Pharmacological

When administering an intravenous push (IVP) medication through a continuous intravenous infusion, which intervention is most important for the nurse to take? 1. Assess for drug and solution compatibility. 2. Clamp the tubing of the large volume infusion above the injection port. 3. Stop the large volume infusion and flush the tubing . 4. Use the port nearest the client to administer the IVP medication.

1. Correct: This would have the most life threatening affect on a client if it is not done and an incompatibility exists. Checking for incompatibility between the large volume solution and the medication is a safety issue.

The nurse is teaching a group of clients about selective serotonin reuptake inhibitors (SSRI). Which comment by a client in the group indicates adequate understanding of the effects/side effects of the medications? 1. My weight may have decrease while taking this drug. 2. I may expect increased sweating while taking this drug. 3. I may actually feel more depressed while taking this medication. 4. I should feel better within a couple of days after beginning the med.

2. Correct. The drug causes temperature dysregulation, with increased sweating in some clients.

The family member of a schizophrenic client asks the nurse why the client is receiving chlorpromazine and benztropin. What is the best response by the nurse? 1. The chlorpromazine makes the benztropine more effective so a smaller dose of both drugs can be used. 2. Benztropin is given to treat the side effects produced by the chlorpromazine. 3. Chlorpromazine is used for severe hiccups that can occur with the use of benztropin. 4. Chlorpromazine is used for psychosis and benztropin is used for preventing agranulocytosis.

2. Correct: Benztropin is used to treat parkinsonism of various causes and drug-induced extrapyramidal reactions seen with chlorpromazine.

During a physical assessment of a client who was started on haloperidol 5 days ago, the nurse notes restlessness, muscle weakness, drooling, and a shuffling gait. What should be the nurse's first action? 1. Hold the next haloperidol dose. 2. Administer the prn benztropine mesylate. 3. Notify the primary healthcare provider to discontinue the haloperidol. 4. Draw a blood sample for drug level.

2. Correct: Benztropine mesylate is an anticholinergic that conteracts the extrapyramidal symptoms (EPS) seen with the use of haloperidol.

A client comes into the clinic for a routine check-up during her second trimester of pregnancy. The client reports GI upset and constipation. The nurse reviews the client's medications. Which client medication is most commonly associated with GI upset and constipation? 1. Calcium supplement 2. Ferrous sulfate 3. Folic acid 4. Zyrtec

2. Correct: Ferrous sulfate commonly causes constipation and GI upset.

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

2. Correct: Glucocorticoids (steroids) are an appropriate pharmacologic treatment for rheumatoid arthritis.

A client being treated for osteoporosis with alendronate reports experiencing slight heartburn after taking the medicine. What should the nurse suggest to reduce this side effect? 1. Stop taking the medication and call the primary healthcare provider. 2. Drink plenty of water with the medication. 3. Take the medication before bedtime. 4. Take antacids when taking the medication.

2. Correct: Increased heartburn can be reduced or prevented by drinking plenty of water, sitting upright following the administration of the medication, and avoiding sucking on the tablet.

The nurse is caring for a client diagnosed with Addison's disease. Which finding would indicate to the nurse that a client has received excessive mineralocorticoid replacement? Select all that apply: 1. Oily skin 2. Weight gain of 4 pounds in one week 3. Loss of muscle mass in extremities 4. Blood glucose of 128 mg/dL 5. Serum potassium of 3.2 mEq

2., & 5. Correct: Remember that aldosterone is a mineralocorticoid, which causes the client to retain sodium and water. Retaining sodium and water will cause the client's weight to increase. Remember, any sudden gain in weight is due to water retention. Too much aldosterone makes you retain too much sodium and water and lose potassium. Normal potassium is 3.5-5.0 mEq/L.

The nurse is caring for a trauma client who is receiving a unit of whole blood. The client begins to experience lower back pain. What actions should the nurse take? Select all that supply: 1. Assess the client's pain. 2. Collect a urine specimen. 3. Stop the transfusion. 4. Take the client's vital signs. 5. Change the IV tubing

2., 3., 4., & 5. Correct: Assume the worst, and stop the transfusion first, then continue with the assessment. Low back pain is a sign of an acute hemolytic reaction. This is the most dangerous and potentially life-threatening type of transfusion reaction. It occurs when the donor blood is incompatible with that of the recipient . Get lab tests for presence of hemoglobin, which indicates hemolytic reaction. Take vital signs. Change IV tubing to remove all blood.

The nurse is caring for a client who is taking an antipsychotic medication for the treatment of schizophrenia. The nurse is told in report that the client has akathisia. What symptom should the nurse expect upon assessment? 1. Upward gaze of the eyes. 2. Involuntary movement of the tongue. 3. Complaints of restlessness. 4. Lack of movement or slowed movement.

3. Correct: Reports of restlessness, inability to sit still, and nervous energy indicate akathisia. These symptoms respond poorly to treatment. If possible, the dose of the medication may be reduced.

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

3. Correct: Warfarin sodium is initiated while the client remains on heparin. This is done so the client remains adequately anticoagulated during the transition from IV heparin to warfarin sodium.

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

4. Correct: Vitamin B6 is given to prevent the peripheral neuropathy with isoniazid use.

After the nurse administers eardrops to an adult client, it is important for the nurse to implement which action? 1. Leave the client lying with the unaffected ear facing up. 2. Place a cotton ball firmly into the affected ear for 15 minutes. 3. Pull the pinna of the ear down and back. 4. Gently massage the tragus of the ear.

4. Correct: This is a correct nursing measure that will facilitate the flow of medication in the auditory canal.

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

Changing 0.6 g to mg equals 600 mg. Then 200 mg : 1 mL = 600 mg : x mL 200x = 600 x = 3

Based on the Parkland formula, the primary healthcare provider has determined that a burn victim needs 9,250 mL of LR intravenously over the first 24 hours. How many milliliters of LR should the nurse administer over the first eight hours? Round answer to the nearest whole number.

4625

The primary healthcare provider prescribed diazepam 10 mg IM to a client. The pharmacy dispenses diazepam 5 mg/mL. How many mL will the nurse administer? Round answer using one decimal point.

5 mg : 1 mL = 10 mg : x mL 5 x = 10 x = 2

The primary healthcare provider prescribed tolbutamide 250 mg orally twice a day. The pharmacy dispensed tolbutamide 0.5 g scored tablets. How many tablets will the nurse administer? Round your answer using one decimal point.

0.5

The nurse is caring for a client with chronic renal failure who receives dialysis treatment. Which findings would indicate to the nurse that the client's AV shunt is patent? Select all that apply: 1. A bruit is heard with a stethoscope. 2. A thrill is felt on palpation. 3. There is a blood return on the venous side of the shunt. 4. Urine output greater than 30 mL/hr. 5. There is a strong radial pulse in the arm with the AV shunt.

