NCLEX Pharmacology

The nurse is monitoring the IV medications that a client is receiving by an IV infusion pump. How many milligrams per hour of epinephrine should the nurse determine that the client is receiving? Round to the second decimal place. Use numbers only to answer. IV Infusion Pump: Infusing 15.0 mL/h 1.0 mcg/min Epinephrine Infusing 14.1 mL/h 5.0 mcg/kg/min Dopamine Infusing 3.0 mL/h 10.0 mcg/min Nitroglycerin Ans:______

0.06 (Rationale: (1 mcg ÷ 1 min) × (1 mg ÷ 1,000 mcg) × (60 min ÷ 1 hr) = (60 ÷ 1,000) = 0.06 mg/hr Ans: 0.06 mg/hr)

The primary healthcare provider prescribes 12,000 units of Heparin every 12 hours. The pharmacy dispensed a vial of heparin containing 40,000 units per mL. How many mL will the nurse administer? Round answer using one decimal point. Ans:______

0.3 (Rationale: (12,000 u ÷ 1) × (1 mL ÷ 40,000 u) = (12,000 ÷ 40,000) = 0.3 mL Ans: 0.3 mL)

The nurse is caring for a client in the emergency department. The primary healthcare provider prescribed penicillin 100,000 units IM. The drug label reads penicillin 300,000 units/mL. The nurse would administer how many mL of this medication? Round answer using two decimal points. Ans:______

0.33 (Rationale: (100,000 u ÷ 1) × (1 mL ÷ 300,000 u) = (100,000 ÷ 300,000) ≈ 0.33 mL Ans: 0.33 mL)

A client has a prescription for nitroglycerin gr 1/400 SL prn for angina pain. How many tablets should the nurse give the client? Use numbers and decimals only. Nitroglycerin tablets, USP Rx Only 0.3 mg (1/200 gr) 100 Sublingual Tablets Ans:______

0.5 (Rationale: (0.0025 gr ÷ 1) × (0.3 mg ÷ 0.005 gr) × (1 tab ÷ 0.3 mg) = (0.00075 ÷ 0.0015) = 0.5 tab Ans: 0.5 tab)

The nurse is preparing to give a client's prescribed ampicillin dose. How many mL will the nurse give to the client? Answer to the first decimal place. Answer with numbers and decimal only. Perscription: Ampicillin 200 mg IM every 8 hours AMPicillin IM Injection (Sandoz) 1 g / 4 mL (250 mg / mL) Ingredient (DRUG): AMPicillin 1 g (1 vial) Ingredient (DILUENT): Sterile Water for Injection 10 mL (1 vial) Procedure: 1. Withdraw 3.4 mL of Sterile Water for Injection 2. Inject the 3.4 mL of Steril

0.8 (Rationale: (200 mg ÷ 1) × (1 mL ÷ 250 mg) = (200 ÷ 250) = 0.8 mL Ans: 0.8 mL NOTE: The information tells you that 200 mg is in 0.8 mL in the bottom left corner but it is always good to double check the dose.)

A client diagnosed with hypertension has been prescribed metoprolol. Which statement by the client indicates that the client's medication instruction for metoprolol has been effective? 1. "I should not stop taking this drug immediately." 2. "I will need to rinse my mouth with water 3 times a day." 3. "I can decrease my aerobic exercises from 3 to 2 times per week." 4. "I will report irregular heartbeats, if they continue for more than 3 days."

1. "I should not stop taking this drug immediately." (1. Correct: Metoprolol, a beta-adrenergic antagonist, should not be discontinued abruptly. This action may have the serious result of precipitating angina. Metoprolol should be gradually discontinued. 2. Incorrect: Dry mouth is not a side effect of metoprolol. This drug does not stimulate anticholinergics to block acetylcholine from binding to its receptors on certain nerve cells. 3. Incorrect: Lifestyle modifications by the client should be continued. The client should not reduce the number of aerobic exercises after metoprolol has been prescribed. 4. Incorrect: The client should monitor their pulse rate, quality and rhythm daily. If changes in the quality and rhythm of the pulse occur, the primary healthcare provider should be notified immediately. A cardiovascular side of effect of metoprolol is bradycardia.)

A client with diabetes mellitus has a newly prescribed insulin pump. Which statements made by the client indicate understanding of an insulin pump? Select all that apply 1. "I will attach the pump to my waistband or wear it in the pocket of my pants." 2. "I can eat whatever I want as long as I cover the calories with sufficient insulin." 3. "I may take my insulin pump off when I exercise." 4. "I need to check my blood glucose level several times a day." 5. "I have to change the catheter at

1. "I will attach the pump to my waistband or wear it in the pocket of my pants." 3. "I may take my insulin pump off when I exercise." 4. "I need to check my blood glucose level several times a day." (1., 3. & 4. Correct: Insulin pumps are externally worn on clothing or in a pocket. Pumps can be easily disconnected for limited periods such as for showering, exercise, and sexual activity. Clients must assess their blood glucose level several times daily. 2. Incorrect: Clients are prescribed a specific caloric intake and insulin regimen, and maintaining as much consistency as possible in the amount of calories and carbohydrates is essential. 5. Incorrect: The needle or catheter attached at the end is changed at least every three days.)

Which comment made by a new nurse regarding calcium gluconate 1000 mg (10 mL) IV indicates to the charge nurse that further education is needed? 1. "Infusion rate should be 5 mL/minute." 2. "Calcium gluconate will counteract the effects of the client's hyperkalemia." 3. "I will monitor for hypophosphatemia after administering this medication." 4. "This medication is given to reverse the effects of hypermagnesemia."

1. "Infusion rate should be 5 mL/minute." (1. Correct: Calcium gluconate is administered IVP very slowly. Rapid injection may cause vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias and even cardiac arrest. The max rate is 1.5- 2 mL/min. Administration at a faster rate would indicate further education is needed. 2. Incorrect: This is a correct statement by the new nurse, indicating that the nurse understands the use of this medication. It counteracts the effects of hyperkalemia on cardiac excitability. 3. Incorrect: This is a correct statement. Calcium and phosphorus have an inverse relationship to each other. As calcium goes up, phosphorus goes down. Hypophosaphetemia may occur after administration. 4. Incorrect: This is a correct statement. Calcium gluconate is used to treat calcium deficiencies as well as magnesium sulfate overdose.)

The client diagnosed with active tuberculosis has been prescribed isoniazid 300 mg by mouth every day. What should the nurse teach this client? Select all that apply 1. "Notify your healthcare provider if your urine turns dark." 2. "Your healthcare provider has prescribed B6 along with the isoniazid to prevent neuritis." 3. "You should avoid eating aged cheeses and smoked fish." 4. "Eat foods such as tuna twice a week." 5. "Rise slowly from lying to sitting, or sitting to standing."

1. "Notify your healthcare provider if your urine turns dark." 2. "Your healthcare provider has prescribed B6 along with the isoniazid to prevent neuritis." 3. "You should avoid eating aged cheeses and smoked fish." 5. "Rise slowly from lying to sitting, or sitting to standing." (1., 2., 3., & 5 Correct: Signs of hepatotoxicity from this medication include dark urine, jaundice, and clay-colored stool. Isoniazide- induced pyridoxine (Vitamin B6) depletion causes neurotoxic effects. Vitamin B6 supplementation of 10-50 mg usually accompanies isoniazid use. Aged cheeses and smoked fish are high in tyramine which may cause palpitations, flushing, and blood pressure elevation while taking isoniazid. Avoid these foods during treatment. Isoniazid should be taken on an empty stomach, one hour before or two hours after food. Some clients experience orthostatic hypotension while taking isoniazid, so caution against rapid positional changes. 4. Incorrect: Histamine containing foods such as tu

A client newly diagnosed with insulin dependent diabetes mellitus is started on insulin aspart protamine suspension/insulin aspart solution mixture. The nurse would teach the client that the insulin should start to lower the blood sugar within how many minutes? 1. 15 2. 30 3. 45 4. 90

1. 15 (1. Correct: Insulin aspart mixture is a rapid-acting insulin and starts to work within 15 minutes after given subcutaneously. 2. Incorrect: Regular insulin has an onset of 30 minutes to 1 hour. Aspart is a rapid-acting insulin, and begins to work within 15 mnutes. 3. Incorrect: Long acting insulin has an onset of 45-48 minutes. An example of long acting insulin would be lantus. 4. Incorrect: Intermediate acting insulin such as NPH insulin has an onset of 90 minutes.)

The nurse is assessing the injection site of a healthy client who received a Mantoux skin test 48 hours ago. Which finding at the injection site indicates a need for further evaluation? 1. 16 mm induration 2. 4 mm erythrokeratodemia 3. 0.1 mL bluish colored hard wheal 4. Multiple fluid-filled vesicles

1. 16 mm induration (1. Correct: An induration of 15 mm or greater is usually considered positive in people who have normal or mildly impaired immunity. A client with a positive reaction of 15mm or greater will need further evaluation by a primary healthcare provider. 2. Incorrect: This is a small, red, hard area that is smaller than 10 mm. Therefore the size is not considered significant. Induration is roughness, not hardness. The induration is what nurses assess to determine significance. 3. Incorrect: When administering a Mantoux skin test, 0.1 mL of solution is injected under the top layer of the skin to produce a wheal. The presence of the 0.1 mL wheal is not expected at this time. 4. Incorrect: This is the significant reaction that one would find with a multiple puncture tine, which is sometimes used with mass screening for TB. This is not expected with a Mantoux skin test.)

The nurse is caring for a client who has hypercholesterolemia. When evaluating the effects of atorvastatin, the nurse should monitor the results of which laboratory tests? Select all that apply 1. AST 2. Alkaline phophatase 3. Complete blood count 4. Serum cholesterol levels 5. Serum triglyceride levels

1. AST 2. Alkaline phophatase 4. Serum cholesterol levels 5. Serum triglyceride levels (1., 2., 4. & 5. Correct: AST is a liver function test. Liver function tests including AST should be monitored before, at 12 weeks after initiation of therapy or after dose elevation, and then every 6 months. If AST levels increase to 3 times normal, atorvastatin should be reduced or discontinued. Atorvastatin may increase alkaline phosphatase and bilirubin levels. Atorvastatin is a lipid-lowering agent/HMG-CoA reductase inhibitor. The expected outcome of treatment with atorvastatin is lower serum cholesterol and triglycerides. 3. Incorrect: The CBC results would not be used to evaluate the effectiveness of treatment with atorvastatin. The CBC is used to evaluate your overall health and can be used to measure components and features of your blood such as RBC'c, WBC's, Hgb, Hct and platelets.)

The unlicensed assistive personnel (UAP) reports to the nurse that a client who received morphine sulfate 4 mg IVP 30 minutes ago has a respiratory rate of 10 breaths/ minute. What is the nurse's priority intervention? 1. Administer naloxone 0.4 mg IVP. 2. Notify the primary healthcare provider of respiratory status. 3. Deliver breaths at 20 breaths/ minute via a bag-valve mask. 4. Instruct the UAP to ambulate the client.

1. Administer naloxone 0.4 mg IVP. (1. Correct: The problem is respiratory depression due to morphine sulfate IV. Giving naloxone will reverse the respiratory depression. 2. Incorrect: The primary healthcare provider needs to know what happened, however, fix the problem first if you can. And we can, by giving the naloxone. 3. Incorrect: Give naloxone first and the client may not even need ventilation with a bag-valve mask. 4. Incorrect: Ambulation will not reverse the effects of the narcotic. And this is a safety issue. The client could fall.)

