Pharmacology Review

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

50 mL : 30 min. = ___ mL : 60 min. 100 mL

While in the emergency department, a 68-year-old client being treated for flu symptoms, became symptomatic with an episode of atrial tachycardia which was successfully treated with cardioversion. After stabilization, the client was admitted to the telemetry unit with a diagnosis of the flu and a history of angina. Primary healthcare provider prescriptions were received. What is most important for the nurse to ensure prior to administering Peramivir? - Bedrest with bathroom privileges. - Continuous cardiac monitoring. - ½ Normal Saline at 75 mL/hour. - 2 gm Low sodium diet. - Peramivir 600 mg IVPB times one dose. - ECG every 8 hours times three. - Lab: CBC, sodium, potassium, BNP, Troponin, Creatinine clearance, Urinalysis 1. Creatinine clearance is greater than 50 mL/min. 2. Pulse greater than 70 beats/min. 3. Cardiac rhythm showing normal sinus rhythm. 4. Oral temperature of less than 101° F (38.3° C)

First, what is peramivir? It is an inhibitor of the influenza virus and is indicated for the treatment of acute influenza in clients over the age of 2 years who have been symptomatic for no more than 2 days. 1. Correct: The dose of this medication needs to be decreased if the creatinine clearance of a client is less than 50 mL/min, so the nurse must know the prescribe creatinine clearance level of this client prior to administering peramivir. 2., 3., & 4. Incorrect: Few side effects or adverse reactions are noted with peramivir. There is no need to monitor the heart rate prior to administration. There is no need to monitor the cardiac rhythm prior to administration. There is no need to monitor the temperature prior to administration.

The primary healthcare provider prescribes an intravenous infusion of D5W at 125 mL per hour. The tubing has a drop factor of 20 gtt/mL. How many drops per minute should the nurse administer? Round answer to the nearest whole number.

(125 x 20)/60 = 41.666 Since partial drops cannot be counted, always round to the nearest whole number which, is 42.

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

1., 4. & 5. Correct: Narcotics sedate and decrease the respiratory rate, which increases CO2 retention. Always monitor respiratory rate. Some antiemetics (such as promethazine) are very sedating and will decrease the respiratory rate while increasing CO2 retention. Sleeping pills can cause sedation to the point of hypoventilation, which leads to CO2 retention. Always monitor respiratory rate. 2. Incorrect: Diuretics do not affect breathing patterns. 3. Incorrect: Steroids do not affect breathing patterns.

How should a nurse prepare to administer a Measles, Mumps, Rubella (MMR) vaccination to a 6 year old child? 1. 3 mL syringe with 23 gauge, 1" needle for IM injection 2. Use a 25 gauge, ¾" needle for subcutaneous (Sub-Q) injection. 3. Prime intranasal spray for administration. 4. Tuberculin (TB) syringe with 28 gauge, 3/8" needle for intradermal injection.

2. Correct: MMR is given Sub-Q. Subcutaneous injections are administered in the fat layer, underneath the skin. When administering SQ injections use a 23-25 gauge needle, needle length for infants (1- 12 months) is 5/8", children 12 months and older 5/8" - ¾". 1., 3., & 4. Incorrect: MMR is given Sub-Q.

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

3. Correct: If a catheter becomes partially blocked due to a fibrin sheath or loses its blood return, a fibrinolytic is typically prescribed. Currently, alteplase is the preferred thrombolytic to treat thrombotic occlusions. 1. Incorrect: Systemic anticoagulation with heparin for treatment of a fibrin sheath has not been proven to be beneficial. 2. Incorrect: Enoxaparin is a low dose molecular heparin and is not beneficial in treating a fibrin sheath. 4. Incorrect: One of the effects of acetylsalicylic acid is its inhibition of platelet aggregation. However, these blood thinning effects are not beneficial in treatment of a fibrin sheath.

The nurse is caring for a client admitted with an episode of bleeding esophageal varices. What should the nurse monitor for after administering propranolol to this client? Select all that apply 1. Increased systolic BP 2. Hypokalemia 3. Bradycardia 4. Wheezing 5. Decreased hematemesis

3., 4., & 5. Correct: Propranolol is a beta blocker that affects the heart and circulation. It is used in the treatment of high blood pressure, irregular heartbeats and in the prevention of angina and headaches. This medication works by blocking epinephrine and reduces heart rate, blood pressure and strain on the heart. Decreasing the heart rate should decrease bleeding. Wheezing is an adverse reaction from propranolol and should be monitored for after administration. A decreased in heart rate and blood pressure will help to decrease bleeding. Hematemesis is vomiting blood. 1. Incorrect: Blood pressure is the force of blood flow against the walls of your arteries. Propranolol should decrease blood pressure, thus decreasing bleeding. 2. Incorrect: Beta blockers inhibit renin release which can decrease the release of aldosterone. We should monitor for hyperkalemia, rather than hypokalemia.

Which action by the nurse administering intravenous ciprofloxacin would require intervention by the charge nurse? 1. Sets IV pump to administer ciprofloxacin over a period of 30 minutes. 2. Educates client that medication may cause dizziness. 3. Instructs client to notify nurse for any tendon pain. 4. Administers ciprofloxacin through 20 gauge catheter into the cephalic vein.

1. Correct: Cipro IV should be administered to by intravenous infusion over a period of 60 minutes. Slow infusion of a dilute solution into a larger vein will minimize client discomfort and reduce the risk of venous irritation. 2. Incorrect: This action does not require intervention by the charge nurse as dizziness is a side effect of this medication. 3. Incorrect: This is a correct action. Fluoroquinolones, including Cipro IV, are associated with an increased risk of tendinitis and tendon rupture in all ages. This adverse reaction most frequently involves the Achilles tendon, and rupture of the Achilles tendon may require surgical repair. Tendinitis and tendon rupture in the rotator cuff (the shoulder), the hand, the biceps, the thumb, and other tendon sites have also been reported. 4. Incorrect: Slow infusion of a dilute solution into a larger vein will minimize client discomfort and reduce the risk of venous irritation.

A client becomes progressively cyanotic and unresponsive post central line insertion. Which action should the nurse take? 1. Place the client on the left side with the client's head down. 2. Administer a thrombolytic agent. 3. Auscultate the client's heart sounds. 4. Have the client bear down and perform valsalva maneuver.

1. Correct: The nurse should immediately place the client in the left side-lying position with the client's head down. This position will trap a bubble in the right ventricle preventing it from passing into the pulmonary circulation. 2. Incorrect: Thrombolytic agents are not indicated in this scenario. 3. Incorrect: Auscultation of heart sounds would be an assessment performed after the client has stabilized. 4. Incorrect: The client would not be able to perform valsalva because the client is unresponsive.

