pharm hesi "green book"

A client with chronic gouty arthritis is talking allopurinol, 100 mg PO daily. Which laboratory serum level should the nurse report to the health care provider to determine the therapeutic outcome? A. Prothrombin time B. Uric acid level C. White blood cell count D. Creatinine level

B. Uric acid level

The nurse is preparing a teaching plan for a client's new medication. Which factor will the nurse consider is most important to ensure compliance when developing the plan? A. Genetics B. Client age C. Client education D. Absorption rate

C. Client education

During administration of theophylline, the nurse should monitor for signs of toxicity. Which symptom would cause the nurse to suspect theophylline toxicity? A. Dry mouth B. Urinary retention C. Restlessness D. Sedation

C. Restlessness

A client is ordered 22 mg of gentamicin by IM injection. The drug is available in 20 mg/2 mL. How many milliliters should be administered? _____ mL

2.2mL

Amoxicillin, 500 mg PO every 8 hours, is prescribed for a client with an infection. The drug is available in a suspension of 125 mg/5 mL. How many milliliters should the nurse administer with each dose? _______ mL

20ml

Which question should the nurse ask a client prior to the initiation of treatment with IV infusions of gentamicin sulfate? A. "Are you having difficulty hearing?" B. "Have you ever been diagnosed with cancer?" C. "Do you have any type of diabetes mellitus?" D. "Have you ever had anemia?

A. "Are you having difficulty hearing?"

A client is receiving oral griseofulvin for a persistent tinea corporis infection. Which client statement indicates to the nurse an understanding of the medication regimen? A. "I might feel some tingling in my fingers." B. "This is the worse bacterial infection I've ever had." C. "I will need to take the medication for 7 days." D. "My urine will probably turn brown due to this drug."

A. "I might feel some tingling in my fingers."

A client is receiving antiinfective drug therapy for a postoperative infection. Which complaint should alert the nurse to the possibility that the client has contracted a superinfection? A. "My mouth feels sore." B. "I have a headache." C. "My ears feel plugged up." D. "I feel constipated.

A. "My mouth feels sore."

Which instructions should the nurse provide to an adolescent female client who is initiating treatment with isotretinoin for acne vulgaris? (Select all that apply.) A. "Notify the health care provider immediately if you think you are pregnant." B. "If your acne gets worse, stop the medication and call the health care provider." C. "Take a daily multiple vitamin to prevent deficiencies and promote dermal healing." D. "Dermabrasion for deep acne scars should be postponed for 1 month after therapy is stopped." E. "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." F. "Before, during, and after therapy, two effective forms of birth control must be used at the same time."

A. "Notify the health care provider immediately if you think you are pregnant." E. "If you begin crying more than usual and feel sad, stop the drug and call the health care provider." F. "Before, during, and after therapy, two effective forms of birth control must be used at the same time."

The nurse is administering the early morning dose of insulin aspart, 5 units subcutaneously, to a client with diabetes mellitus type 1. The client's fingerstick serum glucose level is 140 mg/dL. Considering the onset of insulin aspart, when should the nurse ensure that the client's breakfast be given? A. 5 minutes after subcutaneous administration B. 30 minutes after subcutaneous administration C. 1 to 2 hours after administration D. At any time because of a flat peak of action

A. 5 minutes after subcutaneous administration

A male client with prostatic carcinoma has arrived for his scheduled dose of docetaxel chemotherapy. What symptom would indicate a need for an immediate response by the nurse prior to implementing another dose of this chemotherapeutic agent? A. A cough that is new and persistent B. Persistent nausea and vomiting C. Fingernail and toenail changes D. Increasing weakness and neuropathy

A. A cough that is new and persistent

Methylphenidate is prescribed for daily administration to a 10-year-old child with attention-deficit/hyperactivity disorder (ADHD). In preparing a teaching plan for the parents of this child newly diagnosed with ADHD, which instruction is most important for the nurse to provide to the parents? A. Administer the medication in the morning before the child goes to school. B. Plan to implement periodic interruptions in the administration of the drug. C. Attempt to be consistent when setting limits on inappropriate behavior. D. Seek professional counseling if the child's behavior continues to be disruptive.

A. Administer the medication in the morning before the child goes to school.

The nurse performs a client assessment prior to the administration of a prescribed dose of dipyridamole and aspirin PO. The nurse notes that the client's carotid bruit is louder than previously assessed. What is the best nursing action related to this finding? A. Administer the prescribed dose as scheduled. B. Hold the dose until the health care provider is contacted. C. Advise the client to take nothing by mouth until further assessment is completed. D. Elevate the head of the bed and apply oxygen by nasal cannula.

A. Administer the prescribed dose as scheduled.

A client has started long-term corticosteroid therapy tells the nurse that the daily dose will be taken at bedtime with a snack of crackers and milk. Which is the best response by the nurse? A. Advise the client to take the medication in the morning, rather than at bedtime. B. Teach the client that dairy products should not be taken with her medication. C. Tell the client that absorption is improved when taken on an empty stomach. D. Affirm that the client has a safe and effective routine for taking the medication.

A. Advise the client to take the medication in the morning, rather than at bedtime.

Which nursing action has the highest priority during IV administration of mechlorethamine HCl and actinomycin? A. Assess for extravasation at the IV site during infusion. B. Premedicate with antiemetics 30 to 60 minutes before infusion. C. Monitor cardiac rate and rhythm during the IV infusion. D. Check the granulocyte count daily for the presence of neutropenia

A. Assess for extravasation at the IV site during infusion.

A client with Tourette syndrome takes haloperidol. The client has become increasingly drowsy over the past 2 days, and reports becoming dizzy when changing from a supine to sitting position. Which action should the nurse take? A. Assess skin tone and urine. B. Document the expected findings. C. Have the caregiver hold the next two doses of the medication. D. Determine whether the client's urine is pink or reddish brown.

