PrepU Medication and IV

A loading dose of digoxin is given to a client newly diagnosed with atrial fibrillation. The nurse begins instructing the client about the medication and the importance of monitoring his heart rate. An expected outcome of this instruction is: A) verbalization of why the client has atrial fibrillation. B) a return demonstration of palpating the radial pulse. C) a return demonstration of how to take the medication. D) verbalization of the need for the medication.

B) a return demonstration of palpating the radial pulse. The goal of the education program is to instruct the client to take the pulse; therefore, the expected outcome would be the ability to give a return demonstration of how to palpate the heart rate.

A client complains of difficulty swallowing when the nurse tries to administer a medication in capsule form. What action should the nurse take next? A) Dissolve the capsule in a full glass of water. B) Check for availability of a liquid preparation. C) Withhold the medication. D) Break the capsule and mix the contents with applesauce.

B) Check for availability of a liquid preparation. The nurse should find out whether the medication is available in liquid form. Dissolving or breaking the capsule may interfere with drug action or absorption. The nurse shouldn't withhold any medication without first notifying the physician.

The nurse has an order to administer 1200 mg of an antibiotic. The drug is prepared as 6 grams of the drug in 2 ml of solution. The nurse should administer how many ml of the drug? Record your answer using one decimal place.

0.4

A client who weighs 187 lb (85 kg) has an order to receive enoxaparin 1 mg/kg. This drug is available in a concentration of 30 mg/0.3 mL. What dose would the nurse administer in milliliters? Record your answer using two decimal places.

0.85 The physician's order is for the client to receive enoxaparin 1 mg/kg. Therefore, the client is to receive 85 mg. The desired dose in milliliters then can be calculated by using the formula of desired dose (D) divided by dose or strength of dose on hand (H) times volume (V). 85 (mg) × 0.3 mL = 25.5 mg/mL 25.5 mg divided by 30 = 0.85 mL.

The nurse is preparing 1,000 mL D5/N5 to deliver over 6 hours. If the infusion set administers 15 gtts/mL, what is the required flow rate in gtts/min? (Round to the nearest whole number.)

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Clients who are receiving total parenteral nutrition (TPN) are at risk for development of which complication? A) pulmonary hypertension B) orthostatic hypotension C) hypostatic pneumonia D) fluid imbalances

D) fluid imbalances Clients receiving TPN are at risk for a number of complications, including fluid imbalances such as fluid overload and hyperosmolar diuresis. Other common complications include hyperglycemia, sepsis, pneumothorax, and air embolism. Hypostatic pneumonia, pulmonary hypertension, and orthostatic hypotension are not complications of TPN.

Sodium polystyrene sulfonate is prescribed for a client following crush injury. The drug is effective if: A) there is muscle weakness on physical examination. B) the ECG is showing tall, peaked T waves. C) the pulse is weak and irregular. D) the serum potassium is 4.0 mEq/L (4.0 mmol/L).

D) the serum potassium is 4.0 mEq/L (4.0 mmol/L). Following crush injury, serum potassium rises to high levels. Sodium polystyrene sulfonate is a potassium binding resin. The resin combines with potassium in the colon and is then eliminated, and serum potassium levels should come back to normal. Normal serum potassium is 3.5 to 5.3. Weak, irregular pulse and tall peaked T waves on ECG are signs of hyperkalemia, and muscle weakness is a sign of hypokalemia.

The antidote for heparin is: A) thrombin. B) protamine sulfate. C) warfarin. D) vitamin K.

B) protamine sulfate. The antidote for heparin is 1% protamine sulfate. Vitamin K is the antidote for warfarin, an oral anticoagulant. Thrombin is a topical anticoagulant.

A client is to be discharged with a prescription for an analgesic that is a controlled substance. Which comment by the client indicates to the nurse that further teaching is needed? A) "I will avoid sharp objects." B) "I know I can titrate the dose according to the pain level." C) "I will keep the medication in a safe place." D) "I will avoid operating a motor vehicle."

B) "I know I can titrate the dose according to the pain level." A client should never take it upon themselves to titrate or change a prescribed dose. The other comments indicate the client has an understanding of the discharge teachings.

The nurse instructs the client in mixing and administering regular and NPH insulin. Which statement indicates that the client needs additional instruction? A) "I draw up the regular insulin first." B) "I shake the bottle of NPH insulin before drawing it up." C) "I insert the needle at a 90-degree angle." D) "I store the insulin in a cool place."

B) "I shake the bottle of NPH insulin before drawing it up." NPH insulin should be rolled between the palms to mix it before drawing it up; shaking it will introduce air bubbles into the solution, which can cause inaccurate dosing. The client should draw up the insulin first, store the insulin in a cool place, and inject the insulin at a 90-degree angle.

A client is receiving spironolactone for treatment of bilateral lower extremity edema. The nurse should instruct the client to make which nutritional modification to prevent an electrolyte imbalance? A) Restrict fluid intake to 1,000 mL/day. B) Decrease foods high in potassium. C) Increase foods high in sodium. D) Increase intake of milk and milk products.

B) Decrease foods high in potassium. Aldactone is a potassium-sparing diuretic often used to counteract potassium loss caused by other diuretics. If foods or fluids are ingested that are high in potassium, hyperkalemia may result and lead to cardiac arrhythmias. Increasing the intake of milk or milk products does not affect the potassium level. Restricting fluid may elevate all electrolytes due to extracellular fluid volume depletion. By increasing foods high in sodium, water would tend to be retained and so would dilute all electrolytes in the extracellular fluid compartment.

A client is taking phenelzine 15 mg PO three times a day. The nurse is about to administer the next dose when the client tells the nurse about having a throbbing headache. Which action should the nurse do first? A) Call the health care provider (HCP) to report the symptom. B) Obtain the client's vital signs. C) Administer the client's next dose of phenelzine. D) Give the client an analgesic prescribed PRN.

B) Obtain the client's vital signs. The nurse should first take the client's vital signs because the client could be experiencing a hypertensive crisis, which requires prompt intervention. Signs and symptoms of a hypertensive crisis include occipital headache, a stiff or sore neck, nausea, vomiting, sweating, dilated pupils and photophobia, nosebleed, tachycardia, bradycardia, and constricting chest pain. Giving this client an analgesic without taking his vital signs first is inappropriate. After the client's vital signs have been obtained, then the nurse would call the HCP to report the client's problems and vital signs. Administering the client's next dose of phenelzine before taking his vital signs could result in a dangerous situation if the client is experiencing a hypertensive crisis.

When caring for the client who is receiving an aminoglycoside antibiotic, the nurse should monitor which laboratory value? A) serum calcium B) serum creatinine C) serum potassium D) serum sodium

B) serum creatinine It is essential to monitor serum creatinine in the client receiving an aminoglycoside antibiotic because of the potential of this type of drug to cause acute tubular necrosis. Aminoglycoside antibiotics do not affect serum sodium, potassium, or calcium levels.

During gentamicin therapy, the nurse should monitor a client's: A) partial thromboplastin time (PTT). B) serum creatinine level. C) serum potassium level. D) serum glucose level.

B) serum creatinine level. During gentamicin therapy, the nurse should monitor a client's serum creatinine level because the most notable adverse reactions to aminoglycoside therapy are nephrotoxicity and ototoxicity. The drug doesn't appear to affect serum potassium or glucose levels or PTT.

What is the main advantage of using a floor stock system? A) The system minimizes transcription errors. B) The system reinforces accurate calculations. C) A nurse can implement medication orders quickly. D) A nurse receives input from the pharmacist.

C) A nurse can implement medication orders quickly. A floor stock system enables a nurse to implement medication orders quickly. It doesn't allow for pharmacist input, nor does it minimize transcription errors or reinforce accurate calculations.

When preparing to teach a client about phenytoin sodium therapy, the nurse should urge the client not to stop the drug suddenly because: A) a hypoglycemic reaction develops. B) heart block is likely to develop. C) status epilepticus may develop. D) physical dependency on the drug develops over time.

C) status epilepticus may develop. Anticonvulsant drug therapy should never be stopped suddenly; doing so can lead to life-threatening status epilepticus. Phenytoin sodium does not carry a risk of physical dependency or lead to hypoglycemia. Phenytoin has antiarrhythmic properties, and discontinuation does not cause heart block.

Which finding is the best indication that fluid replacement for the client in hypovolemic shock is adequate? A) systolic blood pressure greater than 110 mm Hg B) respiratory rate of 20 breaths/minute C) urine output greater than 30 ml/hour D) diastolic blood pressure greater than 90 mm Hg

C) urine output greater than 30 ml/hour Urine output provides the most sensitive indication of the client's response to therapy for hypovolemic shock. Urine output should be consistently greater than 35 mL/h. Blood pressure is a more accurate reflection of the adequacy of vasoconstriction than of tissue perfusion. Respiratory rate is not a sensitive indicator of fluid balance in the client recovering from hypovolemic shock.

An older adult who experienced a brief delirium realizes that the condition was caused by prescription medication intoxication. Which of the following statements indicates the need for further education? A) "I never realized that taking a little extra medication now and then could cause such a problem." B) "I didn't know that cold and flu medicines might not mix with my regular medicines." C) "I thought that the herbal medicines would help me. I never realized they would make me sick." D) "I get medicines from three different doctors and they don't all know what I'm taking."

D) "I get medicines from three different doctors and they don't all know what I'm taking." The elderly client commonly has multiple physicians. The client needs to inform every doctor about all the medications being prescribed by all of them.

An elderly client who experiences several adverse drug reactions may benefit from: A) increased drug doses at longer intervals. B) nursing home placement. C) frequent visits to the physician. D) reduced drug dosages.

D) reduced drug dosages. In older clients, diminished hepatic and renal function commonly reduces drug metabolism and excretion. Because adverse reactions are frequently related to drug blood level, the client may benefit from reduced drug dosages. Adverse drug reactions don't represent a reason for nursing home placement. Increased drug doses at longer intervals may increase adverse reactions rather than decrease them. Although frequent visits to the physician may benefit the client, the visits themselves won't alter how the client's body reacts to the drug.

The nurse is to administer 1,200 mg of an antibiotic. The drug is prepared with 6 g of the drug in 2 mL of solution. The nurse should administer how many milliliters of the drug? Record your answer using one decimal place.

0.4 First, convert grams to milligram: 6 g = 6,000 mg. Next, set up a proportion: 6,000 mg/2 mL = 1,200 mg/X X = (1,200/6,000) x 2 mL X = 0.4 mL.

The nurse is preparing a client's preoperative medication. The prescription reads atropine 0.6 mg and meperidine hydrochloride 50 mg IM. The dosage of available atropine is 0.8 mg/mL, and the dosage of available meperidine is 100 mg/mL. What will be the total volume of medication the nurse will administer? Record your answer using two decimal places.

1.25 The atropine dosage is calculated as follows: 0.6 mg/x mL = 0.8 mg/mL. x = 0.75 mL. The meperidine dosage is calculated as follows: 50 mg/x mL = 100 mg/mL. x = 0.5 mL. The total volume to be administered is 1.25 mL.

The physician prescribes furosemide, 2 mg/kg P.O., as a one-time dose for an infant with fluid overload. The infant's documented weight is 14 lb (6.4 kg). The oral solution contains 10 mg/mL. How many milliliters of solution should the nurse administer? Record your answer using one decimal place.

1.3 Perform the following calculation to determine the total dose prescribed: 2 mg/kg = X/6.4 kg X = 12.8 mg. Then set up the following proportion to determine the volume of medication to administer: 10 mg/mL = 12.8 mg/X X = 1.3 mL.

The nurse is evaluating a parent's understanding of measuring one tablespoon of medication in a medicine cup. At which level on the medicine cup would the nurse confirm an appropriate dose in cc?

15cc One tablespoon equals 15 cc's of medication.

The physician prescribes acetaminophen 650 mg by mouth every 4 hours for a client with a temperature of 102° F (38.8° C) who has a feeding tube in place. The nurse has acetaminophen solution on hand containing 160 mg/5 ml. How many milliliters of solution should the nurse administer? Record your answer using one decimal place.

20.3 The following formula is used to calculate drug dosages: dose on hand/quantity on hand = dose desired/X. In this example, the equation is as follows: 160 mg/5 ml = 650 mg/X X = 20.3 ml

A client has an ordered intravenous infusion that is ordered to infuse at 3000 mL of D5W in a 24-hour period (drop factor of 10). Calculate the drops per minute. Record your answer using a whole number.

21 Volume to be infused times the drop factor, divided by the number of hours, times 60 minutes. 3000 times 10 divided by 24 times 60 equals 30,000 divided by 1440 = 21.

A client is receiving an IV infusion of heparin sodium at 1,200 units/h. The dilution is 25,000 units/500 mL. How many milliliters per hour will this client receive? Record your answer using a whole number.

24 First, calculate how many units are in each milliliter of the medication. 25,000 units/500 mL = 50 units/1 mL. Next, calculate how many milliliters the client receives per hour. 1,200 units/1 hour divided by 50 units/1 mL = 1,200 units/1 hour X 1 mL/50 units = 24 mL/h.

A client returns to the room from the postanesthesia care unit after undergoing a right hemicolectomy. The health care provider orders 1 L of dextrose 5% in half-normal saline solution to infuse at 125 ml/hour. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Round your answer to the nearest whole number. (For example: 62)

31 The flow rate is 125 ml/hour or 125 ml/60 minutes. UUse the following equation to determine the drip rate: 125 ml/60 minutes x 15 gtt/1 ml = 31.25 gtt/minute (round down to 31 gtt/minute).

A client who is experiencing an exacerbation of ulcerative colitis is receiving IV fluids that are to be infused at 125 mL/h. The IV tubing delivers 15 gtt/mL. How quickly should the nurse infuse the fluids in drops per minute to infuse the fluids at the prescribed rate? Record your answer using a whole number.

31 To administer I.V. fluids at 125 mL/h using tubing that has a drip factor of 15 gtt/mL, the nurse should use the following formula: 125 mL/60 min × 15 gtt/1 mL = 31 gtt/min.

The nurse is to administer chloramphenicol 50 mg IV in 100 mL of dextrose 5% in water over 30 minutes. The infusion set administers 10 gtt/mL. At what flow rate (in drops per minute) should the nurse set the infusion? Round to the nearest whole number.

33 The flow rate is determined by the rate of infusion and the number of drops per milliliter of the fluid being administered: gtt/mL × mL/min = IV flow rate (gtt/minute). Therefore: 10 gtt/mL × 100 mL/30 min = 33 gtt/min.

A client with a deep vein thrombosis has heparin sodium infusing at 1,500 units/hour. The concentration of heparin is 25,000 units/500 mL. If the infusion remains at the same rate for a full 12 hour shift, how many milliliters of fluid will infuse? Record your answer using a whole number.

360 25,000 u/500 ml = 50 units/ml. 1 ml/50 units x 1500 units/hour = 30 ml/hour x 12 hours = 360 ml

Two days after a client undergoes repair of a ruptured cerebral aneurysm, a physician orders mannitol, 0.5 g/kg to be infused over 60 minutes. The client weighs 175 lb. The nurse should administer how many grams of mannitol? Record your answer using a whole number.

40 To determine the number of grams to administer, the nurse first must convert the client's weight from pounds to kilograms using the following conversion factor: 1 kg = 2.2 lb 175 lb x 1 kg / 2.2 lb = 79.55 kg (pounds cancel out in this equation) 175 lb / 2.2 lb = 79.55 kg Next multiply the client's weight by the ordered amount (0.5 mg / kg). 79.55 kg x 0.5 g/kg = 39.775 g (kilograms cancel out) Round this number to the nearest whole number to determine the dose to be administered equals 40 grams.

The nurse must administer ferrous sulfate to an infant who weighs 8 lb 13 oz (4 kg). The dosage prescribed is 6 mg/kg/day to be given in three doses. What would be the correct amount to be administered for each dose? Record your answer using a whole number.

8 6 mg × 4 kg = 24 mg/24 hours. The dose is to be administered three times every 24 hours, resulting in 24 mg/3doses = 8 mg/dose.

A client is prescribed an intravenous solution of 1,000 ml to be infused from 0800 to 2000. The nurse will use an infusion pump that delivers the solution in milliliters per hour. At what rate would the nurse set the pump to deliver the solution? Record your answer using a whole number. (For example: 62)

83 First, determine how many hours the infusion needs to run. 0800 to 2000 is 12 hours. Use the following equation to determine the milliliters per hour: (volume to infuse/infusion time) = flow rate per hour; (1,000 ml/12 hours) = 83.3 ml/hour (rounded to 83 ml/hour). The pump should be set to deliver 83 ml/hour.

The nurse teaches a client taking desmopressin nasal spray about how to manage treatment. The nurse determines that the client needs additional instruction when the client says: A) "I should use the same nostril each time I take the medicine." B) "I should report nasal congestion." C) "I should report any signs of respiratory infection." D) "I should check for sores in my nose while taking this medication."