In which situations should the nurse notify the primary healthcare provider of a medication incident? Select all that apply 1. Every occurrence. 2. Client is harmed or dies. 3. Medication incident is a near miss. 4. Nurse administers an incorrect dosage. 5. Client questions the medication color.

2. & 4. Correct: The primary healthcare provider should be notified if harm is brought to the client or death occurs as a result of the medication incident. The primary healthcare provider should be notified if the nurse administers an incorrect dosage to the client, and an incident report needs to be completed in this situation. 1. Incorrect: The primary healthcare provider should be notified if harm is brought to the client but not for all events with medications. An incident report should be completed so the hospital can track incident patterns for quality improvement. 3. Incorrect: Near misses do not need to be reported to the primary healthcare provider. Following the rights of medication administration every time ensures medication error prevention. 5. Incorrect: The nurse should answer questions regarding medication color. Depending on the manufacturer, the shape and color of the medication can vary.

Which prescription should the nurse question when a client is receiving spironolactone 25 mg by mouth daily? 1. Digoxin 0.125 mg by IVP daily 2. Potassium chloride 40 mEq orally TID 3. Cimetadine 200 mg IVPB q6h 4. Metoprolol 100 mg PO daily

2. Correct: Do not give potassium supplements, salt substitutes, or angiotensin-converting enzyme inhibitors to clients taking potassium sparing diuretics because these drugs can increase the risk of developing high to extremely high blood potassium levels. 1. Incorrect: This medication does not adversely interact with potassium sparing diuretics; however, the nurse should be on the alert for digoxin toxicity with hyper or hypokalemia. 3. Incorrect: Cimetadine is a H2 receptor antagonist indicated for ulcers and GI complaints. It does not adversely interact with potassium sparing diuretics. 4. Incorrect: This medication is a beta blocker, which may be given in addition to a diuretic for hypertension control.

What is the primary electrolyte imbalance that the nurse should monitor for in a client who is receiving an insulin infusion? 1. Hypernatremia 2. Hypokalemia 3. Hypocalcemia 4. Hypophosphatemia

2. Correct: Insulin causes movement of potassium into the cells, which can lead to a severe reduction in serum potassium if not regulated appropriately. A severe decrease in serum potassium could be fatal. 1. Incorrect: Although insulin has been shown to increase sodium reabsorption in the kidneys, the change is not as rapid and not as life threatening as the change in potassium. 3. Incorrect: A significant change in the calcium level is not anticipated with the insulin infusion. 4. Incorrect: A significant change in the phosphorus level is not anticipated with the insulin infusion.

Which assessment finding by the nurse is likely to be the result of long-term corticosteroid use in a client? Select all that apply 1. Occasional nausea that occurs after eating the evening meal. 2. A wound that is slow to heal. 3. Weight loss of 15 pounds (6.8 kg) over a 6 week period. 4. The appearance of acne on the forehead and cheeks. 5. Vertebral compression fracture.

2., 4., & 5. Correct: Suppression of the immune system occurs with long-term steroid use. This leads to slow wound healing. Acne is sometimes seen with steroid use due to oily skin and overproduction of the acne bacterium. Osteoporosis risk is increased with long-term use of steroids. Remember steroids pull calcium from the bone and place it in the blood. 1. Incorrect: Nausea is not commonly seen with steroid use. 3. Incorrect: Changes in metabolism usually lead to weight gain, not weight loss.

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

1. Correct. Clients taking MAOIs cannot consume foods containing large amounts of tyramine. MAOIs block monoamine oxidase which breakdown tyramine. Having a MAOI prescribed and eating a diet high in tyramine can cause a severe increase in blood pressure. Smoked ham and avocados are high in tyramine. 2. Incorrect. Clients taking these medications cannot eat the following foods: sausage, salami, liver, or bologna which have high levels of tyramine. 3. Incorrect. Clients taking these medications cannot consume beer, sherry, chianti wines, or ales due to their high tyramine levels. 4. Incorrect. Consuming blue cheese on a salad may result in a hypertensive crisis due to the presence of tyramine.

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

1. Correct: Antisecretory agents like proton pump inhibitors are indicated for the treatment of peptic ulcer disease. Antisecretory agents decrease the secretion of gastric acids. Protein pump inhibitors, a combination of antibiotics and bismuth salts are most commonly used for treatment of H Pylori. 2. Incorrect: Mitotic inhibitors are chemotherapeutic agents that are indicated for the treatment of malignancies and cancerous cells. They are most often used in combination chemotherapy regimens to enhance the overall cytotoxic effect. 3. Incorrect: Serotonin antagonists are antiemetic agents that are indicated for the treatment of nausea and vomiting. Serotonin antagonists block the serotonin receptor sites located throughout the body responsible for the mediation of nausea and vomiting. 4. Incorrect: Acetylsalicylic acid is a non narcotic analgesic that inhibits the cox-2 protective mechanisms to the gastric mucosa. This could make the ulcer worse. Clients are advised to avoid the use of NSAIDs and acetylsalicylic acid due to increased bleeding potential.

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

1. Correct: Applesauce is an appropriate baby food for a 9 month old infant. The medication is being mixed with a very small amount of baby food to facilitate all of the medication being consumed. 2. Incorrect: Although the medication can be administered directly into the mouth, a 9 month old is not likely to tolerate medication granules being placed in the back of the mouth and would likely spit the medication out or gag when the medication is placed in the back of the mouth, 3. Incorrect: The medication is being placed in too much juice. The infant might not drink this amount and would not receive all of the medication ordered. 4. Incorrect: If the child does not eat the entire amount of the cereal, the child would not receive the prescribed dose of the medication.

Which comment made by a new nurse regarding calcium gluconate 1000 mg (10 mL) IV indicates to the charge nurse that further education is needed? 1. "Infusion rate should be 5 mL/minute." 2. "Calcium gluconate will counteract the effects of the client's hyperkalemia." 3. "I will monitor for hypophosphatemia after administering this medication." 4. "This medication is given to reverse the effects of hypermagnesemia."

1. Correct: Calcium gluconate is administered IVP very slowly. Rapid injection may cause vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias and even cardiac arrest. The max rate is 1.5- 2 mL/min. Administration at a faster rate would indicate further education is needed. 2. Incorrect: This is a correct statement by the new nurse, indicating that the nurse understands the use of this medication. It counteracts the effects of hyperkalemia on cardiac excitability. 3. Incorrect: This is a correct statement. Calcium and phosphorus have an inverse relationship to each other. As calcium goes up, phosphorus goes down. Hypophosphatemia may occur after administration. 4. Incorrect: This is a correct statement. Calcium gluconate is used to treat calcium deficiencies as well as magnesium sulfate overdose.

