Pharmacology "Hard"

A nurse is providing teaching to a client who has ulcerative colitis and a new prescription for sulfasalazine. The nurse should instruct the client to monitor for which of the following adverse effects of this medication? A. Jaundice B. Constipation C. Oral candidiasis D. Sedation

A. Jaundice Sulfasalazine can cause a yellow discoloration of the skin and yellow/orange discoloration of the urine. The nurse should instruct the client to notify the provider if these occur. - B: Sulfasalazine does not cause constipation, but it can cause bloody diarrhea. - C: Sulfasalazine can cause stomatitis; however, oral candidiasis is not associated with this medication. - D: Sulfasalazine can cause headache and peripheral neuropathy; however, sedation is not associated with this medication.

A nurse is caring for a client who takes sulfasalazine twice daily for rheumatoid arthritis. Which of the following values should the nurse review prior to the administration of the medication? A. Respirations B. Serum creatinine level C. Blood pressure D. Complete blood count

D. Complete blood count The nurse should identify that sulfasalazine can cause bone marrow suppression, which can lead to agranulocytosis, hemolytic anemia, and macrocytic anemia. - As a result, the client's complete blood count should be periodically monitored, and the nurse should review it prior to administering this medication. - A & C: Sulfasalazine does not affect respirations or blood pressure. - B: Sulfasalazine is excreted by the kidneys and does not have nephrotoxic properties. The nurse does not need to monitor the client's serum creatinine level prior to administering this medication.

A nurse is preparing to administer raloxifene to a client. Which of the following conditions is a contraindication for the administration of this medication? A. Osteoporosis B. Hyperthyroidism C. Myocardial infarction D. Deep-vein thrombosis

D. Deep-vein thrombosis The nurse should identify that raloxifine, like estrogen, increases the risk of DVT, pulmonary embolism, and stroke. Raloxifene is contraindicated for clients who have a history of venous thrombotic events. - A: Raloxifene preserves bone mineral density and is used to prevent and treat postmenopausal osteoporosis. It is also used to reduce the risk of breast cancer. Raloxifene is a selective estrogen receptor modulator that provides the benefits of estrogen without producing some of the adverse effects of estrogen. - B: Raloxifene can increase the incidence of hot flashes in women. However, it is not contraindicated for clients who have hyperthyroidism. - C: Raloxifene, in contrast to estrogen, does not increase the risk of myocardial infarction (MI) early in therapy. Raloxifene lowers LDL cholesterol, which lowers the risk of MI in women who have MI risk factors.

A nurse is caring for a client who is 12 hours postoperative following a total hip arthroplasty. Which of the following medications should the nurse anticipate administering to this client to prevent deep vein thrombosis (DVT)? A. Aspirin B. Warfarin C. Ticagrelor D. Enoxaparin

D. Enoxaparin The nurse should anticipate the administration of enoxaparin for a client who is 12 hours postoperative following surgery. - Enoxaparin is a low-molecular-weight (LMW) heparin that is used to prevent DVT by inhibiting the effects of antithrombin and thrombin. - A: Aspirin is an antipyretic and a nonopioid analgesic that suppresses platelet aggregation, not anticoagulation. Aspirin can be used as a prophylactic therapy for ischemic stroke, transient ischemic attack, chronic stable angina, and coronary stenting. - B: Warfarin is an anticoagulant that is indicated to prevent thrombosis. However, it has a delayed onset and is prescribed for long-term prophylaxis. - C: Ticagrelor is an antiplatelet agent indicated to prevent thrombotic events in clients who have acute coronary syndrome by inhibiting platelet aggregation.

A nurse is caring for a client with benign prostatic hyperplasia who has a new prescription for doxazosin. Which of the following manifestations should the nurse monitor for as an adverse effect of doxazosin? A. Seizures B. Tachycardia C. Bronchodilation D. Hypotension

D. Hypotension Nonselective alpha1-adrenergic antagonists like doxazosin block sympathetic receptors in the blood vessels as well as receptors in the bladder. These agents promote vasodilation, which can cause decreased blood pressure. - A: Adrenergic antagonists do not cause seizures. CNS adverse effects of doxazosin can include dizziness, headaches, depression, and drowsiness. - B & C: Tachycardia and bronchodilation are not adverse effects of doxazosin.

A nurse is providing teaching to a client who has a urinary tract infection and new prescriptions for phenazopyridine and ciprofloxacin. Which of the following statements by the client indicates a need for further teaching? A. If phenazopyridine upsets my stomach, I can take it with meals B. Phenazopyridine will relieve my discomfort, but ciprofloxacin will get rid of the infection C. I need to drink 2 L of fluid per day while I am taking the ciprofloxacin D. I should notify my provider immediately if my urine turns an orange color

D. I should notify my provider immediately if my urine turns an orange color Phenazopyridine is a urinary tract analgesic used to relive pain and burning during urination. The medication can cause the client's urine to turn a reddish-orange color. This coloration is an expected effect of this medication (although it can stain clothing) and does not need to be reported to the provider. - A: Phenazopyridine can cause mild gastrointestinal upset. The client can take this medication with meals to relieve this adverse effect. - B: Phenazopyridine is a urinary tract analgesic used to relive pain and burning during urination. Ciprofloxacin is a fluoroquinolone antibiotic that acts by destroying and inhibiting bacteria. - C: The client should drink 2 to 3 L of fluid while taking ciprofloxacin to dilute the urine and flush the urinary tract.

A nurse is providing discharge teaching to a client who has heart failure and a prescription for digoxin 0.125 mg PO daily and furosemide 20 mg PO daily. Which of the following statements by the client indicates an understanding of the teaching? A. I know that blurred vision is expected to happen while I'm taking digoxin B. I will measure my urine output each day and document it in my diary C. I will skip a dose of my digoxin if my resting heart rate is below 72 beats per minute D. I will eat fruits and vegetables that have a high potassium content every day

D. I will eat fruits and vegetables that have a high potassium content every day Hypokalemia is an adverse effect of diuretic therapy. Because the client is taking digoxin, it is important to maintain a potassium level between 3.5 to 5.0 mg/dL to avoid digoxin toxicity. - A: Visual disturbances such as blurred vision or yellow vision can occur with digoxin toxicity. The client should report any changes in vision to the provider immediately. - B: For home care, the nurse should instruct the client to weigh herself daily at the same time, record the weight, and report weight gain or loss to the provider. Measurement of intake and output is done in acute care facilities but is not necessary for the home setting. - C: Clients are instructed to withhold digoxin if their heart rate is below 60/min. The client should report a heart rate of <60/min, which can signify digoxin toxicity.

A charge nurse is monitoring a newly licensed nurse who is caring for a postoperative client who is receiving morphine through a PCA pump. Which of the following actions by the newly licensed nurse requires intervention? A. Instruct the client to administer a PCA dose prior to a dressing change B. Providing increased fluids while the client is using the PCA pump C. Informing the client's partner that only the client should administer the PCA doses D. Maintaining the client on bed rest while the PCA pump is in use

D. Maintaining the client on bed rest while the PCA pump is in use Use of a PCA pump does not prevent ambulation following surgery. Early ambulation should be encouraged. - The nurse should instruct the client to sit at the side of the bed prior to standing to reduce the risks of orthostatic hypotension and falls. - A: The newly licensed nurse should instruct the client to administer PCA doses prior to procedures or activities that might cause discomfort - B: An adverse effect of opioids, such as morphine, is constipation. The client should increase fluid intake to prevent or relieve constipation while using the PCA pump. - C: The nurse should inform the client and the partner that having someone else administer PCA doses could lead to an overdose

A nurse is caring for a client who is experiencing an acute asthma exacerbation. Which of the following medications should the nurse identify as being contraindicated for this client? A. Dextromethorphan B. Montelukast C. Ciprofloxacin D. Propranolol

D. Propranolol The nurse should identify that a client who is experiencing an acute asthma exacerbation requires the use of a beta2-agonist to alleviate bronchospasm and relax the client's airway. - Therefore, propranolol is contraindicated for this client. Propranolol is a beta-blocker that is used to treat cardiac conditions, including hypertension. Blocking the beta receptors prevents the action of beta2-agonists such as albuterol. - A: Dextromethorphan is an over-the-counter cough suppressant and is not contraindicated for clients who have asthma. - B: Montelukast is a leukotriene receptor blocker that is used for prophylaxis for the maintenance of asthma. This medication is not contraindicated in clients who have asthma. - C: Ciprofloxacin is an antibiotic that is used to treat bacterial infections and is not contraindicated in clients who have asthma.

A nurse is caring for a female adult client who is experiencing menopause and has a prescription for estrogen along with progestin. The nurse should identify that the provider has prescribed these medications for which of the following reasons? A. Long-term use to reduce the risk of breast cancer B. Short-term use to stimulate the endometrium C. Long-term use to prevent osteoporosis D. Short-term use to control urogenital atrophy

D. Short-term use to control urogenital atrophy The nurse should identify that estrogen, along with progestin, can be prescribed for a client who is experiencing menopause for hormonal therapy (HT). The use of short-term HT can assist with managing the manifestations of menopause like urogenital atrophy. - A: Progestin can protect against estrogen-induced cancer of the uterus. However, estrogen increases the risk of estrogen-induced breast cancer. - B: Progestin can be used to counterbalance estrogen-mediated stimulation of the endometrium, which can lead to endometrial hyperplasia and cancer. - C: The risks of hormone therapy for most female clients are greater than the benefits (e.g. preventing chronic disorders like osteoporosis).