A. Assess skin tone and urine.

A client with trichomoniasis (Trichomonas vaginalis) receives a prescription for metronidazole. Which instruction is most important for the nurse to include in this client's teaching plan? A. Avoid alcohol consumption. B. Complete the medication regimen. C. Use a barrier contraceptive method. D. Treat partner(s) concurrently.

A. Avoid alcohol consumption.

The nurse is providing discharge instructions to a client who has received a prescription for an antibiotic that is hepatotoxic. Which information should the nurse include in the instructions? A. Avoid ingesting any alcohol or acetaminophen. B. Schedule a follow-up visit for a liver biopsy in 1 month. C. Activities that are strenuous should be avoided. D. Notify the health care provider of any increase in appetite.

A. Avoid ingesting any alcohol or acetaminophen.

A 26-year-old primigravida client is experiencing increasing discomfort and anxiety during the active phase of labor. She requests something for pain. Which analgesic should the nurse anticipate administering? A. Butorphanol B. Hydromorphone C. Morphine sulfate D. Codeine sulfate

A. Butorphanol

Following the administration of sublingual nitroglycerin, which assessment finding indicates to the nurse that the medication was effective? A. Decrease in level of chest pain B. Clear bilateral breath sounds C. Increase in blood pressure D. Increase in urinary output

A. Decrease in level of chest pain

The nurse is preparing a child for transport to the operating room for an emergency appendectomy. The anesthesiologist prescribes atropine sulfate, IM STAT. What is the primary purpose for administering this drug to the child at this time? A. Decrease the oral secretions. B. Reduce the child's anxiety. C. Potentiate the opioid effects. D. Prevent possible peritonitis.

A. Decrease the oral secretions.

Which intervention is most important for a nurse to implement prior to administering atropine PO? A. Determine the presence of 5 to 35 bowel sounds/min. B. Provide oral care prior to administration. C. Verify that the client's tendon reflexes are 2+. D. Use the 0 to 10 scale to rate the pain.

A. Determine the presence of 5 to 35 bowel sounds/min.

A client experiencing dysrhythmias is given quinidine, 300 mg PO every 6 hours. The nurse plans to observe this client for which common side effect associated with the use of this medication? A. Diarrhea B. Hypothermia C. Seizures D. Dysphagia

A. Diarrhea

A chemotherapeutic regimen with doxorubicin HCl is being planned for a client recently diagnosed with cancer. What diagnostic test results should the nurse review prior to initiating this treatment? A. Electrocardiogram (ECG) B. Arterial blood gases (ABGs) C. Serum cholesterol level D. Pelvic ultrasound

A. Electrocardiogram (ECG)

A client who is hypertensive receives a prescription for hydrochlorothiazide. When teaching about the side effects of this drug, which symptoms are most important for the nurse to instruct the client to report? A. Fatigue and muscle weakness B. Anxiety and heart palpitations C. Abdominal cramping and diarrhea D. Confusion and personality changes

A. Fatigue and muscle weakness

A client who is HIV-positive is receiving epoetin alfa for the management of anemia secondary to zidovudine (AZT) therapy. Which laboratory finding is most important for the nurse to report to the health care provider? A. Hematocrit (HCT) of 58% B. Hemoglobin of 10.8 g/dL C. White blood cell count of 5000 mm3 D. Serum potassium level of 5 mEq/L

A. Hematocrit (HCT) of 58%

A client receives a prescription for theophylline PO to be initiated in the morning after the dose of theophylline IV is complete. The nurse determines that a theophylline level drawn yesterday was 22 mcg/mL. Based on this information, which action should the nurse take first? A. Hold the theophylline dose and notify the health care provider. B. Start the client on a half-dose of theophylline PO. C. The theophylline dose can be initiated as planned. D. The client is not ready to be weaned from the IV to the PO route

A. Hold the theophylline dose and notify the health care provider.

The nurse is reviewing a client's laboratory results before a procedure in which a neuromuscular blocking agent is prescribed. Which finding should the nurse report to the health care provider? A. Hypokalemia B. Hyponatremia C. Hypercalcemia D. Hypomagnesemia

A. Hypokalemia

In addition to nitrate therapy, a client is receiving nifedipine, 10 mg PO every 6 hours. The nurse should plan to observe for which common side effect of this treatment regimen? A. Hypotension B. Hyperkalemia C. Hypocalcemia D. Seizures

A. Hypotension

A female client is receiving tamoxifen following surgery for breast cancer. She reports to the nurse the onset of hot flashes. Which is the best nursing action? A. Instruct the client that hot flashes are a side effect that often occurs with the use of this medication. B. Encourage the client to verbalize her feelings and fears about the recurrence of her breast cancer. C. Help the client schedule an appointment for evaluation of the need to increase the dose of medication. D. Notify the health care provider that the client needs immediate evaluation for medication toxicity.

A. Instruct the client that hot flashes are a side effect that often occurs with the use of this medication.

A client has a positive skin test for tuberculosis. Which prophylactic drug should the nurse expect to administer to this client? A. Isoniazid B. Carvedilol C. Acyclovir D. Griseofulvin

A. Isoniazid

During therapy with isoniazid, it is most important for the nurse to monitor which laboratory value closely? A. Liver enzyme levels B. Blood urea nitrogen (BUN) level C. Serum electrolyte levels D. Complete blood count (CBC)

A. Liver enzyme levels

A pediatric client is discharged home with multiple prescriptions for medications. Which information should the nurse provide that is most helpful to the parents when managing the medication regimens? A. Maintain a drug administration record. B. Fill all prescriptions at one pharmacy. C. Allow one person to give the medications. D. Give all medications in small volumes.

