4th TEST

The nurse asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which statement indicates that further teaching is needed about administration of the eye medication? 1. "I will flush the eyes after instilling the ointment." 2. "I will clean the newborn's eyes before instilling the ointment." 3. "I need to administer the eye ointment within 1 hour of delivery." 4. "I will instill the eye ointment into each of the newborn's conjunctival sacs."

1. "I will flush the eyes after instilling the ointment." Rationale: eye prophylaxis protects newborns against gonorrhea and chlamydia. The eyes are not flush after installation of the medication because the flush would wash away the administered medication. Options two, three, and four are correct statements regarding the procedure for administering medication to the new born

The nurse determines the client needs further instruction on cimetidine if which statements were made? Select all that apply 1. "i will take the cimetidine with my meals" 2. "i'll know the medication is working if my diarrhea stops" 3. "my episodes of heartburn will decrease if the medication is effective" 4. "taking the cimetidine with an antacid will increase its effectiveness" 5. "i will notify my HCP if i become depressed or anxious" 6. "some of my blood levels will need to be monitored closely since i also take warfarin for atrial fibrillation"

1. "i will take the cimetidine with my meals" 2. "i'll know the medication is working if my diarrhea stops" 4. "taking the cimetidine with an antacid will increase its effectiveness" Cimetidine, a Histamine (h2) receptor antagonist, helps alleviate the symptom of heartburn, not diarrhea. Because Cimetidine crosses the blood-brain barrier, CNS side and adverse effects, such as mental confusion, agitation, depression, and anxiety can occur. Food reduces the rate of absorption, so if cimetidine is taken with meals, absorption will be slowed. Antacids decrease the absorption of cimetidine and should be taken a t least 1 hour apart. If cimetidine is concomitantly administered with warfarin Therapy, warfarin dose may need to be reduced, so prothrombin and INR results must be followed.

A client is prescribed an eye drop and an eye ointment for the right eye. How should the nurse best administer the medications? 1. Administer the eye drop first, followed by the eye ointment. 2. Administer the eye ointment first, followed by the eye drop. 3. Administer the eye drop, wait 15 minutes, and administer the eye ointment. 4. Administer the eye ointment, wait 15 minutes, and administer the eye drop.

1. Administer the eye drop first, followed by the eye ointment. Rationale: When an eye drop and an eye ointment are scheduled to be administered at the same time, the eye drop is administered first. The instillation of two medications is separated by 3 to 5 minutes.

The nurse is applying a topical corticosteroid to a client with eczema. The nurse apply the medication to which body area? Select all that apply. 1. Back 2. Axilla 3. Eyelids 4. Soles of the feet 5. Palms of the hands

1. Back 4. Soles of the feet 5. Palms of the hands Rationale: topical corticosteroids can be absorbed into the systemic circulation. Absorption is higher from regions where the skin is especially permeable ( scalp, axilla, face, eyelids, neck, perineum, genitalia), and lower from regions where permeability is poor (back, palms, soles). The nurse should avoid areas of higher absorption to prevent systemic absorption.

A client has begun therapy with theophylline. The nurse should plan to teach the client to limit the intake of which items while taking this medication? 1.coffee, cola and chocolate 2. oysters, lobster and shrimp 3. melons, oranges and pineapple 4. cottage cheese, cream cheese and dairy creamers

1. Coffee, cola and chocolate Theophylline is a methylxanthine bronchodilator. the nurse teaches the client to limit the intake of xanthine-containing foods while taking the medication. these foods include coffee, cola and chocolate.

The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? Select all that apply. 1. Flushing 2. Hypertension 3. Increased urine output 4. Depressed respirations 5. Extreme muscle weakness 6. Hyperactive deep tendon reflexes

1. Flushing 4. Depressed respirations 5. Extreme muscle weakness Rationale: magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It did use to Halt preterm labor contractions and is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.

A burn client is receiving treatments of topical mafenide acetate to the site of injury. the nurse monitor the clients, knowing that which finding indicates that a systemic effect has occurred? 1. Hyperventilation 2. Elevated blood pressure 3. Local rash at burn site 4. Local pain at burn site

1. Hyperventilation Rationale: mafenide acetate is a Carbonic anhydrase inhibitor and can suppress renal excretion of acid, thereby causing acidosis. Clients receiving this treatment should be monitored for signs of an acid base imbalance (hyperventilation). if this occurs, the medication will probably be discontinued for one to two days. Options three and four describe local rather than systemic effects. An elevated blood pressure may be expected from the pain that occurs with a burn injury.

