Gastrointestinal System

19. 1. The suppository should be retained for 1-3 hours if possible to get the maximum benefit of the medication. 2. The client should use caution when using the suppository because it may stain clothing, flooring, painted surfaces, vinyl, enamel, marble, granite, and other surfaces. This statement indicates the client understands the teaching. 3. The medication should be stored at room temperature away from moisture and heat. 4. The client should empty the bowel just before inserting the rectal suppository

19. The client diagnosed with inflammatory bowel disease is prescribed mesalamine (Asacol), an aspirin product, suppositories. Which statement indicates the client understands the medication teaching? 1. "I should retain the suppository for at least 15 minutes." 2. "The suppository may stain my underwear or clothing." 3. "I should store my medication in the refrigerator." 4. "I should have a full rectum when applying the suppository."

2. 1. A medication for a client on call to surgery is a priority; the client's surgery could be delayed if the medication has not been administered when the call to surgery comes. 2. This would be the second medication to administer; this client has a complaint of discomfort. 3. This medication is a routine medication and could be administered at any time. 4. This medication is a routine medication and could be administered at any time.

2. The nurse on a medical unit has received the morning report. Which medication should the nurse administer first? 1. The proton-pump inhibitor pantoprazole (Protonix) to a client on call to surgery. 2. The antacid calcium carbonate (TUMS) to a client complaining of indigestion. 3. The antimicrobial bismuth (Pepto-Bismol) to a client diagnosed with an ulcer. 4. The H2 blocker famotidine (Pepcid) to a client diagnosed with GERD.

25. 1. H. pylori is a bacterial infection. Zantac is not an antibiotic and would not prevent an infection. 2. In this situation, Zantac or a proton-pump inhibitor would be administered to all clients, not just those with a history of ulcer disease. 3. Because of the fluid shifts that occur as a result of severe burn injuries, the blood supply to the gastrointestinal tract is diminished while the stress placed on the body increases the gastric acid secretion, leading to gastric ulcers, a condition called Curling's ulcer. Zantac would be administered to decrease the production of gastric acid. 4. The nurse should request an H2 receptor blocker or a proton-pump inhibitor if one is not ordered; the nurse would not question the order.

25. The intensive care nurse is preparing to administer the H2 receptor blocker ranitidine (Zantac) IVPB to a client with severe burns. Which statement is the scientific rationale for administering this medication? 1. Zantac will prevent an H. pylori infection. 2. The client has a history of ulcer disease. 3. It is for prophylaxis to prevent Curling's ulcer. 4. There is no rationale; the nurse should question the order.

3. 1. Antacids, not proton-pump inhibitors, neutralize gastric secretions. 2. Histamine2 blockers block receptors on the parietal cells. 3. Proton-pump inhibitors inhibit the enzyme that generates gastric acid. 4. Mucosal barrier agents form a protective barrier against acid and pepsin.

3. Which statement is the scientific rationale for administering a proton-pump inhibitor (PPI) to a client diagnosed with gastrointestinal reflux disease (GERD)? 1. PPI medications neutralize the gastric secretions. 2. PPI medications block H2 receptors on the parietal cells. 3. PPI medications inhibit the enzyme that generates gastric acid. 4. PPI medications form a protective barrier against acid and pepsin.

38. 1. When docusate and certain herbs, such as senna, cascara, rhubarb, or aloe, are taken simultaneously, it will increase their absorption and the risk of liver toxicity. The nurse should tell the client to stop taking the herb. 2. The herb will not help the diverticulitis and could cause complications. 3. The nurse cannot talk to the client's daughter because of HIPAA regulations. 4. The nurse can discuss herbs and prescribed medications with the client; there is no specific reason for the client to notify the HCP. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the herb will interact with the conventional medicine or in any way possibly cause harm to the client. The nurse should always be the client's advocate

38. The elderly female client with diverticulosis is taking docusate calcium (Surfak), a stool softener, daily. The client tells the clinic nurse that her daughter has her taking the herb cascara every day. Which intervention should the nurse implement? 1. Instruct the client to quit taking the herb immediately. 2. Explain that the herb will help the diverticulosis. 3. Tell the client to have her daughter call the nurse. 4. Advise the client to inform her health-care provider.

1. 1. There are several classifications of medications used to treat acid reflux problems. Sometimes losing weight will help relieve symptoms, but the client did not ask about lifestyle modifications. 2. Proton-pump inhibitors, histamine2 blockers, and antacids all treat the symptoms of acid reflux. The nurse should encourage the client to discuss which medication is best with the HCP. 3. The symptoms do not indicate cancer. The nurse should not scare the client. 4. Acid reflux can lead to complications, including adult-onset asthma, that should be treated, but most HCPs will empirically treat the symptoms of acid reflux before ordering tests to determine the cause or possible complications.

1. The client complaining of "acid" when lying down at night asks the nurse if there is any medication that might help. Which statement is the nurse's best response? 1. "There are no medications to treat this problem, but losing weight will sometimes help the symptoms." 2. "There are several over-the-counter and prescription medications available to treat this. You should discuss this with the HCP." 3. "Have you had any x-rays or other tests to determine if you have cancer or some other serious illness?" 4. "Acid reflux at night can lead to serious complications. You need to have tests done to determine the cause."

10. 1. Up to 90% of adult-onset asthma is the result of gastroesophageal reflux disease (GERD). Treating the gastric reflux will treat the asthma. 2. The client is diagnosed with asthma, not an infection. There is no reason to administer an antibiotic. 3. Antihistamines such as Claritin are used to treat allergic reactions to pollens, dust, or other irritating substances. They are not effective against asthma. 4. Glucocorticoids are prescribed daily for clients with chronic lung diseases, such as emphysema or chronic bronchitis. A client with asthma would not be prescribed a daily steroid.

10. The adult client recently has been diagnosed with asthma. Which medication is recommended to treat this problem? 1. Omeprazole (Prilosec), a proton-pump inhibitor, daily. 2. Amoxicillin (Amoxil), an antibiotic, twice daily. 3. Loratadine (Claritin), an antihistamine, twice daily. 4. Prednisone, a glucocorticoid, daily.

100. 1. The WBC count is elevated, indicating an infection. The surgeon would not have performed an elective surgery if the client had an infection at the time. This indicates the antibiotic is not working. 2. This might indicate that the pain medication is not relieving the client's pain, but it does not provide information about the antibiotic. 3. The sodium level is within normal limits; it does not provide information about the antibiotic. 4. This is normal color of drainage of a nasogastric tube, but it does not provide information about the antibiotic. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

100. The client who had an elective cholecystectomy is receiving a prophylactic antibiotic. Which information indicates the medication is not effective? 1. The client's white blood cell (WBC) count is 18,000. 2. The client refuses to turn, cough, and deep breathe. 3. The client's sodium level is 139 mEq/L. 4. The client's nasogastric tube has green drainage.

101. 1. TPN is high in dextrose, which is glucose; therefore, the client's blood glucose level must be monitored closely. 2. The client may be on sliding-scale regular insulin coverage for the high glucose level. 3. The TPN must be administered via a subclavian line because of the high glucose level. 4. The client would be NPO to put the bowel at rest, which is the rationale for administering the TPN. 5. The TPN must be administered via a subclavian line due to the high glucose level causing a peripheral line to collapse. Dressing changes may be daily, every 3 days, or weekly depending on the dressing and biopatch.

101. The client diagnosed with full thickness burns is prescribed total parental nutrition (TPN). Which interventions should the nurse implement? Select all that apply. 1. Check the client's glucose level. 2. Administer sliding-scale regular insulin. 3. Assess the peripheral intravenous site. 4. Monitor the client's oral fluid intake. 5. Change the subclavian dressing per protocol.

102. 1. The nurse should first check the IV pump that is sounding an alarm, because there is something wrong with the intravenous fluid. Air in the line is a potential life-threatening complication of TPN. 2. The nurse should ensure the next bag of TPN is available when the current bag is empty, but it is not priority over an alarm on the IV pump. 3. The nurse should notify the HCP about an inflamed insertion site, but the nurse should first assess the alarm on the pump to correct a problem immediately. 4. The nurse should monitor the client's serum potassium level, but laboratory results are not priority over an alarm on an intravenous pump.

102. Which intervention should the nurse implement first for the client receiving total parental nutrition (TPN) bag #8? 1. Check the intravenous pump with a sounding alarm. 2. Request TPN bag #9 from the hospital pharmacy. 3. Notify the HCP of the inflamed insertion site. 4. Obtain the client's serum potassium level.

103. 1. The client's blood glucose (BG) is 311; therefore, 4 units is not the appropriate medication. 2. Six units of regular insulin does not cover a blood glucose (BG) level of 311. 3. The HCP order requires 10 units of regular insulin, not 8 units. 4. The client has a BG level of 311 per the client's chart. This requires 10 units of regular insulin.

103. The client is receiving TPN bag #4 via a right subclavian line. Which medication should the nurse administer? 1. Administer 4 units of regular insulin. 2. Administer 6 units of regular insulin. 3. Administer 8 units of regular insulin. 4. Administer 10 units of regular insulin.

104. 1. The TPN must be weaned or the client will experience hypoglycemia. 2. The nurse should question the HCP's order because the TPN must be weaned to prevent hypoglycemia, and there is no order to decrease rate just to discontinue the TPN. 3. The nurse cannot decrease the TPN rate without a HCP's order, so the nurse cannot implement this intervention. 4. The nurse cannot discontinue the TPN immediately because the TPN must be weaned to prevent hypoglycemia.

104. The client with inflammatory bowel disease is receiving TPN bag #5 at 73 mL/hr. The HCP writes an order to discontinue the TPN. Which intervention should the nurse implement? 1. Discontinue the TPN after bag #5 has infused. 2. Question the health-care provider's order. 3. Decrease the TPN IV rate to 68 mL/hr. 4. Discontinue the TPN immediately.

105. 1. The client must have the same glucose content as the TPN; the nurse cannot administer D5W because the client will experience hypoglycemia. 2. The client will experience hypoglycemia if the nurse decreases the rate to 30 mL/hr. The rate should be weaned 5 mL/hr when discontinuing TPN. 3. The nurse must ensure the same glucose content will be administered until TPN bag #2 is ready, so this is the most appropriate intervention. 4. The nurse does not need to notify the health-care provider because hanging D10 is appropriate until TPN bag #2 is ready.

105. The client's total parenteral nutrition (TPN) bag #1 has 25 mL in the bag and bag #2 is not on the unit. The client's intravenous (IV) rate is 68 mL/hr. Which intervention should the nurse implement? 1. Administer D5W at 68 mL/hr. 2. Decrease the IV rate to 30 mL/hr. 3. Administer Dextrose 10% at 68 mL/hr. 4. Notify the health-care provider.

106. 1. The UAP can weigh the client since he or she is not assessing, teaching, evaluating, or administering medications. 2. The subclavian dressing change is a sterile procedure and the UAP cannot perform sterile procedures. 3. The client receiving TPN should be NPO; therefore, the nurse should not delegate this to the UAP. 4. The nurse cannot delegate assessment to the UAP.

106. The nurse and unlicensed assistive personnel (UAP) are caring for the client receiving total parental nutrition (TPN) at 70 mL/hr. Which task is most appropriate for the nurse to delegate to the UAP? 1. Instruct the UAP to weigh the client. 2. Ask the UAP to change the subclavian dressing. 3. Tell the UAP to assist the client with feeding. 4. Request the UAP to assess the client's bowel sounds.

107. 1. The TPN should be kept in the refrigerator until 1 hour before administering to client, but this is not the first intervention the nurse should implement. 2. The nurse should first check the TPN bag #4 label with the HCP's order to ensure the prescription is correct. Each TPN bag may have amounts of dextrose, amino acids, lipids, and potassium. TPN should be treated as a medication. 3. The nurse must use new tubing with every bag, but this is not the first intervention. The bag should be spiked just before hanging TPN bag #4. 4. The client's glucose level is checked every 6 hours around the clock, not prior to administering the TPN bag.

107. The client is receiving TPN bag #3 and TPN bag #4 is brought to the unit by the pharmacy technician. Which intervention should the nurse implement first? 1. Place the TPN bag in the refrigerator. 2. Check the TPN bag #4 with the HCP's order. 3. Place new IV tubing on the TPN bag. 4. Obtain client's glucose level prior to hanging.

108. 62 mL/hr. The nurse should decrease the rate by 5 mL every hour. In 3 hours it should be decreased by 15 mL. The nurse should subtract 15 mL from 77 mL to get 62 mL.

108. The health-care provider writes an order to decrease TPN rate by 5 mL every hour while discontinuing TPN. The current rate is 77 mL/hr. What rate should the nurse set 3 hours after transcribing the order?

109. 1. The client's potassium level is high and needs immediate intervention since this could cause cardiac problems. Normal is 3.5-5.5 mEq/L. 2. The normal serum sodium level is 135-145 mEq/L so the nurse does not need to notify the HCP. 3. This glucose level is elevated (normal would be 70-120 mg/dL), but the nurse has a sliding-scale insulin to cover this glucose level. The HCP does not need to be notified. 4. The normal serum total protein level is 6.4-8.3 g/dL; therefore, the nurse does not need to notify the HCP.

109. Which laboratory data requires the nurse to notify the health-care provider? 1. The serum potassium level is 6.2 mEq/mL. 2. The serum sodium level is 145 mEq/mL. 3. The serum glucose level is 252 mg/dL. 4. The serum total protein level is 7.2 g/dL.

11. 1. The client should notify the health-care provider if undissolved tablets or capsules are found in the stool because this is not expected. 2. This medication can be taken with or without food; food does not affect the effectiveness of the medication. 3. There are no restrictions on foods, beverages, or activities when taking this medication unless the health-care provider directs otherwise. 4. The tablets must be swallowed whole because they are specially formulated to release the medication after it has passed through the stomach.

11. The client diagnosed with ulcerative colitis is prescribed mesalamine (Asacol), an aspirin product. Which information should the nurse discuss with the client? 1. Explain to the client that undissolved tablets may be expelled in stool. 2. Discuss the importance of taking the medication on an empty stomach only. 3. Tell the client to avoid drinking any type of carbonated beverages. 4. Instruct the client not to crush, break, or chew the tablets or capsules.

110. 1. The client with IBD needs to rest the bowel; therefore, the client should not eat any food while on TPN. This statement indicates the client understands the teaching. 2. The client with IBD must rest the bowel, which means no food or fluids; therefore, the client needs more teaching. 3. The client's blood glucose must be checked every 6 hours, which indicates the client understands the teaching. 4. The client can ambulate; therefore, the client understands the client teaching.

110. Which statement indicates the client diagnosed with inflammatory bowel disease (IBD) receiving total parental nutrition (TPN) needs more teaching? 1. "I should not eat any food while receiving TPN." 2. "I can drink 1000 mL of water a day but no other fluids." 3. "I must have my blood glucose checked every 6 hours." 4. "I can walk in the hallways while receiving TPN."

111. 1. The client's MAR designated ketorolac and a medication she is allergic to. The nurse would have to know that the client is not allergic to the medication prior to administering it. 2. Only the client should administer the medication via the PCA pump for safety to prevent overdosing the client. 3. The nurse should determine the patency of the IV and functioning of the pump before calling the surgeon. 4. The client is receiving a narcotic analgesic that she can control herself. According to the MAR she has been able to receive medication during the last shift. The first intervention for the nurse is to determine if the IV is patent and the pump is working. MEDICATION MEMORY JOGGER: A PCA pump is client controlled and the nurse should not call the HCP if the nurse can determine the cause of a problem and intervene to resolve it.