On morning rounds, the nurse finds a somnolent client with a blood glucose of 89 mg/dL(4.9 mmol/L). A sulfonylurea and a proton pump inhibitor are scheduled to be administered. What is the nurse's best action? 1. Give the proton pump inhibitor and hold the sulfonylurea until the client eats. 2. Hold the medications and notify the primary healthcare provider. 3. Arouse the client and give some orange juice with sugar packets added. 4. Give the medications as prescribed and re-check the blood sugar in one hour.

1. Correct: Sulfonylureas are a class of oral hypoglycemics and should be held until after a meal in a client with a blood glucose of 89mg/dl. 2. Incorrect: It is not necessary to call the primary healthcare provider; you are just waiting until the client eats. Also, the proton pump inhibitor does not affect blood glucose levels and should be administered. 3. Incorrect: A blood glucose of 89mg/dl is not hypoglcemia, do not treat unless the blood glucose drops to or below the 70-80 range. 4. Incorrect: If you administer the sulfonylurea, you are going to cause the client to secrete insulin from their pancreas, causing the blood sugar to drop and cause hypoglycemia.

A client is admitted to the surgical unit with cholelithiasis and a history of psychosis and a known allergy to phenothiazines. Which prescription should the nurse discuss with the primary healthcare provider? Orders - Clear liquid diet - Gallbladder ultrasound - IV of LR with KCL 20 mEq at 125 ml/hr - Thioridazine 50 mg PO TID ​- Ciprofloxicin 200 mg IVPB q 12 hours - Haloperidol 5 mg PO BID - Ondansetron 4 mg IM PRN for N/V Allergies - Phenothiazines ​- Penicillin 1. Thioridazine 50 mg PO tid 2. Ciprofloxicin 200 mg IVPB every 12 hours 3. Haloperidol 5 mg PO bid 4. Ondansetron 4 mg IM prn nausea or vomiting

1. Correct: The client is allergic to phenothiazines. Thioridazine is a phenothiazine and should not be given to this client. 2. Incorrect: Ciprofloxicin is an antibiotic but is not a penicillin drug; therefore, it can be administered to this client. 3. Incorrect: Haloperidol is an antipsychotic medication. The classification is butyrophenone, not a phenothiazine. 4. Incorrect: Ondansetron is an antiemetic and is an appropriate drug for this client.

A client with an ischemic stroke was prescribed warfarin 5 mg daily by mouth 48 hours ago. At 0830 the international normalized ratio (INR) reading was 2.0. What action should the nurse take? 1. Administer warfarin. 2. Administer phytonadione. 3. Request the lab to run another INR. 4. Notify the primary healthcare provider about the INR level.

1. Correct: The nurse should continue to monitor the client and administer the warfarin. The normal range for INR is 0.8 - 1.1 for a client not prescribed an anticoagulant. The optimal therapeutic INR range for a client on warfarin should be 2.0 - 3.0. 2. Incorrect: Phytonadione is administered to reverse the anticoagulant effects of warfarin. Since the INR is within the acceptable therapeutic INR range (2.0 - 3.0) for a client prescribed an anticoagulant, the phytonadione should not be prescribed. 3. Incorrect: The INR reading of 2.0 is not within the critical level for a client prescribed an anticoagulant. It is not necessary to notify the lab to run another INR. 4. Incorrect: There are client situations where the primary healthcare provider should be consulted. In this situation the primary healthcare provider does not need to be notified since the INR of 2.0 is within the acceptable range of a client prescribed warfarin.

The nurse is reviewing the medication prescriptions with a client for which English is a second language (ESL). Which nursing intervention most likely will prevent a medication error with this client? 1. Use the teach-back method so that client is repeating the instructions back to the nurse. 2. Give printed information to the client. 3. Ask the client if they have questions before the client leaves the healthcare setting. 4. Refer medication questions to the pharmacist.

1. Correct: The teach-back method of asking the client to repeat the teaching instructions to the nurse will most likely reveal any misunderstanding. This allows the nurse to reinforce any areas where clarification is needed. 2. Incorrect: Printed information may or may not be helpful, depending on the client's level of understanding. 3. Incorrect: The client may not know which questions to ask regarding the medication, particularly if there is a language barrier. 4. Incorrect: The client may not ask another person for help. There has been no relationship established with the pharmacist since the nurse has been providing the teaching. The nurse should not put this responsibility on someone else in the interdisciplinary team.

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

1. Correct: Thiazolidinediones may reduce the plasma concentration of the contraceptives. Additionally, post-menopausal women may resume ovulation. 2. Incorrect: Thiazolidinediones may lead to weight gain and exacerbate congestive heart failure. 3. & 4. Incorrect: With thiazolidinediones therapy, therapeutic effect may not be reached until 8 to 12 weeks of treatment.

A school nurse is planning a session on the effects of cannabis use for a high school health class. Which information does the nurse need to include? Select all that apply 1. Cannabis ingestion can cause tachycardia. 2. Inhaled cannabis produces a greater amount of tar than tobacco. 3. Cannabis smoke contains more carcinogens than tobacco smoke. 4. Cannabis ingestion reduces the risk for heart disease 5. Orthostatic hypotension can be caused by cannabis ingestion.

1., 2., 3. & 5. Correct: Tetrahydrocannabinol (THC) is the chemical compound in cannabis. THC enters the blood stream quickly and is transported to the brain and other organs. Within minutes, the heart rate may increase by 20-50 bpm and last for up to 3 hours. Cannabis ingestion may cause tachycardia and orthostatic hypotension. Cannabis smoke contains more carcinogens and tar than tobacco. Lowering of blood pressure during use is common and can lead to orthostatic hypotension. 4. Incorrect: Research has indicated that the ingestion of cannabis increases the risk for heart disease.

The client's EEG revealed epileptiform abnormalities predictive of seizure activity and was started on valproic acid 500 mg PO twice a day. What nursing interventions should the nurse include in this client's plan of care? Select all that apply 1. Assess for changes in mood. 2. Check for upper stomach pain and jaundice. 3. Monitor ALT and AST. 4. Teach client not to discontinue medication abruptly. 5. Instruct client to take acetaminophen for mild pain.

1., 2., 3., & 4. Correct: Some clients have suicidal thoughts when first taking this medication. Upper stomach pain and jaundice could be signs of liver or pancreas problems. ALT and AST are your liver enzymes and you better be watching those because valproic acid can cause serious, even fatal hepatotoxicity. Clients should never discontinue anti-seizure meds abruptly. 5. Incorrect: False because acetaminophen is hepatotoxic! Let's pick another pain reliever since we know valproic acid can be hepatotoxic.

