Pharm #5

a charge nurse is teaching a newly licensed nurse about the purpose of a client being prescribed a transdermal fentanyl patch. which of the following clients should the charge nurse include in the teaching as a client who requires this medication? a. a client who is opioid- tolerant b. a client who has difficulty swallowing c. a client who has severe intermittent pain d a client who is postoperative following abdominal surgery

**A** rationale: the change nurse should including in the teaching that a client who is opioid tolerant can be prescribed as fentanyl patch to manage pain

a nurse is caring for a client who is 12 hr postoperative following a total hip arthroplasty. which of the following medications should the nurse anticipate administering to this client to prevent DVT? a aspirin b warfarin c ticagrelor d enoxaprin

**d** rationale: the nurse should anticipate the administration of enoxaprin for a client who is 12 hr postoperative following surgery. enoxaparin is low-molecular-weight heparin that is used to prevent a DVT by inhibiting the effects of antithrombin and thrombin

a nurse is preparing to administer dextrose 5% in 0.45% sodium chloride 400 mL IV to an older adult client over 8 hr. the nurse should set the IV pump to deliver how many ml/hr?

50

a nurse is caring for a client who is experiencing an acute gout attack. the nurse should anticipate a prescription from the provider for which of the following medications? a. cochicine b. allopurinol c. probenecid d. pegloticase

**A** rationale: the nurse should anticipate a prescription for colchicine because itis the medication of choice for an acute gout attack. the client can experience relief from the attack within hours of receiving this medication. colchicine can also be prescribed for long-term use to prevent future attacks from occurring

a nurse is reviewing the medical record of a client. the medication administration records shows the client is taking clopidogrel. which of the following events should the nurse expect in the client's medical history? a. recent MI b. hx of hemorrhagic stroke c. current outbreak of psoriasis d. hx of HTN

**A** rationale: the nurse should expect the client's medical record to indicate a hx of an atherosclerotic event such as MI, ischemia stroke, or peripheral vascular disease. clopidogrel is an antiplatelet medication that inhibits the aggregation of platelets to prevent such thromnotic events.

a nurse is caring for a client who reports crushing chest pain. the nurse reviews the client's ECG results and notes ST changes. which of the following medications should the nurse administer? a. simvastatin b. furosemide c. nitroglycerin d. sildenfil

**C** rationale the nurse should identify the need to administer nitroglycerin, which is used to treat angina. nitroglycerin acts directterm-54ly on vascular smooth muscle to promote vasodilation

a nurse is teaching a client who has a new prescription for sucralfate for a duodenal ulcer. which of the following client statements indicates an understanding of the teaching? a. i should take this medication with my meals and at bedtime b. i should only have to take this medication for about 2 weeks c. i should wait at least 30 minutes after taking this medication to take an antacid d. i should swallow these tablets whole

**C** rationale: the nurse should recognize that antacids can raise the gastric pH above 4, which can interfere with the effects of sucralfate. to minimize these interactions, sucralfate should be taken at least 30 mins apart of the antacid

a nurse is caring for a client with a pseudomonas infection who has a new prescription for ticarcillin-clavulate. which of the following data should the nurse collect before administering this medication? a. indications of superinfection b. peak and trough medication levels c. baseline BUN and creatinine d. hx of allergies of amioglycoide antibiotics

**C** rationale: ticarcillin-clavulanate is a penicillin antibiotic and is excreted by the kidneys. therefore, any renal impariment could result in a toxic level of the medication. the nurse should assess baseline BUN and creatinine levels and monitor these values throughout therapy

a nurse is admitting a client who has unstable angina. which of the following medications should the nurse anticipate administering to the client? a epinephrine b nitroglycerin c lidocaine d atropine

**b** rationale: the nurse should anticipate administering nitroglycerin to a client who has unstable angina. this medication acts by relaxing or preventing spasms in the coronary arteries along with dilating the arteries, which increases oxygenation and blood flow

a nurse is caring for a client who is experiencing acute alcohol withdrawal. the nurse should expect to administer which of the following medications? a disulfiram b chlordiazepoxide c methadone d varenicle

**b** rationale: the nurse should expect to administer chlordiazepoxide to a client who is experiencing manifestations of acute alcohol withdrawal. chlordiazepoxide is a benzodiazepine; this class of medication is often used to faciliate withdrawal. chlordiazepoxide assists with decreasing withdrawal manifestations, stabilizing vital signs, and preventing seizures and delirium tremens

a nurse is preparing to administer the influenza vaccine to a client. which of the following allergies should the nurse identify as a contraindication to the client receiving this vaccine? a gelatin b chicken eggs c neomycin d prednisone

**b** the nurse should identify that an allergy to chicken eggs is a contraindication to receiving the influenza vaccine. clients who have this allergy can experience angioedema and severe respiratory distress if this vaccine is administered

a nurse is preparing to administer codeine 30 mg PO every 4 hr PRN to a client for pain. the amount available is codeine oral solution 15 mg/5 ml. how many ml should the nurse plan to administer per dose?

