Pharm Practice Assessment

A nurse is teaching a client who is starting to take amitriptyline. Which of the following findings should the nurse include in the teaching as an adverse effect of the medication? A. Diarrhea B. Cough C. Urinary retention D. Increased libido

C. Urinary retention Cough Developing a cough is not an adverse effect of amitriptyline. Urinary retention MY ANSWER The nurse should instruct the client that amitriptyline causes the anticholinergic effect of urinary retention. Increased libido A decrease in libido is an adverse effect of amitriptyline. Diarrhea Constipation is an adverse effect of amitriptyline.

A nurse is preparing to administer heparin subcutaneously to a client. Which of the following actions should the nurse plan to take? A. Administer the medication outside the 5-cm (2-in) radius of the umbilicus. B. Aspirate for blood return before injecting. C. Rub vigorously after the injection to promote absorption. D. Place a pressure dressing on the injection site to prevent bleeding.

A. Administer the medication outside the 5-cm (2-in) radius of the umbilicus. Rub vigorously after the injection to promote absorption. The nurse should apply firm pressure to the injection site for 1 to 2 min after the administration of the heparin to prevent bruising. Aspirate for blood return before injecting. The nurse should not aspirate by pulling back on the plunger of the heparin syringe to check for a blood return, because it will cause the injection site to bruise. Administer the medication outside the 5-cm (2-in) radius of the umbilicus. MY ANSWER The nurse should administer the heparin by subcutaneous injection to the abdomen in an area that is above the iliac crest and at least 2 inches away from the umbilicus. Place a pressure dressing on the injection site to prevent bleeding. The nurse does not need to apply a dressing over the injection site if pressure is held for at least 1 min to prevent bleeding.

A nurse is reviewing the medication list of a client who wants to begin taking oral contraceptives. The nurse should identify that which of the following client medications will interfere with the effectiveness of oral contraceptives? A. Carbamazepine B. Sumatriptan C. Atenolol D. Glipizide

A. Carbamazepine Glipizide There is no medication interaction between oral contraceptives and glipizide, an antidiabetic medication. Carbamazepine MY ANSWER Carbamazepine causes an accelerated inactivation of oral contraceptives because of its action on hepatic medication-metabolizing enzymes. Atenolol There is no medication interaction between oral contraceptives and atenolol, a beta blocker. Sumatriptan There is no medication interaction between oral contraceptives and sumatriptan, which is a medication to treat migraines.

A nurse is providing teaching to a client who is to start taking sumatriptan. Which of the following adverse effects should the nurse instruct the client to monitor for and report to the provider? A. Chest pressure B. White patches on the tongue C. Bruising D. Insomnia

A. Chest pressure Bruising Ecchymosis can indicate thrombocytopenia, which is not an adverse effect of sumatriptan. ​Insomnia Sumatriptan can cause drowsiness and sedation as an adverse effect of the medication. White patches on the tongue White patches on the tongue can indicate a fungal infection, which is not an adverse effect of sumatriptan. Chest pressure MY ANSWER Sumatriptan is an antimigraine agent which can cause coronary vasospasms, resulting in angina. The client should report chest pressure or heavy arms to the provider.

A nurse is preparing to administer medication to a client who has gout. The nurse discovers that an error was made during the previous shift and the client received atenolol instead of allopurinol. Which of the following actions should the nurse take first? A. Obtain the client's blood pressure. B. Contact the client's provider. C. Inform the charge nurse. D. Complete an incident report.

A. Obtain the client's blood pressure. Obtain the client's blood pressure. MY ANSWER The first action the nurse should take to prevent injury to the client when using the nursing process is to assess the client for adverse effects of atenolol, such as hypotension. Contact the client's provider. The nurse should contact the provider, who can provide direction to the nurse to prevent injury to the client. However, there is another action the nurse should take first. Complete an incident report. The nurse should complete an incident report, which is used as part of a facility's quality assurance program. However, there is another action the nurse should take first. Inform the charge nurse. The nurse should alert the charge nurse to the medication error. However, there is another action the nurse should take first.

A nurse is reviewing the prescriptions of a client who has tuberculosis. The nurse should identify that which of the following medications are used to treat tuberculosis? (SATA) A. Rifampin B. Mirtazapine C. Temazepam D. Infliximab E. Isoniazid

A. Rifampin E. Isoniazid Rifampin is correct. This medication is given to treat tuberculosis by inhibiting the production of mycobacteria. Isoniazid is correct. This medication is given to treat tuberculosis by inhibiting the production of mycobacteria. Mirtazapine is incorrect. This medication is given to treat depression. Temazepam is incorrect. This medication is given to treat insomnia. Infliximab is incorrect. This medication is given to treat moderate to severe Crohn's disease or arthritis.

A nurse is providing teaching to a client who has a prescription for a MAOI inhibitor. Which of the following foods should the nurse instruct the client to avoid while taking this medication? A. Smoked sausage. B. Cottage cheese. C. Green beans. D. Apple pie.

A. Smoked sausage. Apple pie The nurse should inform the client that it is safe to eat apple pie, which contains little to no tyramine, when taking MAOI medications. Smoked sausage MY ANSWER The nurse should instruct the client to avoid eating smoked sausage because it contains tyramine. Tyramine can interact with MAOIs and result in hypertensive crisis. Green beans The nurse should inform the client that it is safe to eat green beans, which contain little to no tyramine, when taking MAOI medications. Cottage cheese The nurse should inform the client that it is safe to eat cottage cheese, which contains little to no tyramine, when taking MAOI medications.

The nurse is caring for a client who is taking acetazolamide for chronic open-angle glaucoma. For which of the following adverse effects should the nurse instruct the client to monitor and report? A. Tingling of fingers. B. Constipation. C. Weight gain. D. Oliguria. A. Tingling of fingers.

A. Tingling of fingers. Tingling of fingers MY ANSWER The nurse should instruct the client to report the adverse effect of paresthesia, a tingling sensation in the extremities, when taking acetazolamide. Weight gain Weight loss is an adverse effect of acetazolamide due to gastrointestinal disturbances causing reduced appetite. Constipation Diarrhea is an adverse effect of acetazolamide due to gastrointestinal disturbances. Oliguria Polyuria, rather than oliguria, is an adverse effect of acetazolamide.

A nurse is caring for the mother of a newborn. The mother asks the nurse when her newborn should receive his first DTaP vaccine. The nurse should instruct the mother that her newborn should receive the immunization at which of the following ages? A. Birth B. 2 months C. 6 months D. 15 months

B. 2 months 6 months The CDC recommends that newborns receive the third dose of the five-dose series of the DTaP immunization at 6 months of age. 2 months MY ANSWER The CDC recommends that newborns receive the first dose of the five-dose series of the DTaP immunization at 2 months of age. Birth According to the current recommended immunization schedule, only the hepatitis B vaccine is given at birth. 15 months The CDC recommends that newborns receive the fourth dose of the five-dose series of the DTaP immunization between 15 to 18 months of age.