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

1., 2., 3., & 5 Correct: Signs of hepatotoxicity from this medication include dark urine, jaundice, and clay-colored stool. Isoniazide- induced pyridoxine (Vitamin B6) depletion causes neurotoxic effects. Vitamin B6 supplementation of 10-50 mg usually accompanies isoniazid use. Aged cheeses and smoked fish are high in tyramine which may cause palpitations, flushing, and blood pressure elevation while taking isoniazid. Avoid these foods during treatment. Isoniazid should be taken on an empty stomach, one hour before or two hours after food. Some clients experience orthostatic hypotension while taking isoniazid, so caution against rapid positional changes. 4. Incorrect: Histamine containing foods such as tuna and yeast extracts may cause exaggerated drug response (H/A, hypotension, palpitations sweating, itching, flushing, diarrhea).

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

1., 2., 4. & 5. Correct: AST is a liver function test. Liver function tests including AST should be monitored before, at 12 weeks after initiation of therapy or after dose elevation, and then every 6 months. If AST levels increase to 3 times normal, atorvastatin should be reduced or discontinued. Atorvastatin may increase alkaline phosphatase and bilirubin levels. Atorvastatin is a lipid-lowering agent/HMG-CoA reductase inhibitor. The expected outcome of treatment with atorvastatin is lower serum cholesterol and triglycerides. 3. Incorrect: The CBC results would not be used to evaluate the effectiveness of treatment with atorvastatin. The CBC is used to evaluate your overall health and can be used to measure components and features of your blood such as RBC'c, WBC's, Hgb, Hct and platelets.

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

1., 2., 4. & 5. Correct: The client should comply with regular follow up visits for checks of INR level. INR is the international normalization ratio and is used for clients taking anticoagulants (blood thinning medications). The client should eat a normal healthy diet, but should not increase foods containing high amounts of vitamin K. The client should report using warfarin to any primary healthcare provider, as treatment may be changed due to this medication. The client should not manipulate the dosage unless instructed by the primary healthcare provider. An identification card or bracelet may also be recommended in case of emergencies. Clients should inform dentists and other healthcare providers especially before a medical procedure. The anticoagulant effect must be closely monitored. 3. Incorrect: Vitamin K reverses the anticoagulant effects of warfarin, so instruct the client to avoid foods high in vitamin K (examples are green leafy vegetables, brussels sprouts, prunes, cucumbers and cabbage).

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

1., 2., 4., & 5. Correct: Disulfiram works by reacting with alcohol to produce negative side effect which may last up to two weeks after discontinuation of the drug.The client should not consume any alcohol including hidden alcohol such as mouthwash and cough syrups. Disulfiram is not a cure for alcoholism. It is used in combination with supportive care and psychotherapy. Disulfiram can increase the side effects of caffeine, so avoid chocolate and other caffeine containing substances. 3. Incorrect: Not even a small amount of alcohol can be ingested. This includes sauces and foods made with alcohol vinegar and vanilla extract. Meat holds on to alcohol, so chili with beer in the sauce should not be consumed. Additionally, do not use after shave, cough mixtures, or rubbing alcohol.

What medications should the nurse anticipate the primary healthcare provider prescribing for the client with portal hypertension and bleeding esophageal varices associated with advanced cirrhosis? Select all that apply 1. Oxygen 2. Clopidogrel 3. Propranolol 4. Vitamin K 5. Lactulose

1., 3., 4., & 5. Correct: We know that they need oxygen because they may have been bleeding. Propranolol acts to reduce portal venous pressure and reduce esophageal varices bleeding. Vitamin K is a clotting factor and helps to correct clotting abnormalities because of the damaged liver. Lactulose decreases what? Ammonia, which is elevated with cirrhosis. 2. Incorrect: You don't want to give them a platelet aggregation inhibitor. They are already bleeding.

A client diagnosed with hypothyroidism has been taking levothyroxine in increasing doses over the past week. Which findings, if present, would indicate to the nurse that the drug dosage is too high? Select all that apply. 1. Irritability 2. Weight gain 3. Tachycardia 4. Tremors 5. Headache 6. Bradycardia

1., 3., 4., & 5. Correct: When a nurse administers levothyroxine, there is an expected therapeutic response of an increase in energy, improved affect, improved gastric motility, weight loss, and less sensitivity to cold. If the levothyroxine dose is too high, the client may experience tachycardia, dysrhythmias, tremors, and a headache. When the levothyroxine level is too high, the symptoms are the same as hyperthyroidism. 2. Incorrect: Weight gain is a symptom of the decreased level of the thyroid hormones, T3 and/or T4. This is a symptom of hypothyroidism. 6. Incorrect: Bradycardia is a symptom of hypothyroidism. This is a result of a decrease in the thyroid hormones, T3 and/or T4 is a S/S of hypothyroidism.

The nurse is caring for a client on the cardiac unit. Which assessments are most important for the nurse to perform prior to the administration of diltiazem? Select all that apply 1. Note the rate and character of the apical pulse. 2. Ausculate the anterior and posterior breath sounds. 3. Check the morning results of serum calcium. 4. Review the last 24 hour urine output. 5. Monitor blood pressure. 6. Assess for chest pain.

1., 5., & 6. Correct: Diltiazem is a calcium channel blocker. It works by relaxing the muscles of the heart and blood vessels. Monitor blood pressure and pulse before and frequently during administration of diltiazem, as it causes systemic vasodilation and suppresses arrhythmias. Diltiazem is used to treat angina, so the nurse should assess for anginal pain. 2. Incorrect: Breath sounds need to be assessed to monitor for signs of heart failure, this would be a complication after diltiazem administration. Breath sounds are not necessarily assessed just prior to administration. 3. Incorrect: Diltiazem is a calcium channel blocker, but the total serum calcium concentration is not affected by it. Calcium channel blockers affect the flow of calcium into muscle cells. 4. Incorrect: A decrease in output would be an indicator of heart failure, which is a complication of diltiazem administration. This would be assessed after giving the medication.

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

2. Correct: Both of these drugs can cause CNS depression. There is a drug to drug interaction between antiseizure medications and antihistamines. Loratadine is the only medication in the answer options that can cause CNS depression. 1. Incorrect: Lovastatin is indicated for the treatment of increased cholesterol and triglyceride levels. There is no drug to drug interaction that exists between phenobarbital and lovastatin. 3. Incorrect: Lansoprazole is a proton-pump inhibitor indicated for the treatment of stomach ulcers and GI complaints. There is no drug to drug interaction that exists between phenobarbital and lansoprazole. 4. Incorrect: Lactulose is an ammonia reducer and laxative. It is indicated for the treatment of constipation and to decrease the ammonia level in the treatment of client's with liver disease. There is no drug to drug interaction that exists between phenobarbital and lactulose.