111. At 1030 the female client 1 day postoperative for an open cholecystectomy notifies the unit secretary that she is in severe pain. After ruling out complications, which intervention should the 0701-1500 nurse implement first? 1. Administer the ketorolac, a nonsteroidal anti-inflammatory drug, IV. 2. Push the patient-controlled analgesia (PCA) button and administer the hydromorphone, an opioid analgesic. 3. Notify the surgeon that the client is not receiving relief from the PCA pump medication. 4. Check the PCA and IV tubing to make sure that medication is being delivered.

112. 1. Pain medication is rarely administered intramuscularly anymore, because of the pain the client has with another needle, the development of indurated tissue from repeated injections, and a longer length of time for injected medication to become effective. Most parenteral pain medication is administered via IV. 2. The nurse should check the client's MAR for the last administration time to be sure not to administer the medication too early, increasing the risk of respiratory depression. 3. The Joint Commission standards for medication administration require that two client-specific identifiers be used prior to administration of any medication. 4. Narcotic opioids can cause respiratory depression, so the nurse should assess the respiratory status prior to administering the medication. The pancreas is in the abdominal cavity so the rule out a complication that a narcotic would mask. 5. The amylase is monitored for a client diagnosed with pancreatitis, but not to administer pain medication. MEDICATION MEMO JOGGER: "Select all that apply" questions require the test taker to view each option as a true/false question. One option cannot assist the test taker to eliminate another option.

112. The nurse on a medical floor is caring for a 42-year-old client diagnosed with acute exacerbation of pancreatitis. The client requests a pain medication for pain rated an 8 on a scale of 1-10. Which interventions should the nurse implement? Select all that apply. 1. Administer the pain medication intramuscularly only to prevent addiction. 2. Check the MAR to determine when the last pain medication was administered. 3. Check two client identifiers prior to administering the prescribed pain medication. 4. Assess the client's respiratory and abdomen status. 5. Check the client's amylase level on the chart

113. 2, 3, 5, 4, 1 2. The nurse cannot administer a medication he or she does not have. The first in this list is to obtain the medication. 3. Prior to administering any medication the nurse should assess for allergies. 5. The nurse can administer the medication after assessing for complications and rating pain, assessing for allergies, and identifying the client with two client-specific identifiers. 4. As soon as a medication is administered the nurse should document the administration. This is now considered the sixth Right of Medication Administration. 1. The client should be evaluated for effectiveness of the intervention, but the other interventions come first.

113. The nurse is preparing to administer pain medication to a client complaining of left lower quadrant pain. Which interventions should the nurse implement? Rank in order of performance. 1. Evaluate the client's pain level for medication effectiveness. 2. Remove the medication from the narcotics cabinet (PIXYS). 3. Ask the client about allergies to medications. 4. Document the administration on the client's MAR. 5. Administer the medication to the client.

114. 1. Evaluation comes after the medication has some time to take effect. 2. Identifying the client comes before administration of a medication, not after. 3. The medication should be documented immediately after administration. Documentation is the sixth Right of Medication Administration. 4. The nurse should assess the respiratory status before administration.

114. The nurse has administered a narcotic pain medication to a postoperative client. Which is the next intervention to implement? 1. Evaluate the client's pain 30 minutes after administration. 2. Identify the client using two client-specific identifiers. 3. Document the administration on the MAR and in the client's chart. 4. Count the client's respirations per minute.

115. 1. The medication should be administered through the lowest port, not the highest. This allows for the medication to enter the client's body faster and not be lost in the tubing if the tubing comes apart. 2. Narcotic analgesics should be administered over 5 minutes so the nurse can observe for drowsiness, lethargy, and respiratory depression, and stop the administration before a full dose is administered. 3. The client's arm should be elevated after an IVP is done when the client is in a code to assist the medication to enter the body and be circulated throughout the system. It is not needed in a nonemergency situation. 4. The client should not be asked to refrain from coughing since he or she is at risk for developing atelectasis.

115. The nurse is administering morphine sulfate 2 mg IVP to a client who has had an open cholecystectomy. Which intervention should the nurse implement? 1. Administer at the port highest up on the tubing. 2. Administer by slow IVP over 5 minutes. 3. Elevate the client's arm after administration. 4. Ask the client to refrain from coughing.

116. 1. The client may go to surgery, and will need to sign a legal document, the operative permit, before doing so. The nurse should not administer a narcotic before asking the client to sign a legal document. 2. Whether or not the HCP writes an order for pain medication, there is still the possibility that the client will need clear thought processes to sign a legal document. 3. This is the correct statement at this time. The nurse must know about the status of the surgery prior to administering a narcotic. 4. This is a therapeutic statement, and the client needs factual information.

116. The emergency department nurse is caring for a 28-year-old client with R/O appendicitis. The client is still undergoing tests to determine if surgery is required, but asks for pain medication "NOW!" Which is the nurse's best response? 1. "I will get the medication for you now." 2. "Your doctor will have to order some medication and then I will give it." 3. "I cannot give you narcotic pain medication until a decision is made about surgery." 4. "You seem anxious; tell me about your pain."

117. 1. A pain level of 4 is considered mild pain and the nurse should see if a less potent medication is available. 2. Hydrocodone is an oral medication. This client should be NPO. The nurse should check to see if a parental medication is available. 3. Tylenol is for mild pain, so this is not the first priority. 4. This client is thrashing in bed, presumably from pain. Continued movement such as "thrashing" could cause other problems such as wound tearing. This medication has priority.

117. The nurse on a medical/surgical unit has received the shift report. Which medication should the nurse administer first? 1. Morphine sulphate, a opioid analgesic, to a postoperative exploratory laparotomy client with a pain level of 4. 2. Hydrocodone (Vicodin), a narcotic analgesic, to a preoperative client going for a splenectomy. 3. Acetaminophen (Tylenol) to a client with abdominal pain who now has a headache. 4. Nalbuphine (Nubain), a narcotic analgesic, to a client just returning from a lap appendectomy who is thrashing in bed.

118. 1. The medication can be administered without question. 2. Demerol metabolizes into normeperidine in the body and can accumulate, causing seizures. Since children are especially vulnerable, the nurse should question the order and obtain a suitable medication. 3. This pain level is moderately high, so morphine is a good medication for this pain. 4. Dilaudid is a potent narcotic analgesic and would be appropriate for a level 10 pain.

118. The nurse is administering medications on a medical/surgical unit. Which medication should the nurse question administering? 1. Tylenol #3, a narcotic analgesic, to a 17-year-old client who had an appendectomy 2 days ago. 2. Meperidine (Demerol), an narcotic analgesic, to a 12-year-old who had an exploratory laparotomy. 3. Morphine sulfate, a narcotic analgesic, to a 38-year-old, 2-day postoperative open cholecystectomy client with a pain level of 6. 4. Hydromorphone (Dilaudid), a narcotic analgesic, to a 40-year-old client complaining of severe abdominal pain rated a 10 on a scale of 1-10.

119. 1. The nurse should intervene immediately, not wait until the anesthesiologist can get to the client. 2. Narcan will reverse the effects of an opioid analgesic. This is the first action. 3. This should be implemented after the administration of Narcan since it has a short half-life and the respiratory depression will return in about 20 minutes. 4. The client is still breathing on his own; therefore, this is not necessary at this time.

119. The nurse working in the postanesthesia care unit (PACU) recovering a male client after an exploratory laparotomy administers the prescribed hydromorphone (Dilaudid) IVP. Five minutes later the nurse assesses respiration of 8. Which intervention should the nurse implement first? 1. Ask the anesthesiologist to come and assess the client. 2. Administer naloxone (Narcan), a narcotic antagonist, IVP. 3. Re-assess the client's respiratory status in 20 minutes. 4. Use an ambu bag and ventilate the client.

12. 1. Increasing fluid intake dilutes the drug, which helps to prevent crystalluria (crystals in the urine) from occurring. 2. The medication is administered every 6-8 hours, not once a day. 3. Instruct the client to report any bruising or bleeding because it could be a sign of a drug-induced blood disorder (agranulocytosis). 4. This medication will not cause fat, frothy stools; therefore, the nurse does not need to assess the stool.

12. The client with inflammatory bowel disease is prescribed sulfasalazine (Azulfidine), a sulfonamide antibiotic. Which intervention should the nurse implement when administering this medication? 1. Ensure the client drinks at least 2000 mL of water daily. 2. Administer the medication once a day with breakfast. 3. Explain that the medication may cause slight bruising. 4. Assess the client's stool for steatorrhea and mucus.

120. 1. Percodan is an oral medication and appropriate for mild-to-moderate pain. 2. This medication may not be strong enough for postoperative pain at this level. 3. Morphine is a potent narcotic analgesic and should be given for moderate-tosevere pain. 4. Zofran is for nausea, not pain.

120. The nurse is assessing the pain level of a postoperative abdominal surgery client. The client complains of a "mild" abdominal pain rated a 4 on a scale of 1-10. Which medication should the nurse prepare to administer? 1. Oxycodone (Percodan), a narcotic analgesic, po. 2. Acetaminophen (Tylenol), an analgesic, po. 3. Morphine sulfate, a narcotic analgesic, IVP. 4. Ondansetron (Zofran), a 5-HT3 antagonist, IVP.

121. 1. Diphenoxylate is combined with atropine to form Lomotil. Diphenoxylate is an opioid whose only indication is to treat diarrhea, but atropine is added to discourage narcotic abuse. The client cannot have more than eight doses of Lomotil daily. 2. The nurse should not increase the client's intravenous rate without an HCP's order. 3. The nurse should notify the HCP because the maximum dose of Lomotil is eight doses in 24 hours. 4. Sending a stool specimen will not treat the diarrhea.

121. The client diagnosed with gastroenteritis was admitted to the medical floor yesterday and has just had another loose, watery stool. Based on the following medication administration record (MAR), which action should the nurse implement? 1. Administer a diphenoxylate (Lomotil) tablet. 2. Increase the intravenous fluid rate. 3. Notify the health-care provider. 4. Send a stool specimen to the lab.

122. 1. The client's diet does not have any bearing on the client's heartburn. 2. Pyrosis, or heartburn, could be secon - dary to the client's taking the prednisone on an empty stomach. Prednisone is very irritating to the stomach and must be taken with food to prevent severe heartburn and possible peptic ulcer. 3. A weight change is not significant to the client's complaint of heartburn. 4. The nurse should assess the client's complaint before referring the client to the HCP. If the nurse can give factual information, the nurse should teach the client.

122. The client diagnosed with inflammatory bowel disease (IBD) has been prescribed the oral glucocorticosteroid prednisone daily. The client has pyrosis. Which statement would be the clinic nurse's best response? 1. "What type of diet are you currently following?" 2. "When do you take your prednisone?" 3. "Have you had a change in your weight?" 4. "Have you discussed this with your health-care provider?"

123. 1. Cornstarch works by absorbing excess water in the intestines, thus stopping diarrhea. Therefore, this is the nurse's best response. In children, antidiarrheal medication is not prescribed because of possible adverse reactions. Pedialyte is prescribed to prevent dehydration, and the diarrhea usually subsides on its own. 2. This statement is judgmental, and many home remedies have produced valid results. 3. A client often interprets a "why" question as judgmental, so this is not the best response. 4. This statement has no factual basis, and even if the nurse were not aware of the effectiveness of cornstarch, the nurse should investigate before making the mother worry about her son's condition. MEDICATION MEMORY JOGGER: Some herbal preparations or alternative therapies are effective, some are not, and a few can be harmful or even deadly. If a client is taking a home remedy, the nurse should investigate. The nurse should always be the client's advocate.

123. The African American mother brought her 3-year-old son to the clinic because the child has had diarrhea since last night. The mother tells the nurse, "My mother was giving my son cornstarch in a glass of warm water to help stop the diarrhea, but it didn't stop the diarrhea completely." Which statement is the clinic nurse's best response? 1. "Cornstarch will not hurt your son and we need to let the diarrhea run its course." 2. "You must tell your mother not to give your son anything the doctor has not ordered." 3. "Why does the grandmother think that cornstarch will help your son's diarrhea?" 4. "I hope that the cornstarch has not made your son's diarrhea get worse."

124. 1. A sore throat and mouth sores could indicate that the client is experiencing agranulocytosis, which is a possible adverse effect of Phenergan and should be reported to the HCP. The HCP would have a complete blood cell count (CBC) drawn to evaluate for this adverse effect. 2. Light-amber-colored urine indicates the client is no longer dehydrated and would not warrant notifying the HCP. 3. Nonpharmacological measures of alleviating nausea and vomiting, such as flattened carbonated beverages, weak tea, crackers, and dry toast, should be discussed with the client. Drinking carbonated beverages should be discouraged. 4. The client should not consume alcohol when taking antiemetics because it can intensify the sedative effect. MEDICATION MEMORY JOGGER: Drinking alcohol is always discouraged when taking any prescribed or over-the-counter medi - cation because of adverse interactions. The nurse should encourage the client not to drink alcoholic beverages.

124. The client with gastroenteritis is being discharged from the emergency department with a prescription for promethazine (Phenergan), an antiemetic. Which information should the nurse discuss with the client? 1. Explain that a sore throat and mouth sores are expected side effects. 2. Tell the client to call the doctor if the urine turns light-amber colored. 3. Encourage the client to drink carbonated beverages. 4. Instruct the client not to drink alcohol with the medication.

130. 1. The nurse should monitor the client's serum potassium level, not sodium level, prior to administering the 0900 Lasix. 2. Prilosec interacts with warfarin and may increase the likelihood of bleeding; therefore, the nurse should check the client's INR. 3. Prilosec can be taken on an empty stomach. 4. The client should sit up after eating a meal but not after taking Prilosec.

130. The nurse is administering the 0900 medications on the following Medication Administration Record (MAR). Which action should the nurse take? 1. Monitor the client's serum sodium level. 2. Check the client's International Normalized Ratio (INR). 3. Ensure that the client ate at least 75% of the breakfast meal. 4. Encourage the client to sit upright at least 30 minutes after taking Prilosec

125. 1. Flulike symptoms are expected and should be treated with Tylenol. 2. Abnormal bleeding and bruising are not expected and should be reported to the HCP. 3. The client may be jaundiced from the hepatitis but not from taking the medication. 4. Interferon is naturally produced by the body in response to a viral infection. The administration of synthetic interferon produces the same flulike symptoms and should be treated with Tylenol, which will help decrease the severity of the symptoms from the injection. After multiple interferon injections, the client will no longer have the flulike symptoms. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medication and has flulike symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicates the medication has caused a sudden drop in the white blood cell count, which, in turn, leaves the body defenseless against bacterial invasion. Biological response modifiers are the exception to the rule.

125. The client with hepatitis is being treated with interferon alfa (Roferon), a biological response modifier. Which information should the clinic nurse discuss with the client? 1. Explain that if flulike symptoms occur, the client must stop taking the medication. 2. Discuss that the client may experience some abnormal bruising and bleeding. 3. Tell the client that the skin will become yellow while taking this medication. 4. Recommend taking acetaminophen (Tylenol), two tablets, before the injection.

126. 1. The client with glaucoma should not receive Lomotil because of the drug's anticholinergic effect, which will increase the intraocular pressure. 2. Lomotil is prescribed for adult clients diagnosed with traveler's diarrhea. In children, diarrhea should be allowed to run its course. 3. Lomotil is not contraindicated in clients with coronary artery disease. 4. Antibiotics sometimes cause a suprainfection that kills the normal flora in the bowel, resulting in diarrhea. This client may receive an antidiarrheal medication. MEDICATION MEMORY JOGGER: Glaucoma is a condition that the nurse should recognize. Its presence precludes the use of many medications.

126. Which client should the nurse question administering the antidiarrheal medication diphenoxylate (Lomotil)? 1. The 68-year-old client diagnosed with glaucoma. 2. The 78-year-old client with traveler's diarrhea. 3. The 44-year-old client with coronary artery disease. 4. The 28-year-old client receiving aminoglycoside antibiotics.