A nurse is administering baclofen for a client who has a spinal cord injury. Which of the following should the nurse document as a therapeutic outcome? A. Increase in seizure threshold. B. Decrease in flexor and extensor spasticity. C. Increase in cognitive function. D. Decrease in paralysis of the extremities.

B. Decrease in flexor and extensor spasticity. Decrease in flexor and extensor spasticity MY ANSWER The client who has a spinal cord injury and takes baclofen can experience a decrease in the frequency and severity of muscle spasms and in flexor and extensor spasticity. Increase in seizure threshold The client who has a seizure disorder and takes baclofen can have a decrease in the seizure threshold, which can result in seizure activity. Decrease in paralysis of the extremities The client who takes baclofen can experience the adverse effect of inhibited reflexes at the spinal level, but the medication does not decrease the effects of paralysis. Increase in cognitive function The client who takes baclofen can experience the adverse effect of memory impairment and a decrease in cognitive function.

A nurse is teaching about zolpidem with a client who has insomnia. The nurse should identify that which of the following client statements indicates an understanding of the teaching? A. I will need to get laboratory testing prior to a refill of this medication. B. I will use this medication for a short period of time. C. I will need to take this medication for 1 week before results are seen. D. I will need to change the medications to prevent building up a tolerance.

B. I will use this medication for a short period of time. "I will use this medication for a short period of time." MY ANSWER Zolpidem is used for short-term treatment of insomnia. Therefore, the provider should reassess the client before refilling the prescription. "I will need to change the medications to prevent building up a tolerance." The client who takes zolpidem should not build up a tolerance with short-term use. "I will need to get laboratory testing prior to a refill of this medication." Laboratory testing is not needed when taking this medication for sleep. "I will need to take this medication for 1 week before results are seen." The client who takes zolpidem should have improved sleep within 2 days of starting this medication.

A nurse is monitoring a client who is receiving amphotericin B intermittent IV bolus for the treatment of histoplasmosis. Which of the following findings should the nurse identify as an adverse reaction to the medication? A. Tachycardia B. Oliguria C. Hyperkalemia D. Weight gain

B. Oliguria Oliguria MY ANSWER Oliguria can indicate renal compromise in a client who is taking amphotericin B. The nurse should report this finding to the provider. Hyperkalemia Hypokalemia, not hyperkalemia, is an adverse effect of amphotericin B due to the medication causing damage to the kidneys. Tachycardia Bradycardia, not tachycardia, is an adverse effect of amphotericin B. Weight gain Weight loss, not weight gain, is an adverse effect of amphotericin B.

A nurse is preparing to administer a scheduled antibiotic at 0800 to a client and discovers the antibiotic is not present in the client's medication drawer. The nurse should identify that administration of the medication can occur at which of the following time periods without requiring an incident report? A. 1000 B. 0900 C. 0830 D. 1200

C. 0830 0830 MY ANSWER The nurse should identify that an antibiotic can be administered 30 min before or after the scheduled time to maintain therapeutic blood levels without requiring an incident report. 1000 The nurse should identify that administering an antibiotic 2 hr after the scheduled time is too late and requires filing an incident report. 1200 The nurse should identify that administering an antibiotic 4 hr after the scheduled time is too late and requires filing an incident report. 0900 The nurse should identify that administering an antibiotic 1 hr after the scheduled time is too late and requires filing an incident report.

A nurse is providing teaching to a client who has a new prescription for phenytoin. Which of the following statements by the client indicates an understanding of the teaching? A. I should take my medication with antacids to minimize gastric upset. B. This type of medication does not require blood monitoring. C. I should let my dentist know I'm taking this medication. D. I should expect to experience some unusual eye movement when taking this medication.

C. I should let my dentist know I'm taking this medication. "I should take my medication with antacids to minimize gastric upset." The client should not take phenytoin with antacids because they can decrease the effects of phenytoin. If needed, antacids should be taken 2 hr before or after the phenytoin. "I should let my dentist know I'm taking this medication." MY ANSWER Phenytoin commonly causes gingival hyperplasia. As a result, the client should notify his dentist. "This type of medication does not require blood monitoring." The client should receive instructions to have blood levels of phenytoin monitored to determine effective dosage. Subtherapeutic and toxic levels can result in poor outcomes. "I should expect to experience some unusual eye movement when taking this medication." The client should not expect to experience unusual eye movement when taking phenytoin. However, nystagmus is a serious adverse effect when taking phenytoin that the client should report to the provider.

A nurse is teaching about self-administration of transdermal medication with a male client who has a new prescription for nitroglycerin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching? A. I can apply the patch to a chest area that has hair. B. I can take this medication if using an erectile dysfunction product. C. I will remove the patch after 14 hours. D. I need to apply a new patch to the same area every day.

C. I will remove the patch after 14 hours. "I can take this medication if using an erectile dysfunction product." The client should not use erectile dysfunction products with nitroglycerin because this combination can cause severe hypotension and death. "I can apply the patch to a chest area that has hair." The client should apply the patch to an area of the skin that is hairless to enhance absorption of the medication. "I will remove the patch after 14 hours." MY ANSWER The client should remove the patch after 12 to 14 hr to prevent tolerance of the medication. "I need to apply a new patch to the same area every day." The client should rotate the location of the patch daily to avoid irritation of the skin.

A nurse is caring for a client who is recovering from a deep vein thrombosis and is to start taking warfarin. For which of the following findings should the nurse monitor as an adverse effect of warfarin? A. Hypertension B. Low INR C. Constipation D. Bleeding gums

D. Bleeding gums Hypertension The nurse should monitor for hypotension, which may indicate bleeding. Bleeding gums MY ANSWER The nurse should monitor the client for bleeding gums, which is an adverse effect of warfarin, an anticoagulant. Low INR The nurse should monitor the INR daily until it increases to a therapeutic level. Constipation The nurse should monitor for gastrointestinal irritation, which can include diarrhea, nausea, and vomiting.

A nurse is providing teaching to a client who is to start taking lisinopril. Which of the following findings is an adverse effect that the nurse should instruct the client to monitor and report to the provider? A. Hair loss B. Ringing in the ears C. Facial flushing D. Dry cough

D. Dry cough Dry cough MY ANSWER A buildup of bradykinin from taking lisinopril can cause a client to have a dry cough and lead to life-threatening consequences. The client should report the finding to the provider. Facial flushing Facial flushing is not an adverse effect of lisinopril. However, facial edema is a serious effect that the client should report to the provider. Hair loss Alopecia, or hair loss, is not an adverse effect of lisinopril. Ringing in the ears Tinnitus, or ringing in the ears, is not an adverse effect of lisinopril.

A nurse is teaching a client who is to start taking temazepam. Which of the following instructions should the nurse include? A. Limit continuous use to 7 to 10 weeks. B. Schedule doses for early morning before breakfast. C. Expect that it will take 4 nights before benefits are noticed. D. Plan to withdraw from the medication gradually.