A nurse is teaching the guardian of a school-aged child about growth hormone therapy. Which of the following statements should the nurse include in the teaching? A. Your child will grow an extra 4 to 6 inches while receiving hormone therapy B. Hormone injection therapy will occur for 2 to 3 years C. Your child will receive hormone injections no more often than 1 to 2 times each week D. The hormone injections are administered subcutaneously

D. The hormone injections are administered subcutaneously The nurse should include in the teaching that growth hormone therapy is administered subcutaneously, which is the preferred route of administration since the injections are more painful when administered intramuscularly. - A: While receiving growth hormone therapy, the child will grow an extra 2.54 to 7.62 cm (1 to 3 in). - B: Growth hormone therapy will last for 4 to 6 years in order to achieve the desired height for the child. - C: Growth hormone therapy is administered 6 to 7 times each week.

A nurse is teaching a client who is starting patient-controlled analgesia (PCA) following a procedure. Which of the following client statements indicates an understanding of the teaching? A. This method of medication can increase the chances of overdose B. I should self-administer the medication 1 hour before walking C. I should expect to receive smaller doses when I am sleeping D. This method works by keeping my opioid levels steady

D. This method works by keeping my opioid levels steady The nurse should tell the client that a PCA pump is effective for pain control because it delivers a small amount of medication continuously rather than administering a large amount of medication infrequently. - A: The nurse should tell the client that the PCA device is set to deliver a certain amount of medication within a prescribed time frame. The PCA device will not allow the client to administer more than the programmed amount of medication. - B: The nurse should tell the client to self-administer medication prophylactically about 10 minutes prior to activity to decrease discomfort. - C: The nurse should tell the client that a larger continuous dose is programmed for times when the client is sleeping. This assists with the prolonging intervals between patient-controlled dosing and facilitates sleep.

A nurse is preparing to administer amlodipine to a client who has hypertension. The nurse should plan to monitor the client for which of the following adverse effects of the medication? (Select all that apply.) A. Dizziness B. Pale appearance C. Palpitations D. Abdominal pain E. Peripheral edema

A, C, E A. Dizziness C. Palpitations E. Peripheral edema The nurse should monitor the client who is taking amlodipine for dizziness, palpitations, and peripheral edema as adverse effects of the medication. - The nurse should advise the client to avoid activities that require alertness until the medication is known and to notify the provider if any of these adverse effects occur. - B: The nurse should monitor a client who is taking amlodipine for flushing as an adverse effect of the medication, not a pale appearance. - D: The nurse should monitor a client who is taking amlodipine for headaches, not abdominal pain, as an adverse effect of the medication.

A nurse is planning care for a client who is receiving gentamicin IM and has a new prescription to obtain gentamicin peak and trough levels. At which of the following times should the nurse plan to obtain a blood sample to evaluate the gentamicin peak? A. 1 hour after administering the IM injection B. Just before administering the IM injection C. 12 hours after the last IM injection D. 30 minutes after administering the IM injection

A. 1 hour after administering the IM injection Timing is important when drawing blood samples for amino glycoside levels. The nurse should obtain blood samples for peak levels 1 hour after administering an IM injection or 30 minutes after completing an IV infusion. - B: The nurse should plan to obtain the blood samples in order to evaluate the gentamicin trough just before administering a dose of the medication. - C: The nurse should obtain the samples to evaluate peak and trough levels within a narrow time frame. Peak levels should be obtained 30 minutes to 1 hour after a dose has been administered, depending on the route the medication was administered. Trough levels should be obtained immediately prior to medication administration, regardless of the route of administration. Waiting 12 hours to obtain a sample will not give accurate gentamicin peak or trough levels because some of the medication will have already metabolized. - D: For clients who are receiving gentamicin via IM injection, it is important to wait for 1 hour after administration to obtain blood for testing peak levels. This allows the medication to be absorbed into the bloodstream and provides an accurate peak level.

A nurse is preparing to administer iron dextran IV to a client. Which of the following actions should the nurse plan to take? A. Administer a small test dose before giving the full dose B. Infuse the medication over 30 seconds C. Monitor the client closely for hypertension after the infusion D. Administer cyanocobalamin as an antidote if iron dextran toxicity occurs

A. Administer a small test dose before giving the full dose A serious adverse effect of iron dextran is anaphylaxis caused by hypersensitivity to the medication. A small test dose should be administered over 5 minutes before giving the full dose. - The client should be monitored carefully for an allergic reaction during and for a period of time following the test dose. - B: Iron dextran should be administered slowly. An IV bolus dose should be administered over at least 1 minute, and an IV infusion dose should be given over 10 to 15 minutes. - C: The nurse should monitor the client for hypotension and other manifestations of anaphylaxis following the infusion of iron dextran. - D: Deferoxamine is an antidote for iron toxicity. Cyanocobalamin, or vitamin B12, is administered to clients who have megaloblastic anemia.

A nurse is caring for a child who has epilepsy and is scheduled to receive a dose of phenytoin. The nurse notes the child's serum phenytoin level is 14 mcg/mL. Which of the following actions should the nurse take? A. Administer the dose B. Administer half the dose C. Do not administer the dose D. Clarify the dose with the provider

A. Administer the dose A serum phenytoin level of 14 is within the expected reference range of 10-20 mcg/mL. The nurse should administer the medication as prescribed. - B: Administering half the dose is not appropriate because it does not follow the provider's prescription. - C: There is no need to withhold the dose because the child's serum level is within the expected reference range. - D: There is no need to clarify the dose with the provider because the child's serum level is within the expected reference range.

A nurse is preparing to administer a hydromorphone IV infusion to a client for pain. Which of the following actions should the nurse take? A. Administer the medication over 4 to 5 minutes B. Place the client in a high-Fowler's position C. Assess the client's pain level after administering the medication D. Review the client's last set of vital signs

A. Administer the medication over 4 to 5 minutes The nurse should administer the IV injection of this opioid medication over 4 to 5 minutes to prevent the adverse effects of the medication such as respiratory depression and cardiac arrest. - B: The nurse should place the client in a supine position during the administration of the medication to help prevent hypotension. - C: The nurse should assess the client's pain level before administering the pain medication and then 30 minutes to 1 hour after administering the medication to evaluate its effectiveness. - D: The nurse should obtain a current set of vital signs prior to administering opioids. If the client's respiratory rate is below 12/min, the blood pressure is low, or the pulse differs greatly from the client's baseline, the nurse should withhold the medication and contact the client's provider.

A nurse is caring for a client who has a new diagnosis of rheumatoid arthritis. The nurse should anticipate a prescription from the provider for which of the following medications for daily management of this condition? A. Celecoxib B. Prednisone C. Adalimumab D. Abatacept

A. Celecoxib The nurse should anticipate that the provider will prescribe celecoxib, which is an NSAID. This medication or another NSAID should be initiated for a client who has a new diagnosis of rheumatoid arthritis. - B: Prednisone is a glucocorticoid and is indicated for clients who have severe rheumatoid arthritis. It should be used for short-term treatment due to the adverse effects of the medication. - C: Adalimumab is a monoclonal antibody that is used for clients with moderate to severe rheumatoid arthritis who have not responded well to other forms of treatment. - D: Abatacept is a T-cell activation inhibitor and acts by reducing T-cells, interferon gamma, and interleukins. This medication is indicated for clients with rheumatoid arthritis who have not responded well to other forms of treatment.

A nurse is caring for a client who has asthma and advanced rheumatoid arthritis and deformity of the hands. The nurse should anticipate that the client will receive which of the following medication-delivery devices for the treatment of asthma? A. Dry-powder inhaler (DPI) B. Metered-dose inhaler (MDI) with spacer C. Respimat D. Nebulizer

A. Dry-powder inhaler (DPI) The nurse should identify that DPIs do not require hand-breath coordination and are easier to use for clients who have deformities of the hands. DPIs are used to deliver medications in a dry, micronized powder directly to the lungs. - B: MDIs with spacer devices require hand-breath coordination in order to ensure maximum deposition of medication. This can be more difficult for a client who has deformity of the hands. - C: Respimat inhalers deliver medication as a fine mist. Although these devices do not require as much hand-breath coordination as MDIs, they still require the client to activate the device using a twisting motion, which can be more difficult for a client who has deformity of the hands. - D: Nebulizers are small machines that convert liquid medication into a fine mist for inhalation. The medications used with nebulizers often require twisting of small ampules to open, which can be more difficult for a client who has deformity of the hands.

A nurse is caring for a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following findings should the nurse identify as an indication that the client requires intervention? A. Heart rate 106/min B. Dry skin C. Oral temperature 36.8c (98.2f) D. Lethargy

A. Heart rate 106/min Tachycardia can be a manifestation of hyperthyroidism, possibly due to excessive hormone replacement. The client might require a lower dosage of levothyroxine. - B: Dry skin is a common manifestation of hypothyroidism, which should resolve after medication therapy works. - C: This oral temperature is within the expected reference range and does not require intervention. - D: Lethargy is a common manifestation of hypothyroidism, which should resolve after medication therapy reaches therapeutic levels.

A nurse is preparing to administer dantrolene to a client who has muscle spasticity. Which of the following findings from the client's medical history should the nurse identify as a contraindication to the administration of this medication? A. History of cirrhosis B. History of multiple sclerosis C. History of cerebral palsy D. History of malignant hyperthermia

A. History of cirrhosis The nurse should identify that dantrolene is contraindicated for clients who have active liver disease because it is hepatotoxic and can cause liver failure. Liver function tests are monitored for clients throughout treatment with this medication. - B: The nurse should identify that dantrolene is administered to treat muscle spasms associated with multiple sclerosis and is not contraindicated for this client. - C: The nurse should identify that dantrolene is administered to treat muscle spasms associated with cerebral palsy and is not contraindicated for this client. - D: Dantrolene is administered for the treatment of malignant hyperthermia. Malignant hyperthermia is a rare, life-threatening syndrome that can be triggered by general anesthesia and by succinylcholine.