1, & 2. Correct: AV shunts should have the presence of a bruit and a thrill.

A school nurse is planning a lesson on inhalant abuse for a high school health class. Which information does the nurse need to include? Select all that supply: 1. Substances used for inhaling include lighter fluid, spray paint, and airplane glue. 2. Inhalants are absorbed through the lungs and cause central nervous system depression rapidly. 3. Although inhaling can make a person very ill, death is highly unlikely. 4. Inhaling substances can cause abdominal pain, lethargy, and renal failure. 5. Inhalants cause the heart to beat slowly.

1., 2. & 4. Correct: All of these statements need to be included.

A client who has developed hypovolemic shock is receiving albumin. What assessment finding by the nurse indicates that the albumin has been effective? 1. Decrease in urine output 2. Reduction in tachycardia 3. Proteinuria 4. Absence of Kussmaul's respirations

2. Correct: Tachycardia is a compensatory mechanism of hypovolemic shock. A reduction in tachycardia in the hypovolemic shock client is indicative of an improved circulating blood volume.

The nurse is caring for a client who is to receive an IV infusion of heparin. The client's dose is based on a sliding scale order. What is the priority lab value to check before initiating the heparin infusion? 1. PT and/or INR 2. aPTT 3. Platelet count 4. WBC count

2. Correct: The aPTT (activated partial thromboplastin time) is a lab value used to assess pathways in the clotting cascade and is used to monitor Heparin therapy in clients. To maintain a therapeutic level of Heparin, the aPTT should be maintained at 1.5-2.5 times the normal range.

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

2.5 mg : 5 mL :: 10 mg : x mL 2.5 mg/x mL = 50 mg/mL 2.5 mg/x mL = 50 mg/mL x = 20 mL

The nurse is caring for a client taking sprionolactone. Which snack choices would indicate to the nurse that the client understands proper dietary choices while on this medication? Select all that apply: 1. Bananas 2. Cheese and crackers 3. Apples 4. Oranges 5. Grapes

3. & 5. Correct: Apples and grapes are low in sodium and potassium. Spironolactone is a potassium sparing diuretic. This client needs to limit sodium and potassium.

The primary healthcare provider has prescribed 1000 mL of D5W to infuse over a 12 hour period. The drop factor is 20 gtt/mL. How many gtt/min should the nurse administer? Round answer to the nearest whole number

28

The nurse is teaching a client about foods containing tyramine which should be avoided while taking a monoamine oxidase inhibitor (MAOI). Which meal selection, if chosen by the client, indicates successful teaching? 1. Smoked turkey and dressing, sweet peas and carrots, milk. 2. Baked chicken over pasta with parmesan sauce, asparagus tips, tea. 3. Fried catfish, French fries, coleslaw, apple juice. 4. Liver smothered in gravy and onions, rice, squash, water.

3. Correct: These foods are not high in tyramine.

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

1. Correct: The drug may reduce the plasma concentration of the contraceptives. Post-menopausal women may resume ovulation.

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

4. Correct: This is a beta blocker. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication.

The client has been taking divalproex for the management of bipolar disorder. The nurse should give priority to monitoring which laboratory test? 1. Alanine aminotransferase (ALT) 2. Serum glucose 3. Serum creatinine 4. Serum electrolytes

1. Correct: ALT levels will increase primarily in liver damage/disorders. A side effect of administering divalproex is drug-induced hepatitis.

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

1., 2., 3., & 5 Correct: Signs of hepatotoxicity from this medication includes dark urine, jaundice, and clay-colored stool. Isoniazide-induced pyridoxine (Vitamin B6) depletion causes neurotoxic effects. Vitamin B6 supplementation of 10-50 mg usually accompanies isoniazid use. Aged cheeses and smoked fish are high in tyramine which may cause palpitations, flushing, and Blood pressure elevation while taking isoniazid. Some clients experience orthostatic hypotension while taking isoniazid, so caution against rapid positional changes.

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

1., 2., 4., & 5. Correct: Both cyclosporine and azathioprine are immunosuppressants. Clients should be taught to protect themselves from sources of infection. Vaccinations are not given to immunocompromised clients. These drugs may lead to bleeding. These drugs are tetratogenic. Clients should avoid pregnancy while on these medications.

The nurse is caring for a client taking benazepril. Which symptoms would be important for the nurse to report to the primary healthcare provider? Select all that apply: 1. BP 150/108 decreases to 138/86 2. Weight gain of 5 pounds in one week 3. Serum sodium level of 139 mmol/L 4. Angioedema 5. Serum potassium of 5.8 mEq

2., 4., & 5. Correct: Weight gain of 5 pounds in one week is a s/s of adverse effect of ACE inhibitor use. Weight gain is a sign of fluid retention. Angioedema is an adverse effect of ACE inhibitors and can be life threatening. This should be reported immediately to the healthcare provider. The potassium level is too high. Hyperkalemia is an adverse effect of an ACE inhibitor and needs to be reported.

The nurse is caring for a client who is receiving weekly infusions of Factor VIII for Hemophilia. What assessment finding by the nurse is related to the client's skin is indicative of a therapeutic response? 1. An absence of jaundice 2. The presence of petechiae 3. A reduction of bruising 4. A capillary refill time of < 3 seconds

3. Correct: A reduction in bruising indicates an increase in circulating coagulating substances in the blood of hemophilia clients. Factor VIII is the clotting factor that is deficient in hemophilia clients. Administration of Factor VIII in these clients would result in a reduction of bleeding episodes and the s/s associated with them.

A client calls the clinic to ask the nurse if it would be okay to take the herbal medication kava-kava to help reduce anxiety. What is the nurse's best response? 1. "Why do you want to take kava-kava?" 2. "I really doubt your primary healthcare provider will approve your taking kava-kava." 3. "Kava-kava can cause liver damage, so we need to consult your healthcare provider." 4. "Do not take Kava-kava for more than a year without a primary healthcare providers supervision."

3. Correct: Kava-kava can cause liver damage.

The nurse is teaching a diabetic client who has been prescribed Lispro insulin about avoiding hypoglycemia. What administration teaching is priority? 1. Take insulin 30 minutes before bedtime 2. Take insulin twice daily in AM and PM 3. Take insulin one hour before meals 4. Take insulin with meals

4. Correct: Lispro is a rapid-acting insulin that should only be taken with food or within 15 minutes of a meal.

A client with a head injury manifests symptoms of increasing intracranial pressure. The primary healthcare provider prescribes mannitol IV. How would the nurse plan to evaluate the effectiveness of this medication? 1. Monitor urine output hourly 2. Take vital signs every 15 minutes 3. Measure head circumference every 8 hours 4. Assess the level of consciousness every hour

4. Correct: The stem of the question says the client manifests symptoms of increased ICP. Assessing the LOC is the only answer that assesses for increased ICP. Even if you do not know how mannitol works, the only answer that assesses the client for increased ICP is to assess the LOC.