10

a nurse is caring for a client who has a new prescription for levothyroxine to treat hypothyrodism. which of the following findings should the nurse identify as an indication that the client requires intervention? a. HR 106/min b. dry skin c oral temp 98.2F lethargy

**A** Rationale: tachy can be a manifestation of hyperthyroidism, possibly due to excessive hormone replacement. the client might require a lower dosage of levothyroxine.

a nurse is providing teaching to a client with hypertension and type 1 diabetes mellitus who has a new prescription for metoprolol. which of the following statements by the client indicates an understanding of the teaching? a. i might have difficulty recognizing when blood sugar is low b. i will have a lower risk of developing an infection while i take this medication c. should be concerned about losing excess weight while i take this medication d. i could have more problems with high blood sugar while taking this medication

**A** rationale metoprolol, a beta-adrenergic blocker, is used to treat HTN. because it decreases the heart rate, this common manifestation of hypoglycemia can be masked, and the hypoglycemia might become more difficult to recognize hypoglycemia by other manifestations, such as hunger, N and sweating B. metoprolol does not decrease the risk of an infection c. metoprolol can cause weight gain due to fluid retention. the client should be taught to report unexpected weight gain, edema, and coughing while taking beta-adrenergic blocker d. metoprolol dose not extend or increase the risk of hyperglycemia. however, hypoglycemia can be prolonged while taking this medication

a nurse is caring for a client who takes warfarin to treat chronic atrial fibrillation and has early manifestations of Alzheimer's disease. the client's partner asks the nurse if the client would benefit from taking gingko biloba. which of the following responses should the nurse make? a. gingko biloba will likely interfere with the effectiveness of his other medications b. you should ask his provider if gingko biloba is safe c. gingko biloba is most effective in the later stages of Alzheimer's disease d. people who have Alzhemier's disease should adhere to the medications regimen their provider prescribes

**A** rationale: Gingko biloba may delay the mental deterioration of Alzhiemer's disease if taken in the early stages. research has not demonstrate this, however. more importantly, gingo biloba increases the client's risk of bleeding when taken with warfarin

a nurse is caring for a client who has asthma and a prescription for zileuton. which of the following laboratory values should the nurse monitor while the client is taking this medication? a. alanine aminotransferase (ALT) b. WBC count c. potassium d. chloride

**A** rationale: a nurse should identify that ALT is a liver function test. Zileuton is a leukotriene modifier that can affect the liver, causing increased ALT levels. the nurse should monitor this laboratory value closely while the client is taking this medication.

a nurse is preparing to administer iron dextran IV to a client. which of the following actions should the nurse plan to take? a. administer a small test dose before giving the full dose b. infuse the medication over 30 seconds c. monitor the client closely for HTN after the infusion d. administer cyanocobalamin as an antidote if iron dextran toxicity occurs

**A** rationale: a serious effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. a small test dose should be administered over 5 mins before giving the full dose. the client should be monitored carefully for an allergic reaction during and for a period of time following the test dose. deferoxamine is the antidote for iron toxicity

a nurse is preparing to administer the varicella vaccine to a 12-month old infant. the nurse asks the infant's guardian if the infant has any allergies. which of the following allergies is a contraindication to the infant receiving the vaccine? a. gelatin b milk c eggs d peanuts

**A** rationale: an allergy to gelatin is contraindication to receiving the varicella vaccine; therefore, the nurse should contact the infant's providers

a nurse is caring for a client who has schizophrenia and a prescription for chlorpromazine. for which of the following adverse effects should the nurse monitor? a. orthostatic hypotension b. diarrhea c. urinary frequency d. bradycardia

**A** rationale: orthostatic hypotension is an adverse effect of chlorpromazine. other adverse effects including palpitations, tachycardia, constipation, sedation and photosensitivity B. constipation is an adverse effect of chlorpromazine due to its anticholinergic action C. urinary retention is an adverse effect of chlorpromazine due to its anticholinergic action D. tachycardia is an adverse effect of chlorpromazine due to its anticholinergic action

a nurse is aproviding teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. the nurse should instruct the client to monitor for which of the following adverse effects of this medication? a jaudice b constipation c oral candidiasis d sedation

**A** rationale: sulfasalazine can cause a yellow discoloration of the skin and yellow/orange discoloration of the urine. the nurse should instruct the client to notify the provider if these occur

a nurse is caring for a client who has MS and is receiving interferon beta-1. the nurse should identify that which of the following client statements indicates a potential adverse effect of the medication? a. my body aches all over b. i have abdominal cramping c. my hair seems to be thinning d. it hurt when i urinate