127. 1. Zelnorm is prescribed for women with IBS who present with constipation as their primary complaint; it binds to 5HT receptors in the gastrointestinal tract to stimulate peristalsis. A daily bowel movement indicates the medication is effective. 2. Flatus, or "passing gas," is a symptom of IBS and indicates the medication is not effective. 3. Zelnorm is not prescribed for diarrhea, so this response is not applicable. 4. The ability to eat high-fiber foods does not indicate the effectiveness of the medication.

127. The female client is diagnosed with irritable bowel syndrome (IBS). The health-care provider prescribes tegaserod (Zelnorm), a gastrointestinal agent. Which assessment data indicates the medication is effective? 1. The client reports daily bowel movements. 2. The client complains of "passing gas." 3. The client reports a decrease in loose stools. 4. The client is able to eat high-fiber foods.

128. 1. These are the signs or symptoms of IBS. 2. Agitation, confusion, and drowsiness are signs or symptoms of an adverse reaction in the client who is elderly or debilitated that requires discontinuation of the medication. 3. Diarrhea alternating with constipation is a sign of IBS, not an adverse reaction to the medication. 4. Mucus in the stool is a sign of IBS, but low-grade fever is not. However, neither of these indicates an adverse reaction to the medication.

128. The elderly client diagnosed with irritable bowel syndrome (IBS) is prescribed propantheline (Pro-Banthine), an antispasmodic. Which signs or symptoms indicate an adverse reaction to the medication? 1. Flatus, abdominal pain, and cramping. 2. Agitation, confusion, and drowsiness. 3. Diarrhea alternating with constipation. 4. Mucus in the stool and low-grade fever.

129. 1. Taking antacids with other medications is not an acceptable standard of practice. 2. The charge nurse should discuss changing the times of Maalox administration to 1-2 hours before or after taking other drugs because Maalox could affect the absorption of the other drugs. However, this is not the first intervention. 3. The client should not receive any oral medications 1-2 hours before or after taking an antacid because the antacid may interfere with absorption of the other medications. 4. Maalox is a suspension and should be shaken, but this is not the first action the nurse should take.

129. The charge nurse notices that the primary nurse is preparing to administer the antacid Maalox to the client receiving his routine morning medications. Which intervention should the charge nurse take first? 1. Take no action because this is acceptable standard of practice. 2. Discuss changing the administration time with the pharmacist. 3. Inform the primary nurse to not administer the Maalox. 4. Instruct the primary nurse to shake the Maalox container.

13. 1. Azathioprine can cause a decrease in the number of blood cells in the bone marrow (agranulocytosis). Signs or symptoms that would warrant intervention by the nurse include sore throat, fever, chills, unusual bleeding or bruising, pale skin, headache, confusion, tachycardia, insomnia, and shortness of breath. 2. Ten to 20 loose, watery stools a day are characteristic of an acute exacerbation of ulcerative colitis and would not warrant intervention by the nurse secondary to the medication. 3. Abdominal pain and tenderness are characteristic of an acute exacerbation of ulcerative colitis and would not warrant intervention by the nurse secondary to the medication. 4. Dehydration may occur with ulcerative colitis, but it does not warrant intervention by the nurse secondary to the medication. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint or if the nurse's assessment data or laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an indepen - dent intervention or notify the healthcare provider because medications can result in serious or even life-threatening complications.

13. The client diagnosed with severe ulcerative colitis is prescribed azathioprine (Imuran), an immunosuppressant. Which assessment data concerning the medication warrants immediate intervention by the nurse? 1. Complaints of a sore throat, fever, and chills. 2. Reports of 10-20 loose stools a day. 3. Complaints of abdominal pain and tenderness. 4. Reports of dry mouth and oral mucosa.

131. 1. The client would not be NPO at this time because the client will have to drink a gallon of GoLYTELY. There is no reason for the UAP to remove the water pitcher. 2. There is no reason for the client's vital signs to be taken every 2 hours preoperatively. Vital signs are tasks that can be delegated to a UAP. 3. GoLYTELY is a colonic stimulant that is prescribed to cleanse the bowel prior to bowel surgery; therefore, the client should have a bedside commode readily available and the nurse can delegate the UAP to perform this task. 4. The UAP is allowed to apply a moisture barrier to excoriated perianal areas, but nothing in the stem indicates the client has this need.

131. The client is scheduled for a bowel resection in the morning. The nurse administered one bottle of GoLYTELY. Which task is most appropriate for the nurse delegate to the unlicensed assistive personnel (UAP)? 1. Remove the client's water pitcher from the room. 2. Take the client's vital signs every 2 hours. 3. Place a bedside commode in the client's room. 4. Administer moisture barrier cream to the anal area.

132. 1. Lactulose is not administered to help with the client's complaints of itching. 2. Lactulose will not help decrease the client's ascites. 3. Diarrhea is a sign of medication toxicity and would warrant decreasing the medication dose. 4. Lactulose is administered to decrease the client's serum ammonia level; the normal adult level is 19-60 mcg/dL.

132. The client diagnosed with end-stage liver failure is taking lactulose (Chronulac), a laxative. Which assessment data indicates the medication is effective? 1. The client reports a decrease in pruritus. 2. The client's abdominal girth has decreased. 3. The client is experiencing diarrhea. 4. The client's ammonia level is decreased.

133. 1. The primary IV is normal saline; therefore, the nurse does not need to flush the tubing prior to administering the medication. 2. Phenergan is caustic to the peripheral vein and should be diluted when administering intravenously. 3. Phenergan is compatible with normal saline; therefore, the nurse need not start a saline lock in the other arm, causing the patient discomfort. 4. Phenergan is caustic to peripheral veins, is very painful when administered peripherally, and may result in a chemical phlebitis. The nurse must dilute the medication and push slowly to prevent pain and sclerosing of the vein. 5. The nurse must dilute the medication and push slowly to prevent pain and sclerosing of the vein.

133. The client is 2 days post-gastric bypass surgery and is complaining of nausea. The nurse is preparing to administer promethazine (Phenergan) 12.5 mg intravenous push. The client has a peripheral IV line infusing normal saline at 100 mL/hour. Which interventions should the nurse implement? Select all that apply. 1. Flush the peripheral IV prior to administering mediation. 2. Administer the Phenergan undiluted via the port closest to client. 3. Start a saline lock in the other arm to administer Phenergan. 4. Dilute the Phenergan with 9 mL normal saline. 5. Administer the intravenous medication slowly.

134. 1. Maalox should not be administered to a client with chronic kidney disease because it contains magnesium, and diseased kidneys are unable to excrete magnesium, resulting in the client developing hypermagnesemia. If the client needs an antacid, he or she should receive aluminum hydroxide (Amphogel) because it helps remove phosphates. 2. A proton-pump inhibitor decreases gastric secretion and would be prescribed for a client with PUD. 3. A stool softener would be prescribed for a client with diverticulosis to help prevent constipation. 4. A bulk laxative adds substance to the feces and will help decrease watery stools

134. The nurse is administering medications to the following clients. Which medication should the nurse question administering? 1. Maalox, an antacid, to a client diagnosed with chronic kidney disease. 2. Prevacid, a proton-pump inhibitor, to a client diagnosed with ulcer disease. 3. Surfak, a stool softener, to a client diagnosed with diverticulosis. 4. Metamucil, a bulk laxative, to a client diagnosed with diarrhea.

135. 1. A cathartic laxative is a stimulant laxative, and daily use can lead to laxative depen - dence. Elderly clients should be encouraged to use other methods to ensure a daily bowel movement. 2. A bulk laxative is recommended for daily use because it increases fiber and requires the colon to function normally. Stimulant laxatives may cause "laxative dependency," which is not healthy for the client. 3. The client should not be encouraged to take Fleet's enemas unless recommended by an HCP because they may cause dependence. The nurse should encourage the use of medications that require the bowel to function normally. 4. If the client needs to have a bowel movement daily, then a stool softener should be encouraged because it does not stimulate the bowel; it just softens the stool. 5. Increasing the client's water intake will help soften the stool.

135. The home health-care nurse is discussing bowel elimination patterns with an elderly client. The client tells the nurse he must take something to make his bowels move every day. Which information should the nurse discuss with the client? Select all that apply. 1. Tell the client to take a cathartic laxative daily. 2. Encourage the client to take a bulk laxative daily. 3. Demonstrate how to give a Fleet's enema. 4. Instruct the client to take a daily stool softener. 5. Recommend the client drink at least 2000 mL of water a day.

136. 1. This medication is prescribed to help stimulate the client's appetite; therefore, the client does not need more teaching. 2. A side effect of this medication is drowsiness; therefore, the client does not need more teaching. 3. Cannabinoid, the active ingredient in marijuana, is frequently abused as an illegal drug, but it is not addicting. 4. A side effect of this medication is a dry mouth, so chewing sugarless gum indicates the client understands the medication teaching.

136. The client with cancer is not eating and has lost 15 lb in the past month. The healthcare provider has prescribed the cannabinoid dronabinol (Marinol). Which statement indicates the client needs more teaching concerning this medication? 1. "This medication will help stimulate my appetite." 2. "It is not uncommon to get drowsy when taking this medication." 3. "This is marijuana and I do not want to get addicted to it." 4. "I should chew sugarless gum when taking this medication."

137. 1. Enzymes break down food; therefore, they must be administered with food. 2. This medication does not need to be administered with water to be effective. 3. Lactaid is a gastrointestinal enzyme essential for the absorption of lactose from the intestines. It must be taken with food. 4. Vitamin D deficiency results from a lack of milk and milk products in the diet. Lactaid is administered so the client can tolerate milk products, but it does not need to be administered with vitamin D.

137. The client diagnosed with lactose intolerance is prescribed lactase (Lactaid), a digestive enzyme. Which intervention should the nurse implement when administering this medication? 1. Administer the medication on an empty stomach. 2. Administer the medication with a full glass of water. 3. Administer the medication with the client's food. 4. Administer the medication with vitamin D.

138. 1. A stool thickener, such as Lomotil, can be prescribed to thicken the watery ileostomy output, which will decrease the odor. 2. Decreasing odor is the scientific rationale for administering bismuth subcarbonate to a client with an ileostomy. 3. This medication does not affect the pH of the ileostomy output. 4. This medication does not coat the lining of the small intestine.

138. The client with an ileostomy is prescribed bismuth subcarbonate tablets orally four times a day. Which statement best describes the scientific rationale for administering this medication? 1. This medication will help thicken the ileostomy output. 2. This medication will help decrease the odor in the ileostomy pouch. 3. This medication helps to change the pH of the ileostomy output. 4. This medication coats the lining of the small intestine.

139. 1. This medication is being used as an antipruritic; therefore, a decrease in nausea does not indicate the effectiveness of the medication. 2. This medication does not stimulate the appetite; therefore, assessment of the appetite does not determine the effectiveness of the medication. 3. Atarax will cause drowsiness and is not administered to increase the client's cognitive ability. 4. The client in end-stage liver disease often has jaundice, which causes pruritus (itching). A decrease in itching indicates the medication is effective. MEDICATION MEMORY JOGGER: The test taker must note the drug classification to determine the effectiveness of the medication. Many medications are administered for different reasons, which changes their drug classification.

139. The client is diagnosed with end-stage liver disease and is prescribed hydroxyzine (Atarax), an antipruritic. Which assessment data indicates the medication is effective? 1. The client reports a decrease in nausea. 2. The client reports an increase in appetite. 3. The client reports being more alert. 4. The client reports a decrease in itching.

14. 1. TPN is 50% dextrose; therefore, the client's blood glucose level should be checked every 6 hours; sliding-scale regular insulin coverage is usually ordered. 2. TPN should always be administered using an intravenous pump and not via gravity; fluid volume resulting from an overload of TPN could cause a life-threatening hyperglycemic crisis. 3. TPN must be administered via a subclavian line because a peripheral line will collapse as a result of the hyperosmolarity of the TPN and phlebitis may occur. 4. TPN is considered a medication and should be administered as any other medication. 5. The client with severe acute exacerbation of Crohn's is NPO to rest the bowel. When on TPN, the client is usually NPO because the TPN provides all necessary nutrients; therefore, the nurse would not encourage the client to eat food.

14. The client with a severe acute exacerbation of Crohn's disease is prescribed total parenteral nutrition (TPN). Which interventions should the nurse implement when administering TPN? Select all that apply. 1. Monitor the client's glucose level every 6 hours. 2. Administer the TPN on an intravenous pump. 3. Assess the peripheral intravenous site every 4 hours. 4. Check the TPN according to the five rights prior to administering. 5. Encourage the client to eat all of the food offered at meals.

140. 1. The Transderm Scop patch is applied behind the ears. 2. The patch can be left on for up to 3 days before changing, but it should not be alternated on and off. 3. The client should not wear two patches at one time because of the anticholinergic effect of the medication. 4. The patch is effective up to 3 days; therefore, this indicates the client understands the medication teaching. 5. Transderm should indicate to the nurse the medication is a patch not a pill to be taken with water

140. The female client tells the clinic nurse that she gets carsick every time the family goes on a vacation and the health-care provider prescribed the anticholinergic scopolamine (Transderm Scop). Which statement indicates the client understands the medication teaching? Select all that apply. 1. "I will put the Transderm Scop patch behind my ear." 2. "I will put the patch on for 12 hours and take it off at night." 3. "If my carsickness does not go away, I will wear two patches." 4. "I should leave the patch on for 3 days before changing it." 5. "I should take the medication with one glass of water."

15. 1. The client should not quit taking the medication abruptly because that would result in an acute exacerbation of the inflammatory bowel disease. 2. A PPI will not help treat these symptoms. 3. These are side effects of the medication, and the HCP should be notified, but the client should not stop taking the medication. 4. These symptoms will not resolve with time and should be reported to the HCP.

15. The client diagnosed with inflammatory bowel disease taking mesalamine (Asacol), an aspirin product, has complaints of nausea, vomiting, and diarrhea. Which intervention should the clinic nurse take? 1. Instruct the client to quit taking the medication immediately. 2. Tell the client to take Prevacid, a proton-pump inhibitor, with the medication. 3. Advise the client to keep taking the medication, but notify the HCP. 4. Explain that these symptoms are expected and will resolve with time.

16. 1. The client should not take an antacid with this medication because it will decrease the absorption rate of the medication. 2. Any type of rash should be considered a possible allergic reaction and should be reported to the health-care provider immediately. 3. The client should drink several quarts of water a day to prevent the formation of crystals in the urine, but a strict record of urinary output is not required or needed. 4. The client should avoid direct sunlight, use sunblock, and wear protective clothing to decrease the risk of photosensitivity reactions to the medication.

16. Which statement indicates to the nurse the client with Crohn's disease understands the medication teaching concerning sulfasalazine (Azulfidine), a sulfonamide antibiotic? 1. "I will take an antacid 30 minutes before taking my medication." 2. "I may get a slight red rash when taking this medication." 3. "I need to keep a strict record of my urinary output." 4. "I should avoid direct sunlight and use sunblock when outside."

17. 1. TPN must be tapered off because of its high glucose content; if TPN is not tapered, the client may experience hypoglycemia. Therefore, the nurse should call the HCP to request an order to taper the TPN. 2. TPN must be tapered; therefore, the nurse should not discontinue the TPN abruptly. 3. If the nurse is not going to implement the order as written, the nurse should notify the HCP immediately and not wait for the HCP to make rounds. TPN is a medication and the client should not be taking it any longer than necessary. 4. The pharmacist cannot change a health-care provider's order; therefore, there is no reason for the nurse to talk to the pharmacist.

17. The client with inflammatory bowel disease has been on hyperalimentation, total parenteral nutrition (TPN), for 2 weeks. The HCP has written orders to discontinue TPN. Which intervention should the nurse implement? 1. Notify the health-care provider and question the order. 2. Discontinue the TPN and flush the subclavian port. 3. Do not implement the order and talk to the HCP on rounds. 4. Discuss the order with the pharmacist before discontinuing.