The nurse is caring for an adolescent client diagnosed with depression. The client is prescribed fluoxetine. What is the best response by the nurse when the client says, "What will this medicine do to me?" 1. It will regulate a neurotransmitter called serotonin. 2. It will help you feel less depressed. 3. It will raise your level of the brain hormone norepinephrine. 4. It will balance blood glucose and dopamine levels in your head.

1. Correct: The action of the drug should be explained to the adolescent in a manner that will be understood.

The nurse has been teaching the parents of a child taking methylphenidate for the treatment of attention deficit hyperactivity disorder (ADHD). Which comments by the parents indicate adequate understanding of the important considerations for methylphenidate? Select all that apply: 1. "I know that I need to monitor weight and growth with the primary healthcare provider." 2. "I am supposed to give the medication before meals." 3. "This medication may cause increased drowsiness." 4. "I need to report any extreme weight loss to the primary healthcare provider." 5. "If my child can't sleep, the dosage may need to be increased."

1., 2. & 4. Correct: Continued use of the medication may cause delays in growth and loss of appetite. The medication is usually administered before meals. Lack of appetite may cause weight loss.

The nurse is caring for a client starting on vancomycin for MRSA infection. What nursing interventions are appropriate? 1. Provide the client food or a snack to take with the medication 2. Verify that the client's BUN and cretinine are within normal range 3. Check the chart for a perscription for an antiemetic. 4. Request the placement of a PICC line for IV administration

2. Correct: Vancomycin is nephrotoxic and caution should be exercised in clients with impaired renal function.

The primary healthcare provider prescribes glycopyrrolate 0.2 mg IM thirty minutes prior to electroconvulsive therapy (ECT). What should be the nurse's response when the client asks why this drug is being given? 1. You wouldn't understand what it is for. Just roll over so I can give you the shot. 2. This drug will prevent you from having a seizure. 3. This medication will relax your muscles so that you do not break a bone. 4. Glycopyrrolate will decrease secretions and could slow your heart rate.

4. Correct: Glycopyrrolate reduces secretions in the mouth, throat, airway, and stomach. It is used prior to procedures to decrease the risk of aspiration.

A client is admitted in Sickle Cell Crisis. The client is started on oxygen at 2L/NC and given a narcotic analgesic for pain control. What additional prescription is a priority for the nurse to initiate? 1. A high protein, low fat diet 2. Administration of a thrombolytic, such as streptokinase 3. Implementation of bleeding precautions 4. Administration of IV fluids for hydration

4. Correct: Increasing hydration status via the administration of IV fluids is indicated in sickle cell crisis to increase that volume in the vascular space and subsequently decrease the sickling effects of the RBCs.

A client diagnosed with arachnophobia is prescribed alprazolam 0.5 mg orally three times daily. The nurse knows that teaching about this medication is successful when the client makes what statement? 1. Alprazolam will take up to two weeks to start working. 2. The drug does not cause drowsiness, so my daily activities will not suffer. 3. This medication cannot be taken with food. 4. I should not stop taking alprazolam suddenly.

4. Correct: Suddenly stopping could produce serious withdrawal symptoms, such as depression, insomnia, anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium.

A client who has chronic renal failure has been prescribed synthetic erythropoietin for the prevention of anemia. Which assessment findings should be reported to the primary healthcare provider? 1. Hemoglobin level of 10 g/dl (1.6 mmol/L) 2. Blood pressure of 120/84 3. Constipation 4. Swelling of feet and ankles

4. Correct: Swelling of feet and ankles may indicate the beginning of a cardiovascular problem. Clients taking this drug are at risk for myocardial infarctions.

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

1. Correct. Clients taking MAOIs cannot consume foods containing large amounts of tyramine. Bananas and avocados are high in tyramine.

The nurse is assessing a client who is being treated with a non-steroidal anti-inflammatory medication (NSAID) for an acute flare-up of gout. Which finding is expected in the assessment? 1. The client may report dramatic decrease in pain after beginning medications. 2. The client may report severe abdominal pain following medication administration. 3. The client may have decreased plasma uric acid levels. 4. The client may report a low-grade fever and rash.

1. Correct. The client usually experiences dramatic improvement within 24 hours after beginning NSAIDs.

The nurse is caring for a client following spinal surgery. The client is placed on methylprednisolone. What additional drug therapy would the nurse expect to be prescribed with methylprednisolone? 1. Pantoprazole 2. Phenytoin 3. Imipramine HCI 4. Aminocaproic acid

1. Correct: A potential side effect of methylprednisolone is a peptic ulcer. The primary healthcare provider will prescribe a proton pump inhibitor or H2 blocker to prevent this side effect.

The nurse is assessing the injection site of a healthy client who received a Mantoux skin test 48 hours ago. Which finding at the injection site indicates a need for further evaluation? 1. 11 mm induration 2. 4 mm erythrokeratodemia 3. 0.1 mL bluish colored hard wheal 4. Multiple fluid filled vesicles

1. Correct: An induration of 10 mm or greater is usually considered significant in people who have normal or mildly impaired immunity.

A client is diagnosed with a duodenal ulcer due to Helicobacter pylori (H Pylori). In addition to antibiotic therapy, the nurse anticipates that the client will also receive what class of pharmacologic agent? 1. Proton pump inhibitor (antisecretory agent) 2. Mitotic inhibitor (chemotherapeutic agent) 3. Serotonin antagonist (antiemetic agent) 4. Aspirin (non narcotic anagelsic agent)

1. Correct: Antisecretory agents like the proton pump inhibitors are indicated for the treatment of peptic ulcer disease. Antisecretory agents decrease the secretion of gastric acids.

A client newly diagnosed with insulin dependent diabetes mellitus is started on insulin aspart protamine suspension/insulin aspart solution mixture. The nurse would teach the client that the insulin should start to lower the blood sugar in how many minutes? 1. 15 2. 30 3. 45 4. 60

1. Correct: Insulin aspart mixture starts to work in 15 minutes after given subcutaneously.

A female client with a history of frequent exacerbations of asthma asks the nurse to explain to her why she is at greater risk for fractures than other women her age. What is the nurse's best response? 1. "The steroids you are taking decrease calcium in the bone by sending it to the blood." 2. "Taking steroids causes bone calcium to increase, thus causing osteoporosis." 3. "Clients who have asthma are not able to exercise enough to prevent fractures from occurring." 4. "Asthma should not put you at increased risk for fractures but you are at risk for increased blood glucose levels."

1. Correct: Long term use of steroids decreases serum calcium, so the body takes calcium from the bone and puts it in the blood in order to bring serum calcium back to normal. Every time a steroid is given, calcium is removed from the bone, thus leading to a greater risk for osteoporosis and fractures.