While reviewing the prescriptions written by a primary healthcare provider, the nurse notes that ibuprofen 30 mg by mouth every 6 hours is prescribed for a child weighing 6 kg. The drug information book states that the appropriate dosage range is 20-30 mg/kg/24 hours. What action should the nurse take? 1. Administer the ibuprofen at 30 mg by mouth every 6 hours. 2. Contact the nursing supervisor regarding the prescription. 3. Ask the pharmacist to calculate the appropriate dose. 4. Notify th

1. Administer the ibuprofen at 30 mg by mouth every 6 hours. (1. Correct: The appropriate range is 120 (20 mg × 6 kg) to 180 (30 mg × 6 kg) per 24 hours. Appropriate range per 6 hours is 30 (120 ÷ 4) to 45 (180 ÷ 4). 30 mg every 6 hours is appropriate. 2. Incorrect: The nursing supervisor does not need to be notified. This is a safe dose. 3. Incorrect: The nurse can calculate the appropriate dose based on the information provided. The primary healthcare provider does not need to be notified. The prescription is within the safe range. 4. Incorrect: The primary healthcare provider does not need to be notified since the prescription is written within the safe range.)

The nurse is caring for a client post heart transplant who is being discharged on cyclosporine and azathioprine. Which precautions would be important for the nurse to teach the client? Select all that apply 1. Avoid crowds. 2. Do not obtain live vaccinations. 3. Drink at least 3 liters of fluids per day and watch the urine for sediment. 4. Use a soft-bristled brush to clean your teeth. 5. Advise to use contraceptive measures during treatment.

1. Avoid crowds. 2. Do not obtain live vaccinations. 4. Use a soft-bristled brush to clean your teeth. 5. Advise to use contraceptive measures during treatment. (1., 2., 4., & 5. Correct: Both cyclosporine and azathioprine are immunosuppressants. Clients should be taught to protect themselves from sources of infection. Vaccinations are not given to immunocompromised clients. Avoidance of crowds will decrease the client's chance of contact with infections, especially those spread by droplets. As a general rule, significantly immunosuppressed clients should not receive live vaccines. Cyclosporine may cause growth of extra tissue in your gums so use a dentist regularly. These drugs are teratogenic. Clients should avoid pregnancy while on these medications. 3. Incorrect: Drinking 3 liters of fluids per day will not prevent renal impairment.)

A school nurse is planning a session on the effects of cannabis use for a high school health class. Which information does the nurse need to include? Select all that apply 1. Cannabis ingestion can cause tachycardia. 2. Inhaled cannabis produces a greater amount of tar than tobacco. 3. Cannabis smoke contains more carcinogens than tobacco smoke. 4. Cannabis ingestion reduces the risk for heart disease 5. Orthostatic hypotension can be caused by cannabis ingestion.

1. Cannabis ingestion can cause tachycardia. 2. Inhaled cannabis produces a greater amount of tar than tobacco. 3. Cannabis smoke contains more carcinogens than tobacco smoke. 5. Orthostatic hypotension can be caused by cannabis ingestion. (1., 2., 3. & 5. Correct: Tetrahydrocannabinol (THC) is the chemical compound in cannabis. THC enters the blood stream quickly and is transported to the brain and other organs. Within minutes, the heart rate may increase by 20-50 bpm and last for up to 3 hours. Cannabis ingestion may cause tachycardia and orthostatic hypotension. Cannabis smoke contains more carcinogens and tar than tobacco. Lowering of blood pressure during use is common and can lead to orthostatic hypotension. 4. Incorrect: Research has indicated that the ingestion of cannabis increases the risk for heart disease.)

A client has been instructed not to take non-steroidal anti-inflammatory drugs (NSAIDs) post lumbar laminectomy with spinal fusion. The nurse knows that education was successul when the client identifies which medications should be avoided? Select all that apply 1. Celecoxib 2. Ibuprofen 3. Naproxen 4. Acetaminophen 5. Indomethacin

1. Celecoxib 2. Ibuprofen 3. Naproxen 5. Indomethacin (1., 2., 3. & 5. Correct: NSAIDs, such as celecoxib, ibuprofen, naproxen, and indomethacin prevent platelet aggregation. This can result in a tendency for bleeding that interferes with healing after a laminectomy with spinal fusion surgery. 4. Incorrect: Acetaminophen is a peripheral-acting analgesic and not a non-steroidal anti-inflammatory drug.)

The nurse is caring for a client on the surgical unit. Which prescriptions could the nurse safely administer to the client? Select all that apply 1. Chlordiazepoxide 10 mg p.o. q 4h p.r.n. for agitation 2. Regular insulin 10 U stat 3. MS 2 mg IVP every 2 hours as needed for pain 4. Cefepime 1 gram IVPB every 8 hours 5. Diphenhydramine 25 mg p.o. hour of sleep for three nights

1. Chlordiazepoxide 10 mg p.o. q 4h p.r.n. for agitation 4. Cefepime 1 gram IVPB every 8 hours 5. Diphenhydramine 25 mg p.o. hour of sleep for three nights (1., 4. & 5. Correct: These medication prescriptions are correctly written following approved Joint Commission abbreviations. 2. Incorrect: The "U" can be mistaken for "0" (zero), the number "4" (four) or "cc". Units should be written out completely. 3. Incorrect: MS can mean morphine sulfate or magnesium sulfate. Write "morphine sulfate". Write "magnesium sulfate".)

The nurse is reviewing medications for a client who is being treated for major depression. The client is prescribed a selective serotonin reuptake inhibitor (SSRI). Which over the counter medication/supplement taken by the client should be reported to the primary healthcare provider immediately? 1. Daily intake of St. John's Wort. 2. Daily intake of a multi-vitamin. 3. Occasional use of ibuprofen. 4. Twice daily intake of an antacid.

1. Daily intake of St. John's Wort. (1. Correct: St. John's Wort is an herbal supplement often used in the treatment of mild depression. It should not be taken in combination with a selective serotonin reuptake inhibitor due to the risk of serotonin syndrome, which can be fatal. 2. Incorrect: A multi-vitamin taken with an SSRI poses no risk. 3. Incorrect: This medication taken with the SSRI would not warrant immediate reporting to the primary healthcare provider. 4. Incorrect: Antacids would not require immediate reporting.)

The nurse recognizes that Rho(D) immune globulin would be indicated for which Rh negative client? Select all that apply 1. Elective abortion at sixteen weeks gestation 2. Involved in a major car accident 3. Requires amniocentesis 4. Diagnosed with an ectopic pregnancy 5. Forty-eight hours post delivery of term Rh positive baby 6. Twenty weeks gestatation

1. Elective abortion at sixteen weeks gestation 2. Involved in a major car accident 3. Requires amniocentesis 4. Diagnosed with an ectopic pregnancy 5. Forty-eight hours post delivery of term Rh positive baby (1., 2., 3., 4. & 5. Correct: All of these clients may need to receive the Rho(D) immune globulin because they could have some bleeding and therefore develop antibodies against a Rh positive fetus. 6. Incorrect: An optional Rho(D) immune globulin dose may have been given during pregnancy by the practitioner, but it is 28 weeks, not 20 weeks.)

The nurse is caring for a client admitted with heart failure. Which prescriptions would necessitate that the nurse seek clarification from the primary healthcare provider? Select all that apply 1. Furosemide 20.0 mg p.o. daily 2. Rosuvastatin 5 mg p.o hs 3. Digoxin 0.125 mg IVP every 8 hours for three doses 4. Folic acid 1 mg daily 5. Heparin 1000 IU subcutaneously daily

1. Furosemide 20.0 mg p.o. daily 4. Folic acid 1 mg daily 5. Heparin 1000 IU subcutaneously daily (1., 4. & 5. Correct: It is inappropriate to have a trailing zero after a decimal point for doses expressed in whole numbers. It can be mistaken as 200 if the decimal point is not seen. The folic acid order lacks a route, thus needs clarification. The Heparin order should be written as Heparin 1,000 units subcutaneously daily. Use commas for dosing units at or above 1,000 or use words such as one thousand to improve readability. Use units rather than IU (International units) as this can be mistaken as IV or 10. 2., & 3. Incorrect: This medication order is written correctly.)

On morning rounds, the nurse finds a somnolent client with a blood glucose of 89 mg/dL(4.9 mmol/L). A sulfonylurea and a proton pump inhibitor are scheduled to be administered. What is the nurse's best action? 1. Give the proton pump inhibitor and hold the sulfonylurea until the client eats. 2. Hold the medications and notify the primary healthcare provider. 3. Arouse the client and give some orange juice with sugar packets added. 4. Give the medications as prescribed and re-check the blood

1. Give the proton pump inhibitor and hold the sulfonylurea until the client eats. (1. Correct: Sulfonylureas are a class of oral hypoglycemics and should be held until after a meal in a client with a blood glucose of 89mg/dl. 2. Incorrect: It is not necessary to call the primary healthcare provider; you are just waiting until the client eats. Also, the proton pump inhibitor does not affect blood glucose levels and should be administered. 3. Incorrect: A blood glucose of 89mg/dl is not hypoglcemia, do not treat unless the blood glucose drops to or below the 70-80 range. 4. Incorrect: If you administer the sulfonylurea, you are going to cause the client to secrete insulin from their pancreas, causing the blood sugar to drop and cause hypoglycemia.)

In which client should the nurse question the prescribed medication levofloxacin? 1. History of myasthenia gravis. 2. Has a prescription for verapamil. 3. Thrombocytopenic 4. Admitted with renal arterial stenosis.

1. History of myasthenia gravis. (1. Correct: Levofloxacin is contraindicated in clients with a history of myasthenia gravis because it may cause the condition to become worse. Myasthenia gravis results in a breakdown in the communication between muscles and nerves and is characterized by muscle weakness. The most commonly affected muscles are those of the eye, face, throat, neck and limbs. 2. Incorrect: Levofloxacin and verapamil are not known to be incompatible. Levofloxacin is a quinolone antibiotic and there are no contraindications for use with verapamil, a calcium channel blocker. 3. Incorrect: You would worry about thrombocytopenia in clients taking anticoagulants. Thrombocytopenia is a decrease in platelets in the blood. 4. Incorrect: ACE inhibitors are contraindicated with renal arterial stenosis. There are no contraindications of using levofloxacin with renal arteral stenosis.)

A pregnant client who had been on a magnesium drip for severe pregnancy induced hypertension (PIH) has had an emergency cesarean section at 35 weeks. The nursery nurse should anticipate what findings in the newborn related to the magnesium therapy? Select all that apply 1. Hypotension 2. Hypoglycemia 3. Hyperreflexia 4. Flaccid muscle tone 5. Respiratory depression

1. Hypotension 4. Flaccid muscle tone 5. Respiratory depression (1., 4. & 5. Correct: When magnesium sulfate is administered to the mother for preeclampsia, the intent is to prevent seizures and decrease blood pressure by suppressing the central nervous system, thus preventing premature labor. The dose of this drug and the length of time administered will determine what side effects might be seen in the newborn, since magnesium crosses the placental barrier. The nurse will most likely note hypotension and some degree of respiratory depression in the newborn. Additionally, the newborn may have flaccid or weak muscles along with poor, or even absent reflexes. Treatment of the newborn will be based on the degree of depression. 2. Incorrect: The use of magnesium sulfate in the mother prior to delivery does not affect the blood glucose level of the fetus/newborn. Magnesium sulfate affects the central nervous system, not the pancreas, so blood sugar should be within normal limits. 3. In

A client was prescribed a monoamine oxidase inhibitor (MAOI) for the treatment of depression. Which comment by the client indicates adequate understanding of the tyramine restrictions that apply? 1. I cannot eat avocados or smoked ham. 2. I can eat sausage for breakfast, but not bacon. 3. At least I can still have my beer. 4. I can have blue cheese on my salad but not ranch dressing.

1. I cannot eat avocados or smoked ham. (1. Correct. Clients taking MAOIs cannot consume foods containing large amounts of tyramine. MAOIs block monoamine oxidase which breakdown tyramine. Having a MAOI prescribed and eating a diet high in tyramine can cause a severe increase in blood pressure. Smoked ham and avocados are high in tyramine. 2. Incorrect. Clients taking these medications cannot eat the following foods: sausage, salami, liver, or bologna which have high levels of tyramine. 3. Incorrect. Clients taking these medications cannot consume beer, sherry, chianti wines, or ales due to their high tyramine levels. 4. Incorrect. Consuming blue cheese on a salad may result in a hypertensive crisis due to the presence of tyramine.)