18. 1. There is no indication that sulfasalazine is hepatotoxic; therefore, liver function tests do not need to be monitored when administering this medication. 2. The serum potassium level is not affected by sulfasalazine; therefore, the nurse does not need to monitor this laboratory data. 3. Sulfasalazine is insoluble in acid urine and can cause crystalluria and hematuria, resulting in kidney damage. Therefore, the nurse should monitor the serum creatinine level, which is normally 0.5-1.5 mg/dL. 4. Sulfasalazine may cause abnormal bleeding and bruising, but the INR is monitored for clients taking the oral anticoagulant warfarin (Coumadin). MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medi - cation administration, including which client assessment data and laboratory data should be monitored prior to and during the use of the medication.

18. Which laboratory data should the nurse monitor for the client with inflammatory bowel disease who is prescribed sulfasalazine (Azulfidine), a sulfonamide antibiotic? 1. The client's liver function tests. 2. The client's serum potassium level. 3. The client's serum creatinine level. 4. The client's International Normalized Ratio (INR).

20. 1. Prednisone increases the glucose level; therefore, it should be monitored by the nurse. 2. Long-term side effects occur and the nurse should teach when administering the medication. 3. Steroids are notorious for causing gastric irritation that may result in peptic ulcers; therefore, administering the prednisone with food is priority. 4. Explaining to the client about tapering the medication is important. 5. A moon face is an expected sign of prednisone toxicity so the client should not notify the health-care provider.

20. The client with inflammatory bowel disease is prescribed the glucocorticoid prednisone. Which interventions should the nurse implement? Select all that apply. 1. Monitor the client's blood glucose level. 2. Discuss the long-term side effects of prednisone. 3. Administer the medication with food. 4. Explain prednisone will be tapered when being discontinued. 5. Tell the client to notify HCP if moon face occurs.

21. 1. A 29-year-old female is of childbearing age. The nurse should determine that the client is not pregnant before administering this medication. Misoprostol can be used in a combination with mifepristone to produce an abortion. 2. Prilosec is prescribed to treat duodenal and gastric ulcers; the nurse would not question this medication. 3. The potassium level is within normal range (3.5-5.5 mEq/L); the nurse would not question this medication. 4. Tylenol is frequently administered for headaches; the nurse would not question this medication. MEDICATION MEMORY JOGGER: Whenever an age is mentioned in the stem of the question or in the answer options, one or more of the ages will be important. The only option that gives the test taker a clue regarding the correct answer is the 29-year-old, and the test taker should also note that it is a female client. Twentynine- year-old females are of childbearing age, so the nurse has two potential clients to consider.

21. The nurse is administering 0800 medications. Which medication should the nurse question? 1. Misoprostol (Cytotec), a prostaglandin analog, to a 29-year-old female with an NSAID-produced ulcer. 2. Omeprazole (Prilosec), a proton-pump inhibitor, to a 68-year-old male with a duodenal ulcer. 3. Furosemide (Lasix), a loop diuretic, to a 56-year-old male with a potassium level of 4.2 mEq/L. 4. Acetaminophen (Tylenol), a nonnarcotic analgesic, to an 84-year-old female with a frontal headache.

22. 1. Clients with congestive heart failure are limited in the amount of sodium they should consume. Sodium bicarbonate has sodium as an ingredient. 2. Amphogel is not a low-sodium preparation. This client requires a low-sodium antacid. 3. Riopan is the antacid of choice for clients who need to limit their sodium intake. 4. Mylanta is not a low-sodium preparation. This client requires a low-sodium antacid. MEDICATION MEMORY JOGGER: The nurse must always be aware of comorbid conditions when administering medications. The two key words or phrases in this question are "severe congestive heart failure" and "indigestion."

22. The client diagnosed with severe congestive heart failure is complaining of indigestion. Which antacid medication should the nurse administer? 1. Sodium bicarbonate. 2. Amphogel. 3. Riopan. 4. Mylanta DS.

23. 1. This is information to teach when the client is taking antihypertensive medications, not NSAIDs. 2. A life-threatening complication of NSAID use is the development of gastric ulcers that can hemorrhage; dizziness and light-headedness could indicate a bleeding problem. The client has been taking the medications "around the clock," indicating use during the night when it would be unusual for the client to consume food along with the medication. 3. NSAID medications should be taken with food or something to coat the stomach lining, but this client is symptomatic and should be seen by an HCP. 4. There is no reason to suggest a change in NSAID; the nurse should be concerned that the client has developed an NSAIDproduced ulcer.

23. The female client diagnosed with low back pain has been self-medicating with ibuprofen (Motrin), a nonsteroidal anti-inflammatory drug (NSAID), around the clock. The client calls the clinic and tells the nurse that she has been getting dizzy and light-headed. Which intervention should the nurse implement? 1. Tell the client to get up from a sitting or lying position slowly. 2. Have the client come to the clinic for lab work immediately. 3. Suggest the client take the ibuprofen with food or an antacid. 4. Discuss changing to a different nonsteroidal anti-inflammatory medication.

24. 1. The client has PUD, not gastroesophageal reflux disease (GERD), for which elevating the head of the bed would be recommended. 2. The client's ulcer is caused by a bacterial infection, not NSAID use. The client should limit use of NSAIDs until the ulcer has healed to prevent complicating the healing process, but the client should be able to use NSAID medications once the H. pylori infection has been treated. 3. Smoking decreases prostaglandin production and results in decreased protection of the mucosal lining. Smoking should be stopped. 4. A soft, bland diet is not ordered for a client with peptic ulcer disease. 5. H. pylori is a bacterial infection that is treated with a combination of medications. At least two antibiotics and an antisecretory medication will be ordered. As with all antibiotic prescriptions, the client should be taught to take all the medications as ordered. Resistant strains of H. pylori are being documented in clients who have not been compliant with the treatment program.

24. The client is diagnosed with a Helicobacter pylori infection and peptic ulcer disease (PUD). Which discharge instructions should the nurse teach? Select all that apply. 1. Discuss placing the head of the bed on blocks to prevent reflux. 2. Teach to never use nonsteroidal anti-inflammatory drugs again. 3. Encourage the client to quit smoking cigarettes. 4. Instruct the client to eat a soft, bland diet. 5. Take the combination of medications for 14 days as directed.

26. 1. Milk of Magnesia is the most potent antacid, but it is usually used as a laxative because of the actions of magnesium hydroxide on the bowel. A combination antacid—magnesium hydroxide (produces diarrhea) and aluminum hydroxide (produces constipation)—is preferred to balance the side effects. 2. The nurse can answer the client's question. It is only necessary to discuss this with the health-care provider if antacids are not resolving the client's complaints of indigestion. 3. The Milk of Magnesia is causing the problem, and changing antacids should resolve the situation. 4. Most clients are concerned about diarrhea, and the nurse should be concerned about fluid and electrolyte imbalances resulting from diarrhea.

26. The male client diagnosed with peptic ulcer disease (PUD) has been taking magnesium hydroxide (Milk of Magnesia) for indigestion. The client complains that he has been having diarrhea. Which intervention should the nurse implement? 1. Suggest that the client use magnesium hydroxide with aluminum hydroxide (Mylanta). 2. Encourage the client to discuss the problem with the health-care provider. 3. Tell the client to take loperamide (Imodium), over the counter. 4. Discuss why the client is concerned about experiencing diarrhea.

27. 1. The client would need an intravenous proton-pump inhibitor at first and then later could be changed to an oral PPI. The client may also need a nasogastric tube or to be NPO. This client has a very low hemoglobin and hematocrit level, indicating active bleeding and the need for a fast route for the delivery of fluids and medications. 2. The nurse should observe the stool for color (black) and consistency (tarry) indicating blood, but this is not the first action. 3. This client has very low blood counts; is at risk for shock; and should be assessed for hypotension, tachycardia, and cold clammy skin. The client will need fluid and blood cell replacement. The nurse should start the IV as soon as possible. 4. The client should have a bedside commode for safety, but it is not the first intervention. Prevention of or treating shock is the first intervention. MEDICATION MEMORY JOGGER: The stem told the test taker the client's hemoglobin and hematocrit levels, which were levels indicating a "crisis" situation. The first step in many crises is to make sure that an IV access is available to administer fluids and medications.

27. The client diagnosed with peptic ulcer disease is admitted to the medical unit with a hemoglobin level of 6.2 g/dL and a hematocrit level of 18%. Which intervention should the nurse prepare to implement first? 1. Obtain an order for an oral proton-pump inhibitor. 2. Instruct the client to save all stools for observation. 3. Initiate an IV with 0.9% NS with an 18-gauge catheter. 4. Place a bedside commode in the client's room.

28. 50 gtt per minute. The nurse must first determine the rate per hour: 20 minutes into 60 minutes = 3 (20-minute time segments). 50 mL of fluid × 3 = 150 mL per hour. 150 mL ÷ 60 minutes = 2.5 mL/min to infuse. 2.5 mL/min × 20 drops per mL = 50 gtt per minute.

28. The nurse is preparing to administer pantoprazole (Protonix), a proton-pump inhibitor, IVPB, in 50 mL of fluid over 20 minutes to a client diagnosed with peptic ulcer disease. The IVPB set delivers 20 drops per mL. At what rate would the nurse set the infusion?

29. 1. Flagyl is administered in combination with Pepto Bismol, Prevacid, and one other antibiotic to treat PUD; the nurse would not question this medication. 2. Pepto Bismol is administered in combination with Flagyl, Prevacid, and one other antibiotic to treat PUD; the nurse would not question this medication. 3. Prevacid is administered with a combination of antibiotics to treat PUD; the nurse would not question this medication. 4. Sucralfate (Carafate) is a mucosal barrier agent and must be administered on an empty stomach for the medication to coat the stomach lining. The nurse should question the time the medication is scheduled for and arrange for the medication to be administered at 0730.

29. The nurse is administering 0900 medications to a client diagnosed with peptic ulcer disease (PUD). Which medication should the nurse question? 1. Metronidazole (Flagyl), an anti-infective. 2. Bismuth subsalicylate (Pepto Bismol), an antibiotic. 3. Lansoprazole (Prevacid), a proton-pump inhibitor. 4. Sucralfate (Carafate), a mucosal barrier agent.

30 1. A lack of epigastric pain would indicate the medication is effective. The question asks for which data indicates the medication is not effective. 2. A hemoglobin of 15 g/dL and hematocrit of 44% are within normal limits and would indicate that the client is not bleeding as a result of the ulcer. 3. Clients who experience a gastric ulcer lose weight because of the pain associated with eating. A weight gain would indicate less pain and the client being able to consume nutrients. 4. The client has a rapid pulse and low blood pressure, which indicate shock. This could be caused by hemorrhage from the ulcer. This client's treatment has not been effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

30. The client has been on a therapeutic regimen for an H. pylori infection. Which data suggests the medication is not effective? 1. The client states that the midepigastric pain has been relieved. 2. The client's hemoglobin is 15 g/dL and the hematocrit is 44%. 3. The client has gained 3 pounds in 1 week. 4. The client's pulse is 124 and blood pressure is 92/48.

31. 1. This is a question that the nurse could ask the client, but it is not specific or important to ask for a client taking Metamucil; therefore, it is not the most important question to ask the client. 2. Bulk laxatives can swell and cause obstruction of the esophagus; therefore, the most important question to ask the client is if he or she has difficulty swallowing. If the client has difficulty swallowing, the nurse should question the client taking Metamucil. 3. Fiber helps decrease constipation, but fiber does not affect the effectiveness of Metamucil; therefore, it is not the most important question the nurse should ask the client. 4. Metamucil may cause abdominal cramping, but abdominal tenderness is not pertinent information regarding taking a bulk laxative daily; therefore, it is not the most important question for the nurse to ask the client.

31. The elderly client with diverticulosis is instructed to take the bulk laxative psyllium mucilloid (Metamucil). Which question is most important for the nurse to ask the client? 1. "When was your last bowel movement?" 2. "Do you have any difficulty swallowing?" 3. "How much fiber do you eat daily?" 4. "Do you ever notice any abdominal tenderness?"

43. 1. End-stage liver failure causes inadequate absorption of vitamins. Vitamin K deficiency results in hypoprothrombinemia, which results in spontaneous bleeding and ecchymosis. 2. Night blindness and eye and skin changes result from a deficiency of vitamin A, not of vitamin K. 3. Skin and mucous membrane lesions are caused by deficiency of riboflavin and pyridoxine, not of vitamin K. 4. This psychosis, along with beriberi and polyneuritis, results from a deficiency of thiamine, not of vitamin K.

43. The client in end-stage liver failure is prescribed vitamin K. The client asks the nurse, "Why do I have to take vitamin K?" Which statement is the nurse's best response? 1. "It will help your blood to clot so you won't have spontaneous bleeding." 2. "It may help prevent eye and skin changes along with night blindness." 3. "Vitamin K helps prevent skin and mucous membrane lesions." 4. "It prevents a complication called Wernicke-Korsakoff psychosis."

32. 1. The white blood cell count is monitored to determine the effectiveness of the medication and would not be checked prior to administering the first dose of the antibiotic medication. 2. The nurse should monitor the client's vital signs, especially the temperature, but it would not affect the nurse administering the first dose of antibiotics. 3. Antibiotics are notorious for causing allergic reactions, and the nurse should make sure the client is not allergic to any antibiotics prior to administering this medication. Therefore, this is the first intervention. 4. Stool specimens are sent to the laboratory to detect ova or parasites. Diverticulitis is not the result of ova or parasites; therefore, there is no need for the client to have a stool specimen sent to the laboratory.

32. The 72-year-old client is admitted to the medical unit diagnosed with an acute exacerbation of diverticulosis. The health-care provider has prescribed the intravenous antibiotic ceftriaxone (Rocephin). Which intervention should the nurse implement first? 1. Monitor the client's white blood cell count. 2. Assess the client's most recent vital signs. 3. Determine if the client has any known allergies. 4. Send a stool specimen to the laboratory.

33. 1. The client should be NPO and not have any fecal matter going through an inflamed descending and sigmoid bowel; therefore, the nurse would question administering a stimulant laxative, which would cause the client to have a bowel movement. 2. Because the client is NPO, a nasogastric tube is inserted to remove gastric acid and decompress the bowel. 3. The client would have pain medication; therefore, this order would not be questioned. 4. Because the client is NPO the nurse would not question an order for intravenous fluids. 5. The client's rectum and sigmoid colon are irritated secondary to the diverticulitis, and nothing should be inserted to the rectum to further irritate rectum; and the client is not constipated, so therefore Fleet's enema should be questioned by the nurse. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

33. The nurse is transcribing the admitting health-care provider's orders for an elderly client diagnosed with diverticulitis. Which orders would the nurse question? Select all that apply. 1. Administer one bisacodyl (Dulcolax), by mouth, daily. 2. Insert a nasogastric tube to intermittent low suction. 3. Administer morphine 2 mg intravenous push for pain every 4 hours. 4. Infuse D5 0.45 NS intravenously at 100 mL an hour. 5. Administer a Fleet's enema after each bowel movement.

34. 1. Abdominal cramping is expected when this medication is first started; therefore, the client would not need to notify the HCP. 2. It takes 2-3 days after the initial dose for the medication to work. 3. Esophageal or intestinal obstruction may result if the client does not take in adequate amounts of fluid with the medication. 4. When taking this medication, the client should increase dietary fiber, such as whole grains, fibrous fruits, and vegetables.

34. Which information should the nurse discuss with the 75-year-old client diagnosed with diverticulosis who is prescribed methylcellulose (Citrucel), a bulk laxative? 1. Notify the health-care provider if abdominal cramping occurs. 2. Explain that results should be evident within 24 hours. 3. Encourage the client to increase the intake of fluids, especially water. 4. Instruct the client to decrease fiber intake while taking this medication.