The nurse is caring for a client receiving an albuterol/ipratropium nebulized breathing treatment. Which report from the client should the nurse note as an expected side effect of this combination medication? 1. I feel like my heart is racing 2. I feel more bloated than usual 3. My eyes have been watering lately 4. I haven't had a bowel movement in 4 days.

1. I feel like my heart is racing. Albuterol/ipratropium is a combination agent- one is b2-adrenergic agonist and the other is an anticholinergic medication, in combination they produce an overall bronchodilation effect. common side effects include headache, dizziness, dry mouth, tremors, nervousness and tachycardia.

The nurse is caring for a client with a diagnosis of influenza who first began to experience symptoms yesterday. Antiviral therapy is prescribed and the nurse provides instructions to the client about the therapy. Which statement by the client indicates an understanding of the instructions? 1. I must take the medication exactly as prescribed 2 Once I start the medication, I will no longer be contagious 3. I will not get any colds or infections while taking this medication 4. This medication has minimal side effects and I can return to normal activities.

1. I must take the medication exactly as prescribed. Antiviral Medications for influenza must be taken exactly as prescribed. these medications do not prevent the spread of influenza, and clients are usually contagious for up to 2 days after the initiation of antiviral meds. Secondary Bacterial infections may occur despite antiviral treatments. side effects occur with these meds and may necessitate change in activities

The clinic nurse performing an admission assessment on a client votes the client is taking azelaic acid period the nurse determines that which client complaint may be associated with the use of this medication? 1. Itching 2. Euphoria 3. Drowsiness 4. Frequent urination

1. Itching Rationale: azelaic acid is a topical medication used to treat mild to moderate acne. Adverse effects include burning, itching, stinging, redness of the skin, and hypo pigmentation of the skin in clients with a dark complexion. the effects noted in the other options are not specifically associated with this medication.

An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily accessible should respiratory depression occur? 1. Naloxone 2. Morphine sulfate 3. Betamethasone 4. Hydromorphone hydrochloride

1. Naloxone Rationale: opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and hydromorphone hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.

The client arrives at the ED complaining of back spasms. The client states, "i have been taking 2-3 aspirin every 4 hours for the last week, and it hasnt helped my back" Since acetylsalicylic acid intoxication is suspected, the nurse should assess the client for which manifestations? 1. tinnitus 2. diarrhea 3. constipation 4. photosensitivity

1. Tinnitus Rationale: Mild Intoxication with acetylsalicylic acid is called Salicylism and is experienced commonly when the daily dosage is high than 4g. Tinnitus (ringing in the ears) is the most frequent effect noted with intoxication. Hyperventilation may occur, because salicylate stimulates the respiratory center. Fever may result, because salicylate interferes with the metabolic pathways coupling oxygen consumption and heat production 2, 3,4 are not associated specifically with toxicity .

The health education nurse provides instructions to a group of clients regarding measures that will assist with preventing skin cancer. Which instructions should the nurse provide? Select all that apply. 1. Sunscreen should be applied every 8 hrs 2. Use sunscreen when participating in outdoor activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. 4. Avoid sun exposure in the late afternoon and early evening hours. 5. Examine your body monthly for any lesions that may be suspicious.

1. Use sunscreen when participating in outdoor activities. 3. Wear a hat, opaque clothing, and sunglasses when in the sun. 5. Examine your body monthly for any lesions that may be suspicious. Rationale: the client should be instructed to avoid sun exposure between the hours of brightest sunlight: 10 a.m. and 4 p.m. Sunscreen, a hat, opaque clothing, and sunglasses should be warm for outdoor activities. The client should be instructed to examine the body monthly for appearances of any cancerous or pre-cancerous lesions. Sunscreen should be reapplied every 2 to 3 hours and after swimming or sweating; otherwise, the duration of protection is reduced.

The nurse prepares a client for ear irrigation as prescribed by the health care provider. Which action should the nurse take when performing the procedure? 1. Warm the irrigating solution to 98.6°F (37.0°C) . 2. Position the client with the affected side up following the irrigation. 3. Direct a slow, steady stream of irrigation solution toward the eardrum. 4. Assist the client to turn his or her head so that the ear to be irrigated is facing upward.

1. Warm the irrigating solution to 98.6°F (37.0°C) Rationale: Before ear irrigation, the nurse should inspect the tympanic membrane to ensure that it is intact. The irrigating solution should be warmed to 98.6°F (37.0°C) because a solution temperature that is not close to the client's body temperature will cause ear injury, nausea, and vertigo. The affected side should be down following the irrigation to assist in drainage of the fluid. When irrigating, a direct and slow steady stream of irrigation solution is directed toward the wall of the canal, not toward the eardrum. The client is positioned sitting, facing forward with the head in a natural position; if the ear is faced upward, the nurse would not be able to visualize the canal.

