Pharm 1 Final Review

Nifedipine (Procardia) 30 mg p.o. is prescribed for a client. The nurse teaches the side effects and instructs the client to immediately report: A. Increased shortness of breath and orthopnea. B. Dizziness when changing positions. C. Weight loss of two pounds per week. D. Blood pressure 110/70-114/78 for two successive readings.

A. Increased shortness of breath and orthopnea.

A client has a serum cholesterol level of 265 mg/dL, triglyceride level of 235 mg/dL, and LDL of 180 mg/dL. What do these serum levels indicate? A. Hyperlipidemia. B. Alipidemia. C. Hypolipidemia. D. Normolipidemia.

A. Hyperlipidemia.

The nurse evaluates that the client understood discharge teaching regarding warfarin (Coumadin) based on which statement? A. "I should use a soft toothbrush for dental hygiene." B. "I will double my dose if I forget to take it the day before." C. "I should decrease the dose if I start bruising easily." D. "I should keep taking ibuprofen for my arthritis."

A. "I should use a soft toothbrush for dental hygiene." This statement is accurate and will reduce the risk of bleeding. Ibuprofen will potentiate bleeding. The client should call the health care provider if experiencing excessive bruising.

Which statement indicates the client understands discharge instructions regarding cholestyramine (Questran)? A. "I will increase fluids and fiber in my diet." B. "I will have my blood pressure checked weekly." C. "I will take cholestyramine (Questran) at the same time as my other medications." D. "I will weigh myself weekly."

A. "I will increase fluids and fiber in my diet."

The nurse is caring for a client with chronic hypertension. The client is receiving a beta-adrenergic blocker daily. Which client manifestations would the nurse conclude are adverse effects of this medication? Select all the Apply. A. Bradycardia. B. Decreased serum triglycerides. C. Hypotension. D. Thrombocytopenia. E. Hypoglycemia.

A. Bradycardia. C. Hypotension. E. Hypoglycemia.

A client has been treated for chronic open-angle glaucoma for 5 years asks the nurse, "How does glaucoma damage my eyesight." The nurse's reply should be based on the knowledge that open-angle glaucoma: A. Causes increased intraocular pressure and damage to the optic nerve. B. Leads to detatchment of the retina. C. Is caused by decreased blood flow to the retina. D. Results from chronic eye inflammation.

A. Causes increased intraocular pressure and damage to the optic nerve. In open-angle glaucoma, there is an obstruction to the outflow of aqueous humor, leading to increased intraocular pressure. The increased intraocular pressure eventually causes destruction of the retina's nerve fibers. This nerve destruction causes painless vision loss. The exact cause of gluacoma is unknown. Glaucoma does not lead to retinal detachment.

The nurse would question an order for cholestyramine (Questran) if the client has which condition? A. Decrease Gastric Motility. B. Renal Disease. C. Hepatic Disease. D. Glaucoma.

A. Decrease Gastric Motility. Cholestyramine (Questran) binds with bile in the intestinal tract to form an insoluble complex. It can also bind to other substances and lead to intestinal obstruction.

A nurse is administering IV furosemide (Lasix) to a patient admitted with congestive heart failure. After the infusion, which of the following symptom is NOT an expected use of the drug? A. Decreased pain. B. Increased urinary output. C. Decreased edema. D. Decreased blood pressure.

A. Decreased pain.

What is the primary role of a nurse in medication administration? A. Ensure medications are administered and delivered in a safe manner. B.Inform the client that prescribed medications need to be taken only if the client agrees with the treatment plan. C. Be certain that provider orders are accurate. D. Assure client adherence by watching he client swallow all prescribed medications.

A. Ensure medications are administered and delivered in a safe manner. The primary responsibility of the nurse is to ensure client safety when administering prescribed medications. Client adherence includes much more than watching the client take their medications. Accurate provider orders are part of ensuring safe medication administration

Which of the following is the part of the Nursing Process that has the nurse assess the effectiveness of the medication? A. Evaluation. B. Diagnosis. C. Implementation. D. Assessment.

A. Evaluation. The purpose of evaluation in the nursing process is to determine whether the goals and outcomes have been adequately met by the client.

A client who is admitted for an elective dental procedure reports that the last time he received nitrous oxide for a procedure he had what felt like a​ "hangover" for days afterward. Which intervention should the nurse plan to help avoid this​ adverse effect? A. Have the client breathe​ 100% oxygen for several minutes following the nitrous oxide. B. Report this comment to the anesthesiologist so he will change the agent used. C. Rehydrate the client with intravenous normal saline. D.Provide the client with​ caffeine-containing beverages immediately after the procedure.

A. Have the client breathe​ 100% oxygen for several minutes following the nitrous oxide. Having the client breathe​ 100% oxygen for several minutes following nitrous oxide use has been shown to prevent alveolar hypoxia. It is the alveolar hypoxia that produces the​ "hangover" effect. There is no evidence to support prehydration causing a change for this effect. It is not necessary to change anesthesia agents. Administering caffeine with nitrous oxide may exacerbate dysrhythmias.

A client diagnosed with hypercholesterolemia is prescribed atorvastatin (Lipitor). The nurse is reviewing the client's history and would contact the health care provider about which of these conditions in the client's history? A. Hepatic Disease. B. Renal disease. C. Leukemia. D. Chronic Obstructive Pulmonary Disease.

A. Hepatic Disease.

The nurse is teaching a client about the​ beta2-adrenergic agonist albuterol​ (Proventil) prescribed for exercise induced asthma. Which instruction would reduce the onset of a bronchospasm during​ exercise? A. Inhale a dose of the medication 15 to 30 minutes prior to physical activity. B. Clean the mouthpiece at least once a week. C. After taking the medication, drink a cup of hot tea. D. Inhale a dose of the medication immediately after physical activity.

A. Inhale a dose of the medication 15 to 30 minutes prior to physical activity.

Timolol (Timoptic), beta-adrenergic agent, may be used to treat glaucoma. The nurse should teach the clients and family to: A. Monitor pulse and blood pressure. B. Monitor urine output. C. Monitor blood glucose. D. Monitor respiratory rate.

A. Monitor pulse and blood pressure. Beta-adrenergic drugs may reduce resting heart rate and blood pressure. The client family should be taught how to check the pulse and blood pressure before administration and to notify the provider if extremes occur. Beta-adrenergic drugs do not affect urine output, respiratory rate, or glucose levels.

Which of the following is the Highest nursing priority when a client has an allergic reaction to a newly prescribed medication: A. Notify the provider of the allergic reaction. B. Instruct the client to remain calm. C. Place an allergy bracelet on the client. D. Document the allergy in the medical record.

A. Notify the provider of the allergic reaction.

In the first-pass effect or pre-systemic metabolism, a drug is extensively metabolized in the liver, with only part of the drug reaching the systemic circulation for distribution to sites of action. The first-pass effect occurs when some drugs are given by which of the following routes? A. Orally. B. Intravenously. C. Parentally. D. Rectally.