The nurse is developing a teaching plan for a female client who is taking one of the thiazolidinediones for the treatment of type 2 diabetes. What instruction should be included in the teaching plan? 1. Make sure that you use effective contraception while taking this drug. 2. The drug may lead to weight loss. 3. Therapeutic effect is reached within one to two weeks. 4. Therapeutic effect is reached within one month.

1. Make sure that you use effective contraception while taking this drug. (1. Correct: Thiazolidinediones may reduce the plasma concentration of the contraceptives. Additionally, post-menopausal women may resume ovulation. 2. Incorrect: Thiazolidinediones may lead to weight gain and exacerbate congestive heart failure. 3. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 8 to 12 weeks of treatment. 4. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 2 to 3 months of treatment.)

The nurse is assisting with a client who will receive electroconvulsive therapy (ECT). The anesthesiologist administers succinylcholine chloride intravenously. What adverse effects should the nurse monitor for post procedure? Select all that apply 1. Malignant hyperthermia 2. Hypokalemia 3. Apnea 4. Tetany 5. Arrhythmias

1. Malignant hyperthermia 3. Apnea 4. Tetany 5. Arrhythmias (1., 3., 4. & 5. Correct: Succinylcholine is a paralytic used to relax the muscles to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fracture or dislocated bones. Adverse effects include malignant hyperthermia, apnea, and arrhythmias. It causes paralysis of the muscles of the face and those used to breath, so monitoring for apnea is very important. Tetany, spasms or stiffness in the jaw would be adverse effects and can indicate malignant hyperthermia. 2. Incorrect: Hyperkalemia can occur. Succinylcholine is a depolarizing muscle relaxant which means during prolonged muscle depolarization, the muscle may release large amounts of potassium into the blood.)

The nurse is caring for a client on the cardiac unit. Which assessments are most important for the nurse to perform prior to the administration of diltiazem? Select all that apply 1. Note the rate and character of the apical pulse. 2. Ausculate the anterior and posterior breath sounds. 3. Check the morning results of serum calcium. 4. Review the last 24 hour urine output. 5. Monitor blood pressure. 6. Assess for chest pain.

1. Note the rate and character of the apical pulse. 5. Monitor blood pressure. 6. Assess for chest pain. (1., 5., & 6. Correct: Diltiazem is a calcium channel blocker. It works by relaxing the muscles of the heart and blood vessels. Monitor blood pressure and pulse before and frequently during administration of diltiazem, as it causes systemic vasodilation and suppresses arrhythmias. Diltiazem is used to treat angina, so the nurse should assess for anginal pain. 2. Incorrect: Breath sounds need to be assessed to monitor for signs of heart failure, this would be a complication after diltiazem administration. Breath sounds are not necessarily assessed just prior to administration. 3. Incorrect: Diltiazem is a calcium channel blocker, but the total serum calcium concentration is not affected by it. Calcium channel blockers affect the flow of calcium into muscle cells. 4. Incorrect: A decrease in output would be an indicator of heart failure, which is a complication of diltiazem adm

The nurse is caring for a client diagnosed with alcohol dependence who is prescribed a benzodiazepine. Which potential side effect of benzodiazepine has a higher priority for the nurse to monitor? 1. Sedation 2. Drowsiness 3. Drug dependence 4. Impaired coordination

1. Sedation (1. Correct: Maintaining a client's airway is always a priority. The nurse should observe the client for excessive sedation. After a benzodiazepine is administered, the client may fall asleep, transition into respiratory depression and apnea. 2. Incorrect: A side effect of benzodiazepine is drowsiness. Though the actions of the client may be slower, and the client may feel drowsy, the nurse's priority is to assess the client's sedation level. 3. Incorrect: Benzodiazepine therapy can result in substance abuse which can result in physical dependence. Maintaining a client's airway or apnea is a life-threatening situation. The priority intervention is to monitor the client's sedation. 4. Incorrect: The client may experience impaired coordination when prescribed benzodiazepine. Benzodiazepine depresses the central nervous system (CNS). The nurse's priority is to monitor the sedation level of the client.)

The nurse is preparing to administer 1000 mL D5W with 40 mEq KCl IV over 12 hours. How many gtts/min will the nurse need to set the IV rate at? Primary I.V. Set, Convertible Pin, 80 Inch With Backcheck Valve And 2 Injection Sites Piggyback No. 5966 10 Drops/mL Ans:______

14 (Rationale: (1,000 mL ÷ 12 hr) × (10 gtt ÷ 1 mL) × (1 hr ÷ 60 min) = (10,000 ÷ 720) ≈ 14 gtt/min Ans: 14 gtt/min)

The nurse is preparing to hang an IV bottle of fat emulsions 20% on a client. At what rate should the nurse set the IV infusion pump? Answer in numbers only. Perscription: 200 mL fat emulsion 20% IV at 17 mL/hour. *CHANGE TUBING/BOTTLE EVERY 12 HOURS. Liposyn II 20% 500 mL Intravenous Fat Emulsion Ans:______

17 (Perscription: 200 mL fat emulsion 20% IV at 17 mL/hr.)

The nurse is preparing to give a client's prescribed nafcillin dose. How many mL will the nurse give to the client? Answer as a whole number. Perscription: Nafcillin 500 mg IM every 6 hours Nafcillin for Injection, USP 2 grams per vial Buffered for IV or IM Use Vial contains nafcillin sodium as the monohydrate, equivalent to 2g nafcilin. Each gram is buffered with 40 mg sodium citrate and contains 66.2 [2.9 mEq] sodium. Sterile, Nonpyrogenic, Preservative-free. When reconsitituted with 6.6 mL

2 (Rationale: (500 mg ÷ 1) × (1 g ÷ 1,000 mg) × (8 mL ÷ 2 g) = (4,000 ÷ 2,000) = 2 mL Ans: 2 mL)

Which comment made by a new nurse regarding sodium polystyrene sulfonate indicates to the charge nurse that the new nurse understands the effects of this medication? 1. "Sodium is exchanged for potassium in the blood." 2. "Fluids will need to be encouraged after administration." 3. "This medication will increase potassium and decrease sodium." 4. "Sodium polystyrene sulfate is only given as an enema."

2. "Fluids will need to be encouraged after administration." (2. Correct: Sodium polysterene sulfonate (kayexalate) is used to treat hyperkalemia, and it works by helping your body get rid of the extra potassium by exchanging sodium ions for potassium ions in the intestines. Sodium level increases after administration and this increase causes some dehydration. Pushing fluids will offset the dehydration. 1. Incorrect: This is an incorrect statement by the new nurse. Sodium is exchanged for potassium in the GI tract, and the majority of the exchange occurs in the large intestine where potassium ions are excreted in larger amounts. 3. Incorrect: Potassium will decrease and sodium will increase. Remember, this medication is used for hyperkalemia. 4. Incorrect: Sodium polystyrene sulfonate can be given as a liquid by mouth, through a stomach feeding tube, or as a rectal enema.)

A teenager leaves class in the middle of an exam to go to the school nurse's office. The student reports difficulty sleeping for several days, increasing nervousness, irritability, and palpitations. The nurse notes flushing of the skin, and an irregular heartbeat. What would be the best question for the nurse to ask this client? 1. "Do you feel this way because you are afraid that you are failing the exam?" 2. "Have you been drinking energy drinks while studying for your exam?" 3. "What drugs

2. "Have you been drinking energy drinks while studying for your exam?" (2. Incorrect: Caffeine is a stimulant used to keep people awake and increase energy. It is found in many OTC medications and in many soft drinks and energy drinks. The student is exhibiting all the signs/symptoms of ingesting too much caffeine. 1. Incorrect: This is not addressing the problem. These are physical symptoms of a problem. 3. Incorrect: This is confrontational and will put the student on the defensive. Caffeine is not generally thought of as a drug by clients, so might not even be considered in the first place. 4. Incorrect: This might be done later, but this question does not help to determine what is going on with the student.)

A client who has been prescribed zolpidem for insomnia has received medication education. Which statement by the client indicates to the nurse that education was successful? 1. "There is a high potential for tolerance with this medication." 2. "I may do things in my sleep that I will not remember the next day." 3. "Daytime drowsiness is rare when taking this medication." 4. "The most common side effects of this medication are confusion and a bitter aftertaste."

2. "I may do things in my sleep that I will not remember the next day." (2. Correct: Zolpidem is a sedative, also called a hypnotic. It affects chemicals in the brain that may be unbalanced in people with sleep problems (insomnia). Zolpidem may impair the client's thinking or reactions. The cleint may still feel sleepy the morning after taking this medicine, especially if taking the extended-release tablet. Wait at least 4 hours or until fully awake before doing anything that requires being awake and alert. Some people using this medicine have engaged in activity such as driving, eating, walking, making phone calls, or having sex and later having no memory of the activity. 1. Incorrect: This is a schedule 4 substance. There is a low potential for tolerance, dependence, or abuse with this medication. 3. Incorrect: Daytime drowsiness and dizziness are common side effects. 4. Incorrect: Daytime drowsiness and dizziness are the most common side effects. Bitter aftertaste does not occur

The nurse is caring for a client taking lithium. Which comment by the client indicates lack of understanding of the therapeutic regimen? 1. "I must keep my sodium intake steady over time. " 2. "If I miss a dose of lithium, I should make it up with the next dose." 3. "I must check with my primary healthcare provider before changing my diet for weight loss." 4. "I must keep my exercise routine the same or discuss with my primary healthcare provider. "

2. "If I miss a dose of lithium, I should make it up with the next dose." (2. Correct: If a client misses a dose of lithium, the client should take the next dose as prescribed without doubling it. If the client adds the missed dose, toxicity may occur. If sodium intake is reduced or the body is depleted of its normal sodium (due to sweating, fever, diuresis), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity. 1. Incorrect: This comment indicates understanding. The client should keep sodium levels the same over time as lithium and sodium are both excreted by the kidney. 3. Incorrect: This comment indicates understanding. Food intake should remain constant. Therapeutic levels should be monitored closely while the client is losing weight. Sodium reduction can lead to lithium reabsorption in the body causing toxicity. 4. Incorrect: This comment indicates that the client does understand the treatment regimen. Any changes that would change the concentration of

The nurse is caring for a client admitted to rule out myocardial infarction. The nurse has administered sublingual nitroglycerin. What time frame should the nurse expect the earliest onset of effectiveness? 1. 15 seconds 2. 3 minutes 3. 5 minutes 4. 15 minutes

2. 3 minutes (2. Correct: The onset of action for nitroglycerin sublingual is 1 to 3 minutes. So the effectiveness can be assessed 3 minutes after the drug is administered. 1. Incorrect: This time frame is too short for the onset of action of nitroglycerin given sublingual. 3. Incorrect: Sublingual doses of nitroglycerin can be repeated every 5 minutes. The drug would start to be effective before 5 minutes. 4. Incorrect: Fifteen minutes would be to long to wait to assess the effectiveness of nitroglycerin sublingual, in a client suspected of a myocardial infarction.)

The nurse is preparing to administer subcutaneous injection. At which angle should the syringe enter the client's skin? 1. 90° 2. 45° 3. 25° 4. 10-15°

2. 45° (2. Correct: SQ injections are delivered at a 45 degree angle to get the medication into the subcutaneous tissue. 1: Incorrect: IM injections are delivered at a 90 degree angle. 3: Intravenous lines are inserted at a 25 degree angle. 4. Intradermal medications are delivered at a 10-15 degree angle.)

The nurse is assigned a group of clients. For which client would the use of acetaminophen pose a higher risk? 1. 42 year old female who abuses cocaine. 2. 54 year old male who abuses alcohol. 3. 23 year old female who has asthma. 4. 34 year old male with sickle cell anemia.