A) "I should use the same nostril each time I take the medicine." The client who is taking desmopressin nasal spray should not use the same nares for administration each time. The client should alternate nares every dose. The client should observe for and report promptly signs and symptoms of nasal ulceration, congestion, or respiratory infection.

A nurse is preparing to give an average-size 9-year-old child a preoperative I.M. injection. Which size needle should the nurse use? A) 22G, 1″ B) 22G, 1½″ C) 20G, 1½″ D) 20G, 1″

A) 22G, 1″ The nurse should evaluate the muscle mass and amount of subcutaneous fat and then select the correct needle size. Without more information, the nurse would select the 22G, 1″ needle, appropriate for an average-size school-age child. The 20G, 1″ needle would be unnecessarily large. The 22G, 1½″ needle would be too long. The 20G, 1½″ needle would be too long and unnecessarily large.

A nurse is to administer 10 mg of morphine sulfate to a client with three fractured ribs. The available concentration for this drug is 15 mg/mL. How many milliliters should the nurse administer? Record your answer using one decimal place.

0.7 10 mg : X = 15 mg : 1 mL 15 mg × X = 10 mg × 1 mL 15X = 10 mL X = 0.67 mL, which rounds to 0.7 mL.

A health care provider prescribes intravenous normal saline solution to be infused at a rate of 150 ml/hour for a client. How many liter(s) of solution will the client receive during an 8-hour shift? Record your answer using one decimal place (For example: 6.2).

1.2 The ordered infusion rate is 150 ml/hour. The nurse would multiply 150 ml by 8 hours to determine the total volume in milliliters the client will receive during an 8-hour shift (1,200 ml). Then the nurse would convert milliliters to liters by dividing by 1,000. The total volume in liters that the client will receive in 8 hours is 1.2 liters.

A client is receiving magnesium sulfate at 3 g/h intravenously. The bag of 1,000 mL normal saline contains 20 g of magnesium sulfate. How many mL/hour should the nurse set the IV pump rate in order to deliver 3 g/h? Record your answer using a whole number.

150 The rate can be calculated as follows: mL/hr = (1000 mL/20 g) X (3 g/1 h) = (3000 mL/20 h) = 150 mL/h.

The physician has ordered an IV of 3000 mL of 0.9% sodium chloride to be infused over the next 24 hours. The nurse uses IV tubing that has a drip factor of 10. Calculate the drops per minute needed to deliver the correct amount of IV fluid. Record your answer using a whole number.

21 Formula for calculating drops per minute: mL/hr x drop factor = gtts/minute 60 minutes 3000 mL/24 hr = 125 mL/hr 125 mL/hr x 10 = 20.8 or 21 gtts/min 60

After undergoing small-bowel resection, a client is prescribed metronidazole 500 mg intravenously. The mixed solution is 100 ml. The nurse is to administer the drug over 30 minutes. The drop factor of the available intravenous tubing is 15 gtt/ml. What is the drip rate in drops per minute? Record your answer using a whole number.

50 The nurse would use the following equation to calculate the drip rate: Total volume (ml)/administration time (in minutes) x drip factor (gtt/ml) = X 100 ml/30 minutes x 15 gtt/ml = X X = 1500 gtt/ 30 minutes X = 50 gtt/minute

A nurse working in a blood conservation program is being mentored by a supervising nurse. A client asks for information about iron supplements and epoetin alpa as alternatives to a blood transfusion. Which of the following responses by the nurse causes the supervising nurse to plan a review of professional and ethical standards? A) "You should take the unit of blood. It will help you feel better." B) "Tell me how the nurse educator explained the procedure." C) "Do you have any questions that I can clarify for you?" D) "Do you have all the information you need for informed consent?"

A) "You should take the unit of blood. It will help you feel better." This answer does not allow for client choice because the nurse is influencing the choice. This is a violation of professional and ethical standards. In order to give informed consent, the client must have all the information and understand it. All of the client's questions should be answered. The other options demonstrate that the nurse understands these factors.

When preparing a teaching plan for an adult client about general anesthesia induction, which explanation would be most appropriate? A) "You will breathe in an inhalant anesthetic mixed with oxygen through a facial mask and receive intravenous medication to make you sleepy." B) "Your premedication will put you to sleep." C) "You will receive intravenous medication to make you sleepy." D) "You will breathe in medication through a facial mask to make you sleepy."

A) "You will breathe in an inhalant anesthetic mixed with oxygen through a facial mask and receive intravenous medication to make you sleepy." Adult clients are induced for general anesthesia by breathing in an inhalant anesthetic mixed with oxygen through a facial mask and receiving intravenous medication to make them sleepy. Clients are not induced with the premedication. Clients usually are not induced with the intravenous infusion or the mask alone.

A nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of [800 mg/dl (44.4 mmol/L)]. Which solution is the most appropriate at the beginning of therapy? A) 100 units of regular insulin in normal saline solution B) 100 units of neutral protamine Hagedorn (NPH) insulin in normal saline solution C) 100 units of regular insulin in dextrose 5% in water D) 100 units of NPH insulin in dextrose 5% in water

A) 100 units of regular insulin in normal saline solution Continuous insulin infusions use only short-acting regular insulin. Insulin is added to normal saline solution and administered until the client's blood glucose level falls. Further along in the therapy, a dextrose solution is administered to prevent hypoglycemia.

A client is brought to the emergency department with abdominal trauma following an automobile accident. The vital signs are as follows: heart rate, 132 bpm; respirations, 28 breaths/min; blood pressure, 84/58 mm Hg; temperature, 97.0° F (36.1° C); oxygen saturation 89% on room air. Which prescription should the nurse implement first? A) Administer 1 liter 0.9% saline IV. B) Draw a complete blood count (CBC) with hematocrit and hemoglobin. C) Insert an indwelling urinary catheter. D) Obtain an abdominal x-ray.

A) Administer 1 liter 0.9% saline IV. The client is demonstrating vital signs consistent with fluid volume deficit, likely due to bleeding and/or hypovolemic shock as a result of the automobile accident. The client will need intravenous fluid volume replacement using an isotonic fluid (e.g., 0.9% normal saline) to expand or replace blood volume and normalize vital signs. The other prescriptions can be implemented once the intravenous fluids have been initiated.

Which type of solution, when administered I.V., would cause fluid to shift from body tissues to the bloodstream? A) Hypertonic B) Hypotonic C) Isotonic D) Sodium chloride

A) Hypertonic A hypertonic solution causes the bloodstream to absorb fluids until pressure on both sides of the blood vessel is equal. A hypotonic solution causes fluids to move from the bloodstream into the tissues. An isotonic solution has no effect on the cell. Depending on the concentration of sodium, a sodium chloride solution can be isotonic, hypertonic, or hypotonic.

A client continually reports of pain after the administration of an oral analgesic. The physician writes an order for the nurse to administer a placebo to the client the next time the client reports of pain. The doctor states, "Tell the client it is a stronger analgesic." What would be the appropriate action by the nurse? A) Refuse to administer the placebo to the client. B) Give the placebo but do not tell the client it is a stronger medication. C) Consult with the pharmacist to discuss the dosage of the placebo. D) Give the placebo as ordered by the physician.

A) Refuse to administer the placebo to the client. The nurse should refuse to give the placebo and should also refuse to misinform the client. The nurse has a responsibility to explain the client's medications to the client. The client can then make an informed decision about accepting or refusing the medication. The other options are incorrect because the nurse would be misinforming the client about the medication that is being administered. The client would not be able to provide informed consent.

A nurse prepares a client's medication by reconstituting a multi-dose vial of medication. What other nursing intervention should the nurse take? Select all that apply. A) The person reconstituting the medication should place their initials on the vial. B) Label the vial with the strength of the medication. C) Demand the pharmacy department mix all future doses. D) Store the multi-dose vial in a secure place. E) Leave the vial in the client's room for easy access.

A) The person reconstituting the medication should place their initials on the vial. B) Label the vial with the strength of the medication. D) Store the multi-dose vial in a secure place. Labeling the vial will identify the medication, dosage and the preparer and decrease the chance of an error.Storing in safe place will also decrease medication errors. Leaving the vial in the client's room is not an acceptable. practice for any medication. Pharmacy reconstituting my not be an options since it is very practical for the nurse to prepare the dose. Medication should never be left in a client's room rather prepared or not.

A client has been prescribed digoxin. Which symptom should the nurse tell the client to report as a potential indication of digoxin toxicity? A) visual disturbances B) shortness of breath C) urticaria D) hypertension

A) visual disturbances Visual disturbances are a symptom of digoxin toxicity. These disturbances can include double, blurred, or yellow vision. Cardiovascular manifestations of digoxin toxicity include bradycardia, other dysrhythmias, and pulse deficit. Gastrointestinal symptoms include anorexia, nausea, and vomiting.

Before administering packed red blood cells, a nurse must flush a client's I.V. line. Which solution should the nurse use to flush the line? A) Dextrose 5% in normal saline solution B) Dextrose 5% in water C) Normal saline solution D) Lactated Ringer's solution

C) Normal saline solution Normal saline solution is the only I.V. solution that is compatible with any blood product. Lactated Ringer's and dextrose solutions are incompatible with blood products.

What therapeutic outcome does the nurse expect for a client who has received a premedication of glycopyrrolate? A) increased respiratory rate B) increased heart rate C) decreased secretions D) decreased amnesia

C) decreased secretions Glycopyrrolate is an anticholinergic given for its ability to reduce oral and respiratory secretions before general anesthesia. Increased heart rate and respiratory rate would be adverse effects of the drug. Amnesia should not be an effect of the drug.

A physician orders the following preoperative medications to be administered to a client by the I.M. route: meperidine, 50 mg; hydroxyzine pamoate, 25 mg; and glycopyrrolate, 0.3 mg. The medications are dispensed as follows: meperidine, 100 mg/ml; hydroxyzine pamoate, 100 mg/2 ml; and glycopyrrolate, 0.2 mg/ml. How many milliliters in total should the nurse administer? A) 3.8 ml B) 2.5 ml C) 5 ml D) 2 ml

B) 2.5 ml Using the proportion method, the nurse solves for X and then adds the total number of milliliters together.

The maximum transfusion time for a unit of packed red blood cells (RBCs) is: A) 6 hours. B) 4 hours. C) 1 hour. D) 2 hours.

B) 4 hours. A unit of packed RBCs may be transfused over a period of between 1 and 4 hours. It shouldn't infuse for longer than 4 hours because the risk of contamination and sepsis increases after that time. The nurse should discard any blood not given within this time, or return it to the blood bank, in accordance with facility policy.

Gentamicin IV has been prescribed to treat a client's infection. The nurse should monitor the client for: A) confusion. B) cardiac arrhythmias. C) ototoxicity. D) ascites.

C) ototoxicity. Ototoxicity is a serious side effect of gentamicin. Tinnitus and dizziness are common; irreversible deafness can develop if the onset of ototoxicity is not detected early. Gentamicin is also known to be nephrotoxic and hepatotoxic.

Which client statement indicates to the nurse that the client needs further teaching about disulfiram? A) "A metallic or garlic taste in my mouth is normal when starting on disulfiram." B) "I can drink one or two beers and not get sick while on disulfiram." C) "I will read the labels on cough syrup and mouthwash for possible alcohol content." D) "I can take disulfiram at bedtime if it makes me sleepy."

B) "I can drink one or two beers and not get sick while on disulfiram." Any amount of alcohol consumed while taking disulfiram can cause an alcohol-disulfiram reaction. The reaction experienced is in proportion to the amount of alcohol ingested. The alcohol-disulfiram reaction can begin 5 to 10 minutes after alcohol is ingested. Symptoms can be mild, as in flushing, throbbing in the head and neck, nausea, and diaphoresis. Other symptoms include vomiting, respiratory difficulty, hypotension, vertigo, syncope, and confusion. Severe reactions involve respiratory depression, convulsions, coma, and even death. Disulfiram can be taken at bedtime if the client feels sleepy from the medication. Some clients experience a metallic or garlic taste when initiating disulfiram treatment. Anything containing alcohol, such as cough medicine, aftershave lotion, and mouthwash, can cause a reaction. Therefore, the client needs to check the labels of these items for their alcohol content.

For a hospitalized client, the physician orders morphine, 4 mg I.V., every 2 hours as needed for pain. However, the client refuses to take injections. Which nursing action is most appropriate? A) Explaining that no other medication can be given until the client receives the pain medication B) Calling the physician to request an oral pain medication C) Administering the medication as ordered D) Withholding the medication until the client understands its importance

B) Calling the physician to request an oral pain medication The most appropriate action is to call the physician to request an oral pain medication. By doing so, the nurse is adhering to the client's wishes. Administering an I.V. injection without client consent is considered battery and may result in a lawsuit. Withholding medication without providing an alternative and attempting to manipulate the client into taking the medication would violate the standards of care.

A primary health care provider prescribes regular insulin 10 units intravenously (IV) along with 50 ml of dextrose 50% for a client with acute renal failure. What electrolyte imbalance is this client most likely experiencing? A) Hypernatremia B) Hyperkalemia C) Hypercalcemia D) Hypermagnesemia

B) Hyperkalemia Administering regular insulin IV concomitantly with 50 ml of dextrose 50% helps shift potassium from the extracellular fluid into the cell, which normalizes serum potassium levels in the client with hyperkalemia. This combination does not help reverse the effects of hypercalcemia, hypernatremia, or hypermagnesemia.

A client will receive IV midazolam hydrochloride during surgery. Which finding indicates a therapeutic effect? A) mild agitation B) amnesia C) blurred vision D) nausea

B) amnesia Midazolam hydrochloride causes antegrade amnesia or decreased ability to remember events that occurred around the time of sedation. Nausea, mild agitation, and blurred vision are adverse effects of midazolam.

A nurse may delegate adding medications to I.V. fluid containers to a: A) pharmacist. B) pharmacy technician. C) student nurse. D) nursing assistant.

A) pharmacist. A nurse should delegate the task of adding medications to primary fluid containers to a pharmacist. Other assistive personnel aren't qualified to perform this task.

Small air bubbles adhering to the interior surface of the syringe might have which effect on parenteral administration? A) Altered drug dose B) Altered duration C) Altered drug absorption D) Altered onset of action

A) Altered drug dose Although not harmful to the client when injected, small air bubbles can actually change the dose of medication administered; therefore, the nurse should remove the air bubbles. Small air bubbles won't affect the drug's onset of action, duration, or absorption. Air bubbles may be helpful in some situations but should be added only after the dose of the drug has been withdrawn accurately. For example, with iron dextran, an air bubble and the Z-track method of injection help prevent permanent staining of the client's skin if the solution leaks into the subcutaneous tissue.

The health care provider (HCP) is calling in a prescription for ampicillin for a neonate. What should the nurse do? Select all that apply. A) Ask the HCP to confirm that the prescription is correct. B) Repeat the prescription to the HCP over the telephone. C) Ask the HCP to come to the hospital and write the prescription on the medical record. D) Ask the nursing supervisor to cosign the telephone prescription as transcribed by the nurse. E) Write down the prescription.

A) Ask the HCP to confirm that the prescription is correct. B) Repeat the prescription to the HCP over the telephone. E) Write down the prescription. The nurse should write down the prescription, read the prescription back to the HCP, and receive confirmation from the provider that the prescription is correct as understood by the nurse. It is not necessary for the HCP to come to the hospital to write the prescription on the medical record or to have the nursing supervisor cosign the telephone prescription.

Which instruction is most important for the nurse to include in the teaching plan for a client who is taking phenelzine? A) Avoid foods high in tyramine. B) Allow 10 days to achieve therapeutic effects. C) Eat a normal amount of salt in the diet. D) Drink 10 to 12 glasses of water each day.

A) Avoid foods high in tyramine. A client who is taking phenelzine, a monoamine oxidase inhibitor, needs to avoid foods that are rich in tyramine because this food-drug combination can cause hypertensive crisis. The client should be given a list of foods to avoid and should report headaches, palpitations, and a stiff neck to the health care provider (HCP) immediately. The client does not need to restrict or add salt to the diet. Drinking 10 to 12 glasses of water each day is important to teach the client who is receiving lithium therapy. Antidepressant drugs take 2 to 4 weeks to achieve therapeutic effects.

Which class of medication protects the ischemic myocardium by blocking catecholamines and sympathetic nerve stimulation? A) Beta-adrenergic blockers B) Opioids C) Nitrates D) Calcium channel blockers

A) Beta-adrenergic blockers Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of another infarction by decreasing myocardial oxygen demand. Calcium channel blockers reduce the heart's workload by decreasing the heart rate. Opioids reduce myocardial oxygen demand, promote vasodilation, and decrease anxiety. Nitrates reduce myocardial oxygen consumption by decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).