A. Orally.

A client is to receive recombinant tissue plasminogen activator (Alteplase) after being diagnosed with an acute ischemic stroke. Prior to beginning this infusion, the nurse should check to see if which laboratory results are present? Select all that apply. A. Prothrombin (PT) and Partial Prothrombin Time (PTT) B. Complete Blood Count (CBC) C. Type and Screen for Blood Transfusion. D. Electrolyte levels.

A. Prothrombin (PT) and Partial Prothrombin Time (PTT) B. Complete Blood Count (CBC)

Which of the following DEA regulated Drug Schedules correctly list the highest to the lowest potential for abuse: A. Schedule I, II, III, IV, V B. Schedule V, IV, III, II, I C. Schedule V, II, III, I, IV D. Schedule I, IV, III, V, II

A. Schedule I, II, III, IV, V

Clients in a nursing home have been prescribed permethrin shampoo (Nix) for head lice. The nurse will question the order for the client who has a history of: A. An allergy to sulfites. B. Seizures. C. Diabetes mellitus. D. Hypothyroidism.

A. an allergy to sulfites Contraindications to permethrin use include hypersensitivity to pyrethrins, chrysanthemums, sulfites, or other preservatives.

After listening to the nurse explain the use of the PO version of tretinoin (isotretinoin - Accutane) to a 19 year-old female client, the client demonstrates understanding of the most important point by making which statement at the end of the teaching session: A."Have a pregnancy test prior to beginning therapy and use two forms of contraception." B. "Apply thick layer of isotretinoin twice a day." C. "Increase exposure to sun for added benefit." D. "Keep lips moist and lubricated to prevent inflammation."

A."Have a pregnancy test prior to beginning therapy and use two forms of contraception." Isotretinoin, an oral preparation, is a known teratogen that may result in spontaneous abortion and/or major fetal abnormalities such as hydrocephalus. Prevention of pregnancy is mandatory during isotretinoin therapy.

The nurse and the client have established this goal: "The client will verbalize safety considerations for use of tramadol (Ultram) before being discharged from the hospital." Which client statements would support evaluation that this goal has been achieved? (Select all that Apply). A."I will work with my health care provider to taper off the dose of this medication when it is no longer needed." B. "I will not drive until I know how I am going to react to the tramadol." C. "I will not eat aged cheese while taking tramadol." D. "I will limit my alcohol intake to a couple of glasses of wine with dinner." E. "I will avoid taking my regular dose of kava-herbal medication while I am on this drug."

A."I will work with my health care provider to taper off the dose of this medication when it is no longer needed." B. "I will not drive until I know how I am going to react to the tramadol." E. "I will avoid taking my regular dose of kava-herbal medication while I am on this drug." Symptoms such as confusion and visual impairment can occur with tramadol use. Ethanol combined with tramadol may result in death. Caution should be observed when using herbs such as kava that may have an additive CNS depressant effect. There is no contraindication to eating aged cheese with tramadol. If tramadol is abruptly discontinued, symptoms of opioid withdrawal may occur.

A client who had a stroke was prescribed alteplase (Activase). Prior to administering this medication, the nurse spoke with the client's spouse. Which comments by the spouse would the nurse immediately report to the prescriber? Select all that apply. A."I've been worried about him. He has been having black, tarry stools for a week or more." B. "I've tried so hard to help him control his hypertension through the years." C."He has never had a seizure until the one he had today and I am wondering if he hit his head during the seizure activity?" D. "He has never been in the hospital except for when he had his hip surgery 5 years ago." E. "I wonder if he was having little strokes when he fell off the ladder last week."

A."I've been worried about him. He has been having black, tarry stools for a week or more." C."He has never had a seizure until the one he had today and I am wondering if he hit his head during the seizure activity?" E. "I wonder if he was having little strokes when he fell off the ladder last week." Active internal bleeding (which could be evidenced by black, tarry stools) is a contraindication for use of rt-PA. Seizure at the beginning of the stroke is a contraindication for the administration of rt-PA. Falling off a ladder could cause head injury or other trauma that would be a contraindication to rt-PA administration.

Mr. Smith was diagnosed with scabies and was prescribed permethrin 5% cream (Elimite). Which is the best instruction by the nurse to ensure the client applies the cream appropriately? A."Leave the cream on the body for approximately 8-12 hours, preferrably at night, and rinse the cream off in the bath or shower in the morning." B. "After applying the cream, immediately rinse the cream off in the shower." C. "Apply the cream only to the affected areas on the skin, so it can be more effective." D. "Leave the cream on the body for 24 hours."

A."Leave the cream on the body for approximately 8-12 hours, preferrably at night, and rinse the cream off in the bath or shower in the morning." Permethrin is the preferred agent for scabies. The 5% cream (Elimite) is applied to the entire skin surface and allowed to remain for 8-12 hours before bathing.

What priority nursing intervention is essential for the client receiving alteplase (Activase), a thombolytic? A.Assess for signs and symptoms of increase bleeding, bruising, and repurfusion irregular heart rate (dysrhythmias). B. Administer vitamin K if bruising is observed. C. Monitor liver enzymes. D. Monitor blood pressure and stop the medication if blood pressure is 110/80 mmHg.

A.Assess for signs and symptoms of increase bleeding, bruising, and repurfusion irregular heart rate (dysrhythmias). Alteplase (Activase) can cause bleeding as well as reperfusion dysrhythmias. Alteplase does not directly affect liver enzymes. Vitamin K will not reverse the effects of Activase. Vital sign changes can alert the nurse to complications; however, a blood pressure of 110/80 mmHg is not, in itself, cause for alarm.

A patient arrives at the emergency department with severe 10/10 lower leg pain after a fall in a touch football game. Following routine triage, which of the following is the appropriate next step in assessment and treatment? A. Apply an elastic bandage to the leg. B. Apply heat to the painful area. C. Administer the ordered intravenous fentanyl. D. Elevate the leg.

Administer the ordered intravenous fentanyl. Following triage, an x-ray should be performed to rule out fracture and pain control measures should be implemented. Ice, not heat, should be applied to a recent sports injury. An elastic bandage may be applied once fracture has been excluded.

An adult client with a history of​ obesity, asthma, peripheral vascular​ disease, and migraine headaches tells the nurse she saw an advertisement in a magazine for a drug for migraine​ headaches: "The drug was​ Imitrex; it looked very​ effective, and I wonder why my provider​ hasn't talked to me about using it for my​ headaches." What is the​ nurse's best response to this question about sumatriptan​ (Imitrex)? A. "I think it would be good for you. Bring in the ad." B. "Your peripheral vascular disease is a contraindication for the​ drug." C. "You have​ asthma, so you cannot use the​ drug." D. ​"Once you lose some​ weight, the drug will be perfect for​ you."