35. 1. A stool surfactant or softener does not stimulate a bowel movement. 2. Colace is a stool softener; if the client has soft brown stools, the medication is effective. 3. The abdomen should be soft and nontender, but this does not indicate that the medication is effective. 4. The client should have bowel sounds in all four quadrants of the abdomen, but this does not indicate the medication is effective. MEDICATION MEMORY JOGGER: To determine if the medication is effective, the nurse should think about why the medication is being administered. Consider what disease process or condition the medication is being prescribed to treat.

35. The 80-year-old client with diverticulosis is prescribed the stool surfactant docusate sodium (Colace). Which assessment data indicate the medication is effective? 1. The client has a bowel movement within 8 hours. 2. The client has soft, brown stools. 3. The client has a soft, nontender abdomen. 4. The client has bowel sounds in all four quadrants.

36. 1. In addition to being given an osmotic laxative, such as Fleet's Phospho-Soda, the client will be NPO. This can lead to dehydration. Skin turgor and the condition of the oral mucosa should be monitored to assess for dehydration. 2. The client will need an intravenous line, but it is not priority over assessing the client. 3. Iodine is not used in a colonoscopy, so the nurse need not ask this question. 4. The client should not be having any bowel movements at this time; the bowel should be cleaned out prior to the colonoscopy.

36. The 62-year-old client suspected of having diverticulosis is scheduled for a colonoscopy and is prescribed sodium biphosphate (Fleet's Phospho-Soda) the night before the procedure. Which priority intervention should the nurse implement prior to the procedure? 1. Assess the client's skin turgor and oral mucosa. 2. Initiate intravenous therapy for the client. 3. Determine if the client has iodine allergies. 4. Monitor the client's bowel movements.

37. 1. Lubricating the stool and colon mucosa is the rationale for administering mineral oil. 2. Irritating the bowel to increase peristalsis is the rationale for administering stimulants. 3. Stool softeners or surfactants cause more water and fat to be absorbed into the stool. 4. Bulk-forming agents absorb water and swell, thus increasing the size of the fecal mass. The larger the fecal mass, the more the defecation reflex is stimulated and the passage of stool is promoted.

37. The client is prescribed a bulk-forming agent. Which statement best describes the scientific rationale for administering this medication? 1. The medication acts by lubricating the stool and the colon mucosa. 2. Bulk-forming agents irritate the bowel to increase peristalsis. 3. The medication causes more water and fat to be absorbed into the stool. 4. Bulk-forming agents absorb water, which adds size to the fecal mass.

5. 1. Tagamet is used to treat indigestion and heartburn (pyrosis). 2. Over time, Tagamet can cause males to become impotent, have decreased libido, and have breast development (gynecomastia). 3. Tagamet can cause lethargy and somnolence, not insomnia and hypervigilance. 4. Tagamet is used to treat Zollinger-Ellison syndrome, a syndrome characterized by hypersecretion of gastric acid and the formation of peptic ulcers.

5. Which side effects would the nurse explain to the male client who is prescribed cimetidine (Tagamet), a histamine2 blocker? 1. The medication can cause indigestion and heartburn. 2. The medication can cause impotence and gynecomastia. 3. The medication can cause insomnia and hypervigilance. 4. The medication can cause Zollinger-Ellison syndrome.

39. 1. The nurse should not administer pain medication without first assessing the client for any complications. 2. Electrolyte levels do not need to be monitored prior to administering pain medication for clients with diverticulitis. 3. The nurse should determine when the next pain medication could be administered, but the first intervention is always assessing the client. 4. The nurse must assess the client to determine if the pain is pain expected with diverticulitis or if it is a result of a complication of diverticulitis, such as bowel obstruction or bowel perforation. Remember that the first intervention is assessment. MEDICATION MEMORY JOGGER: Remember that pain may be expected as a result of the disease process or the condition, but it may also indicate a complication. Assessment is the first intervention when addressing the client's complaints of pain.

39. The client diagnosed with diverticulitis is requesting pain medication. Which intervention should the medical nurse implement first? 1. Administer the client's pain medication as requested. 2. Check the client's serum sodium and potassium level. 3. Determine when the last pain medication was administered. 4. Assess the client's bowel sounds and abdomen for tenderness.

4. 1. H2 blockers actually block the production of gastric acid; they have a longer effect than an antacid. 2. An increase in side effects would not be an advantage. 3. Antacids are usually less expensive than H2 blockers. 4. H2 blockers require less frequent administration than do antacids, which require frequent administration, seven or more times a day, for therapeutic effects. The fewer times a client is expected to take a medication, the more likely the client is to comply with a medication regimen.

4. Which statement is an advantage to administering a histamine2 blocker rather than an antacid to a client diagnosed with gastroesophageal reflux disease (GERD)? 1. Antacids are more potent than H2 blockers in relieving the symptoms of GERD. 2. Histamine2 blockers have more side effects than antacids. 3. Histamine2 blockers are less expensive than antacids. 4. Histamine2 blockers require less frequent dosing than antacids.

40. 1. Stool softeners do not increase the number of bowel movements; they make the stool softer and easier to pass. Therefore, determining how often the client has a bowel movement is not priority. 2. A client with essential hypertension would be on a low-sodium diet; docusate sodium (Colace) should not be given to clients on sodium restriction. 3. The client's current blood pressure should be assessed; the client's last blood pressure would not be priority. 4. There is nothing to indicate that the client is at risk for gastrointestinal bleeding; therefore, this is not a priority intervention.

40. The male client who has essential hypertension tells the clinic nurse he is taking the over-the-counter stool softener docusate sodium (Colace). Which priority action should the clinic nurse implement? 1. Determine how often the client has a bowel movement. 2. Discuss the importance of not taking this stool softener. 3. Ask the client what was his last blood pressure reading. 4. Obtain a stool specimen for an occult blood test.

41. 1. Lactulose will not affect the client's urinary output. 2. An elevated ammonia level affects the client's neurological status. Lactulose is prescribed to remove ammonia through the intestinal tract. Assessing the client's neurological status will determine the effectiveness of the medication. 3. Lactulose is not administered to treat the client's ascites; therefore, measuring the abdominal girth will not help determine the effectiveness of lactulose. 4. Lactulose is a laxative and will cause the client to have bowel movements, but the bowel movements will not determine the effectiveness of this medication. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

41. The client in end-stage liver failure has an elevated ammonia level. The health-care provider prescribes lactulose (Cephulac), a laxative. Which intervention should the nurse implement to determine the effectiveness of the medication? 1. Monitor the client's intake and output. 2. Assess the client's neurological status. 3. Measure the client's abdominal girth. 4. Document the number of bowel movements.

42. 1. Neomycin does not help reduce hepatic venous pressure. 2. Diuretics, not the antibiotic neomycin, help increase the excretion of fluid through the kidneys. 3. Neomycin is an antibiotic, but it is not administered to help prevent a systemic infection. 4. Neomycin sulfate is administered to help reduce the ammonia level by reducing the number of ammoniaforming bacteria in the bowel.

42. The client in end-stage liver failure is prescribed neomycin sulfate. Which statement best describes the scientific rationale for administering this medication? 1. Neomycin sulfate helps lower the hepatic venous pressure. 2. It helps increase the excretion of fluid through the kidneys. 3. Neomycin is administered to help prevent a systemic infection. 4. It reduces the number of ammonia-forming bacteria in the bowel.

44. 1. Venodilation is the scientific rationale for administering nitrates such as isosorbide (Isordil), not vasopressin. 2. Vasopressin is prescribed for a client with end-stage liver failure because it produces constriction of the splanchnic arterial bed, resulting in a decrease in portal pressure, which will help decrease esophageal bleeding. Vasopressin is administered intravenously or by intra-arterial infusion. 3. Vasoconstriction of the coronary arteries is a side effect of vasopressin. It is treated by administering nitroglycerin in combination with the vasopressin. 4. Vasopressin does not affect the size or vascularity of the liver.

44. The client in end-stage liver failure is experiencing esophageal bleeding. The healthcare provider has prescribed vasopressin (Pitressin). Which statement is the scientific rationale for administering this medication? 1. It lowers portal pressure by venodilation and decreased cardiac output. 2. Vasopressin produces constriction of the splanchnic arterial bed. 3. This medication causes vasoconstriction of the coronary arteries. 4. Vasopressin causes the liver to decrease in size and vascularity.

45. 1. The normal plasma ammonia level is 15-45 g/dL (varies with method), and this client's level is above normal so the nurse would not question administering this medication, which is prescribed to remove ammonia from the intestinal tract. 2. This client's potassium level is within normal limits (3.5-5.5 mEq/L); therefore, the nurse should not question the administration of the diuretic. 3. This client's potassium level is above normal level (3.5-5.5 mEq/L); therefore, the nurse should question administering this potassium-sparing diuretic. 4. This client's sodium level is within normal limits (135-145 mEq/L); therefore, the nurse would not question administering the medication. Clients taking vasopressin may, however, develop hyponatremia, or below-normal sodium levels. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. Remember that the nurse is a client advocate.

45. The nurse is preparing to administer medications to the following clients. Which client should the nurse question administering the medication? 1. Lactulose (Cephulac), a laxative, to a client who has an ammonia level of 50 g/dL. 2. Furosemide (Lasix), a loop diuretic, to a client who has a potassium level of 3.7 mEq/L. 3. Spironolactone (Aldactone), a potassium-sparing diuretic, to a client with a potassium level of 5.9 mEq/L. 4. Vasopressin (Pitressin) to a client with a serum sodium level of 137 mEq/L.

46. 1. Paracentesis is the removal of fluid (ascites) from the peritoneal cavity through a small incision or puncture through the abdominal wall under aseptic conditions. This would be an expected procedure for a client in end-stage liver failure. 2. Liver failure causes a decrease in the absorption of vitamins; therefore, an order for vitamin C to help prevent hemorrhagic lesions of scurvy would be an expected order. 3. The client in end-stage liver failure would have hepatic encephalopathy, which affects the client's neurological status. Therefore, sedatives, tranquilizers, and analgesic medications are not administered to the client. The nurse would question this order. 4. Glucose is administered intravenously to clients with end-stage liver disease to minimize protein breakdown. Because the client is third spacing, the IV rate will be low.

46. The client in end-stage liver failure is being admitted to the medical floor. Which health-care provider's order should the nurse question? 1. Prepare the client for a paracentesis. 2. Administer vitamin C 100 mg po daily. 3. Administer morphine 2 mg IVP for pain. 4. Give D5W 0.9 NS at 25 mL/hour.

47. 1. Proton-pump inhibitors are not routine medications prescribed after endoscopic sclerotherapy. 2. The client does not have to be NPO for 24 hours after endoscopic sclerotherapy. 3. Endoscopic sclerotherapy does not cause nausea or vomiting; therefore, there is no need to administer an antiemetic. 4. Antacids may be administered after the procedure to counteract the effect of gastric reflux.

47. The client with esophageal varices undergoes endoscopic sclerotherapy. Which postprocedure intervention should the nurse implement? 1. Administer the proton-pump inhibitor omeprazole (Prilosec). 2. Do not allow the client to eat or drink anything for 24 hours. 3. Administer promethazine (Phenergan), an antiemetic. 4. Administer the antacid aluminum hydroxide (Maalox).

48. 1. The client should use warm water, rather than hot water, when bathing. Hot water increases pruritus. 2. Emollient or lubricants should be used to keep the skin moist to prevent dry skin. 3. Antihistamines are prescribed to help the itching (pruritus) but should be used as directed because decreased liver function increases the risk for altered drug responses. 4. Hydrocortisone cream will not help this type of itching because the itching is not secondary to a rash or skin irritation. Severe jaundice with bile salt deposits on the skin causes the pruritus. 5. The client should not scratch the skin because it will cause bleeding and may cause infection.

48. The client in end-stage liver failure is complaining of pruritus. Which information should the nurse discuss with the client? Select all that apply. 1. Encourage the client to sit in a hot spa before going to bed. 2. Instruct the client to use emollients or lotions on the skin. 3. Explain the need to take the prescribed antihistamine as directed. 4. Apply hydrocortisone 1.0% cream to the affected areas. 5. Tell the client the importance on not scratching the skin.

49. 1. Diarrhea indicates an overdose of the medication and the client should call the HCP for a decrease in the dosage; therefore, this comment indicates the client understands the teaching. 2. Although the drug may cause nausea, the client should keep taking it because it decreases the ammonia level. The nurse should instruct the client to take the medication with crackers or a soft drink, which may decrease the nausea. This statement indicates the client does not understand the medication teaching and needs more teaching. 3. To mask the sweet taste, lactulose can be diluted with fruit juice. This statement indicates the client understands the medication teaching. 4. Having two to three soft stools a day indicates the medication is working to help decrease the ammonia level.

49. The client in end-stage liver failure is taking the laxative lactulose (Cephulac). Which statement indicates the client needs more teaching concerning this medication? 1. "I will notify my doctor if I have any watery diarrhea." 2. "If I get nauseated, I will quit taking the lactulose." 3. "I will take my lactulose with fruit juice." 4. "I should have two or three soft stools a day."

50. 1. Aldactone addresses one of the causes of ascites, which is increased aldosterone levels that cause water retention. Aldactone is a potassium-sparing diuretic; therefore, the client should be monitored for hyperkalemia. 2. Diuretics cause excretion of fluid, and a daily weight check is an excellent assessment of the effectiveness of the medication. Also, 1000 mL is approximately 1 pound. 3. Diuretics do not affect the client's gastrointestinal system, so there is no need to monitor the client's bowel sounds. 4. Diuretics cause excretion of fluid, and intake and output levels evaluate the effectiveness of the diuretic therapy.

50. The client in end-stage liver failure with ascites is prescribed spironolactone (Aldactone). Which interventions should the nurse implement? Select all that apply. 1. Check the serum potassium level. 2. Weigh the client daily at the same time. 3. Assess the client's bowel sounds. 4. Monitor the client's intake and output. 5. Monitor the client's abdominal girth.

51. 1. Usually adults achieve immunity after one dose of the vaccine, but two doses are recommended for full protection. 2. The nurse should inform the client that pain is expected at the injection site, and there is no reason to notify the clinic. 3. Hepatitis A vaccine provides long-term protection against hepatitis A infection, which is transmitted by the fecal-oral route via contaminated shellfish or other food or water and by direct contact with an infected person. 4. This vaccine is administered intramuscularly into the deltoid muscle.

51. The public health nurse is administering the hepatitis A vaccine to a client. Which statement indicates the client understands the medication teaching about the vaccine? 1. "I will not need to have another dose of the vaccine." 2. "I will notify the clinic if there is pain at the injection site." 3. "This vaccine will provide long-term protection against hepatitis A." 4. "This medication will be injected in my buttocks."

52. 1. This is a question that a nurse should ask any client before giving a medication, but it is not the most important question when administering the hepatitis B vaccine. 2. A yeast-recombinant hepatitis B vaccine (Recombivax HB) is used to provide active immunity; therefore, the nurse should specifically ask the employee if he or she is allergic to yeast. 3. The hepatitis B vaccine is not made with egg yolks; therefore, this would not be an important question. 4. The hepatitis B vaccine is not made with any type of milk; therefore, this would not be an important question. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data and laboratory data should be monitored prior to administering the medication.

52. The employee health nurse is preparing to administer the first dose of hepatitis B vaccine to an employee. Which question is most important for the nurse to ask the employee before administering this medication? 1. "Do you have any known allergies to medications?" 2. "Are you allergic to yeast or any type of yeast products?" 3. "Have you ever had an allergic reaction to egg yolks?" 4. "Are you allergic to any type of milk or milk products?"