**A** rationale: the adverse effect of interferon beta1a can include flu-like symptoms such as general body and muscle aches b. dimethyl fumarate can cause GI discomfort, including abdominal cramping c. teriflunomide, a disease-modifying medication can cause alopecia d. natalizumab, a disease-modifiying medication, can cause urinary tract infection that manifest as dysuria.

a nurse is administering subcutaneous heparin to a client who is at risk for DVT. which of the following actions should the nurse take? a. administer the medication into the client's abdomen b. inject the medication into a muscle c. massage the site after administering the medication d. use a 22 guage needle to adminsiter the medication

**A** rationale: the heparin should be administered into the client's abdomen b. heparin should be administered subcutaneously c. the nurse should apply firm pressure to the injection site after administration d. the nurse should administer heparin using a 25 gauge or smaller needle to decrease the risk of hemorrhage

a nurse is assessing a client who is taking varenicline for smoking cessation. which of the following findings is the nurse's priority? a. mood changes b. nausea c. altered sense of taste d. skin rash

**A** rationale: the nurse should apply the safety and risk-reduction priority-setting framework, which assigns priority to the factor or situation posting the greatest safety risk to the client. when there are several risks to a client safety, the one posing the greatest threat is the highest priority. the nurse should use maslow's hierachy of needs, the ABC priority-setting framework, and/or nursing knowledge to identify which risk poses the greatest threat to the client. the greatest risk to the client is the development of neuropsychiatric effects that can progress to depression and suicide. therefore, the highest priority is a change in the client's mood

an 18-month old toddler who has Kawasaki disease (KD). the child is receiving IV immune globin. The guardian asks the nurse to administer the child's scheduled measles, mumps, and rubella (MMR) vaccine before discharge. which of the following responses should the nurse provide? a. your child will not be able to receive the MMR vaccine for at least 3 months after discharge. b. i cannot administer routine vaccines to children while they are in the hospital c. your child can receive the MMR vaccine once his fever is gone d. I can administer the measles and rubella vaccines, but i cannot administer the mumps vaccine

**A** rationale: the nurse should explain to the guardian that IVIG given for the treatment of KD contains antibodies that can interfere with the action of live-virus vaccines like MMR. the MMR immunization should be postponed for 3-6 months

a nurse is caring for a client with asthma who has been taking an inhaled glucocorticoid and long-acting beta2- agonist combination dry-powdered inhaler or maintenance therapy. the nurse should identify that which of the following is a disadvantage of this medication? a. restricted dosage flexibility b. complicated delivery device c. serious systemic effects d. limited efficacy over time

**A** rationale: the nurse should identify that a disadvantage of an inhaled glucocorticoid and long-acting beta2-agonist being combined is that the dosages of these medications are fixed, so the dose cannot be adjusted.

a nurse is caring for a client who has a prescription for a QT interval medicatio. which of the following conditions should the nurse idenifty as an adverse effect of the medication? a. bradycardia b. jaundice c. low blood pressure d. dark urine

**A** rationale: the nurse should identify that an adverse effect of a QT interval medication is bradycardia. this medication should be used with caution for clients who have hypotension or HF, older adult clients or clients who have low potassium or magnesium levels B. hepatotoxic medications such as amoxicillin are metabolizd by the liver and are converted into toic products that can injure liver cells. Medications that can cause liver failure can elevate liver enzyme and prompt manifestations of jaundice, which can include yellowing of the skin and sclerae in clients who have light-pigmented skin and yellowing of the hard palate and sclera near the iris in clients who have dark-pigment skin C. some medications such as morphine can cause hypotension, leading to respiratory distress if not treated. the client's blood pressure should be monitored when administering medication that can affect blood pressure D. hepatotoxic medications shich as amoxicillin are metabolized by the liver and are converted into toxic products that can injure liver cells. dark-urine, light-colored stools, n/v, malaise, abdominal discomfort, and loss of appetite are possible indications of liver failure

a nurse is working in the ED is admitting a client who has gastric ulcers and GI bleeding. which of the following factors in the client's medical history should the nurse report? a arthritis treated with ibuprofen every 8 hr as needed b previous tobacco smoking with cessation 5 years ago c negative H. pylori breath test 1 year prior d prescribed bismuth subsalicylate as needed for GI upset

**A** rationale: the nurse should identify that ibuprofen is a NSAID. NSAID can cause GI bleeding and are contraindicated for clients who have ulcer disease. NSAIDs inhibit prostaglandin secretion, which decreases blood flow in the GI tract and decreases bicarbonate and mucus secretion. this environment promotes the secretion of gastric acid and needs to be reported to the provider

a nurse is preparing a continuous IV infusion of erythromycin lactobionate for a client who has a Bordetella pertussis infection. which of the following actions should the nurse take to minimize the risk of thrombophlebitis? a. infuse the medication slowly b. administer half the dosage c. avoid diluting the solution d. initiate intermittent dosing