B. "Your peripheral vascular disease is a contraindication for the​ drug." Sumatriptan​ (Imitrex) is contraindicated in clients with peripheral vascular​ disease, CAD, and cerebrovascular disease due to the risk of myocardial infarction. Clients with asthma can safety use sumatriptan. The drug is not ideal for this client due to her health history. Obesity is not a contraindication for sumatriptan.

Miss. Batten is prescribed topical retinoids - tretinoin for her moderate acne. She returns to the office 1 week later, disappointed because she does not see improvement in her condition. You explain to the client that improvement may not be seen for up to how many weeks? A. 3 weeks. B. 8 weeks. C. 2 weeks. D. 2-1/2 weeks.

B. 8 weeks.

Before administering drugs by the enteral route, the nurse should evaluate which of the following? A. Compatibility of the drug with IV fluid. B. Ability of the client to swallow medications. C. Patency of the injection port. D. Ability of the client to lie supine.

B. Ability of the client to swallow medications. The enteral route involves the process of swallowing by definition.

What are the four phases of pharmacokinetics that a drug goes through? A. Absorption, distribution, ionization, and metabolism. B. Absorption, distribution, metabolism, and excretion. C. Diffusion, bioavailability, metabolism, and excretion. D. Active transport, ionization, diffusion, and excretion.

B. Absorption, distribution, metabolism, and excretion. Pharmacokinetics includes Absorption, Distribution, Metabolism, and Excretion (ADME).

Unexpected and undesired drug reactions are labeled: A. Idiosyncratic reactions. B. Adverse effects. C. Unaltered reactions. D. Enzyme-specific reactions.

B. Adverse effects. Undesired, inadvertent, and unexpected dangerous effects of medication are labeled adverse effects.

The nurse is reviewing the laboratory work for a patient who is taking atorvastatin (Lipitor). Which laboratory value is most useful for monitoring this drug? A. Blood urea nitrogen (BUN). B. Aspartate aminotransferase (AST). C. International normalized ratio (INR). D. C-reactive protein (CRP).

B. Aspartate aminotransferase (AST). AST is a liver enzyme that is helpful for monitoring liver function (hepatotoxicity). Lipitor, a lipid-lowering drug, is a commonly prescribed example of a hepatotoxic drug. The BUN is a measure of kidney function. The INR is a comparative rating of prothrombin time ratios that is used to monitor patients taking the anticoagulant agent warfarin. The CRP is elevated in inflammatory and neoplastic disease, myocardial infarction, and the third trimester of pregnancy. It is used as a cardiac risk marker.

Hydroxychloroquine sulfate (Plaquenil) has been prescribed for a 24-year-old client for the control of his auto-immune disease. The nurse will teach the client to immediately report: A. Dry mouth. B. Blister-like rash to the oral mucosa or on the skin. C. Leg cramps. D. Lethargy.

B. Blister-like rash to the oral mucosa or on the skin.

The client should be aware of potential side effects of prostaglandins latanoprost (Xalatan) used in the treatment of glaucoma. The nurse should include which of the following in the teaching plan: A. Hypertension. B. Brown pigmentation of the treated eye. C. Dilation of pupils. D. Loss of eyelashes.

B. Brown pigmentation of the treated eye. Side effects include eye irritation, conjunctival edema, burning, stinging, redness, blurred vision, pain, itching, the sensation of foreign body in the eye, photophobia, and visual disturbances. The client may experience the phenomenon of increasing amounts of brown pigmentation in the treated eye only and thickening of the eyelashes and hair adjacent to the treated eye. Loss of eyelashes, hypertension, and dilation of the pupils do not occur with the use of prostaglandins.

Which of the following is the priority of the nurse when assessing a client prior to administering the first dose of any medication to a client: A. Client's understanding of drug action. B. Client's history of medication allergies. C. Client's level of consciousness. D. Client's understanding of the purpose of the medication.

B. Client's history of medication allergies. Assessment of allergies and reactions to medications is essential when administering a new medication. Hypersensitivity responses can occur with any medication and severe adverse reactions may by systemically absorbed.

When a newly admitted client is placed on heparin intravenously, the nurse acknowledges that heparin is effective for preventing new clot formation in clients who have which disorder(s)? (Select all that apply.) A. Ruptured Spleen. B. Deep Venous Thrombosis (DVT). C. Pneumonia. D. Chronic Obstructive Pulmonary Disease (COPD). E. Pulmonary Embolism (PE).

B. Deep Venous Thrombosis (DVT). E. Pulmonary Embolism (PE).

A client who is in kidney (renal) failure may have a diminished capacity to excrete medications. It is imperative that this client be assessed for what development? A. Decreased creatinine levels. B. Drug toxicity. C. Increased levels of potassium. D. Decreased levels of blood urea nitrogen.

B. Drug toxicity. The kidneys are the primary site of excretion. Renal failure increases the duration of the drug's action because of decreased excretion. The client must by assessed for drug toxicity.

Some drugs may be completely metabolized by the liver circulation before ever reaching the general circulation. This effect is known as: A. Blood-brain barrier. B. First-pass effect. C. Hepatic microsomal enzyme system. D. Conjugation of drugs.

B. First-pass effect. Some oral drugs are rendered inactive by hepatic metabolic reactions, during the process known as the first-pass effect. An alternative route may need to be assessed.

A client who is experiencing acute asthma exacerbations after having a recent upper respiratory infection is prescribed a short-term beclomethasone inhaler. Which is the expected outcome for the use of steroids in clients with asthma? A. Prevent development of respiratory infections. B. Have an anti-inflammatory effect. C. Act as an expectorant. D. Promote bronchodilation.

B. Have an anti-inflammatory effect.

The nurse observes the client instill eye drops for gluacoma. The client asks, "why should I hold pressure to my lacrimal duct for approximately 2 minutes after I instill the drops?" The nurse explains to the client that this method is the best technique because: A. It prevents corneal injury. B. It helps to prevent systemic absorption. C. It reduces excessive lacrimation. D. It prevents scleral staining.

B. It helps to prevent systemic absorption. Holding pressure to the lacrimial duct helps prevent systemic absorption because the medication can reach the systemic circulation by entering through the tear duct if pressure is not held for approximately 2 minutes, which is the amount of time it takes for the medication to be absorbed into the eye.

Which of the following is an Incorrect statement regarding nursing diagnoses? A. It is a clinical judgment made by the nurse. B. It identifies the medical problem experienced by the client. C. It determines nursing interventions for which the nurse is accountable. D. It identifies the client's response to actual or potential health and life processes.

B. It identifies the medical problem experienced by the client. NANDA classifies a nursing diagnosis as a clinical judgment about individual, family, or community responses to actual or potential health/life processes. Per NANDA, during diagnoses provide the basis for the selection of nursing interventions to achieve outcomes for which the nurse is accountable.