A. Maintain a drug administration record.

The nurse is assessing a stuporous client in the emergency department who is suspected of overdosing with opioids. Which agent should the nurse prepare to administer if the client becomes comatose? A. Naloxone hydrochloride B. Atropine sulfate C. Vitamin K D. Flumazenil

A. Naloxone hydrochloride

A 4-year-old child is receiving chemotherapy for acute lymphocytic leukemia. Which laboratory result should the nurse examine to assess the child's risk for infection? A. Neutrophil count B. Platelet count C. Reticulocyte count D. Lymphocyte count

A. Neutrophil count

A 21-year-old female client is receiving tetracycline for acne. Which client teaching should the nurse include? A. Oral contraceptives may not be effective. B. Drinking cranberry juice will promote healing. C. Breast tenderness may occur as a side effect. D. The urine will turn a red-orange color.

A. Oral contraceptives may not be effective.

A child with cystic fibrosis is receiving ticarcillin disodium for Pseudomonas pneumonia. Which adverse effect should the nurse report promptly to the health care provider? A. Petechiae B. Tinnitus C. Oliguria D. Hypertension

A. Petechiae

In administering the antiinfective agent chloramphenicol IV to a client with bacterial meningitis, the nurse observes the client closely for signs of bone marrow depression. Which laboratory data would be most important for the nurse to monitor? A. Platelet count B. Blood urea nitrogen level C. Culture and sensitivity D. Serum calcium leve

A. Platelet count

Minocycline, 50 mg PO every 8 hours, is prescribed for an adolescent girl diagnosed with acne. The nurse discusses self-care with the client while she is taking the medication. Which teaching points should be included in the discussion? (Select all that apply.) A. Report vaginal itching or discharge. B. Take the medication at 0800, 1500, and 2200 hours. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. E. Take with an antacid tablet to prevent nausea. F. Use a nonhormonal method of contraception if sexually active.

A. Report vaginal itching or discharge. C. Protect skin from natural and artificial ultraviolet light. D. Avoid driving until response to medication is known. F. Use a nonhormonal method of contraception if sexually active.

The nurse is preparing to administer amphotericin B IV to a client. What laboratory data is most important for the nurse to assess before initiating an IV infusion of this medication? A. Serum potassium level B. Platelet count C. Serum creatinine level D. Hemoglobin level

A. Serum potassium level

Two hours after taking the first dose of penicillin, a client arrives at the emergency department complaining of feeling ill, exhibiting hives, having difficulty breathing, and experiencing hypotension. The nurse will develop an immediate plan of care based on which finding? A. Severe acute anaphylactic response B. Side reaction that should resolve C. Idiosyncratic reaction D. Cumulative drug response

A. Severe acute anaphylactic response

A 42-year-old client is admitted to the emergency department after taking an overdose of amitriptyline in a suicide attempt. Which drug should the nurse plan to administer to reverse the cardiac and central nervous system effects of amitriptyline? A. Sodium bicarbonate B. Naloxone C. Phentolamine mesylate D. Atropine sulfate

A. Sodium bicarbonate

During the initial nursing assessment history, the client reports taking tetracycline hydrochloride for urethritis. Which concurrent medication will the nurse report to the health care provider? A. Sucralfate B. Hydrochlorothiazide C. Acetaminophen D. Phenytoin

A. Sucralfate

The health care provider prescribes oral contraceptives for a client who wants to prevent pregnancy. Which information is the most important for the nurse to provide to this client? A. Take one pill at the same time every day for the entire pack of pills. B. Use condoms and foam instead of the pill while on any antibiotics. C. Limit sexual intercourse for at least one cycle after starting the pill. D. Use another contraceptive if two or more pills are missed in one cycle

A. Take one pill at the same time every day for the entire pack of pills.

Methenamine mandelate is prescribed for a client with a urinary tract infection and renal calculi. Which finding indicates to the nurse that the medication is effective? A. The frequency of urinary tract infections decreases. B. The urine changes color and pain is diminished. C. The dipstick test changes from +1 to trace. D. The daily urinary output increases by 10%.

A. The frequency of urinary tract infections decreases.

The nurse plans to draw blood samples for the determination of peak and trough levels of gentamicin sulfate in a client receiving IV doses of this medication. When should the nurse plan to obtain the peak level? A. Thirty minutes after the dose is administered B. Immediately before giving the next dose C. When the next electrolyte levels are drawn D. When the client's temperature is 98.6°F/37°C.

A. Thirty minutes after the dose is administered

The nurse is preparing a plan of care for a client receiving the glucocorticoid methylprednisolone. Which assessment finding reflects a problem related to this medication that should be included in the care plan? A. Persistent dry cough B. Temperature of 101.3°F/38.5°C. C. Dry mouth and gums D. Impaired gas exchange oxygen saturation of 94%

B. Temperature of 101.3°F/38.5°C.

Which class of antineoplastic chemotherapy agents resembles the essential elements required for DNA and RNA synthesis and inhibits enzymes necessary for cellular function and replication? A. Alkylating agents B. Antimetabolites C. Antitumor antibiotics D. Plant alkaloids

B. Antimetabolites

When providing nursing care for a client receiving pyridostigmine bromide for myasthenia gravis, which nursing action has the highest priority? A. Monitor the client frequently for urinary retention. B. Assess respiratory status and breath sounds often. C. Monitor blood pressure each shift to screen for hypertension. D. Administer most medications after meals to decrease gastrointestinal irritation.