D. Plan to withdraw from the medication gradually. Limit continuous use to 7 to 10 weeks. The nurse should include in the teaching to limit use of temazepam to 7 to 10 days. Schedule doses for early morning before breakfast. The nurse should instruct the client to administer temazepam at bedtime to treat insomnia. Expect that it will take 4 nights before benefits are noticed. The nurse should include in the teaching that it will take 2 nights before benefits are noticed. Plan to withdraw from the medication gradually. MY ANSWER The nurse should include in the teaching to have the client plan to withdraw from taking temazepam gradually to avoid mild withdrawal syndrome.

A nurse is providing teaching for a client who has multiple sclerosis and a new prescription for methylprednisolone. Which of the following instructions should the nurse include? (SATA) A. Blood glucose levels will be monitored during therapy. B. Avoid contact with people who have known infections. C. Take the medication 1 hr before breakfast. D. Decrease dietary intake of foods containing potassium. E. Grapefruit juice can increase the effects of this medication.

A. Blood glucose levels will be monitored during therapy. B. Avoid contact with people who have known infections. E. Grapefruit juice can increase the effects of this medication. Blood glucose levels will be monitored during therapy is correct. The nurse should monitor the client for hyperglycemia while providing this medication to the client. Glucocorticoids, such as methylprednisolone, increase serum glucose levels and can require management with insulin or antihyperglycemics. Avoid contact with people who have known infections is correct. The nurse should instruct the client to avoid exposure to infectious agents, such as contact with those who have active infections or illnesses. Glucocorticoids, such as methylprednisolone, depress the immune system, placing the client at an increased risk for developing an infection. Take the medication 1 hr before breakfast is incorrect. The nurse should instruct the client to take the medication with food or milk to decrease gastrointestinal upset. Decrease dietary intake of foods containing potassium is incorrect. The nurse should instruct the client to increase dietary intake of potassium-rich foods while taking this medication. Glucocorticoids, such as methylprednisolone, deplete potassium in the body, which manifests as hypokalemia. Grapefruit juice can increase the effects of the medication is correct. The nurse should instruct the client that grapefruit and grapefruit juice can increase the level of methylprednisolone in the body.

A nurse is teaching a client who is starting to take ketorolac. Which of the following information should the nurse include in the teaching? A. Check for bruising while taking this medication. B. Take the medication on an empty stomach. C. The medication can cause anxiety. D. Increase iron intake with this medication.

A. Check for bruising while taking this medication. "Increase iron intake with this medication." There is no indication that the client should increase iron intake. "Check for bruising while taking this medication." MY ANSWER The nurse should instruct the client to check for bruising because ketorolac can increase the risk of bleeding by interfering with platelet aggregation. "The medication can cause anxiety." There is no indication that ketorolac causes anxiety. "Take the medication on an empty stomach." Ketorolac should be taken with food to prevent gastrointestinal distress.

A nurse is caring for a client who has cancer and is taking oral morphine and docusate sodium. The nurse should instruct the client that taking the docusate sodium on a daily basis can minimize which of the following adverse effects of morphine? A. Constipation B. Drowsiness C. Facial flushing D. Itching

A. Constipation Constipation MY ANSWER Constipation is a common adverse effect of morphine that will minimize when the client takes docusate sodium, a stool softener that promotes easier evacuation of stool by increasing water and fat in the intestine. Facial flushing Facial flushing is not an adverse effect of morphine that will be minimized while taking docusate sodium. Drowsiness Drowsiness is not an adverse effect of morphine that will be minimized while taking docusate sodium. Itching Itching is not an adverse effect of morphine that will be minimized while taking docusate sodium.

A nurse in a provider's office is assessing a client who has been taking aspirin daily for the past year. For which of the following findings should the nurse notify the provider immediately? A. Hyperventilation B. Heartburn C. Anorexia D. Swollen ankles

A. Hyperventilation Swollen ankles Swollen ankles are nonurgent because the client who is taking aspirin can experience sodium and fluid retention. Therefore, there is another finding that is the nurse's priority. Anorexia Anorexia is nonurgent because the client who is taking aspirin can experience a decrease in appetite. Therefore, there is another finding that is the nurse's priority. Hyperventilation MY ANSWER When using the urgent vs. nonurgent approach to client care, the nurse should determine that the priority finding is hyperventilation. This indicates the client might have acute salicylate poisoning, which causes respiratory alkalosis in the early stages. Heartburn Heartburn is nonurgent because the client who is taking aspirin can experience gastrointestinal distress. Therefore, there is another finding that is the nurse's priority.

A nurse at an urgent care clinic is collecting a history from a female client who has a UTI. The nurse anticipates a prescription for ciprofloxacin. The nurse should identify that which of the following client statements indicates a contraindication for administering this medication? A. I have tendonitis, so I haven't been able to exercise. B. I take a stool softener for chronic constipation. C. I take medicine for my thyroid. D. I am allergic to sulfa.

A. I have tendonitis, so I haven't been able to exercise. "I have tendonitis, so I haven't been able to exercise." MY ANSWER The nurse should identify tendonitis is a contraindication for taking ciprofloxacin due to the risk of tendon rupture. "I take medicine for my thyroid." Ciprofloxacin does not affect thyroid function and is not contraindicated for the client who takes thyroid medication. "I am allergic to sulfa." Ciprofloxacin is a quinolone antibiotic. Therefore, the client who has a sulfa allergy can take this medication. "I take a stool softener for chronic constipation." Ciprofloxacin is not contraindicated for the client who takes a stool softener for chronic constipation. An adverse effect of the medication is diarrhea.

A nurse is developing a teaching plan for a client who has a new prescription for simvastatin. Which of the following instructions should the nurse include in the teaching plan? (SATA) A. Report muscle pain to the provider. B. Avoid taking the medication with grapefruit juice. C. Take the medication in the early morning. D. Expect a flushing of the skin as a reaction to the medication. E. Expect therapy with this medication to be lifelong.

A. Report muscle pain to the provider. B. Avoid taking the medication with grapefruit juice. E. Expect therapy with this medication to be lifelong. Report muscle pain to the provider is correct. Myopathy is an adverse effect of simvastatin that can lead to rhabdomyolysis, so it should be reported to the provider. Avoid taking the medication with grapefruit juice is correct. When taken with grapefruit juice, simvastatin increases the risk of muscle injury from elevations in creatine kinase. Take the medication in the early morning is incorrect. This medication is most effective when taken in the evening because cholesterol production generally increases overnight. Expect a flushing of the skin as a reaction to the medication is incorrect. The nurse should identify flushing of the skin as an adverse effect of the medication niacin, which can be used to decrease the client's triglyceride levels. Expect therapy with this medication to be lifelong is correct. If medication therapy is discontinued, cholesterol levels will return to their pretreatment range within several weeks to months.

A nurse is teaching a client who has an upper respiratory infection about guaifenesin. Which of the following statements should the nurse include in the teaching? A. Constipation is an expected adverse effect of this medication. B. Increase your fluid intake to at least 2 liters each day while taking this medication. C. Store your medication in the refrigerator. D. You can expect to experience insomnia while taking this medication.