2. 54 year old male who abuses alcohol. (2. Correct: The use of acetaminophen poses a higher risk for the client who abuses alcohol due to its interaction with the liver. Clients should be educated to be cautious if using acetaminophen due to the hepatotoxicity that can occur with liver dysfunction and failure. 1. Incorrect: Clients who use cocaine do not carry a higher risk of hepatotoxicity with acetaminophen use. 3. Incorrect: Clients who have a history of asthma do not carry a higher risk of hepatotoxicity with acetaminophen use. 4. Incorrect: Pain management should follow the "analgesic ladder" recommended by the World Health Organization for the treatment of cancer-related pain. The choice of analgesic and the dosage should be based on the severity of pain in the individual client. The ladder starts with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for mild-to-moderate pain. Because clients with sickle cell disease have varying degrees of hepatic impairment,

Which assessment finding by the nurse is likely to be the result of long-term corticosteroid use in a client? Select all that apply 1. Occasional nausea that occurs after eating the evening meal. 2. A wound that is slow to heal. 3. Weight loss of 15 pounds (6.8 kg) over a 6 week period. 4. The appearance of acne on the forehead and cheeks. 5. Vertebral compression fracture.

2. A wound that is slow to heal. 4. The appearance of acne on the forehead and cheeks. 5. Vertebral compression fracture. (2., 4., & 5. Correct: Suppression of the immune system occurs with long-term steroid use. This leads to slow wound healing. Acne is sometimes seen with steroid use due to oily skin and overproduction of the acne bacterium. Osteoporosis risk is increased with long-term use of steroids. Remember steroids pull calcium from the bone and place it in the blood. 1. Incorrect: Nausea is not commonly seen with steroid use. 3. Incorrect: Changes in metabolism usually lead to weight gain, not weight loss.)

The staff nurse is caring for a 3-month old client receiving potassium IV therapy. Which actions indicate to the charge nurse that the staff nurse understands IV management? Select all that apply 1. Uses a 15 gtt factor drip chamber when changing the IV tubing. 2. Applies elbow restraints to prevent dislodgement of the IV catheter. 3. Checks the IV site for blood return hourly. 4. Instructs unlicensed assistive personnel (UAP) to count drip rate hourly. 5. Attaches a volume-controlled IV ad

2. Applies elbow restraints to prevent dislodgement of the IV catheter. 3. Checks the IV site for blood return hourly. 5. Attaches a volume-controlled IV administration set to IV bag prior to beginning IV therapy. (2., 3. & 5. Correct: Young children and infants usually must be restrained to some degree to prevent accidental dislodging of the needle. Elbow restraints can prevent an infant with a scalp IV from rubbing or touching the IV site. When a foot, leg, or arm is used, limb motion must be limited. IV potassium is an irritant. When the fluid being infused is a known irritant or vesicant, the nurse should check the IV site for blood return and possible infiltration hourly. Infants and young children have a narrow range of normal fluid volume, and the risk for fluid overload is great, especially in an infant. Always use a volume-controlled IV administration set with an infant or small child. These sets hold no more than 100-150 mL of fluid, so the maximum amount that could accide

A client diagnosed with new onset atrial fibrillation has been prescribed dabigatran. What should the nurse teach this client? Select all that apply 1. Place medication in a weekly pill organizer so that medication is not forgotten. 2. Do not take with clopidogrel. 3. Dabigatran decreases the risk of stroke associated with atrial fibrillation. 4. Take this medication with food. 5. aPTT and INR levels will be drawn monthly.

2. Do not take with clopidogrel. 3. Dabigatran decreases the risk of stroke associated with atrial fibrillation. 4. Take this medication with food. (2., 3., & 4. Correct: Do not take dabigatran with any other anticoagulants, including clopidogrel due to increased bleeding risk. Dabigatran decreases the risk of stroke and systemic embolism in clients with atrial fibrillation that is not associated with a cardiac valve problem. Take this medication with food to decrease gastric side effects such as dyspepsia and gastritis. Proton pump inhibitors and histamine 2 recepter blockers may also decrease gastric side effects. 1. Incorrect: After container is opened, medication should be used within 30 days. It is sensitive to moisture and should not be stored in weekly pill organizers. To maintain efficacy, keep medication in manufacturer- supplied bottle. 5. Incorrect: This medication does not require monitoring of INR levels. However, the client should be informed about the risk of bleedi

The nurse is caring for a client with Addison's disease that is taking fludrocortisone 0.1mg/day. What assessment data by the nurse would suggest that the client's dose is too high? Select all that apply 1. Weight loss of 2 lbs (0.907 kg)/24 hours 2. Elevated serum sodium level 3. Bilateral pedal edema 4. Crackles in the lung fields bilaterally 5. Elevated blood pressure

2. Elevated serum sodium level 3. Bilateral pedal edema 4. Crackles in the lung fields bilaterally 5. Elevated blood pressure (2., 3., 4., & 5. Correct: Now, remember that with Addison's disease the client does not have enough steroids, so we have to ADD steroids. All of these options indicate the client is holding onto fluid, and we would expect the client to hold onto fluid when their steroid dose is too high. 1. Incorrect: We would expect weight gain with this client, and what is the amount of weight gain we worry about? That's right, anything over 2-3 lbs (0.907 - 1.360 kg) in 24 hours.

After obtaining vital signs, which prescribed medication should the nurse hold when caring for a client on the cardiac unit? T - 98 ° (36.7°) P - 74 R - 20 BP - 88/50 1. Rosuvastatin 2. Enalapril 3. Digoxin 4. Clopidogrel

2. Enalapril (2. Correct: Enalapril is an angiotensin converting enzyme (ACE) inhibitor. An ACE inhibitor will lower the client's blood pressure. The blood pressure in the stem's exhibit is low. Lowering the client's blood pressure more could have a negative effect on the client's condition. 1. Incorrect: Rosuvastatin is a lipid lowering medication. The client's blood pressure has no bearing on whether or not to administer the medication. 3. Incorrect: Digoxin is an antiarrhythmic/inotropic agent. It will slow the heart rate and increase the force of myocardial contraction. This action could actually increase the blood pressure. 4. Incorrect: Clopidogrel is an antiplatelet agent. The client's blood pressure would not have a bearing on whether or not to administer the medication.)

The nurse is caring for a client who has the diagnosis of schizophrenia. The nurse enters the room to administer the morning dose of the prescribed antipsychotic medication. The client is drooling and has extreme muscular rigidity. After assessing the client for adequate respiratory effort, what is the nurse's priority? 1. Elevate HOB and give the medication as prescribed. 2. Hold the medication and call the primary healthcare provider. 3. Report the behaviors to the on-coming shift. 4. Hold

2. Hold the medication and call the primary healthcare provider. (2. Correct: The nurse should hold the medication, and report the symptoms to the primary healthcare provider. The client may be experiencing neuroleptic malignant syndrome. 1. Incorrect: The client is experiencing symptoms of possible neuroleptic malignant syndrome. The nurse should not give another dose of the medication without consultating with the primary healthcare provider. 3. Incorrect: The symptoms that the client has are very serious and should be reported to the primary healthcare provider immediately. 4. Incorrect: The client may be experiencing neuroleptic malignant syndrome. It is important to notify the primary healthcare provider immediately.)

A client diagnosed with bipolar mania was prescribed lithium carbonate 2000 mg daily two months ago. What is the nurse's best action? Sodium - 143 mEq/L (143 mmol/L) Potassium - 4.5 mEq/L (4.5 mmol/L) Magnesium - 1.9 mEq/L (0.8 mmol/L) Serum Lithium - 1.8 mEq/L 1. Record the lab results in the chart and recheck in one month. 2. Inform the primary healthcare provider that the lithium level is too high. 3. Notify the primary healthcare provider because the sodium level is too high. 4. Let the

2. Inform the primary healthcare provider that the lithium level is too high. (2. Correct: The appropriate serum lithium level for acute mania is 1.0 to 1.5 mEq/L. For maintenance it is 0.6 to 1.2 mEq/L. Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity. 1. Incorrect: All lab results should be documented; however, the lithium needs to be reported so that the dose can be adjusted. 3. Incorrect: The sodium level is normal: 135-145 mEq/L (135-145 mmol/l). 4. Incorrect: The magnesium level is normal: 1.3 - 2.1 mEq/L (0.65-1.05 mmol/l).)

What medications would the nurse anticipate for the treatment of hyperthyroidism? Select all that apply 1. Levothyroxine 2. Methimazole 3. Propranolol 4. Iodine compounds 5. Calcitonin

2. Methimazole 3. Propranolol 4. Iodine compounds (2., 3., & 4. Correct: Methimazole is correct because it decreases the production of thyroid hormones. It is an antithyroid drug and it is used to "stun" the thyroid pre-operatively. It makes the thyroid "freak out" and stop producing hormones temporarily. Propanolol is correct because it is a beta blocker and beta blockers decrease the heart rate and decrease anxiety. Why is this important? Because the heart rate and anxiety are going to be increased in the hyperthyroid client. Iodine compounds like Lugol's solution® are correct because these decrease the size and vascularity of the thyroid gland. Do you think this might be important pre-operatively? Yes, to decrease the likelihood of bleeding/hemorrhage. And we also, just learned that pharmacologic doses of iodine will also do what? That's right, large doses will decrease thyroid hormone production for a few weeks. So that's two reasons we might use an Iodine compound for Hyperthy

The nurse is discharging a client who had a kidney transplant and the primary healthcare provider has prescribed mycophenolate. Which nursing instruction is priority regarding this medication? 1. Take the medication with food 2. Notify primary healthcare provider at first signs of an infection 3. Nausea, vomiting, and diarrhea are common side effects 4. Use sunscreen when planning to be outdoors

2. Notify primary healthcare provider at first signs of an infection (2. Correct: Calling the primary healthcare provider at the first signs of an infection is priority because mycophenolate is an immunosuppressant. It diminishes the body's ability to identify and eliminate pathogens. 1. Incorrect: It is recommended the client take the medication on an empty stomach but the drug may be taken with food if the client experiences stomach upset. This is not the priority teaching point. 3. Incorrect: These side effects may be experienced but this is not the priority teaching point. 4. Incorrect: Sun exposure should be avoided and clients should be advised to use sunscreen because it can make the client more prone to sunburn but this is not the priority teaching point.)

A client who has Parkinson's disease has a new prescription for benztropine. What should the nurse include when teaching the client and spouse about this medication? Select all that apply 1. This medication blocks dopamine in the brain to decrease tremors and muscle stiffness. 2. Notify your primary healthcare provider if you develop urinary retention. 3. Benztropine can reduce the ability to sweat, so do not become overheated. 4. No lab tests are needed while taking this medication. 5. Sit

2. Notify your primary healthcare provider if you develop urinary retention. 3. Benztropine can reduce the ability to sweat, so do not become overheated. 5. Sit up or stand up slowly to prevent lightheadedness. (2., 3., & 5. Correct: Urinary retention is a side effect of benztropine. Benztropine can reduce the ability to sweat and cause the body to overheat. Do not become overheated in hot weather or while you are being active because heatstroke may occur. Benztropine may cause dizziness, lightheadedness, or fainting. Alcohol, hot weather, exercise, or fever may increase these effects. To prevent these negative effects, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. 1. Incorrect: Benztropine is an anticholinergic. It works by decreasing the effects of acetylcholine, a chemical in the brain. This results in decreased tremors or muscle stiffness, and helps improve walking ability for clients with Parkinson's disease. 4.