Which medications, if prescribed to a client, should indicate to a nurse that retention of CO2 is a possibility? Select all that apply: 1. Narcotics 2. Diuretics 3. Steroids 4. Antiemetics 5. Hypnotics

1. Correct: Narcotics sedate and decrease the respiratory rate, which increases CO2 retention. 4. Correct: Some antiemetics are very sedating and will decrease the respiratory rate while increasing CO2 retention. 5. Correct: Sleeping pills can cause sedation to the point of hypoventilation, which leads to CO2 retention.

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

1. Correct: St. John's Wort in combination with a selective serotonin reuptake inhibitor could cause serotonin syndrome which can be fatal.

A new mother brings her infant to the clinic for a well-baby checkup. While at the clinic, the mother asks the nurse if there are any reasons why her infant should not have the MMR (measles, mumps, rubella) vaccine. The nurse's response is based on evidence that the MMR vaccine is contraindicated under which condition? 1. A known allergy to egg products. 2. A family history of autism. 3. In infants with diarrhea. 4. A known allergy to sulfonamides.

1. Correct: The MMR vaccine is grown using chicken embryos and manufactured with the use of gelatin. Known allergies to these would be a contraindication for administration.

A client has a prescription for digoxin 0.125 mg IV push every morning. Prior to administering digoxin, the nurse notes that the digoxin level drawn this morning was 0.9 ng/mL. Which action would be most important for the nurse to take? 1. Administer the digoxin. 2. Hold the digoxin. 3. Notify the primary healthcare provider. 4. Repeat the digoxin level.

1. Correct: This is a normal digoxin level. The nurse would administer the prescribed digoxin. The therapeutic serum levels of digoxin range from 0.5 to 2 ng/mL.

The drug nadolol is prescribed for a client with stable angina. Which findings would indicate to the nurse that the drug is effective? Select all that apply: 1. Decreased anxiety 2. Relief of chest pain 3. Bounding pulses 4. Lowered blood pressure 5. Bradycardia

1., 2., & 4. Correct: Nadolol is a beta-blocking agent. Beta-blockers block the beta 1 adrenergic receptor cells in the heart, thereby decreasing heart rate, contractility, and blood pressure. These effects decrease the workload on the heart. With decreased oxygen demand (workload on the heart), chest pain is relieved. Beta-blockers decrease cardiac contractility thereby decreasing cardiac output. Beta blockers also relieves anxiety.

The home care nurse is caring for an elderly client status post total hip replacement and a history of cirrhosis. Which statements by the client's spouse indicates that teaching regarding pain management has been successful? Select all that apply: 1. "If the pain increases, I must let the nurse know immediately." 2. "I should have my spouse try the breathing exercises to help control pain." 3. "This narcotic causes very deep sleep, which is what my spouse needs." 4. "If constipation is a problem, increased fluids will help." 5. "My spouse can have one glass of wine to help promote pain relief."

1., 2., & 4. Correct: These are correct responses by the spouse. Increased pain may indicate something else is going on. Breathing exercises would be an excellent non-pharmacological intervention. Increasing fluid is an appropriate intervention for constipation. Narcotics place the client at risk for constipation.

A nurse is teaching a client the advantages of having a PICC line inserted rather than a peripheral IV. What information should the nurse include? Select all that apply: 1. TPN may be infused using a PICC line 2. Use of a PICC can allow for early client discharge. 3. PICC lines do not have to be replaced as often as a peripheral IV line. 4. PICC lines provide the same risk of infection than a peripheral IV line. 5. PICC lines do not need to be flushed as frequently. 6. PICC placement decreases the need for skin puncture when blood sampling is needed.

1., 2., 3., & 6. Correct: Peripheral IV lines must be changed every 72-96 hours. PICC lines may remain in place for a year or more. A PICC can be cared for at home by home care nurses, client family members, or in outpatient clinics. TPN cannot be administered via a peripheral line since it is hypertonic. PICC lines offer a lower chance for infection than a peripheral line.

A client is being discharged on lithium carbonate. The nurse knows that teaching about the drug was successful when the client makes which statements? Select all that apply: 1. "I will notify my primary healthcare provider if I develop severe diarrhea or an excessive urinary output." 2. "I will do my best to maintain a moderate sodium intake in my diet." 3. "I will need to drink between 6-8 glasses of water a day." 4. "I should not drink alcohol while on this medication." 5. "I will avoid strenuous activity."

1., 2., 3., 4., & 5. Correct. All statements are correct and indicate client understanding of this medication. Lithium is similar in chemical structure to sodium, behaving in the body much the same way and competing with sodium at various sites in the body. If sodium intake is reduced or the body is depleted of its normal sodium (due to sweating, fever, diuresis), lithium is reabsorbed by the kidneys, increasing the possibility of toxicity. Diarrhea and excessive urinary output will eliminate sodium as well. The client should consume a diet adequate in sodium. Consuming an adequate amount of water per day will help to maintain an adequate sodium level. Alcohol causes excessive diuresis which can decrease sodium. The client should avoid activities that cause excess sodium loss, such as heavy exertion, exercise in hot weather, or saunas.

The charge nurse on the pediatric unit is reviewing the protocol for blood administration with a staff nurse. Which actions by the staff nurse indicate understanding of blood administration? Select all that apply: 1. The blood infusion time was within 4 hours. 2. A filter was used when administering the blood. 3. A second nurse checked the blood compatibility. 4. A set of vital signs were taken 5 minutes after the blood infusion started. 5. Two forms of client identification were obtained prior to infusion.

1., 2., 3., 4., & 5. Correct: Blood should hang for no longer than 4 hours because it increases the chances of a reaction. Filters are used when infusing blood. Two nurses must check the blood product label and blood group. Vital signs are checked frequently during a blood transfusion. For example: A baseline set of vital signs are taken, then again 5 minutes after the initiation of the transfusion, then 15 minutes after transfusion started and every 15 minutes for one hour, then every 30 minutes for one hour, then hourly until infusion complete. At least two methods of proper identification should be obtained, such as asking client his/her name and checking ID band.

What teaching points should the nurse include when preparing to discharge a client from the hospital with a prescription for subcutaneous heparin? Select all that apply: 1. Use an electric shaver 2. Avoid nicotine 3. Report any minor injury 4. Wear identification stating use of anticoagulant therapy 5. Avoid all contact sports

1., 2., 3., 4., & 5. Correct: Use a soft toothbrush and an electric shaver to prevent bleeding from gum injury and cuts. Nicotine decreases the effect of heparin so client should avoid smoking. Report even minor injuries to healthcare provider, as bleeding can result. Wearing identification allows others to know of anticoagulant therapy in the event the client is unable to communicate. Contact sports are too traumatic and can lead to bleeding with injury (even minor injuries).