A nurse is calculating the most accurate dosage of a medication for a child. What parameter should influence this calculation? A) Body surface area in relation to weight B) Body weight C) Developmental stage in relation to age D) Age

A) Body surface area in relation to weight Body surface area in relation to weight is the most reliable method for estimating proper medication dosage for a child. Body surface area is more accurate for dosage calculation than height or weight alone because height and weight vary widely. Developmental stage does not enter into dosage calculation.

A nurse is reviewing the health care provider's (HCP's) admitting prescriptions for a 52-year-old client scheduled for a dilatation and curettage. The nurse is unable to decipher the handwriting but thinks the medication prescription reads either metoprolol or topiramate. What should the nurse do next? A) Call the HCP to clarify the prescription. B) Ask the client if she has hypertension. C) Ask the pharmacist to interpret the prescription. D) Ask the client if she has migraines.

A) Call the HCP to clarify the prescription. The nurse must clarify this prescription with the admitting HCP to ensure medication accuracy and client safety. In health care settings without computerized medical records or computer prescribing, misinterpretation of handwriting remains a leading cause of medication errors. It is not safe practice to question the client regarding a diagnosis and assume the medication is correctly prescribed. The pharmacist will need clarification of the prescription as well. It is not the role of the pharmacist to interpret the prescription.

A client reports pain in the right heel and is requesting medication. The nurse assesses the client and administers an analgesic. The client experiences no pain relief and states that the heel pain is worse. What is an appropriate intervention by the nurse? A) Call the physician to report the finding. B) Repeat the dose of analgesia every hour. C) Apply warm, moist heat to the right ankle area. D) Massage the client's foot in a circular motion.

A) Call the physician to report the finding. The best response would be to notify the physician. The nurse cannot repeat the dose of analgesia without an order. Massaging the ankle and applying moist heat would be inappropriate for a number of reasons. The client could be developing a deep vein thrombosis, which may dislodge an embolus. Unrelieved pain indicates that an adverse event is developing, and the physician should be made aware of the situation.

When assessing a client's I.V. insertion site, a nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first? A) Check the tubing for kinks and reposition the client's wrist and elbow. B) Irrigate the I.V. tubing with 1 ml of normal saline solution. C) Discontinue the I.V. infusion at that site and restart it in the other arm. D) Elevate the I.V. fluid bag.

A) Check the tubing for kinks and reposition the client's wrist and elbow. The nurse should check for common causes of a decreased I.V. flow rate, such as kinks in the tubing and poor positioning of the affected arm. The nurse should discontinue the I.V. infusion only if other measures fail to solve the problem. Irrigating I.V. tubing may dislodge any clots that are present. Elevating the I.V. fluid bag may help if the nurse finds no kinks and if repositioning doesn't resolve the problem.

The nurse is reviewing the following physician's order written for a postmenopausal woman: "calcitonin salmon nasal spray 200 IU, one spray every day." What is the appropriate action to be taken by the nurse regarding this order? A) Clarify with the physician that the spray should be given in only one nostril per day. B) Ask the physician why this medication was ordered for a postmenopausal woman. C) Inform the physician that the medication is not a nasally applied medication. D) Remind the physician that this medication can be purchased over-the-counter.

A) Clarify with the physician that the spray should be given in only one nostril per day. Calcitonin salmon nasal spray should be administered in only one nostril per day. Many preprinted order sheets automatically print "administer in both nostrils" when a nasal spray is ordered. Nurses must be familiar with the directions for each medication they give before administering medications. The other options are incorrect because calcitonin salmon nasal spray is prescribed to postmenopausal women for the treatment of osteoporosis and requires a physician's order.

The nurse is caring for a client with a serum sodium level of 128 mEq/L. Which orders for intravenous fluids should the nurse should question? A) Dextrose 5% in water (D5W) B) Dextrose 5% in half-normal saline solution D5.45 C) Normal saline solution 0.9 D) Lactated Ringer's solution

A) Dextrose 5% in water (D5W) A serum sodium level of 128 mEq/L indicates a hypotonic state. Administering a hypotonic IV solution. D5W, also referred to as free water, will cause further hemodilution. Dextrose 5% in half-normal saline solution is slightly hypertonic; normal saline solution is isotonic; and lactated Ringer's solution is isotonic. The latter three are more appropriate choices to restore normal tonicity of the blood.

While making rounds, a nurse observes that a client's primary bag of intravenous (IV) solution is light yellow. The label on the IV bag says the solution is D5W. What should the nurse do first? A) Hang a new bag of D5W, and complete an incident report. B) Notify the health care provider (HCP). C) Ask another nurse to look at the solution. D) Continue to monitor the bag of IV solution.

A) Hang a new bag of D5W, and complete an incident report. Maintenance of IV sites and systems includes regular assessment and rotation of the site and periodic changes of the dressing, solution, and tubing; these measures help prevent complications. The nurse should also observe the solution for discoloration, turbidity, and particulates. An IV solution is changed every 24 hours or as needed, and because the nurse noted an abnormal color, the nurse should change the bag of D5W and note this on an incident report. It is not necessary to verify this action with another nurse. Paging the HCP is not necessary; maintaining the IV and using the correct solutions is a nursing responsibility. Although the first action is to hang a new bag, hospital policy should be followed if there is a question as to whether there could have been an unknown substance in the bag that caused it to change color.

The nurse observes a new parent give an oral medication to their 4-month-old infant. The parent instills the medication directly in the back of the infant's throat. Which of the following is the nurse's best action? A) Instruct the parent to instill a small amount of the medication inside the baby's cheek B) Have the parent lay the infant flat, restraining the arms, while giving the medication C) Praise the parent's technique of giving the medication D) Demonstrate to the parent ways to prop the infant in a sitting position for medication administration

A) Instruct the parent to instill a small amount of the medication inside the baby's cheek The parent's technique of instilling the medication in the back of the throat is not correct and could cause the infant to choke. The nurse should instruct the parents to instill a small amount at a time inside the infant's cheek. The parent should hold an infant in the bottle-feeding position when administering an oral medication by placing the child's inner arm behind the back, supporting the head in the crook of the elbow, and holding the child's free hand with the hand of the supporting arm. Propping a 4-month-old infant is not appropriate. The infant cannot sit unsupported even in a seated position. Administering medication to an infant lying flat could cause choking and aspiration.

A nurse receives a report that a client has had an overdose of heparin. Which of the following actions by the nurse is most important in managing the overdose? A) Obtain an order to give protamine sulfate. B) Review the client's coagulation studies. C) Inform the client that nosebleeds may occur. D) Have the client remain on bed rest to prevent injury.

A) Obtain an order to give protamine sulfate. Protamine sulfate is the reversal agent for heparin. Administering this would be the best way to treat the client. The other options do not reverse heparin and therefore will not treat the overdose.

A 9-month-old infant is ordered 5% permethrin to treat scabies. When teaching the caregiver about the medication, what would be most important to include in the teaching? A) Only apply the topical treatment once in 14 days. B) It is normal for this cream to cause painful burning and stinging of the skin. C) Wear loose fitting clothes as the cream dries. D) Do not shower or bathe for 24 hours after application.

A) Only apply the topical treatment once in 14 days. Five percent permethrin is supplied in a cream and is the treatment of choice for children younger than age 1. However, its safety has not been established for clients younger than 2 months. The treatment is applied only once in a 14-day period to prevent toxic effects. The client should wash off the medication within 8 to 14 hours of application, preferably in a shower or bath. The fit of the client's clothes does not matter as long as the clothes are clean. Slight burning and itching may occur with this cream, but it should not be painful or sting the skin.

A client has been diagnosed with hypothyroidism and started on synthetic levothyroxine for thyroid replacement therapy. Which of the following is the most important effect to report to the physician? A) Palpitations and chest pain on exertion B) Increased temperature and metabolic rate C) Increased energy level and reduction of edema D) Insomnia and loss of weight

A) Palpitations and chest pain on exertion Assessment of the effects of severe hypothyroidism on the circulatory system is important. Serum cholesterol levels are also elevated in clients with hypothyroidism. As the metabolic rate increases with the thyroid replacement therapy, there is more demand on the heart, and angina and palpitations may occur. All of the choices are expected effects once the replacement hormone is started. There is an increase in temperature, a loss in weight, and increased energy levels.

The nurse is aware that a client receiving morphine sulfate intravenously post-surgical repair of a hip fracture may exhibit which of the following outcomes when getting out of bed for the first time? A) Postural or orthostatic hypotension B) Respiratory distress because of increased pain from movement C) Acute hip pain based on the movement D) Initial hypertension due to the medication administration 2 hours earlier

A) Postural or orthostatic hypotension After the administration of certain antihypertensives or narcotics, the client's neurocirculatory reflexes may have some difficulty adjusting to the force of gravity when he/she assumes an upright position. Postural or orthostatic hypotension may then occur, causing a temporarily decreased blood supply to the brain. The client received analgesia, so pain should be controlled and the client's blood pressure should be within normal range or slightly lower. Pain should not be acute.

Eardrops have been prescribed to be instilled in the adult client's left ear to soften cerumen. To position the client, what should the nurse do? A) Pull the auricle lobe up and back. B) Pull the ear lobe down and back. C) Chill the eardrops prior to administering. D) Have the client lie on the left side.

A) Pull the auricle lobe up and back. The nurse should have the client lie on the side opposite the affected ear. To straighten the client's ear canal, pull the auricle of the ear up and back for an adult. For an infant or a young child, gently pull the auricle down and back to the nasopharynx. The eardrops should be administered at body temperature.

A nurse is assessing a post-surgical client who has been receiving nasogastric suctioning for 3 days. The client is restless, confused, and has generalized edema. What is the nurse's best intervention? A) Stop the infusion of 5% dextrose in water (D5W) at 100 mL/hr. B) Administer IV morphine sulfate 4 mg every 2 hours PRN. C) Infuse 100 ml bolus of 3% saline if serum sodium decreases to less than 128 mEq/L. D) Administer IV metoclopramide 10 mg every 6 hours PRN for nausea.

A) Stop the infusion of 5% dextrose in water (D5W) at 100 mL/hr. Hyponatremia is decrease in serum Na concentration < 136 mEq/L caused by an excess of water relative to solute. Because the client's gastric suction has been depleting electrolytes, the client is displaying signs of fluid volume overload and hyponatremia. Clinical manifestations are primarily neurologic due to an osmotic shift of water into brain cells causing edema. They include headache, confusion, and stupor. D5W becomes hypotonic as it is metabolized and could worsen fluid volume overload. The action of the nurse should be to recognize the symptoms and stop the D5W IV infusion. Once completed, the IV solution should be changed to a solution that includes electrolyte (sodium) replacement. The client is not in acute pain therefore morphine should not be given. Metoclopramide is given for a client who has nausea and vomiting.

A nurse is to administer several oral medications to a client at the same time. Which nursing instruction or action is appropriate in this situation? A) Tell the client the name and action or use of each medication before administering it. B) Tell the client to take all the medications at once. C) Leave the medications at the bedside for the client to take when he wishes. D) Advise the client to take each medication with 8 oz (240 mL) of water.

A) Tell the client the name and action or use of each medication before administering it. When administering several oral medications at the same time, the nurse should tell the client the name of each medication and its action or use before administering it. The client may take the medications all at once or one at a time with any amount of fluid. Leaving medications at the bedside may lead to errors such as the client not taking them. To ensure that the client takes his medication, the nurse should always observe the client taking it.

A nurse inadvertently gives a client a double dose of an ordered medication. After discovering the error, whom should the nurse notify first? A) The prescriber B) The client C) The risk manager D) The pharmacist

A) The prescriber After discovering a medication error, the safety of the patient is top priority. The nurse should immediately check the client and observe for any adverse effects which may develop. The first person the nurse needs to notify is the prescriber, followed by the nursing manager (or the nursing supervisor). Then pharmacist and risk manager should also be notified.

A client with early acute renal failure has anemia, tachycardia, hypotension, and shortness of breath. The health care provider (HCP) has prescribed 2 units of packed red blood cells (RBCs). What should the nurse determine prior to initiating the blood transfusion? Select all that apply. A) There is a signed informed consent for transfusion therapy. B) Blood typing and cross-matching are documented in the medical record. C) The client has an identification bracelet. D) There is the second unit of blood in the medication room. E) The vital signs have been taken and documented in accordance with facility policy and procedure. F) There is an IV access with the appropriate tubing and normal saline as the priming solution.

A) There is a signed informed consent for transfusion therapy. B) Blood typing and cross-matching are documented in the medical record. C) The client has an identification bracelet. E) The vital signs have been taken and documented in accordance with facility policy and procedure. F) There is an IV access with the appropriate tubing and normal saline as the priming solution. Before prescribing and administering packed RBCs, the nurse should assess the IV site to make sure it has an 18G to 20G infusion set. The nurse should also ensure that normal saline solution is used to prime the tubing to prevent RBCs from adhering to the tubing. The client must indicate informed consent for the procedure by signing the consent form. The client's blood must be typed to determine ABO blood typing and Rh factor and ensure that the client receives compatible blood. Cross-matching is done to detect the presence of recipient antibodies to the donor's minor antigens. Vital signs provide a baseline reference for continuous monitoring throughout the transfusion. An identification bracelet and red blood band are essential for client identification per facility policy. Two nurses must double check the client's identification with the client listed on the unit of RBCs. The transfusion should be started within 30 minutes of the time that the RBC unit is checked out of the blood bank. Thus, no blood should be kept in the medication room before transfusion.

A woman is taking oral contraceptives. The nurse teaches the client that medications that may interfere with oral contraceptive efficacy include: A) antibiotics. B) diuretics. C) antihypertensives. D) antihistamines.

A) antibiotics. Broad-spectrum antibiotics can cause decreased efficacy of oral contraceptives, placing the client at risk for an unplanned pregnancy. When a client is prescribed a course of antibiotics, a back-up method of contraception should be used. Antihypertensives, diuretics, and antihistamines do not interfere with oral contraceptive efficacy.

A client has sustained a head injury and is to receive mannitol by IV push. In evaluating the effectiveness of the drug, the nurse should expect to find which of the following? A) Increased lung expansion and ease of breathing B) Decreased cerebral edema C) Decreased cardiac workload D) Increased cerebral circulation causing increase in mental alertness

B) Decreased cerebral edema Mannitol, an osmotic diuretic, is used to decrease cerebral edema in clients with head injuries. The other choices are not correct results of mannitol.

The nurse is teaching a client with hypertension about taking atenololol. The nurse should instruct the client to: A) avoid sudden discontinuation of the drug. B) monitor the blood pressure annually. C) discontinue the medication if severe headaches develop. D) follow a 2-g sodium diet.

A) avoid sudden discontinuation of the drug. Atenolol is a beta-adrenergic antagonist indicated for management of hypertension. Sudden discontinuation of this drug is dangerous because it may exacerbate symptoms. The medication should not be discontinued without a prescription. Blood pressure needs to be monitored more frequently than annually in a client who is newly diagnosed and treated for hypertension. Clients are not usually placed on a 2-g sodium diet for hypertension.

When teaching a client about propranolol hydrochloride, the nurse should base the information on the knowledge that propranolol: A) blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. B) is a potent arterial and venous vasodilator that reduces peripheral vascular resistance and lowers blood pressure. C) increases norepinephrine secretion and thus decreases blood pressure and heart rate. D) is an angiotensin-converting enzyme inhibitor that reduces blood pressure by blocking the conversion of angiotensin I to angiotensin II.

A) blocks beta-adrenergic stimulation and thus causes decreased heart rate, myocardial contractility, and conduction. Propranolol is a beta-adrenergic blocking agent. Actions of propranolol include reducing heart rate, decreasing myocardial contractility, and slowing conduction. Propranolol does not increase norepinephrine secretion, cause vasodilation, or block conversion of angiotensin I to angiotensin II.

Which adverse effects occur when there is too rapid an infusion of TPN solution? A) circulatory overload B) hypokalemia C) negative nitrogen balance D) hypoglycemia

A) circulatory overload Too rapid infusion of a TPN solution can lead to circulatory overload. The client should be assessed carefully for indications of excessive fluid volume. A negative nitrogen balance occurs in nutritionally depleted individuals, not when TPN fluids are administered in excess. When TPN is administered too rapidly, the client is at risk for receiving an excess of dextrose and electrolytes. Therefore, the client is at risk for hyperglycemia and hyperkalemia.

The nurse observes the client instill eyedrops. The client says, "I just try to hit the middle of my eyeball so the drops do not run out of my eye." The nurse explains to the client that this method may cause: A) corneal injury. B) excessive lacrimation. C) scleral staining. D) systemic drug absorption.