B. Increase your fluid intake to at least 2 liters each day while taking this medication. "Store your medication in the refrigerator." The nurse should instruct the client to store the medication at room temperature. Refrigeration can alter the properties of the medication. "You can expect to experience insomnia while taking this medication." The nurse should inform the client that drowsiness, not insomnia, is an expected adverse effect of this medication. The client should avoid driving or other potentially hazardous activities while taking this medication if drowsiness occurs. "Increase your fluid intake to at least 2 liters each day while taking this medication." MY ANSWER The nurse should instruct the client to increase fluid intake to at least 2 L per day while taking guaifenesin. An increase in fluid intake facilitates the removal of secretions and helps to create a more productive cough. "Constipation is an expected adverse effect of this medication." The nurse should inform the client that diarrhea, not constipation, is an expected adverse effect of guaifenesin.

A nurse is providing teaching for a client who has a new prescription for ferrous sulfate. The nurse should instruct the client to take the medication with which of the following to promote absorption? A. Vitamin E B. Orange juice C. Milk D. Antacids

B. Orange juice Milk Milk inhibits iron absorption. Vitamin E Vitamin E has no effect on iron absorption. Orange juice MY ANSWER The absorption of ferrous sulfate is enhanced by a vitamin C source, such as orange juice. However, increasing the dosage of ferrous sulfate can provide the same benefit to increase the amount of iron uptake. Antacids Antacids inhibit iron absorption.

A nurse is caring for a 20-year-old female client who has a prescription for isotretinoin for severe nodulocystic acne vulgaris. Before the client can obtain a refill, the nurse should advise the client that which of the following tests is required? A. Serum calcium B. Pregnancy test C. 24 hour urine collection for protein D. Aspartate aminotransferase level

B. Pregnancy test 24 hr urine collection for protein The client does not need to have a 24 hr urine test for protein levels when taking isotretinoin. Pregnancy test MY ANSWER The client who is pregnant or might become pregnant must not take isotretinoin because this medication has teratogenic effects. Pregnancy testing is mandatory before the initial prescription (two tests) and before monthly refills (one test). Aspartate aminotransferase level The client does not need to have a laboratory test for aspartate aminotransferase levels when taking isotretinoin. Serum calcium The client does not need to have a laboratory test for serum calcium levels when taking isotretinoin.

A nurse is providing teaching about adverse effects of clindamycin to a client. Which of the following findings should the nurse instruct the client to report to the provider? A. Orange urine B. Watery diarrhea C. Weight gain D. Headache

B. Watery diarrhea Orange urine The client who takes clindamycin can develop jaundice, which can cause the urine to turn dark brown in color. Weight gain The client who takes clindamycin can have the adverse effect of weight loss. Watery diarrhea MY ANSWER The client who takes clindamycin can have an adverse effect of watery diarrhea that can lead to Clostridium difficile-associated diarrhea or pseudomembranous colitis. The client should report these findings immediately to the provider. Headache The client who takes clindamycin will not have adverse effects that involve the central nervous system or cause a headache.

A nurse is assessing a client who has received atropine eye drops during an eye examination. Which of the following findings should the nurse expect as an adverse effect of the medication? A. Difficulty seeing in the dark. B. Pinpoint pupils. C. Blurred vision. D. Excessive tearing.

C. Blurred vision. Difficulty seeing in the dark The client who has received atropine eye drops can have photosensitivity, which causes difficulty seeing in brightly lit areas due to the muscarinic receptors causing mydriasis. Blurred vision MY ANSWER Blurred vision is an expected finding following the administration of atropine eye drops. This is due to the cycloplegic effects of the medication, which cause distant objects to appear blurry to the client. Excessive tearing Excessive tearing is not an expected finding following the administration of atropine eye drops. Pinpoint pupils Dilation of pupils, or mydriasis, is an expected finding following the administration of atropine eye drops.

A nurse in an emergency department is caring for a client whose family reports the client has taken large amounts of diazepam. Which of the following medications should the nurse anticipate administering? A. Ondansetron B. Magnesium sulfate C. Flumazenil D. Protamine sulfate

C. Flumazenil Protamine sulfate Protamine sulfate is an antidote for heparin and the nurse should administer the medication to reverse an elevated aPTT caused by the use of heparin. Flumazenil MY ANSWER Flumazenil is an antidote and the nurse should administer the medication to reverse benzodiazepines, such as diazepam. Magnesium sulfate Magnesium sulfate is an electrolyte replacement and the nurse should administer the medication to treat the risk of seizure activity. Ondansetron Ondansetron is an antiemetic and the nurse should administer the medication to treat nausea and vomiting.

A nurse is providing discharge instruction to a client who is to self-administer insulin at home. Which of the following client statements should indicate to the nurse that the teaching is effective? A. I should avoid getting rid of the air bubble in the syringe. B. I should inject the insulin into my thigh for the fastest absorption. C. I will store my unopened bottles of insulin in the refrigerator. D. I need to shake the insulin before using it to make sure it is well mixed.

C. I will store my unopened bottles of insulin in the refrigerator. "I should avoid getting rid of the air bubble in the syringe." The nurse should instruct the client to expel all air bubbles in the syringe to ensure an accurate dosage is delivered. "I should inject the insulin into my thigh for the fastest absorption." The nurse should instruct the client that the fastest absorption of insulin occurs with abdominal injections. Absorption is slowest when the injection is into the thigh. "I need to shake the insulin before using it to make sure it is well mixed." The nurse should instruct the client to mix insulin by rolling the insulin in the palm of his hand to prevent frothing, which can cause the drawing up of an inaccurate dose of insulin. "I will store my unopened bottles of insulin in the refrigerator." MY ANSWER The client should store unopened vials of insulin in the refrigerator to maintain medication viability. Once opened, the insulin may remain at room temperature for up to 1 month.

A nurse is caring for a client who is receiving long-term treatment for systemic lupus erythematosus with prednisone. The nurse should inform the client to expect to undergo which of the following diagnostic tests to monitor for long-term complications of prednisone? A. Pulmonary function tests B. Electrocardiograms C. Liver function studies D. Bone density scans

D. Bone density scans Liver function studies Liver function studies are not indicated for a client who is taking prednisone. Electrocardiograms Routine echocardiograms are not indicated for a client who is taking prednisone. Bone density scans MY ANSWER The client who is taking prednisone, which is a glucocorticoid, should have regularly scheduled bone density scans to monitor for the adverse effects of osteoporosis. Pulmonary function tests Pulmonary function tests are not indicated for a client who is taking prednisone.

A nurse is preparing to teach a client who is to start a new prescription for extended-release verapamil. Which of the following instructions should the nurse plan to include? A. Take the medication on an empty stomach. B. Avoid crowds. C. Discontinue the medication if palpitations occur. D. Change positions slowly.

D. Change positions slowly. ​Change positions slowly. MY ANSWER The nurse should instruct the client to change positions gradually to prevent orthostatic hypotension and syncope. ​Avoid crowds. Avoiding crowds is not necessary for the client who is taking verapamil because it does not cause an immunosuppression disorder. Take the medication on an empty stomach. The nurse should instruct the client to take extended release verapamil with food to minimize gastric distress. ​Discontinue the medication if palpitations occur. The nurse should instruct the client that verapamil can cause palpitations, which should be reported to the provider. The client should never discontinue the medication abruptly because the client may experience chest pain.