**A** rationale: the nurse should infuse erythroycin slowly to minimize the risk of thrombophlebitis, which is an inflammatory process resulting from the formation of a blood clot in a vein. the blood clots usually form in the legs.

a nurse is caring for a client who is developing acute pulmonary edema and has a new prescription for furosemide 40 mg IV bolus. the nurse should plan to administer the medication using which of the following methods? a. undiluted administered over 2 mins b. diluted administered over 20 mins c. undiluted administered as rapidly as possible d. diluted administered over 5 mins

**A** rationale: the nurse should plan to administer low-dose furosemide therapy at a rate of 20 mg/min or a dose of 40 mg over 2 mins

a nurse is preparing to administer an eppy IV bolus to a client. which of the following should the nurse verify before initiating the IV medication? a. concentration of the formulation b. reversibility of the medication c. potential barriers to absroption d. gastric emptying time

**A** rationale: the nurse should verify the concentration of the formulation of the medication prior to administion. Eppy can be injected through several routes, and a solution prepared for use by a certain route can differ in concentration form others. solutions intended for subcutaneous administration are generally concentrated, whereas solutions intended for IV use are dilute. if a solution prepared for SubQ adminstration of concentrated eppy can overstimulate the heart and blood vessels, causing severe hypertension, cerebral hemorrhage, stroke and death

A nurse is admitting a client who has atrial fibrillation with a heart rate of 155/min. the nurse should anticipate a prescription for the provider for which of the following medications? a. atropine b. diltiazen c. epinephrine d. vascopressin

**B** Rationale: the nurse should anticipate the provider to prescribe diltizem for a client who is experiencing atrial fibrillation. diltiazem is an antiarrhythmic agent that reduces the ventricular rate in atrial fibrillation

a nurse is reviewing the laboratory report for a client who is taking tobromycin and notes that the peak blood level is 9.3mcg/ml. which of the following actions should the nurse take? a. administer half of the prescribed dosage at the client's next scheduled dose/ b. tell the client that the medication seems to be appropriate c. advise the client to drink more water throughout the day d. ask it the client has been experiencing any peripheral neuropathy

**B** rationale: a therapeutic peak level of 9.3 mcg/ml within the expected range of 5-10 mcg/dl. the nurse should recognize that this laboratory result indicates the client is recieving a sufficient dose of the medication to promote therapeutic effects and a reduction in the manifestation of infection A. the nurse should not alter the mediction prescriptions without approval from the provider. therefore, the nurse should not administer only half of the dose because this is not within the nurse's scrope of practice c. the therapeutic peak level of 9.3 mcg/ml does not reflect dehydration or inadequate water intake. therefore, the nurse does not need to make this recommendation d. there is no reason for the nurse to suspect the client would be experiencing peripheral neuropathy. the therapeutic peak level of 9.3 mcg.ml does not indicate an alteration of the peripheral nervous system

a nurse is reviewing the medical record of a client who might have hearing loss. which of the following data from the client's medical record should the nurse identify as a risk factor for hearing loss? a. frequent use of steroids b. chronic use of salicylates c. intermittent use of antacids d. habitual use of laxatives

**B** rationale: chronic use of salicylates such as aspirin can lead to ototoxicity, which can manifest as tinnitus or hearing loss

a nurse is caring for a client who is at 28 weeks gestation and is experiencing preterm labor. which of the following medications should the nurse plan to administer? a. oxytocin b. nifedipine c. dinoprostone d. misoprostol

**B** rationale: nifedipine is a tocolytic medication that is administered to stop preterm labor A. oxytocin is an oxytocic medication that is used to stimulate uterine contractions for clients who are at term and to control postpartum hemorrhage, it is contraindicated for clients who are experiencing preterm labor C. dinoprostone is an oxytocic medication that is used to stimulate uterine contractions for clients who are at term and to control postpartum hemorrhae. it is contraindicated for clients who are experiencing preterm labor. D. misoprostol is an prostaglandin that is used to promote ripening of the cervix and to induce labor. it is contraindicated for clients who are experiencing preterm labor.

a nurse is preparing to administer nitroglycerin topical ointment to a client who has angina. which of the following actions should the nurse take? a. cover the applied ointment with cotton gauze b. apply the ointment using a dose-measuring applicator c. apply the ointment using the index finger d. massage the ointment into the client's skin