A client refuses a PRN medication of morphine sulfate PO; you document the reason for the refusal in the medication administration record and dispose of the medication according to facility policy. By documenting the client's refusal and reason for declining the medication, you are adhering to which of the "rights" of medication administration? A. Right dose. B. Right documentation. C. Right patient. D. Right medication.

B. Right documentation. By documenting the client's refusal of the medication within the medication administration record, the nurse is adhering to the safety measure of the Right documentation.

In considering the pharmacotherapeutic perspective, which property is considered the greatest maximal response that can be produced from a particular drug: A. Toxicity. B. Interaction with other drugs. C. Potency. D. Efficacy.

D. Efficacy.

A client is taking warfarin 5 mg/day for atrial fibrillation. The client's international normalized ration (INR) is 3.8. The nurse would consider the INR to be what? A. Low INR range. B. Within normal range. C. Sub-therapeutic INR range. D. Elevated INR range.

D. Elevated INR range. Therapeutic INR range of a patient who is taking warfarin (Coumadin) is 2-3.

The nurse cares for a client diagnosed with gout. The nurse instructs the client about allopurinol (Zyloprim). Which statement by the client indicates to the nurse the need for further instruction? A. "This medication increases the excretion of uric acid through the kidneys." B. "I should take the medication with meals to decrease upset stomach." C. "It will be necessary for me to decrease my fluid intake now." D. "It will take at least 2 to 3 weeks for my gout symptoms to improve."

C. "It will be necessary for me to decrease my fluid intake now." It takes approximately 2 to 3 weeks for serum uric acid levels to return to normal limits after allopurinol therapy is initiated. When taking allopurinol, the client should consume enough fluids to maintain a urine output of at least 2 liters per day; will prevent formation of uric acid kidney stones. Allopurinol should be taken with or immediately after meals to decrease gastric irritation. Allopurinol decreases the formation of uric acid by blocking the enzyme necessary for uric acid formation. Allopurinol is used to treat chronic gout and will decrease the size of tophi and prevents formation of new tophi.

The nurse concludes that a client newly diagnosed with glaucoma knows the purpose for the prescribed timolol (Timoptic) blocker when the clients makes which statement: A. "This eyedrop is the only treatment available for glaucoma." B. "I can stop using the eyedrop once my intraocular pressure is normal." C. "This eyedrop will reduce the intraocular pressure." D. "The medicine will help to increase my intraocular pressure."

C. "This eyedrop will reduce the intraocular pressure." Ophthalmic beta-blockers such as timolol are administered to reduce intraocular pressure by decreasing production of aqueous humor. The medication must be continued as a lifelong therapy to maintain a stable intraocular pressure.

Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis? A. A female patient being treated for high blood pressure with an ACE inhibitor. B. A patient on a calorie restricted diet. C. A patient on bed rest who must maintain a supine position. D. A patient who is allergic to iodine/shellfish.

C. A patient on bed rest who must maintain a supine position.

A client with cirrhosis of the liver exhibits decreased metabolic activity. This will require what possible change in the client's drug regimen? A. An increased dose of prescribed drugs. B. All prescribed drugs must be given by intramuscular injection. C. A reduction in the dosage of drugs. D. A change in the timing of medication administration.

C. A reduction in the dosage of drugs. The liver is the primary site of drug metabolism. Clients with severe liver damage, such as that caused by cirrhosis, will require reductions in drug dosage because of the decreased metabolic activity.

A nurse is preparing to administer a heparin injection to a client for prevention of deep vein thrombosis while hospitalized. What is an essential nursing intervention? A.Draw up the medication in an intramuscular (IM) syringe with a 22-gauge, 1-½ inch needle. B. Utilize the Z-track method to inject the medication. C. Administer the medication into the subcutaneous tissue. D. Rub the administration site after injecting.

C. Administer the medication into the subcutaneous tissue.

The client with liver dysfunction experiences toxicity to a drug following administration of several doses. This adverse reaction may have been prevented if the nurse had followed which phase of the nursing process? A. Evaluation. B. Implementation. C. Assessment. D. Planning.

C. Assessment.

A client is admitted to the hospital with an acute gout attack. The nurse expects that which medication will be ordered to treat acute gout? A. Allopurinol. B. Probenecid. C. Colchicine. D. Sulfinpyrazone.

C. Colchicine. This medication is used to prevent or treat gout attacks (flares). Usually gout symptoms develop suddenly and involve only one or a few joints. The big toe, knee, or ankle joints are most often affected. Gout is caused by too much uric acid in the blood. When uric acid levels in the blood are too high, the uric acid may form hard crystals in your joints. Colchicine works by decreasing swelling and lessening the build up of uric acid crystals that cause pain in the affected joint(s).

The nurse is caring for a 78-year-old client who has multiple medications ordered to treat various medical problems. The nurse considers which of the following common age physiological change will most likely require a reduction in medication dosage for this client? A. Decreased efficiency in drug distribution. B. Increased total body fluid proportionate to body mass. C. Decreased rate of drug metabolism by the liver. D. Increased rate of drug excretion.

C. Decreased rate of drug metabolism by the liver.

Because of the physiologic and biochemical changes of aging in the geriatric patient, the nurse recognizes which adjustment in medications may be necessary? A. The parental route of administration is preferred. B. Medications will need to be given more frequently. C. Dosages of medications may need to be decreased. D. Drugs should be given in the early AM.

C. Dosages of medications may need to be decreased. Due to the decline in liver and kidney function in the geriatric patient, dosages of medications may need to adjusted to combat the physiological aging process of decreased metabolism and excretion of drugs.

The client diagnosed with a head injury after a skiing accident is ordered to have a head CT scan. The client is requesting to receive morphine sulfate IV prior to being transported to the radiology department. What teaching should the nurse include when discussing the administration of morphine sulfate to the client? A. Explain to the client that fentanyl will work best to control pain. B.Morphine sulfate can not be taken with any other routine medications; therefore, the client should not receive the drug. C. Explain to the client that morphine sulfate is contraindicated because this could put the client at potential risk of increased cerebrospinal fluid (CSF) pressure. D. Inform the client that an intravenous line (IV) will be started prior to the procedure and the client can receive the morphine sulfate at that time.

C. Explain to the client that morphine sulfate is contraindicated because this could put the client at potential risk of increased cerebrospinal fluid (CSF) pressure. Morphine sulfate reduces the sensitivity of the respiratory center to CO2 thus decreasing tidal volume and rate and producing respiratory depression. The resulting increase in CO2 produces vasodilation and increases CSF pressure. Morphine sulfate can be given with most routine medications. Morphine sulfate and fentanyl are contraindicated in patients with head injuries.

The period of time needed for a medication to be reduced by 50% in the body is referred to as: A. First-pass effect. B. Therapeutic Response. C. Half-life. D. Efficacy.