A nurse is providing teaching to a client who is to start treatment for asthma with beclomethasone and albuterol inhalers. Which of the following instructions should the nurse include in the teaching? A. Take beclomethasone to avoid an acute attack. B. Use beclomethasone 5 minutes before using albuterol. C. Limit your calcium and vitamin D intake when taking beclomethasone. D. Rinse your mouth after inhaling the beclomethasone.

D. Rinse your mouth after inhaling the beclomethasone. "Take beclomethasone to avoid an acute attack." The client should take albuterol, a short-acting beta2-adrenergic agonist, to avoid an acute asthma attack. "Use beclomethasone 5 minutes before using albuterol." The client should use the bronchodilator, albuterol, prior to taking beclomethasone, a glucocorticoid inhaler, to enhance its absorption. "Rinse your mouth after inhaling the beclomethasone." MY ANSWER The client should rinse her mouth after using beclomethasone, a glucocorticoid inhaler, to prevent oropharyngeal candidiasis and hoarseness. "Limit your calcium and vitamin D intake when taking beclomethasone." The client should increase the intake of calcium and vitamin D to minimize bone loss while taking beclomethasone, a glucocorticoid inhaler.

A nurse is providing discharge teaching about handling medication to a client who is to continue taking oral transmucosal fentanyl raspberry-flavored lozenges on a stick. Which of the following information should the nurse include in the teaching? A. Chew on the medication stick to release the medication. B. Leave the medication stick in one location of the mouth until melted. C. Allow the medication 1 hr for analgesia effects to begin. D. Store unused medication sticks in a storage container. D. Store unused medication sticks in a storage container.

D. Store unused medication sticks in a storage container. Chew on the medication stick to release the medication. The nurse should instruct the client to place the fentanyl stick between her cheek and lower gum and to actively suck it for increased absorption of the medication. Allow the medication 1 hr for analgesia effects to begin. The nurse should instruct the client to expect the medication's analgesia effects to begin within 10 to 15 min. Leave the medication stick in one location of the mouth until melted. The nurse should instruct the client to periodically move the medication stick to a different location in the mouth for best absorption. Store unused medication sticks in a storage container. MY ANSWER The nurse should instruct the client to store unused, used, or partially used medication sticks in the safe storage container that comes in the kit when the medication is initially prescribed.

A nurse is preparing to administer to a client 0.9% sodium chloride 1,000 mL IV over 8 hours. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min?

31 gtt/min Ratio and Proportion STEP 1: What is the unit of measurement the nurse should calculate? gtt/min STEP 2: What is the volume the nurse should infuse? 1 L = 1,000 mL STEP 3: What is the total infusion time? 8 hr STEP 4: Should the nurse convert the units of measurement? Yes (hr ≠ min) 1 hr/60 min = 8 hr/X min X = 480 min STEP 5: Set up an equation and solve for X. Volume (mL)/Time (min) x drop factor (gtt/mL) = X gtt/mL 1,000 mL/480 min x 15 gtt/mL = X gtt/mL X = 31.25 STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads 0.9% sodium chloride 1,000 mL IV to infuse over 8 hr, it makes sense to administer 15 gtt/min. The nurse should set the manual IV infusion to deliver 0.9% sodium chloride IV at 31 gtt/min. Desired Over Have STEP 1: What is the unit of measurement the nurse should calculate? gtt/min STEP 2: What is the volume the nurse should infuse? 1 L = 1,000 mL STEP 3: What is the total infusion time? 8 hr STEP 4: Should the nurse convert the units of measurement? Yes (hr ≠ min) 1 hr/60 min = 8 hr/X min X = 480 min STEP 5: Set up an equation and solve for X. Volume (mL)/Time (min) x drop factor (gtt/mL) = X gtt/mL 1,000 mL/480 min x 15 gtt/mL = X gtt/mL X = 31.25 STEP 6: Round if necessary. STEP 7: Reassess to determine whether the amount to administer makes sense. If the prescription reads 0.9% sodium chloride 1,000 mL IV to infuse over 8 hr, it makes sense to administer 15 gtt/min. The nurse should set the manual IV infusion to deliver 0.9% sodium chloride IV at 31 gtt/min. Dimensional Analysis STEP 1: What is the unit of measurement the nurse should calculate? gtt/min STEP 2: What is the quantity of the drop factor that is available? 15 gtt/mL STEP 3: What is the total infusion time? 8 hr STEP 4: What is the volume the nurse should infuse? 1 L = 1,000 mL STEP 5: Should the nurse convert the units of measurement? Yes (hr ≠ min) 1 hr/60 min STEP 6: Set up an equation and solve for X. X = Quantity/1 mL x Conversion (hr)/Conversion (min) x Volume (mL)/ Time (min) X = gtt/mL = 15 gtt/1 mL x 1 hr/60 min x 1,000 mL/8 hr X = 31.25 STEP 7: Round if necessary. 31.25 = 31 STEP 8: Reassess to determine whether the amount to administer makes sense. If the prescription reads 0.9% sodium chloride 1,000 mL IV to infuse over 8 hr, it makes sense to administer 15 gtt/min. The nurse should set the manual IV infusion to deliver 0.9% sodium chloride IV at 31 gtt/min.

A nurse is caring for a client who has diabetes mellitus and is taking glyburide. The client reports feeling confused and anxious. Which of the following actions should the nurse take first? A. Perform a capillary blood glucose test. B. Provide the client with a protein-rich snack. C. Give the client 120 mL (4 oz) of orange juice. D. Schedule an early meal tray.

A. Perform a capillary blood glucose test. Perform a capillary blood glucose test. MY ANSWER The greatest risk to this client is injury from hypoglycemia. Therefore, the nurse should perform a capillary blood glucose test to determine the client's blood glucose status. Manifestations of hypoglycemia include weakness, anxiety, confusion, sweating, and seizures. Give the client 120 mL (4 oz) of orange juice. The nurse should give the client 10 to 15 g of carbohydrates, such as 4 oz of orange juice, to treat hypoglycemia. However, there is another action that the nurse should take first. Provide the client with a protein-rich snack. The nurse should provide the client with a protein-rich snack after determining the client's blood glucose value and providing a carbohydrate first. However, there is another action that the nurse should take first. Schedule an early meal tray. The nurse should schedule the client an early meal tray to maintain the client's blood glucose level following the initial interventions for hypoglycemia. However, there is another action the nurse should take first.