**B** rationale: the nurse should apply the ointment using a dose-measuring applicator. this allows the nurse to measure the correct dose the client is to receive A. the nurse should cover the ointment that has been applied to the client's skin with plastic wrap. this allows the medication to absorb into the client's skin fully C. the nurse should apply the ointment to the client's skin using gloves and a dose-measuring applicatory. skin that comes into contact with this medication will absorb the medication d. the nurse should avoid massaging or rubbing the ointment into the client's skin, as this will increase the absorption and interfere with the efficacy of the medication

a nurse is caring for a client who is experiencing acute pain and is receiving morphine. which of the following findings should indicate to the nurse the need to withhold the client's next does of morphine? a. the client reports an inability to void b. the client's respiratory rate is 10/min c. the client has hypoactive bowel sounds d. the client has vomited once in the last 4 hours

**B** rationale: the nurse should identify that morphine can cause respiratory depression. therefore, if the client's respiratory rate is less than 12/min, the nurse should withhold the next dose of morphine and notify the provider

a nurse is providing teaching for a client who has received a liver transplant and has a prescription to transition from cycloporine to tacrolimus. which of the following instructions should the nurse include in the teaching? a. take both medications together for 72 hr and then stoptake the cyclosporine b. stop taking the cyclosporine for 25 hrs and then begin taking tacrolimus c. alternate taking the medications for 48 hours and then take only the tacrolimus d. if adverse reactions to the tacrolimus occur, stop taking it and restart the cyclosporine

**B** rationale: the nurse should instruct the client that these medications should not be taken concurrently due to the increased risk of developing nephrotoxicity. the client should stop cyclosporine for 24 hr prior to beginning tacrolimus prescription

a nurse is checking a client who is receiving an IV infusion of telavancin for Streptococcus pyogenes. which of the following actions should the nurse include? a. check to see if the client's urine is blue b. check the client for pruritus c. check HTN d. check for numbness in the limbs

**B** rationale: the nurse should monitor a client who receives telavancin for pruritus which can occur if the client develops generalized exfoliate dermatitis for infusing the medication too rapidly. manifestations of this condition can include flushing, rash, pruritus, urticaria, tachy, and hypotension

the nurse is caring for a client who is taking glucocorticoids. the nurse should monitr the client for which of the following adverse effects of the medication? a. weight loss b. peptic ulcer c. hyperkalemia d. diplopia

**B** rationale: the nurse should monitor this client who is taking glucocorticords for peptic ulcer disease due to irritation of the gastric mucosa. the nurse should periodically check the client's stool for occult blood and instruct the client to contact the provider if any black or tarry stools occur A. the nurse should monitor a client taking glucocorticoids for weight gain, not weight loss. C. the nurse should monitor a client taking glucocorticoids for hypokalemia, not hyperkalemia D. the nurse should monitor a client taking glucocorticoids for visual complications like cataracts and glaucoma. however, diplopia is not an adverse effect of glucocorticoids.

a nurse is caring for a client who is receiving IV famotide. which of the following adverse effects should the nurse report to the provider immediately? a. nausea b. bloody stool c. drowsiness d. headache

**B** rationale: when using the urgent vs nonurgent approach to client care, the nurse should determine that the ppriority finding is bloody stools becasue adverse effects of treatment with famotidine might cause blood dyscrasias, which can lead to bleeding. this finding should be reported to the provider immediately

a nurse is caring for a client who has multiple medication allergies. during which of the following steps of the nurse identify the client's allergies? a. planning b. evaluation c. assessment d. implementation

**C** rationale: assessment step of the nursing process involves collecting pertinent data, which includes the identification of the client's allergies

a nurse is teaching female client who has a new prescription for misoprostol to treat peptic ulcer disease. which of the following client statements should inficate to the nurse that the teaching was effective? a. i should avoid taking NSAIDs while using this medication b. misoprostol is used to treat stress-induced gastric ulcers c. i should avoid becoming pregnant while taking this medication d. this medication is also used to treat dysmenorrhea

**C** rationale: the nurse should identify that misoprostol is contraindicated during pregnancy and is classified as pregnancy risk category X by the FDA. it has the potential to stimulate uterine contractions, and the use of the misoprostol during pregnency has been known to cause partial or complete expulson of the developing fetus. A. misoprostol is an analog of prostaglandin E. NSAIDs and aspirin can cause gastric ulcers by inhibiting prostagandin synthesis. this makes misoprostol an ideal antiulcer medication for clients who frequenty take NSAIDs. b. in the US, misoprostol's only approved gastrointestinal indication is for the prevention of gastric ulcers. it is not approved for ulcer treatment d. misoprostol has an adverse effect of dysmenorrhea and should not be given to treat this condition

a nurse is preparing to administer an otic medication to an adult client. which of the following actions should the nurse take? a. place the client leaning forward in a chair b. hold the medication dropper 2.5 cm from the clients ear canal c. pull the pinna of the client's ear upward and outward d. have the client remain still for 30 seconds after the medication is administered