A nurse is caring for a client who has tuberculosis and is taking rifampin. Which of the following client statements should indicate to the nurse that the client is experiencing an adverse effect of the medication? A. I have noticed my urine is orange in color B. I sleep more than I used to C. My tongue and mouth are sore D. My voice seems hoarse

A. I have noticed my urine is orange in color The nurse should identify that an adverse effect of rifampin can be red-orange colored urine, saliva, sweat, and tears as the medication is excreted from the body. - The nurse should also inform the client that permanent staining of contact lenses can occur. However, this adverse effect is harmless. - The client should inform the provider if urine becomes dark in color since this can be an indication of hepatotoxicity. - B, C, & D: These are not adverse effects associated with this medication.

A nurse is providing teaching to a parent of a child who has asthma and a new prescription for a cromolyn sodium metered-dose inhaler. Which of the following statements by the parent indicates the need for further teaching? A. I will give my child a dose as soon as wheezing starts B. My child should rinse out his mouth after using the inhaler C. My child should exhale completely before placing the inhaler in his mouth D. If my child has difficulty breathing in the dose, a spacer can be used

A. I will give my child a dose as soon as wheezing starts Cromolyn is a mast cell inhibitor that has a slow onset and is given for prophylactic treatment of asthma. It is not a rescue medication. - B: Cromolyn administered by inhaler can cause mouth and throat irritation. The client should rinse or gargle with water after each use. - C: The client should exhale completely and breathe in evenly while depressing the canister. - D: A spacer provides a chamber to hold the medication exhaled in suspension. It allows clients who have difficulty breathing in the entire dose in one inhalation to continue to receive medication in subsequent breaths.

A nurse is teaching a client who is about to start taking propylthiouracil to treat hyperthyroidism. Which of the following statements should the nurse identify as an indication that the teaching has been effective? A. I will need laboratory tests to check my liver function B. I should take this medication once daily C. If I get a rash, I am probably having an allergic reaction D. If I have difficulty sleeping, it is probably because of this medication

A. I will need laboratory tests to check my liver function Propylthiouracil is hepatotoxic and can cause severe liver injury. The nurse should instruct the client to report dark urine and yellowing of the eyes, which can indicate an injury to the liver. - B: For initial treatment, the client should take propylthiouracil multiple times each day as prescribed by the provider. - C: The nurse should inform the client that a rash is the most common adverse reaction to propylthiouracil and does not indicate an allergic reaction to the medication. - D: Hyperthyroidism can cause insomnia. However, propylthiouracil is more likely to cause drowsiness.

A nurse is teaching a client about the adverse effects of omeprazole. Which of the following client statements indicates an understanding of the teaching? A. If I experience severe diarrhea, I will call my doctor B. Pneumonia is associated with long-term use of this medication C. I will need to take this medication with food D. I should take vitamin B12 while using this medication

A. If I experience severe diarrhea, I will call my doctor Clients who experience diarrhea while taking omeprazole or other proton pump inhibitors (PPIs) should report this finding to the provider immediately. - Omeprazole and other PPIs are associated with a dose-related increase in the risk of infection with C-diff, which is a bacterium that can cause severe diarrhea. - B: The client's risk of pneumonia is limited to the first few days of using PPIs. After that period, the risk of pneumonia is no higher than in clients who do not use the medication. - C: The nurse should instruct the client to take this medication before a meal and preferably in the morning for absorption. - D: Omeprazole does not cause a deficiency in vitamin B12. However, this medication can cause a deficiency in magnesium, especially with long-term use.

A nurse is teaching about adverse effects of ergotamine with a client who has migraine headaches. Which of the following client statements should indicate an understanding of the teaching? A. If I overuse this medication, I might become addicted to it B. This medication is okay to use during pregnancy C. Tingling in my fingers and toes is an adverse effect that goes away with continued use D. I will experience restlessness as an adverse effect when I begin taking this medication

A. If I overuse this medication, I might become addicted to it The client should take the ergotamine according to the prescribed dose and should only take the medication when needed to avoid developing a physical dependence. - B: Ergotamine is not safe during pregnancy because the medication can stimulate uterine contractions. Clients who are pregnant or might become pregnant should not use ergotamine to treat migraine headaches. - C: A client who is taking ergotamine and is experiencing tingling in the fingers and toes should notify the provider immediately because this is a manifestation of ergotism or toxicity. Overuse of the medication can cause physical dependence, and signs of withdrawal can include headaches, nausea, vomiting, and restlessness during medication-free periods. - D: A client who experiences a manifestation of withdrawal such as restlessness, headaches, nausea, and vomiting should notify the provider.

A charge nurse is teaching a newly licensed nurse about a client who has severe allergy-related asthma and a new prescription for omalizumab. Which of the following pieces of information should the charge nurse include to describe the medication's mechanism of action? A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells B. It stabilizes the cellular membrane of mast cells C. It decreases the synthesis and release of inflammatory mediators D. It relaxes the smooth muscles by blocking adenosine receptors

A. It reduces the number of immunoglobulin E (IgE) molecules on mast cells The charge nurse should include in the teaching that the mechanism of action of omalizumab reduces the number of IgE molecules on mast cells. This limits the ability of allergens to trigger immune mediators that cause bronchospasm. - B: Stabilizing the cellular membrane of mast cells is the mechanism of action of mast cell stabilizers. - C: Decreasing the synthesis and release of inflammatory mediators is the mechanism of action of glucocorticoids. - D: Relaxing smooth muscle by blocking adenosine receptors is the mechanism of action of methylxanthines.

A nurse is assessing a client who is taking varenicline for smoking cessation. Which of the following findings is the nurse's priority? A. Mood changes B. Nausea C. Altered sense of taste D. Skin rash

A. Mood changes The greatest risk to the client is the development of neuropsychiatric effects that can progress to depression and suicide. Therefore, the highest priority is a change in the client's mood. - B, C, & D: Nausea and vomiting, an altered sense of taste, and a skin rash are common adverse effects of varenicline; however, there is another finding that is the priority.

A nurse is caring for a client who received spinal anesthesia 30 minutes ago. The client reports feeling dizzy, and the nurse notes that the client's blood pressure is 84/54 mmHg. Which of the following actions should the nurse take? A. Place the client in the head-down position B. Assess the placement of the catheter C. Prepare to administer an IV reversal agent D. Assist the client in passive range of motion movements

A. Place the client in the head-down position The nurse should identify the client is experiencing an adverse effect from receiving the spinal anesthesia. Hypotension is the common adverse effect of spinal anesthesia due to the loss of venous tone and decreased venous return to the heart. - Therefore, the nurse should position the client in a 10-15 degree, head-down position to rapidly promote venous return to the heart, which increases the client's blood pressure. - B: Assessing the placement of a spinal catheter is outside the scope of practice for the nurse and is the responsibility of the provider. - C: The client is experiencing an adverse reaction to receiving the spinal anesthesia. Therefore, administering a reversal agent is not indicated. - D: Passive range of motion is needed to decrease the risk of thromboembolism for a client who is unable to ambulate following surgery.

A nurse is teaching a client who has type 1 diabetes mellitus about a new subcutaneous insulin infusion pump. Which of the following pieces of information should the nurse include in the teaching? A. Plan to use a type of short-duration insulin in the infusion pump B. Replace the infusion pump set every 4 days C. Turn off the infusion pump for at least 3 hours each day D. Move the infusion pump catheter 1.27cm (0.5in) away from the old site

A. Plan to use a type of short-duration insulin in the infusion pump The client should plan to use short-duration insulin such as regular, lispro, apart, or glassine insulin in the infusion pump to deliver a baseline infusion of insulin. The client should also administer bolus doses of insulin before each meal. - B: The client should replace the infusion set every 1 to 3 days to maintain asepsis and to reduce the formation of insulin micro deposits within the tubing, which can decrease the amount of insulin infused. - C: The client's insulin level will drop rapidly if the infusion pump is turned off due to a stop in the deliver of short-acting insulin. The client should plan to maintain a constant infusion of insulin with the exception of removing the device on special occasions for 1 to 2 hours. - D: The client should move the catheter infusion site at least 2.54 cm (1 in) away from the old site to maintain tissue integrity.

A nurse is preparing to administer IV nitroprusside for a client who had a myocardial infarction. Which of the following actions should the nurse take? A. Regulate the infusion pump using the client's weight in the calculation B. Change the IV solution bag every 48 hr after the time of preparation C. Ensure the freshly prepared IV solution has a slight greenish tint D. Cover the medication with an amber plastic bag to protect it from light

A. Regulate the infusion pump using the client's weight in the calculation The nurse should regulate the infusion pump rate based on the client's weight. - Sodium nitroprusside is a potent vasodilator that works faster than any other medication available and is administered as a continuous IV infusion to clients who require a rapid reduction of blood pressure. - The nurse should monitor the client's blood pressure either continuously with an arterial line or at least every 15 minutes with an electronic monitoring device because this medication can cause a rapid reduction of blood pressure that can be life-threatening if not managed properly. - B: The nurse should plan to use or change the IV solution bag every 24 hours after the time of preparation. - C: The nurse should ensure the freshly prepared IV solution is a light brown color. The nurse should discard the solution if it is green, blue, dark red, or dark brown. - D: The nurse should cover the nitroprusside solution with a bag that is made of an opaque material because the medication is degraded by light.