A nurse is reviewing the medical record of a client who has hypertension. The nurse should identify which of the following findings as a contraindication to receiving propranolol? A. Cholelithiasis B. Asthma C. Angina pectoris D. Tachycardia

B. Asthma Angina pectoris The client who has angina pectoris can receive propranolol to decrease heart rate and contractility, resulting in a reduction of oxygen demand. Propranolol is contraindicated for use when a client has vasospastic angina. Asthma MY ANSWER Asthma is a contraindication to receiving propranolol. Propranolol is an adrenergic antagonist which blocks the beta2 receptors in the lungs, causing bronchoconstriction and leading to serious airway resistance and possibly respiratory arrest. Cholelithiasis Cholelithiasis is not a contraindication to receiving propranolol. Tachycardia Tachycardia is not a contraindication to receiving propranolol. Propranolol is administered to slow a client's heart rate and decrease oxygen demand.

A nurse in an emergency department is caring for a client who has heroin toxicity. The client is unresponsive with pinpoint pupils and a respiratory rate of 6/min. Which of the following medications should the nurse plan to administer? A. Methadone B. Naloxone C. Diazepam D. Bupropion

B. Naloxone Bupropion The nurse should administer bupropion, an atypical antidepressant, for a client who is trying to quit smoking cigarettes to decrease the manifestations of nicotine withdrawal and ease the client's cravings for nicotine. Naloxone MY ANSWER The nurse should administer naloxone, an opioid antagonist, to a client who has heroin toxicity to reverse the respiratory depressive effects of the heroin. However, the nurse should not administer naloxone too quickly because naloxone can cause hypertension, tachycardia, nausea, vomiting, and might cause the client to enter a state of opioid withdrawal. Methadone The nurse should administer methadone, an opioid agonist, to a client who has heroin toxicity to decrease manifestations of opioid withdrawal and to suppress the euphoria the client feels when using heroin. However, the client should not receive methadone in an emergency. Diazepam The nurse should administer diazepam, a benzodiazepine, to a client who has alcohol toxicity to decrease the manifestations of alcohol withdrawal and prevent withdrawal seizures.

A circulating nurse is planning care for a client who is scheduled for surgery and has a latex allergy. Which of the following actions should the nurse include in the plan of care? A. Schedule the client for the last surgery of the day. B. Place monitoring cords and tubes in a stockinet. C. Choose rubber injection ports for fluid administration. D. Ensure phenytoin IV is readily available.

B. Place monitoring cords and tubes in a stockinet. Ensure phenytoin IV is readily available. The nurse should ensure that epinephrine is readily available in the operating room in case of an anaphylactic reaction of accidental exposure to latex. Place monitoring cords and tubes in a stockinet. MY ANSWER The circulating nurse should place monitoring devices in a stockinet to prevent direct contact with the client's skin. Schedule the client for the last surgery of the day. The circulating nurse should schedule the client for the first surgery of the day to minimize the client's exposure to latex, including latex dust. Choose rubber injection ports for fluid administration. The circulating nurse should ensure that latex-free products are used in the care of this client. Rubber injection ports contain latex, which would place the client at risk for a severe allergic reaction.

A nurse is reviewing the medical record of a client who has schizophrenia and a prescription for clozapine. Which of the following laboratory tests should the nurse review before administering the medication? A. Troponin B. Total cholesterol C. Creatinine D. Thyroid stimulating hormone

B. Total cholesterol

A nurse is providing teaching about insulin glargine to a client who has type 1 diabetes mellitus. Which of the following information should the nurse include in the instructions? A. Observe for hypoglycemia when the insulin peaks. B. Administer the insulin immediately before meals. C. Do not mix this medication in a syringe with other insulin. D. Rotate the bottle gently prior to drawing up the insulin.

C. Do not mix this medication in a syringe with other insulin. Administer the insulin immediately before meals. The client can inject glargine once or twice a day, any time during the day, but always at the same time every day. Rotate the bottle gently prior to drawing up the insulin. Insulin glargine is clear. Therefore, there is no need for the client to rotate the bottle prior to drawing up the insulin. Observe for hypoglycemia when the insulin peaks. Insulin glargine does not cause peaks. Instead, it maintains a steady blood level up to a 24-hr period, which reduces the risk of hypoglycemia. Do not mix this medication in a syringe with other insulin. MY ANSWER The client should not mix insulin glargine with any other type of insulin in the same syringe, because this procedure can alter the medication's effects.

A nurse is caring for a client who has heart failure and is receiving an IV infusion of dopamine. Which of the following findings indicates that the medication is effective? A. Decreased blood pressure. B. Increased heart rate. C. Increased cardiac output. D. Decreased serum potassium.

C. Increased cardiac output. Increased heart rate Tachycardia is an adverse effect of dopamine, and it does not indicate the medication's effectiveness. Decreased serum potassium Dopamine does not affect serum potassium levels. Decreased blood pressure Dopamine is an adrenergic that causes a receptor specificity effect, which increases blood pressure. Increased cardiac output MY ANSWER Dopamine is an adrenergic that causes a receptor specificity effect, which increases cardiac output and improves perfusion.

A nurse is caring for a client who is taking atenolol. Which of the following findings should indicate to the nurse that the medication is effective? A. The client has an increase in urinary output. B. The client reports an improvement in memory. C. The client has a decrease in blood pressure. D. The client reports having an increase in libido.

C. The client has a decrease in blood pressure. The client has a decrease in blood pressure. MY ANSWER Atenolol, a beta-adrenergic blocking agent, lowers blood pressure by decreasing peripheral vascular resistance. The client reports an improvement in memory. Atenolol, a beta-adrenergic blocking agent, has an adverse effect of memory loss. The client reports having an increase in libido. Atenolol, a beta-adrenergic blocking agent, can cause a decrease in libido and sexual ability. The client has an increase in urinary output. Atenolol, a beta-adrenergic blocking agent, has no direct effect on kidney function.

A nurse is assessing a client who has myasthenia gravis and is taking neostigmine. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect? A. Tachycardia B. Oliguria C. Xerostomia D. Miosis

D. Miosis Oliguria Neostigmine can cause urinary urgency, rather than decreased urinary output, due to the excessive muscarinic stimulation. Miosis MY ANSWER Miosis, which is pupillary constriction, is a common adverse effect of neostigmine due to the excessive muscarinic stimulation that causes difficulty with visual accommodation. Tachycardia Neostigmine can cause bradycardia, rather than tachycardia, due to the excessive muscarinic stimulation. Xerostomia Neostigmine can cause increased salivation, rather than dry mouth, due to the excessive muscarinic stimulation.

A nurse is caring for a client who is receiving end-of-life care and has a prescription for fentanyl patches. Which of the following information regarding adverse effects of fentanyl should the nurse plan to give the client and family? A. The provider will prescribe naloxone at home for respiratory depression. B. Remove the patch to reverse the adverse effects immediately. C. Expect an increase in urinary output. D. Take a stool softener on a daily basis.

D. Take a stool softener on a daily basis. The provider will prescribe naloxone at home for respiratory depression. Naloxone is only for use in an acute care setting for the reversal of severe respiratory depression. Take a stool softener on a daily basis. MY ANSWER Constipation is an adverse effect of opioid use and stool softeners can decrease the severity of this adverse effect. Remove the patch to reverse the adverse effects immediately. After removing the patch, the effects will persist for several hours due to the absorption of the residual medication on the skin. Expect an increase in urinary output. Urinary retention is an adverse effect of opioids, including fentanyl.