B. Assess respiratory status and breath sounds often.

A client is receiving pyridostigmine bromide to control the symptoms of myasthenia gravis. Which assessment will the nurse include in the client's plan of care? A. Decreased oral secretions B. Clear speech C. Diminished hand tremors D. Increased ptosi

B. Clear speech

An older client is receiving a water-soluble drug that is more than the average dose for a young adult. Which action should the nurse implement first? A. Obtain a prescription for lower medication dosages. B. Determine the drug's serum levels for toxicity. C. Start IV fluids to decrease the serum drug levels. D. Hold the next dosage and notify the health care provider.

B. Determine the drug's serum levels for toxicity.

A 6-year-old child is admitted to the emergency department with status epilepticus. The parents report that the seizure disorder has been managed with phenytoin, 50 mg PO bid, for the past year. Which drug should the nurse plan to administer? A. Phenytoin B. Diazepam C. Phenobarbital D. Carbamazepine

B. Diazepam

In developing a nursing care plan for a 9-month-old infant with cystic fibrosis, because the nurse is concerned about adequate nutrition, which intervention would best meet this child's needs? A. Give aluminum hydroxide and magnesium hydroxide after meals. B. Give pancrelipase capsule mixed with applesauce before each meal. C. Administer cholestyramine resin before each meal and at bedtime. D. Administer omeprazole for gastroesophageal reflux.

B. Give pancrelipase capsule mixed with applesauce before each meal.

A child is being treated with mebendazole for pinworms. What dietary information will the nurse relay to the client's mother? A. Lactose-free foods B. High-fat diet C. Vitamin C-enriched foods D. High-fiber diet

B. High-fat diet

The health care provider prescribes the H2 antagonist famotidine, 20 mg PO in the morning and at bedtime. Which statement regarding the action of H2 antagonists offers the correct rationale for administering the medication at bedtime? A. Gastric acid secreted at night is buffered, preventing pepsin formation. B. Hydrochloric acid secreted during the night is blocked. C. The drug relaxes stomach muscles at night to reduce acid. D. Ingestion of the medication at night offers a sedative effect, promoting sleep.

B. Hydrochloric acid secreted during the night is blocked.

A client is receiving acyclovir sodium IV for a severe herpes simplex infection. Which nursing action will the nurse include in the client's plan of care? A. Maintain respiratory isolation precautions. B. Increase daily fluids to 2000 to 4000 mL/day. C. Administer with meals to decrease gastric irritation. D. Assess for signs of severe liver dysfunction.

B. Increase daily fluids to 2000 to 4000 mL/day.

Dopamine is administered to a client who is hypotensive. Which finding should the nurse identify as a therapeutic response? A. Gain in weight B. Increase in urine output C. Improved gastric motility D. Decrease in blood pressure

B. Increase in urine output

A client with a dislocated shoulder is being prepared for a closed manual reduction using conscious sedation. Which medication should the nurse explain as a sedative used during the procedure? A. Inhaled nitrous oxide B. Midazolam IV C. Ketamine IM D. Fentanyl and droperidol IM

B. Midazolam IV

A client with HIV who was recently diagnosed with tuberculosis (TB) asks the nurse, "Why do I need to take all of these medications for TB?" What information should the nurse provide? A. Antiretroviral medications decrease the efficacy of the TB drugs. B. Multiple drugs prevent the development of resistant organisms. C. Duration of the medication regimen is shortened. D. Potential adverse drug reactions are minimized.

B. Multiple drugs prevent the development of resistant organisms.

A 19-year-old has sustained a severe head injury is intubated and placed on assisted mechanical ventilation. To facilitate optimal ventilation and prevent the client from "fighting" the ventilator, the health care provider administers pancuronium bromide IV, with adjunctive opioid analgesia. What medication should be immediately accessible for a potential complication with this drug? A. Dantrolene sodium B. Neostigmine bromide C. Succinylcholine bromide D. Epinephrine

B. Neostigmine bromide

The apical heart rate of an infant receiving digoxin for congestive heart failure is 80 beats/min. Which intervention should the nurse implement first? A. Administer the next dose of digoxin as scheduled. B. Obtain a serum digoxin level. C. Administer a PRN dose of atropine sulfate. D. Assess for S3 and S4 heart sounds.

B. Obtain a serum digoxin level.

A client receives an antihypertensive agent daily. Which action is most important for the nurse to implement prior to administering the medication? A. Verify the expiration date. B. Obtain the client's blood pressure. C. Determine the client's history of adverse reactions. D. Review the client's medical record for a change in drug route.

B. Obtain the client's blood pressure.

The nurse is teaching a student about the dynamics of medication administration. Which physiologic mechanism will the nurse include in the teaching which explains a drug's increased metabolism triggered by a disease process? A. Selectivity response B. Pharmacokinetics C. Pharmacodynamics D. Pharmacotherapeutics

B. Pharmacokinetics

A client receiving a continuous infusion of heparin IV starts to hemorrhage from an arterial access site. Which medication should the nurse anticipate administering to prevent further heparin-induced hemorrhaging? A. Vitamin K1 B. Protamine sulfate C. Warfarin sodium D. Prothrombin

B. Protamine sulfate

The nurse is providing care to a client recently diagnosed with acute lymphocytic leukemia. The health care provider's prescription specifies that ondansetron is to be administered IV 30 minutes prior to the infusion of cisplatin. What is the most important information for the nurse to include in the client's teaching plan? A. Promotion of diuresis to prevent nephrotoxicity B. Reduction or elimination of nausea and vomiting C. Prevention of a secondary hyperuricemia D. Reduction in the risk of an allergic reaction

B. Reduction or elimination of nausea and vomiting

A 67-year-old client is discharged from the hospital with a prescription for digoxin, 0.25 mg daily. Which instruction should the nurse include in this client's discharge teaching plan? A. Take the medication in the morning before rising. B. Take and record radial pulse rate daily. C. Expect some vision changes caused by the medication. D. Increase intake of foods rich in vitamin K.