A) corneal injury. The cornea is sensitive and can be injured by eyedrops falling onto it. Therefore, eyedrops should be instilled into the lower conjunctival sac of the eye to avoid the risk of corneal damage. The drops do not cause scleral staining or excessive lacrimation. Systemic absorption occurs when eyedrops enter the tear ducts.

After administering an I.M. injection, a nurse should: A) discard the uncapped needle and syringe in a puncture-proof container. B) break the needle using the facility-approved device and discard the needle and syringe in any medical waste container. C) recap the needle and discard the needle and syringe in any medical waste container. D) recap the needle and discard the needle and syringe in a puncture-proof container.

A) discard the uncapped needle and syringe in a puncture-proof container. The appropriate procedure is to discard uncapped needles in a puncture-proof, leak-proof container. To reduce the risk of accidental needle sticks, the nurse should never recap a needle. She should never place a used needle in a garbage can or in a medical waste container that isn't puncture-proof and leak-proof. She should never break or bend a needle before discarding it. Doing so increases the risk of a needle stick.

The nurse is preparing to start an IV infusion. Before inserting the needle into a vein, the nurse should apply a tourniquet to the client's arm to: A) distend the veins. B) occlude arterial circulation. C) stabilize the veins. D) immobilize the arm.

A) distend the veins. Applying a tourniquet obstructs venous blood flow and, as a result, distends the veins. A tourniquet does not stabilize veins or immobilize the arm, nor is it applied to occlude arterial circulation.

Which prescription is entered correctly on the medical record? A) fentanyl 50 mcg given IV every 2 hours as needed for pain greater than 6/10 B) give 4 U regular insulin IV now C) 60.0 mg ketorolac tromethamine given IM for c/o pain D) .5 mg MS given IM for c/o pain

A) fentanyl 50 mcg given IV every 2 hours as needed for pain greater than 6/10 Prescriptions should be written clearly to avoid confusion or misinterpretation. Clearly written prescriptions do not use a "trailing" zero (a zero following a decimal point) and do use a "leading" zero (a zero preceding a decimal point). Additionally, the prescribed medication should be written in full and avoid abbreviations of the drug and the dosage, for example "morphine sulfate" (avoiding use of "MS"), "ml" instead of "cc," and "micrograms" instead of "mcg."

The nurse should assess older adults for which serious adverse effects of ibuprofen? A) impaired renal function B) hypoglycemia C) neuropathy D) rebound headaches

A) impaired renal function Renal function may already be compromised in the elderly, and ibuprofen can further impair renal or liver function. Nonsteroidal anti-inflammatory drugs can also cause nephrosis, cirrhosis, and heart failure in elderly persons. Rebound headaches are not a serious adverse effect of ibuprofen. Neuropathy and hypoglycemia are not adverse effects of ibuprofen.

Immediately after a lumbar laminectomy, the nurse administers ondansetron hydrochloride to the client as prescribed. The nurse determines that the drug is effective when which sign is controlled? A) nausea B) shivering C) muscle spasms D) dry mouth

A) nausea Ondansetron hydrochloride is a selective serotonin receptor antagonist that acts centrally to control the client's nausea in the postoperative phase. It does not control muscle spasms, shivering, or dry mouth.

Cross-tolerance to a drug is defined as: A) one drug reduces response to another drug. B) an allergic reaction to a class of drugs. C) one drug that can prevent withdrawal symptoms from another drug. D) one drug increases another drug's potency.

A) one drug reduces response to another drug. Cross-tolerance occurs when a drug with a similar action causes a decreased response to another drug. A drug that can prevent withdrawal symptoms from another drug describes cross-dependence. Cross-tolerance isn't an allergic reaction to a class of drugs. A drug's ability to increase the potency of another drug describes potentiating effects.

The nurse notes grapefruit juice on the breakfast tray of a client taking repaglinide. The nurse should: A) remove the grapefruit juice from the client's tray and bring another juice of the client's preference. B) contact the manager of the Food and Nutrition Department. C) substitute a half grapefruit in place of grapefruit juice. D) request that the dietitian discuss the drug-food interaction of repaglinide and grapefruit juice.

A) remove the grapefruit juice from the client's tray and bring another juice of the client's preference. There is a drug-food interaction between repaglinide and grapefruit juice that may inhibit metabolism of repaglinide; the fresh grapefruit also interacts with repaglinide. It is not necessary that the dietitian inform the client of the drug-food interaction first. To contact the manager of the Food and Nutrition Department is not an intervention that will bring about prompt removal of the juice.

When using a Z-track injection technique, the nurse holds the gauze pledget against an IM injection site while removing the needle from the muscle. This technique helps to: A) seal off the track left by the needle in the tissue. B) prevent organisms from entering the body through the skin puncture. C) avoid the discomfort of the needle pulling on the skin. D) speed the spread of the medication in the tissue.

A) seal off the track left by the needle in the tissue. When administering an injection using the Z track method, holding the gauze pledget against the site while removing the needle from the muscle helps to seal off the track left by the needle in the tissue.

A female client is treated for trichomoniasis with metronidazole. The nurse instructs the client that: A) she should avoid alcohol during treatment and for 24 hours after completion of the drug. B) the medication should not alter the color of the urine. C) she should discontinue oral contraceptive use during this treatment. D) her partner does not need treatment.

A) she should avoid alcohol during treatment and for 24 hours after completion of the drug. Metronidazole can cause a disulfiram-like reaction if it is taken with alcohol. Tachycardia, nausea, vomiting, and other serious interaction effects can occur. Flagyl will make the urine a darker color. Oral contraceptives should never be discontinued with trichomoniasis. The partner also requires treatment to prevent retransmission of infection.

When positioned properly, the tip of a central venous catheter should lie in the: A) superior vena cava. B) basilic vein. C) jugular vein. D) subclavian vein.

A) superior vena cava. When positioned correctly, the tip of a central venous catheter lies in the superior vena cava, inferior vena cava, or right atrium — that is, in the central venous circulation. Blood flows unimpeded around the tip, allowing the rapid infusion of large amounts of fluid directly into circulation. The basilic, jugular, and subclavian veins are common insertion sites for central venous catheters.

A nulligravid client calls the clinic and tells the nurse that she forgot to take her oral contraceptive this morning. The nurse should tell the client to: A) take the medication immediately. B) restart the medication in the morning. C) take two pills tonight before bedtime. D) use another form of contraception for 2 weeks.

A) take the medication immediately. The nurse should instruct the client to take the medication immediately or as soon as she remembers that she missed the medication. There is only a slight risk that the client will become pregnant when only one pill has been missed, so there is no need to use another form of contraception. However, if the client wishes to increase the chances of not getting pregnant, a condom can be used by the male partner. The client should not omit the missed pill and then restart the medication in the morning because there is a possibility that ovulation can occur, after which intercourse could result in pregnancy. Taking two pills is not necessary and also will result in putting the client off her schedule.

The postoperative nursing assessment of a client's ability to swallow fluids before providing oral fluids is based on the type of anesthesia given. Which client would not have delayed fluid restrictions? A) the client who has undergone a repair of carpal tunnel syndrome under local anesthesia B) the client who has undergone a bronchoscopy under local anesthesia C) the client who has undergone an inguinal herniorrhaphy with spinal and intravenous conscious sedation D) the client who has undergone a transurethral resection of a bladder tumor under general anesthesia

A) the client who has undergone a repair of carpal tunnel syndrome under local anesthesia The client who has not had the gag reflex anesthetized is the client who had a repair of the carpal tunnel syndrome under local anesthesia because the area being anesthetized was the tissue in the wrist. The client who had a bronchoscopy received a local anesthetic on the vocal cords, and the nurse should check the gag reflex or ability to swallow before administering fluids. Clients who had general anesthesia or intravenous conscious sedation received medication for central nervous system sedation, and the nurse should assess the level of consciousness and ability to swallow before administering fluids.

The nurse instructs a client who is taking iron supplements that: A) the stools will become darker. B) iron supplements should be taken on an empty stomach. C) liquid iron supplements will not discolor teeth. D) a daily bulk laxative such as psyllium hydrophilic mucilloid should be avoided.

A) the stools will become darker. Iron supplements will darken the stools. Iron supplements should not be taken on an empty stomach because they can cause gastric irritation. Iron is constipating, and a daily bulk-forming laxative should be started prophylactically. A straw should be used when taking liquid iron to avoid discoloring the teeth.

A client has been on long-term prednisone therapy. What should the nurse instruct the client to include in her diet? Select all that apply. A) vitamin D B) carbohydrate C) calcium D) potassium E) trans fat F) protein

A) vitamin D C) calcium D) potassium F) protein Adverse effects of prednisone are weight gain, retention of sodium and fluids with hypertension and cushingoid features, a low serum albumin level, suppressed inflammatory processes with masked symptoms, and osteoporosis. A diet high in protein, potassium, calcium, and vitamin D is recommended. Carbohydrates would elevate glucose and further compromise a client's immune status. Trans fat does not counteract the adverse effects of steroids such as prednisone.

A physician orders an infusion of 2,400 ml of I.V. fluid over 24 hours, with half this amount to be infused over the first 10 hours. During the first 10 hours, a client should receive how many milliliters of I.V. fluid per hour? A) 100 ml/hour B) 50 ml/hour C) 120 ml/hour D) 240 ml/hour

C) 120 ml/hour First, the nurse determines how many milliliters (half of the total) to administer over the first 10 hours: 2,400 ml ÷ 2 = 1,200 ml. Then she determines how many of these milliliters to deliver per hour: 1,200 ml ÷ 10 hours = 120 ml/hour.

A 14-year-old with rheumatic fever who is on bed rest is receiving an IV infusion of dextrose 5% r administered by an infusion pump. The nurse should verify the alarm settings on the infusion pump at which times? Select all that apply. A) when the infusion is started B) when the child returns from X-ray C) at the beginning of each shift D) when the child is sleeping E) when the child moves in the bed

A) when the infusion is started B) when the child returns from X-ray C) at the beginning of each shift The alarm settings on infusion pumps should be verified at the time the infusion is started, at the beginning of each shift, and when the client is moved. The child can move in bed or sleep, but if the alarm is triggered, the nurse should verify the settings.

The nurse is administering an intradermal injection (see the accompanying figure). The nurse should: A) withdraw the needle. B) aspirate the medication and administer the medication at another site. C) report an adverse reaction to the medication. D) instruct the client to massage the area for 1 minute.

A) withdraw the needle. The nurse observes a wheal indicating that the medication has been deposited in the dermis; the nurse can now withdraw the needle. The wheal is an expected outcome of an intradermal injection. The area should not be massaged; massaging will cause the medication to move into the subcutaneous tissue. The medication has been administered correctly, and the nurse should not aspirate the medication or attempt to administer it again.

A nurse is to give a client a 325-mg aspirin suppository. The client has diarrhea and is in the bathroom. The best nursing approach at this time would be to: A) withhold the suppository and notify the client's physician. B) administer the suppository 15 minutes after the diarrhea stops. C) substitute 325-mg aspirin by mouth. D) tell the client you'll give him the suppository when he's finished in the bathroom.

A) withhold the suppository and notify the client's physician. Because the client has diarrhea, the nurse should hold the medication and talk with the physician. She should never give a suppository to a client with diarrhea because the client would expel the suppository. Waiting 15 minutes or until the client is finished in the bathroom is inappropriate because the client will most likely have another urge to defecate and will expel the suppository. Substituting the oral form is inappropriate; only the physician can change the administration route of an ordered drug.

A client is to be discharged with a prescription for lactulose. The nurse teaches the client and the client's spouse how to administer this medication. Which statement would indicate that the client has understood the information? A) "I will take it with an antacid." B) "I will mix it with apple juice." C) "I will take it with a laxative." D) "I will mix the crushed tablets in some gelatin."

B) "I will mix it with apple juice." The taste of lactulose is a problem for some clients. Mixing it with fruit juice, water, or milk can make it more palatable. Lactulose should not be given with antacids, which may inhibit its action. Lactulose should not be taken with a laxative because increased stooling is an adverse effect of the drug and would be potentiated by using a laxative. Lactulose comes in the form of syrup for oral or rectal administration.

A client is asking about dietary modifications to counteract the long-term effects of prednisone. What is the most appropriate information for the nurse to give the client? A) "Increase your intake of complex carbohydrates." B) "Increase your intake of calcium and vitamin D." C) "Increase your intake of polyunsaturated fats." D) "Increase your intake of dietary sodium."

B) "Increase your intake of calcium and vitamin D." Problems associated with long-term corticosteroid therapy include sodium retention, osteoporosis, and hyperglycemia. An increase in calcium and vitamin D is needed to help prevent bone deterioration. Dietary modifications need to reduce sodium, maintain high protein levels for tissue repair, and reduce carbohydrates, as there is a tendency toward hyperglycemia. Increased intake of complex carbohydrates is not indicated because of hyperglycemia. There should be decreased fat intake because there is a tendency for central fat deposition.

A nurse is supervising a student during medication administration to a client. Which of the following action by the student would cause the nurse to intervene during the med pass at the bedside? A) Check the client's identification band. B) Check the room number and the client's name on the bed. C) First asks the client's name. D) Compare data to the medication administration record.

B) Check the room number and the client's name on the bed. Checking the client's identification band is the safest way to verify a client's identity because the band is assigned on admission and should not be removed at any time. Asking the client's name or having the client repeat his name would be also be appropriate. Checking the room number isn't appropriate because clients may be transferred from another room and the paperwork may not be correct. Checking the client's name on the bed is not appropriate because names on beds are also not always correct.

The nurse is planning care for a client with severe postoperative pain. There is a prescription for morphine written as "10 mg MSO4" on the medical record. What should the nurse do first? A) Prepare the medication for administration. B) Contact the health care provider (HCP) who prescribed the medication. C) Obtain an intravenous infusion system. D) Contact the pharmacy department.

B) Contact the health care provider (HCP) who prescribed the medication. The nurse should first contact the HCP because the prescription for the morphine is not complete. The Joint Commission of the United States and the Institute for Safe Medication Practices Canada recommend not to use MSO4 because it can apply to morphine as well as to magnesium sulfate. There is no mention of an IV system being needed. The morphine should not be in the medication cabinet because the prescription is not complete. Although pharmacy may offer a suggestion as to what the medication prescribed is, the best means to confirm the intent of the prescription is to contact the HCP who wrote the prescription.

A client with a deficient fluid volume is receiving an I.V. infusion of dextrose 5% in water and lactated Ringer's solution at 125 ml/hour. Which assessment finding indicates the need for additional I.V. fluids? A) Jugular vein distention B) Dark amber urine C) Temperature of 99.6° F (37.6° C ) D) Serum sodium level of 135 mEq/L

B) Dark amber urine Normally, urine appears light yellow; dark amber urine is concentrated and suggests decreased fluid intake. The serum sodium level normally ranges from 135 to 145 mEq/L. A temperature of 37.6° C (99.6° F) is only slightly elevated and doesn't indicate a fluid volume deficit. Neck vein distention is a sign of fluid volume overload, not deficient fluid volume.

A graduate nurse is reviewing the procedure for removing a peripherally inserted central catheter (PICC) with her preceptor. Which planned action by the graduate nurse should the preceptor correct? A) Applying a dressing over the site and leaving it in place for 24 hours B) Discarding the catheter in a trash container C) Flushing the PICC with 0.9% sodium chloride before removing it D) Measuring the length of the removed catheter and comparing it with the documented length of the inserted catheter

B) Discarding the catheter in a trash container To prevent injury to others, the graduate nurse should discard the catheter in a sharps-disposal container rather than a trash container. She should measure the length of the catheter to ensure that the entire catheter has been removed. Flushing the line ensures that there are no problems with the line. Applying a dressing and leaving it in place for 24 hours helps ensure hemostasis.

A nurse notes that a client's I.V. insertion site is red, swollen, and warm to the touch. Which action should the nurse take first? A) Apply an ice pack to the I.V. site. B) Discontinue the I.V. infusion. C) Apply a warm, moist compress to the I.V. site. D) Check the I.V. infusion for patency.

B) Discontinue the I.V. infusion. Because redness, swelling, and warmth at an I.V. site are signs of infection, the nurse should discontinue the infusion immediately and restart it at another site. After doing this, the nurse should apply warmth to the original site. Checking infusion patency isn't warranted because assessment findings suggest infection and inflammation, not infiltration. Heat, not cold, is the appropriate treatment for inflammation.

When checking a client's medication profile, a nurse notes that the client is receiving a drug contraindicated for clients with glaucoma. The nurse knows that this client, who has a history of glaucoma, has been taking the medication for the past 3 days. What should the nurse do first? A) Continue to give the medication because the client has been taking it for 3 days. B) Hold the medication and report the information to the physician to ensure client safety. C) File an incident report because several other staff members have given the medication to the client. D) Find out whether there are extenuating reasons for giving the drug to this client.