A nurse is educating a client with urethritis who has a new prescription for oral erythromycin. Which of the following statements should the nurse include in the teaching? A. Report persistent diarrhea to the provider B. Take this medication with a full glass of milk C. Some people who take erythromycin experience vision loss D. Antacids will reduce the extent of absorption of this medication

A. Report persistent diarrhea to the provider Although gastrointestinal disturbances are the most common adverse effects of erythromycin, clients should report persistent or severe gastrointestinal reactions to the provider. - Erythromycin can cause superinfection of the bowel because it destroys some sensitive flora in the gastrointestinal system. - B: The nurse should instruct the client to take the medication on an empty stomach and with 240 mL (8 oz) of water. The client should avoid milk and other chelating agents to ensure efficacy of the medication. - C: Erythromycin is more likely to cause hearing loss than vision loss. High-dose therapy with erythromycin can cause transient hearing loss. - D: Antacids that contain aluminum and magnesium reduce the rate of absorption of azithromycin, not erythromycin. However, for azithromycin, they do not reduce the extent of absorption.

A nurse is caring for a client with asthma who has been taking an inhaled glucocorticoid and long-acting beta2-agonist combination dry-powdered inhaler (DPI) for maintenance therapy. The nurse should identify that which of the following is a disadvantage of this medication? A. Restricted dosage flexibility B. Complicated delivery device C. Serious systemic effects D. Limited efficacy over time

A. Restricted dosage flexibility The nurse should identify that a disadvantage of an inhaled glucocorticoid and long-acting beta2-agonist being combined is that the dosages of these medications are fixed, so the dose cannot be adjusted. - B: This combination medication DPI is an easy-to-use device that allows the client to self-administer medication after receiving basic instruction about its use. - C: This combination medication DPI is delivered locally to the lungs. Systemic effects are mild and generally do not occur. - D: This combination medication DPI is effective for long-term use for clients who have asthma.

A nurse is providing discharge teaching to a client who has a bacterial infection about adverse effects of imipenem to report to the provider. Which of the following pieces of information should the nurse include? A. Seizures can occur with this medication B. You should observe for manifestations of bleeding C. Check your hands and feet for sensory dysfunction D. This medication can increase the risk of ototoxicity

A. Seizures can occur with this medication The nurse should tell the client that seizures can occur when receiving imipenem. The client should notify the provider immediately if these occur. - B: Imipenem does not increase the client's risk of bleeding. However, other antibiotics can increase the risk of bleeding such as some cephalosporins. - C: Imipenem does not cause sensory dysfunction. However, sensory dysfunction is an adverse effect of penicillin G intramuscular injections as a result of accidental injection of the medication into a peripheral nerve. - D: Imipenem does not have an adverse effect of ototoxicity. However, aminoglycoside antibiotics can cause this adverse effect.

A nurse is caring for a school-aged child who has cystic fibrosis (CF) and has been using a corticosteroid inhaler for long-term treatment. Which of the following findings should the nurse identify as an adverse effect of long-term use of this medication? A. Small stature for age B. Decreased weight C. Poor dentition D. Atrophied muscles

A. Small stature for age The nurse should identify that an adverse effect of the long-term use of inhaled glucocorticoids can be a slowing in the rate of growth in children. - B: A decrease in weight is not an adverse effect of the long-term use of inhaled corticosteroids in children. - C: Poor dentition is not an adverse effect of the long-term use of inhaled corticosteroid in children. - D: Muscle wasting can be an adverse effect of the use of long-term systemic corticosteroids. However, it is not an adverse effect of inhaled corticosteroids in children.

A nurse is assessing a client who began taking clozapine 3 weeks ago. Which of the following findings should the nurse report to the provider immediately? A. Tachypnea and tachycardia B. Abdominal pain and constipation C. Enuresis and polyuria D. Dry mouth and blurred vision

A. Tachypnea and tachycardia The greatest risk to the client is the development of myocarditis, a potentially fatal adverse effect of clozapine. - Myocarditis is an inflammation of the heart muscle that typically occurs within 30 days of starting the medication. - Manifestations of myocarditis include chest pain, palpitations, tachycardia, cardiac arrhythmias, dyspnea, tachypnea, a fever, peripheral edema, and unexplained fatigue. - Clozapine should be discontinued if a client develops myocarditis, and its use should be avoided in the future. - B: The nurse should inform the provider if the client reports abdominal pain and constipation so that treatment to promote bowel evacuation can be implemented. However, another set of findings is the priority. - C: The nurse should inform the provider if the client reports enuresis and polyuria because these are adverse effects of the medication. Polyuria can indicate the development of diabetes, and blood glucose monitoring should be a part of the client's regimen. However, another set of findings is the priority. - D: The nurse should inform the provider if the client reports dry mouth and blurred vision because these are indications that the client is experiencing anticholinergic effects of the medication. Treatment includes frequent oral care and the use of sugarless gum or candy to promote salivation. The client should also be monitored for other anticholinergic effects such as urinary retention and constipation. However, another set of findings is the priority.

A nurse is teaching a client with type 2 diabetes mellitus about self-administration of a new prescription for acarbose. Which of the following pieces of information should the nurse include in the teaching? A. Tell the client to take the medication with food B. Show the client how to perform an intramuscular injection C. Advise the client to avoid taking this medication with insulin D. Warn the client against exercising while taking this medication

A. Tell the client to take the medication with food Acarbose should be taken with food. The nurse should advise the client that this medication should be taken with the first bite of a meal 3 times each day. - Acarbose inhibits an enzyme in the intestines that slows the digestion of carbohydrates and results in a lower postprandial increase in blood glucose levels. - B: Acarbose is administered by mouth, not by intramuscular injection. Therefore, the nurse does not need to demonstrate to the client how to perform an intramuscular injection. - C: Acarbose can be used alone or in combination with insulin, metformin, or a sulfonylurea. - D: Acarbose is indicated for clients who have type 2 diabetes mellitus and is to be used in conjunction with a program of diet modification and exercise.

A nurse is evaluating a 20-month-old child who received a hepatitis A immunization 3 days ago. The parent reports that the child has exhibited a loss of appetite following the immunization. Which of the following actions should the nurse take? A. Tell the parent that this reaction should only last for a couple of days B. Notify the provider immediately C. Prepare an antidote to administer to the child D. Request that the provider order a serum titer level

A. Tell the parent that this reaction should only last for a couple of days The nurse should tell the parent that a loss of appetite is a mild reaction in response to the hepatitis A vaccine and will usually last 1 to 2 days. - B: The nurse does not need to notify the provider immediately because this is a mild response to the hepatitis A vaccine and is not considered an emergency. - C: There is no antidote to administer to a child who has a loss of appetite from the hepatitis A vaccine. Additionally, it is not within the nurse's scope of practice to prepare antidotes without a prescription from the provider. - D: The nurse should not request a serum titer level for the client because it would not provide any information about the cause of the child's loss of appetite.

A nurse is planning care for a female client who has severe irritable bowel syndrome with diarrhea (IBS-D) and a new prescription for alosetron. Which of the following interventions should the nurse include in the plan of care? A. The client must sign an agreement with the provider before beginning alosetron B. The client must stop taking alosetron if diarrhea continues for 1 week after beginning the medication C. The client should expect to have a slower heart rate while taking alosetron D. The client should use a barrier birth control method because alosetron interacts with oral contraceptives

A. The client must sign an agreement with the provider before beginning alosetron Alosetron has potentially fatal adverse effects associated with constipation and bowel obstruction. The FDA has allowed alosetron to be placed on the market only if clients sign and adhere to a risk management program, which includes signing a client-provider agreement before starting alosetron. - B: The client should be taught to notify the provider and stop the medication if diarrhea is not controlled after 1 month of starting alosetron. - C: The client should notify the provider about tachydysrhythmia, which is an adverse effect of alosetron. - D: Alosetron has few medication interactions and does not interact with oral contraceptives.

A nurse in a long-term care facility is administering medications to a group of older adult clients. Which of the following factors of pharmacokinetics should the nurse consider when caring for this age group? A. The excretion of medication is reduced B. The percentage of medication absorbed is increased C. The liver metabolizes medication more quickly D. The rate at which the liver metabolizes medication declines with age

A. The excretion of medication is reduced - B: Gastric emptying and motility slow with age, decreasing the absorption level of medications. - C: The rate at which the liver metabolizes medication declines with age. - D: The amount of medication stored in fatty tissue does not decrease, but the amount of lean body mass tends to decrease with age, which can reduce available sites for protein-bound medications. The total amount of water in the body also decreases with age and can increase the concentration of water-soluble medications.

A nurse is providing teaching to a client who has a new prescription for lisinopril. Which of the following should the nurse include in the teaching as an adverse effect of lisinopril? A. Tongue swelling B. Low potassium level C. Runny nose D. Bruising

A. Tongue swelling Angioedema is a fatal response that occurs in about 1% of clients who use ACE inhibitors such as lisinopril. - Manifestations of angioedema include swelling of the tongue, lips, or pharynx. - B: ACE inhibitors, like lisinopril, inhibit the release of aldosterone and can cause potassium retention and hyperkalemia. - C: ACE inhibitors can cause a persistent, dry, and irritating cough. A runny nose (rhinorrhea) is not an adverse effect associated with this type of medication. - D: ACE inhibitors can cause adverse effects such as flushing, pruritus, and rashes. However, bruising is not an adverse effect associated with this medication.