A child diagnosed with acute lymphocytic leukemia (ALL) is receiving vincristine sulfate during the induction phase of chemotherapy. What client side effect should the nurse report immediately to the primary healthcare provider? 1. Anemia 2. Paresthesia 3. Nosebleeds 4. Alopecia

2. Paresthesia (2. Correct: Paresthesia is an uncommon but serious reaction to chemotherapy, particularly vinca alkaloids like vincristine sulfate. The abnormal tingling or pins and needles sensation is caused by pressure or damage to peripheral nerves which may include both motor and sensory sensations. The nurse should immediately notify the primary healthcare provider of this critical side effect of vincristine therapy. 1. Incorrect: Anemia is an expected side effect of many types of chemotherapy, including vincristine sulfate. Chemotherapy drugs attack rapidly dividing cells, including those that create red blood cells. Anemia contributes to fatigue, shortness of breath and lack of energy. This should definitely be evaluated, but is not the most urgent concern for the nurse at this time. 3. Incorrect: Vincristine sulfate has many side effects, including depletion of platelets which are responsible for blood clotting. When platelets are depleted, the client can experience nose bl

A nurse notes redness, warmth, and pain at a client's intravenous (IV) insertion site. What does the nurse suspect? 1. Colonization 2. Phlebitis 3. Infectious disease 4. Bacteremia

2. Phlebitis (2. Correct: Phlebitis refers to inflammation of a vein and it can be caused by any insult to the blood vessel wall, impaired venous flow, or coagulation abnormality.Clinical evidence includes redness, heat and pain. These signs and symptoms show that the client is experiencing a localized inflammation such as phebitis. 1. Incorrect: Colonization is used to describe microorganisms present without host interference or interaction. There is an absence of tissue invasion or damage. 3. Incorrect: Infectious disease is the state in which the infected host displays a decline in wellness due to the infection. Clinical signs and symptoms may or may not be present. 4. Incorrect: Bacteremia is determined by presence of bacteria in the bloodstream. Bacteremia can lead to sepsis and signs and symptoms such as fever, hypothermia, tachycardia, tachypnea and inadequate blood flow to internal organs.)

A nurse is teaching a group of expectant parents about epidural anesthesia. What information should the nurse include? Select all that apply 1. Contraindications for an epidural include a previous cesarean section. 2. Post procedure position should be side lying. 3. Headache is a post procedure side effect. 4. The major complication is hypotension. 5. Usually administered at 3-4 cm dilation.

2. Post procedure position should be side lying. 4. The major complication is hypotension. 5. Usually administered at 3-4 cm dilation. (2., 4., & 5. Correct: The client should not lie supine but should position self in a side-lying position. This will prevent compression on the vena cava. The major complication of epidural anesthesia is hypotension and supine position increases the risk. If this occurs, a bolus with 1000 mL of NS or LR to increase blood pressure by increasing vascular volume. Epidurals are usually placed during stage 1 at 3-4 cm dilation. 1. Incorrect: Previous C-sections do not eliminate the ability to have an epidural. Epidurals are commonly utilized for anesthesia during a cesarean birth. 3. Incorrect: A sterile guide needle and a small epidural catheter is placed between the spinal cord and the outer membrane. There is usually no headache since the needle does not enter the spinal column but rather the epidural space.)

Which prescription should the nurse question when a client is receiving spironolactone 25 mg by mouth daily? 1. Digoxin 0.125 mg by IVP daily 2. Potassium chloride 40 mEq orally t.i.d. 3. Cimetadine 200 mg IVPB q6h 4. Metoprolol 100 mg p.o. daily

2. Potassium chloride 40 mEq orally t.i.d. (2. Correct: Do not give potassium supplements, salt substitutes, or angiotensin-converting enzyme inhibitors to clients taking potassium sparing diuretics because these drugs can increase the risk of developing high to extremely high blood potassium levels. 1. Incorrect: This medication does not adversely interact with potassium sparing diuretics; however, the nurse should be on the alert for digoxin toxicity with hyper or hypokalemia. 3. Incorrect: Cimetadine is a H₂ receptor antagonist indicated for ulcers and GI complaints. It does not adversely interact with potassium sparing diuretics. 4. Incorrect: This medication is a beta blocker, which may be given in addition to a diuretic for hypertension control.

The primary healthcare provider has prescribed hydromorphone 2 mg intravenously (IV) every 4 hours as needed for pain. When should the nurse plan to administer the medication to the client? 1. Only when requested. 2. Prior to onset of intense pain. 3. With reports of acute pain lasting for at least one hour. 4. Continuously every 4 hours to keep the client pain free.

2. Prior to onset of intense pain. (2. Correct: Pain is best managed before acute pain has developed. If the client waits until the pain is intense, the pain medication may not work as effectively or not at all. 1. Incorrect: Clients sometimes need pharmacologic treatment for pain even if not requested. Nurses should monitor the client for physical signs of pain. Vital sign changes and facial grimacing may be signs of pain. The word "only" is too limiting. 3. Incorrect: Clients should be treated for pain before acute pain develops when possible. The client should be educated to report pain prior to experiencing it for at least one hour. 4. Incorrect: The order is as needed, not continuously. Also, the goal of being pain free may be unrealistic. The nurse wants to keep the client's pain at a tolerable level. Always measure pain on a pain scale such as 0-10.)

A client with asthma uses a corticoid inhaler. What teaching should the nurse provide to decrease the risk of an oral fungal infection? 1. Lessen the exposure of the oral mucosa to the ICS by exhaling rapidly. 2. Rinse the mouth completely and brush teeth following the use of the ICS. 3. Use alcohol based mouth rinses with ICS. 4. Drink water prior to using the ICS.

2. Rinse the mouth completely and brush teeth following the use of the ICS. (2. Correct: Thrush, is an oral fungal infection, which is one of the most common side effects of ICS. Up to 1/3 of all clients on ICS develop this infection. Rinsing and brushing helps to remove the medication residual from the oral mucosa and upper pharyngeal area. 1. Incorrect: This is not appropriate because exhaling rapidly would result in a loss of the medication and reduce the effectiveness. 3. Incorrect: This is not accurate because alcohol based mouth rinses have not been shown to reduce the risk of thrush. Alcohol based mouth wash can be drying to the oral mucosa. 4. Incorrect: Drinking water, prior to using the ICS is not an effective means of preventing thrush.)

A client has recently been diagnosed with rheumatoid arthritis. The nurse anticipates which class of pharmacologic agents will likely be a part of the client's treatment regimen? 1. Mitotic inhibitors 2. Systemic glucocorticoids 3. Antifungals 4. Anticoagulants

2. Systemic glucocorticoids (2. Correct: Glucocorticoids (steroids) are an appropriate pharmacologic treatment for rheumatoid arthritis. Other treatment options include the use of NSAIDs, biologic and nonbiologic DMARDs (methotrexate and others). Remember, all the other problems associated with the use of steroids. 1. Incorrect: Mitotic inhibitors are a class of chemotherapeutic agents and are not indicated for the treatment of rheumatoid arthritis. Medications in this class include plant alkaloids (vincristine) and taxanes (paclitaxel). 3. Incorrect: Antifungals are not indicated for the treatment of rheumatoid arthritis. Rheumatoid arthritis is an autoimmune disease, not associated with a fungal disorders. 4. Incorrect: Anticoagulants are indicated for the treatment and prevention of thrombolytic disease and are not indicated for the treatment of rheumatoid arthritis. Salicylate (aspirin), an antiplatelets, may be used as an anti-inflammatory agent.)

The nurse is preparing to give a client's prescribed furosemide dose. How many mL will the nurse give to the client? Answer to the first decimal place. Answer with numbers and decimal only. Perscription: Furosemide 25 mg by mouth daily Furosemide Oral Solution USP 10 mg per mL Each mL contains 10 mg furosemide USP. SUGAR FREE Ans:______

2.5 (Rationale: (25 mg ÷ 1) × (1 mL ÷ 10 mg) = (25 ÷ 10) = 2.5 mL Ans: 2.5 mL)

The nurse is caring for a client on the psychiatric unit. The client is prescribed fluphenazine 10 mg. The drug is available as an elixir: 2.5 mg / 5 mL. How many mL will the nurse give to the client? ______ mL. Round answer to the nearest whole number. Ans:______

20 (Rationale: (10 mg ÷ 1) × (5 mL ÷ 2.5 mg) = (50 ÷ 2.5) = 20 mL Ans: 20 mL)

The primary healthcare provider prescribes nafcillin 0.6 gram every 12 hours IM. Available is a vial labeled 200 mg per 1 mL. How many mL should the nurse give? Round your answer to the nearest whole number. Ans:______

3 (Rationale: (0.6 g ÷ 1) × (1,000 mg ÷ 1g) × (1 mL ÷ 200 mg) = (600 ÷ 200) = 3 mL Ans: 3 mL)

A client with the diagnosis of mild anxiety asks the nurse why the primary healthcare provider switched medications from lorazepam to buspirone. What should the nurse tell the client? 1. "Lorazepam takes longer to start working than buspirone so the primary healthcare provider decided to switch medications." 2. "Buspirone can be stopped quickly if neccessary." 3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." 4. "You need

3. "Buspirone does not depress the central nervous system like lorazepam does, so you should not have as much sedation." (3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors. 1. Incorrect: Buspirone takes 1-2 weeks to take effect and can take up to 4-6 weeks to achieve full clinical benefits. Lorazepam is a benzodiazepine and begins to work within a few hours to 1-2 days. 2. Incorrect: The client should not stop taking any antianxiety medications abruptly. Serious withdrawal symptoms can occur: depression, insomnia, anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, delirium. 4. Incorrect: The nurse should be able to discuss medication administration with the primary healthcare provider.)

The nurse is teaching a client diagnosed with asthma about using a peak expiratory flow meter. The nurse asks the client what action should be taken if the reading is 65% of the client's personal best value. What statement by the client indicates to the nurse that education was successful? 1. "This is a good reading for me, so I can go about my usual activities." 2. "I will administer my long-term inhaler medication." 3. "My as needed inhaler medication needs to be administered." 4. "I need

3. "My as needed inhaler medication needs to be administered." (3. Correct: Between 50% and 79% of the client's personal best value indicates asthma is getting worse and the client should immediately take the "as needed" medication which should be a short-acting bronchodilator. 1. Incorrect: 80% to 100% of a client's personal best value is considered "doing well" and is the range recommended that the client can do usual activities. However, a reading of 65% falls below this recommended level, so the client may not be able to perform usual activities. 2. Incorrect: 80% to 100% of a client's personal best value indicates continuation of long term inhaler medication each day. The level of 65% of the client's personal best value confirms the need for a rescue medication. 4. Incorrect: If the client is unresponsive to immediate therapy, emergency care may be required.)

What nursing intervention takes priority for the client one day postoperative bowel resection reporting pain of a 6 on a 0 to 10 pain scale? 1. Assist the client in changing positions. 2. Use a distraction technique. 3. Administer the prescribed analgesic. 4. Encourage the client to walk.

3. Administer the prescribed analgesic. (3. Correct: Rating pain a 1-3 is a mild pain. This pain is nagging, annoying, interfering little with the client's activities of daily living. This is when repositioning, alternative therapies, and distraction techniques are beneficial. Pain rated between 4-6 is considered to be moderate in severity and interferes significantly with activities of daily living. This is the time to give pain medication in an attempt to lessen the severity of the pain. A score of 7-10 is severe pain that is disabling. The client is unable to perform activities of daily living. Pain medication is often delayed in helping at this point. We want to give pain medication before it reaches this intense level. 1. Incorrect: There is no information to indicate repositioning may be effective. 2. Incorrect: Distraction is not an effective strategy for severe pain. 4. Incorrect: There is no information to indicate walking would be effective.)

A client is given an intramuscular injection of morphine following a laparoscopic cholecystectomy four hours ago. What client data would best indicate to the nurse that the medication has been effective? 1. Rates pain as 6 on 1-10 scale. 2. Heart rate is within normal limits. 3. Ambulates with assistance of one. 4. Voided 250 mL in 4 hours.