An occupational health nurse is reviewing the current medications of a client who has recently been prescribed propranolol for hypertension. Which current medication taken with propranolol by the client should be of concern to the nurse? 1. Cyanocobalamin 2. Melatonin 3. Cetirizine 4. Esomeprazole

2. Correct: Melatonin is a manmade form of the hormone that is key in regulation your body's internal clock. It is often used in treating sleep disorders. Melatonin can raise blood pressure in people who are taking beta blockers to control blood pressure. Avoid using it in conjuction with propanolol or any other beta blockers. 1. Incorrect: There are no known interactions between propranolol and Vitamin B12 (cyanocobalamin). Vitamin B12 is one of the essential vitamins and can be found in meat, fish and dairy. 3. Incorrect: There are no known interactions between propranolol and Zyrtec (cetirinzine). Cetirinzine is an antihistamine used to treat cold or allergy symptoms. This medication may cause severe drowsiness. 4. Incorrect: There are no known interactions between propranolol and Nexium (esomeprazole). Esomeprazole is a proton inhibitor that decreases stomach acid, and remember, it is not used for immediate relief of heartburn symptoms.

A client diagnosed with bipolar mania was prescribed lithium carbonate 2000 mg daily two months ago. What is the nurse's best action? Sodium - 143 mEq/L Potassium - 4.5 mEq/L Magnesium - 1.9 mEq/L Serum Lithium - 1.8 mEq/L 1. Record the lab results in the chart and recheck in one month. 2. Inform the primary healthcare provider that the Lithium level is too high. 3. Notify the primary healthcare provider because the Sodium level is too high. 4. Let the primary healthcare provider know that the Magnesium level is too low.

2. Correct: The appropriate serum lithium level for acute mania is 1.0 to 1.5 mEq/L. For maintenance it is 0.6 to 1.2 mEq/L. Levels exceeding 1.5 to 2.5 mEq/L begin to produce toxicity. Acute lithium toxicity symptoms are dizziness, vomiting, coma, hand tremors, lack of coordination of arms and legs and uncontrollable eye movement. 1. Incorrect: All lab results should be documented, however, the lithium needs to be reported so that the dose can be adjusted. 3. Incorrect: The sodium level is normal: 135-145 mEq/L (135-145 mmol/l). 4. Incorrect: The magnesium level is normal: 1.3 - 2.1 mEq/L (0.65-1.05 mmol/l).

The nurse is assigned a group of clients. For which client would the use of acetaminophen pose a higher risk? 1. 42 year old female who abuses cocaine. 2. 54 year old male who abuses alcohol. 3. 23 year old female who has asthma. 4. 34 year old male with sickle cell anemia.

2. Correct: The use of acetaminophen poses a higher risk for the client who abuses alcohol due to its interaction with the liver. Clients should be educated to be cautious if using acetaminophen due to the hepatotoxicity that can occur with liver dysfunction and failure. 1. Incorrect: Clients who use cocaine do not carry a higher risk of hepatotoxicity with acetaminophen use. 3. Incorrect: Clients who have a history of asthma do not carry a higher risk of hepatotoxicity with acetaminophen use. 4. Incorrect: Pain management should follow the "analgesic ladder" recommended by the World Health Organization for the treatment of cancer-related pain. The choice of analgesic and the dosage should be based on the severity of pain in the individual client. The ladder starts with nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen for mild-to-moderate pain. Because clients with sickle cell disease have varying degrees of hepatic impairment, acetaminophen may be contraindicated. So, the alcoholic client is at greatest risk.

A client who has been prescribed zolpidem for insomnia has received medication education. Which statement by the client indicates to the nurse that education was successful? 1. "There is a high potential for tolerance with this medication." 2. "I may do things in my sleep that I will not remember the next day." 3. "Daytime drowsiness is rare when taking this medication." 4. "The most common side effects of this medication are confusion and a bitter aftertaste."

2. Correct: This is a true statement. Zolpidem is a sedative, also called a hypnotic. It affects chemicals in the brain that may be unbalanced in people with sleep problems (insomnia). Zolpidem may impair the client's thinking or reactions. The client may still feel sleepy the morning after taking this medicine, especially if taking the extended-release tablet. Wait at least 4 hours or until fully awake before doing anything that requires being awake and alert. Some people using this medicine have engaged in activity such as driving, eating, walking, making phone calls, or having sex and later having no memory of the activity. 1. Incorrect: This is a schedule 4 substance. There is a low potential for tolerance, dependence, or abuse with this medication. 3. Incorrect: Daytime drowsiness and dizziness are common side effects. 4. Incorrect: Daytime drowsiness and dizziness are the most common side effects. Bitter aftertaste does not occur with this medication.

A client with a history of adrenal insufficiency is placed on fludrocortisone. Which value is most important for the nurse to monitor? 1. Magnesium 2. Weight 3. Pain 4. Glucose

2. Correct: Weight is monitored daily to assess for sudden increases which would indicate fluid retention. Fludrocortisone is a man made glucocorticoid and is used to treat low glucocorticoid levels caused by diseases of the adrenal gland. Glucocorticoids are important in maintaining salt and water balance in the body and normalizing blood pressure. 1. Incorrect: No, monitor for lowered serum potassium instead of magnesium because fludrocortisone causes the body to retain sodium, and excrete calcium and potassium. 3. Incorrect: Adrenal insufficiency and steroid therapy are not precursors of pain. 4. Incorrect: Glucose may increase as a result of steroid therapy as glucocorticoids inhibit insulin. But, weight is the critical value to monitor for dosing, as treatment may be discontinued with a sudden weight increase.

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

2., 3., 4., & 5. Correct: Assume the worst, and stop the transfusion first, then continue with the assessment. Low back pain is a sign of an acute hemolytic reaction. This is the most dangerous and potentially life-threatening type of transfusion reaction. It occurs when the donor blood is incompatible with that of the recipient. Get lab tests such as a urinalysis to check for presence of hemoglobin, which indicates hemolytic reaction. Take vital signs. Change IV tubing to remove all blood and maintain the IV line with normal saline solution, with new IV tubing, at a slow rate. 1. Incorrect: Diphenhydramine is indicated for an allergic reaction to the blood component being transfused. It is not indicated for a hemolytic reaction.

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

2., 3., 4., & 5. Correct: To promote consistency in insulin absorption, the client should systematically rotate injection sites within an anatomic area to prevent lipodystrophy. Four main areas for injection are the abdomen, upper arms, thighs and hips. The client should try not to use the exact same site more than once in 2 to 3 weeks. If insulin is injected where there is more fat underneath the skin, insulin may be absorbed more slowly. Also, insulin should not be injected into the limb that will be exercised; absorption will be faster, increasing risk of hypoglycemia. The client should avoid using the exact same site more than once in 2 to 3 weeks. 1. Incorrect: The diabetic client should rotate sites within the same area before moving to a new area. This will assist in preventing lipodystrophy. Use of the abdominal site has nothing to do with being close to the pancreas. The abdomen is the preferred site because it provides the most rapid insulin absorption.