A nurse is caring for a client who is developing acute pulmonary edema and has a new prescription for furosemide 40 mg IV bolus. The nurse should plan to administer the medication using which of the following methods? A. Undiluted administered over 2 min B. Diluted administered over 20 min C. Undiluted administered as rapidly as possible D. Diluted administered over 5 min

A. Undiluted administered over 2 min The nurse should plan to administer low-dose furosemide therapy (e.g. 40 mg undiluted via IV bolus) at a rate of 20 mg/min or a dose of 40 mg over 2 min. - B & D: The nurse should plan to administer higher-dose furosemide therapy via continuous IV infusion at a maximal rate of 4g/min. A low dose of 40 mg does not require dilution or continuous infusion. - C: The nurse should plan to administer low-dose furosemide therapy at a rate of 20 mg/min or a dose of 40 mg over 2 min.

A nurse is assessing a client who reports using several herbal and vitamin supplements daily, including saw palmetto. The nurse should recognize that saw palmetto is a supplement used by clients to elicit which of the following therapeutic effects? A. Urinary health promotion B. Immune system stimulation C. Decreased leg pain from arterial disease D. Prevention of nausea caused by motion sickness

A. Urinary health promotion Saw palmetto is used primarily for manifestations related to prostatic conditions such as benign prostatic hypertrophy (BPH). - Its effectiveness has not been scientifically verified, however. - The nurse should instruct the client to check with the provider about interactions between saw palmetto and other medications. - B: Echinacea is a popular herb widely used in the US to reduce the duration of colds and flu-like illnesses, although its effectiveness has not been verified. - C: Ginkgo biloba has become a widely used dietary supplement in the US for increasing cognitive functions in elderly people, although this effect has not been verified. Ginkgo blob has been shown to improve leg pain of intermittent claudication and other peripheral arterial disorders. - D: Ginger root is sometimes used to prevent and treat nausea due to motion sickness, seasickness, and other causes.

A nurse is planning care for a client who has a seizure disorder and a new prescription for valproic acid. Which of the following laboratory values should the nurse plan to monitor? (Select all that apply.) A. BUN B. PTT C. Aspartate aminotransferase (AST) D. Urinalysis E. Alanine aminotransferase (ALT)

B, C, E B. PTT C. Aspartate aminotransferase (AST) E. Alanine aminotransferase (ALT) - Valproic acid can alter coagulation; therefore PT and PTT should be monitored. - Valproic acid can cause life-threatening hepatotoxicity; the client should have baseline liver function tests (LFTs) before starting this medication, and LFTs should be repeated at regular intervals during therapy. - ALT is a liver enzyme that is measured as a component of liver function tests. Level of the enzyme identify liver damage. - A & D: Valproic acid has no effect on kidney function.

A nurse is administering insulin glulisine 10 units subcutaneously at 0730 to an adolescent client who has type 1 diabetes mellitus. The nurse should anticipate the onset of action of the insulin at which of the following times? A. 0800 B. 0745 C. 0900 D. 1030

B. 0745 Insulin glulisine has a very short onset action of 15 minutes. The nurse should expect the onset of action around 0745 and ensure the client eats breakfast immediately following the administration of the insulin. - A: The onset of action for regular insulin is 30 to 60 minutes, not insulin glulisine. - C: NPH insulin has an onset of action of 1 to 2 hours, not insulin glulisine. - D: Insulin glulisine does not have an onset of action of 3 hours.

A nurse is caring for a client who has a suspected adrenal insufficiency. Which of the following medications should the nurse anticipate the provider using to determine the presence of adrenal insufficiency? A. Prednisone B. Cosyntropin C. Dexamethasone D. Ketoconazole

B. Cosyntropin The nurse should expect the provider to use cosyntropin to determine if the client has adrenal insufficiency. - The client is monitored after the provider injects cosyntropin to see if the cortisol level rises above 20 mcg/dL. - If the adrenal response causes the cortisol level to elevate, the response is considered to be within the expected reference range. If the cortisol level does not elevate, the provider should determine that the client has adrenal insufficiency. - A: Prednisone is a medication used for lifelong glucocorticoid replacement therapy for adrenal insufficiency. - C: Dexamethasone is a synthetic steroid that is used to determine if a client has Cushing's syndrome, as indicated by minimal or no suppression of cortisol production. - D: Ketoconazole is used to suppress the synthesis of adrenal steroids in clients who have Cushing's syndrome. However, this medication is used only as an adjunct to surgery or radiation therapy.

A nurse is caring for a client who has Alzheimer's disease and a prescription for memantine. Which of the following laboratory findings should the nurse identify as a contraindication to receiving this medication? A. Alanine aminotransferase (ALT) 60 units/L B. Creatinine clearance 35 mL/min C. HbA1c 5% D. BMI 31

B. Creatinine clearance 35 mL/min The nurse should identify that creatinine clearance is a value of the glomerular filtration rate (GFR) that determines the kidney'a ability to filter waste. - A creatinine clearance of 35 is outside of the expected reference range and reveals moderate renal impairment. - Memantine is excreted by the kidneys, and a decreased clearance occurs in moderate renal impairment. Therefore, this finding is a contraindication to receiving the medication. - A: ALT is a liver function test. Elevated ALT levels indicate hepatic impairment. Memantine is not excreted by the liver. - C: HbA1c is a laboratory value that calculates the average blood glucose level over a period of time, usually 3 months. An increased HbA1c indicates diabetes. However, an HbA1c of 5% is within the expected reference range and is not a contraindication to receiving this medication. - D: BMI is a calculation of body fat based on height and weight. A BMI of 31 is greater than the expected reference range. Although an increased BMI increases the risk of certain chronic diseases, it is not a contraindication to receiving this medication.

A nurse is caring for a client who is taking acarbose to treat type 2 diabetes mellitus. For which of the following adverse effects of this medication should the nurse monitor for the client? A. Insomnia B. Diarrhea C. Joint pain D. Polycythemia

B. Diarrhea The most common adverse effects of acarbose, an alpha-glucosidase inhibitor, are gastrointestinal. - They include diarrhea, abdominal distention, abdominal cramping, and flatulence. - A: Acarbose is more likely to cause sleepiness than insomnia. - C: Acarbose is more likely to cause headaches than joint pain. - D: Acarbose is more likely to cause anemia than polycythemia because it can decrease the absorption of iron.

A nurse is admitting a client who has atrial fibrillation with a heart rate of 155/min. The nurse should anticipate a prescription from the provider for which of the following medications? A. Atropine B. Diltiazem C. Epinephrine D. Vasopressin

B. Diltiazem The nurse should anticipate the provider to prescribe diltiazem for a client who is experiencing atrial fibrillation. Diltiazem is an anti arrhythmic agent that reduces the ventricular rate in atrial fibrillation. - A: Atropine is an anti arrhythmic agent that is administered to accelerate the heart rate to treat sinus bradycardia and heart block. - C: Epinephrine is a vasopressor and bronchodilator agent that is administered to treat cardiac arrest and severe allergic reactions that cause anaphylaxis. - D: Vasopressin is a vasopressor agent that is administered to treat cardiac arrest and asystole.

A nurse is caring for a client who is receiving cefotetan 1 g via intermittent IV bolus every 12 hr to treat a postoperative infection. Which of the following manifestations should the nurse monitor for as an adverse effect of the medication? A. Disorientation B. Epistaxis C. Constipation D. Jaundice

B. Epistaxis Cefotetan is an antibiotic that affects vitamin K levels, which can result in bleeding and epistaxis. The nurse should monitor the client for bleeding and notify the provider if this manifestation occurs so the medication can be discontinued. - A: Cefotetan is a second-generation cephalosporin, a class of antibiotics that does not manifest disorientation as an adverse effect. - C: Cefotetan does not manifest constipation as an adverse effect. The nurse should monitor this client for diarrhea. - D: Cefotetan does not manifest jaundice as an adverse effect.

A nurse is caring for a client who is taking streptomycin. Which of the following medications increases the client's risk of developing ototoxicity when taken with streptomycin? A. Cefoxitin B. Furosemide C. Naproxen D. Amphotericin B

B. Furosemide Furosemide, a high-ceiling (loop) diuretic, increases the risk of developing ototoxicity when taken with streptomycin, an aminoglycoside.

A nurse is reviewing the medical record of a client with rheumatoid arthritis who has a prescription for infliximab. Which of the following findings should the nurse identify as a contraindication to the client receiving this medication? A. Psoriatic arthritis B. Hepatitis B virus C. Ulcerative colitis D. Ankylosing spondylitis

B. Hepatitis B virus The nurse should identify that infliximab is a tumor necrosis factor (TNF) antibody medication that is used to reduce the disease manifestations and to delay disease progression. - Infliximab has immunosuppressant properties that can reduce the risk of infection. Clients who have an active or chronic infection such as hepatitis B virus should not take infliximab. - A: Psoriatic arthritis is a chronic disease characterized by inflammation of the skin and joints. TNF medications such as infliximab suppress inflammation by suppressing TNF, which can reduce the manifestations of psoriatic arthritis. - C: Ulcerative colitis is an inflammatory bowel disease that affects the innermost lining of the colon. Treatment includes surgery and medication therapy, which can include TNF medications. - D: Ankylosing spondylitis is a form of arthritis that primarily affects the spine, causing severe, chronic pain and discomfort. Infliximab is a TNF medication that can limit the progression of arthritis and decrease inflammation.