3. Ambulates with assistance of one. (3. Correct: The client's ability to ambulate with one assistant indicates that pain is controlled enough to get out of bed. Even a laparoscopic procedure can cause extreme discomfort in the immediate post-op period. This action is the best indicator the client has experienced some pain relief. 1. Incorrect: Although a baseline pain measurement is not noted, a level of 6 on the 1-10 scale is still very elevated. This client response indicates the morphine was not effective. 2. Incorrect: Many clients do become tachycardic in response to pain; however, with no baseline to compare, a heart rate within normal levels is not the best indicator of effective pain medication. 4. Incorrect: The amount and ability to void does not provide evidence of successful pain control. The voiding instinct is rarely affected by pain.)

A client is admitted with new onset hyperthyroidism. Which medication is of concern to the nurse while reviewing the client's routine medications? 1. Ranitidine 2. Furosemide 3. Amiodarone 4. Propranolol

3. Amiodarone (3. Correct: Amiodarone, a class III anti-arrhythmic drug, has multiple effects on myocardial depolarization and repolarization that make it an extremely effective antiarrhythmic drug. However, amiodarone is associated with a number of side effects, including thyroid dysfunction (both hypo- and hyperthyroidism), which is due to amiodarone's high iodine content and its direct toxic effect on the thyroid. 1. Incorrect: Ranitidine has not been found to contribute to the development of hyperthyroidism or hypothyroidism. 2. Incorrect: Furosemide has not been found to affect the thyroid. 4. Incorrect: Beta blockers are given to hyperthyroid clients to decrease myocardial contractility BP, and HR. It also decreases anxiety. This will help the hyperthyroid client.)

A nurse is preparing to administer an insulin infusion to a client. The nurse calculates the infusion pump setting as 9 mL/hr. What should the nurse do next? 1. Administer the calculated medication dosage. 2. Call the primary healthcare provider to clarify the dosage. 3. Ask another nurse to calculate the dosage. 4. Notify pharmacy of the pump setting for the calculated dosage.

3. Ask another nurse to calculate the dosage. (3. Correct: Insulin is a high alert drug and must be double checked by another nurse before it is administered. High alert drugs that could have significant side effects if administered improperly. 1. Incorrect: Insulin is a high alert drug and must be double checked by another nurse before it is administered. High alert drugs that could have significant side effects if administered improperly. 2. Incorrect: Calling the primary healthcare provider is inappropriate. The nurses are trained to properly calculate this drug calculation problem. 4. Incorrect: The nurse will calculate the infusion rate and then have a second nurse verify the rate. There is no reason to notify pharmacy.)

The nurse is caring for a client diagnosed with deep vein thrombosis, who has been treated with intravenous heparin for one week. The primary healthcare provider plans to change the medication from heparin IV to warfarin sodium by mouth. The nurse understands which approach would be appropriate? 1. Begin the warfarin sodium and stop the heparin simultaneously. 2. Stop the heparin 24 hours, then begin the warfarin sodium. 3. Begin the warfarin sodium before stopping the heparin. 4. Stop the h

3. Begin the warfarin sodium before stopping the heparin. (3. Correct: Warfarin sodium is initiated while the client remains on heparin. This is done so that the client remains adequately anticoagulated during the transition from IV heparin to warfarin sodium. The onset of action of warfarin sodium is 36 hours to 3 days. 1. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. If heparin were stopped and warfarin sodium initiated there would be a lag time when the client would be inadequately anticoagulated and at an increased risk for clotting. 2. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. Stopping heparin 24 hours before administering warfarin sodium would cause a lag time and increased risk of clotting. 4. Incorrect: Waiting for coagulation studies before administering warfarin sodium would cause a lag time and put the client at increased risk for clotting. Additionally, heparin and warfarin are measured by different clotting lab tests. The

The nurse is caring for a client admitted with an episode of bleeding esophogeal varices. What should the nurse monitor for after administering propranolol to this client? Select all that apply 1. Increased systolic BP 2. Hypokalemia 3. Bradycardia 4. Wheezing 5. Decreased hematemesis

3. Bradycardia 4. Wheezing 5. Decreased hematemesis (3., 4., & 5. Correct: Propranolol is a beta blocker that affects the heart and circulation. It is used in the treatment of high blood pressure, irregular heartbeats and in the prevention of angina and headaches. This medication works by blocking epinephrine and reduces heart rate, blood pressure and strain on the heart. Decreasing the heart rate should decrease bleeding. Wheezing is an adverse reaction from propranolol and should be monitored for after administration. A decreased in heart rate and blood pressure will help to decrease bleeding. Hematemesis is vomiting blood. 1. Incorrect: Blood pressure is the force of blood flow against the walls of your arteries. Propranolol should decrease blood pressure, thus decreasing bleeding. 2. Incorrect: Beta blockers inhibit renin release which can decrease the release of aldosterone. We should monitor for hyperkalemia, rather than hypokalemia.)

A nurse is to administer a time release capsule to a client who has difficulty swallowing. Which intervention would be the best course of action for the nurse to take? 1. Open the capsule and sprinkle it on applesauce. 2. Melt the capsule in juice or water. 3. Call the primary healthcare provider to change the order. 4. Break the capsule in half using a pill splitter.

3. Call the primary healthcare provider to change the order. (3. Correct: If the client has difficulty swallowing a capsule or tablet, ask the primary healthcare provider to substitute a liquid medication if possible. 1. Incorrect: Sprinkling the medication over applesauce or pudding may be the only option the nurse has if there is no other form, but since this medication is time-released, the best answer and priority would be to get a liquid form, if available, for the drug. 2. Incorrect: Never melt a time release capsule or tablet as this would release the medication all at once. 4. Incorrect: Breaking or splitting would also release the medication in boluses and could cause harm to the client.)

What should the nurse teach a client who has been prescribed sertraline 100 mg PO daily? 1. Kidney function must be monitored regularly 2. Decrease the dose of the prescribed MAO inhibitor 3. Do not stop taking medication abruptly 4. Expect weight loss

3. Do not stop taking medication abruptly (3. Correct: We do not abruptly stop a medication that is being used for depression, plus sudden withdrawal may cause flu symptoms or thought disturbances. 1. Incorrect: No, you should monitor liver function regularly, not kidney function. 2. Incorrect: Again, no. Sertraline is an SSRI (selective serotonin reuptake Inhibitor) and should not be given with MAO inhibitors. Do you know why? Because both SSRIs and MAO inhibitors increase the levels of serotonin in the brain, we don't want to give both and double dose them. 4. Incorrect: Antidepressants usually cause weight gain.)

The nurse is caring for a diabetic client. The client's glucose level at 0700 is 265. What is the nurse's best action? Perscription: 40 units NPH insulin every AM Regular Insulin per Sliding Scale both AC and HS Sliding Scale: Blood glucose < 200: 0 units Blood glucose 200-249: 2 units Blood glucose 250-299: 4 units Blood glucose 300-349: 6 units Blood glucose 350-399: 8 units Blood glucose 400 or >: Call primary healthcare provider 1. Hold the NPH and regular insulin 2. Give 8 units of regul

3. Give the NPH and 4 units of regular insulin (3. Correct: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299. 1., 2., & 4. Incorrect: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299.)

Donepezil has been prescribed to a client with cognitive impairment. Which statement by the family member indicates understanding of the nurse's instructions on this medication? 1. This medicine will control agitation and aggression. 2. This medication should be given at bedtime since it is for insomnia. 3. Notify the primary healthcare provider if the client is vomiting coffee ground material. 4. This drug is given as needed for confusion.

3. Notify the primary healthcare provider if the client is vomiting coffee ground material. (3. Correct: A rare but very serious side effect that can occur: black stools, vomit that looks like coffee grounds, severe stomach/abdominal pain. Notify the primary healthcare provider immediately. 1. Incorrect: An antipsychotic medication such as risperidone is used for agitation, aggression, hallucinations, thought disturbances, and wandering. Donepezil helps to decrease the symptoms of dementia (impairment of memory, judgment, abstract thinking and personality changes) in client's with Alzheimer disease. 2. Incorrect: Donepezil should be given in the evening just before bedtime, however, it is not for insomnia. Sedative/hypnotics such as zolpidem and temzaepam are given for insomnia. 4. Incorrect: Donepezil should be given regularly in order to get the most benefit from it. Do not stop taking it or increase the dosage unless the primary healthcare provider changes the dose. It may take

A community health nurse is reconciling medications of a client who was discharged from the hospital with a diagnosis of congestive heart failure, hypertension, and arthritis. After reviewing the client's medications, what action is most important for the nurse to take? Prescriptions: Furosemide 20 mg tablet by mouth every morning Carvedilol 6.25 mg one tablet by mouth twice daily Potassium Chloride 20 mEq one tablet by mouth every morning Current Medications: Saw palmetto one tablet by mouth

3. Notify the primary healthcare provider that the client is receiving adalimumab. (3. Correct: This is the "most important" action for client safety. Medication reconciliation is "the process of comparing a client's medication prescriptions to all of the medications that the client has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care. [Adalimumab can cause serious side effects, including heart failure (new or worsening).] 1. Incorrect: Although the nurse will need to teach the client about the new medications, the most important thing for the nurse to do is inform the HCP about the client taking adalimumab. 2. Incorrect: The nurse cannot change the primary healthcare providers RX. Most HF clien

Which side effect of vincristine should the nurse immediately report to the primary healthcare provider? 1. Nausea 2. Fatigue 3. Paresthesia 4. Anorexia

3. Paresthesia (3. Correct: Paresthesia is a side effect of some chemotherapeutic medications and if it occurs, the primary healthcare provider needs to modify the dosage or discontinue. 1. Incorrect: Nausea and vomiting are common side effects of many chemotherapeutic medications. 2. Incorrect: Fatigue is a common side effect of many chemotherapeutic medications. 4. Incorrect: Anorexia is a common side effect of many chemotherapeutic medications.)

What should the nurse include when teaching a client diagnosed with Grave's disease who is scheduled to receive radioactive iodine? Select all that apply 1. Stay 6 feet from people for 2 weeks. 2. This medication is given intravenously as a one-time dose. 3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant. 5. Radioactive iodine is absorbed by the parathyroid glands.

3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant. (3., & 4. Correct: Within a few days after treatment, the radioactive iodine will leave the body in urine and saliva. If the client is pregnant, she should not receive radioactive iodine treatment. This kind of treatment can damage the fetus's thyroid gland or expose the fetus to radioactivity. Women should wait a year before conceiving if they have been treated with radioactive iodine. 1. Incorrect: Stay away from babies for 1 week and do not kiss anyone for 1 week. 2. Incorrect: Radioactive iodine is given in a capsule or liquid form. One dose is usually all that is needed. 5. Incorrect: Radioactive iodine is absorbed by the thyroid gland. It destroys the thyroid. So now the client becomes hypothyroid.)

The nurse is caring for a client diagnosed with pneumonia. The primary healthcare provider has prescribed erythromycin ER. What teaching points should the nurse plan to teach the client regarding this medication? Select all that apply 1. Crush the medication if unable to swallow capsule. 2. Take erythromycin 1 hour after eating. 3. Report clay-colored stools. 4. Do not take erythromycin with grapefruit juice. 5. Keep capsules in bathroom cabinet.

3. Report clay-colored stools. 4. Do not take erythromycin with grapefruit juice. (3., & 4. Correct: The client should be taught signs and symptoms of liver problems such as nausea, increased stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, or jaundice. Grapefruit juice can interfere with absorption of this medication. 1. Incorrect: Do not crush, chew, or break a delayed release capsule or tablet. Swallow it whole. 2. Incorrect: This medication should be taken 1 hour before or 2 hours after a meal. 5. Incorrect: Keep at room temperature, away from excess heat and moisture (not in bathroom).)