53. 1. Once the client has been exposed to the hepatitis A virus, the hepatitis A vaccine will not help prevent the client from getting hepatitis A. 2. This is providing incorrect information to the client because there is something available to prevent the client from getting hepatitis A. 3. This is correct information. An immune globulin injection within 2 weeks of exposure will help prevent the client from getting hepatitis A. 4. There is no reason for the client to go to the emergency department. The client can come to the clinic and receive the injection.

53. The client exposed to hepatitis A calls the clinic and wants to know if anything can be done to prevent getting hepatitis A. Which information should the nurse discuss with the client? 1. Explain that there is a hepatitis A vaccine available that the client can receive. 2. Inform the client that there is nothing available to help prevent hepatitis A. 3. Instruct the client to get an immune globulin injection within 2 weeks. 4. Tell the client to go to the nearest emergency department as soon as possible.

54. 1. Flulike symptoms, including fever, fatigue, myalgia, headache, and chills, are the most common side effects of Infergen and do not require discontinuing the medication. 2. Some of the flulike symptoms (fever, headache, myalgia) can be reduced with acetaminophen. 3. These flulike symptoms tend to diminish with continued therapy; therefore, the client will not have to live with these side effects. 4. The nurse must be knowledgeable about the expected side effects of medications and is responsible for teaching the client. These side effects are common and the client does not need to see the health-care provider. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

54. The client diagnosed with chronic hepatitis C who is taking interferon alfacon (Infergen), an antiviral medication, reports having fever, muscle pain, and headaches to the nurse. Which intervention should the nurse implement? 1. Instruct the client to taper off the medications immediately. 2. Encourage the client to take acetaminophen (Tylenol). 3. Explain that the client will just have to live with these side effects. 4. Recommend that the client see the health-care provider.

55. 1. At this time, there is no vaccination for the prevention of hepatitis C; therefore, this is the nurse's best response. 2. There are vaccines to prevent hepatitis A and B, but there is no vaccination for hepatitis C. 3. This question does not have any relevance to the client's request. 4. This question may be construed as challenging by the client, and the nurse should give the client factual information.

55. The client tells the nurse, "I would like to get the vaccine for hepatitis C." Which response is most appropriate by the nurse? 1. "There is no vaccination against hepatitis C." 2. "The vaccination must be administered in two doses." 3. "Have you received the hepatitis B vaccination?" 4. "Why are you interested in receiving this vaccine?"

67. 1. Compazine is an antiemetic and should relieve nausea and vomiting; it is not known to cause diarrhea. 2. Tremors, involuntary twitching, and restlessness are signs of an extrapyramidal reaction. Children, the elderly, and clients who are dehydrated are especially susceptible. If these symptoms occur, the medication is held and the HCP is notified. 3. Compazine does not cause diplopia (double vision), ptosis (drooping eyelids), or urinary retention. It can cause blurred vision. 4. Compazine does not cause myalgias (muscle aches), hallucinations, or weakness.

67. The 8-year-old child diagnosed with gastroenteritis is admitted to the pediatric unit. The nurse administered prochlorperazine (Compazine), an antiemetic, rectally. Which side effects should the nurse assess for? 1. Nausea, vomiting, and diarrhea. 2. Tremors, involuntary twitching, and restlessness. 3. Diplopia, ptosis, and urinary retention. 4. Myalgias, hallucinations, and weakness.

56. 1. The nurse should first determine if the medication will affect liver function before telling the client to quit taking the medication. The herb may need to be tapered. 2. The nurse should investigate to determine if the medication will damage the client's liver before taking any action. 3. If the herb is treating the client's depression and is not hepatotoxic, then there is no reason for the client to take a prescribed antidepressant. Prescribed antidepressants may be hepatotoxic and usually cost more than herbs. 4. The nurse should advise the client to avoid substances (medications, herbs, illicit drugs, and toxins) that may affect liver function; therefore, the nurse should determine if St. John's wort is hepatotoxic.

56. The male client diagnosed with chronic hepatitis C tells the nurse that he is taking the herb St. John's wort for depression. Which intervention should the nurse implement? 1. Tell the client to quit taking the herb immediately. 2. Document the information and take no action. 3. Encourage the client to take a prescribed antidepressant. 4. Determine if the herb has hepatotoxic properties.

57. 1. This is information the woman should be told, but it is not priority at this time; getting the woman medical treatment for the virus is priority. 2. This information should be discussed with the woman, but the most important intervention is to provide medical treatment. 3. Hepatitis B immune globulin (HBIG) provides passive immunity against hepatitis B and is indicated for people exposed to the hepatitis B virus who have never had hepatitis B and have never received the hepatitis B vaccination. 4. Prompt immunization with hepatitis B vaccine (within a few hours or days after exposure to hepatitis B) increases the likelihood of protection. Because the incubation period for hepatitis B is on the average 70-80 days, it would be too late for the woman to receive the immunization because her partner has just been diagnosed with hepatitis B. The client would have to have been vaccinated within 2-3 days after exposure from her partner.

57. The public health nurse notified a young woman that one of her sexual contacts was positive for hepatitis B. The woman denied ever having hepatitis B or having received the hepatitis B vaccinations. Which information is most important for the nurse to discuss with the woman? 1. Instruct the woman not to have unprotected sexual intercourse. 2. Advise the woman not to drink any type of alcoholic beverage. 3. Tell the woman to get hepatitis B immune globulin (HBIG). 4. Encourage the client to get the hepatitis B vaccination.

58. 1. During ribavirin treatment, pregnancy must be ruled out. During treatment, pregnancy must be avoided both by females and by female partners of men taking ribavirin. To avoid pregnancy, couples should use two reliable forms of birth control during treatment and for 6 months after treatment. 2. There is no vitamin requirement for clients taking ribavirin. 3. Sunlight does not cause complications when taking this medication. 4. This medication does not cause impotence in men.

58. The male client with chronic hepatitis C is being prescribed ribavirin (Virazole), an antiviral medication. Which information should the nurse discuss with the client? 1. Discuss the importance of using two reliable forms of birth control. 2. Explain the need to eat a diet high in vitamin K during treatment. 3. Instruct the client to avoid direct sunlight for long periods. 4. Teach the client that the medication might cause temporary impotence.

59. 1. This vaccine must be administered in three doses, not two doses. Therefore, requesting the client to come back in 2 months and telling the client it is the last dose is incorrect information. 2. There is no reason why the client cannot wash the injection site. 3. There is no reason to rotate arms because there is 1 month and 6 months between the injections. 4. The hepatitis B vaccine must be administered intramuscularly in three doses, with the second and third doses at 1 and 6 months after the first dose. The third dose is very important in producing prolonged immunity.

59. The clinic nurse is preparing to administer the hepatitis B vaccine to the client. Which information should the nurse discuss with the client? 1. Instruct the client to come back to the clinic in 2 months for the last injection. 2. Teach the client not to wash the injection site for at least 24 hours. 3. Encourage the client to rotate the arms when receiving the hepatitis B vaccine. 4. Explain that the client must have two more doses of the vaccine at 1 and 6 months.

6. 1. This indicates client compliance with the dosing regimen for antacids, not that the medication is effective. 2. The return of symptoms indicates the medication is not effective. 3. This indicates an improvement in symptoms and that the medication is effective. 4. Losing weight would not indicate that a medication for hiatal hernia is effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

6. The home health-care nurse is caring for a male client diagnosed with a hiatal hernia and reflux. Which data indicates the medication therapy is effective? 1. The client takes the antacid 1 hour before and 3 hours after a meal. 2. The client complains of indigestion after eating a large meal. 3. The client states that he did not wake up with heartburn during the night. 4. The client has lost 3 pounds in the past 2 weeks.

60. 1. The U.S. Food and Drug Administration (FDA, 2001) has approved a combined hepatitis A and B vaccine (Twinrix) for vaccination of persons 18 years of age and older with indications for both hepatitis A and B vaccination. The Twinrix vaccination consists of three doses, given on the same schedule as that used for single-antigen hepatitis B vaccine—that is, initial dose, after 1 month, and at 6 months. 2. Because the client is homeless and uses illegal IV drugs, the nurse should recommend both the hepatitis A and B combined vaccination. 3. The client needs to quit using the illegal drugs, but recommending the rehabilitation center may not lead to the client agreeing to go and receiving the hepatitis vaccination to prevent a chronic potentially life-threatening disease. 4. There is an oral test for HIV. Oral tests detect HIV antibodies in mouth fluid taken from a scraping inside the cheek. 5. Recommending the client to seek treatment to quit using IV drugs is an appropriate intervention. The client probably will not seek treatment but the nurse should recommend it.

60. The client who is homeless comes to the free clinic. During the interview the client admits to using illegal intravenous drugs. Which intervention should the nurse recommend to the client? Select all that apply. 1. Recommend the combined hepatitis A and B vaccine (Twinrix). 2. Recommend the client receive the hepatitis B vaccination. 3. Recommend the client go to the county rehabilitation center. 4. Recommend the client be tested orally for the HIV virus. 5. Recommend the client to seek treatment to quit using intravenous drugs.

61. 1. Bilberry is used to treat diarrhea in children and is not an emetic. 2. Bilberry does not treat lactose intolerance. 3. Bilberry is not an antipyretic and would not treat a fever. 4. Bilberry is used to treat diarrhea. This question would assess the effectiveness of the herb. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the herb will cause harm to the client. The nurse should always be the client's advocate.

61. The pediatric clinic nurse is assessing the 4-year-old child with gastroenteritis. The mother tells the nurse that she has been using bilberry herbs to help the child. Which statement assesses the effectiveness of the herb? 1. "Did your child vomit after you administered the bilberry?" 2. "Does this herb help your child's allergy to milk and milk products?" 3. "What was the child's temperature when you administered the herb?" 4. "How many diarrhea stools has your child had since taking the bilberry?"

62. 6.8 mL per dose. The first step is to determine the body weight in kilograms. 60 pounds divided by the 2.2 conversion factor is 27.272, or 27.27 kg. Multiply 27.27 times 10 to find the milligrams, which results in 272.2 or 272 mg of medication each 24 hours. Divide 272 mg by 2 to determine the amount of medication to be administered each dosing time; this equals 136 mg per dose. To set up the algebraic formula: 136x = 100 Then cross multiply: 100x = 680 To solve for x, divide each side of the equation by 100: x = 6.8 mL per dose

62. The child diagnosed with infectious gastroenteritis is prescribed Bactrim, a sulfa antibiotic, 10 mg/kg/day in divided doses twice a day. The child weighs 60 pounds. The medication comes 100 mg/5 mL. How many milliliters will the nurse administer with the morning dose?

63. 1. The most likely cause of the child's developing the diarrhea is the administration of antibiotic medications. The antibiotics kill the "good" bacteria in the bowel that are needed for digestion. Penicillin would increase the diarrhea. 2. Cholestyramine is used to enhance mucosal recovery and decrease the length of the diarrhea. 3. The most likely cause of the child's developing the diarrhea is the administration of antibiotic medications. The antibiotics kill the "good" bacteria in the bowel needed for digestion. Trimethoprim would increase the diarrhea. 4. Diphenoxylate is an opioid that contains atropine; use of this medication should be limited in children. This would not be the first medication administered.

63. The child with chronic kidney infections develops Clostridium difficile. Which medication should the nurse administer first to decrease the amount of diarrhea? 1. Penicillin (Ampicillin), an antibiotic. 2. Cholestyramine (Questran), an antilipemic. 3. Trimethoprim sulfa (Bactrim), a sulfa drug. 4. Diphenoxylate (Lomotil), an antidiarrheal.

64. 1. The American Academy of Pediatrics recommends 50 mL/kg body weight over 4 hours for mild diarrhea and 100 mL/kg for moderate diarrhea. The child is 37.5 pounds, or 17.04 kg (35 ÷ 2.2 = 17.04) or 17 kg; 17 times 50 equals 850 mL and 17 times 100 mL equals 1700 mL Pedialyte or Rehydralyte is recommended because they contain electrolytes that should be replaced. The recommended schedule for ORT is given in the following table. 2. This would only be 200 mL over 2 hours and not enough to treat the diarrhea. Homemade rice water does not contain replacement electrolytes. 3. Because juices and soft drinks have high carbohydrate content and because the osmotic effect in the intestine can increase the diarrhea, they are not recommended. 4. The child should resume an age-appropriate diet as soon as the fluids have been replaced. Current research indicates that resuming solid food actually reduces the duration of the diarrhea.

64. The 3-year-old child weighing 37.5 pounds is diagnosed with mild to moderate diarrhea and placed on oral replacement therapy (ORT). Which information should the nurse teach the parent? 1. "Try to get your child to drink about 1000 mL of Pedialyte over 4 hours." 2. "The child should drink 100 mL of homemade rice water every 2 hours." 3. "Get the child to drink apple juice or a lemon-lime soda every 3-4 hours." 4. "Do not let the child eat any solid foods for a few days. Just give the liquids."

65. 1. The client is receiving IV fluids and the nurse should monitor the child's electrolytes. 2. A 6-year-old child's fontanels have closed; the child is assessed for dehydration by checking skin turgor on the abdomen. 3. The order is incomplete. No rate has been given. The nurse should clarify the order with the HCP. 4. All pediatric intravenous infusions require safety measures to make sure the child is not fluid overloaded. Using a pump is a method of ensuring that the rate of infusion is maintained and that too much fluid is not infused at one time. Most hospitals also require simultaneous use of a chambered infusion device (Buretrol). 5. The nurse should assess pediatric IV sites at least every hour.

65. The HCP wrote an order for "0.33% dextrose solution IV" for a 6-year-old child diagnosed with gastroenteritis. Which interventions should the nurse implement? Select all that apply. 1. Monitor the serum sodium and potassium levels. 2. Check the fontanels for the hydration status. 3. Discuss the order with the health-care provider. 4. Use a chamber infusion device on the IV pump. 5. Assess the intravenous site every hour.

66. 1. The HCP is responsible for identifying abnormal data noted during the procedure. 2. The instrument being used is a fiberoptic scope, and it will be in the HCP's hands during the procedure. The instrument that might be handed is the biopsy instrument, but this is not a priority over the respiratory function of the client. 3. The child will have received conscious sedation; the nurse should monitor the child's respiratory status to make sure that respiratory depression leading to respiratory failure does not occur. 4. The nurse or a technician will clean the instruments after a procedure, but this is not priority over monitoring the client.

66. The child diagnosed with gastroenteritis is scheduled for an endoscopic examination of the stomach and duodenum. Which intervention is priority for the nurse assisting with the procedure? 1. Watch the screen for abnormal data. 2. Hand the physician the instruments. 3. Monitor the child's respiratory status. 4. Clean the instruments between clients.

68. 1. Antiemetic suppositories are not administered on this schedule for clients with gastroenteritis. They are administered on a PRN basis. Suppositories are manufactured in a set mg/suppository (25 mg); this could be an excessive amount of medication depending on the weight of the child. 2. The bacteria are transmitted by an oral route. The child should be in contact precautions in the hospital and the family should be cautious with handwashing and sharing glasses or eating utensils at home, but wearing a mask is not necessary. 3. E. coli is a bacterium and is treated with antibiotics. The nurse should teach the parents to make sure that the child takes all the antibiotics as prescribed. 4. Current research indicates that taking antidiarrheal medications when an infectious bacterium is present only delays healing because the bacteria cannot be eliminated from the body through the stool.

68. The 10-year-old client is diagnosed with an Escherichia coli infection after being at a day camp. Which discharge instructions should the nurse teach the parent? 1. Give the child an antiemetic suppository before each meal. 2. Have anyone in contact with the child wear a mask. 3. Be sure the child takes all the antibiotic medication. 4. Administer an antidiarrheal after each loose stool.