A nurse is providing discharge teaching to a client who had a kidney transplant and has a prescription for oral cyclosporine. Which of the following statements by the client indicates an understanding of the teaching? A. I will be able to stop taking this medication within 6months after my surgery B. I am likely to develop higher blood pressure while taking this medication C. I am likely to lose my hair while taking this medication D. I am taking this medication to boost my immune system

B. I am likely to develop higher blood pressure while taking this medication Half the client who take cyclosporine develop a 10% to 15% increase in blood pressure and might need to start antihypertensive therapy. - A: Cyclosporine and similar medications that are taken after a kidney transplant must be continued for the rest of the client's life. - C: Cyclosporine causes some hirsutism (unusual hair growth) in many clients. It does not cause hair loss. - D: Cyclosporine is an immunosuppressive agent that prevents rejection of the transplanted kidney.

A nurse is providing teaching to a client who has a new prescription for a fentanyl transdermal patch. Which of the following statements by the client indicates an understanding of the teaching? A. The patch will not cause constipation like other pain medications do B. I will have to stop drinking grapefruit juice while using the patch C. I will place a heating pad over the patch to boost its effectiveness D. The patch will give me relief from my pain faster than pills can

B. I will have to stop drinking grapefruit juice while using the patch The nurse should instruct the client to avoid drinking grapefruit juice while using the fentanyl transdermal patch. Grapefruit juice can increase the absorption of the medication, raising the amount of fentanyl in the client's blood. This effect can place the client at risk for CNS and respiratory depression. - A: Using an opioid in transdermal form does not prevent constipation from occurring, and a laxative or stool softener might be required. The client should increase fiber, fluids, and exercise while using the fentanyl transdermal patch. - C: The nurse should advise the client to avoid applying direct heat to the patch because this increases the absorption of the medication and can result in an overdose. - D: It takes up to 24 hours for the fentanyl patch to reach maximum effect. Short-acting pain medications might be required during this time.

A nurse is providing teaching to a newly licensed nurse about metoclopramide. The nurse should highlight that which of the following conditions is a contraindication to this medication? A. Hyperthyroidism B. Intestinal obstruction C. Glaucoma D. Low blood pressure

B. Intestinal obstruction Metoclopramide reduces nausea and vomiting by increasing gastric motility and promoting gastric emptying. It is contraindicated in a client who has an intestinal obstruction or perforation. - A & C: Metoclopramide can be administered to a client who has hyperthyroidism or glaucoma. - D: Metoclopramide can be administered to a client who has hypotension. It should be used with caution for a client who has hypertension.

A nurse is administering a medication to a client. The nurse should identify that which of the following medication distribution factors facilitates the effective passage of the medication across the client's cell membranes? A. Protein-binding ability B. Lipid solubility C. Hepatic metabolism D. Slow dissolution

B. Lipid solubility A medication being lipid soluble and the presence of a transport system both facilitate the ability of a medication to cross cell membranes that separate the medication from the blood. - A: Protein-binding ability is a factor that restricts medication distribution. Medications that bond with albumin, for example, cannot leave the bloodstream to access their target areas in the body. - C: The hepatic microsomal enzyme system (the P450 system) metabolizes most of the medications that the liver metabolizes. To undergo this process, medications need to have already crossed the cell membranes. - D: Medications that dissolve rapidly work faster than those that dissolve slowly. However, the dissolution rate affects the onset of action, not the effective passage of the medication across cell membranes.

A nurse is reviewing the medical record of a client who has a prescription for a combination oral contraceptive. The nurse should identify that which of the following findings is a contraindication to receiving this medication? A. High cholesterol levels B. Liver disease C. Family history of ovarian cancer D. Client report of hypermenorrhea

B. Liver disease The nurse should identify that liver disease or abnormal liver function is a contraindication to receiving a combination oral contraceptive. Therefore, the nurse should notify the client's provider. - Other contraindications include thrombophlebitis or breast cancer. - A: Combination oral contraceptives do not affect cholesterol levels. - C: Combination oral contraceptives protect against ovarian cancer. Therefore, a history of ovarian cancer is not a contraindication to this medication. - D: Hypermenorrhea is not a contraindication to the use of combination oral contraceptives. Excessive bleeding during menses can be corrected by a combination oral contraceptive.

A nurse is reinforcing teaching with a newly licensed nurse about contraindications to vaccines. Which of the following examples should the nurse provide as a true contraindication for all vaccines? A. Previous local reaction to an injectable vaccine B. Moderate illness without a fever C. Recent exposure to an infectious disease D. Family history of an allergy to penicillin

B. Moderate illness without a fever The nurse should identify that a client who has a moderate or severe illness with or without a fever has a true contraindication to receiving a vaccine. - The nurse should postpone the immunization until the client has recovered from the illness. - A: A mild local reaction such as soreness, erythema, or swelling following a dose of an injectable vaccine is not a contraindication to receiving an immunization. The nurse can still administer subsequent immunizations. - C: Recent exposure to an infectious disease is not a contraindication to receiving a vaccine. The nurse can still administer subsequent immunizations. - D: A family history to penicillin is not a contraindication to receiving a vaccine. The nurse can still administer subsequent immunizations.

A nurse is caring for a client who is at 28 weeks gestation and is experiencing preterm labor. Which of the following medications should the nurse plan to administer? A. Oxytocin B. Nifedipine C. Dinoprostone D. Misoprostol

B. Nifedipine Nifedipine is a tocolytic medication that is administered to stop preterm labor. - A: Oxytocin is an oxytocic medication that is used to stimulate uterine contractions for clients who are at term and to control postpartum hemorrhage. It is contraindicated for clients who are experiencing preterm labor. - C: Dinoprostone is an oxytocic medication that is used to stimulate uterine contractions for clients who are at term and to control postpartum hemorrhage. It is contraindicated for clients who are experiencing preterm labor. - D: Misoprostol is a prostaglandin that is used to promote ripening of the cervix and to induce labor. It is contraindicated for clients who are experiencing preterm labor.

A nurse is assessing a client who is receiving IV gentamicin 3 times daily. Which of the following findings indicates that the client is experiencing an adverse effect of this medication? A. Hypoglycemia B. Proteinuria C. Nasal congestion D. Visual disturbances

B. Proteinuria Proteinuria is a manifestation of nephrotoxicity, an adverse effect of gentamicin. The nurse should monitor for oliguria and hematuria. - A: Gentamicin can cause hypokalemia; however, hypoglycemia is not an adverse effect of gentamicin. - C: Gentamicin can cause apnea at high doses; however, nasal congestion is not an adverse effect of gentamicin. - D: Gentamicin can cause impaired hearing; however, visual disturbances are not adverse effects of IV gentamicin. Gentamicin administered by the ophthalmic route can cause eye photosensitivity, redness, itching, and excess tearing.

A nurse is caring for a client who has rheumatoid arthritis and a new prescription for etanercept. Which of the following values should the nurse review prior to the administration of the medication? A. Ability to swallow B. Results of last purified protein derivative (PPD) test C. Serum creatinine level D. Blood glucose level

B. Results of last purified protein derivative (PPD) test The nurse should identify that a client who is taking etanercept is at risk for infections such as tuberculosis (TB). To reduce this risk, the client should be tested for latent TB; if the test is positive, the client should undergo TB treatment before receiving etanercept. - During treatment with etanercept, the client should be monitored closely for the development of TB. - A: Etanercept is administered via injection. The client's ability to swallow should not affect the administration of this medication. - C: Etanercept does not require the nurse to review the client's serum creatinine level prior to the administration because this medication is not contraindicated in clients who have renal impairment and does not cause nephrotoxicity. However, it can cause injury to the liver. Therefore, liver function tests should be completed periodically. - D: Etanercept does not affect a client's blood glucose level. However, clients who have diabetes mellitus have an increased risk of infection.

A nurse is assessing an infant who is scheduled to receive the rotavirus vaccine. Which of the following criteria should the nurse identify as a potential contraindication for administering this vaccine? A. The infant is teething B. The infant has a history of intussusception C. The infant has been constipated for 3 days D. The infant is 9 weeks old

B. The infant has a history of intussusception The nurse should identify that the rotavirus vaccine is contraindicated for infants who have a history of intussusception. - The rotavirus vaccine is also contraindicated for infants who have an uncorrected gastrointestinal congenital malformation that could result in intussusception. - A: Teething is not a contraindication for receiving the rotavirus vaccine. It is safe to administer this vaccine to an infant who is teething. - C: Infants who have moderate to severe diarrhea or vomiting should not receive the vaccine until they recover. Therefore, constipation is not a contraindication for the administration of this vaccine. - D: The Advisory Committee on Immunization Practices (ACIP) recommends that all infants receive the rotavirus vaccine beginning around the age of 8 weeks. Therefore, receiving the rotavirus vaccine is not contraindicated for a 9-week-old infant.

A nurse is reviewing a new prescription for fexofenadine for a 7-year-old client who has seasonal allergies. Which of the following findings should the nurse clarify with the provider? A. The prescription says to avoid taking the medicine with orange juice B. The prescription says to take standard tablets C. The prescription says to take 30 mg twice daily D. The prescription says to administer the medicine orally

B. The prescription says to take standard tablets The nurse should identify that this 7-year-old client has been prescribed a standard tablet, which is appropriate for client 12 years of age and older. Therefore, the nurse should clarify this aspect of the prescription with the provider because a client who is 7 years old should be administered orally disintegrating tablets or an oral suspension. - A: The therapeutic effect of fexofenadine is decreased when taken with orange juice. Therefore, there is no need for the nurse to clarify this aspect of the prescription with the provider. - C: The nurse can administer fexofenadine 30 mg twice daily, which is an appropriate dosage for a 7-year-old child. There is no need for the nurse to clarify this aspect of the prescription with the provider. - D: The route of administration for fexofenadine is PO, or orally. There is no need for the nurse to clarify this aspect of the prescription with the provider.

