calcium levels are expected to decrease while creatinine, blood urea nitrogen, and potassium levels are expected to increase. In CKD, glomerular filtration rate is expected to _____.

Dialysis is usually initiated in the later stages of chronic kidney disease when uremia is no longer controlled by medications. Dialysis mimics the function of the kidneys by using a semipermeable membrane to filter blood and remove excess fluid, electrolytes, and waste products (eg, urea). Dialysis is initiated when uremia is no longer controlled by _____.

An arteriovenous fistula (AVF) is formed when an artery and vein are surgically connected to provide long-term vascular access for hemodialysis therapy. Expected interventions for clients receiving hemodialysis include weighing the client before and after dialysis, assessing distal pulses before accessing the AVF, and applying a pressure dressing to the AVF site after the hemodialysis access is removed. An AVF is formed by connecting an artery and a _____ for hemodialysis.

Numbness or tingling in an extremity distal to an arteriovenous fistula is indicative of impaired circulation. The nurse should assess for signs of dialysis access steal syndrome (eg, pain, numbness, tingling) which can result in ischemia if left untreated. Numbness distal to an AVF indicates impaired _____.

Lifestyle management for clients with chronic kidney disease (CKD) includes chewing gum and sucking on hard candy to manage thirst; reducing sodium intake to decrease fluid retention; and receiving erythropoietin-stimulating agents to treat anemia. Genetically related siblings are more likely to be a match for kidney donation and transplant. CKD management includes reducing _____ intake.

Angina pectoris is chest pain caused by myocardial ischemia. Any factor that increases oxygen demand or decreases oxygen supply may deprive the myocardium of necessary oxygen needed to function effectively. Angina pectoris is caused by myocardial _____.

A sucking chest wound indicates a traumatic, or 'open,' pneumothorax and is a medical emergency. Respiratory distress results from inability to expand the lung. The priority action is to apply a sterile occlusive dressing (eg, petroleum gauze) taped on three sides. A sucking chest wound indicates a traumatic _____ and is a medical emergency.

Following a molar pregnancy, the nurse should instruct the client to avoid pregnancy during follow-up care while the health care provider monitors human chorionic gonadotropin levels to ensure that gestational trophoblastic neoplasia (eg, choriocarcinoma) does not develop. After a molar pregnancy, avoid _____ during follow-up.

Diabetic ketoacidosis (DKA) is characterized by hyperglycemia (blood glucose usually >250 mg/dL [13.9 mmol/L]), metabolic acidosis (pH <7.35 and HCO3⁻ <21 mEq/L [21 mmol/L]), and ketosis. In clients with DKA, the lungs compensate (ie, increase the pH) with deep, rapid respirations (Kussmaul respirations) to 'blow off' carbon dioxide. DKA is characterized by _____ and metabolic acidosis.

Rather than avoid vitamin K-rich foods, the client should keep vitamin K intake consistent. Sudden increases or decreases in the consumption of vitamin K-rich foods could inversely alter the effectiveness of warfarin. Keep vitamin K intake _____ when on warfarin.

Tachycardia (heart rate >100/min) is a finding that occurs secondary to many different underlying causes (eg, pain, dehydration, hyperthyroidism, anxiety). Although clients may be able to temporarily tolerate an elevated heart rate without side effects (eg, dizziness, lightheadedness), a prolonged or significantly elevated heart rate reduces cardiac output and increases myocardial oxygen demand, straining the cardiac muscle. Tachycardia occurs secondary to various _____ causes.

Hyperthyroidism and hypothyroidism are both conditions associated with an imbalance of circulating thyroid hormone (T3 and T4) levels. Hyperthyroidism results in a hypermetabolic state that may cause tachycardia, heat intolerance, hand tremors, and exophthalmos. Hypothyroidism results in a hypometabolic state that may cause constipation and weight gain. Thyroid conditions are associated with an imbalance of _____ hormone levels.

Acute thyrotoxicosis (ie, thyroid storm) is a potentially life-threatening complication of hyperthyroidism characterized by severe hypermetabolic symptoms (eg, unstable tachycardia, shock, hyperthermia, seizures, confusion, coma). Acute thyrotoxicosis can be triggered by an acute event (eg, illness, infection, surgery) or irregular use of antithyroid medications. Thyroid storm is a complication of _____.

Anticipated prescriptions for clients with hyperthyroidism include administering beta-adrenergic blockers (eg, propranolol); initiating a high-calorie diet; performing a pregnancy test (when appropriate); administering an antithyroid medication (eg, methimazole); and administering artificial tears (for exophthalmos). Hyperthyroidism management includes administering _____ blockers.

Following radioactive iodine therapy, clients will emit radiation through bodily fluids (eg, saliva, urine). Appropriate home precautions to reduce radiation exposure to others include avoiding sharing utensils, washing clothes separately, sleeping in a separate bedroom, using a separate bathroom, delaying pregnancy attempts for 4-6 months, and limiting exposure to pregnant women and children for the first week following treatment. After radioactive iodine therapy, radiation is emitted through _____ fluids.

Primary hypothyroidism occurs secondary to the destruction of thyroid gland tissue, which is likely to occur with radioactive iodine therapy. Destruction of thyroid gland tissue results in decreased thyroid hormone (T3 and T4 levels). Because the hypothalamus and anterior pituitary gland remain intact, low T3 and T4 levels will lead to an increase in TSH. Primary hypothyroidism occurs due to destruction of _____ tissue.

Sundown syndrome (sundowning) is characterized by acute behavioral disturbances (eg, wandering, confusion, aggression) experienced by clients with dementia in the late afternoon or evening. When caring for a client experiencing sundowning, the nurse should frequently reorient the client to the time and environment. Sundowning is characterized by behavioral disturbances in the _____.

Following a molar pregnancy, the nurse should instruct the client to avoid pregnancy during follow-up care while the health care provider monitors human chorionic gonadotropin levels to ensure that gestational trophoblastic neoplasia (eg, choriocarcinoma) does not develop. After a molar pregnancy, avoid _____ during follow-up.

UWORLD 2024 QUESTION RATIONALES

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