A nurse is teaching a group of expectant parents about epidural anesthesia. What information should the nurse include? Select all that apply 1. Contraindications for an epidural include a previous cesarean section. 2. Post-procedure position should be side lying. 3. Headache is a post-procedure side effect. 4. The major complication is hypotension. 5. Usually administered at 3-4 cm dilation.

2., 4., & 5. Correct: The client should not lie supine but should position self in a side-lying position. This will prevent compression on the vena cava. The major complication of epidural anesthesia is hypotension and supine position increases the risk. If this occurs, a bolus with 1000 mL of NS or LR to increase blood pressure by increasing vascular volume. Epidurals are usually placed during stage 1 at 3-4 cm dilation. 1. Incorrect: Previous C-sections do not eliminate the ability to have an epidural. Epidurals are commonly utilized for anesthesia during a cesarean birth. 3. Incorrect: A sterile guide needle and a small epidural catheter is placed between the spinal cord and the outer membrane. There is usually no headache since the needle does not enter the spinal column but rather the epidural space.

What nursing intervention takes priority for the client one day postoperative bowel resection reporting pain of a 6 on a 0 to 10 pain scale? 1. Assist the client in changing positions. 2. Use a distraction technique. 3. Administer the prescribed analgesic. 4. Encourage the client to walk.

3 is true. Adequate pharmacological intervention is needed for pain relief immediately after a major abdominal surgery. When using the pain scale, you must remember a couple of things. First, pain is what the client says it is. And second, you need to understand the numbers. If someone says zero that means no pain. Rating pain a 1-3 is a mild pain. This pain is nagging, annoying, interfering little with the client's activities of daily living. This is when repositioning, alternative therapies, and distraction techniques are beneficial. Pain rated between 4-6 is considered to be moderate in severity and interferes significantly with activities of daily living. This is the time to give pain medication in an attempt to lessen the severity of the pain. A score of 7-10 is severe pain that is disabling. The client is unable to perform activities of daily living. Pain medication is often delayed in helping at this point. We want to give pain medication before it reaches this intense level. 1 is false. The client is reporting pain of a 6 on a 0 to 10 pain scale and is one day post-operative surgery. This is the time to give pain medication. Repositioning alone is not going to help at this point. 2 is false. The pain level is 6 indicating the client needs the prescribed pain medication. Higher levels of pain are expected one day after surgery. Nonpharmacologic methods are usually effective alone for mild to some moderate intensity pain and should complement, not replace pharmacologic therapy. 4 is false. Walking will not relieve the pain. The client will not want to walk with this level of pain. Relieving the pain will allow the client to move more easily.

The nurse has initiated instruction for an 11 year old child newly diagnosed with diabetes mellitus. The child indicates anxiety about the need for daily insulin injections. What nursing action would best address this issue? 1. Tell the child it only hurts for a moment. 2. Have the parents administer the shots. 3. Show the child how to give self injections. 4. Provide toy syringe for the client to play with.

3. Correct: A school age child needs a sense of achievement and control of the situation. Because diabetes will be a life-long disease, it is important for the child to begin learning about self-care which includes daily insulin injections. Age eleven is not too young to begin administering self injections. 1. Incorrect: This is a false statement, considering the fact that pain perception varies. Minimizing the amount of potential discomfort will instill distrust in the child, decreasing compliance with the health regimen. This is false assurance. 2. Incorrect: While parents may administer injections for much younger children, school aged children are capable of becoming independent with all aspects of diabetes. Additionally, an 11 year old client needs to develop a sense of mastery and achievement to accomplish this stage successfully. 4. Incorrect: The client is too old for pretend play with imitation syringes. That process is more appropriate for a preschool child. It would be beneficial to allow this child to handle regular syringes without a needle initially, and then add all the necessary equipment when the client feels more comfortable handling everything.

The nurse is caring for a diabetic client. The client's glucose level at 0700 is 265. What is the nurse's best action? - 40 units NPH insulin every AM - Regular Insulin per Sliding Scale both AC and HS Sliding Scale: Blood glucose < 200: 0 units Blood glucose 200-249: 2 units Blood glucose 250-299: 4 units Blood glucose 300-349: 6 units Blood glucose 350-399: 8 units Blood glucose 400 or >: Call the PCP 1. Hold the NPH and regular insulin 2. Give 8 units of regular insulin and hold the NPH 3. Give the NPH and 4 units of regular insulin 4. Give 40 units of NPH and hold the regular insulin

3. Correct: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299. 1., 2., & 4. Incorrect: According to the prescription and sliding scale, the client will need 40 units of NPH and 4 units of regular insulin for a glucose level of 250-299.

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

3. Correct: Beta blockers help anxiety and tremors. Beta blockers reduce the effects of adrenaline in the body and help decrease anxiety. In times of stress and emergency the adrenal gland produces adrenaline that acts on various organs in the body to enable us to deal with the situation. For example, the heart beats faster due to adrenaline. In order for adrenaline to be able to do this, various organs have beta receptors to accept the adrenaline and use it to behave differently in times of stress. Beta blockers block these receptors. They stop various organs in the body from accepting adrenaline. Taking them means the heart does less work generally and doesn't get over-worked in times of stress. One of the main symptoms of anxiety is a speeding heart which is part of the fight-or-flight response. In times of danger our body produces adrenaline to stop the heart from beating faster makes us feel calmer. Taking beta blockers for anxiety also makes us feel less shaky. The energy boost to our muscles (from the increased supply of blood and oxygen) which makes us feel 'jittery' and 'on-edge' doesn't happen without a fast heartbeat. 1. Incorrect: Steroids influence the body system in several ways, but they are used mostly for their strong anti-inflammatory effects and in conditions that are related to the immune system function such as arthritis, colitis (ulcerative colitis, and Crohn's disease), asthma, bronchitis. Steroids are used to treat systemic lupus, severe psoriasis, leukemia, lymphomas, idiopathic thrombocytopenic purpura, and autoimmune hemolytic anemia. These corticosteroids also are used to suppress the immune system and prevent rejection in people who have undergone organ transplant as well as many other conditions. 2. Incorrect: Anticonvulsants are used to normalize the electrical activity in the brain which in turn reduces the risk of seizures. But anticonvulsants have also been shown to work on mood disorders such as depression or mania. Anticonvulsants help increase the naturally occurring nerve calming chemical known as GABA while decreasing the nerve exciting chemical known as glutamate. Tremors can actually be a side effect of anticonvulsants. 4. Incorrect: Iodine compounds decrease the production of thyroid hormones in the treatment of hyperthyroidism. It does not have an effect on tremors.