A nurse is planning care for a client who is postoperative and scheduled to ambulate. At which of the following times should the nurse plan to administer PO morphine to the client for peak analgesic effect during the ambulation? A. 3 to 4 hr before ambulation B. 10 to 15 min before ambulation C. 60 to 90 min before ambulation D. Immediately before ambulation

C. 60 to 90 min before ambulation The peak effect of PO morphine takes 60 to 90 minutes to occur. Medicating the client 60 to 90 minutes prior to ambulation will provide the greatest analgesic effect. - A: At 3 to 4 hr, the client may not feel as much analgesic effect as necessary to avoid pain. - B: At 10 to 15 minutes, the client will feel a minimal analgesic effect from the medication. - D: Medicating the client immediately prior to ambulation will not allow enough time for any analgesic effect.

A nurse is caring for a client with a pseudomonas infection who has a new prescription for ticarcillin-clavulanate. Which of the following data should the nurse collect before administering this medication? A. Indications of superinfection B. Peak and trough medication levels C. Baseline BUN and creatinine D. History of allergy to aminoglycoside antibiotics

C. Baseline BUN and creatinine Ticarcillin-clavulanate is a penicillin antibiotic and is excreted by the kidneys. Therefore, any renal impairment could result in a toxic level of the medication. - The nurse should assess baseline BUN and creatinine levels and monitor these values throughout therapy. - A: A superinfection occurs when the normal flora is eliminated following the administration of a broad-spectrum antibiotic. Super-infections are caused by drug-resistant microbes and would not be seen until ticarcillin-clavulanate had been administered for several days. - B: Peak and trough levels are not monitored for penicillin antibiotics. Peak and trough levels are monitored for aminoglycoside antibiotics. - D: Ticarcillin-clavulanate does not have cross-sensitivity with amino glycoside antibiotics; therefore, assessing for an allergy to these antibiotics should not be necessary. Penicillin and aminoglycosides should not be infused through the same IV line.

A nurse in a provider's office is assessing a client who reports taking a dietary supplement to reduce hot flashes related to menopause. Which of the following supplements should the nurse expect the client to report taking? A. Flaxseed B. Ginkgo biloba C. Black cohosh D. St. John's wort

C. Black cohosh Black cohosh is an herb that is used for the treatment of menopausal symptoms such as hot flashes, vaginal dryness, irritability, and sleep disturbance. - A: Flaxseed is used to relive constipation and to reduce high cholesterol. It does not reduce hot flashes. - B: Ginkgo biloba improves blood flow and can reduce pain related to peripheral arterial disease. It does not reduce hot flashes. - D: St. John's wort is used to treat mild to moderate depression. It does not reduce hot flashes.

A nurse is reviewing the medical record of a client who is receiving hydrochlorothiazide (HCTZ). The nurse should expect to find an improvement in which of the following conditions as a result of this medication? A. Gouty arthritis B. Dehydration C. Diabetes insipidus D. Hypokalemia

C. Diabetes insipidus A thiazide diuretic such as HCTZ is administered to treat diabetes insipidus. - Diabetes insipidus is a condition in which there is an overproduction of urine. Thiazides reduce urine production by 30%-50%. - A: Gouty arthritis can be an adverse effect of HCTZ due to the retention of uric acid. The nurse should periodically monitor the client's plasma levels of uric acid. - B: Dehydration can be an adverse effect of thiazide medications such as HCTZ due to the loss of water, sodium, and chlorite. The nurse should weigh the client on a regular basis to monitor for dehydration. - D: Hypokalemia can be an adverse effect of taking HCTZ due to excessive potassium excretion. The nurse should monitor the client's potassium levels and encourage the client to eat potassium-rich foods.

A nurse is caring for an older adult client who has a new prescription for amitriptyline to treat depression. Which of the following diagnostic tests should the nurse plan to perform prior to starting the client on this medication? A. Hearing examination B. Glucose tolerance test C. Electrocardiogram D. Pulmonary function tests

C. Electrocardiogram Amitriptyline can cause tachycardia and ECG changes. An older adult client is at risk for cardiovascular effects while using amitriptyline; therefore, an ECG should be performed prior to the start of therapy to obtain a baseline of the client's cardiovascular status. - A: Amitriptyline can cause blurred vision; however, it does not affect hearing. - B: Amitriptyline does not cause hyperglycemia or alter glucose tolerance. - D: Amitriptyline does not affect pulmonary function.

A nurse is teaching a client who has severe generalized rheumatoid arthritis and is scheduled to start taking prednisone for long-term therapy. The nurse should instruct the client to report which of the following as an adverse effect of prednisone? A. Thrombosis B. Immunosuppression C. Gastric ulceration D. Liver toxicity

C. Gastric ulceration The nurse should instruct the client to monitor for gastric ulceration as an adverse effect of the long-term use of prednisone. Other adverse effects of this medication include osteoporosis and adrenal suppression. - A: The nurse should identify that NSAIDs can selectively inhibit COX-2 and can increase the risk of thrombotic events. - B: The nurse should identify that non-biological disease-modifying anti-rheumatic drugs (DMARDs) can cause immunosuppression. - D: The nurse should identify that methotrexate, which is a DMARD, can cause hepatotoxicity.

A nurse is monitoring a client who has diabetes insipidus and was administered desmopressin. Which of the following findings should indicate to the nurse the client is experiencing an adverse effect of this medication? A. Thirst B. Nocturia C. Headache D. Heart palpitations

C. Headache Headaches are an indicator of the adverse effect of water intoxication, which can occur as a result of taking desmopressin. This medication causes fluid retention and places the client at risk of water intoxication. - A: A client who has diabetes insipid will report frequent thirst due to a lack of antidiuretic hormone (ADH). Desmopressin is administered to stop the manifestations of diabetes insipid such as thirst by improving the reabsorption of water in the kidneys. - B: A client who has diabetes insipid will report nocturia and excessive urination due to a lack of ADH. Desmopressin is administered to stop the manifestations of diabetes insipid (e.g. nocturia and excessive urination) by improving the reabsorption of water in the kidneys. - D: A client who has diabetes insipid is at risk for dehydration. As the body attempts to compensate, the heart rate increases, causing heart palpitations. Desmopressin is administered to stop these manifestations of diabetes insipidus by improving the reabsorption of water in the kidneys.

A nurse is reviewing the medical history of a client who has spasticity due to multiple sclerosis and a new prescription for tizanidine. Which of the following co-morbidities increases the client's risk of adverse effects while taking this medication? A. Pneumonia B. Benign prostatic hypertrophy (BPH) C. Hepatitis D. Diabetes mellitus

C. Hepatitis Tizanidine can cause liver damage. This medication should be used with extreme caution in a client who has a preexisting impairment of hepatic function. - A: Tizanidine can cause urinary rhinitis; however, a history of pneumonia does not increase the client's risk of developing adverse effects while taking tizanidine. - B: Baclofen might cause urinary retention, which should be considered in male clients who have BPH. However, BPH does not increase the client's risk of developing adverse effects while taking tizanidine. - D: Clients who have diabetes mellitus do not have an increased risk of developing adverse effects while taking tizanidine.

A nurse is caring for a client who is taking fludrocortisone. Which of the following findings indicates to the nurse that the client is experiencing an adverse effect of the medication? A. Hypotension B. Weight loss C. Hypokalemia D. Anorexia

C. Hypokalemia The nurse should identify that hypokalemia is an adverse effect of fludrocortisone due to excessive sodium and water retention, resulting in the loss of excessive amounts of potassium. - A: The nurse should identify that hypertension is an adverse effect of fludrocortisone because the medication acts on the kidneys to promote the retention of sodium and water. - B: The nurse should identify that the client can experience the adverse effect of weight gain due to increased fluid retention. The client also can experience redistribution to the abdomen, face, and upper back. - D: The nurse should identify that increased appetite and nausea are adverse effects of fludrocortisone.

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

C. I can develop lithium toxicity if I experience vomiting or diarrhea Vomiting or diarrhea can cause electrolyte imbalances. If serum sodium decreases, lithium is retained by the kidneys, and the risk of lithium toxicity increases. - A: NSAIDs such as naproxen and ibuprofen increase renal reabsorption of sodium and lithium, which causes an increase in lithium levels and possible toxicity. Acetylsalicylic acid and sulindac are NSAIDs that do not affect lithium levels. - B: When sodium levels are low, lithium excretion by the kidneys is increased. Therefore, eating foods with larger amounts of sodium reduces the risk of lithium toxicity. Increased sodium intake can lead to excretion of lithium and a decreased lithium level. It is important for clients to eat normal and consistent amounts of sodium to maintain lithium levels. - D: Diuretics decrease kidney excretion of lithium, which causes lithium levels to rise and increases the potential for toxicity.

A nurse is teaching a female client who has a new prescription for misoprostol to treat peptic ulcer disease. Which of the following client statements should indicate to the nurse that the teaching was effective? A. I should avoid taking NSAIDs while using this medication B. Misoprostol is used to treat stress-induced gastric ulcers C. I should avoid becoming pregnant while taking this medication D. This medication is also used to treat dysmenorrhea

C. I should avoid becoming pregnant while taking this medication The nurse should identify that misoprostol is contraindicated during pregnancy and is classified as pregnancy risk category X by the FDA. It has the potential to stimulate uterine contractions, and the use of misoprostol during pregnancy has been known to cause partial or complete expulsion of the developing fetus. - A: Misoprostol is an analog of prostaglandin E. NSAIDs and aspirin can cause gastric ulcers by inhibiting prostaglandin synthesis. This makes misoprostol an ideal anti ulcer medication for clients who frequently take NSAIDs. - B: In the United States, misoprostol's only approved gastrointestinal indication is for the prevention of gastric ulcers. It is not approved for ulcer treatment. - D: Misoprostol has an adverse effect of dysmenorrhea and should not be given to treat this condition.