**C** rationale: the nurse should pull the pinna of the client's ear upward and outward so the nurse can instill the medication into the client's ear canal

a nurse is providing teaching to a client who has hypothyroidism and is taking levothyroxine. the nurse should instruct the client that which of the following findings is an indication of throtoxicosis? a. weight gain b. constipation c. chest pain d. fatigue

**C** rationale: thyrotoxicosis can result if a client takes too much levothyroxine. manifestations include chest pain, tachy, insomnia, tremors, hyperthermia, heat intolerance, and diaphoresis. The client should notify the provider if any of these manifestations are present A. clients who have hypothyroidsm often lose weight when they take levothyroxine and revert to an average baseal metabolic rate B. constipation is a common manifestation of hypothyroidism and should subside with effective levothyroxine therapy D. fatigue is common with hypothyroidism and can persist until clients taking levothyroxine reach therapeutic levels

a nurse is providing discharge teaching about lithium toxicity to a client who has a new prescription for lithium. Which of the following statements by the client indicates an understanding of the teaching? a. i should take naproxen if i have a headache because aspirin can cause lithium toxicity b. i can develop lithium toxicity if i eat foods with lots of sodium c. i can develop lithium toxicity if i experience vomiting or diarrhea d. i might need to take a daily diuretic along with my lithium to prevent lithium toxicity.

**C** rationale: vomiting or diarrha can cause electrolyte imbalances. if serum sodium decreases, lithium is retained by the kidneys, and the risk of lithium toxicity increases

a nurse in a provider's office is assessing a client who reports taking a dietary supplement to reduce hot flashes related to menopause. which of the following supplements should the nurse expect the client to report taking? a. flaxseed b. gingko biloba c. black cohosh d. st. johns wort

**C.** rationale: black cohosh is a herb that is used for the treatment of menopausal symptoms such as hot flashes, vaginal dryness, irritability, and sleep disturbances a. flaxseed is used to relieve constipation and to reduce high cholesterol. not hot flashes. b. ginkgo improves blood flow and can reduce pain related to peripheral arterial disease. not hot flashes d. st. john wort is used to treat mild to moderate depression. not hot flashes

a nurse manager is instructing a newly licensed nurse about routes of medication administration. which of the following routes involves medication absorption through the mucous membrane under the tongue? a. oral b. topical c. parenteral d. sublingual

**D** rationale: absorption through the sublingual route occurs by placing the medication under the tongue

a nurse is providing teaching to a client with TB who has prescriptions for rifampin and ethambutol. which of the following findings is an adverse effect of these medications that the client should report to the provider? a. red-orange discoloration of urine b. unexpected weight gain c. ringing in the ears d. decreased visual acuity

**D** rationale: the nurse should identify optic neuritis as an adverse effect of ethambutol. the nurse should instruct the client to monitor for changes in visual acuity or color identification a indications of optic neuritis to report the provider. this adverse effect necessitates termination of ethambutol therapy becasue irreverible blindness can result

a nurse is reviewing the laboratory data for a client who is receiving clozapine for schizophrenia. the nurse should identify which of the following findings as a potential adverse effect of this medication? a. fast glucose 95 b. triglycerides 135 c. total cholesterol 175 d. absolute neutrophil count 1200

**D** rationale: the nurse should identify that an absolute neutrophil count of 1200 is less than expected reference range of 2500-8000. an adverse effect of clozapine can include agranulocytosis, which is a life-threatening condition in which WBC are severely decreased A. 74-106 b. 35-160 c. <200

a nurse is caring for a client who has HF and is prescribed dobutamine hydrochloride by continuous IV infusion. the nurse should identify that which of the following is the therapeutic effect of this medication? a improves oxygen saturation rate b decreases elevated blood pressure c reduces HR d improve cardiac output

**D** rationale: the nurse should identify that dobutamine is a vasopressor that improves cardiac output and hemodynamic status in clients

a nurse is caring for a female client who has osteoporosis and is taking raloxifene. which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of this medication? a. severe leg cramps b. urinary frequency c. jaw pain d. sudden onset of dyspnea

**D** rationale: the nurse should identify that raloxifene is a selective estrogen receptor modulator SERM, which can have estrogenic effects in some tissues and anti-estrogenic effect in other tissue. clients who are taking raloxifene have an increased risk of thromboembolic events such as DVT, PE, or stroke. therefore, the nurse should notify the provider if the client is experiencing this adverse effect of raloxifene

a nurse is preparing to administer raloxifene to a client. which of the following conditions is a contraindication for the administration of this medication? a. osteoporosis b. hyperthyroidism c. MI d. DVT

**D** rationale: the nurse should identify that raloxifene, like estrogen, increases the risk of DVT, PE, and stroke. raloxifene is contraindicated for clients who have a hx of thromobic events

a nurse is providing discharge teaching to a client who is postoperative and has a new prescription for an oral opioid analgesic. which of the following pieces of information should the nurse include as a rationale for increasing the client's daily intake of fiber? a. fiber binds with the medication to relieve pain b. dietary fiber prevents nausea caused by opioids c. fiber promotes the absorption of opioids d. dietary fiber helps prevent constipation