Two nurses are checking a unit of packed red blood cells (PRBCs) for client compatibility prior to infusion. What action should the primary nurse take after completing this process? Unit of Packed Red Blood Cells: O Rh Positive CPDA-1 Red Blood Cells Volunteer Donor H708 202 417 336R Blood Compatibility Label: Last Name: Monty First Name: Mira DOB: 12/08/1959 Gender: Female Client Address: 22 Main Street, MyTown, USA Client Identity No: 600287J Component: Red Blood Cells Donation Number: H100

3. Send unit of PRBCs back to the blood bank. (3. Correct: The blood compatibility label does not match the PRBC unit sent to the unit. Note that the donor numbers are not the same. So, this unit needs to be sent back to the blood bank and the correct unit needs to be obtained. 1. Incorrect: Do not give uncrossed matched blood. This unit is not the one that was cross matched to the client. The unit numbers are different. 2. Incorrect: It takes a while to cross match blood and the blood cannot stay out of the refrigerator that long. And what if it is not compatible. A unit of blood has been wasted. 4. Incorrect: The wrong unit of PRBCs has not been hung. There is no need to contact the primary healthcare provider.)

The nurse is reinforcing the dietary discharge instruction for a client prescribed warfarin. Which food choices should be avoided on the warfarin dietary instruction plan? Select all that apply 1. Corn 2. Carrot 3. Spinach 4. Broccoli 5. Watermelon

3. Spinach 4. Broccoli (3. & 4. Correct: Clients prescribed warfarin will need to reduce the intake of food sources with high levels of vitamin K. High levels of vitamin K interfere with warfarin by decreasing the effectiveness of warfarin to prevent blood clots. The vitamin K level of 1 cup of raw spinach is 144.87 mcg. The vitamin K level of 1 cup of raw broccoli is 92.46 mcg. Because spinach and broccoli are high in vitamin K, the client should eat sparingly or refrain from eating spinach, and broccoli. 1. Incorrect: There is 0.31 mcg of Vitamin K in 1.0 ear, medium (6-3/4" to 7-1/2" long) of corn. This level of vitamin K in the corn can be consumed with warfarin. The vitamin K level of corn will not interfere with the action of warfarin. 2. Incorrect: The level of vitamin K in a cup of raw carrots is 16.9 mcg. Carrots will not reduce the action of warfarin, due to the low level of vitamin K in corn. 5. Incorrect: The content of vitamin K in a cup of watermelon is 0.15 mcg. Due

After drawing up insulin for subcutaneous administration, the nurse receives a return phone call from a primary healthcare provider who wants to give prescription orders on a new admit. The nurse asks a new nurse to administer the insulin dose. What action should the new nurse take? 1. Administer the insulin dose to the client. 2. Consult with the charge nurse about administering the insulin dose to the client. 3. Tell the nurse that whoever draws up the medication has to administer that medi

3. Tell the nurse that whoever draws up the medication has to administer that medication. (3. Correct: A nurse can only administer medication that has been drawn up by that nurse. It is not acceptable practice to administer a medication drawn up by another nurse. 1. Incorrect: The nurse who gives this medication does not really know what was drawn up. It could be the wrong medication, the wrong dose, the wrong time. A nurse can only administer medication that has been drawn up by that nurse. 2. Incorrect: There is no need to consult the charge nurse because the new nurse should not administer the medication that has been drawn up by another nurse. 4. Incorrect: The nurse should first take the return phone call from the primary healthcare provider and then administer the insulin yourself.)

What would the nurse include when teaching a client newly prescribed timolol maleate eyedrops for glaucoma? 1. The medication works by causing the pupils to constrict 2. The medication will dilate the canals of Schlemm 3. This medication decreases the production of aqueous humor 4. The medication improves ciliary muscle contraction

3. This medication decreases the production of aqueous humor (3. Correct: timolol decreases aqueous humor formation; therefore decreasing IOP. 1. Incorrect: timolol does not constrict pupils​. 2. Incorrect: timolol does not dilate the canals of Schlemm​. 4. Incorrect: timolol does not cause ciliary muscle contraction​.)

The nurse is preparing to give a client's prescribed ceftazidime dose. How many mL will the nurse give to the client? Answer to the first decimal place. Answer with numbers and decimal only. Perscription: Ceftazidime 1 gm IM every 6 hours Tazicef Ceftazidime For Injection, USP For IM injection, IV direct (bolus) injection, or IV infusion, reconstitute with Sterile Water for injection according to the following information. The vacuum may assist entry of the diluent. SHAKE WELL. Vial Size →

3.6 (Rationale: Prescription: Ceftazidime 1 gm IM every 6 hours Available: Ceftazidime 1 gm in 3.6 mL Step 1: The instructions say to add 3.0 mL sterile water for injection to the vial. Volume yields 3.6 mL.)

Which statement made by a client prescribed naproxen for rheumatoid arthritis would require further investigation by the nurse? 1. "I signed up for swimming classes at the local recreation center." 2. "I take acetaminophen when I have a headache." 3. "I have lost 2 pounds in the past 2 weeks." 4. "I am taking an antacid to help with indigestion."

4. "I am taking an antacid to help with indigestion." (4. Correct: ​Naproxen is a nonsteroidal anti-inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. So what do we know is a concern about NSAIDs? They may cause GI bleeding and dyspepsia. This client might be experiencing these symptoms if they are taking an antacid for indigestion. Follow-up is required. 1. Incorrect: There is nothing wrong with the client taking swimming classes. This form of aerobic exercise can help decrease pain and improve strength. 2. Incorrect: Acetaminophen is not considered an NSAID. It can be taken for a headache while taking an NSAID. It is best to stagger the acetamenophen between naproxen doses if needed for headache. 3. Incorrect: There is nothing unusual or worrisome about a 1 to 2 pound (0.45 - 0.9 kg) weight loss a week. This weight loss would not be related to the medication.)

A nurse is providing education to a client regarding the use of an inhaler for acute asthma symptoms. Which statement made by the client would indicate the need for further teaching? 1. "I should shake the inhaler well before use." 2. "I should breathe out slowly and completely through my mouth before placing the mouthpiece of the inhaler in my mouth." 3. "I should hold my breath for approximately 8-10 seconds before exhaling slowly." 4. "I should administer the two puffs that are ordered in

4. "I should administer the two puffs that are ordered in rapid sequence." (4. Correct: Rapid sequencing of the puffs is not a correct measure for using an inhaler. The client should wait 1 minute between puffs. This statement indicates the need for further teaching. 1. Incorrect: This is a correct measure that should be followed when using an inhaler. Clients are instructed to shake the inhaler well before use. 2. Incorrect: This is a correct measure that should be followed when using an inhaler. Clients are instructed to exhale slowly before bringing the inhaler to the mouth. 3. Incorrect: This is a correct measure that should be followed when using an inhaler. After removing the inhaler from the mouth, clients are instructed to hold their breath for 10 seconds, then breath out slowly.)

The primary healthcare provider has prescribed ampicillin and ciprofloxacin piggyback in the same hour, every 6 hours. How will the nurse administer these medications? 1. Administer one of the medications every 4 hours and the other every 6 hours. 2. Administer the medications by combining them into 150 mL of normal saline (NS). 3. Administer the medications at the same time by connecting the secondary tubing to two separate ports on the primary tubing. 4. Administer the medications separate

4. Administer the medications separately, flushing with normal saline (NS) between medications. (4. Correct: Even though two IV piggyback medications have been ordered at the same time, they can both be infused separately on time. It just takes planning. The nurse must follow the medication rights (right client, right medication, right route, right dose, right time). The antibiotics need to be administered one at a time and normal saline is used to flush the remaining medication of the first antibiotic before the second is administered. 1. Incorrect: The primary healthcare provider will prescribe the dosing schedule. Its beyond the scope of practice for the nurse to independently the dosing schedule. 2. Incorrect: The properties of each antibiotic are different. The two different antibiotics cannot be mixed together. 3. Incorrect: Administering the antibiotic into different parts of the IV tubing is the same as mixing the IVs together. Only one antibiotic should be administered at

A nurse is caring for a client who has been prescribed sucralfate. Which client education intervention would the nurse include for the client prescribed sucralfate? 1. Take medication 1 hour after meals. 2. Crush tablets prior to taking medication. 3. Consume 1000 mL of fluid every 24 hours. 4. Avoid antacids 1 hour before and after this medication.

4. Avoid antacids 1 hour before and after this medication. (4. Correct: Sucralfate is absorbed more effectively in an acidic state. Since an antacid medication will increase the alkaline state, the client should avoid taking antacids within 1 hour before or after taking sucralfate to increase the absorption rate of sucralfate. 1. Incorrect: Sucralfate should not be taken 1 hour after a meal. To increase the absorption of sucralfate the medication should be taken on an empty stomach when the stomach is more acidic. 2. Incorrect: Clients should not crush, or chew sucralfate tablets. The outer layer of the tablet has specific formulated pharmacokinetic properties that should not be crushed or chewed. 3. Incorrect: A potential side effect of sucralfate is constipation. An increase of fluids during the medication therapy is recommended to decrease the side effect of constipation. An intake of 1000 mL of fluid per 24 hours intervention is not enough fluid to reduce the possibility of con

Which medication should the nurse administer first after receiving the morning shift report? 1. Levothyroxine to the client with hypothyroidism and a thyroid stimulating hormone (TSH) level of 2.8 mU/L 2. Amlodipine to the client with hypertension and a blood pressure of 150/86 3. Regular insulin sliding scale dose to the client with diabetes and a 210 blood glucose level. 4. Cefotaxime intravenous piggyback to the newly admitted client with a diagnosis of pneumonia and a white blood cell co

4. Cefotaxime intravenous piggyback to the newly admitted client with a diagnosis of pneumonia and a white blood cell count (WBC) of 12,000 mm³ (4. Correct: The first dose of intravenous antibiotic medication is the priority since the WBCs are elevated and the antibiotic should be administered first. 1. Incorrect: The TSH is normal so the thyroid medication is not the priority. 2. Incorrect: Amlodipine is for high blood pressure and is important but the antibiotic is the priority. 3. Incorrect: It is important to administer the regular insulin but it is not priority over initiating the intravenous antibiotic medication.)

What information should the nurse include in teaching an oncology client the purpose of taking epoetin? 1. Emergency treatment of anemia. 2. Improves quality of life. 3. Used for the prevention of pure red cell aplasia (PRCA). 4. Decreases the need for transfusion.

4. Decreases the need for transfusion. (4. Correct: Epoetin is prescribed to treat a lower than normal number of red blood cells (anemia) caused by chronic kidney disease in clients on dialysis, in HIV clients receiving zidovudine and in cancer clients receiving chemotherapy that develop anemia. Epoetin stimulates the bone marrow to produce more RBCs. 1. Incorrect: Epoetin does not work raoidly enough to be used for the emergency treatment of anemia (RBC transfusion). 2. Incorrect: Epoetin has not been proven to improve quality of life, fatigue, or sense of well-being in clients with cancer. 3. Incorrect: Pure red cell aplasia (PRCA) is a type of anemia that starts after treatment with epoetin or other erythropoetin medications.)

The nurse is preparing to administer nadolol to a hospitalized client. Which client data would indicate to the nurse that the medication should be held and the primary healthcare provider notified? 1. Blood pressure 102/68 2. Glucose 118 mg/dL 3. UOP 440 mL over previous 8 hour shift. 4. Heart rate 56/min

4. Heart rate 56/min (4. Correct: This is a beta blocker. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication. You can identify that nadolol is a beta blocker because it ends in "lol". 1. Incorrect: Beta blocker are prescribed to lower BP. When the baseline BP is not known, worry about a BP of 90/60 or below. If the client's BP drops below 90/60, this beta blocker should be held and the primary healthcare provider notified. 2. Incorrect: This is a normal glucose level. If the client is a diabetic, beta blockers can mask the signs of hypoglycemia. 3. Incorrect: Urinary output is adequate. Beta blockers do not alter renal function.)