69. 1. Acidophilus is not an antibiotic and will not treat a bacterial infection. 2. Acidophilus will not increase the child's ability to develop immunity to Shigella. 3. Acidophilus is a bacterium that replaces the normal intestinal flora and helps to prevent secondary diarrhea caused by destroying this flora. 4. Acidophilus is not an antibiotic

69. Which is the scientific rationale for administering acidophilus capsules to a child diagnosed with a Shigella infection? 1. The acidophilus capsule will treat the Shigella infection. 2. The acidophilus will help the child develop an immunity to Shigella. 3. The acidophilus will prevent a complication of the antibiotics. 4. The acidophilus is the antibiotic of choice for Shigella.

7. 1. Nexium is an oral medication; an intravenous pump is not needed. 2. The head of the bed is elevated for the client to be able to swallow the medication. 3. The nurse must check the medication administration record (MAR) with the client's ID band to ensure the correct client is receiving the medication. 4. Nexium is not a cephalosporin. The cephalosporins are a class of antibiotics. 5. The Joint Commission requires that two patient identifiers be used to determine the "right patient." Most health-care facilities use the client's name and date of birth as these identifiers.

7. The nurse is preparing to administer the proton-pump inhibitor esomeprazole (Nexium). Which intervention should the nurse implement? Select all that apply. 1. Order an infusion pump for the client. 2. Elevate the client's head of the bed. 3. Check the client's ID band with MAR. 4. Check for allergies to cephalosporin. 5. Ask the client his or her date of birth.

70. 1. The mode of transmission for rotavirus is oral-fecal route; therefore, anyone coming into contact with the child's feces should wash his or her hands. 2. The rotavirus is a virus and antibiotics do not treat a virus. 3. The parents should not discard the diapers until the nurse has weighed the diapers to determine the toddler's hydration status. 4. The purpose of admitting a child with rotavirus is to ensure that dehydration is prevented or treated. The nurse should start the IV and use a controlled IV chamber device. 5. At this time there is no vaccine for rotavirus. If there were a vaccine it would not help once the child has the infection. Vaccines are administered prior to the infection to prevent an infection from occurring.

70. The toddler diagnosed with rotavirus is admitted to the hospital. Which intervention should the nurse implement? Select all that apply. 1. Instruct the parents to wash their hands after changing diapers. 2. Schedule the antibiotic for around-the-clock dosing. 3. Teach the parent to discard the diapers in a biohazard can. 4. Initiate intravenous fluids with a controlled chamber device. 5. Administer the rotavirus vaccine in the toddler's thigh.

71. 1. Medications alone will not guarantee weight loss. The client should exercise regularly and limit calories to lose an appreciable amount of weight. 2. Some of the medications have drug interactions with selective serotonin reuptake inhibitors, MAO inhibitors, triptans, and some opioids, but not with antihypertensive medications. 3. Weight loss attributable to drug therapy is usually between 4.4 and 22 pounds over a 6-month period. 4. The medications are prescribed for up to a year at a time.

71. The client who is obese is prescribed medication therapy to aid in weight reduction. Which information should the nurse teach the client? 1. While taking the medications, the client does not need to limit caloric intake. 2. The medications cannot be taken with antihypertensive medications. 3. The medications will not result in the loss of large amounts of weight. 4. The client will be taking the medications for 2-3 weeks at a time.

72. 1. Sibutramine does not act on the thyroid gland. 2. Sibutramine is not an antidepressant. Caution is used when prescribing sibutramine to a client taking an SSRI or MAO inhibitor antidepressant because a potentially life-threatening serotonin syndrome can occur. 3. Sibutramine can cause constipation, not diarrhea. 4. Sibutramine works by suppressing the client's appetite and possibly by increasing the client's metabolism by blocking serotonin and norepinephrine uptake.

72. The client with a body mass index (BMI) of 35 is prescribed sibutramine (Meridia), an antiobesity medication. Which statement is the scientific rationale for prescribing this medication? 1. Sibutramine works by increasing the production of thyroid hormone. 2. Sibutramine works by treating the depression associated with obesity. 3. Sibutramine works by causing diarrhea and weight loss through the bowel. 4. Sibutramine works by suppressing the client's appetite.

73. 1. Xenical acts by inhibiting the absorption of fats and cholesterol in the GI tract. The client should eat a reducedcalorie diet with no more than 30% of the calories coming from fats. Increasing the fat intake can result in foulsmelling, frothy, diarrhea stools. The client needs more teaching. 2. The client should eat a reduced-calorie diet with no more than 30% of the calories coming from fats. Increasing the fat intake can result in foul-smelling, frothy, diarrhea stools. This statement does not require intervention. 3. Metamucil will add bulk to the stool and limit the diarrhea that can occur with Xenical. This statement does not require intervention. 4. Xenical can interfere with the absorption of needed vitamins and minerals. This statement does not require intervention.

73. The client is prescribed orlistat (Xenical), a lipase inhibitor. Which statement by the client indicates the client requires more teaching? 1. "It does not matter what I eat because I will still lose weight." 2. "I will limit the amount of fat in my diet to 30%." 3. "I may need to take Metamucil daily with the orlistat." 4. "I will take a daily multivitamin supplement."

74. 1. Leptin is administered subcutaneously daily and can suppress the appetite to achieve a moderate weight loss. Weight loss resulting from leptin is almost all fat. 2. Leptin is given by the parenteral route, not orally. 3. The risk of an allergic reaction is rare. EpiPens are used by clients who are allergic to bee stings or wasp venom. 4. The most common side effect of leptin is a localized itching or swelling at the injection site

74. The client diagnosed with type 2 diabetes mellitus and a body mass index (BMI) of 29 is prescribed the hormone leptin. Which intervention should the nurse implement? 1. Administer the medication subcutaneously in the deltoid. 2. Determine if the client is taking OTC oral leptin supplements. 3. Have an EpiPen ready for possible allergic reaction. 4. Teach that flulike symptoms are a side effect of leptin.

75. 1. This is an over-the-counter preparation that can be used safely, if used as directed by the manufacturer. All medications can be abused if taken incorrectly, but the client did not say that she was abusing the drug. 2. The nurse should portray a nonjudgmental attitude when discussing treatments and medications or herbs the client has used to treat any health problem. The nurse should assess what else the client has tried for weight loss. 3. This is a judgmental statement, and the nurse does not know what the HCP will prescribe. 4. The question does not require a therapeutic response from the nurse. The question requires a factual response.

75. The female client tells the clinic nurse that she has been taking Dexedrine, an overthe- counter medication, for weight loss. Which statement should be the nurse's best response? 1. "This is a dangerous medication and you should not take it." 2. "What other things have you tried to lose weight?" 3. "Your HCP can prescribe a better weight loss program." 4. "Tell me how you feel about being overweight."

76. 1. Xenical will decrease the absorption of fats and cholesterol in the GI tract, but it will not help the client to quit smoking. 2. Meridia can suppress the appetite, but it will not address the smoking. 3. Zyban is an antidepressant that is used to assist clients to quit smoking. It has also been shown to suppress the appetite by suppressing the uptake of norepinephrine and serotonin. 4. Olean is a nonabsorbable fat substitute; it does not help with nicotine withdrawal or suppress the appetite.

76. Which medication should be the most appropriate medication for the client who is obese who is trying to quit smoking? 1. Orlistat (Xenical), a lipase inhibitor. 2. Sibutramine (Meridia), an appetite suppressant. 3. Bupropion (Zyban), an antidepressant. 4. Olestra (Olean), a fat substitute.

77. 1. Meridia can be taken at any time, with food or on an empty stomach. 2. All weight loss programs include some type of exercise. Exercise for at least 20 minutes 3-4 times a week is recommended 3. An appropriate weight loss goal is 1-2 pounds per week. Many Americans want a quick-fix solution to obesity, but a slow weight loss program that includes reduced calories, exercise, and behavior modification is the only proven method of sustained weight loss other than surgery. 4. Meridia can cause a mild elevation in the blood pressure, not orthostatic hypotension. 5. Meridia can cause a mild elevation in the blood pressure; the client should avoid medications that contain ephedrine or pseudoephedrine, which are found in many OTC cold remedies and which can raise the blood pressure.

77. The nurse is discussing weight loss therapy with a client who is obese who has been prescribed sibutramine (Meridia). Which information should the nurse provide? Select all that apply. 1. Do not take Meridia on an empty stomach. 2. Exercise for 20 minutes 3-4 times a week. 3. An appropriate goal is a 1-2-pound loss weekly. 4. Meridia can cause orthostatic hypotension. 5. Do not take OTC cold remedies while taking Meridia.

78. 1. Glucophage is being investigated for weight loss in clients who do not have diabetes. There is no need to monitor the hemoglobin A1C. Glucophage acts on the liver to prevent gluconeogenesis; it does not increase insulin levels. 2. Glucophage is being investigated for weight loss in clients who do not have diabetes. There is no need to monitor daily fasting blood glucose levels. Glucophage acts on the liver to prevent gluconeogenesis; it does not increase insulin levels. 3. Urine ketones are monitored when a client diagnosed with diabetes has a high glucose level and sometimes by clients on the Atkins diet to monitor if they are having success. Normal diets do not monitor urine ketones. 4. The medication is being administered for weight loss; the client's weight should be monitored.

78. The client who is obese is participating in an investigational study using metformin (Glucophage), a biguanide antidiabetic medication, for weight loss. Which data should the nurse monitor? 1. The hemoglobin A1C every 2 months. 2. Daily fasting glucose levels. 3. The urine ketones every 2 weeks. 4. The client's weight every month.

79. 1. If a client consumes more than 30% of daily calories in fats while taking Xenical, the fats will not be absorbed by the gastrointestinal tract and the result is foul-smelling, frothy, diarrhea stools. 2. The "statins," or lipid-lowering medications, would not cause this response. 3. This is an uncomfortable and sometimes embarrassing possibility with this medication; it is not desired. 4. The foul-smelling, frothy, diarrhea stool indicates that the stool contains undigested fats. This is not a symptom of a chronic bowel syndrome.

79. The client taking orlistat (Xenical), a lipase inhibitor, reports copious frothy diarrhea stools. Which data should the nurse suspect is the cause of the diarrhea? 1. The client has consumed an excessive amount of fats. 2. The client is also taking a lipid-lowering medication. 3. This is a desired effect of the medication. 4. The client has developed a chronic bowel syndrome.

8. 1. There may be several complications of GERD. Adult-onset asthma and Barrett's esophagus leading to cancer of the esophagus are two complications of GERD. The chance of developing these problems is less if the GERD is adequately treated, but there are no guarantees. 2. The client should always be informed of what symptoms to report to the HCP. 3. The client should be instructed to sit upright for at least 60 minutes following a meal to prevent reflux from occurring. 4. NSAIDs can increase gastric distress. Ulcers caused by NSAID use may be asymptomatic, or the symptoms may be attributed to the GERD. The client should use the prescribed H2 receptor blocker, proton-pump inhibitor, or an antacid to relieve the discomfort associated with GERD.

8. The nurse is discharging a client diagnosed with gastroesophageal reflux disease (GERD). Which information should the nurse include in the teaching? 1. There are no complications of GERD as long as the client takes the medications. 2. Notify the health-care provider if the medication does not resolve the symptoms. 3. Immediately after a meal, lie down for at least 45 minutes. 4. If any discomfort is noted, take an NSAID for the pain.

80. 1. Zyban is listed as an antidepressant, but it has proven efficacy for nicotine withdrawal. The main risk factor for developing COPD is smoking; therefore, the nurse would not question administering this medication. 2. Clients who have had surgery have significant pain; the nurse would not question administering a narcotic medication. 3. Clients diagnosed with IBS experience frequent diarrhea. The nurse would not question this medication. 4. Combining Meridia with any other serotonergic medication, such as Prozac, can cause serotonin syndrome, a potentially life-threatening reaction characterized by incoordination, hyperreflexia, myoclonus, fever, tremors, sweating, and mental changes. The nurse should hold the medication and discuss this with the HCP.

80. The nurse is administering morning medications. Which medication should the nurse question administering? 1. Bupropion (Zyban), an antidepressant, to a client who has chronic obstructive pulmonary disease (COPD). 2. Meperidine (Demerol), a narcotic analgesic, to a client who has had gastric bypass surgery for obesity. 3. Loperamide (Imodium), an antidiarrheal, to a client who has irritable bowel syndrome (IBS). 4. Sibutramine (Meridia), an appetite suppressant, to a client receiving fluoxetine (Prozac) for depression.

81. 1. Some laxatives are high in sodium or glucose and the contents of the laxative should be checked, but this should not be the nurse's first response. 2. Rash or itching is indicative of an allergic reaction that can occur with laxatives, but because the client has been taking the laxatives daily this should not be the nurse's first response. 3. Laxatives are indicated for short-term use only and overuse of laxatives robs the bowel of its ability to perform well on its own. Laxative dependency is a very serious and common problem of the elderly; therefore, this should be the nurse's first response. The nurse should teach the client safety. 4. This is a true statement, but the nurse should first teach the client about safety, specifically the importance of not taking laxatives daily.

81. The older adult client is discussing complaints of constipation with the clinic nurse. The client tells the nurse, "I take a laxative every day so that I will have a bowel movement every day." Which statement should the nurse respond to first? 1. "Do you have heart problems or diabetes?" 2. "Have you ever had a rash or itching when you took a laxative?" 3. "You should not use laxatives every day." 4. "Most people don't have to have bowel movements daily."

82. 1. Bulk laxatives add fiber to the diet and should be taken daily, but it may take from 12 hours to 3 days for the laxative to work. Therefore, this should not be recommended to the client. 2. The nurse cannot prescribe medications, but laxatives are over-the-counter medications and the nurse can recommend one to the client. Constipation is not a condition that requires an appointment with an HCP unless a laxative does not work or if the stool is abnormal. 3. A stool softener takes from 24 to 48 hours to work and this client needs something that will work immediately. 4. A stimulant laxative usually acts within 6-10 hours. However, castor oil acts within 1-3 hours. Therefore, this should be recommended because the client has not had a bowel movement in 4 days and is symptomatic.

82. The client is complaining of not having a bowel movement in 4 days and is having abdominal discomfort. Which intervention should the nurse recommend to the client? 1. Instruct the client to take methylcellulose (Citrucel), a bulk-forming laxative. 2. Encourage the client to make an appointment with the health-care provider. 3. Explain to the client the need to take docusate sodium (Colace), a stool softener. 4. Tell the client to take the lubricant laxative castor oil 2 hours after the next meal.

83. 1. Bacid is a nonprescription product specifically used to treat diarrhea caused by antibiotics. It reestablishes normal intestinal flora and may be used prophylactically in clients with a history of antibiotic-induced diarrhea. 2. Diarrhea is a side effect of some antibiotics because antibiotics kill the good flora in the bowel, but the HCP needs to be notified so something can be done about the diarrhea. 3. The nurse should realize that antibiotics can cause diarrhea and should not assess for possible gastroenteritis. 4. The client should not quit taking the antibiotic because there may be a relapse of the infection for which the antibiotic was prescribed and the full dosage of antibiotic prescribed should always be taken. 5. Lomotil may cause serious health problems when overdosed which is why the client cannot take more than eight tablets in 24 hours.

83. The client taking antibiotics calls the clinic and tells the nurse the client has diarrhea. Which interventions should the nurse implement? Select all that apply. 1. Recommend the client take lactobacillus (Bacid), an antidiarrheal agent. 2. Explain diarrhea is a side effect of antibiotics and should be reported to health-care provider. 3. Ask the client if he or she has had any type of bad-tasting or -smelling food. 4. Instruct the client to quit taking the antibiotic for 24 hours, and then start taking again. 5. Tell client to take one diphenoxylate/atropine (Lomotil) after each loose stool up to 8 a day.