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

1., 2., 4. & 5. Correct: AST is a liver function test. Liver function tests including AST should be monitored before, at 12 weeks after initiation of therapy or after dose elevation, and then every 6 months. If AST levels increase to 3 times normal, atorvastatin should be reduced or discontinued. Atorvastatin may increase alkaline phosphatase and bilirubin levels. Atorvastatin is a lipid-lowering agent/HMG-CoA reductase inhibitor. The expected outcome of treatment with atorvastatin is lower serum cholesterol and triglycerides.

An alcoholic client has agreed to take disulfiram 250 mg PO daily. The nurse recognizes that education has been successful when the client makes which statements? Select all that apply: 1. "If I decide to stop taking disulfiram, I should not ingest any alcohol for at least 2 weeks or I will have a reaction." 2. "I must read labels carefully so that I know that alcohol is not an ingredient." 3. "I am allowed to eat chili made with beer since the alcohol evaporates from the chili with prolonged cooking." 4. "This medication is not a cure. I still need to attend therapy sessions." 5. "I should avoid eating a lot of chocolate while on this medication."

1., 2., 4., & 5. Correct: Disulfiram works by reacting with alcohol to produce negative side effect which may last up to two weeks after discontinuation of the drug.The client should not consume any alcohol including hidden alcohol such as mouthwash and cough syrups. Disulfiram is not a cure for alcoholism. Disulfiram can increase the side effects of caffeine, so avoid chocolate and other caffeine containing substances.

The nurse is caring for a client who has just arrived at the emergency department with suspected acute myocardial infarction. Which medications should the nurse administer immediately? Select all that apply: 1. Oxygen 2. Heparin 3. Morphine 4. Sublingual nitroglycerin 5. Furosemide

1., 3., & 4. Correct: Initial management should take place immediately. According to the American Heart Association/Heart & Stroke Foundation of Canada and the American College of Cardiology oxygen, SL nitroglycerin, morphine, and aspirin should be administered immediately.

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

1., 3., & 5. Correct: To relax the muscles to prevent severe muscle contractions during the seizure, thereby reducing the possibility of fracture or dislocated bones. Adverse effects include malignant hyperthermia, apnea, and arrhythmias.

The nurse is caring for a client admitted with heart failure. Which prescriptions would necessitate that the nurse seek clarification from the primary healthcare provider? Select all that apply: 1. Furosemide 20.0 mg p.o. daily 2. Chlordiazepoxide 50 mg p.o. q4h p.r.n. for agitation 3. Diphenhydramine 25 mg p.o. hour of sleep for three nights 4. Folic acid 1 mg daily 5. Heparin 1000 IU subcutaneously daily

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

The nurse is caring for a client on the surgical unit. Which prescriptions would necessitate that the nurse seek clarification from the primary healthcare provider? Select all that apply: 1. Lasix 20.0 mg p.o. daily 2. Librium 50 mg p.o. q 4h p.r.n. for agitation 3. Benadryl 25 mg p.o. hour of sleep for three nights 4. Folic acid 1 mg daily 5. Heparin 1000 IU subcutaneously daily

1., 4. & 5. Correct: It is inappropriate to have a trailing zero after a decimal point for doses expressed in whole numbers. It can be mistaken as 200 if the decimal point is not seen and read appropriately. The folic acid order lacks a route, thus needs clarification. This order should be written as heparin 1,000 units subcutaneously daily. Use commas for dosing units at or above 1,000 or use words such as one thousand to improve readability. Use units rather than IU (international units) as it can be mistaken as IV or 10.

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

10 g : 15 mL = 30 g : x mL 10 x = 450 x = 45

The nurse is caring for a client on the surgical unit. The primary healthcare provider prescribed morphine sulfate 20 mg IM one time dose. The nurse has available: morphine sulfate in a 20 mL vial, labeled 15 mg per mL. How many mL should the nurse administer? Record answer using one decimal place.

15 mg: 1 mL = 20 mg: x mL 15x = 20 x= 1.33 = 1.3

A client is admitted to the intensive care unit after overdosing on meperidine. What is the nurse's first priority? 1. Maintain continuous cardiac monitoring. 2. Administer naloxone hydrochlride 0.4 mg IV every 2-3 minutes prn. 3. Provide alprazolam 0.25 mg PO PRN. 4. Initiate intravenous fluid resuscitation with lactated ringers at 125 mL/hr.

2. Correct: Respiratory status/patent airway takes priority. ABCs: airway, breathing, circulation. Naloxone hydrochloride is the antidote for opioid overdose.

The nurse is preparing to discharge a client who has been placed on tranylcypromine. The nurse teaches the client about food to avoid while taking this medication. What food choose by the client confirms appropriate understanding of the teaching? 1. Cottage cheese 2. Salami 3. Baked chicken 4. Potatoes

2. Correct: The client taking a monamine oxidase inhibitor (MAOI) such as tranylcypromine should avoid foods rich in tyramine or tryptophan. These include: cured foods, those that have been aged, pickled, fermented, or smoked. These can precipate a hypertensive crisis.

The primary healthcare provider has prescribed phenytoin 100 mg intravenous push (IVP) stat for an adult client. What is the least amount of time that the nurse can safely administer this medication? 1. 1 minute 2. 2 minutes 3. 5 minutes 4. 10 minutes

2. Correct: The rate of IV administration should not exceed 50 mg/min. for adults and 1-3 mg/kg/min (or 50 mg/min, whichever is slower) in pediatric clients because of severe hypotension and cardiac arrhythmias. So 100 mg can safely be delivered over a period of at least 2 minutes.

The nurse is caring for a client taking enoxaparin. Which group of symptoms should be reported to the primary healthcare provider? 1. AST of 12 U/L and ALT 20 U/L 2. Hematocrit of 46% decreased to 35% and blood pressure decreases from 122/78 to 108/54 3. Ecchymosis around the abdominal subcutaneous injection site and platelet count of 200,000. 4. Hemoglobin of 14.5 g/dL (2.3 mmol/L) increased to 16 g/dL (2.5 mmol/L) and increased erythemia of oral mucus membranes.

2. Correct: These values indicate a drop in hematocrit and drop in blood pressure. Both of these could represent bleeding. These would be important to report to the primary healthcare provider.

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

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

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

3. Correct: Buspirone does not depress the CNS system and is believed to produce the desired effects through interaction with serotonin, dopamine, and other neurotransmitter receptors.

The previous shift nurse reported to the oncoming nurse a suspicion that a client's central line has developed a fibrin sheath. Which prescription does the nurse anticipate the healthcare provider will prescribe? 1. Heparin 2. Enoxaparin 3. Alteplase 4. Reteplase

3. Correct: If a catheter becomes partially blocked due to a fibrin sheath or loses its blood return, a fibrinolytic is typically prescribed. Currently, alteplase is the only fibrinolytic approved by the FDA to treat thrombotic occlusions.