A nurse is preparing to administer amoxicillin 250 mg PO to a school-age child. The amount available is amoxicillin oral suspension 200 mg/5 mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth.)

6.3 mL (I know. I put 6.25 mL too. Stupid rounding.)

A nurse is caring for a client who has sickle cell anemia and is taking hydroxyurea. Which of the following findings should the nurse report to the provider? (SATA) A. Hemoglobin 7.0 B. Creatinine 1 C. RBC 4.7 million D. Platelets 75,000 E. Potassium 5.2

A. Hemoglobin 7.0 D. Platelets 75,000 E. Potassium 5.2 Hemoglobin 7.0 g/dL is correct. A hemoglobin level of 7.0 g/dL indicates hydroxyurea toxicity, and the nurse should report it to the provider. Platelets 75,000/mm3 is correct. A platelet level of 75,000/mm3 indicates hydroxyurea toxicity, and the nurse should report it to the provider. Potassium 5.2 mEq/L is correct. A potassium level of 5.2 mEq/L indicates tumor lysis syndrome, and the nurse should report it to the provider. Creatinine 1 mg/dL is incorrect. A creatinine level of 1 mg/dL is within the expected reference range. RBC 4.7 million/mm3 is incorrect. An RBC level of 4.7 x 1012/L is within the expected reference range.

A nurse administers ceftazidime to a client who has a severe penicillin allergy. The nurse should identify which of the following client findings as an indication she should complete an incident report? A. The client reports shortness of breath. B. The client is also taking lisinopril. C. The client's pulse rate is 60/min D. The client's WBC count is 14,000

A. The client reports shortness of breath. The client's WBC count is 14,000/mm3. An elevated WBC count is an indication the client has an infection and should receive antibiotic therapy. The client reports shortness of breath. MY ANSWER A severe penicillin allergy is a contraindication for taking ceftazidime, a cephalosporin antibiotic, due to the potential for cross-sensitivity. Shortness of breath can indicate the client is developing anaphylaxis. The client's pulse rate is 60/min. Cephalosporins do not affect the client's pulse rate. The client's pulse rate of 60/min is within the expected reference range. The client is also taking lisinopril. Lisinopril is an ACE inhibitor medication that has no known interaction with cephalosporins.

A nurse is caring for a client who is in labor. The client is receiving oxytocin by continuous IV infusion with a maintenance IV solution. The external FHR monitor indicates late decelerations. Which of the following actions should the nurse take first? A. Turn the client to a side-lying position. B. Disconnect the client's oxytocin from the maintenance IV. C. Apply oxygen to the client by face mask. D. Increase the client's maintenance IV infusion rate.

A. Turn the client to a side-lying position. Disconnect the client's oxytocin from the maintenance IV. The nurse should discontinue the oxytocin to reduce uterine contractions. However, another action is the nurse's priority. Apply oxygen to the client by face mask. The nurse should apply oxygen by face mask to provide supplemental oxygen to the fetus. However, another action is the nurse's priority. Increase the client's maintenance IV infusion rate. The nurse should increase the client's maintenance IV infusion rate to maintain adequate blood flow and promote placental perfusion. However, another action is the nurse's priority. Turn the client to a side-lying position. MY ANSWER The greatest risk to the fetus experiencing late decelerations is injury from uteroplacental insufficiency. Therefore, the priority intervention the nurse should take is to place the client in a lateral position.

A nurse is administering cefotetan via intermittent IV bolus to a client who suddenly develops dyspnea and widespread hives. Which of the following actions should the nurse take first? A. Administer epinephrine 0.5 mL via IV bolus B. Discontinue the medication IV infusion C. Elevate the client's legs above the level of the heart. D. Collect a blood specimen for ABGs.

B. Discontinue the medication IV infusion Collect a blood specimen for ABGs. The nurse should collect a blood specimen for ABGs levels to evaluate the client's respiratory status. However, there is another action the nurse should take first. Administer epinephrine 0.5 mL via IV bolus. The nurse should administer epinephrine, which is a beta-adrenergic agonist that can stimulate the heart, cause vasoconstriction of blood vessels in the skin and mucous membranes, and cause bronchodilation in the lungs. However, there is another action the nurse should take first. Discontinue the medication IV infusion. MY ANSWER The greatest risk to the client is respiratory arrest from anaphylaxis. Therefore, the first action the nurse should take is to discontinue the medication IV infusion to prevent the client from receiving more medication. However, the nurse should not remove the IV catheter. Instead, the nurse should change the tubing and administer 0.9% sodium chloride by continuous IV infusion. Elevate the client's legs above the level of the heart. The nurse should elevate the client's legs and feet to a level above the client's heart to facilitate blood flow to the vital organs. However, there is another action the nurse should take first.

A nurse is teaching a client who is to start taking ranitidine for peptic ulcer disease. Which of the following client statements should the nurse identify as understanding of the teaching? A. I will stop taking ranitidine when my stomach pain is gone. B. I know smoking makes ranitidine less effective. C. I will take ranitidine anytime my stomach hurts. D. I know that ranitidine will turn my stools black.

B. I know smoking makes ranitidine less effective. "I know smoking makes ranitidine less effective." MY ANSWER The nurse should instruct the client that smoking decreases the effectiveness of ranitidine by exacerbating the ulcer manifestations. "I know that ranitidine will turn my stools black." Ranitidine does not cause stools to appear black. However, a bleeding peptic ulcer can cause a client's stools to turn black. "I will take ranitidine anytime my stomach hurts." The nurse should instruct the client to take ranitidine on a continuous basis for the prescribed time. "I will stop taking ranitidine when my stomach pain is gone." The nurse should instruct the client to take ranitidine on a continuous basis for the prescribed time.

A nurse is monitoring for adverse effects of hydrochlorothiazide after administering the medication to an older adult client who has heart failure. Which of the following findings should the nurse identify as an adverse effect of the medication? A. Hypoglycemia B. Orthostatic hypotension C. Bradycardia D. Xanthopsia

B. Orthostatic hypotension Xanthopsia The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication and has an adverse effect of blurred vision. Xanthopsia causes objects to appear yellow and is not an adverse effect of this medication. Orthostatic hypotension MY ANSWER The nurse should identify that hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause orthostatic hypotension and light headedness in clients who are taking the medication. Therefore, the nurse should instruct the client to rise slowly when moving from a recumbent to a standing position. Bradycardia The nurse should identify palpitations as an adverse effect of hydrochlorothiazide, which is an antihypertensive thiazide diuretic medication. Hypoglycemia Hydrochlorothiazide is an antihypertensive thiazide diuretic medication, which can cause hyperglycemia.