B. Take and record radial pulse rate daily.

A client with angina pectoris is instructed to take sublingual nitroglycerin tablets PRN for chest pain. Which instruction should the nurse include in the client's teaching plan? A. Take one tablet every 3 minutes, up to five tablets. B. Take one tablet at the onset of angina and stop activity. C. Replace nitroglycerin tablets yearly to maintain freshness. D. Allow 30 minutes for a tablet to provide relief from angina

B. Take one tablet at the onset of angina and stop activity.

A 3-year-old boy is admitted to the emergency department after ingesting an unknown amount of phenobarbital elixir prescribed for his brother's seizure disorder. Which nursing action should the nurse take first? A. Place a nasogastric tube. B. Take the child's vital signs. C. Draw a blood specimen for a phenobarbital level. D. Teach the mother safe medication storage practices.

B. Take the child's vital signs.

A psychiatric client is discharged from the hospital with a prescription for haloperidol. Which instruction should the nurse include in the discharge teaching plan for this client? A. Take with antacids to reduce gastrointestinal irritation. B. Use sunglasses and sunscreen when outdoors. C. Eat foods low in fiber and salt. D. Count the pulse before each dose.

B. Use sunglasses and sunscreen when outdoors.

A 2-month-old infant is scheduled to receive the first DPT immunization. What is the preferred injection site to administer this immunization? A. Dorsal gluteal B. Vastus lateralis C. Ventral gluteal D. Deltoid

B. Vastus lateralis

The nurse is preparing a teaching plan for a client who has received a new prescription for levothyroxine sodium. Which instruction should be included? A. "Take this medication with a high-protein snack at bedtime." B. "You may change at any time to a less expensive generic brand." C. "Contact your health care provider if your daily pulse rate exceeds 100 beats/minute." D. "Return to the clinic weekly for serum blood glucose testing."

C. "Contact your health care provider if your daily pulse rate exceeds 100 beats/minute."

Which statement indicates that client teaching regarding the administration of the chemotherapeutic agent daunorubicin HCl has been effective? A. "I should use an astringent mouthwash after every meal." B. "I will eat high-fiber foods and drink lots of water." C. "I expect my urine to be red for the next few days." D. "I should use sunscreen when I spend time outdoors."

C. "I expect my urine to be red for the next few days."

A client who has chronic back pain is on long-term pain medication management and asks the nurse why his pain relief therapy is not as effective as it was 2 months ago. How should the nurse respond? A. "The phenomenon occurs when opiates are used for more than 6 months to relieve pain." B. "Withdrawal occurs if the drug is not tapered slowly while being discontinued." C. "Tolerance to medication requires increased drug levels to achieve the same effect." D. "A consistent dosage with around-the-clock administration is the most effective."

C. "Tolerance to medication requires increased drug levels to achieve the same effect."

The charge nurse is reviewing the admission history and physical data for four clients newly admitted to the unit. Which client is at greatest risk for adverse reactions to medications? A. 30-year-old man with a fracture B. 7-year-old child with an ear infection C. 75-year-old woman with liver disease D. 50-year-old man with an upper respiratory tract infection

C. 75-year-old woman with liver disease

Which parameter is most important for the nurse to check prior to administering a subcutaneous injection of heparin? A. Heart rate B. Urinary output C. Activated partial thromboplastin time (aPTT) D. Prothrombin time (PT) and international normalized ratio (INR)

C. Activated partial thromboplastin time (aPTT)

For which clients should the nurse withhold the initial dose of a cyclooxygenase 2 (COX-2) inhibitor until notifying the health care provider? (Select all that apply.) A. A middle-aged adult with a history of tinnitus while taking aspirin B. A middle-aged adult with a history of polycystic ovarian disease C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin E. An older adult with a history of gastrointestinal upset while taking naproxen sodium (Naprosyn) F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema

C. An older adult with a history of a skin rash while taking glyburide (DiaBeta) D. An adolescent with a history of an anaphylactic reaction to penicillin F. An adolescent at 34 weeks of gestation experiencing 1+ pitting edema

The nurse is preparing to apply a surface anesthetic agent for a client. Which action should the nurse take first to reduce the risk of systemic absorption? A. Apply the anesthetic to mucous membranes. B. Limit the area of application to inflamed areas. C. Avoid abraded skin areas when applying the anesthetic. D. Spread the topical agent over a large surface area.

C. Avoid abraded skin areas when applying the anesthetic.

Which assessment datum indicates to the nurse that a dose of granisetron administered IV prior to chemotherapy has had the desired effect? A. Oral mucosa pink and intact B. Scalp intact without alopecia C. Client denies nausea D. Client denies pain

C. Client denies nausea

To evaluate whether the administration of an antihypertensive medication has caused a therapeutic effect, what is the best nursing action? A. Ask the client about the onset of any dizziness since taking the medication. B. Measure the client's blood pressure while the client is lying, sitting, and then standing. C. Compare the client's blood pressure before and after the client takes the medication. D. Interview the client about any past or recent history of high blood pressure.

C. Compare the client's blood pressure before and after the client takes the medication.

A client with viral influenza is receiving vitamin C, 3000 mg PO daily, and acetaminophen elixir, 650 mg PO every 4 hours PRN. The nurse calls the health care provider to report that the client has developed diarrhea. Which change in prescriptions should the nurse anticipate? A. Change the acetaminophen to ibuprofen. B. Change the elixir to an injectable route. C. Decrease the dose of vitamin C. D. Begin treatment with an antibiotic.