**D** rationale: the nurse should inform the client that constipation is an adverse effect of opioids. increasing dietary fiber consumption can help manage opioid-induced constipation. the nurse should also instruct the client to increase physical activity and fluid intake. a stool softener and a laxative might also be needed to prevent the complications associated with opioid-induced constipation B. fiber might increase nausea because it promotes a feeling of gastric fullness. opioid included nausea should be treated with an antiemetic C. dietary fiber is not absorbed by the body and passes through the gastrointestinal tract essentially uncharged. therefore, it does not assist with medication absorption

a nurse is providing teaching to a client who has MS and a new prescription for baclofen PO. which of the following pieces of information should the nurse include? a. you should take the medication on an empty stomach to increase absorption b. you can stop taking the medication once your back spasms disappear c. you can expect to experience urinary frequency when you first start taking this medication d. you should change positions slowly while taking this medication

**D** rationale: the nurse should teach the client that dizziness and hypotension are adverse effects of this medication. the client should change positions slowly to minimize orthostatic hypotension a. the nurse should teach the client to take baclofen with milk or food to minimize gastric irritaton b. the nurse should teach the client that stopping the medication abruptly can cause an acute withdrawal reaction, including manifestations such as hallucination and increased spasticity. the medication should be discontinued gradually over the least 2 weeks c. the nurse should teach the client that urinary frequency is an adverse effect of baclofen. the client should notify the provider if this manifestation occurs

a nurse is caring for a client who is taking diphenhydramine for allergices. the client reports I feel sleepy during the day. which of the following responses should the nurse make? a. you will find that all antihistamines cause sedation b. you should avoid taking the antihistamine with food c. the effects of sedation will occur with each dose d. you should try antihistamines with non-sedative effects

**D** rationale: the nurse should tell the client to try second-generation antihistamines that have no sedative effects, as these are large molecules with low lipid solubility that cannot cross the blood-brain barrier. diphenhydramine is a first-generation antihistamines and has a common adverse effect of sedation a. diphenhydramine is a first-generation antihistamine and has a common adverse effect of sedation b. the nurse should tell the client to take diphenhydramine with food to decrease gastrointestinal irritation that can cause nausea and vomiting c. diphenhydramine is a first-generation antihistamine and has a common adverse effect for sedation. however, sedation effects subside after a few days of taking the antihistamine

a nurse is reviewing the laboratory result of a client who is taking tobramycin and notes that the medication's peak level is 7 mcg/ml. which of the following actions should the nurse take? a. administer half of the prescribed dosage at the client's next schedule dose. b. tell the client that medication seems to be effective. c. advise the client to drink more water throughout the day d. continue to administer the medication as prescribed

**D** rationale: the nurse should identify that a peak level of 7mcg/ml for tobramycin is within the expected reference range of 5-10 mcg/ml. therefore, the nurse should continue to administer the scheduled medication as prescribed

a nurse is teaching about levodopa with a family member of a client who has parkinson's disease. which of the following pieces of information should the nurse include? a a full therapeutic response may take several months to happen b the medication should be taken with high-protein foods c a full therapeutic response might cause vivid dreams d the medication is given at the onset of mild symptoms

**a** rationale the nurse should inform the family member that although levodopa is the most effective medication for Parkinson's disease, a full therapeutic response might not occur for several months

a nurse is caring for a client who received spinal anesthesia 30 mins ago. the client reports feeling dizzy, and the nurse notes that the client's blood pressure is 84/54. which of the following actions should the nurse take? a place the client in the head down position b assess the placement of the catheter c prepare to administer an IV reversal agent d assist the client in passive range of motion movements

**a** rationale: the nurse should identify the client is experiencing an adverse effect from receiving the spinal anesthesia. hypotension is the common adverse side effect of spinal anesthesia due to the loss of venous tone and decreased position the client in a 10-15 degree, head-down position to rapidly promote venous return to the heart, which increases the client's blood pressure

a nurse is teaching a client who has a new prescription for phenytoin. the nurse informs the client that which of the following adverse effects can occur with the abrupt withdrawal of phenytoin? a status epilepticus b bleeding gums c disorientation d severe nausea

**a** rationale: the nurse should instruct the client that abruptly discontinuing phenytoin can cause status epilepticus.

a nurse is teaching a client who had kidney transplant surgery about immunosuppressive medications. which of the following adverse effects of these medications should the nurse include in the teaching? a. increased urinary output b. increased susceptibility to infection c. increased hair loss d. increased risk of autoimmune disorder