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

3. Correct: If the client has difficulty swallowing a capsule or tablet, ask the primary healthcare provider to substitute a liquid medication if possible.

A child was diagnosed with attention-deficit/hyperactivity disorder (ADHD) in the clinic one week ago. Today the child's mother calls the clinic to tell the nurse, "Ever since my child has been on methyphenidate he has not been able to sleep." What is the best response for the nurse to make? 1. "I will discuss this with the primary healthcare provider. A different medication may be prescribed." 2. "The insomnia will get better over time. Just wait it out." 3. "To prevent insomnia, give him the last daily dose at least 6 hours before bedtime." 4. "He may have overdosed on the medication. Take him to the emergency department now."

3. Correct: If the medication is sustained-released, administer the dose in the morning.

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

3., & 4. Correct: The client should be taught signs ad symptoms of liver problems such as nausea, increased stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, or jaundice. Fruit juices such as apple juice or grapefruit juice can interfere with absorption of this medication.

The nurse is caring for a client on the oncology unit. The client asks, "Why do I need this LifePort to receive my chemotherapy?" What evidence should the nurse consider when answering? 1. IV infusions can be more rapidly administered via an implantable IV port 2. Implantable IV ports are kept sterile and therefore do not become infected 3. Chemothereapeutic agents are more readily absorbed from implantable IV ports 4. Implantable ports are beneficial when long-term and/or multiple IV therapy is indicated.

4. Correct: Clients requiring long-term and/or multiple IV therapy benefit from implantable ports because it reduces the number of IV sticks, preserves the integrity of peripheral veins and provides a vessel with adequate blood flow.

A nurse teaches a client who is HIV positive about the client's medication therapy and assesses that the client understood the teaching when the client makes which statement? 1. "I will only need to take one type of HIV medication at a time." 2. "This medication will cure my HIV." 3. "When my CD-4 count returns to normal, I can resume having unprotected sex." 4. "If I develop signs of an infection, I should call my primary healthcare provider."

4. Correct: Infection may be a sign of an increased viral load, a decreased CD-4 count and progression of the virus in HIV (+) clients. It should be evaluated by a primary healthcare provider.

What instruction is most important to include when teaching a child how to self administer a combined dose of isophane suspension and regular insulin subcutaneously? 1. Alternate the injection sites from one body area to another with each dose. 2. Draw up the isophane suspension insulin first and then regular insulin into the same insulin syringe. 3. Massage the injection site after the medication is injected. 4. Insulin syringes should be stored at room temperature.

4. Correct: Insulin syringes and needles should be stored at room temperature. The potential benefits or risks of refrigerating the syringe are unknown.

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

4. Correct: The client's output is below normal. This could indicate a problem with renal perfusion. Potassium is excreted through the kidneys, so if the kidneys are not being perfused, the client would retain potassium. The healthcare provider would need to be aware of the client's low urine output.

A client with heart failure and pulmonary edema is given furosemide intravenously. Which assessment indicates that the furosemide has achieved the desired effect? 1. The client's weight has decreased 2 pounds. 2. The client's systolic blood pressure has decreased. 3. The client's urinary output has increased. 4. The client's lungs have fewer rales on auscultation.

4. Correct: The goal for diuretic therapy in this client is to prevent/relieve fluid accumulation in the lungs. This answer addresses the most life threatening sequelae with HF. The number one thing to worry about in clients with HF is pulmonary edema, because this is what can kill the client.

A client who is occasionally confused states that the medication is the wrong color when the nurse hands it to the client. What action should the nurse take? 1. Encourage the client to take the medication. 2. Tell the client that the medication is correct. 3. Explain that generic medications may be different colors. 4. Double check the medication before administering.

4. Correct: The nurse cannot assume that the client is confused. The nurse must double-check. An error may be prevented by doing this.

The nurse is caring for a client with a diagnosis of major depression. The client began taking a selective serotonin reuptake inhibitor (SSRI) three days ago. The client says, "I am just not feeling well. My medicine is not working." Which reply by the nurse indicates adequate understanding of treatment? 1. "I agree, your medication is not working." 2. "Your treatment may have to be changed." 3. "Most SSRIs take about 5 days to work." 4. "You should reach desired effect in 1-3 weeks."

4. Correct: Therapeutic effect is usually reached in one to three weeks, or longer.

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

4. Correct: This is a beta blocker. If a client's heart rate is less than 60 beats per minute, notify the primary healthcare provider and ask if the client should receive this medication.

A client diagnosed with a duodenal ulcer and is prescribed lansoprazole and sucralfate. What should the nurse teach the client about taking these medications? 1. Take together immediately before meals. 2. Take together immediately after meals. 3. The sucralfate first, wait at least 30 minutes, then take the lansoprazole. 4. The lansoprazole first, wait at least 30 minutes ,then take the sucralfate.

4. Correct: When prescribed a medication and sucralfate, avoid taking the medication at the same time you take sucralfate. Sucralfate can make it harder for your body to absorb lansoprazole. Wait at least 30 minutes after taking this medicine before you take sucralfate.

The nurse is caring for a client who is to receive an antibiotic in 50 mL of D5W over 30 minutes using an infusion pump. The nurse will set the infusion pump to deliver how many mL per hour? Round answer to the nearest whole number.

100

A client who is 20 weeks pregnant and diagnosed with pelvic inflammatory disease is given a prescription for metronidazole. What should the nurse inform the client to avoid in order to prevent an interaction with metronidazole? 1. Furosemide 2. Alcohol 3. Doxycycline 4. St. John's Wort

2. Correct: Metronidazole and alcohol can interact with each other, causing severe nausea and vomiting as well as cramping and flushed appearance.

A client with chronic alcoholism has been admitted to the intensive care unit after overdosing on alcohol. Which medication should the nurse prepare to administer? 1. Disulfiram 250 mg po daily 2. Thiamine 100 mg IV twice a day 3. Naloxone 0.4 mg IV prn 4. Clonidine TTS patch 2.5 mg per week

2. Correct: Thiamine 50-100 mg IV or IM is indicated twice a day for clients with chronic alcholism. It is usually given for several days, followed by 10-20 mg once a day until a therapeutic response is obtained.

The primary healthcare provider's prescription for a client instructs the nurse to give digoxin 0.125 mg intravenously as a one-time dose. The available medication is in a concentration of 0.5 mg/2 mL. How many milliliters should the nurse give? Round answer using one decimal point.

____ mL= 2 mL x 0.125 mg = 0.5 mL 0.5 mL

The primary healthcare provider prescribes an intravenous infusion of D5 W at 125 mL per hour. The tubing has a drop factor of 20 gtt/mL. How many drops per minute should the nurse administer? Round answer to the nearest whole number.