B) Hold the medication and report the information to the physician to ensure client safety. The nurse should report the information to the physician because the client's safety may be endangered. She shouldn't give the drug until clarifying the order with the physician. The fact that the client has taken the drug for several days doesn't guarantee that giving him another dose is safe. Filing an incident report and finding out whether there are extenuating reasons for giving the drug wouldn't address client safety.

Which type of solution raises serum osmolarity and pulls fluid from the intracellular and intrastitial compartments into the intravascular compartment? A) Isotonic B) Hypertonic C) Hypotonic D) Electrotonic

B) Hypertonic The osmolarity of a hypertonic solution is higher than that of serum. A hypertonic solution draws fluid into the intravascular compartment from the intracellular and interstitial compartments. An isotonic solution's osmolarity is about equal to that of serum. It expands the intravascular and interstitial compartments. A hypotonic solution's osmolarity is lower than serum's. A hypotonic solution hydrates the intracellular and interstitial compartments by shifting fluid out of the intravascular compartment. Electrotonic solution is incorrect.

A client rates the pain level of a migraine an 8 on a scale of 1-10. How would the nurse administer the medication to give the client the quickest relief? A) Intramuscular (IM) B) Intravenous (IV) C) Sublingual D) Buccal

B) Intravenous (IV) The nurse would want the client to receive the benefit of the medication as quickly a possible to help alleviate the migraine. A drug placed directly into intravenous system enters the client's bloodstream more quickly than oral, IM, or buccal, thereby avoiding the barriers of food and the destructive effects of stomach acid. With oral, IM, and buccal administration, the client's response to the drug is slower.

The health care provider (HCP) prescribes IV cefazolin 1 g for a client. In preparing to administer the cefazolin, the nurse notes that the client is allergic to penicillin. Based on this information, what is an appropriate action for the nurse to take? A) Continue to prepare to administer the cefazolin as prescribed. B) Notify the HCP of the client's allergy to penicillin. C) Call the pharmacist to verify that the cefazolin should be administered as prescribed. D) Administer the cefazolin, staying at the client's bedside during the infusion.

B) Notify the HCP of the client's allergy to penicillin. The nurse should notify the HCP that the client is allergic to penicillin before giving the cefazolin. Cephalosporins are contraindicated in clients who are allergic to penicillin. Clients who are allergic to penicillin may have a cross-allergy to cephalosporins.

A nurse is caring for a client who is vomiting. The physician has ordered oral dimenhydrinate. What is the most appropriate action by the nurse to help the client? A) Administer the medication intravenously due to the vomiting. B) Notify the physician of the vomiting, and obtain a new medication order. C) Administer the oral medication, and monitor the client's emesis. D) Wait for the vomiting to cease, and then administer the oral medication.

B) Notify the physician of the vomiting, and obtain a new medication order. Because of the vomiting, the oral medication will be ineffective. The nurse should contact the physician, notify the physician of the vomiting, and obtain a new order for the medication (or an alternate medication) to be given by a different route. Changing the route of the medication without a physician's order is outside the scope of nursing practice. This is also considered prescribing a medication and violates the professional standards for medication administration.

Twenty minutes after a transfusion of packed red blood cells is initiated, a client reports shivering, headache, and lower back pain. The vital signs show a normal temperature and increased pulse and respiratory rate. What should be the first nursing actions? A) Stop the transfusion, check the oxygen saturation levels, and check the urine volume. B) Stop the transfusion, continue with saline infusion, and notify the physician regarding a suspected hemolytic reaction. C) Slow the transfusion, notify the physician regarding a possible febrile reaction, and follow the physician's orders. D) Slow the transfusion, give an antihistamine as ordered, and notify the physician regarding a possible allergic reaction.

B) Stop the transfusion, continue with saline infusion, and notify the physician regarding a suspected hemolytic reaction. Hemolytic reaction is one of the most severe blood reactions, so prompt action to stop the transfusion is very important, followed by ensuring the IV access is preserved.

Immediately after receiving an injection of bupivacaine, the client becomes restless and nervous and reports a feeling of impending doom. The nurse should: A) reassure the client that it is normal to feel restless before a procedure. B) assess the client's vital signs. C) administer epinephrine. D) ask the client explain these feelings.

B) assess the client's vital signs. The nurse should assess the client's vital signs because there is a likelihood of having a reaction to the bupivacaine. If the client's vital signs are abnormal, immediate intervention may be necessary. Although the nurse may ask the client to continue to describe feelings, this is not likely to be a psychosocial reaction. Simple reassurance is inappropriate in most clinical situations and can be dangerous if physiologic causes of restlessness are overlooked. The nurse should not administer epinephrine until vital signs have been assessed.

An unconscious client in the emergency department is given IV naloxone due to an overdose of heroin. Which findings would indicate a therapeutic response to the naloxone? Select all that apply. A) decreased pulse rate B) consciousness C) increased respirations D) warm mosit skin E) dilated pupils

B) consciousness C) increased respirations Naloxone is an opioid antagonist used to treat an opioid overdose. Within a few minutes, the client should have an increase of respirations to near normal and become conscious. With a heroin overdose, the pulse is not significantly affected, the skin becomes warm and wet, and the pupils are dilated. With naloxone the skin would return to a normal temperature and become dry. The pupils also would react normally, and the pulse would not be decreased.

A client is receiving chemotherapy that has the potential to cause pulmonary toxicity. Which signs or symptoms indicates a toxic response to the chemotherapy? A) spasms of the diaphragm B) cough and shortness of breath C) drowsiness D) decrease in appetite

B) cough and shortness of breath Cough and shortness of breath are significant symptoms because they may indicate decreasing pulmonary function secondary to drug toxicity. Decrease in appetite, difficulty in thinking clearly, and spasms of the diaphragm may occur as a result of chemotherapy; however, they are not indicative of pulmonary toxicity.

A client is receiving total parenteral nutrition (TPN). The nurse notices that the bag of TPN solution has been infusing for 24 hours but has 300 mL of solution left. The nurse should: A) notify the health care provider (HCP) and obtain prescriptions to alter the flow rate of the solution. B) discontinue the current solution, change the tubing, and hang a new bag of TPN solution. C) change the filter on the tubing and continue with the infusion. D) continue the infusion until the remaining 300 mL is infused.

B) discontinue the current solution, change the tubing, and hang a new bag of TPN solution. IV fluids should not be infused for longer than 24 hours because of the risk of bacterial growth in the solution. The appropriate action for the nurse to take is to discontinue the current TPN solution, change the tubing, and hang a new bag of solution. Changing the filter does not decrease the risk of contamination. Notifying the HCP for a change in flow rate is not an acceptable solution.

The nurse administers an intradermal injection to a client. Proper technique has been used if the injection site demonstrates: A) no swelling. B) evidence of a bleb or wheal. C) minimal leaking. D) tissue pallor.

B) evidence of a bleb or wheal. A properly administered intradermal injection shows evidence of a bleb at the injection site. There should be no leaking of medication from the bleb; it needs to be absorbed into the tissue. Lack of swelling at the injection site means that the injection was given too deeply. The presence of tissue pallor does not indicate that the injection was given correctly.

The nurse is admitting a client with glaucoma. The client brings prescribed eyedrops from home and insists on using them in the hospital. The nurse should: A) ask the client's wife to assist the client in administering the eye drops while the client is in the hospital. B) explain to the client that the health care provider (HCP) will write a prescription for the eyedrops to be used at the hospital. C) place the eyedrops in the hospital medication drawer and administer as labeled on the bottle. D) allow the client to keep the eyedrops at the bedside and use as prescribed on the bottle.

B) explain to the client that the health care provider (HCP) will write a prescription for the eyedrops to be used at the hospital. In order to prevent medication errors, clients may not use medications they bring from home; the HCP will prescribe the eyedrops as required. It is not safe to place the eyedrops in the client's medication box or to permit the client to use them at the bedside. The nurse should ask the wife to take the eyedrops home.

The nurse should instruct a client who is taking dexamethasone and furosemide to report: A) excitability. B) muscle weakness. C) increased thirst. D) diarrhea.

B) muscle weakness. The nurse should instruct the client who is taking dexamethasone and furosemide to observe for signs and symptoms of hypokalemia, such as malaise, muscle weakness, vomiting, and a paralytic ileus, because both dexamethasone and furosemide deplete serum potassium. This combination of drugs does not cause the client to become excitable or have diarrhea or thirst.

A health care provider prescribes gentamicin for a client with peritonitis. The client has preexisting impaired vision and hearing. The nurse should: A) question whether the drug is appropriate for treatment of peritonitis. B) question the prescription because gentamicin could cause further hearing impairment. C) give the drug as prescribed. D) question the prescription because gentamicin could cause further visual impairment.

B) question the prescription because gentamicin could cause further hearing impairment. Aminoglycoside antibiotics can cause damage to the eighth cranial nerve and result in ototoxicity. If the client is already hearing impaired, the nurse should question the prescription with the health care provider, who may determine that prescribing another antibiotic would be safer. Gentamicin is an appropriate antibiotic for gram-negative infections such as peritonitis. Gentamicin does not cause visual impairment.

A client is to receive 1,000 mL of lactated Ringer's (LR) over 10 hours. The drip factor is 15 drops (gtts)/mL. How many gtts per minute should the client receive? A) 33 gtts/min B) 28 gtts/min C) 25 gtts/min D) 14 gtts/min

C) 25 gtts/min To convert mL/h to gtts/min: 1,000 mL/h x 15 gtts/mL x 1 h/60 min = 25 gtts/min.

A client receives an IV dose of gentamicin sulfate. How long after the completion of the dose should the peak serum concentration level be measured? A) 10 minutes B) 20 minutes C) 30 minutes D) 40 minutes

C) 30 minutes The peak serum dose of an antibiotic is drawn 30 minutes after the completion of the IV dose of the antibiotic.

A 77-year-old client is brought to the emergency department by her son. The client has a severe headache and lack of sleep because "I am so worried about everything." Her son says that she has heart failure and chronic schizophrenia. "In addition to all of her heart medicines, she is on aripiprazole, which was increased to 30 mg by her health care provider (HCP) 3 days ago." In addition to documenting all of the client's medications and exact dosages, the nurse should particularly investigate which factors? Select all that apply. A) the qualifications of the client's HCP B) the client's symptoms of heart failure C) the client's relationship with her son D) the dose of aripiprazole E) the client's symptoms of schizophrenia

B) the client's symptoms of heart failure C) the client's relationship with her son E) the client's symptoms of schizophrenia The client's symptoms are likely to be adverse effects of aripiprazole, especially at the reported dose. The normal adult dose is 5 to 10 mg. The elderly client commonly needs a lower dose compared with other adults. The anxiety and sleep disturbance could be symptoms of schizophrenia or medication adverse effects. A holistic approach would include assessing the client's heart failure. Questioning the qualifications of the family HCP is unproductive. There are no indications of problems in the client's relationship with her son.

A nurse has an order to administer iron dextran 50 mg I.M. injection. When carrying out this order, the nurse should: A) pull the skin laterally toward the injection site. B) use the Z-track technique. C) wipe the needle immediately after injection. D) insert the needle at a 45-degree angle.

B) use the Z-track technique. Iron dextran is an iron preparation given using the Z-track technique to prevent leakage into the subcutaneous tissue and staining of the skin. When giving an I.M. injection using the Z-track technique, the nurse pulls the skin laterally away from the injection site to seal the drug in the muscle, inserts the needle at a 90-degree angle, waits 10 seconds after injecting the medication to ensure drug dispersion, then simultaneously withdraws the needle and releases the skin to seal the needle track. Wiping the needle immediately after injection poses the risk of a needle stick.

A client who has severe thermal burns and is on mechanical ventilation becomes delusional and attempts to extubate himself. The nurse gives him propofol, a sedative. As a result, it's most important that the client receive a supplementation of: A) sodium. B) zinc. C) potassium. D) magnesium.

B) zinc. Propofol causes urinary zinc losses. Clients with burns are particularly susceptible to zinc deficiency; therefore, this client may need zinc supplementation. Burn clients are prone to electrolyte imbalances, including elevated or depressed sodium and potassium levels; however, these aren't specifically related to propofol therapy. The client may need magnesium supplementation, but not as a result of propofol therapy.

A physician orders heparin, 7,500 units, to be administered subcutaneously every 12 hours. The vial reads 10,000 units per milliliter. The nurse should anticipate giving how much heparin for each dose? A) 1¼ ml B) ¾ ml C) ½ ml D) ¼ ml

B) ¾ ml The nurse solves the problem as follows: 1 mL/10,000 units X 7,500 units = 0.75 mL or 3/4 mL

Which statement by a student nurse demonstrates that further instruction about cytotoxic drugs is needed? A) "Linen contaminated with blood or body fluids of a client receiving cytotoxic drugs should be placed in a leak-proof container and marked with a chemotherapy hazard label." B) "Cytotoxic parenteral infusion containers should be marked with special hazard labels." C) "Nurses who are pregnant must wear gloves during administration of cytotoxic drugs." D) "Infusion set administration connections should be tight."

C) "Nurses who are pregnant must wear gloves during administration of cytotoxic drugs." Pregnant nurses should not administer cytotoxic drugs because long-term exposure to cytotoxic drugs may be associated with teratogenic effects. Nonpregnant nurses should wear double gloves and long sleeve disposable gowns while administering cytotoxic drugs. To prevent exposure and leakage, the nurse should mark all parenteral infusion containers with hazard labels and check infusion container connections before drug administration. Linens that have become contaminated by blood or body fluid of a client receiving chemotherapy should be handled with caution, placed in a leak-proof, closed - system and labeled "chemotherapy contaminated linens."

A client who is being discharged from the hospital with bacterial pneumonia discusses not completing all medication in antibiotic regimens in the past. Which of the following statements should be a priority by the nurse? A) "You are infectious with the bacteria until all antibiotics are completed." B) "Complete the medication unless you are not coughing any sputum." C) "Taking only part of the prescription medication will result in antibiotic-resistant microbes." D) "Taking the medication until you feel better is usually okay."

C) "Taking only part of the prescription medication will result in antibiotic-resistant microbes." Taking medication until completed will lessen antibiotic-resistant strains of bacteria. Nurses cannot offer false advice, so telling the client to take the medication until the client feels better is incorrect. Bacteria can still be present without a cough, and infectious time frames vary.

While providing palliative care to a client in the home setting, the client's family expresses concern that the client is receiving "too much narcotic medication." Which of the following statements is the most therapeutic response by the nurse? A) "Do you want me to call the doctor now and explain that you are concerned?" B) "You don't need to worry at this point about too much pain medication." C) "You are concerned that the client is receiving too much narcotic medication?" D) "I am sure the doctor has ordered the appropriate amount of narcotic."

C) "You are concerned that the client is receiving too much narcotic medication?" Using a reflective statement without judgment allows the family to elaborate so the nurse can answer the specific concerns. The other options are not correct because they do not promote more conversation to help the family gain a better perspective on the treatment.

The label of a drug package reads "meperidine hydrochloride, 50 mg/ml." How many milliliters should a nurse give a client for a 30-mg dose? A) 0.5 ml B) 1 ml C) 0.6 ml D) 1.6 ml

C) 0.6 ml A measure of 0.6 ml equals 30 mg when the ratio is 50 mg/ml. The ratio to determine this answer is 30 mg : X ml :: 50 mg : 1 ml.

The physician orders 2 teaspoons of an oral laxative as needed for a constipated client. How many milliliters should the nurse administer to the client? A) 5 B) 12 C) 10 D) 2

C) 10 One teaspoon equals 5 ml. Therefore, to administer the correct amount of medication, the nurse should administer 10 ml.

A nurse is caring for a 3-year-old child admitted to the pediatric unit with acetaminophen poisoning. The nurse administers acetylcysteine every 4 hours for 72 hours. Which laboratory findings confirm the effectiveness of the drug therapy? A) Blood urea nitrogen and serum creatinine B) Complete blood count C) Alanine aminotransferase and aspartate aminotransferase D) Creatine kinase-MB

C) Alanine aminotransferase and aspartate aminotransferase Acetaminophen poisoning causes liver damage, raising the liver enzymes alanine aminotransferase and aspartate aminotransferase. Creatine kinase-MB levels are elevated with heart muscle damage and aren't associated with acetaminophen poisoning. Blood urea nitrogen and serum creatinine levels provide information on renal function and aren't indicators of effectiveness of drug therapy in acetaminophen poisoning. A complete blood count won't give the nurse information on the effectiveness of therapy.

Which drug delivery system most effectively reduces the likelihood of medication errors? A) Individual prescription B) Floor stock C) Automated D) Unit-dose

C) Automated An automated drug delivery system most effectively reduces the likelihood of medication errors by automatically dispensing the drug. Medication errors can still occur with this method but are less likely than with floor stock, unit-dose, and individual prescription methods.