The nurse is preparing to administer eye drops. Which interventions should the nurse take to administer the drops? Select all that apply. 1. Wash hands 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheekbone. 5. Instruct the client to squeeze the eyes shut after instilling the eye drop. 6. Instruct the client to tilt the head forward, open the eyes, and look down.

1. Wash hands. 2. Put gloves on. 3. Place the drop in the conjunctival sac. 4. Pull the lower lid down against the cheekbone .Rationale: To administer eye medications, the nurse should wash hands and put gloves on. The client is instructed to tilt the head backward, open the eyes, and look up. The nurse pulls the lower lid down against the cheekbone and holds the bottle like a pencil with the tip downward. Holding the bottle, the nurse gently rests the wrist of the hand on the client's cheek and squeezes the bottle gently to allow the drop to fall into the conjunctival sac. The client is instructed to close the eyes gently and not to squeeze the eyes shut to prevent the loss of medication.

Rifabutin is prescribed for a client with active Mycobacterium avium complex (MAC) disease and tuberculosis. For which side and adverse effects of the medication should the nurse monitor? Select all that apply. 1. signs of hepatitis 2. flu like symptoms 3. low neutrophil count 4. vitamin b6 deficiency 5. ocular pain or blurred vision 6. tingling and numbness of fingers.

1. signs of hepatitis 2. flu like symptoms 3. low neutrophil count 5. ocular pain or blurred vision rifabutin may be prescribed for client with active MAC disease and TB. it inhibits mycobacterial DNA-dependent RNA polymerase and suppress protein synthesis. side and adverse effects include rash, GI disturbances, neutropenia (low neutrophil count), red-orange colored body secretions, uveitis (blurred vision and eye pain), myositis, arthralgia, hepatitis, chest pain with dyspnea and flu like symptoms.

The nurse is planning to administer hydrochlorothiazide to a client. The nurse understands that which is a concern related to the administration of this medication? 1. Sulfa allergy 2. Osteoporosis 3. Hypokalemia 4. Hypouricemia 5. Hyperglycemia 6. Hypercalcemia

1.sulfa allergy 3..Hypokalemia, 5 Hyperglycemia, 6..Hypercalcemia Rationale: Thiazide diuretics such as term-42hydrochlorothiazide are sulfa-based medications, and a client with a sulfa allergy is at risk for an allergic reaction. Also, clients are at risk for hypokalemia, hyperglycemia, hypercalcemia, hyperlipidemia, and hyperuricemia.

The nurse is monitoring a client who is taking digoxin (Lanoxin) for adverse effects. Which findings are characteristic of digoxin toxicity? SELECT ALL THAT APPLY 1. Tremors 2. Diarrhea 3. Irritability 4. Blurred vision 5. Nausea and vomiting

2 Diarrhea 4.Blurred vision 5. nausea and vomiting Rationale: Digoxin (Lanoxin) is a cardiac glycoside. The risk of toxicity can occur with the use of this medication. Toxicity can lead to life-threatening events and the nurse needs to monitor the client closely for signs of toxicity. Early signs of toxicity include gastrointestinal manifestations such as anorexia, nausea, vomiting, and diarrhea. Subsequent manifestations include headache; visual disturbances such as diplopia, blurred vision, yellow-green halos, and photophobia; drowsiness; fatigue; and weakness. Cardiac rhythm abnormalities can also occur. The nurse also monitors the digoxin level. Therapeutic levels for digoxin range from 0.5-2ng/ml

he nurse has given medication instructions to a client receiving phenytoin. Which statement indicates that the client has an adequate understanding of the instructions? 1. "alcohol is not contraindicated while taking this medication" 2. "good oral hygiene is needed, including brushing and flossing" 3. "the medication dose may be self-adjusted, depending on side effects" 4. "the morning dose of the medication should be taken before a serum medication level is drawn"

2. "good oral hygiene is needed, including brushing and flossing" Rationale: typical antiseizure meds instructions include taking the med as prescribed so blood levels of drug are constant. Take sample for blood levels right before morning dose. Client should be taught not to sudden stop the medication, avoid alcohol, check with pcp before taking any OTC meds, to avoid activities in which alertness and coordination are required until med effects are known. to provide good oral hygiene and to obtain regular dental care.

A client with atrial fibrillation is receiving a continuous heparin infusion at 1000 units/hr. The nurse determines that the client is receiving the therapeutic effect based on which results? 1. Prothrombin time of 12.5 seconds 2. Activated partial thromboplastin time of 60 seconds 3. Activated partial thromboplastin time of 28 seconds 4. Activated partial thromboplastin time longer than 120 seconds

2. Activated partial thromboplastin time of 60 seconds Rationale: Common laboratory ranges for activated partial thromboplastin time are 20-36 seconds. Because the activated partial thromboplastin time should be 1.5-2.5 times the normal value, the client's activated partial thromboplastin time would be considered therapeutic if it was 60 seconds.