C. Half-life.

The nurse is completing a medical history for a client with asthma. For which reason would the​ beta2-adrenergic agonist albuterol​ (Proventil) be contraindicated for this​ client? A. Connective tissue disease. B. Spinal stenosis. C. High blood pressure. D. Mitral valve prolapse.

C. High blood pressure.

A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient? A. Monitor urine output. B. Monitor heart rate. C. Monitor respiratory rate. D. Monitor temperature.

C. Monitor respiratory rate. Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Morphine sulfate does not significantly affect urine output, heart rate, or body temperature.

The charge nurse on an orthopedic unit is transcribing orders for a client diagnosed with 2/10 back pain. Which health care provider order should the charge nurse question? A. CBC and CMP (complete metabolic panel) lab work. B. Carisoprodol (SOMA), a muscle relaxant, PO, twice daily. C. Morphine sulfate, an opioid agonist, 10 mg IV Push every hour. D. tramadol (Ultram), centrally acting nonopioid analgesic, 50 mg PO every 6-8 hours PRN.

C. Morphine sulfate, an opioid agonist, 10 mg IV Push every hour. Morphine sulfate is a potent analgesic with addictive properties, and the nurse should question a routine administration of this medication. The health care provider may have failed to write PRN after the order. Many medications can affect the kidneys or the liver and the blood counts. Baseline data should be obtained. There is no reason to question this order. Soma comes in one strength, so this order is complete. There is no reason to question this order.

A client has been started on gemfibrozil (Lopid) in combination with atorvastatin (Lipitor) for treatment of severely elevated triglyceride levels. When the client develops bruising and epitaxis, the nurse anticipates which provider order? A. The dose of atorvastatin will be reduced. B. A p.r.n. analgesic will be ordered. C. Obtain labs to assess the patient's clotting state. D. An ECG will be ordered.

C. Obtain labs to assess the patient's clotting state. Fibric acid derivatives, such as gemfibrozil, can increase bleeding times. Example: the INR or prothrombin time will help to evaluate the client's clotting state. The statin is not the cause of the problem. An analgesic or ECG would not help to correct the underlying problem.

The nurse receives the patient's lab values throughout warfarin drug therapy. The expected therapeutic level is: A. aPTT one to two times the patient's baseline level. B. aPTT of three to four times the normal control value. C. PT/INR one and a half to two times the control value. D. PT one to two times the patient's last result.

C. PT/INR one and a half to two times the control value. aPT/INR is the coagulation study that monitors oral anticoagulant use, such as warfarin. As a result of one and half to two times the control value indicates adquate anticoagulation. aPTT is the coagulation study that monitors heparin use. aPT level of one would indicate a less than therapeutic level of anticoagulation.

Mrs. Walker requires pain relief for a recent sunburn. The provider orders benzocaine 20% topical spray to apply to Mrs. Walker's affected areas and then the phone reception is interrupted and the phone conversation is disconnected. When the nurse calls the provider back, which 5 right would the nurse need to clarify? A. Right brand name of the drug. B. Right patient. C. Right time and frequency of drug administration. D. Right cost of the drug.

C. Right time and frequency of drug administration. Interpret the prescriber's order accurately (i.e., drug name, dose, frequency of administration). Question the prescriber if any information is unclear or if the drug seems inappropriate for the client's condition.

A patient calls the clinic today because he is taking atorvastatin (Lipitor) to treat his high cholesterol and is having pain in both of his legs. You instruct him to: A.Stop taking the medication and make an appointment to be seen in the clinic next week. B.Continue taking the medication and make an appointment to be seen in the clinic next week. C. Stop taking the medication and come to the clinic to be seen today. D. Ambulate for about 30 minutes and call to be seen in the clinic if symptoms continue.

C. Stop taking the medication and come to the clinic to be seen today. Muscle aches, soreness, and weakness may be early signs of myopathy such as rhabdomyolysis associated with the HMG-CoA reductase class of antilipemic agents. This patient will need an immediate evaluation to rule out myopathy. Additional doses may exacerbate the problem. Exercise will not reverse myopathy and delays diagnosis.

The nurse is preparing to administer a 9:00 AM medication of morphine sulfate 1 mg IV to the following clients. Which client should the nurse QUESTION administering the medication? A. The client who drank a full glass water and ate a large meal. B. The client who is complaining of lower back pain. C. The client who has a blood pressure of 88/58 mm/Hg. D. The client who has a a normal platelet count.

C. The client who has a blood pressure of 88/58 mm/Hg. The blood pressure is below 100/60 mm/Hg; therefore, the nurse should question administering morphine sulfate due to the risk of causing an additional CNS adverse effect of hypotension. The patient drinking water or eating a large meal should not affect the absorption of the morphine sulfate when given via the IV route. Lower back pain is not a contraindication for morphine sulfate administration. The client's platelet count is within the normal range and would not piose a risk of being a contraindication for morphine sulfate administration.

The nurse is teaching a client about safe drug administration when using topical permethrin for the treatment of scabies. The nurse determines that instruction has been effective when the client states: A. "I need to rinse off the topical medication after it has been on my skin for a few days." B. "I need to sign a consent for this medication." C."I must promptly report any irritation, broken skin, erythema, rashes, or edema when using this lotion." D. "I should cover the area with a clean cloth when applying the medication."

C."I must promptly report any irritation, broken skin, erythema, rashes, or edema when using this lotion." The nurse should teach the patient, family, or caregiver to report any redness, swelling, itching, excoriation, or burning to the health care provider.

Which statement indicates to the nurse that the client needs further medication instruction about cholestyramine (Questran)? A. "I should take this medication 1 hour after or 4 hours before my other medications." B. "The medication may cause constipation, so I will increase fluid and fiber in my diet." C."It is not necessary to stir the powder in 6-8 oz of fluid to maintain potency of the medication." D. "I might need to take fat-soluble vitamins to supplement my diet."

C."It is not necessary to stir the powder in 6-8 oz of fluid to maintain potency of the medication."

A 16-year-old adolescent who is 6 weeks pregnant has acne that has been exacerbated during the pregnancy. She asks the nurse if she can resume taking her PO tretinoin (Retin-A) prescription. The best response by the nurse is: A. "You should reduce your PO Retin-A dose by half during pregnancy." B. "Since you already have a prescription for PO Retin-A, it is safe to take during pregnancy." C."The PO formulation of Retin-A is known to cause birth defects; therefore, it is not recommended that you take it during pregnancy." D. "You should check with your provider at your next visit."

C."The PO formulation of Retin-A is known to cause birth defects; therefore, it is not recommended that you take it during pregnancy." The PO formulation of Retin-A is Category D and demonstrates positive evidence of human fetal risk. There is a high risk that infants will be severely deformed if this PO formulation of the drug is administered during pregnancy.

Nurses have a legal and moral responsibility to report medication errors. The steps of reporting these errors include: A. Identifying potential unsafe medication facilities. B. Monitoring unsafe medication orders. C.Examining interdisciplinary causes of errors and assisting professionals in ways to avoid mistakes. D. Punishing the nurse committing the error.