A client who is receiving doxorubicin should have a plan of care for reducing the risk for which of the following complications? Select all that apply. A) Ototoxicity B) Neurotoxicity C) Cardiac toxicity D) Pulmonary toxicity E) Ocular toxicity

C) Cardiac toxicity D) Pulmonary toxicity Doxorubicin is an antitumor antibiotic that can cause toxicity to the heart and lungs. This medication does not cause toxicity to the nervous system or the ears or eyes.

A short time after administering pain medication to a client, the nurse returns to the client's room and finds the client difficult to arouse. The nurse realizes that 25 ml of the liquid medication was administered instead of the ordered 25 mg, which is contained in 5 ml. How could the nurse have prevented this error? A) Attempt non-pharmacological pain control methods, and administer PRN pain medications as a last resort. B) Have another nurse double check the medications before administration. C) Carefully review the order and medication label, then calculate the ordered dose. D) Highlight dosage instructions on the medication bottles.

C) Carefully review the order and medication label, then calculate the ordered dose. The nurse should always take the time to identify the client, carefully review the medication order, read the medication label, and calculate the ordered dose. Consistently following these steps helps prevent medication administration errors. The nurse should double check calculations with another nurse, not ask another nurse to double check all medications. The nurse can use non-pharmacological pain therapies, but as an adjunct to pain medications and not a last resort. Using non-pharmacological therapies only delays treatment and places the client at risk for intensified pain. Highlighting dosage instructions can lead to errors if done inconsistently. It is best to carefully review each order.

A nurse administers digoxin 0.125 mg to a client at 1400 instead of the prescribed dose of digoxin 0.25 mg. Which of the following statements should the nurse record in the medical record? A) Nurse accidentally gave digoxin 0.125 mg to the client at 1400. B) Digoxin 0.25 mg administered at 1400, physician notified. C) Digoxin 0.125 mg given at 1400 instead of prescribed dose of 0.25 mg. D) At 1400, wrong dose of digoxin given due to heavy workload.

C) Digoxin 0.125 mg given at 1400 instead of prescribed dose of 0.25 mg. The nurse should not include judgment statements, opinion, assumptions, or conclusions about what happened. The nurse should simply state the occurrence. The other options present judgment, blame, and conclusion.

A client is refusing to take the prescribed oral medication. Which of the following measures by the nurse can be used to get the client to take the medication? Select all that apply. A) Crushing the medication and hiding it in apple sauce B) Having a family member give the medication C) Explaining the purpose of the medication to the client D) Asking the client the reason for not taking the medication E) Suggesting a liquid form of the medication instead of a pill

C) Explaining the purpose of the medication to the client D) Asking the client the reason for not taking the medication E) Suggesting a liquid form of the medication instead of a pill The correct answers provide an alternative solution for the client and provide the client an opportunity to consent to taking the medication in another form, neither of which would be considered abuse. Providing health education regarding the medications to ensure the client has all the information needed to make an informed consent would be appropriate. Hiding medication or disguising it in food knowing that the client has refused the medication would be considered abuse. The client has the right to refuse care, including medication, and a family member should not be placed in a position of having to give the medication.

A physician orders an I.V. bolus injection of diltiazem hydrochloride for a client with uncontrolled atrial fibrillation. What should the nurse do before administering an I.V. bolus? A) Warm the I.V. medication to room temperature. B) Insert a second I.V. line into the opposite arm. C) Gently aspirate the I.V. catheter to check for a blood return. D) Place a tourniquet on the arm in which she will administer the injection.

C) Gently aspirate the I.V. catheter to check for a blood return. Before administering an I.V. bolus, the nurse should gently aspirate the I.V. catheter for a small amount of blood to ensure correct placement of the I.V. catheter. Then the nurse may inject the medication over the recommended time interval. She doesn't need to insert another I.V. line unless the ordered medication is incompatible with the medication in the I.V. solution. Warming the medication could alter the drug's action. Placing a tourniquet on the arm would close off the venous system and prevent drug injection.

The nurse is caring for a client who is receiving parenteral nutrition. Which of the following assessments is most important for the nurse to make in order to detect early signs of metabolic complications? A) Lung sounds B) Vital signs C) Urine output D) Daily weights

C) Urine output Monitor urine output to detect signs of hyperosmolar hyperglycemia. Hyperosmolar hyperglycemia is a metabolic complication of parenteral nutrition. Expansion of the blood volume combined with hyperglycemia can cause osmotic diuresis, presenting as increased urine output. Intake and output should be recorded so that a fluid imbalance can be readily detected. Urine can also be tested for hyperosmolar diuresis. Each of the assessments is important, but does not indicate metabolic complications.

A nurse is teaching a client about taking antihistamines. Which information should the nurse include in the teaching plan? Select all that apply. A) Continue taking antihistamines even if nasal infection develops. B) The effect of antihistamines is not felt until a day later. C) Increase fluid intake to 2,000 mL/day. D) Do not use alcohol with antihistamines. E) Operating machinery and driving may be dangerous while taking antihistamines.

C) Increase fluid intake to 2,000 mL/day. D) Do not use alcohol with antihistamines. E) Operating machinery and driving may be dangerous while taking antihistamines. Antihistamines have an anticholinergic action and a drying effect and reduce nasal, salivary, and lacrimal gland hypersecretion (runny nose, tearing, and itching eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during antihistamine use. The client should ensure adequate fluid intake of at least 2,000 ml (about eight glasses) per day due to the drying effect of the drug. Antihistamines have no antibacterial action, and are not used to treat nasal infections.. The effect of antihistamines is prompt, not delayed.

Which technique is correct when the nurse administers a subcutaneous injection? A) Spread the skin tightly at the injection site. B) Use a 1-inch (2.5-cm) needle for injection. C) Insert the needle at a 45-degree angle to the skin. D) Draw 0.2 mL of air into the syringe before administration.

C) Insert the needle at a 45-degree angle to the skin. Subcutaneous injections are administered at an angle of 45 to 90 degrees, depending on the size of the client. Subcutaneous needles are typically ? to ? inches in length. The skin should be pinched up at the injection site to elevate the subcutaneous tissue. Air is not drawn into the syringe for a subcutaneous injection.

A client who has been taking furosemide has a serum potassium level of 3.2 mEq/L. Which assessment findings by the nurse would confirm an electrolyte imbalance? A) Tetany and tremors B) Diarrhea and cramps C) Muscle weakness and a weak, irregular pulse D) Mental status changes and poor tissue turgor

C) Muscle weakness and a weak, irregular pulse The serum potassium level of 3.2 mEq/L is an indication of hypokalemia. Only 2% of the potassium is found in the extracellular fluid, and it is primarily responsible for neuromuscular activity. Muscle weakness and heart irregularities would be evident with hypokalemia. Potassium deficit is caused by diarrhea. Tetany and tremors are associated with hypokalemia. Headaches and poor tissue turgor are associated with hyponatremia.

The nurse learns that a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for poison ivy on the leg. What should the nurse do first? A) Notify the surgeon of the poison ivy. B) Send the client to surgery. C) Notify the anesthesiologist of the prednisone administration. D) Document the prednisone with current medications.

C) Notify the anesthesiologist of the prednisone administration. The nurse should notify the anesthesiologist because supplemental prednisone suppresses the adrenal cortex's natural ability to produce increased corticosteroids in times of stress such as surgery. The anesthesiologist may need to prescribe supplemental steroid coverage during the perioperative period. The nurse should document the prednisone with current medications, but it is a priority to inform the anesthesiologist. Because the poison ivy is not in the surgical field, the surgeon does not need to be called regarding the skin disruption.

A client is scheduled for surgery at 8 a.m.(0800). While completing the preoperative checklist, the nurse sees that the surgical consent form isn't signed. It's time to administer the preoperative analgesic. Which nursing action takes the highest priority in this situation? A) Asking the client to sign the consent form B) Giving the client the preoperative analgesic at the scheduled time C) Notifying the surgeon that the client hasn't signed the consent form D) Canceling the surgery

C) Notifying the surgeon that the client hasn't signed the consent form Notifying the surgeon takes priority because the physician must obtain informed consent before the client receives drugs that can alter cognition. Giving the preoperative analgesic at the scheduled time would alter the client's ability to give informed consent. Obtaining consent to surgery isn't within the scope of nursing practice, although the nurse may confirm or witness consent. Canceling surgery isn't within the scope of nursing practice.

The nurse should dispose of a used needle and syringe by: A) Recapping the needle and placing the needle and syringe in the universal precaution container in the client's room. B) Separating the needle and syringe and placing both in the precaution container in the client's room. C) Placing uncapped, used needles and syringes immediately in the universal precaution container in the client's room. D) Cutting the needle at the hilt in a needle cutter before disposing of it in the universal precaution container in the client's room.

C) Placing uncapped, used needles and syringes immediately in the universal precaution container in the client's room. The nurse should dispose of any used needle and syringe by immediately placing uncapped, used needles and syringes in the precaution container.

A client is receiving intravenous fluids and upon assessment presents with increased pulse, increased respirations, and jugular vein distension. What is the priority action by the nurse? A) Lower the head of the bed. B) Repeat the vital signs in 1 hour. C) Slow the intravenous rate and notify the physician. D) Administer oxygen and encourage the client to breathe deeply.

C) Slow the intravenous rate and notify the physician. The increased volume from too-rapid fluid infusion will result in increased heart rate. There can be pulmonary edema with resultant increase in the respiratory rate to compensate. Jugular vein distension also indicates fluid overload. The rate of the intravenous fluids would need to be slowed, and the physician notified for new orders. Repeating the vital signs in 1 hour is incorrect because the client is already in distress. Lowering the head of the bed will increase the symptoms. Although oxygen may help, the priority is to decrease fluid volume.

What is the main reason desflurane and sevoflurane, volatile liquid anesthesia agents, are used for surgical clients who go home the day of surgery? A) These agents are predictable in their cardiovascular effects. B) These agents are nonirritating to the respiratory tract. C) These agents are rapidly eliminated. D) These agents are better tolerated.

C) These agents are rapidly eliminated. Desflurane and sevoflurane are volatile liquid anesthesia agents that are used for outpatient surgeries primarily because they are rapidly eliminated. They have the added benefits of being better tolerated and nonirritating to the respiratory tract, and they have predictable cardiovascular effects. However, rapid elimination is an important consideration for outpatient procedures.

A nurse is administering indomethacin to a neonate. What should the nurse do to ensure that the nurse has identified the neonate correctly? Select all that apply. A) Ask another nurse to confirm that this is the neonate for whom the medication has been prescribed. B) Check the neonate's identification band against the medical record number. C) Verify the date of birth from the medical record with the date of birth on the client's identification band. D) Ask the parents to confirm that this is their baby. E) Compare the number on the crib with the number on the client's identification band. B) Check the neonate's identification band against the medical record number.

C) Verify the date of birth from the medical record with the date of birth on the client's identification band. The nurse should use at least two sources of identification prior to administering medication to any client, such as the medical record number and the client's date of birth. It is not safe practice to ask the parent or a nurse to verify the correct neonate. It is also not safe to use the room number or crib number as a source of identification because neonates' locations in the hospital change frequently.

The nurse should advise which client who is taking lithium to consult with the health care provider (HCP) regarding a potential adjustment in lithium dosage? A) a client who can now care for her children B) a client who attends college classes C) a client who is beginning training for a tennis team D) a client who continues work as a computer programmer

C) a client who is beginning training for a tennis team A client who is beginning training for a tennis team would most likely require an adjustment in lithium dosage because excessive sweating can increase the serum lithium level, possibly leading to toxicity. Adjustments in lithium dosage would also be necessary when other medications have been added, when an illness with high fever occurs, and when a new diet begins.

A client has been taking furosemide for 2 days. The nurse should assess the client for: A) an elevated potassium level. B) an elevated sodium level. C) a decreased potassium level. D) an elevated blood urea nitrogen (BUN) level.

C) a decreased potassium level. Furosemide is a loop diuretic and inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle. Furosemide promotes sodium diuresis, resulting in a loss of potassium and serious electrolyte imbalances. Furosemide does not affect the BUN level.

A nurse is caring for a client who is taking an oral anticoagulant. The nurse should teach the client to: A) report incidents of diarrhea. B) take aspirin for pain relief. C) avoid foods high in vitamin K. D) use a straight razor when shaving.

C) avoid foods high in vitamin K. The client should avoid consuming large amounts of vitamin K because vitamin K can interfere with anticoagulation. The client may need to report diarrhea, but anticoagulants don't cause diarrhea. The client should use an electric razor — not a straight razor — to prevent cuts that bleed. Aspirin may increase the risk of bleeding; the client should use acetaminophen for pain relief.

The nurse should caution sexually active female clients taking isoniazid (INH) that the drug: A) increases the risk of vaginal infection. B) inhibits ovulation. C) decreases the effectiveness of hormonal contraceptives. D) has mutagenic effects on ova.

C) decreases the effectiveness of hormonal contraceptives. INH interferes with the effectiveness of hormonal contraceptives, and female clients of childbearing age should be counseled to use an alternative form of birth control while taking the drug. INH does not increase the risk of vaginal infection, nor does it affect the ova or ovulation.

The client is receiving an IV infusion of 5% dextrose in normal saline running at 125 ml/h. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first: A) stop the flow of solution temporarily. B) apply a warm soak to the site. C) discontinue the infusion. D) irrigate the needle with normal saline.

C) discontinue the infusion. Signs of infiltration include slowing of the infusion and swelling, pain, hardness, pallor, and coolness of the skin at the site. If these signs occur, the IV line should be discontinued and restarted at another infusion site. The new anatomic site, time, and type of cannula used should be documented. The nurse may apply a warm soak to the site, but only after the IV line is discontinued. Parenteral administration of fluids should not be stopped intermittently. Stopping the flow does not treat the problem, nor does it address the client's needs for fluid replacement. Infiltrated IV sites should not be irrigated; doing so will only cause more swelling and pain.

Nursing responsibilities for the client with a patient-controlled analgesia (PCA) system include: A) instructing the client to continue pressing the system's button whenever pain occurs. B) titrating the client's pain medication until the client is free from pain. C) documenting the client's response to pain medication. D) reassuring the client that pain will be relieved.

C) documenting the client's response to pain medication. It is essential that the nurse document the client's response to pain medication on a routine, systematic basis. Reassuring the client that pain will be relieved is often not realistic. A client who continually presses the PCA button may not be getting adequate pain relief, but through careful assessment and documentation, the effectiveness of pain relief interventions can be evaluated and modified. Pain medication is not titrated until the client is free from pain but rather until an acceptable level of pain management is reached.

The nurse is reviewing the laboratory report with the client's lithium level prior to administering the 1700 hours dose. The lithium level is 1.8 mEq/L (1.8 mmol/L). The nurse should: A) give the 240 mL of water with the lithium. B) administer the 1700 hours dose of lithium. C) hold the 1700 hours dose of lithium. D) give the lithium after the client's supper.

C) hold the 1700 hours dose of lithium. The nurse should hold the 1700 hour dose of lithium because a level of 1.8 mEq/L (1.8 mmol/L) can cause adverse reactions, including diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination, which are early signs of lithium toxicity. The nurse should report the lithium level to the health care provider (HCP) , including any symptoms of toxicity. Administering the 1700 hour dose of lithium, giving the client the lithium with 240mL of water, or giving it after supper would result in an increase of the lithium level, thus increasing the risk of lithium toxicity.

A client is receiving total parenteral nutrition (TPN) solution. The nurse should assess a client's ability to metabolize the TPN solution adequately by monitoring the client for which sign? A) hypertension B) tachycardia C) hyperglycemia D) elevated blood urea nitrogen concentration

C) hyperglycemia During TPN administration, the client should be monitored regularly for hyperglycemia. The client may require small amounts of insulin to improve glucose metabolism. The client should also be observed for signs and symptoms of hypoglycemia, which may occur if the body overproduces insulin in response to a high glucose intake or if too much insulin is administered to help improve glucose metabolism. Tachycardia or hypertension is not indicative of the client's ability to metabolize the solution. An elevated blood urea nitrogen concentration is indicative of renal status and fluid balance.

The health care provider (HCP) has prescribed nitroglycerin to a client with angina. The client also has closed-angle glaucoma. The nurse contacts the HCP to discuss the potential for: A) hypotension. B) decreased intraocular pressure. C) increased intraocular pressure. D) hypertension.

C) increased intraocular pressure. Nitroglycerin causes vasodilation, which results in increased intraocular pressure. The vasodilatory effects of the medication can trigger an attack, causing pain and loss of vision. Hypotension is a common side effect of nitroglycerin, which dilates the blood vessels but is not a concern in the client with glaucoma.