A client in preterm labor (31 weeks) who is dilated to 4 cm had been started on magnesium sulfate and contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? 1. Nalbuphine 2. Betamethasone 3. Rho (D) immune globulin 4. Dinoprostone vaginal insert

2. Betamethasone Rationale: betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if labor can be inhibited for 48 hours. Now Buford is an opioid analgesic. Rho immune globulin is given to rh- clients to prevent sensitization. Dinoprostone vaginal insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.

Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority assessment? 1. Uterine tone 2. Blood pressure 3. Amount of lochia 4. Deep tendon reflexes

2. Blood pressure Rationale: methylergonovine, and I go alkaloid comma is used to prevent or control postpartum Hemorrhage by Contracting the uterus. Methylergonovine causes continuous uterine contractions and may Elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The healthcare provider needs to be notified if hypertension is present. Although options one, three, and four may be components of postpartum assessment, blood pressure is related specifically to the administration of this medication

A client with Valvular heart Disease who has a clot in the right atrium is receiving a heparin sodium infusion at 1000 units/hr and warfarin 7.5mg at 5pm daily. The morning laboratory results are as follows: activated partial thromboplastin time (aPTT) = 32 seconds; internationalized normalized ratio (INR) = 1.3. The nurse should plan to take which action based on the client's laboratory results? 1. Collaborate with the health care provider (HCP) to discontinue the heparin infusion and administer the warfarin sodium as prescribed. 2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. 3. Collaborate with the HCP to withhold the warfarin sodium since the client is receiving a heparin infusion and the aPTT is within the therapeutic range. 4. Collaborate with the HCP to continue the heparin infusion at the same rate and to discuss use of dabigatran etexilate in place of warfarin sodium.

2. Collaborate with the HCP to obtain a prescription to increase the heparin infusion and administer the warfarin sodium as prescribed. Rationale: When a client is receiving warfarin (Coumadin) for clot prevention due to atrial fibrillation, an INR of 2-3 is appropriate for most clients. Until the INR has achieved a therapeutic range the client should be maintained on a continuous heparin infusion with the aPTT ranging between 60-80 seconds. Therefore, the nurse should collaborate with the health care provider to obtain a prescription to increase the heparin infusion and to administer the warfarin as prescribed.

The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route? 1. Intradermal 2. Intratracheal 3. Subcutaneous 4. Intramuscular

2. Intratracheal Rationale: respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The Mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Options 1, 3, and 4 are not routes of administration for this medication

The nurse is caring for a client with chronic back pain. Codeine has been prescribed for the client. Specific to this medication, which intervention should the nurse include in the plan of care while the client is taking this medication? 1. monitor radial pulse 2. monitor bowel activity 3. monitor apical heart rate 4. monitor peripheral pulses

2. Monitor Bowel activity. Med can cause constipation. Nurse should monitor for hypotension, urine retention, bowel sounds, monitor the pattern of bowel movements. and monitor resp status and how effective the med is for pain reduction.

Intravenous Heparin therapy is prescribed for a client with atrial fibrillation. While implementing this prescription, the nurse ensures that which medication is available? 1. Vitamin K 2. Protamine sulfate 3. Potassium chloride 4. Aminocaproic acid

2. Protamine sulfate rationale- The antidote for heparin is protamine sulfate; it should be readily available for use if excessive bleeding or hemorrhage should occur. vitamin K is an antidote for warfarin sodium. Potassium Chloride is administered for a potassium deficit. Aminocaproic acid is the antidote for thrombolytic therapy.

A client who uses NSAIDs has been taking misoprostol. The nurse determines that the misoprostol is having the intended therapeutic effect if which finding is noted? 1. resolved diarrhea 2. relief of epigastric painterm-30 3. decreased platelet count 4. decreased WBC count

2. Relief of epigastric pain Clients who use NSAIDs are prone to gastric mucosal injury. Misoprostol is a gastric protectant and is given specifically to prevent this occurrence in clients taken NSAIDs frequently. Diarrhea can be a side effect of the medication but is not an intended effect.