C.Examining interdisciplinary causes of errors and assisting professionals in ways to avoid mistakes.

After a nurse provided instructions about timolol (Timoptic) to a client with a history of chronic heart disease, the client asks, "How can this eye drops affect my heart?" The nurse's best response includes which of the following information? A.Clients are at risk if timolol is given at the same time as the oral medications taken for cardiac disease. B. This medication does not have any effects on the cardiac system. C.If this ophthalmic medication is systemically absorbed, it can have the same systemic effects as other beta-blocking agents. D. Clients are only at risk if the prescribed ophthalmic medication is pulmonary-selective.

C.If this ophthalmic medication is systemically absorbed, it can have the same systemic effects as other beta-blocking agents. If systemic absorption occurs after the administration of timolol, the adverse effects such as decreased heart rate blood pressure may develop.

The nurse administers a medication to the wrong client. The appropriate nursing action is to: A. Document the error if the client has an adverse reaction. B. Monitor the client for an adverse reaction before reporting the incident. C.Report the error to the provider, document the medication in the client record, and complete an incident report. D. Notify the provider and document the error in the incident report only.

C.Report the error to the provider, document the medication in the client record, and complete an incident report. The nurse is responsible for documenting medication errors and completing an incident report for review by the facility's quality assurance personnel.

A patient's wife asks the nurse why her husband did not receive the clot busting medication alteplase (tPA) she has been reading about. Her husband is diagnosed with a hemorrhagic stroke. What should the nurse respond? A. You should discuss the treatment of your husband with your doctor. B. Not every is eligible for this drug. Has he had surgery lately? C.The medication you are talking about dissolves clots and could cause more bleeding in your husband's head. D. He didn't arrive within the time frame for that therapy.

C.The medication you are talking about dissolves clots and could cause more bleeding in your husband's head.

The nurse is reconciling the medications with a client who is being discharged. Which of the following indicates there is a "discrepancy?" A. There is justification for a difference in the medication orders. B.There is agreement between the client's home medication list and current medication orders. C.There is lack of congruence between a client's home medication list and current medication orders. D. Sample medications have been included in the medication list.

C.There is lack of congruence between a client's home medication list and current medication orders. The medications ordered for, administered to, or dispensed to the client while under the care of a health care organization are compared to those on the list and any discrepancies (e.g., omissions, duplications, potential interactions) are resolved. A complete list of the client's medications is communicated to the next provider of service when a client is referred or transferred to another setting, service, practitioner, or level of care within or outside the organization. The complete, accurate list of medications is also provided to the client on discharge from the organization. The next provider of service checks the Medication Reconciliation List again to make sure it is accurate and in concert with any new medications to be ordered or prescribed.

Mrs. Geonity is prescribed a medication, and the provider modifies the dose on multiple occasions to achieve the maximum therapeutic effect of the drug. She asks you what the rationale is for the dosage changes. How should you respond? A."Your generic drug does not work as efficiently, and the provider increased your dose." B. "Your insurance plan requires that we change the drug dose frequently." C. "Dosage varies based on the brand name." D. "Dosages determines whether the drug actions may be therapeutic or toxic."

D. "Dosages determines whether the drug actions may be therapeutic or toxic."

Mr. Dow works the evening shift. The provider orders a medication that must be taken three times a day on an empty stomach. He asks you if he can take his evening dose with supper for convenience. How should you respond? A. "It does not matter if the drug is taken on an empty stomach or not." B. "It it is only the one meal, the food will not make a difference." C. "Food may increase the effectiveness of the medication." D. "Food may slow the absorption of the drug."

D. "Food may slow the absorption of the drug."

The client diagnosed with essential hypertension is taking furosemide (Lasix). Which statement by the client warrants notifying the client's healthcare provider? A. "I usually have one or two cups of coffee a day." B. "I get a little dizzy when I get up too fast." C. "I really wish my mouth would not be so dry." D. "I have been experiencing really bad leg cramps."

D. "I have been experiencing really bad leg cramps." Leg cramps could indicate hypokalemia, which is potentially life threatening secondary to cardiac dysrhythmias. This needs to be reported to the healthcare provider so that the dosage can be reduced or potassium supplements can be ordered for the client.

Mrs. Smith is 12 hours post appendectomy. Her husband asks the nurse to reduce the amount of morphine sulfate that his wife is receiving. He states, "When I had my appendix out, I needed half the pain medication that she does." Based on the nurse's knowledge, what is the best nursing response? A. "I agree she is taking far too much pain medication." B."I will call the physician for an order to decrease the dose and the frequency of your wife's pain medication." C. "You should discuss your wife's pain management with the physician." D. "Pain is a subjective experience, we all feel pain differently."

D. "Pain is a subjective experience, we all feel pain differently." Pain is a subjective experience. Stressors such as anxiety, depression, fatigue, anger, and fear tend to increase pain; rest, mood elevation, and diversionary activities tend to decrease pain. Pain is a complex physiologic, psychological, and sociocultural phenomenon that must be thoroughly assessed if it is to be managed effectively.

The mother of a client who has been diagnosed with head lice has completed the application of permethrin (Nix) shampoo. Which of the following is the next step the nurse should teach the mother regarding the treatment of head lice: A. "Check the heads of your child's friends before allowing them to play together." B. "You are fine now; just watch your child for a reinfection." C. "Keep your child's hair short so it will be easier to treat next time." D. "Remove all nits from the hair shaft with a nit comb or a fine-tooth comb."

D. "Remove all nits from the hair shaft with a nit comb or a fine-tooth comb." The client's mom should be instructed to clear the dead lice eggs with a fine-toothed comb as the next step after shampooing with Nix for proper head lice treatment.

The nurse is discussing the System to Manage Accutane (tretinoin) Related Teratogenicity (SMART) with a client who has severe acne. Which statement by the female client would cause the healthcare provider to Not Prescribe PO tretinoin (Accutane)? A. "My menstrual cycles have been regular and heavy." B. "I will have to come in every month for a pregnancy test." C. "I hope this works because I am so tired of being ugly." D. "The only contraception I use is birth control pills."

D. "The only contraception I use is birth control pills." The client must use two forms of birth control when taking PO Accutane (tretinoin) because it is extremely damaging to the fetus. The SMART protocol has been instituted to ensure that no female clients are or become pregnant while taking this medication.

What is the best information for the nurse to provide to the client who is receiving spironolactone (Aldactone) [potassium-sparing diuretic]and furosemide (Lasix) [Loop (high-ceiling) diuretic] therapy? A."Using two drugs increases the osmolality of plasma and the glomerular filtration rate." B."Moderate doses of two different diuretics are more effective than a large dose of one." C. "This combination prevents dehydration and hypovolemia." D. "This combination promotes diuresis but decreases the risk of hypokalemia."