C. Decrease the dose of vitamin C.

The health care provider prescribes the anticonvulsant carbamazepine for an adolescent client with a seizure disorder. The nurse should instruct the client to notify the health care provider if which condition occurs? A. Experiences dry mouth B. Experiences dizziness C. Develops a sore throat D. Develops gingival hyperplasia

C. Develops a sore throat

A client with mild parkinsonism is started on oral amantadine. Which information will the nurse include in the client's teaching plan? A. Viral organisms that provide the underlying pathophysiology for parkinsonism are eliminated. B. Acetylcholine in the myoneural junction is enhanced. C. Dopamine in the central nervous system is increased. D. Norepinephrine release is reduced within the peripheral system as the final step in dopamine uptake.

C. Dopamine in the central nervous system is increased.

The nurse is providing care to a 55-year-old client was diagnosed with schizophrenia 5 years earlier. Numerous hospitalizations have occurred since the diagnosis because of noncompliance with the prescribed medication regimen. The nurse anticipates a prescription for which medication? A. Chlorpromazine HCl B. Lithium carbonate C. Fluphenazine decanoate D. Diazepam

C. Fluphenazine decanoate

The nurse is preparing to administer the disease-modifying antirheumatic drug (DMARD) methotrexate to a client diagnosed with rheumatoid arthritis. Which action is most important prior to administering this medication? A. Assess the client's liver function test results. B. Monitor the client's intake and output. C. Have another nurse check the prescription. D. Assess the client's oral mucosa.

C. Have another nurse check the prescription.

A primigravida at 34 weeks of gestation is admitted to labor and delivery in preterm labor. She is started on a terbutaline sulfate continuous IV infusion via pump. This therapy is ineffective, and the baby is delivered vaginally. For which complication should the nurse monitor in this infant during the first few hours after delivery? A. Hypokalemia B. Hypermagnesia C. Hypoglycemia D. Hypernatremia

C. Hypoglycemia

A client is prescribed a cholinesterase inhibitor, and a family member asks the nurse how this medication works. Which pharmacophysiologic explanation should the nurse use to describe this class of drug? A. Promotes excretion of neurotoxins B. Slows nerve cell degeneration C. Improves nerve impulse transmission D. Stimulates nerve cell regeneration

C. Improves nerve impulse transmission

A client taking linezolid at home for an infected foot ulcer calls the home care nurse to report the onset of watery diarrhea. What is the best nursing action for this client? A. Schedule appointments to obtain blood samples for drug peak and trough levels. B. Reassure the client that this is an expected side effect that will resolve in a few days. C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis. D. Advise the client to begin taking an over-the-counter antidiarrheal agent.

C. Instruct the client to obtain a stool specimen to be taken to the laboratory for analysis.

The nurse is scheduling a client's antibiotic peak and trough levels with the laboratory personnel. What is the best schedule for drawing the trough level? A. Give the dose of medication and call the laboratory to draw the trough STAT. B. Arrange for the laboratory to draw the trough 1 hour after the dose is given. C. Instruct the laboratory to draw the trough immediately before the next scheduled dose. D. Give the first dose of medication after the laboratory reports that the trough has been drawn.

C. Instruct the laboratory to draw the trough immediately before the next scheduled dose.

When caring for a client on digoxin therapy which laboratory finding alerts the nurse to the potential for digoxin toxicity? A. Low serum sodium level B. High serum sodium level C. Low serum potassium level D. High serum potassium level

C. Low serum potassium level

The health care provider prescribes carbamazepine for a child whose tonic-clonic seizures have been poorly controlled. The nurse informs the mother that the child must have blood tests every week. Which complication is assessed through frequent laboratory testing that the nurse should explain to this mother? A. Nephrotoxicity B. Ototoxicity C. Myelosuppression D. Hepatotoxicity

C. Myelosuppression

A client with metastatic cancer who has been receiving fentanyl for several weeks reports to the nurse that the medication is not effectively controlling the pain. Which action should the nurse initiate? A. Instruct the client about the indications of opioid dependence. B. Monitor the client for symptoms of opioid withdrawal. C. Notify the health care provider of the need to increase the dose. D. Administer naloxone per PRN protocol for reversal.

C. Notify the health care provider of the need to increase the dose.

A client is experiencing an adverse effect of the gastrointestinal stimulant metoclopramide HCl. Which assessment finding would require immediate intervention by the nurse? A. Dizziness when first getting up B. An unpleasant metallic taste in the mouth C. Parkinson-like symptoms D. Inability to see well at night

C. Parkinson-like symptoms

A client receives pancuronium, a long-acting, nondepolarizing neuromuscular blocker, during surgical anesthesia. Which client situation should alert the nurse to evaluate the client for a prolonged muscle relaxation response to this medication? A. Hepatitis B. Heart failure C. Renal insufficiency D. History of emphysema

C. Renal insufficiency

A client who is HIV-positive is receiving combination therapy with the antiviral medication zidovudine. Which instruction should the nurse include in this client's teaching plan? A. Take the drug as prescribed to cure HIV infections. B. Use the drug to reduce the risk of transmitting HIV to sexual contacts. C. Return to the clinic every 2 weeks for blood counts. D. Report to the health care provider immediately if dizziness is experienced.