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? Select all that apply. 1. Protienuria of 3+ 2. Respirations of 10 breaths/minute 3. Presence of deep tendon reflexes 4. Urine output of 20 mL in an hour 5. Serum magnesium level of 4 mEq/L (2 mmol/L)

2. Respirations of 10 breaths/minute& 4. Urine output of 20 mL in an hour Rationale: magnesium toxicity can occur from magnesium sulfate therapy. signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. Respiratory rate below 12 breaths per minute is a sign of toxicity. Urine output should be at least 25 to 30 milliliters per hour. Proteinuria of 3 + is an expected finding in a client with pre-eclampsia. Presence of deep tendon reflexes is normal and expected finding. Therapeutic serum levels of magnesium are for 27.5 mEq per liter

The nurse in monitoring a client who is taking propranolol. Which assessment data indicates a potential adverse complication associated with this medication? 1. The development of complaints of insomnia 2. The development of audible expiratory wheezes 3. A baseline BP of 150/80mmHg followed by a BP of 138/72mmHg after two doses of the medication 4. A baseline resting HR of 88bpm followed by a resting HR of 72bmp after two doses of the medication

2. The development of audible expiratory wheezes Rationale: Audible expiratory wheezes may indicate a serious adverse reaction, bronchospasm. B-blockers may induce this reaction, particularly in clients with chronic obstructive pulmonary disease or asthma. Normal decreases in BP and heart rate are expected. Insomnia is a frequent mild side effect and should be monitored.

Meperidine has been prescribed for a client to treat pain. Which side and adverse effects should the nurse monitor for? Select all that apply. 1. diarrhea 2. tremors 3. drowsiness 4. hypotension 5. urinary frequency 6. increased respiratory rate

2. Tremors 3. Drowsiness 4. Hypotension Rationale- Meperidine is an opioid analgesic. Side and adverse effects include resp. depression, drowsiness, hypotension, constipation, urinary retention, nausea, vomiting, and tremors.

Isotretinoin is prescribed for a client with severe acne. Before the administration of this medication, the nurse anticipates that which Laboratory test will be prescribed? 1. Potassium level 2. Triglyceride level 3. Hemoglobin A1C 4. Total cholesterol level

2. Triglyceride level Rationale: isotretinoin can Elevate triglyceride levels period blood triglyceride levels should be measured before treatment and periodically thereafter until the effect on triglycerides has been evaluated. There is no indication that isotretinoin effects potassium, hemoglobin A1c, or total cholesterol levels.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1. diarrhea 2. heartburn 3. flatulence 4. constipation

2. heartburn Omeprazole is a proton pump inhibitor classified as an antiulcer agent. The intended effect of the medication is relief of pain from gastric irritation (heartburn). Omeprazole is not used to treat 1, 3 or 4

the nurse teaches a client about the effects of diphenhydramine, which has been prescribed as a cough suppressant. The nurse determines that the client needs further instruction if the client makes which statement? 1. i will take the medication on an empty stomach 2. i wont drink alcohol while taking this medication 3. i wont do activities that require mental alertness while taking this medication 4. i will us sugarless gum, candy, or oral rinses to decrease dryness in my mouth

2. i will take this medication on an empty stomach

A client has been taking isoniazid for 2 months. The client complains to the nurse about numbness, paresthesia, and tingling in the extremities. The nurse interprets that the client is experiencing which problem? 1.hypercalemia 2. peripheral neuritis 3. small blood vessel spasm 4. impaired peripheral circulation

2. peripheral neuritis isoniazid is an antitubercular medication. common side effects are peripheral neuritis, manifested by numbness tingling and paresthesia in the extremities. this can be minimized with pyridozine b6 intake.

A client is to begin a 6-month course of therapy with isoniazid. The nurse should plan to teach the client to take which action? 1. use alcohol in small amounts only. 2. report yellow eyes or skin immediately 3. increase intake of swiss and aged cheeses 4. avoid vitamin supplements during therapy.

2. report yellow eyes and skin immediately med is hepatotoxic ..

The nurse has a prescription to give a client salmeterol, 2 puffs, and beclomethasone dipropionate, 2 puffs, by metered-dose inhaler. The nurse should administer the medication using which procedure? 1. beclomethasone first then the salmeterol 2. salmeterol first then the beclomethasone 3.alternating a single puff of each, beginning with the salmeterol 4. alternating a single puff of each, beginning with the beclomethasone

2. salmeterol first then the beclomethasone salmeterol is an adrenergic type of bronchodilator, and beclomethasone dipropionate is a glucocorticoid. bronchodilators are always administered before glucocorticoids when both are given on the same time schedule. this allows widening of the airs passages by the bronchodilator which then makes the glucocorticoid to work more effective.