125 x 20 60 = 41.666 = 42

The nurse is caring for a client in an outpatient clinic. The client is being treated with warfarin for prevention of a stroke due to atrial fibrillation. The international normalized ratio (INR) was noted to be 4.6. What should the nurse do? Select all that apply: 1. Inform the primary healthcare provider immediately. 2. Instruct the client to continue medication as ordered. 3. Inform the client to watch for signs of bleeding. 4. Inform the client to return to the clinic per routine monitoring schedule. 5. Take no action as this value is within target range.

1. & 3. Correct: The value of 4 is above the usual target range of 2-3. The client should be told to watch for signs of bleeding. Further treatment is indicated.

A client is diagnosed with a duodenal ulcer due to Helicobacter pylori (H Pylori). In addition to antibiotic therapy, the nurse anticipates that the client will also receive what class of pharmacologic agent? 1. Proton pump inhibitor 2. Mitotic inhibitor 3. Serotonin antagonist 4. Acetylsalicyclic acid

1. Correct: Antisecretory agents like proton pump inhibitors are indicated for the treatment of peptic ulcer disease. Antisecretory agents decrease the secretion of gastric acids.

A new mother brings her infant to the clinic for a well-baby checkup. While at the clinic, the mother asks the nurse if there are any reasons why her infant should not have the MMR (measles, mumps, rubella) vaccine. The nurse's response is based on evidence that the MMR vaccine is contraindicated under which condition? 1. A known allergy to gelatin. 2. A family history of autism. 3. In infants with diarrhea. 4. A known allergy to sulfonamides.

1. Correct: The MMR vaccine is grown using chicken embryos and manufactured with the use of gelatin. Known allergies to gelatin would be a contraindication for administration.

Which signs and symptoms would indicate to the nurse that the client is having an anaphylactic response after receiving penicillin? Select all that apply: 1. Reports a scratchy throat 2. Faint expiratory wheeze on auscultation. 3. Client statement, "I feel like something is wrong." 4. Bounding radial pulse rate of 100/min 5. BP 100/70

1., 2. & 3. Correct: Swelling of face, mouth, throat, and a scratchy throat are indicative of an inflammatory response that could obstruct the airway. Wheezes and stridor are indicators of breathing difficulties seen with anaphylactic reaction. A sense that something bad is happening should serve as a warning that something bad is really going on. Suspect anaphylactic response.

The nurse has been teaching the client about warfarin for prevention of pulmonary emboli. Which comments by the client indicate understanding of the medication? Select all that apply: 1. "I must get my blood levels checked regularly." 2. "I shouldn't change my diet to include a lot of foods containing vitamin K without supervision." 3. "I should eat lots of foods containing vitamin K." 4. "I should report this medication to any primary healthcare provider that I see." 5. "I should not change the dosage without talking with my primary healthcare provider."

1., 2., 4. & 5. Correct: The client should comply with regular checks of INR levels. Vitamin K reverses the therapeutic action of warfarin. The client should report using warfarin to any primary healthcare provider, as treatment may be changed due to this medication. The client should not manipulate the dosage unless instructed by the primary healthcare provider. The anticoagulant effect must be closely monitored.

The nurse is teaching the client with asthma on proper use of an inhaler. Which statements by the client indicates that teaching has been successful? Select all that apply: 1. "Exhale completely before using my inhaler." 2. "Use my steriod inhaler before the bronchodilator." 3. "Inhale slowly and push down firmly on the inhaler." 4. "Rinse my mouth with water after using my inhaler." 5. "Wait 5 minutes between puffs."

1., 3. & 4. Correct: The client should exhale completely before using the inhaler; this response indicates the teaching was effective. The client should inhale slowly and push down firmly on the inhaler when administering the medication, therefore the teaching was effective. The client should rinse the mouth after using the inhaler to prevent thrush.

The nurse is teaching a group of clients about selective serotonin reuptake inhibitors (SSRI). Which comment by a client in the group indicates adequate understanding of the effects/side effects of the medications? 1. My weight may decrease while taking this drug. 2. I may expect increased sweating while taking this drug. 3. I may actually feel more depressed while taking this medication. 4. I should feel better within a couple of days after beginning the med.

2. Correct. The drug causes temperature dysregulation, with increased sweating in some clients.

The nurse in the outpatient clinic performs an assessment on a client who takes propanolol for management of palpitations associated with mitral valve prolapse. Which statement by the client should be reported immediately to the primary healthcare provider? 1. "My resting pulse was 60 this morning." 2. "I feel a little short of breath when walking." 3. "I have lost 5 pounds in the last 2 weeks." 4. "My blood pressure was lower this visit than last time."

2. Correct: Propranolol is a non-selective beta blocker so it blocks sites in the heart and in the lungs. The shortness of breath could be the result of the adverse reactions of bronchospams or heart failure. This statement requires immediate investigation by the primary healthcare provider.

The nurse is teaching a newly diagnosed diabetic client about self-injection of insulin. Which statement made by the client indicates to the nurse that teaching has been effective? Select all that apply: 1. "The abdominal site is best because it is closest to the pancreas." 2. "I can reach my thigh the best, so I will use different areas of the same thigh." 3. "By rotating the sites within one area, my chances of having tissue changes are less." 4. "If I change injection sites from the thigh to the arm, the rate of absorption will be different." 5. "I should inject at least 1 1/2 inches away from the last injection site."

2., 3., 4., & 5. Correct: These are correct statements by the client. Rotate within one anatomic site prevent day to day changes in absorption. This will assist in preventing lipodystrophy.

The nurse is caring for a client who has taken an acetaminophen overdose. Which symptom is the client most likely to exhibit? 1. Expectorating pink frothy sputum 2. Sudden onset of mid-sternal chest pain 3. Jaundiced conjunctiva 4. Diaphoresis and fever

3. Correct: This is a sign of liver damage, which is caused by an overdose of acetaminophen.

A female client taking captopril for hypertension tells the clinic nurse that she is planning to get pregnant. What recommendation should the nurse make? 1. "Captopril can be taken safely during pregnancy, but we will need to decrease your dose so you do not become hypotensive." 2. "We will need to increase your dose of captopril once you become pregnant." 3. "In order to prevent neural tube defects, start taking folic acid." 4. "Captopril can cause serious harm to an unborn baby, so you must prevent pregnancy while taking this medication. "

4. Correct: Serious harm (possibly fatal) to unborn baby when taking during pregnancy. Captopril should not be taken during pregnancy.