The client is started on simvastatin as a component of cholesterol management. Which laboratory test needs to be monitored while on this therapy? A) serum glucose B) complete blood count C) liver function tests D) total protein

C) liver function tests Liver function tests, including aspartate transaminase (AST), should be monitored before therapy, 6 to 12 weeks after initiation of therapy or after dose elevation, and then every 6 months. If AST levels increase to three times normal, therapy should be discontinued. Simvastatin does not influence serum glucose, complete blood count, or total protein. Serum cholesterol and triglyceride levels should be evaluated before initiating therapy, after 4 to 6 weeks of therapy, and periodically thereafter.

When preparing the teaching plan for a client about lithium therapy, the nurse should teach the client about: A) buying foods labeled "low in sodium." B) increasing sodium in the diet. C) maintaining an adequate sodium intake. D) discontinuing sodium in the diet.

C) maintaining an adequate sodium intake. The nurse would teach the client taking lithium and his family about the importance of maintaining adequate sodium intake to prevent lithium toxicity. Because lithium is a salt, reduced sodium intake could result in lithium retention with subsequent toxicity. Increasing sodium in the diet is not recommended and may be harmful. Increased sodium levels result in lower lithium levels. Therefore, the drug may not reach therapeutic effectiveness.

The sudden onset of which sign indicates a potentially serious complication for the client receiving an IV infusion? A) moist skin B) pupillary constriction C) noisy respirations D) halitosis

C) noisy respirations A serious complication of IV therapy is fluid overload. Noisy respirations can develop as a result of pulmonary congestion. Additional symptoms of fluid overload include dyspnea, crackles, hypertension, bounding pulse, and distended neck veins.

The nurse should ensure that which item is placed when the client is to receive intravascular therapy for more than 6 days? A) central venous access in the femoral vein B) short peripheral catheter C) peripherally inserted central catheter (PICC) D) intravenous catheter insertion device

C) peripherally inserted central catheter (PICC) When the duration of intravascular therapy is likely to be more than 6 days, a midline catheter or peripherally inserted central catheter (PICC) is preferred to a short peripheral catheter. In adult clients, use of the femoral vein for central venous access should be avoided. Steel needles should be avoided when administering fluids and medications that might cause tissue necrosis if extravasation occurs.

The nurse must be aware that adverse drug reactions in the elderly client may be underestimated because: A) cognitive impairment is an expected finding in the elderly client. B) adverse reactions rarely have an atypical presentation. C) physical or psychological symptoms are attributed to the effects of aging. D) excess sedation is difficult to assess in the elderly client.

C) physical or psychological symptoms are attributed to the effects of aging. The elderly client commonly has vague or atypical responses to medications and diseases that are erroneously attributed to aging. A new cognitive change needs to be investigated and is not an expected change with aging. Changes in a client's behavior should be investigated to see whether there is a relation to excessive sedation. The nurse can interview the family members to obtain information.

Which laboratory test should the nurse monitor when the client is receiving warfarin sodium therapy? A) partial thromboplastin time (PTT) B) serum potassium C) prothrombin time (PT) D) arterial blood gas (ABG) values

C) prothrombin time (PT) Warfarin sodium interferes with clotting. The nurse should monitor the PT and evaluate for the therapeutic effects of coumadin. A therapeutic PT is between 1.5 and 2.5 times the control value; the PT should be established by the health care provider (HCP). It may also be reported as an International Normalized Ratio, a standardized system that provides a common basis for communicating and interpreting PT results. The PTT is monitored in clients who are receiving heparin therapy. Serum potassium levels and ABG values are not affected by coumadin.

A nurse receives a lithium level report of l.0 mEq/L (1 mmol/L) for a client who has been taking lithium for 2 months. How does the nurse interpret this information? A) too high, indicating toxicity B) too low to be therapeutic C) within the therapeutic range D) an error in reporting

C) within the therapeutic range For the client who has been receiving lithium therapy for the past 2 months, a maintenance serum lithium level of 0.6 to 1.2 mEq/L (0.6 to 1.2 mmol/L) is considered therapeutic. A lithium level greater than 1.2 mEq/L (1.2 mmol/L) suggests toxicity.

A client is brought to the emergency department unconscious. An empty bottle of aspirin was found in the car, and a drug overdose is suspected. Which medication should the nurse have available for further emergency treatment? A) dextrose 50% B) sodium thiosulfate C) vitamin K D) activated charcoal powder

D) activated charcoal powder Activated charcoal powder is administered to absorb remaining particles of salicylate. Vitamin K is an antidote for warfarin sodium Dextrose 50% is used to treat hypoglycemia. Sodium thiosulfate is an antidote for cyanide.

The mother of a 28-year-old client who is taking clozapine states, "Something is wrong. My son is drooling like a baby." What response by the nurse would be most helpful? A) "I have seen this happen to other clients who are taking clozapine." B) "I wonder if he is having an adverse reaction to the medicine." C) "Do not worry about it; this is only a minor inconvenience compared to its benefits." D) "Excess saliva is common with this drug; here is a paper cup for him to spit into."

D) "Excess saliva is common with this drug; here is a paper cup for him to spit into." Telling the mother that excess saliva is a common adverse effect of the drug is most helpful because it gives her information about the problem, thereby helping to decrease her anxiety about what is occurring with her son. By offering the paper cup, the nurse also demonstrates concern for the client, thereby leading to increased trust. Saying, "I wonder if he is having an adverse reaction to the medicine," shows the nurse's lack of knowledge about the drug, decreases confidence in the nurse, and indicates poor judgment. Saying, "Do not worry about it, it is only a minor inconvenience compared to its benefits," or telling the mother that the nurse has seen this happening to other clients is insensitive and does not assuage the mother's anxiety.

A nurse who is a practicing Jehovah's Witness is asked by a client whether or not to consent to having a blood transfusion. Which of the following would be the appropriate response by the nurse in this situation? A) "I should not talk about transfusions. But I will ask another nurse to speak to you." B) "It is not part of my job to discuss blood transfusions. I will call your doctor." C) "You should not have a blood transfusion. I can share with you why I am against them." D) "It is your opinion that is important. How do you feel about the transfusion?"

D) "It is your opinion that is important. How do you feel about the transfusion?" The correct answer allows the nurse to recognize his/her own values and opinions but also leaves the focus of the therapeutic relationship on the client. This response also recognizes that the feelings and values of the client are important. The nurse recognizes that the client needs to discuss the transfusion and tries to explore it further. The other options do not allow for the client's needs to be met.

A client with asthma has been prescribed fluticasone, one puff every 12 hours per inhaler. Place in correct order the nurse's statements when teaching the client how to properly use the inhaler with a spacer. A) "Hold your breath for at least 10 seconds, then breathe in and out slowly." B) "Breathe out all of your air. Hold the mouthpiece of your inhaler and spacer between your teeth with your lips closed around it." C) "Rinse your mouth." D) "Take off the cap and shake the inhaler." E) "Attach the spacer." F) "Press down on the inhaler once and breathe in slowly."

D) "Take off the cap and shake the inhaler." E) "Attach the spacer." B) "Breathe out all of your air. Hold the mouthpiece of your inhaler and spacer between your teeth with your lips closed around it." F) "Press down on the inhaler once and breathe in slowly." A) "Hold your breath for at least 10 seconds, then breathe in and out slowly." C) "Rinse your mouth." Using a spacer, especially with inhaled corticosteroid, can make it easier for the medication to reach the lungs; it can also prevent excess medication remaining in the mouth and throat, which can cause minor irritation. It is important for the client to empty the lungs, breathe in slowly, and hold the breath to draw as much medication into the lungs as possible. Rinsing after using a corticosteroid inhaler may help prevent irritation and infection; rinsing will also reduce the amount of drug swallowed and absorbed systemically.

A nurse is instructing a client with asthma on the use of an inhaler with a spacer. The client asks what the purpose of the spacer is. The nurse's best response is: A) "The spacer is a better way for you to receive the medication from the inhaler and you don't have to inhale when using it." B) "The physician has ordered the spacer and wants me to show you how to use it." C) "You should ask your physician to explain the purpose of the spacer." D) "The spacer traps medicine from the inhaler, then breaks up and slows down the medication particles, so you get more medication."

D) "The spacer traps medicine from the inhaler, then breaks up and slows down the medication particles, so you get more medication." Describing how the spacer works accurately explains the purpose and benefit of an inhaler. Telling the client that the physician has ordered the spacer and instructed the nurse to explain its use doesn't answer the client's question. The nurse isn't correct in saying the client doesn't have to inhale when using a spacer; during administration, the client should inhale deeply and slowly for 3 to 5 seconds. The client doesn't need to ask the physician about the spacer; the nurse should be familiar with its purpose and proper use.

A physician orders codeine, ½ grain every 4 hours, for a client experiencing pain. How many milligrams of codeine should the nurse administer? A) 15 mg B) 60 mg C) 120 mg D) 30 mg

D) 30 mg The nurse should administer 30 mg of codeine.

A nurse is teaching a client how to administer subcutaneous (subQ) insulin injections. Which injection site should the client use? A) Vastus lateralis B) Rectus femoris C) Deltoid D) Anterior aspect of the thigh

D) Anterior aspect of the thigh SubQ injection sites, which are relatively distant from bones and major blood vessels, include the lateral aspects of the upper arm, the anterior aspects of the thigh, and the abdomen. The deltoid, rectus femoris, and vastus lateralis are I.M. injection sites.

A nurse inadvertently transcribes a client's medication order that was written as "Ampicillin 250 mg four times a day" as "Ampicillin 2500 mg four times a day." The nurse gives two doses as transcribed to the client. Another nurse gives one dose before the pharmacist questions the reorder of the medication. What should the two nurses do in this situation? A) Tell the pharmacist that the wrong quantity of medication was sent to the unit. B) Adjust the medication administration record to reflect the correct dose only. C) Only the nurse who transcribed the order should be accountable for the error. D) Both nurses must acknowledge making the medication error.

D) Both nurses must acknowledge making the medication error. The correct answer is that both nurses are responsible for this error. The first nurse transcribed the order incorrectly and did not recognize that the dose was too high when administering the medication. The second nurse should have known the dose was too high. Both nurses must admit to the error. The other options do not reflect a nurse's responsibility in admitting to an error and preventing injury to clients.

The nurse reviews the peak and trough serum levels from a client who is receiving gentamicin sulfate in order to: A) avoid allergic reactions. B) prevent side effects. C) reach therapeutic levels more quickly. D) adjust the dosage to the therapeutic range.

D) adjust the dosage to the therapeutic range. Peak and trough serum levels are used to adjust the dosage within a therapeutic range.

A client who had received 25 ml of packed red blood cells (PRBCs) has low back pain and pruritus. After stopping the infusion, the nurse should take what action next? A) Administer prescribed diuretics. B) Administer prescribed antihistamine and an antipyretic. C) Administer prescribed vasopressors. D) Collect blood and urine samples and send to the lab.

D) Collect blood and urine samples and send to the lab. ABO- and Rh-incompatible blood causes an antigen-antibody reaction that produces hemolysis or agglutination of red blood cells (RBCs). At the first indication of any sign/symptom of reaction, the blood transfusion is stopped. Blood and urine samples are obtained from the client and sent to the lab along with the remaining untransfused blood. Hemoglobin in the urine and blood samples taken at the time of the reaction provides evidence of a hemolytic blood transfusion reaction. Antihistamine, antipyretics, diuretics, and vasopressors may be administered with different types of transfusion reactions.

Elderly clients may be concerned about taking too many medications and can be unsure of the reasons for some of the medications. What is the best action by the nurse? A) Give a general presentation on common groupings of medications and indications. B) Set up an appointment to review each medication, actions, and side effects with each client. C) Ask each client to research the individually-prescribed medications and problem solve the reasons they were prescribed. D) Consult with a pharmacist to discuss the medications, effects, side effects, and interactions; initiate physician referrals as needed.

D) Consult with a pharmacist to discuss the medications, effects, side effects, and interactions; initiate physician referrals as needed. Have the pharmacist review the importance of medications, their effects and side effects. It is also important to assess for possible interactions. If changes are needed, then it is important to initiate a physician referral. The nurse would spend an inordinate amount of time reviewing medications with each client; a better resource would be the pharmacist. Giving a general presentation does not individualize what is needed by each person.

A client who is taking lithium carbonate is going home on a 3-day pass. What is the best health teaching the nurse should provide for this client? A) Adjust the lithium dosage if mood changes are noted throughout the day. B) Have a low-sodium, high-protein snack with milk before going to bed. C) Avoid participation in controversial discussions with friends and family about the medication during the 3-day pass. D) Continue to maintain normal sodium intake while at home.

D) Continue to maintain normal sodium intake while at home. Lithium decreases sodium reabsorption by the renal tubules. If sodium intake is decreased, sodium depletion can occur. In addition, lithium retention is increased when sodium intake is decreased. Reduced sodium intake can lead to lithium toxicity. Nursing is not allowed to tell a client to adjust dosages of any drugs. A low-protein snack is not reflective or needed with this drug. Avoiding participation is not a therapeutic discussion.

A nurse is working in a clinic where a family member's spouse is treated for a sexually transmitted disease. The nurse is concerned about the risk to her family member. What is the most appropriate action for the nurse to take? A) Provide the local Board of Health with the family member's name so they can contact him or her with information about the client's diagnosis. B) As legally required, inform the family member of the client's diagnosis. C) Anonymously inform her family member of the spouse's diagnosis so that he or she may seek necessary treatment. D) Encourage the client to speak with the family member about the diagnosis if he or she has not already done so.

D) Encourage the client to speak with the family member about the diagnosis if he or she has not already done so. Encouraging the client to talk with his spouse is the nurse's only option. According to the Privacy Acts, a client's diagnosis is confidential information that shouldn't be shared with anyone, including a spouse, without the client's permission. Telling a family member about the diagnosis is a violation of the client's confidentiality. The nurse isn't legally obligated to report the diagnosis to her family member. It isn't appropriate for the nurse to provide information that would allow other agencies to contact the client's spouse.

A student nurse is reviewing physician orders written on a client's chart. Which entry is written incorrectly because it contains material from the "do not use" list of the Joint Commission on Accreditation of Healthcare Organizations (Joint Commission)? A) Levothyroxine sodium 0.125 mcg po daily. B) Diazepam 5 mg po on-call to the OR. C) Acetaminophen 550 mg po every 4 hours for fever greater than 102 degrees F. D) Epoetin alfa 6500 U SQ daily.

D) Epoetin alfa 6500 U SQ daily. The order written as "Epoetin alfa 6500 U SQ daily" is incorrect according to the Joint Commission's "do not use" list. "U" should not be used because it may be mistaken as zero (0), 4 (four), or cc. The healthcare professional should write "unit" instead. The other medication orders are written correctly. The order for diazepam does not include a trailing zero in the dosage. The order for levothyroxine sodium includes a leading zero prior to the dose. The acetaminophen order is correct in the use of the word "every" instead of Q.D., QD, q.d., or qd.

When a nurse tries to administer medication, the client refuses it, saying, "I don't have to take those pills if I don't want to." What intervention by the nurse would have the highest priority? A) Insisting that the client take the medication because it is specifically ordered for the client B) Reporting the client's comments to the physician and the treatment team C) Explaining the consequences of not taking the medication, such as a negative outcome D) Exploring how the client's feelings affect his/her decision to refuse medication

D) Exploring how the client's feelings affect his/her decision to refuse medication By helping the client explore his/her feelings about his/her change in health status, the nurse can determine how these feelings affect his/her decision to refuse medication. Then the nurse can help the client develop new ways to satisfy self-care, esteem, and other needs and, ultimately, participate fully in the therapeutic regimen. Insisting that the client take the medication, reporting the client's comments to the physician, and explaining the consequences of not taking the medication are inappropriate because these actions do not explore the client's feelings.

When administering naloxone, the nurse should monitor the surgical client closely for which clinical manifestation? A) dizziness B) urine retention C) biliary colic D) bleeding

D) bleeding Abnormal coagulation test results have been associated with naloxone, and the nurse should monitor surgical clients closely for bleeding. Dizziness, biliary colic, and urine retention are not associated with naloxone.

A nurse practitioner (NP) orders an antibiotic to which the client is allergic. The nurse preparing the medication notices the allergy alert and contacts the NP by phone. The NP does not return the call and the first dose is due to be given. Which of the following actions by the nurse is the best solution to this situation? A) Call the pharmacist and discuss a substitution for the medication. B) Give the medication as ordered by the NP. C) Ask if the client is really allergic to the medication. D) Hold the medication until speaking with the NP.

D) Hold the medication until speaking with the NP. The nurse must speak to the NP and review the order. The other answers are incorrect because the nurse is aware of a stated allergy and must not give a medication that can cause an allergic reaction. The pharmacist cannot prescribe a new medication.