A client with Crohn's disease is scheduled to receive an infusion of infliximab (Remicade). What intervention by the nurse will determine the effectiveness of treatment? 1. Monitoring the leukocyte count for 2 days after the infusion 2. Checking the frequency and consistency of bowel movements 3. Checking serum liver enzyme levels before and after the infusion 4. Carrying out a Hematest on gastric fluids after the infusion is completed

2.Checking the frequency and consistency of bowel movements Rationale: The principal manifestations of Crohn's disease are diarrhea and abdominal pain. Infliximab (Remicade) is an immunomodulator that reduces the degree of inflammation in the colon, thereby reducing the diarrhea.

A miotic medication has been prescribed for the client with glaucoma and the client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client? 1. "The medication will help dilate the eye to prevent pressure from occurring." 2. "The medication will relax the muscles of the eyes and prevent blurred vision." 3. "The medication causes the pupil to constrict and will lower the pressure in the eye." 4. "The medication will help block the responses that are sent to the muscles in the eye."

3. "The medication causes the pupil to constrict and will lower the pressure in the eye." Rationale: Miotics cause pupillary constriction and are used to treat glaucoma. They lower the intraocular pressure, thereby increasing blood flow to the retina and decreasing retinal damage and loss of vision. Miotics cause a contraction of the ciliary muscle and a widening of the trabecular meshwork. Options 1, 2, and 4 are incorrect.

Silver sulfadiazine is prescribed for a client with a partial thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication is likely to cause stinging every time it is applied." 4. "The medication should be applied directly to the wound."

3. "The medication is likely to cause stinging every time it is applied." Rationale: silver sulfadiazine is an antibacterial that has a broad spectrum of activity against gram-negative bacteria gram positive bacteria, and yeast. It is applied directly to the wound to assistant healing. It does not cause stinging when applied.

A client with a peptic ulcer is diagnosed with a Helicobacter pylori infection. The nurse is teaching the client about the medications prescribed, including clarithromycin, esomeprazole, and amoxicillin. Which statement by the client indicates the best understanding of the medication regimen? 1. "my ulcer will heal because these medications will kill the bacteria" 2. "these medications are only taken when I have pain from my ulcer" 3. "the medications will kill the bacteria and stop the acid production" 4. "these medications will coat the ulcer and decrease the acid production in my stomach"

3. "the medication will kill the bacteria and stop the acid production" Triple therapy for H. Pylori infection usually includes 2 antibacterial meds and a proton pump inhibitor. They will kill the bacteria and decrease acid production.

The nurse has given instructions to a client who has just been prescribed cholestyramine. Which statement by the client indicates a need for further instruction? 1. "I will continue taking vitamin supplements" 2. "this medication will help to lower my cholesterol" 3. "this medication should only be taken with water" 4. "a high fiber diet is important while taking this medication"

3. "this medication should only be taken with water" Cholestyramine is a bile acid sequestrant used to lower the cholesterol level and client compliance is a problem because of its taste and palatability. . The use of flavored products or fruit juices can improve the states. Some of the side effects of bile acid sequestrants include constipation and decreased vitamin absorption.

A client was just admitted to the hospital to rule out a gastrointestinal (GI) bleed. The client has brought several bottles of medications prescribed by different specialists. During the admission assessment, the client states, "Lately, I have been hearing some roaring sounds in my ears, especially when I am alone." Which medication would the nurse identify as the cause of the client's complaint? 1. Doxycycline 2. Atropine sulfate 3. Acetylsalicylic acid 4. Diltiazem hydrochloride

3. Acetylsalicylic acid Rationale: Aspirin is contraindicated for GI bleeding and is potentially ototoxic. The client should be advised to notify the prescribing health care provider so the medication can be discontinued and/or a substitute that is less toxic to the ear can be taken instead. Options 1, 2, and 4 do not have effects that are potentially associated with hearing difficulties.

The nurse should report which assessment finding to the health care provider (HCP) before initiating thrombolytic therapy in a client with pulmonary embolism? 1. Adventitious breath sounds 2. Temperature of 99.4F orally 3. BP of 198/100mmHg 4. Respiratory rate of 28 breaths/ minute Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the HCP before initiating therapy.

3. BP 198/100mg Rationale: Thrombolytic therapy is contraindicated in a number of preexisting conditions in which there is a risk of uncontrolled bleeding, similar to the case in anticoagulant therapy. Thrombolytic therapy also is contraindicated in severe uncontrolled hypertension because of the risk of cerebral hemorrhage. Therefore the nurse would report the results of the blood pressure to the HCP before initiating therapy.

An older client recently has been taking cimetidine. The nurse monitors the client for which most frequent central nervous system side effect of this medication? 1. tremors 2. dizziness 3. confusion 4. hallucinations

3. Confusion Cimetidine is an Histamine (h2)-receptor antagonist. Older clients are especially susceptible to CNS side effects from cimetidine. Most frequently Confusion. . less common CNS side effects include headaches, dizziness, drowsiness and hallucinations.