The primary healthcare provider has prescribed phenytoin 100 mg intravenous push (IVP) stat through a non-tunneled central venous catheter lumen with no other medication or fluid infusing. In what order should the nurse administer this prescription? *Connect 10 mL normal saline to access port *Administer phenytoin *Gently aspirate for blood *Flush with normal saline, then with heparin *Cleanse access port *Flush saline using push-pause method

Cleanse access port Connect 10 mL normal saline to access port Gently aspirate for blood Flush saline using push-pause method Administer phenytoin Flush with normal saline, then with heparin

The primary healthcare provider has prescribed KCL 20 mEq by mouth once a day. The pharmacy has dispensed KCL 8 mEq/5 mL. How many mL will the nurse administer? Round answer using one decimal point.

8 mEq : 5 mL = 20 mEq : x mL 8 x = 100 x = 12.5

A primary healthcare provider has prescribed chlorpromazine 150 mg by mouth twice a day. The pharmacy sends chlorpromazine oral concentration: 100 mg/ml. How many mL should the nurse administer for each dose? Round answer using one decimal point.

150 mg : x mL :100 mg : 1 mL 100 x = 150 100 100 divide both sides by 100 X = 1.5

A client is prescribed phenobarbital to control seizures. Which medication prescribed for the client would the nurse recognize interacts with phenobarbital? 1. Lovastatin 2. Loratadine 3. Lansoprazole 4. Lactulose

2. Correct: Both of these drugs can cause CNS depression. There is a drug to drug interaction between anti-seizure medications and antihistamines.

Which medication does the nurse expect will help decrease tremors in a client diagnosed with hyperthyroidism? 1. Steroids 2. Anticonvulsants 3. Beta blockers 4. Iodine compounds

3. Correct: Beta blockers help anxiety and tremors.

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

300,000 units : 1 mL = 100,000 units : x mL 300,000 x = 100,000 x = 0.33

The nurse is caring for a client in the emergency department. The primary healthcare provider prescribed 1000 mL of D5 ½ NS. The IV is infusing at 25 gtts/min. (Drop factor is 60 gtts/mL). What is the infusion time in hours? Round your answer to the nearest whole number.

Step 1 1000 x 60 = 25 total fluid x drop factor = infusion time x time in minutes 60,000 = 25 x 25x = 60,000 x = 2400 min. divide by 60 = 40 hours

An adult client has partial and full thickness burns over the anterior chest and anterior and posterior aspects of both legs. Utilizing the rule of nines, what percentage of the body surface area is burned? Round your answer to the nearest whole number.

The anterior chest counts for 18% of the body; entire right leg counts 18%; entire left leg counts 18%. Body surface on this client is 54%.

The nurse is caring for a client in the emergency department. In what order would a nurse correctly administer an intravenous push (IVP) medication through a continuous IV infusion of normal saline? *Cleanse port closest to IV insertion site with alcohol wipes for 15 seconds *Cleanse port with alcohol and administer saline fush *Assess the IV site for the presence of inflammation or infiltration *Check medication label with healthcare provider's prescription *Stop IV pump *Administer medication while assessing IV site *Draw up ordered dose of medication aseptically.

*Check medication label with healthcare provider's prescription *Assess the IV site for the presence of inflammation or infiltration *Draw up ordered dose of medication aseptically. *Stop IV pump *Cleanse port closest to IV insertion site with alcohol wipes for 15 seconds *Administer medication while assessing IV site *Cleanse port with alcohol and administer saline fush First, check medication label with healthcare provider's prescription. Second, Assess the IV site for the presence of inflammation or infiltration. Third, Draw up ordered dose of medication aseptically. Fourth, stop the infusion pump. Fifth, Cleanse the port closest to the IV insertion site with alcohol wipes for 15 seconds. Sixth, Administer medication while assessing IV site. Seventh, Cleanse port with alcohol and administer saline flush.

A client diagnosed with serotonin syndrome is admitted to the unit. The nurse is familiar with this adverse reaction to the serotonin reuptake inhibitors. Which symptoms can the nurse expect on assessment? Select all that apply: 1. Fever and shivering 2. Agitation 3. Decreased body temperature 4. Constipation 5. Increased heart rate

1., 2. & 5. Correct: The client is likely to have a fever and may also experience shivering. The client is usually agitated. Increased heart rate and blood pressure are expected.

The nurse is caring for a client on the pediatric unit. The primary healthcare provider prescribes phenytoin 30 mg by mouth every 8 hours for a client weighting 18 kg. The recommended dosage is 5 mg/kg/day. What does the nurse determine is the safe dosage for the child in mg/day? Round your answer to the nearest whole number.

5mg x 18 kg = 90 mg/day

A 9 month old with asthma symptomology has montelukast sodium oral granules prescribed. What is the most appropriate way for the nurse to instruct the parent on how to administer the medication? 1. Mix the granules with a spoonful of baby food such as applesauce. 2. Pour the granules directly on the back of the infant's tongue. 3. Dissolve the granules in an 8 ounce (240 mL)bottle of juice. 4. Administer the medication in the morning mixed in a bowl of rice cereal.

1. Correct: Applesauce is an appropriate baby food for a 9 month old infant. The medication is being mixed with a very small amount of baby food to facilitate all of the medication being consumed.

The nurse is caring for a client on the oncology unit. The client asks, "Why do I need this LifePort to receive my chemotherapy?" What evidence should the nurse consider when answering? 1. IV infusions can be more rapidly administered via an implantable IV port 2. Implantable IV ports are kept sterile and therefore do not become infected 3. Chemotherapeutic agents are more readily absorbed from implantable IV ports 4. Implantable ports are beneficial when long-term and/or multiple IV therapy is indicated.

4. Correct: Clients requiring long-term and/or multiple IV therapy benefit from implantable ports, because they reduces the number of IV sticks, preserve the integrity of peripheral veins, and provide a vessel with adequate blood flow.

The nurse is caring for a client in an outpatient clinic. The client is being treated with warfarin for prevention of a stroke due to atrial fibrillation. The international normalized ratio (INR) was noted to be 4.6. What should the nurse do? Select all that apply: 1. Inform the primary healthcare provider immediately. 2. Instruct the client to continue medication as ordered. 3. Inform the client that he should watch for signs of bleeding. 4. Inform the client that he should return to the clinic per routine monitoring schedule. 5. Take no action as this value is within target range.

1. & 3. Correct: The value of 4 is above the usual target range of 2-3. The client should be told to watch for signs of bleeding. Further treatment is indicated.

The pediatric nurse is planning an educational seminar for new parents. The seminar will focus on tips for administering medication to children. Which points should the nurse include? Select all that apply: 1. Demonstrate proper measuring techniques for liquid medications. 2. Put crushed medications into the child's favorite food. 3. Place liquid medication in an 8-ounce bottle of formula. 4. Call medication "candy" to encourage children to take the medicine. 5. Do not place medications in a container other than the original container.

1. & 5. Correct: Demonstration with return demonstration by the parent is an appropriate teaching strategy. Never put medications in dishes, cups, bottles, or other household containers.