A female client has used medroxyprogesterone acetate injections for birth control for several years. For the past 6 months, attempts to become pregnant have been unsuccessful. What instruction should the nurse provide to the client? 1. Be seen in the fertility clinic by a primary healthcare provider who specializes in this problem. 2. Have a sperm count performed on the client's partner. 3. Be aware that ovulation may not occur for many months after using medroxyprogesterone acetate. 4. Ensure proper nutrition, rest, and establish an exercise program.

3. Correct: Medroxyprogesterone acetate is an injectable progestin that prevents ovulation for 14 weeks (although injections should be scheduled every 12 weeks). After discontinuing injections, it may take approximately 9 to 10 months to reestablish normal ovulation and menstruation. 1. Incorrect: A fertility workup for the client and her partner may be warranted after adequate time to reestablish ovulation has passed. Fertility is not expected to return until approximately 9 to 10 months and this couple has only been attempting a pregnancy for 6 months. 2. Incorrect: A sperm count on the client's partner may be warranted after adequate time to reestablish ovulation has passed. 4. Incorrect: Good nutrition, rest, and exercise are important for all individuals, but does not apply to this client's concerns.

One hour after administering pyridostigmine, the nurse notes increased salivation, lacrimation, and urination in the client. What initial action should the nurse take? 1. Administer a second dose of pyridostigmine. 2. Place client in side lying position. 3. Notify the primary healthcare provider. 4. Prepare for intubation and mechanical ventilation.

3. Correct: These are signs and symptoms of cholinergic crisis. The client can get increasingly worse. The primary healthcare provider can prescribe atropine as treatment of overdose. 1. Incorrect: Giving an additional dose of pyridostigmine will make the client worse. 2. Incorrect: For better respiratory effort the client should be placed in a semi fowler's position. 4. Incorrect: This can be done after notifying the primary healthcare provider. Anticholinesterase drugs are aimed at enhancing function of the neuromuscular junction. Acetylcholinesterase is the enzyme that breaks down acetylcholine. Thus inhibition of this enzyme by an anticholinesterase inhibitor will prolong the action of acetylcholine and facilitate transmission of impulses at the neuromuscular junction. Pyridostigmine is the most successful drug of this group in long-term treatment of myasthenia gravis. Cholinergic crisis happens when too much cholinergic medications are taken and, if not treated accordingly, respiratory failure and hypotension might happen. When cholinergic crisis takes place, the muscles cannot react to the inflow of acetylcholine so symptoms usually follow. Symptoms may include salivation, lacrimation, urination, and defecation. Failure of the respiratory system occurs due to the insufficient gas exchange. Flaccid paralysis, too much sweating, bronchial secretions, and miosis develop. While myasthenic crisis requires the application of more anticholesterase drugs, cholinergic crisis must not use these. Atropine is given in order to enhance and maintain respiration.

What would the nurse include when teaching a client newly prescribed timolol maleate eye drops for glaucoma? 1. The medication works by causing the pupils to constrict 2. The medication will dilate the canals of Schlemm 3. This medication decreases the production of aqueous humor 4. The medication improves ciliary muscle contraction

3. Correct: Timolol maleate is a beta-blocker. Beta-blockers decrease aqueous humor production and intraocular eye pressure. 1. is false. Miotics are medications that cause pupillary constriction such as pilocarpine. The action of miotics are to increase aqueous fluid outflow by contracting ciliary muscle and causing miosis (constriction of the pupil) and opening of the trabecular network. 2. is false. The canal of Schlemn may be widened by laser trabeculoplasty to promote outflow of aqueous humor and decrease IOP. 4. is false. Ciliary muscle contraction is affected by cholinerigcs causing an increase in the outflow of aqueous humor through a larger opening between the iris and the trabecular meshwork.

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

3. Correct: Warfarin sodium is initiated while the client remains on heparin. This is done so that the client remains adequately anticoagulated during the transition from IV heparin to warfarin sodium. The onset of action of warfarin sodium is 36 hours to 3 days. 1. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. If heparin were stopped and warfarin sodium initiated there would be a lag time when the client would be inadequately anticoagulated and at an increased risk for clotting. 2. Incorrect: Warfarin sodium's onset of action is 36 hours to 3 days. Stopping heparin 24 hours before administering warfarin sodium would cause a lag time and increased risk of clotting. 4. Incorrect: Waiting for coagulation studies before administering warfarin sodium would cause a lag time and put the client at increased risk for clotting. Additionally, heparin and warfarin are measured by different clotting lab tests. The aPTT can measure the effectiveness of heparin. The PT and INR can be used to measure the effectiveness of warfarin sodium.

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

3., & 4. Correct: The client should be taught signs and symptoms of liver problems such as nausea, increased stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, or jaundice. Grapefruit juice can interfere with absorption of this medication. 1. Incorrect: Do not crush, chew, or break a delayed release capsule or tablet. Swallow it whole. 2. Incorrect: This medication should be taken 1 hour before or 2 hours after a meal. 5. Incorrect: Keep at room temperature, away from excess heat and moisture (not in bathroom).

What should the nurse include when teaching a client diagnosed with Grave's disease who is scheduled to receive radioactive iodine? Select all that apply 1. Stay 6 feet from people for 2 weeks. 2. This medication is given intravenously as a one-time dose. 3. Radioactive iodine will leave the body in urine and saliva within a few days. 4. You cannot receive radioactive iodine if you are pregnant. 5. Radioactive iodine is absorbed by the parathyroid glands.

3., & 4. Correct: Within a few days after treatment, the radioactive iodine will leave the body in urine and saliva. If the client is pregnant, she should not receive radioactive iodine treatment. This kind of treatment can damage the fetus's thyroid gland or expose the fetus to radioactivity. Women should wait a year before conceiving if they have been treated with radioactive iodine. 1. Incorrect: Stay away from babies for 1 week and do not kiss anyone for 1 week. 2. Incorrect: Radioactive iodine is given PO in a capsule or liquid form. One dose is usually all that is needed. 5. Incorrect: Radioactive iodine is absorbed by the thyroid gland. It destroys the thyroid. So now the client becomes hypothyroid.

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

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

A child with acute lymphocytic leukemia (ALL) is receiving chemotherapy through a single lumen Groshong catheter. During the infusion, the child reports nausea and has vomited. The primary healthcare provider has prescribed ondansetron IV. What action should the nurse take? 1. Ask primary healthcare provider for an oral antiemetic. 2. Give ondansetron IVPB with the chemotherapy. 3. Wait until chemotherapy is complete to infuse ondansetron. 4. Stop chemotherapy temporarily and flush line to give ondansetron.