C. Return to the clinic every 2 weeks for blood counts.

A client who arrives in the postanesthesia care unit (PACU) after surgery is not awake from general anesthesia. Which action should the nurse take first? A. Assess for deep tendon reflexes. B. Observe urinary output. C. Review the medication administration record (MAR). D. Administer naloxone

C. Review the medication administration record (MAR).

A client who is receiving chlorpromazine HCl to control his psychotic behavior also has a prescription for benztropine. When teaching the client and/or significant others about these medications, what should the nurse explain about the use of benztropine in the treatment plan for this client? A. This medication will reduce the side effect of urinary retention. B. This drug potentiates the effect of chlorpromazine HCl. C. The benztropine is used to control extrapyramidal symptoms. D. The combined effect of these drugs will modify psychotic behavior.

C. The benztropine is used to control extrapyramidal symptoms.

A 45-year-old female client is receiving alprazolam for anxiety. Which client behavior would indicate that the drug is effective? A. Personal hygiene is maintained by the client for the first time in a week. B. The client has an average resting heart rate of 120 beats/min. C. The staff observes the client sitting in the day room reading a book. D. The nurse records that the client lost 2 lb of body weight in the past week.

C. The staff observes the client sitting in the day room reading a book.

A client being treated for an acute myocardial infarction is to receive the tissue plasminogen activator alteplase. The nurse would be correct in providing which explanation to the client regarding the purpose of this drug? A. This drug is a nitrate that promotes vasodilation of the coronary arteries. B. This drug is a clot buster that dissolves clots within a coronary artery. C. This drug is a blood thinner that will help prevent the formation of a new clot. D. This drug is a volume expander that improves myocardial perfusion by increasing output.

C. This drug is a blood thinner that will help prevent the formation of a new clot.

A client with metastatic cancer reports severe continuous pain. Which route of administration should the nurse use to provide the most effective continuous analgesia? A. Oral B. Intravenous C. Transdermal D. Intramuscular

C. Transdermal

The health care provider prescribes cisplatin to be administered in 5% dextrose and 0.45% normal saline with mannitol added. Which assessment parameters would be most helpful to the nurse in evaluating the effectiveness of the therapy? A. Oral temperature B. Blood cultures C. Urine output D. Liver enzyme levels

C. Urine output

A client is taking famotidine. Which client statement should the nurse further assess because it may indicate that the client is experiencing a side effect of this drug? A. "I have heartburn whenever I lie down." B. "I am never hungry. I've lost weight in the past 2 weeks." C. "I have a funny metallic taste in my mouth." D. "I seem to be having difficulty thinking clearly."

D. "I seem to be having difficulty thinking clearly."

The nurse is evaluating a client's understanding of the prescribed antilipemic drug lovastatin. Which client statement indicates that further teaching is needed? A. "My bowel habits should not be affected by this drug." B. "This medication should be taken once a day only." C. "I will still need to follow a low-cholesterol diet." D. "I will take the medication every day before breakfast."

D. "I will take the medication every day before breakfast."

The nurse has completed diabetic teaching for a client who was newly diagnosed with diabetes mellitus. Which statement by this client would indicate to the nurse that further teaching is needed? A. "Regular insulin can be stored at room temperature for 30 days." B. "My legs, arms, and abdomen are all good sites to inject my insulin." C. "I will always carry hard candies to treat hypoglycemic reactions." D. "When I exercise, I should plan to increase my insulin dosage."

D. "When I exercise, I should plan to increase my insulin dosage."

A lidocaine IV infusion at 4 mg/min via infusion pump is prescribed for a client having premature ventricular contractions (PVCs). The available premixed infusion contains 2 mg/mL of D5W. How many milliliters per hour should the nurse program the IV pump? A. 20 B. 24 C. 60 D. 120

D. 120

Dopamine, 5 mcg/kg/min, is prescribed for a client who weighs 105 kg. The nurse mixes 400 mg of dopamine in 250 mL D5W for IV administration via an infusion pump. What is the hourly rate that the nurse should set on the pump? A. 5 mL/hr B. 10 mL/hr C. 15 mL/hr D. 20 mL/hr

D. 20 mL/hr

The nurse is preparing to administer a secondary infusion of a dobutamine solution to a client. The nurse notes that the solution is brown in color. Which action should the nurse take first? A. Verify the prescribed dose with the health care provider. B. Discard the solution and reorder from the pharmacy. C. Dilute the solution with more normal saline until it becomes lighter in color. D. Administer the drug if the solution's reconstitution time is <24 hours.

D. Administer the drug if the solution's reconstitution time is <24 hours.

A mother brings her 18-month-old child to the community health center because the child has had "bad diarrhea" for the last 3 days. She states, "I bought some of this liquid at the pharmacy and gave my child a half-ounce." The nurse sees that the bottle contains loperamide. What is the next nursing action? A. Tell the mother never to give this drug to her toddler. B. Ask if any other siblings have experienced diarrhea. C. Take the child's oral and tympanic temperatures. D. Ask the mother when the child last voided

D. Ask the mother when the child last voided

The health care provider prescribes ipratropium for a client. An allergic reaction to which other medication would cause the nurse to question the prescription for ipratropium? A. Albuterol B. Theophylline C. Metaproterenol D. Atropine sulfate

D. Atropine sulfate

A client who has trouble swallowing pills intermittently has been prescribed venlafaxine (XR) for depression. The medication comes in capsule form. What should the nurse include in the discharge teaching plan for this client? A. Capsule contents can be sprinkled on pudding or applesauce. B. Chew the medication thoroughly to enhance absorption. C. Take the medication with a large glass of water or juice. D. Contact the health care provider for another form of medication.