A client has been started on intravenous gentamicin for osteomyelitis. The nurse informs the client frequent blood work will be done to monitor the amount of medication in the body. The nurse knows what labs are a priority to check every three days for the client? 1. BUN and creatinine. 2. Liver function studies. 3. Hemoglobin and hematocrit. 4. Peak and trough levels.

4. Peak and trough levels. (4. Correct: Peak and trough levels help to determine the amount of medication in the body system at specific times. Gentamicin is a very potent antibiotic; therefore, it is crucial to keep track of blood levels of this medication. Too low a level of this drug would be ineffective against the bacteria while too high a level increases the potential for severe side effects or toxicity from this antibiotic. 1. Incorrect: Because aminoglycosides such as gentamicin can lead to nephrotoxicity, checking BUN and creatinine levels periodically is important. However, it would not be necessary to check those values every three days. 2. Incorrect: Aminoglycosides like gentamicin rarely affect the liver; therefore, liver function studies would not be needed frequently. 3. Incorrect: Hemoglobin and hematocrit levels are rarely impacted by aminoglycosides such as gentamicin. Although an initial level may be obtained prior to treatment, additional levels are not necessar

The nurse instructs a client taking isoniazid for the treatment of tuberculosis (TB) regarding appropriate food choices. Which food choices indicate to the nurse that teaching has been successful? 1. Salad with bleu cheese dressing. 2. Smothered liver with onions. 3. Smoked salmon with crackers. 4. Pear salad with lettuce.

4. Pear salad with lettuce. (4. Correct: Pears are acceptable fruit. Foods high in tyramine can cause headaches, fast or irregular heartbeats, nausea and vomiting and sensitivity to light. Foods high in tyramine such as aged cheeses, certain meats, liver, moked fish, sour cream, raisins, bananas and avocados should not be eaten when taking isoniazid. 1. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as salad with bleu cheese dressing can result in severe reactions when client is taking isoniazid. 2. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smothered liver with onions can result in severe reactions when client is taking isoniazid. 3. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smoked salmon can result in severe reactions when client is taking isoniazid.)

A client with a history of congestive heart failure (CHF) has been admitted with digoxin toxicity. After reviewing the initial laboratory results, the nurse knows what abnormal findings most likely contributed to the digoxin toxicity? Sodium: 146 mEq/L, Potassium 3.1 mEq/L, Calcium 9.9 mg/dL, Magnesium 1.2 mEq/L, Albumin 4.8 gm/dL Select all that apply 1. Sodium 2. Calcium 3. Albumin 4. Potassium 5. Magnesium

4. Potassium 5. Magnesium (4., & 5. Correct: Hypokalemia and hypomagnesemia both can increase the client's potential to develop digoxin toxicity. Digoxin and potassium both bind at the same location on the ATPase pump. When potassium levels are low, more digoxin will attach to the sites, leading to toxicity. Low magnesium levels sensitize the cardiovascular system to the toxic effects of digoxin. 1. Incorrect: The presence of digoxin in the body does slightly inhibit the activity of the Na/K⁺ pump. However, even though the sodium level is slightly elevated, there is no direct correlation between that increased sodium level and digoxin toxicity. 2. Incorrect: A calcium level of 9.9 is within the normal limits of 9.0 to 10.5 mg/dL (2.25-2.62 mmol/L). Calcium is controlled by the parathyroid glands, generally shifting between the bones and serum. A normal calcium level would not contribute to digoxin toxicity. 3. Incorrect: Albumin is a protein synthesized by the liver which helps

The nurse is caring for a client with tuberculosis receiving isoniazid therapy. Because of the possible peripheral neuropathy that can occur, which supplementary nutritional agents would the nurse expect to administer? 1. Cyanocobalamin 2. Vitamin D 3. Ascorbic acid 4. Pyridoxine

4. Pyridoxine (4. Correct: Isoniazid interferes with vitamin B6 (pyridoxine) metabolism by inhibiting the formation of the active form of vitamin B6. This interference often results in peripheral neuropathy. 1. Incorrect: Vitamin B12 (Cyanocobalamin) is not given to prevent peripheral neuropathy caused from isoniazid therapy. It is used to treat vitamin B12 deficiency often caused by pernicious anemia. It may be given in client's with peripheral neuropathy, but is not beneficial in clients whose neuropathy is due to isoniazid therapy. 2. Incorrect: Vitamin D is not given to prevent peripheral neuropathy. It is used in the treatment of weak bones, bone pain and/or bone loss. 3. Incorrect: Vitamin C is not given to prevent peripheral neuropathy cause from isoniazid therapy. It's use can be beneficial in clients with diabetic peripheral neuropathy.)

A post-operative client has received morphine for pain. The nurse re-assesses the client 10 minutes later. Which assessment data warrants further action by the nurse? B/P 110/76, Pulse 68, Respirations 8, Pain level of 5, dressing dry and intact. 1. Blood pressure 94/60 2. Pulse rate 72/min 3. Pain level 3/10 4. Respiratory rate at 8/min

4. Respiratory rate at 8/min (4. Correct: Normal respiratory rate is 12-20 per minute. The respiratory rate indicates respiratory depression following administration of an opioid. Care should be taken to titrate the dose so that the patients pain is controlled without depressing the respiratory function. 1. Incorrect: Respiratory rate warrants immediate action. However, blood pressure will continue to be monitored. 2. Incorrect: Pulse rate warrants no further action. Pulse rate is normal. 3. Incorrect: The pain level is expected following surgery. The client should continue to have a reduction on pain, as 10 minutes is not long enough to fully evaluate.)

A client comes into the clinic reporting muscle pain and tenderness but denies previous injury. Based on data gathered by the nurse, what client medication does the nurse suspect is causing this problem? CPK: 300 U/L ALT: 38 U/L AST: 42 U/L Alert, oriented client with general weakness and muscle tenderness noted. Reports myalgia, muscle weakness, fatigue, and joint pain. Urine sample obtained; urine cola-colored. 1. Captopril 2. Furosemide 3. Nadolol 4. Rosuvastatin

4. Rosuvastatin (4. Correct: Rosuvastatin is a lipid-lowering agent. All lab work is abnormal and indicates muscle and liver damage. Lipid-lowering drugs can cause liver damage. The assessment of the lab values reveals muscle damage and could indicate rhabdomyolysis development. Creatine phosphokinase: males 55-170 u/L and females 30-135 u/L; Alanine aminotransferase (ALT): 4-36 u/L; Aspartate aminotransferase (AST): 0-35 u/L. 1. Incorrect: Captopril does not affect the liver or muscle. Captopril is an angiotensin-converting enzyme (ACE) prescribed for treatment of hypertension. 2. Incorrect: Furosemide does not affect the liver or muscle. Furosemide is a loop diuretic which promotes diuresis. 3. Incorrect: Nadolol does not affect the liver or muscle. Nadolol is a non-selective beta blocker. The action of nadolol is to treat arterial fibrillation, hypertension, migraines and chest pain.)

A child with acute lymphocytic leukemia (ALL) is receiving chemotherapy through a single lumen Groshong catheter. During the infusion, the child reports nausea and has vomited. The primary healthcare provider has prescribed ondansetron IV. What action should the nurse take? 1. Ask primary healthcare provider for an oral antiemetic. 2. Give ondansetron IVPB with the chemotherapy. 3. Wait until chemotherapy is complete to infuse ondansetron. 4. Stop chemotherapy temporarily and flush line to g

4. Stop chemotherapy temporarily and flush line to give ondansetron. (4. Correct: A Groshong catheter is implanted when other venous access sites are no longer useable. The child has begun to react to the chemotherapy and needs medicated now. Because this implanted device has only one lumen, the nurse must stop the chemotherapy infusion temporarily, flush the port, administer the ondansetron, flush again and restart the chemotherapy infusion. 1. Incorrect: Because this client is vomiting, changing the medication to the oral route would not be effective. The medication takes longer to work if given orally, which means the client may vomit again before the medication activates, losing part of the dose. 2. Incorrect: Chemotherapy infusions should not be mixed with other categories of drugs, such as an antiemetic, because of the possibility of drug interactions. Certain chemical mixtures could also cause precipitates to form in the tubing, which is dangerous to the child. 3. Incorrect:

A client with nausea, vomiting, and diarrhea for the past three days has been prescribed one liter of normal saline with 40 mEq (40 mmol/L) of potassium chloride to infuse at 250 mL per hour. Which assessment would the nurse report to the primary healthcare provider prior to initiating the infusion? 1. Blood pressure of 106/54 2. Apical pulse of 112 per minute 3. Tenting of the skin over the sternum 4. Urinary output of 148 mL for the past 6 hours

4. Urinary output of 148 mL for the past 6 hours (4. Correct: The client's output is below normal. This could indicate a problem with renal perfusion. Potassium is excreted through the kidneys, so if the kidneys are not being perfused, the client would retain potassium. The healthcare provider would need to be aware of the client's low urine output. 1. Incorrect: A client in fluid volume deficit would have a low blood pressure. This is an expected assessment prior to fluid resuscitation. 2. Incorrect: A client in fluid volume deficit would have a fast pulse rate. This is an expected assessment prior to fluid resuscitation. 3. Incorrect: A client in fluid volume deficit would have tenting of skin. This is an expected assessment prior to fluid resuscitation.)

The nurse is caring for a client on the medical unit. The primary healthcare provider prescribed Lactulose 30 gram orally once a day. Available is Lactulose labeled 10 g per 15 mL. How many mL will the nurse administer? Round answer to the nearest whole number. Ans:______

45 (Rationale: (30 g ÷ 1) × (15 mL ÷ 10 g) = (450 ÷ 10) = 45 mL Ans: 45 mL)

A client weighing 140 pounds (63.64 kg) has been admitted to the telemetry unit with a diagnosis of Class III pulmonary hypertension. The primary healthcare provider prescribes digoxin. How many micrograms should the nurse administer now? Round to the whole number. Loading dose of digoxin - 15 micrograms/kg. Give ½ of the dose now, Then ¼ the loading dose every 8 hours times 2 doses. Ans:______

477 (Rationale: (63.64 kg ÷ 1) × (15 mcg ÷ 1 kg) = (954.6 ÷ 1) = 954.6 mcg 954.6 × ½ = 477.3 ≈ 477 mcg Ans: 477 mcg)

A client who has been admitted to the intensive care unit with malignant hypertension has been prescribed nitroprusside IV. BP on admit is 210/112. Weight - 56 kg. Based on the prescription, what should the flow rate for a volumetric pump be set at initially? Round to the whole number. Titrate nitroprusside 50 mg in 250 mL D5W at 3 to 6 mcg/kg/min to maintain client's systolic blood pressure below 140 mm Hg. Ans:______

50 (Rationale: Always start with the lowest dosage when beginning nitropusside. 3 mcg/kg × 56 kg = 168 mcg/min (168 mcg ÷ 1 min) × (1 mg ÷ 1,000 mcg) × (250 mL ÷ 50 mg) × (60 min ÷ 1 hr) = (2,520,000 ÷ 50,000) = 50 mL/hr Ans: 50 mL/hr)

An elderly client was admitted with a diagnosis of Type II diabetes. The primary healthcare provider initiated the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The prescription regimen was to begin at the low dose regimen with regular insulin every 6 hours. The 2400 hours glucose level is 252 mg/dL. How much regular insulin should the nurse give the client at this time? Answer using numbers only. Sliding Scale Insulin Protocol: 1. If Potassium is < 3.5, call M.D. 2. Advance to t

8 (The prescription regimen was to begin at the low dose regimen with regular insulin every 6 hours using the Insulin Sliding Scale Protocol for Type II Diabetic Clients. The protocol states to advance to the next higher dose regimen if glucose level is greater than 250 two (2) times in 24 hours and all readings are greater than 100. All glucose readings were greater than 100 and greater than 250 at 1800 hours and 2400 hours, so the client should be moved to the medium dose regimen which indicates that 8 units of regular insulin should be given at 2400 hours.)