4. Correct: A Groshong catheter is implanted when other venous access sites are no longer useable. The child has begun to react to the chemotherapy and needs medicated now. Because this implanted device has only one lumen, the nurse must stop the chemotherapy infusion temporarily, flush the port, administer the ondansetron, flush again and restart the chemotherapy infusion. 1. Incorrect: Because this client is vomiting, changing the medication to the oral route would not be effective. The medication takes longer to work if given orally, which means the client may vomit again before the medication activates, losing part of the dose. 2. Incorrect: Chemotherapy infusions should not be mixed with other categories of drugs, such as an antiemetic, because of the possibility of drug interactions. Certain chemical mixtures could also cause precipitates to form in the tubing, which is dangerous to the child. 3. Incorrect: The child is experiencing nausea and vomiting at this time. Waiting to give the antiemetic until after the chemotherapy is completed causes the child to suffer needlessly. The nurse should take action immediately to alleviate symptoms.

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

4. Correct: Erythropoietin is generally well tolerated. Swelling of feet and ankles may indicate the beginning of a cardiovascular problem. Clients taking this drug are at risk for myocardial infarctions and risk of blood clots. 1. Incorrect: The purpose of this drug is to increase hemoglobin levels. A level of 10g/dL (1.6 mmol/L) would be considered favorable even though still low. The client would still need the medication since anemia still exists. If hgb is above 12 g/dl (1.9 mmol/l), the level should be reported as the client does not need the med any longer. 2. Incorrect: An elevated blood pressure is one of the more common and major side effects. If elevated it should be reported, but this blood pressure is within normal limits. 3. Incorrect: Constipation may be caused by iron preparations. Increasing fiber in the diet may improve that symptom. A common side effect of synthetic erythropoietin is diarrhea.

The primary healthcare provider has prescribed ampicillin and ciprofloxacin piggyback in the same hour, every 6 hours. How will the nurse administer these medications? 1. Administer one of the medications every 4 hours and the other every 6 hours. 2. Administer the medications by combining them into 150 mL of normal saline (NS). 3. Administer the medications at the same time by connecting the secondary tubing to two separate ports on the primary tubing. 4. Administer the medications separately, flushing with normal saline (NS) between medications.

4. Correct: Even though two IV piggyback medications have been ordered at the same time, they can both be infused separately on time. It just takes planning. The nurse must follow the medication rights (right client, right medication, right route, right dose, right time). The antibiotics need to be administered one at a time and normal saline is used to flush the remaining medication of the first antibiotic before the second is administered. 1. Incorrect: The primary healthcare provider will prescribe the dosing schedule. Its beyond the scope of practice for the nurse to independently the dosing schedule. 2. Incorrect: The properties of each antibiotic are different. The two different antibiotics cannot be mixed together. 3. Incorrect: Administering the antibiotic into different parts of the IV tubing is the same as mixing the IVs together. Only one antibiotic should be administered at a time.

A post-operative client has received morphine for pain. The nurse re-assesses the client 10 minutes later. Which assessment data warrants further action by the nurse? BP 110/76 HR 68 RR 8 Pain 5 Dressing dry and intact. 1. Blood pressure 94/60 2. Pulse rate 72/min 3. Pain level 3/10 4. Respiratory rate at 8/min

4. Correct: Normal respiratory rate is 12-20 per minute. The respiratory rate indicates respiratory depression following administration of an opioid. Care should be taken to titrate the dose so that the patients pain is controlled without depressing the respiratory function. 1. Incorrect: Respiratory rate warrants immediate action. However, blood pressure will continue to be monitored. 2. Incorrect: Pulse rate warrants no further action. Pulse rate is normal. 3. Incorrect: The pain level is expected following surgery. The client should continue to have a reduction on pain, as 10 minutes is not long enough to fully evaluate.

What action is most important for the nurse to take when a client receiving a cephalosporin develops abdominal cramping and diarrhea? 1. Administer antidiarrheal medication. 2. Increase fluid intake. 3. Provide food with the medication. 4. Notify the healthcare provider.

4. Correct: Notify the healthcare provider if diarrhea occurs as it can promote the development of Clostridium difficile infection. Cephalosporin difficile is a toxin producing bacteria that causes antibiotics-associated colitis, and can occur with antibiotic therapy. Cephalosporin is one of the most common antibiotics that cause clostridium difficile. 1. Incorrect: Taking a probiotic, stopping the antibiotic or switching to another antibiotic are standard treatments for antibiotic induced diarrhea. Administering an anti-diarrheal is not recommended for antibiotic induced diarrhea. 2. Incorrect: Increasing fluid intake will help with the associated dehydration seen with diarrhea, but will not correct the problem or decrease the risk of clostridium difficile. 3. Incorrect: If the client has GI upset, then cephalosporin may be given with food, however, the most important thing to worry about is the development of Clostridium difficile infection. So notifying the healthcare provider is the most important action.

The nurse instructs a client taking isoniazid for the treatment of tuberculosis (TB) regarding appropriate food choices. Which food choices indicate to the nurse that teaching has been successful? 1. Salad with bleu cheese dressing. 2. Smothered liver with onions. 3. Smoked salmon with crackers. 4. Pear salad with lettuce.

4. Correct: Pears are acceptable fruit. Foods high in tyramine can cause headaches, fast or irregular heartbeats, nausea and vomiting and sensitivity to light. Foods high in tyramine such as aged cheeses, certain meats, liver, moked fish, sour cream, raisins, bananas and avocados should not be eaten when taking isoniazid. 1. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as salad with bleu cheese dressing can result in severe reactions when client is taking isoniazid. 2. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smothered liver with onions can result in severe reactions when client is taking isoniazid. 3. Incorrect: Avoid foods high in tyramine. Foods high in tyramine such as smoked salmon can result in severe reactions when client is taking isoniazid.

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

4. Correct: The stem of the question states the client manifests symptoms of increased ICP. Even if you do not know how mannitol works, the only answer that assesses the client for increased ICP is to assess the LOC. Change in LOC is the early sign for increased ICP. 1. Incorrect: Mannitol causes an osmotic diuresis effect. Urinary output is expected to increase, but this does not assess changes in ICP. Assessing LOC is the only answer that assesses for changes in ICP. 2. Incorrect: Taking frequent vital signs is an answer that sends the message to the NCLEX people that you don't know what to do, so you'll get a set of vital signs. Changes in V/S would indicate late changes as seen in Cushing's Triad. 3. Incorrect: Measuring head circumference is useful if your client is an infant, but frequently assessing the LOC is a more sensitive indicator.