84. 1. This is known as traveler's diarrhea caused by Escherichia coli bacteria. If the client takes an antidiarrheal agent, it will slow peristalsis, delay export of the causative organism, and prolong the infection. Therefore, this should not be the nurse's first intervention. 2. Tourists are often plagued by infectious diarrhea, known as traveler's diarrhea, Montezuma's revenge, or Aztec twostep, which is caused by the bacteria Escherichia coli. As a rule, treatment is not necessary and the diarrhea is self-limiting. If diarrhea is severe, it is treated with an antibiotic. Therefore, the nurse should assess the severity of the diarrhea first. 3. This is probably traveler's diarrhea, and as a rule treatment is not necessary because it is self-limiting. If diarrhea is severe, it is treated with an antibiotic. Therefore, the nurse should assess the severity of the diarrhea first. 4. This is a possibility, but the nurse should assess the severity, length of time of diarrhea, and whether the client is dehydrated before making this statement. MEDICATION MEMORY JOGGER: When answering test questions or when caring for clients at the bedside, the nurse should remember that assessing the client is usually the first intervention, but when the client is in distress, the nurse may need to intervene directly to help the client.

84. The female client calls the clinic complaining of diarrhea and reports that she just came back from vacation in Mexico. Which intervention should the nurse implement first? 1. Instruct the client to take loperamide (Imodium), an antidiarrheal medication. 2. Ask how long the client has had the diarrhea and when she returned from Mexico. 3. Explain that an antibiotic should be prescribed and that the client needs to see the HCP. 4. Tell the client this is probably traveler's diarrhea and it will run its course.

85. 1. Some antidiarrheal medications contain habit-forming drugs and should be used as directed only. 2. Clear liquids allow the bowel to rest. A client with diarrhea should be consuming clear liquids only for 24 hours, then move on to eating a bland diet, and after that progress to eating more solid food if the diarrhea does not reoccur. 3. If the client has had diarrhea more than 48 hours, the nurse should recommend the client come to the office because an elderly client is at risk for dehydration. 4. The client does not need to go to the emergency department but may need to be seen in the clinic if the diarrhea has occurred for longer than 24 hours or the client shows signs of dehydration. 5. The nurse should determine what other medications the client is taking because diarrhea is a side effect of digoxin toxicity and may be a side effect of many other medications. The nurse should always ask what other medications the client is taking.

85. The elderly client calls the clinic and is complaining of loose, watery stools. Which interventions should the nurse implement? Select all that apply. 1. Instruct the client to take the antidiarrheal exactly as recommended. 2. Recommend the client drink clear liquids only, such as tea or broth. 3. Determine how long the client has been having the loose, watery stool. 4. Tell the client to go to the emergency department as soon as possible. 5. Ask the client what other medications he or she has taken in the past 24 hours.

86. 1. An antispasmodic medication controls spasms of the gastrointestinal tract and may help with irritable bowel syndrome, but it does not help prevent constipation. 2. Low-residue foods have low fiber and will cause the client to become constipated. 3. Getting daily exercise, increasing fluid intake, eating a high-fiber diet, and using a stool softener that lubricates the stool lead to regular bowel movements, which, in turn, prevent constipation. 4. A daily bowel movement is not required to prevent constipation; some clients have bowel movements every other day, which is fine as long as the bowel movements are regular. Regular bowel movements prevent the development of constipation.

86. The nurse is working at a senior citizen center. She is giving a lecture on healthpromotion activities for the elderly. Which information should the nurse discuss with the group to help prevent constipation? 1. The antispasmodic dicyclomine (Bentyl), taken every morning with the breakfast meals, will help prevent constipation. 2. Eating five to six small meals a day including low-residue foods will help prevent the development of constipation. 3. Taking a daily stool softener along with daily exercise, increased fluids, and a high-fiber diet will help prevent constipation from developing. 4. Elderly clients must have at least one bowel movement a day to prevent the development of constipation.

87. 1. Because Lomotil has atropine and is a Schedule V controlled substance, the client should not take more than eight in a 24-hour period. 2. The client should drink clear liquids and increase fluid intake to help prevent dehydration. 3. Lomotil should not be taken for more than 2-3 days. If the diarrhea persists more than 48 hours, the client should notify the health-care provider. 4. An adult should take two tablets and then one tablet after each loose stool up to a maximum of eight tablets in 24 hours. Atropine in the medication helps prevent narcotic abuse, but atropine is an anticholinergic medication, which dries up secretions.

87. The client with diarrhea is taking diphenoxylate (Lomotil). Which intervention should the nurse discuss with the client? 1. Instruct the client to take one pill after each loose stool until the diarrhea stops. 2. Discuss the need to decrease fluid intake to help decrease loose, watery stool. 3. Explain that the medication should be taken once a day for 1 week. 4. Tell the client not to take more than eight tablets in a 24-hour period.

88. 1. Lomotil is an antidiarrheal medication, but because the client has had diarrhea the past 3 days, the nurse should have the client come to the clinic. 2. The client with diarrhea should be restricted to clear liquids such as tea, gelatin, or broth. 3. Determining what the client has eaten may help determine the cause of the diarrhea, but 3 days is too long to have diarrhea. The client may become dehydrated. 4. Diarrhea that persists for more than 48 hours should not be self-treated. The client should be seen by the HCP for further evaluation and diagnosis.

88. The client calls the clinic and reports large amounts of watery stool for the past 3 days. Which intervention should the clinic nurse implement? 1. Instruct the client to take diphenoxylate (Lomotil) after each loose stool. 2. Recommend the client eat some cheese or constipating-type food. 3. Request that the client write down all foods ingested in the past 3 days. 4. Make an appointment for the client to come to the clinic today.

89. 1. This information is true and should be shared with the client. Chronic exposure to laxatives can diminish defecatory reflexes, leading to further reliance on laxatives. It may also cause serious pathologic changes, including electrolyte imbalance, dehydration, and colitis. 2. Bulk-forming laxatives increase fiber, which will help decrease constipation, but they do not cause laxative abuse. 3. A daily Fleet's enema should be discouraged because it causes laxative dependency and can irritate the rectum and anal area. 4. The nurse should recommend a high-fiber diet and an increase in fluid intake, but that does not ensure that an elderly client will not get constipated. The client may need laxatives occasionally, and the nurse should always provide correct information to the client.

89. The nurse is discussing the problem of constipation with an elderly client. Which information should the nurse discuss with the client concerning laxative abuse? 1. Explain that stimulant laxatives, the chewing gum and chocolate types, are the kind most often abused. 2. Discuss that laxative abuse can occur if the client takes bulk-forming laxatives on a daily basis. 3. Tell the client that taking a Fleet's enema daily will help prevent the client from becoming dependent on laxatives. 4. Recommend to the client that eating a high-fiber diet and increasing fluid consumption will ensure the client will not get constipated.

9. 1. Prophylactic antibiotics are frequently prescribed both presurgery and postsurgery. The client should be instructed to take all the medication as directed. 2. Hiatal hernia repair may not last and the client should continue the recommended lifestyle modifications, such as eating small meals. 3. Part of the lifestyle modifications for hiatal hernia is to limit pressure on the abdominal cavity, especially after a meal. Using the leg muscles to bend down, rather than bending over, should be taught to the client. 4. Nexium is administered daily, not twice a day. 5. For best relief, pain medication should be taken at the onset of the pain. The client should not wait until the pain is an 8-10 before taking the pain medication.

9. The nurse is discharging a client 2 days postoperative hiatal hernia repair. Which discharge instructions should the nurse include? Select all that apply. 1. Take all the prescribed antibiotic. 2. Eat six small meals per day. 3. Use the legs to bend down, not the back. 4. Take esomeprazole (Nexium) twice a day. 5. Use the pain medication when the pain is at 8-10.

90. 1. Senna may cause the stool to turn this color; therefore, there is no need for the client to come to the clinic. 2. Senna (Senokot, Ex-Lax, and Agoral) may cause a yellow or yellow-green cast to feces; it may cause a red-pink discoloration of alkaline urine or yellow-brown color in acid urine. The nurse should teach the client about this when the medication is prescribed. 3. Because this change in the color of the stool is common with senna, there is no need for the client to bring a stool specimen to the clinic. 4. Some foods can cause a discoloration of feces, but yellow-green feces are a side effect of the medication. MEDICATION MEMORY JOGGER: If the client verbalizes a complaint, if the nurse assesses data, or if laboratory data indicates an adverse effect secondary to a medication, the nurse must intervene. The nurse must implement an independent intervention or notify the health-care provider because medications can result in serious or even life-threatening complications.

90. The client is prescribed the stimulant laxative senna (Senokot) for constipation. The client calls the clinic and reports yellow-green-colored feces. Which intervention should the clinic nurse implement? 1. Have the client come to the clinic immediately. 2. Explain that this is a common side effect of Senokot. 3. Instruct the client to get a stool specimen to bring to the clinic. 4. Determine if the client has eaten any type of yellow or green food.

91. 1. This does not need to be reported to the surgical team. 2. Allergy to shellfish usually indicates an allergy to iodine, the active ingredient in povidone (Betadine) surgical scrub. The nurse should place an allergy alert on the front of the client's chart, put an allergy bracelet on the client, and document the finding on the preoperative checklist. 3. If the client has had something to eat the surgery must be cancelled because food can lead to potential aspiration pneumonia. 4. An infection last month should be cleared by now; this does not need to be reported to the surgical team. 5. If the client has a productive cough, the surgery may be cancelled because coughing postoperatively could cause a dehiscence of the wound. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about diagnostic tests and surgical procedures. If the client provides information that would cause harm to the client, then the nurse must intervene.

91. The day surgery nurse is admitting a client for repair of an inguinal hernia. Which information provided by the client is most important to report to the surgical team? Select all that apply. 1. The client has never had surgery before. 2. The client is allergic to shellfish. 3. The client had breakfast this morning. 4. The client had a sinus infection last month. 5. The client has had a productive cough for a week.

92. 1. The incision is a right upper-abdominal incision for a gallbladder. 2. Clients should be turned every 2 hours, not every hour, and will be turned from side to side and to the back. 3. The client will be NPO for a day or two and will have intravenous fluids, but unless complications occur there is no reason for total parenteral nutrition (TPN). 4. The nurse should discuss pain control procedures with all clients having surgery.

92. The client is being prepped for an open cholecystectomy. Which preoperative instruction is most important for the nurse to teach? 1. There will be an upper-left abdominal incision. 2. The client will be turned to the left side every hour. 3. The client will be placed on total parenteral nutrition. 4. Discuss pain medications and the 1-10 pain scale.

93. 1. This is an intervention that will be done the morning of surgery, not the evening before. 2. This is important, but it can be done at any time prior to surgery. The night nurse or the nurse completing the checklist form in the morning could do this. 3. Preoperative scrubs are ordered to cleanse the skin of bacteria. This should be done the evening before and also may be done the morning of surgery. 4. This is an important intervention for postoperative care, but it is not necessary the evening before surgery.

93. The client is scheduled for an exploratory laparotomy in the morning. Which healthcare order has priority? 1. Prepare the preoperative injection for when the OR notifies the floor. 2. Document the client's hemoglobin and hematocrit on the checklist. 3. Be sure the client has taken the preoperative Phisohex shower. 4. Ambulate the client in the hallway at least two times.

94. 1. For safety the nurse should doublecheck PCA settings with another nurse. This ensures that the correct dosage is being administered when the client pushes the PCA button. 2. The initial bolus should have been administered by the PACU nurse; the PCA button should be controlled by the client and no one else. 3. The client is the only person who should push the PCA button and it should be pushed when the client is in pain. 4. The client is returning from PACU. The cartridge holds 30 mL of medication and should not have been completely used in the PACU. 5. The PCA pump is administered intravenously and the nurse should assess the insertion site to ensure it is not inflamed or infiltrated.

94. The client who has had an abdominal surgery has returned from the post-anesthesia care unit (PACU) with a patient-controlled analgesia (PCA) pump. Which interventions should the nurse implement? Select all that apply. 1. Check the PCA setting with another nurse. 2. Administer a bolus by pushing the button. 3. Instruct the client to push the PCA button when in pain. 4. Change the patient-controlled analgesia cartridge. 5. Assess the client's intravenous insertion site.

95. 1. The client who has had general anesthesia frequently experiences nausea while the effects of the anesthetic agents are wearing off. The charge nurse should anticipate the client's needs and prepare for them. 2. The client would have been "asleep" while under general anesthesia and could not complain of nausea to the anesthesiologist. 3. The surgeon may have overlooked the need for an antiemetic while writing the orders; the nurse should contact the surgeon and ask for the order. 4. The charge nurse should not have to request a primary nurse to keep the charge nurse informed of the client's condition.

95. The client had a general anesthetic for an abdominal surgery. When taking off the postoperative orders the charge nurse notes there is no antiemetic medication ordered. Which action should the charge nurse take? 1. Continue transcribing the orders and do nothing. 2. Ask the anesthesiologist if the client was nauseated during surgery. 3. Contact the surgeon and request an order for an antiemetic. 4. Tell the client's nurse to notify the charge nurse if there is nausea.

96. 1. The nurse should never write "incident report" in a client's chart; this sends a red flag to an attorney that an error has been made. When an error is made, the facts should be charted honestly and succinctly. 2. Many PACU nurses are given standing orders to use their judgment about the route of administration of postoperative pain medications. The theory of administering the medications by both routes is that the client will receive immediate relief from the IV route and the IM route will provide relief when the IV medication has worn off. The nurse should always chart accurately what was done and how. 3. This would be dishonest and could cost the nurse his or her license. 4. The number of milligrams of medication has been reversed in this option.

96. The client in the post-anesthesia care unit (PACU) has an order for meperidine (Demerol), an opioid, 75 mg IVP every 2-3 hours PRN for pain. The nurse working in the PACU administers Demerol 50 mg IM and 25 mg IVP. Which statement best exhibits how the medication should be charted? 1. Demerol administered IM and IVP, incident report completed. 2. Demerol 50 mg IM in R gluteus maximus and 25 mg slow IVP. 3. Demerol 75 mg administered by slow intravenous route. 4. Demerol 25 mg IM in L ventrogluteal and 50 mg slow IVP.

97. 1900 mL of IV fluid. 150 mL multiplied by 12 equals 1800 mL, plus 100 mL of IVPB fluid, equals 1900 mL of IV fluid

97. The client who has had abdominal surgery has an IV at 150 mL/hour for 12 hours and two IVPBs of 50 mL each. How much fluid would the nurse document on the intake and output (I & O) record?

98. 1. The client should have signed the consent form before the call that the orderly is coming to get the client for surgery is placed. Waiting until this point does not give the client time to ask questions and get clarification of concerns. 2. This should have been done the night before or at least earlier on the day of surgery. 3. The family can walk with the client to the operating room entrance and then be escorted or guided to the waiting room. 4. This is the appropriate time to administer any preoperative medication.

98. The client is on call for surgery. Which order should the nurse implement when the operating room nurse notifies the floor that the orderly is on the way to pick up the client? 1. Have the client sign the operative permit. 2. Teach the client to turn, cough, and deep breathe. 3. Notify the family to wait in the OR waiting room. 4. Administer the preoperative antibiotic IVPB.

99. 1. The client's pain level is in the mild range. The nurse can discuss nonpharmacological methods to decrease the pain further, such as distraction or guided imagery, but this level of pain is not a reason for immediate intervention. 2. Serous drainage is expected after a surgery and does not warrant immediate intervention. 3. The client's respiration rate is low, indicating a potential overdose of narcotic medication depressing the respiratory drive. This situation requires immediate intervention. 4. The client should splint the incision prior to coughing. The nurse should praise the client

99. The client post gastrectomy has a patient-controlled analgesia (PCA) pump. Which data requires immediate intervention by the nurse? 1. The client complains that the pain is still a 3. 2. The client has serous drainage on the dressing. 3. The client's has a T 99.2, P 78, R 10, and BP 110/82. 4. The client splints the incision before trying to cough.