D. Contact the health care provider for another form of medication.

The health care provider has prescribed a low-molecular-weight heparin, enoxaparin prefilled syringe, 30 mg/0.3 mL IV every 12 hours, for a client following hip replacement. Prior to administering the first dose, what is the priority nursing action? A. Assess the client's IV site for signs of inflammation. B. Evaluate the client's degree of mobility. C. Instruct the client regarding medication side effects. D. Contact the health care provider to clarify the prescription.

D. Contact the health care provider to clarify the prescription.

When developing a written nursing care plan for a client receiving chemotherapy for treatment of cancer, the nurse writes, "Assess each voiding for hematuria." The administration of which type of chemotherapeutic agent would prompt the nurse to add this assessment? A. Vincristine B. Bleomycin sulfate C. Chlorambucil D. Cyclophosphamide

D. Cyclophosphamide

A female client with myasthenia gravis is taking a cholinesterase inhibitor and asks the nurse what can be done to remedy her fatigue and difficulty swallowing. What action should the nurse take first? A. Explore a plan for development of coping strategies for the symptoms with the client. B. Explain to the client that the dosage is too high, so she should skip every other dose of medication. C. Advise the client to contact her health care provider because of the development of tolerance to the medication. D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.

D. Develop a teaching plan for the client to self-adjust the dose of medication in response to symptoms.

The nurse is providing care for a client with digoxin toxicity. Which medication will the nurse look for in the client's prescriptions? A. Atropine sulfate B. Isoproterenol C. Xylocaine D. Digoxin immune Fab

D. Digoxin immune Fab

A client is being discharged with a prescription for sulfasalazine to treat ulcerative colitis. Which instruction should the nurse provide to this client prior to discharge? A. Maintain good oral hygiene. B. Take the medication 30 minutes before a meal. C. Discontinue use of the drug gradually. D. Drink at least eight glasses of fluid a day

D. Drink at least eight glasses of fluid a day

Prior to administering a scheduled dose of digoxin, the nurse reviews the client's current serum digoxin level, which is 1.3 ng/dL. Which action should the nurse take first? A. Administer Digibind to counteract the toxicity. B. Withhold the drug and notify the health care provider immediately. C. Withhold the dose and notify the health care provider during rounds that the dose was held. D. Give the dose of digoxin if the client's heart rate is within a safe range

D. Give the dose of digoxin if the client's heart rate is within a safe range

A male client asks the nurse why condoms should not be lubricated with the spermicide nonoxynol-9. Which response is best for the nurse to provide? A. The risk of female infertility and spontaneous abortion is linked with nonoxynol-9. B. Partners can develop intermittent interstitial cystitis if the spermicide is used after the expiration date. C. The spermicide decreases the amount of vaginal and penile sensitivity for up to 8 to 12 hours. D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV.

D. Nonoxynol-9 provides no protection from STDs and has been linked to the transmission of HIV.

The nurse notes that the hemoglobin level of a client receiving darbepoetin alfa has increased from 6 to 10 g/dL over the first 2 weeks of treatment. Which is the best nursing action for this client? A. Encourage the client to continue the treatment, because it is effective. B. Advise the client that the dose will need to be increased. C. Assess the client's skin color for continued pallor or cyanosis. D. Notify the health care provider of the change in the client's laboratory values.

D. Notify the health care provider of the change in the client's laboratory values.

When providing client teaching about the administration of methylphenidate to a parent of a child diagnosed with ADHD, which instruction should the nurse include in the teaching plan? A. The doses should be given exactly 12 hours apart to sustain a therapeutic serum level. B. Doses should be scheduled at midmorning and midafternoon to achieve optimal benefit. C. Give the medication only on school days and when the child appears to be anxious. D. Offer the child the medication with breakfast and after the child eats lunch.

D. Offer the child the medication with breakfast and after the child eats lunch.

The nurse is reviewing prescribed medications with a client who is preparing for discharge. The client asks the nurse why the oral dose of an opioid analgesic is higher than the IV dose received during hospitalization. Which response is best for the nurse to provide? A. A higher dose of analgesic medication may be needed after discharge. B. An error in the dose calculation may have occurred when the prescribed dose was converted. C. The doses should be the same unless the pain is not well controlled. D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolize

D. Oral forms of drugs must pass through the liver first, where more of the dose is metabolize

The nurse is providing care to a client on heparin. Which laboratory test indicates to the nurse that the medication is effective? A. Prothrombin time (PT) B. Fibrin split products C. Platelet count D. Partial thromboplastin time (PTT)

D. Partial thromboplastin time (PTT)

Which response best supports the observations that the nurse identifies in a client who is experiencing a placebo effect? A. Beneficial response or cure for disease B. Behavioral or psychotropic responses C. Malingering or drug-seeking behaviors D. Psychological response to inert medication

D. Psychological response to inert medication

A client who is experiencing an acute attack of gouty arthritis is prescribed colchicine USP, 1 mg PO daily. Which information is most important for the nurse to provide the client? A. Take the medication with meals. B. Limit fluid intake until the attack subsides. C. Stop the medication when the pain resolves. D. Report any vomiting to the clinic.

D. Report any vomiting to the clinic.

An 80-year-old client who had a colon resection yesterday is receiving a constant dose of hydromorphone via a patient-controlled analgesia (PCA) pump. Which finding requires immediate nursing action? A. The client is drowsy and complains of pruritus. B. Pupils are 3 mm; PERRLA. C. The area around the sutures is reddened and swollen. D. Respirations decrease to 10 breaths/min.

D. Respirations decrease to 10 breaths/min.

The nurse is assessing a client receiving an antipsychotic medication. Which extrapyramidal symptom is a permanent and irreversible adverse effect of long-term phenothiazine administration? A. Dystonia B. Akathisia C. Pseudoparkinsonism D. Tardive dyskinesia

D. Tardive dyskinesia