In preparation for cataract surgery, the nurse is to administer cyclopentolate eye drops at 0900 for surgery that is scheduled for 0915. What initial action should the nurse take in relation to the characteristics of the medication action? 1. Provide lubrication to the operative eye prior to giving the eye drops. 2. Call the surgeon, as this medication will further constrict the operative pupil. 3. Consult the surgeon, as there is not sufficient time for the dilative effects to occur. 4. Give the medication as prescribed; the surgeon needs optimal constriction of the pupil.

3. Consult the surgeon, as there is not sufficient time for the dilative effects to occur. Rationale: Cyclopentolate is a rapidly acting mydriatic and cycloplegic medication. Cyclopentolate is effective in 25 to 75 minutes, and accommodation returns in 6 to 24 hours. Cyclopentolate is used for preoperative mydriasis, not pupil constriction. The nurse should consult with the surgeon about the time of administration of the eye drops since 15 minutes is not adequate time for dilation to occur.

Terbutaline is prescribed for a client with bronchitis. The nurse checks the client's medical history for which disorder in which the medication should be used with caution? 1.osteoarthritis 2. hypothyroidism 3. diabetes mellitus 4. polycystic disease

3. Diabetes mellitus is contraindicated in client with hypersensitivity to sympathomimetics. it should be used with caution in clients with impaired cardiac function, Diabetes mellitus, hypertension, hyperthyroidism, or history of seizures.

A client is diagnosed with a ST-segment elevation myocardial infarction (STEMI) and is receiving tissue plasminogen activator, alteplase. Which action is a PRIORITY nursing intervention? 1. Monitor for kidney failure 2. Monitor psychosocial status 3. Monitor for signs of bleeding 4. Have heparin sodium available

3. Monitor for signs of bleeding Rationale: Tissue plasminogen activator is a thrombolytic. Hemorrhage is a complication of any type of thrombolytic medication. The client is monitored for bleeding. Monitoring for renal failure and monitoring the client's psychological status are important but are not the most critical interventions. Heparin may be administered after thrombolytic therapy, but the question is not asking about follow-up medications.

Betaxolol hydrochloride eye drops have been prescribed for a client with glaucoma. Which nursing action is most appropriate related to monitoring for side and adverse effects of this medication? 1. Assessing for edema 2. Monitoring temperature 3. Monitoring blood pressure 4. Assessing blood glucose level

3. Monitoring blood pressure Rationale: Hypotension, dizziness, nausea, diaphoresis, headache, fatigue, constipation, and diarrhea are side and adverse effects of the medication. Nursing interventions include monitoring the blood pressure for hypotension and assessing the pulse for strength, weakness, irregular rate, and bradycardia. Options 1, 2, and 4 are not specifically associated with this medication.

A client is taking the prescribed dose of phenytoin to control seizures. Results of a phenytoin blood level study reveal a level of 35 mcg/mL. Which finding would be expected as a result of this lab result? 1. hypotension 2. tachycardia 3. slurred speech 4. no abnormal finding

3. Slurred Speech Rationale- Therapuetic Phenytoin level is 10 to 20mcg/ml (40 to 79 mcmol/L). Ata a level higher than 20mcg/ml, involuntary movements of the eyeballs )nystagmus) occurs. At levels higher than 30mcg/ml, ataxia and slurred speech occur.

The home health nurse visits a client who is taking phenytoin (Dilantin) for control of seizures. During the assessment, the nurse notes that the client is taking birth control pills. Which information should the nurse include in the teaching plan? 1. Pregnancy should be avoided while taking phenytoin. 2. The client may stop the medication if it is causing severe gastrointestinal effects. 3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin. 4. There is the increased risk of thrombophlebitis while taking phenytoin and birth control pills together.

3. There is the potential of decreased effectiveness of birth control pills while taking phenytoin. Rationale:Phenytoin enhances the rate of estrogen metabolism, which can decrease the effectiveness of some birth control pills. Options 1, 2, and 4 are inappropriate instructions. Pregnancy does not need to be "avoided" while taking phenytoin; however, because phenytoin may cause some risk to the fetus (Pregnancy Category D medication), consultation with the health care provider should be done if pregnancy is considered. Telling a client that there is an increased risk of thrombophlebitis is incorrect and inappropriate and could cause anxiety in the client. A client should not be instructed to stop antiseizure medication.)