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

C. I should wait at least 30 minutes before taking this medication after I take an antacid The nurse should recognize that antacids can raise the gastric pH above 4, which can interfere with the effects of sucralfate. To minimize these interactions, sucralfate should be taken at least 30 minutes apart from antacids. - A: Sucralfate should be taken 1 hour before meals and at bedtime for optimal effectiveness. - B: Treatment with sucralfate lasts for about 4 to 8 weeks. The nurse should emphasize the importance of completing the entire prescribed treatment. - D: Sucralfate tablets are large and difficult to swallow but can be broken or dissolved in water before ingestion. Sucralfate tablets do not need to be swallowed whole.

A nurse is providing teaching to a client who has chronic constipation and a new prescription for psyllium. Which of the following instructions should the nurse provide? A. This medication is for short-term use only B. You should eat a low-residual diet while taking this medication C. Mix this medication with water and follow with an additional glass of liquid D. The medication's adverse effects of stomach cramps and nausea will go away in time

C. Mix this medication with water and follow with an additional glass of liquid The nurse should direct the client to administer the medication mixed in a full glass of water or juice followed by an additional glass of liquid. The client should also be instructed to increase intake of fluids to help decrease constipation. - A: Psyllium can be taken on a long-term basis for chronic constipation. - B: In addition to psyllium, dietary bulk and fiber should be increased in the client's diet to relieve constipation. - D: The nurse should instruct the client to not use laxatives, including psyllium, if abdominal pain, nausea, vomiting, or a fever occurs.

A nurse is teaching a client who has ADHD and is starting therapy with an amphetamine/dextroamphetamine mixture. Which of the following manifestations should the nurse instruct the client to identify as an adverse effect and report to the provider? A. Restlessness B. Insomnia C. Palpitations D. Weight gain

C. Palpitations The nurse should instruct the client that palpitations can be a sign of a cardiovascular adverse reaction and requires immediate attention. - The nurse should instruct the client to contact the provider if palpitations develop. - A: The nurse should instruct the client that this medication can cause restlessness. The nurse should also advise the client to eliminate dietary sources of caffeine such as coffee, tea, and other caffeinated beverages. - B: Because this medication can cause restlessness, the nurse should instruct the client to avoid taking the medication before sleep. Taking this medication adds to central nervous system stimulation and can result in increased instances of insomnia. - D: The nurse should instruct the client that this medication can cause weight loss due to appetite suppression.

A nurse is providing teaching to the parents of a child who has a new prescription for lamotrigine for a seizure disorder. The nurse should instruct the parents that which of the following adverse effects is the priority to report to the provider? A. Diplopia B. Dizziness C. Rash D. Headache

C. Rash The greatest risk to this client is an injury from Stevens-Johnson syndrome or toxic epidermal necrolysis, which are life-threatening reactions that manifest initially as a rash in the first 2 to 8 weeks of treatment with lamotrigine. - The nurse should instruct the parents to report a rash immediately to the provider. - A, B, & D: The child is at risk for diplopia, dizziness, and headache, which are common adverse effects of lamotrigine. While the nurse should instruct the parents to report all adverse effects to the provider, a rash is the priority.

A nurse is teaching self-administration of NPH insulin to a client who has type 2 diabetes mellitus. Which of the following instructions should the nurse include? A. Alternate injecting doses between the abdomen and the thigh B. Shake the vial before withdrawing the dosage C. Rotate injection sites within the same area D. Discard the vial if the insulin is cloudy

C. Rotate injection sites within the same area To prevent lipodystrophy, the client should rotate injection sites and keep them about 2.5 cm (1 in) apart within the same anatomical area. - A: Because absorption varies with the site of injection, the client should use the same general area such as the thigh or the abdomen each time. - B: The client should roll the vial between the palms, not shake it. - D: NPH insulin is a cloudy suspension. The client should discard other types of insulin the provider prescribes if the solution is cloudy.

A nurse is teaching a client who has diabetes mellitus about a new prescription for pioglitazone. Which of the following statements should the nurse include in the teaching? A. Monitor for hypoglycemia 6 hours after taking the medication B. This medication cannot be taken if you have a sulfa allergy C. This medication can be taken when using insulin D. This medication is effective for people with type 1 diabetes mellitus

C. This medication can be taken when using insulin The client can take pioglitazone when using insulin because pioglitazone increases the cellular response to insulin, and insulin is needed in order for the medication to be effective. - A: The client should monitor for hypoglycemia 2 to 4 hours after taking pioglitazone because the medication peaks in 2 to 4 hours after administration. - B: The client can take pioglitazone in the presence of a sulfa allergy because it is not a sulfa-based medication. - D: The client can take pioglitazone for type 2 diabetes mellitus, not type 1 diabetes mellitus. This is because insulin is needed in order for the medication to be effective and clients who have type 1 diabetes mellitus do not produce insulin.

A nurse is caring for a client who has severe asthma and allergic rhinitis. The client is taking theophylline. Which of the following medications should the nurse identify as being incompatible with theophylline? A. Cromolyn B. Albuterol C. Zafirlukast D. Methylprednisolone

C. Zafirlukast The nurse should identify that zafirlukast is a leukotriene receptor antagonist prescribed for asthma maintenance. Concurrent use of zafirlukast along with theophylline surpasses the metabolism of theophylline, which can lead to toxicity. Therefore, another medication should be used. - A: Cromolyn is a mast cell stabilizer that decreases inflammation of the airways or nasal passageways. This medication can be taken with theophylline without interaction. - B: Albuterol sulfate is a beta2-agonist that is used to treat acute bronchospasm. This medication can be prescribed along with the use of theophylline without interaction. - D: Methylprednisolone is an oral glucocorticoid that can be used for the long-term treatment and management of asthma. This medication decreases inflammation of the airways and can be prescribed with theophylline without interaction.

A nurse is caring for a client with premenstrual disorder (PMD) who has a prescription for fluoxetine. The client asks the nurse, "When should I notice the benefits of this medication?" Which of the following responses should the nurse make? A. You should expect decreased manifestations within a few days B. Manifestations decrease after about 2 months C. You should expect decreased manifestations immediately D. Manifestations will decrease after several weeks

A. You should expect decreased manifestations within a few days The nurse should inform the client that fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat PMD. Unlike using fluoxetine to treat depression, using fluoxetine to treat PMD will improve manifestations more quickly. - B: Fluoxetine is a SSRI used to treat PMD. This medication begins working in less than 2 months. - C: Manifestations of PMD do not decrease immediately. It takes time to decrease the manifestations associated with PMD. - D: Unlike using fluoxetine to treat depression, using fluoxetine to treat PMD will improve manifestations before several weeks.

A nurse is teaching a client about the use of a dinoprostone vaginal insert pouch to stimulate labor. Which of the following statements should the nurse include in the teaching? A. It is inserted using a catheter B. One pouch is given every 4 hours until labor occurs C. Lie on your back for at least 2 hours without getting up D. If labor doesn't occur within 6 hours, a second dose can be administered

C. Lie on your back for at least 2 hours without getting up The client should remain supine for at least 2 hours after the dinoprostone vaginal pouch is inserted to allow a slow release of the medication from the pouch to stimulate labor. - A: Dinoprostone gel, not the vaginal insert pouch, is administered by endocervical catheter. To prevent leakage when using the gel, the client should remain supine for at least 30 minutes. - B & D: The dinoprostone vaginal insert pouch releases the medication slowly until active labor occurs or is removed after 12 hours.

A nurse is monitoring a client who is receiving terbutaline to suppress preterm labor. Which of the following findings should indicate to the nurse that the client is experiencing an adverse effect of the medication? A. BP 132/84 mmHg B. Blood glucose 106 mg/dL C. Decreased deep tendon reflexes D. Maternal heart rate >120/min

D. Maternal heart rate >120/min A client who is receiving terbutaline can experience tachycardia, which poses a significant risk to the mother. Therefore, when the maternal heart rate exceeds 120/min, the medication should be stopped. - Adverse effects result from activating beta1 receptors as well as beta2 receptors. - A: A client who is receiving can experience hypotension. A BP of 132/84 is within the expected reference range. - B: A client who is receiving terbutaline can experience hyperglycemia. A blood glucose of 106 is within the expected reference range. - C: Decreased or absent deep tendon reflexes are an early manifestation of elevated magnesium levels in a client who is receiving magnesium sulfate.

The nurse is caring for a client who has had a levonorgestrel-releasing intrauterine device (IUD) in place for 1 year. Which of the following findings should indicate that the client is experiencing an adverse effect? A. Developed sensitivity to copper B. Vaginal irritation or inflammation C. Decreased menstrual bleeding D. Spotting between menses cycles

D. Spotting between menses cycles Light spotting and amenorrhea are common adverse effects for clients who use a levonorgestrel-releasing IUD. IUDs can alter menses, prompting spotting between menstruation periods. - A: The levonorgestrel-releasing intrauterine device IUD is made of plastic and does not contain copper. - B: Vaginitis is a common adverse effect of a vaginal contraceptive ring but not of an IUD. IUDs can produce a localized inflammatory response in the uterus, but this reaction is harmless unless the client develops a pelvic inflammatory infection. - C: This type of IUD relates levonorgestrel, which generally reduces menstrual bleeding over time and decreases menorrhagia in clients who use an IUD for contraception. A decrease in menstrual bleeding is not an adverse effect of the device.