D. "This combination promotes diuresis but decreases the risk of hypokalemia." Spironolactone is a potassium-sparing diuretic; furosemide causes potassium loss. Giving these together minimizes electrolyte imbalance.

A client who was admitted for a pulmonary embolism requires emergency surgery. The client has been receiving intravenous heparin and has a current aPTT level of >150 seconds. What nursing intervention will the nurse anticipate as a priority before surgery? A. Teach the client about the phenytoin. B. Assess the INR before surgery. C. Administer vitamin K. D. Administer protamine sulfate.

D. Administer protamine sulfate. Protamine sulfate binds with heparin in the bloodstream to inactivate it and thus reverse its effect.

A diabetic client has been diagnosed with hypertension, and the physician has prescribed propranolol, a beta-blocker. When performing discharge teaching, it is important for the client to recognize that the addition of propranolol with a history of diabetes can cause: A. An increase in the incidence of ketoacidosis. B. A decrease in the incidence of ketoacidosis. C. A decrease in the hypoglycemic effects of insulin. D. An increase risk of masked hypoglycemia effects.

D. An increase risk of masked hypoglycemia effects.

Prior to administering medication to a hospitalized client who is awake and carrying on a conversation with visitors, what would be the most accurate way for the nurse to check one of the 5 rights "the client's identity"? A. Ask the client, "Are you Dale Jones." B. Match the medication administration record with the client's diagnosis. C. Check the client's room number and bed assignment on the door. D. Ask the client, "Can you tell me your name and date of birth?"

D. Ask the client, "Can you tell me your name and date of birth?" Asking the client to state his or her name is an accurate way to identify a client, provided the client is alert. A second unique identifier, such as date of birth or medical record number, should also be used. This information may be found on the client's indentification bracelet, although the client may be asked to state date of birth. Hospitalized or ill clients are often anxious, medicated, or confused and could respond incorrectly to the question, "Are you Dale Jones?" Because client's bed assignments are sometimes changed to meet unit needs, checking the room assignment poses a risk for incorrect identification. Because the same diagnosis with the same medication may be appropriate for more than one client, matching the medication to the diagnosis or need will place the client at risk.

Mr. Gray calls the nurses' station and request his prn break-through pain relief of fentanyl (Sublimaze) for his chronic lower back pain. Which intervention should the nurse perform prior to administering fentanyl to the client? A. Administer the client's prescribed pain medication. B. Check the MAR to see if there is an non-narcotic medication ordered. C. If visitors are present, wait until the visitors leave to administer the medication. D. Assess the client's perception of pain on a 1-10 pain scale.

D. Assess the client's perception of pain on a 1-10 pain scale. The first action is always to assess the client in pain to determine if the client is having a complication that requires medical intervention rather than PRN pain medication. The nurse should not administer pain medication until after assessing the client's pain. The nurse should assess the client, then administer the pain medication whether the client has visitors or not.

When a client asks how nicotinic acid (niacin) will help to treat high lipid levels, the nurse explains that it should: A. Increase VLDL levels. B. Decrease HDL levels. C. Increase triglyceride levels. D. Decrease LDL levels.

D. Decrease LDL levels. The primary effect of nicotinic acid is to lower VLDL levels. Since LDL is synthesized from VLDL, the client experiences a decrease in LDL levels. It also decreases triglycerides, and increases HDL.

Normal age physiological changes in the geriatric patient may affect excretion and promote accumulation of drugs in the body includes which of the following factors: A. Rigidity of the diaphragm. B. Decreased mental status. C. Increased gastric motility. D. Decreased glomerular filtration rate.

D. Decreased glomerular filtration rate. Decreased glomerular fitration rate is part of the normal aging process in the geriatric patient, which results in decreasing of dosages of medications due to the diminished excretion of medication via the kidneys.

The nurse should assess clients with chronic open-angle glaucoma for: A. Eye pain. B. Excessive lacrimation. C. Colored light flashes. D. Decreasing peripheral vision.

D. Decreasing peripheral vision. Although chronic open-angle glaucoma is usually asymptomatic in the early stages, peripheral vision gradually decreases as the disorder progresses. Eye pain is not a feature of chronic open-angle glaucoma but is common in clients with angle-closure glaucoma. Excessive lacrimation is not a symptom of chronic open-angle glaucoma; it may indicate a blocked tear duct. Flashes of light is a common symptom of retinal detachment.

A client is taking spironolactone (Aldactone) to control her hypertension. Her serum potassium level is elevated at 6 mEq/L. For this client, the nurse's priority should be to assess her: A. Bowel sounds. B. Neuromuscular function. C. Respiratory rate. D. EKG (12 lead cardiac rhythm test)

D. EKG (12 lead cardiac rhythm test) Although changes in all these findings are seen in hyperkalemia, ECG results should take priority because changes can indicate potentially lethal arrhythmias such as ventricular fibrillation. It wouldn't be appropriate to assess the client's neuromuscular function, bowel sounds, or respiratory rate for effects of hyperkalemia.

The nurse helps a client establish goals to control asthma with medications. The nurse emphasizes that the preferred drugs for long-term "control" of asthma are: A. Antihistamines. B. Anticholinergics. C. Inhaled Beta-2 adrenergic agonist. D. Inhaled corticosteroids.

D. Inhaled corticosteroids. Inhaled corticosteroids are the drugs of choice for the prevention of asthmatic attacks and for the management of chronic asthma. Although symptoms will improve in the first 1 to 2 weeks of therapy, 4 to 8 weeks may be required for maximum benefit p. 740 Adams & Urban

A drug is 100% bioavailable when it is administered by which of the following routes? A. Oral. B. Rectal. C. Parental. D. Intravenous.

D. Intravenous.

The nurse observes a coworker preparing to administer a solution of lidocaine with epinephrine via the intravenous route to a client whose heart rate is 150 beats per minute. The appropriate action by the nurse is to: A. Notify the nursing supervisor of the error. B. Document administration of the drug. C. Do nothing: the drug choice and route is correct. D. Prevent administration and question the order with the physician.

D. Prevent administration and question the order with the physician. Solutions of lidocaine containing preservatives or epinephrine are intended for local anesthesia only and must never be given IV for dysrhythmias.

A nurse is assisting a physician who is preparing to suture a superficial laceration on a patient's leg. The physician asks the nurse to draw up lidocaine with epinephrine. The nurse understands that epinephrine is used with the lidocaine to: A. Improve perfusion by increasing blood flow to the area. B. Increase the rate of absorption of the lidocaine. C. Allow more systemic absorption to speed up metabolism of the lidocaine. D. Prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

D. Prolong anesthetic effects and reduce the risk of systemic toxicity from lidocaine.

A client uses timolol maleate (Timoptic) eye drops. The expected outcome of this beta-adrenergic blocker is to control glaucoma by: A. Dilating the canals of Schlemm. B. Constricting the pupils. C. Improving the ability of the ciliary muscle to contract. D. Reducing aqueous humor formation.