A nurse is teaching a client who is to start taking diltiazem. The nurse should instruct the client to report which of the following findings as an adverse effect of the medication? A. Blurred vision B. Shortness of breath C. Muscle twitching D. Dry cough

B. Shortness of breath. Blurred vision The client who is taking diltiazem, a calcium channel blocker, has no visional adverse effects. Digoxin can have non-cardiac signs of toxicity, which can include blurred or yellow vision, nausea, vomiting, anorexia, and fatigue. Shortness of breath MY ANSWER The client who is taking diltiazem, a calcium channel blocker, can experience shortness of breath as an adverse effect and should report the finding to the provider immediately. Dry cough The client who is taking diltiazem, a calcium channel blocker, can have adverse effects of rhinitis, dyspnea, and pharyngitis. A cough is an adverse effect of an ACE inhibitor. Muscle twitching The client who is taking diltiazem, a calcium channel blocker, can have weakness, insomnia, tremors and paresthesia but not muscle twitching, which may indicate the client has hyponatremia.

A nurse is providing teaching to a client who has a prescription for trimethoprim/sulfamethoxazole. Which of the following instructions should the nurse include in the teaching? A. Take the medication with food. B. Expect a fine, red rash as a transient effect. C. Drink 8-10 glasses of water daily. D. Store the medication in the refrigerator.

C. Drink 8-10 glasses of water daily. Expect a fine, red rash as a transient effect. The nurse should instruct the client to notify the provider if a rash develops, as this can be an indication of Stevens-Johnson syndrome. However, the client should not expect to have a fine, red rash as a transient effect. Drink 8 to 10 glasses of water daily. The nurse should instruct the client to increase water intake to 1,920 to 2,400 mL (64 to 80 oz) a day to decrease the chance of kidney damage from crystallization. Take the medication with food. The nurse should instruct the client to take the medication on an empty stomach either 1 hr before or 2 hr after meals. Store the medication in the refrigerator. The nurse should inform the client to store trimethoprim/sulfamethoxazole in a light-resistant container at room temperature.

A nurse is providing teaching to a client about the use of ethinyl estradiol/norelgestromin. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching? A. I will apply the patch once a week for 2 weeks. B. I will leave the existing patch on for 4 hours after applying the new patch. C. I will fold the sticky sides of the old patch together before disposing of it. D. I will apply the patch within 14 days of menses.

C. I will fold the sticky sides of the old patch together before disposing of it. "I will apply the patch within 14 days of menses." The client should apply the patch within 7 days of menses to prevent ovulation and the need for another contraceptive method. "I will apply the patch once a week for 2 weeks." The client should apply the patch once a week for 3 weeks and then no patch for 1 week to promote menstruation. "I will leave the existing patch on for 4 hours after applying the new patch." The client should remove and dispose the patch before applying a new patch to prevent an overdose of the medication by combining the remaining medication on the old patch with the medication on the new patch. "I will fold the sticky sides of the old patch together before disposing it." MY ANSWER The client should fold the sticky sides of the old patch together and then place it in a childproof container to ensure safe disposal of the patch.

A nurse is teaching a client about cyclobenzaprine. Which of the following client statements should indicate to the nurse that the teaching is effective? A. I will have increased saliva production. B. I will continue taking the medication until the rash disappears. C. I will taper off the medication before discontinuing it. D. I will report any urinary incontinence.

C. I will taper off the medication before discontinuing it. "I will have increased saliva production." The client should use gum or sip on water to prevent dry mouth, which is an adverse effect of cyclobenzaprine. "I will report any urinary incontinence." The client should report any urinary retention because of the anticholinergic effects created when taking cyclobenzaprine. "I will taper off the medication before discontinuing it." MY ANSWER The client should taper off cyclobenzaprine before discontinuing it to prevent the return of the musculoskeletal condition. "I will continue taking the medication until the rash disappears." The client should take cyclobenzaprine for treatment of muscle spasms. This medication does not have an effect on skin rashes.

A nurse is caring for a client who reports lethargy and myalgia after taking clozapine for 6 months. Which of the following actions should the nurse plan to take? A. Infuse 0.9% sodium chloride 1,000 mL IV bolus B. Schedule the client for an electroencephalogram C. Obtain WBC with absolute neutrophil count. D. Place the client on a tyramine-free diet.

C. Obtain WBC with absolute neutrophil count. Schedule the client for an electroencephalogram. The client who develops seizures may have an electroencephalogram, but it is not used to treat or diagnose the client who has lethargy and myalgia. Infuse 0.9% sodium chloride 1,000 mL IV fluid bolus. The client who is dehydrated may receive 0.9% sodium chloride IV bolus, but it is not used to treat the adverse effects of lethargy, myalgia, and weakness from taking clozapine. Place the client on a tyramine-free diet. The client can take clozapine with or without food and does not need to follow a tyramine-free diet, The client will follow a tyramine-free diet if taking monoamine oxidase inhibitors. Obtain WBC with absolute neutrophil count. MY ANSWER The client who takes clozapine can develop lethargy and myalgia caused by the adverse effect of agranulocytopenia. Therefore, monitoring the WBC with absolute neutrophil count weekly for the first 6 months of treatment is recommended. After 6 months, monitoring can be changed to occur every 2 weeks up to 1 year.

A nurse is caring for a client who has pneumonia. The client tells the nurse she is pregnant and that she has not told her provider yet. The nurse should identify that pregnancy is a contraindication to receiving which of the following medications? A. Acetaminophen B. Ipratropium C. Benzonatate D. Doxycycline

D. Doxycycline Ipratropium Ipratropium is a long-acting bronchodilator and is a category B medication of the FDA pregnancy risk categories, indicating the client should use ipratropium with caution during pregnancy. The nurse should inform the provider of the client's pregnancy. However, this medication is not contraindicated for the client at this time. Acetaminophen Acetaminophen treats mild pain and is a category B medication of the FDA pregnancy risk categories, indicating the client should use acetaminophen with caution during pregnancy. The nurse should inform the provider of the client's pregnancy. However, this medication is not contraindicated for the client at this time. Doxycycline MY ANSWER Doxycycline is a tetracycline antibiotic and is contraindicated for a client who is pregnant because the medication is a category D medication of the FDA pregnancy risk categories, which indicates the medication has fetal risks that can cause fetal damage. The client should only take doxycycline for a life-threatening condition. Benzonatate Benzonatate is a cough suppressant and is not contraindicated for the client who is pregnant.

A nurse is planning discharge teaching for a client who has a prescription for furosemide. The nurse should plan to include which of the following statements in the teaching? A. This medication increases your risk for hypertension. B. Avoid potassium-rich foods in your diet. C. Take each dose of medication in the evening before bed. D. Drink a glass of milk with each dose of medication.

D. Drink a glass of milk with each dose of medication. "Drink a glass of milk with each dose of medication." MY ANSWER The client should take furosemide with food or milk to reduce gastric irritation. "Take each dose of medication in the evening before bed." The client should take each dose of medication in the morning to avoid sleep disturbances from nocturia. "Avoid potassium-rich foods in your diet." The client who takes furosemide has an increased risk for potassium loss because of the diuretic effect of the medication that causes excretion of potassium through the kidneys. The client should increase the intake of potassium-rich foods. "This medication increases your risk for hypertension." The client who takes furosemide has an increased risk of hypotension due to the fluid loss from the diuretic effect of the medication.