A client requests his medication at 9 p.m. (2100) instead of 10 p.m. (2200) so that he can go to sleep earlier. Which type of nursing intervention is required? A) Interdependent B) Intradependent C) Dependent D) Independent

D) Independent Nursing interventions are classified as independent, interdependent, or dependent. Altering the drug schedule to coincide with the client's daily routine represents an independent intervention, whereas consulting with the physician and pharmacist to change a client's medication because of adverse reactions represents an interdependent intervention. Administering an already ordered drug on time is a dependent intervention. There's no such thing as an intradependent nursing intervention.

Which of the following techniques is correct when administering a subcutaneous injection? A) Use a 1-inch (2.5-cm) needle for injection. B) Spread the skin tightly at the injection site. C) Draw 0.2 ml of air into the syringe before administration. D) Insert the needle at a 45-degree angle to the skin.

D) Insert the needle at a 45-degree angle to the skin. Subcutaneous injections are administered at an angle of 45 to 90 degrees, depending on the size of the client. Subcutaneous needles are typically to 1/2 to 5/8 inches (1.3 to 1.6 cm) in length. The skin should be pinched up at the injection site to elevate the subcutaneous tissue. Air is not drawn into the syringe for a subcutaneous injection.

A client taking furosemide and digoxin for exacerbation of heart failure reports weakness and heart fluttering. What would be the priority action by the nurse? A) Tell the client to rest more often to decrease symptoms. B) Tell the client to stop taking the digoxin and to stop all physical activity. C) Offer the client clear instructions about avoiding foods that contain caffeine. D) Investigate the symptoms further with the client and suggest contacting the physician.

D) Investigate the symptoms further with the client and suggest contacting the physician. Furosemide is a potassium-wasting diuretic. A low potassium level may cause weakness and palpitations. Telling the client to rest does not address the priority. Telling the client to stop the digoxin is out of scope of practice. Addressing the diet does not answer the question.

What should a nurse expect to find while assessing the vital signs of a client who has abruptly stopped taking his beta-adrenergic blocker? A) Increased respiratory rate B) Abnormally low blood pressure C) Decreased respiratory rate D) Irregular pulse

D) Irregular pulse Abrupt withdrawal of a beta-adrenergic blocker results in rebound cardiac excitation, which causes ventricular arrhythmias and an irregular pulse. Abnormally low blood pressure would be unlikely because beta-adrenergic blockers are used to treat hypertension. Abrupt withdrawal of this medication wouldn't directly affect a client's respiratory rate.

The nurse understands that assessment of blood pressure in clients receiving antipsychotic drugs is important. What is a reason for this assessment? A) Most antipsychotic drugs cause elevated blood pressure. B) This provides additional support for the client. C) It will indicate the need to institute antiparkinsonian drugs. D) Orthostatic hypotension is a common side effect.

D) Orthostatic hypotension is a common side effect. Orthostatic hypotension is common during the first few weeks of treatment with antipsychotic drugs. An elevated blood pressure usually results from MAOI antidepressants. Additional support should be through therapeutic communications. A problem with the blood pressure is not indicative of antiparkinsonian drugs.

A client has been prescribed diuretic therapy for hypertension. It has been causing frequent urination at night and now the client is refusing to take the morning dose of furosemide. What would be the best response by the nurse? A) Tell the client that the extra fluid will be gone and urination will not be as frequent. B) Take the blood pressure and then discuss with the client the dangers of an increased blood pressure if the medication is not taken. C) Reinforce how much the edema has decreased and how effective the medication has been, and encourage the client to take the medication. D) Reinforce the reason for the medication. Respect the decision if the client still refuses the medication, and chart the refusal.

D) Reinforce the reason for the medication. Respect the decision if the client still refuses the medication, and chart the refusal. The client needs to understand the importance of extra fluid removal and how it helps control blood pressure. The nurse needs to be respectful that the client still has a choice in whether he/she takes the medication.

When a central venous catheter dressing becomes moist or loose, what should a nurse do first? A) Remove the catheter, check for catheter integrity, and send the tip for culture. B) Notify the physician. C) Draw a circle around the moist spot and note the date and time. D) Remove the dressing, clean the site, and apply a new dressing.

D) Remove the dressing, clean the site, and apply a new dressing. A nurse maintaining a central venous catheter should change the dressing every 72 hours or when it becomes soiled, moist, or loose. After removing the soiled dressing, the nurse should use sterile technique to clean around the site in accordance with facility policy. After the cleaning solution has dried, the nurse should cover the site with a transparent semipermeable dressing. A nurse who notes drainage on a wound dressing should draw a circle around the moist spot and note the date and time. She should notify the physician if she observes any catheter-related complications. Only a nurse with the appropriate qualifications may remove a central venous catheter, and a moist or loose dressing isn't a reason to remove the catheter.

A nurse is developing a teaching plan for a client who has just been diagnosed with breast cancer. The nurse should include information about: A) dopamine. B) acetaminophen. C) progesterone. D) tamoxifen.

D) tamoxifen. Tamoxifen is an estrogen blocker used to treat premenopausal and postmenopausal breast cancer and to prevent breast cancer in certain women who are at high risk. Acetaminophen is a nonopioid analgesic antipyretic. Dopamine is a vasoconstrictor used to treat hypotension. Progesterone is a hormone used to treat amenorrhea or dysfunctional uterine bleeding.

Which of the following is the priority action the nurse should take when finding medications at a client's bedside? A) Leave the medications and seek the nurse who left them in the room. B) Label the medications and place them back in the medication room. C) Leave the medications, as the client will take them after breakfast. D) Remove the medications from the room and discard them into an appropriate disposal bin.

D) Remove the medications from the room and discard them into an appropriate disposal bin. This answer reflects best practice of nursing and medication administration. Leaving the medications creates a risk for another client to take them, or for them to get lost. Leaving them and seeking the nurse creates a risk for loss or another client taking them. It is incorrect and unsafe to label medications that were taken out by another nurse.

A physician orders an infusion of whole blood for a client. When planning the client's care, a nurse should include which intervention? A) Starting the infusion through a 22G I.V. catheter B) Starting an I.V. infusion of 5% dextrose in saline solution before hanging the blood bag C) Allowing the blood to warm to room temperature before infusing D) Staying with the client for 15 minutes after starting the infusion

D) Staying with the client for 15 minutes after starting the infusion Because most hemolytic reactions occur during the first 15 minutes of a blood transfusion, the nurse should plan to stay with the client for this length of time. During this time, the nurse should monitor the client's vital signs frequently, in accordance with facility policy. The nurse should start the infusion with normal saline solution only and should use at least a 19G catheter to prevent hemolysis of red blood cells. The nurse shouldn't warm the blood because refrigerating blood until infusion prevents bacterial growth.

Which principle should a nurse consider when administering pain medication to a client? A) I.V. pain medications may take as long as 2 hours to relieve pain. B) Morphine and hydromorphone shouldn't be used to treat severe pain. C) Use opioid combination drugs or nonopioid analgesics only for severe pain. D) Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain.

D) Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain. Administering sustained-release oral formulations around the clock provides better relief of chronic pain by keeping blood levels within therapeutic range. Opioid combination drugs and nonopioid medications are most effective in the treatment of mild to moderate pain. I.V. medications usually act within 1 hour of administration. Morphine and hydromorphone are drugs of choice for severe pain.

The physician has placed a client who has suffered the loss of a child on a selective serotonin reuptake inhibitor (SSRI) for depression. The nurse is aware that the greatest risk for suicide would be during which time period? A) When the nurse sees the client visiting with other clients on the nursing unit B) Once the client is discharged home with family C) On the 1-year anniversary of the child's death D) Ten to fourteen days after the initial medication regime is implemented

D) Ten to fourteen days after the initial medication regime is implemented Ten to fourteen days is the normal response time for antidepressant medications to take effect and subsequent return of energy levels to perform the suicide act. There is no information about problems with the family that would precipitate suicide. The 1-year anniversary could be a stimulus, but a lower priority. Visiting with other clients is a positive interaction with elevation of mood.

Which factors influence safe and effective medication administration for elderly clients? A) There is less likelihood of not taking medications on time. B) There is an increase in lipid solubility and distribution throughout the body. C) There is a lower risk of drug interactions. D) There is less efficient absorption, detoxification, and elimination.

D) There is less efficient absorption, detoxification, and elimination. When giving medications to elderly individuals, consideration needs to be made for physiologic changes associated with aging. There may be poor absorption from the intestines as well as inadequate elimination. In addition, the liver may be inefficient in detoxification. For the elderly, there is an increased risk of drug interactions because of the number of medications prescribed. They could forget to take the meds. There is less likelihood of solubility and distribution.

A client's intravenous catheter has become occluded. The nurse knows that the reason for the occlusion is which of the following? A) An IV infusion rate of 75 mL per hour B) Dressing and tape above the IV insertion site C) Localized infection D) Thrombosis at the site

D) Thrombosis at the site The catheter occlusion may have been caused by inadequate flushing. It is usually a lipid build use, not particulate matter. The other choices are incorrect because they are not common causes. The IV rate is appropriate, infection is not the most common cause of catheter occlusion if the catheter is changed per hospital protocol, and dressing and tape should not occlude flow.

When administering an I.M. injection, which action puts the nurse at risk for a needle-stick injury? A) Choosing safety needle devices for administering injections whenever possible and appropriate B) Planning safe handling and disposal of needles before initiating a procedure C) Disposing of needles, safety needle systems, and all sharps in sharps-disposal containers immediately after use D) Using the one-handed needle-recapping technique after administering all injections

D) Using the one-handed needle-recapping technique after administering all injections A nurse should use the one-handed needle-recapping technique only when absolutely necessary, such as when a sharps-disposal container isn't readily available. A sharps-disposal container is available in most instances. Nurses shouldn't recap needles. Choosing safety needle devices whenever possible and appropriate; planning in advance how to handle and dispose of needles; and discarding needles, safety needle systems, and sharps in sharps-disposal containers immediately after use are safe ways to handle sharps with less risk of needle-stick injuries.

A nurse is administering sublingual nitroglycerin to a client. Immediately after administering nitroglycerin, the nurse should expect to administer: A) prednisone. B) alprazolam. C) insulin. D) acetaminophen.

D) acetaminophen. In the early stages of therapy, nitoglycerin commonly causes headache and dizziness. Acetaminophen usually helps decrease nitroglycerin-induced headaches. Although the client may be anxious, lorazepam usually isn't given after nitroglycerin. There is no indication that the client would need insulin or prednisone.

A client is receiving opioid epidural analgesia. The nurse should notify the health care provider (HCP) if the client has which findings? Select all that apply. A) pain rating of 3 on a scale of 1 to 10 B) report of crushing headache C) 1.5 mL of blood aspirated from the catheter before the bolus injection D) blood pressure of 80/40 mm Hg and baseline blood pressure of 110/60 mm Hg E) respiratory rate of 14 breaths/minute and baseline respiratory rate of 18 breaths/minute B) report of crushing headache C) 1.5 mL of blood aspirated from the catheter before the bolus injection

D) blood pressure of 80/40 mm Hg and baseline blood pressure of 110/60 mm Hg A drop in blood pressure to 80/40 mm Hg is significant and should be reported to the HCP. Hypotension and vasodilation may occur as a result of sympathetic nerve blockage along with the pain nerve blockage. A report of a crushing headache suggests that the epidural catheter may be dislodged and in the subarachnoid space rather than the epidural space. The HCP also should be notified any time more than 1 mL of fluid or blood is aspirated from the catheter before a bolus injection. A respiratory rate of 14 breaths/minute, although somewhat decreased from baseline, is within acceptable parameters. However, if the rate drops to 10 breaths/minute or less, the HCP should be notified. A pain rating of 3 out of 10 suggests that pain is being relieved with the epidural analgesia.

A client begins taking haloperidol. After a few days, he experiences severe tonic contractures of muscles in his neck, mouth, and tongue. The nurse should recognize this as: A) psychotic symptoms. B) parkinsonism. C) akathisia. D) dystonia.

D) dystonia. These symptoms describe dystonia, which commonly occurs after a few days of treatment with haloperidol. Mistaking the symptoms for psychotic symptoms can lead to misdiagnosis. Parkinsonism results in muscle rigidity, shuffling gait, stooped posture, flat-faced affect, tremors, and drooling. Signs and symptoms of akathisia are restlessness, pacing, and inability to sit still.

A client's blood pressure is elevated at 160/90 mm Hg. The health care provider (HCP) prescribed "clonidine 1 mg by mouth now." The nurse sent the prescription to pharmacy at 0710, but the medication still has not arrived at 0800. The nurse should do all except: A) check the client's blood pressure. B) call the pharmacy. C) check all appropriate places on the unit to which the drug could have been delivered. D) go to the pharmacy to obtain the drug.

D) go to the pharmacy to obtain the drug. Although the nurse needs to obtain and administer the medication as soon as possible, it is inappropriate for the nurse to go to the pharmacy and request the drug without first calling the pharmacy and checking to see whether the medication was delivered. The drug may have been delivered to several appropriate spots on the unit, such as the client's drug bin, the transport system, or the delivery box. The nurse should assess the client's blood pressure to determine the immediacy of the condition for which the medication was prescribed.

A client with impaired cardiac functioning is at risk during anesthesia induction with thiopental sodium because this drug causes: A) tachypnea. B) bradycardia. C) complete muscle relaxation. D) hypotension.

D) hypotension. Sodium pentothal, a short-acting barbiturate, can cause hypotension, which may be especially problematic for the client with impaired cardiac functioning. Sodium pentothal does not cause bradycardia, complete muscle relaxation, hypertension, or tachypnea.

After instructing a 20-year-old nulligravid client about adverse effects of oral contraceptives, the nurse determines that further instruction is needed when the client states which as an adverse effect? A) weight gain B) nausea C) headache D) ovarian cancer

D) ovarian cancer The nurse determines that the client needs further instruction when the client says that one of the adverse effects of oral contraceptive use is ovarian cancer. Some studies suggest that ovarian and endometrial cancers are reduced in women using oral contraceptives. Other adverse effects of oral contraceptives include weight gain, nausea, headache, breakthrough bleeding, and monilial infections. The most serious adverse effect is thrombophlebitis.

For a client with rib fractures and a pneumothorax, the health care provider (HCP) prescribes morphine sulfate, 1 to 2 mg/h, given IV as needed for pain. The nursing care goal is to provide adequate pain control so that the client can breathe effectively. Which finding indicates the goal has been met? A) decreased client anxiety B) PaO2 of 70 mm Hg (9.31 kPa) C) respiratory rate of 26 breaths/min D) pain rating of 0 on a scale of 0 to 10 by the client

D) pain rating of 0 on a scale of 0 to 10 by the client If the client reports no pain, then the objective of adequate pain relief has been met. Decreased anxiety is not related only to pain control; it could also be related to other factors. A respiratory rate of 26 breaths/min is not within normal limits, nor is the PaO2 of 70 mm Hg (9.31 kPa), but these values are not measures of pain relief.

An elderly client is receiving meperidine after abdominal surgery. The nurse should observe the client for which most significant side effect of meperidine? A) seizures B) constipation C) dysrhythmias D) respiratory depression

D) respiratory depression It is especially important for the nurse to carefully assess the elderly client for respiratory depression after administering a dose of meperidine. It may be necessary to reduce the dosage to prevent respiratory depression. Dysrhythmias, constipation, and seizures are all potential adverse effects of meperidine, but respiratory depression is most significant in the elderly.

A woman is taking oral contraceptives. The nurse teaches the client to report which complication? A) breakthrough bleeding B) mild headache C) weight gain of 3 lb (1.4 kg) D) severe calf pain

D) severe calf pain Women who take oral contraceptives are at increased risk for thromboembolic conditions. Severe calf pain needs to be investigated as a potential sign of deep vein thrombosis. Breakthrough bleeding, mild headache, or weight gain may be common benign side effects that accompany oral contraceptive use. Clients may be monitored for these side effects without a change in treatment.

After treatment with radioactive iodine (RAI, 1-131) I, the nurse should teach the client to: A) assess for hypertension and tachycardia resulting from altered thyroid activity. B) rest for 1 week to prevent complications of the medication. C) monitor for signs and symptoms of hyperthyroidism. D) take thyroxine replacement for the remainder of the client's life.

D) take thyroxine replacement for the remainder of the client's life. The client needs to be educated about the need for lifelong thyroid hormone replacement. Permanent hypothyroidism is the major complication of radioactive iodine treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client needs to monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1 week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not hypothyroidism.

The nurse is preparing a teaching plan about increased exercise for a female client who is receiving long-term corticosteroid therapy. What type of exercise is most appropriate for this client? A) floor exercises B) stretching C) running D) walking

D) walking The best exercise for females who are on long-term corticosteroid therapy is a low-impact, weightbearing exercise such as walking or weight lifting. Floor exercises do not provide for the weightbearing. Stretching is appropriate but does not offer sufficient weightbearing. Running provides for weightbearing but is hard on the joints and may cause bleeding.