D. Reducing aqueous humor formation. Timolol maleate is commonly administered to control glaucoma. The drug's action is not completely understood, but it is believed to reduce aqueous humor formation, thereby reducing intraocular pressure. Timolol does not constrict the pupils; miotics are used for pupillary constriction and contraction of the ciliary muscle. Timolol does not dilate the canal of Schlemm.

Nurse Clarisse is teaching a patient about a newly prescribed drug. What could cause a geriatric patient to have difficulty retaining knowledge about prescribed medications? A. Decreased plasma drug levels. B. History of Tourette Syndrome. C. Lack of family support. D. Sensory deficits.

D. Sensory deficits. Sensory deficits could cause a geriatric patient to have difficulty retaining knowledge about prescribed medications. Decreased plasma drug levels do not alter the patient's knowledge about the drug. A lack of family support may affect compliance, not knowledge retention. Tourette syndrome is unrelated to knowledge retention.

The nurse is discussing skin care with a teenaged client who has MILD acne. Which medication or treatment should the nurse discuss with the client? A. Injections of Clostridium botulinum into the acne lesions. B. Applying Vitamin E oil directly to the acne pimples to keep them moist. C. Taking isotretinoin (Accutane) by mouth daily. D. Washing the face and neck morning and night with benzoyl peroxide.

D. Washing the face and neck morning and night with benzoyl peroxide. Benzoyl peroxide is used for mild acne to suppress the growth of P. acnes and promote keratolysis (peeling of the horny layer of the epidermis). Accutane has serious side effects, and its use is restricted to only those with severe, disfiguring acne. Clients with acne have too much oil production. Applying Vitamin E oil would increase the client's problem. Clostridium botulinum is Botox, which is used to decrease the appearance of wrinkles. It is not used to treat acne.

Which factor is most important for the nurse to assess when evaluating the effectiveness of a client's drug therapy: A. Client's promise to comply with drug therapy. B. Client's satisfaction with the drug. C. Cost of the medication. D. Evidence of therapeutic benefit.

D. evidence of therapeutic benefit Once phamacotherapy is initiated, ongoing assessment is conducted to determine the presence of therapeutic effects or adverse effects.

Which statement made by the client indicates understanding about discharge instructions on antihyperlipidemic medications? A."It is important to double my dose if I miss one in order to maintain therapeutic blood levels." B. "I will stop taking the medication if it causes nausea and vomiting." C."Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol." D."I will continue my exercise program to help increase my high-density lipoprotein (HDL) serum levels."

D."I will continue my exercise program to help increase my high-density lipoprotein (HDL) serum levels." Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen used to decrease serum cholesterol levels.

A home health care nurse is visiting a client with elevated triglyceride levels and a serum cholesterol level of 398 mg/dL. The client is taking cholestyramine (Questran). Which of the following statements, if made by the client, indicates the need for further education? A. "Constipation and bloating may be a problem when taking this medication." B. "I'll continue to watch my diet and reduce my fats." C. "Increasing my physical activity may help reduce my cholesterol numbers." D."I'll continue taking my non-prescribed over-the-counter nicotinic acid (Niacin) that I purchased at the pharmacy."

D."I'll continue taking my non-prescribed over-the-counter nicotinic acid (Niacin) that I purchased at the pharmacy."

A client is frantic because her two children have been sent home from school with head lice. She has treated her kids' scalps but does not know what else to do. What will be the best teaching by the nurse? A. "Do not let your children return to the school until your house is fumigated." B. "Continue to apply the medication to their scalps as directed for another week." C. "Isolate the children from other family members for three days." D."It is imperative to also wash bed linens and clothing in hot water that have come into contact with your children."

D."It is imperative to also wash bed linens and clothing in hot water that have come into contact with your children." Instruct the patient, family, or caregiver to wash bedding, clothing used currently, combs, and brushes in soapy water and dry thoroughly. Vacuum furniture or fabric that cannot be cleaned to remove any errant vermin. Dry clean hats or caps that cannot be washed. Seal children's toys in plastic bags for 2 weeks if they cannot be washed.

A mother tells the nurse that head lice has been discovered in her​ child's hair. What is the best instruction by the​ nurse? A. "Purchase a lotion and apply it to your​ child's scalp. Leave it on for 12​ hours." B. ​"Purchase a​ lotion, apply it to your​ child's head and​ body, and leave it on for 24​ hours." C. ​"Purchase a lotion and apply it to your​ child's head three times a day for 2​ weeks." D."Purchase the over-the-counter permethrin (Nix) shampoo and apply it to your​ child's rinsed scalp and leave the shampoo on the scalp for 10​ minutes prior to rinsing."

D."Purchase the over-the-counter permethrin (Nix) shampoo and apply it to your​ child's rinsed scalp and leave the shampoo on the scalp for 10​ minutes prior to rinsing." The medication should be allowed to remain on the hair and scalp for 10 minutes before removal. The lotion does not need to be left on the head for 12 hours or applied more than once. Leaving the lotion on for 24 hours is excessive​ treatment, and only the head needs treatment.

A client is receiving morphine sulfate IV for acute pain and tells the nurse, "I get dizzy when I stand up." Which of the following is the most appropriate response by the nurse? A. "You may be experiencing a toxic effect of the drug and I will notify the physician." B. "Dizziness is not related to the drug, but I will need to ask you a few more questions." C. "Episodes of dizziness when moving are common symptoms of acute pain." D."This is an expected side effect of the drug, and you should use caution and move slowly when standing up."

D."This is an expected side effect of the drug, and you should use caution and move slowly when standing up." Feeling dizzy when moving from lying or sitting to standing position is referred to as orthostatic hypotension and is a potential side effect of opioid agonist. The client should be instructed to change positions slowly.

The provider has ordered topical tretinoin (Retin-A) for the treatment of a teenager's acne vulgaris. When caring for a client who is prescribed this medication, the nurse should instruct the client to: A. It is okay to take your friend's PO version of the acne medication. B. It is recommended to only tan in tanning beds while taking this topical medication. C.If the topical medication causes pain, you do not need to report this side effect to the healthcare provider. D.Avoid additional sun exposure or apply sunscreen when going outside during the day when taking this topical medication.

D.Avoid additional sun exposure or apply sunscreen when going outside during the day when taking this topical medication. Topical tretinoin can cause photophobia while taking this medication and it is recommended to avoid additional sun exposure or apply sunscreen when going outside during the day.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: A. Increases norepinephrine secretion and thus decreases blood pressure and heart rate. B.Is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. C.Is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II. D.Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction.

D.Blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. Propranolol is a beta-adrenergic blocking agent. Actions of propranolol include reducing heart rate, decreasing myocardial contractility, and slowing conduction. Propranolol does not increase norepinephrine secretion, cause vasodilation, or block conversion of angiotensin I to angiotensin II.