**b** rationale: immunosuppressive medications such as cyclosporine increase the risk of infection. as the medication classification indicates, these medications impair the immunity and adversely affect the client's ability to resist and fight infections.

a nurse is caring for a client who is taking acarbose to treat type 2 diabetes mellitus. for which of the following adverse effects of this medication should the nurse monitor for the client? a insomnia b. diarrhea c. joint pain d. polycythemia

**b** rationale: the most common adverse effect of acarbose, an alpha-glucosidase inhibitor, are gastrointestinal. they include diarrhea, abdominal distension, and cramping and flatulence

a nurse is assessing a client who has AIDS and is taking zidovudine. which of the following findings is the priority for the nurse is report to the providers? a. N/V b. decreased hemoglobin c. decreased appetite d. anxiety

**b** rationale: the nurse should apply the safety and risk-reduction priority-setting framework. which assigns priority to the factor or situation posing the greatest safety risk to the client. when there are several risks to client safety, the one posting the greatest threat is the highest priority. the nurse should use Maslow's hierarchy of needs, the ABC priority finding for the nurse to report to the provider is a decreased hemoglobin level. zidovudine can cause severe anemia and neutropenia from bone marrow suppression, resulting in hematologic toxicity. A. nausea and vomiting are adverse effects of zidovudine that should be reported to the provider; however, another findings is the priority C. a decreased appetite is an adverse effect of zidovudine that should be reported to the provider, however, another finding is the priority d. anxiety is an adverse effect of zidovudine that should be reported to the provider; however, another finding is the priority

a nurse is providing teaching about benzodiazepines to a client who is discontinuing long-term alprazolam use. which of the following pieces of information should the nurse include in the teaching? a you might experience somnolence b plan to taper the dose slowly over several months c call the provider if you have muscle weakness d confusion is common during this process

**b** rationale: the nurse should instruct the client to plan to taper the alprazolam dose slowly over several weeks or months to ease the physiological and psychological manifestations of withdrawal

a nurse is caring for a client who has osteoporosis and has been taking a VD supplement. the nurse notes that the client reports also taking a multivitamin daily. which of the following findings should indicate to the nurse that the client might be experiencing vitamin D toxicity? a hyperkalemia b hypermagnesemia c hypercalcemia d hypernatremia

**c** rationale: the nurse should identify that VD increases plasma calcium levels by increasing reabsoption from bone, decreasing excretion by the kidneys and increasing absorption from the intestine. clients who take a vitamin D supplement along with a multivitamin daily might be taking too much calcium

a nurse is teaching a client who is experiencing age-related vaginal atrophy and has a prescription for estradiol cream. which of the following statements should the nurse include in the teaching? a this medication should be used daily b this medication should be applied externally c this medication has fewer systemic effects than oral estrogen d this medication can increase you risk of bone loss

**c** rationale: the nurse should instruct the client that intravaginal estradiol cream has few systemic side effects because it is applied topically. however, oral estrogen can cause serious systemic effects

a nurse is providing teaching to a client with a new diagnosis of HF who has a prescriptio for furosemide. which of the following statements should the nurse include in the teaching? a. you can take ibuprofen for headache while taking this medication b. you may experience increased swelling in your lower extremeties while taking this medication c. you should eat foods that high in potassium while taking this medication d. you should take this medication at bedtime

**c** rationale: the nurse should instruct this client who has a prescription for furosemide to consume foods that are high in potassium. furosemide is a high-ceiling loop diuretic that depletes potassium, sodium, chloride, magnesium and water

a nurse is preparing to administer heparin 500 units/hr to a client who has DVT. heparin is avabilable at 25000 units in 500 ml if 5% dextrose in water. the nurse should set the IV pump to deliver how many ml/hr?

10

a nurse is preparing to administer fosphenytoin 550 mg via IV bolus to a client who is having a seizure. Forphenytoin 50 mg/mL is available. how many mL should the nurse administer?

11

a nurse is preparing to administer metoclopramide 10 mg IM to a client who is postoperative and nauseated. the amount avaliable to metoclopramide 5mg/ml. how many ml should the nurse administer?

2

a nurse is preparing to administer verapamil 5.5 mg via IV bolus to a client who has hypertension. the amount available to verapamil 2.5/ ml. how many ml should the nurse administer?

2.2

a nurse is preparing to administer acetaminophen 1 g PO 3x dayPRN to a client who has a fever. the amount avaliable is acetaminophen 325mg/1tab. how many tabs should the nurse admiminster per dose?

3

a nurse is preparing to adminster cefixime 4mg/kg PO twice daily to a preschooler who weights 31 lbs. How many mg should the nurse administer with each dose?

56 mg

a nurse is preparing to administer an enteral feeding through an NG tube at 250 mL over 4hr. the nurse should set the pump to deliver how many ml/hr?

63