The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediately discontinue the oxytocin infusion? Select all that apply 1. Fatigue 2. Drowsiness 3. Uterine hyperstimulation 4. Late decelerations of the fetal heart rate 5. Early decelerations of the fetal heart rate

3. Uterine hyperstimulation 4. Late decelerations of the fetal heart rate Rationale: oxytocin stimulates uterine contractions and is a pharmacological method to induce labor. Late decelerations, a non reassuring fetal heart rate pattern, is an ominous sign indicating fetal distress period oxytocin infusion must be stopped when any signs of uterine hyperstimulation, late decelerations, or other adverse effects occur. Some healthcare providers prescribe the administration of oxytocin in 10-minute Post in fusions rather than as a continuous infusion. This post method, which is more like endogenous secretions of oxytocin, is reported to be effective for labor induction and requires significantly less oxytocin use period drowsiness and fatigue may be caused by the labor experience. Early decelerations fetal heart rate are a reassuring sign and do not indicate fetal distress.

A client with severe acne is seen in the clinic and the healthcare provider prescribes isotretinoin. the nurse reviews the clients medication record and would contact the health care provider if the client is also taking which medication? 1. Digoxin 2. Phenytoin 3. Vitamin A 4. Furosemide

3. Vitamin A Rationale: isotretinoin is a metabolite of vitamin A and can produce generalized intensification of isotretinoin toxicity. Because of the potential for increased toxicity, vitamin A supplements should be discontinued before isotretinoin therapy. There are no contraindications associated with digoxin, phenytoin, or Furosemide.

A client with trigeminal neuralgia is being treated with carbamazepine, 400 mg orally daily. Which value indicates that the client is experiencing an adverse effect to the medication? 1. sodium level, 140 mEq/L 2. uric acid level, 4.0 mg/dL 3. WBC count, 3000 4. BUN level, 10 mg/dL

3. WBC count, 3000 Carbamazepine, classified as an antiseizure medication, is used to treat nerve pain. Adverse effects of this med appear as blood dyscrasias, including aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia. Cardiovascular disturbance including thrombophlebitis and dysrhythmias; and dermatological effects. The WBC reflects agranulocytosis. 1, 2, 4 are normal values.

A client has an as needed prescription for loperamide hydrochloride. For which condition should the nurse administer this medication? 1. constipation 2. abdominal pain 3. an episode of diarrhea 4. hematest-positive nasogastric tube drainage

3. an episode of diarrhea Rationale- Loperamide is an antidiarrheal agent. It is used to manage acute and chronic diarrhea in condition such as IBS. Loperamide can also be used to reduce volume of drainage from an ileostomy.

A client has been started on long-term therapy with rifampin. The nurse should provide which information to the client about the medication? 1.should always be taken with food or antacids 2. should be dosed if 1 dose is forgot 3. causes orange discoloration of sweat, tears, urine and feces 4. may be discontinued independently if symptoms are gone in 3 months.

3. causes orange discoloration of sweat, tears, urine and feces rifampin causes orange-red discoloration of body secretions and will stain soft contacts lenses permanently.

A client with tuberculosis is being started on antituberculosis therapy with isoniazid. Before giving the client the first dose, the nurse should ensure that which baseline study has been completed? 1. Electrolytes levels 2. coagulation times 3. liver enzyme levels 4. serum creatinine level

3. liver enzyme levels Isoniazid therapy can cause an elevation of hepatic enzyme levels and hepatitis. Therefore, liver enzymes levels are monitored when therapy is initiated and during the first 3 months of therapy.

Zafirlukast is prescribed for a client with bronchial asthma. Which laboratory test does the nurse expect to be prescribed before the administration of this medication? 1. platelet count 2. neutrophil count 3. liver function test 4. complete blood count

3. liver function test zafirlukast is a leukotriene receptor antagonist used in the prophylaxis and long term treatment of bronchial asthma. zafirlukast should with caution in clients with impaired hepatic function.

A client has begun medication therapy with pancrelipase. The nurse evaluates that the medication is having the optimal intended benefit if which effect is observed? 1. weight loss 2. relief of heartburn 3. reduction of steatorrhea 4. absence of abdominal pain

3. reduction of steatorrhea Pancrelipase is a pancreatic enzyme use in clients with pancreatitis as an digestive aid. This medication should reduce the amount of fatty stools (steatorrhea). Another intended effect could be improved nutritional status. Its use could result in weight gain.

A client has a prescription to take guaifenesin. The nurse determines that the client understands the proper administration of this medication if the client states that he or she will perform which action? 1. take an extra dose if fever develops 2. take the medication with meals only 3. take the table with a full glass of water 4. decrease the amount of daily fluids

3. take with full glass of water Guaifenesin is an expectorant and should be taken with full glass of water to decrease the viscosity of secretions . client should call pcp if cough is longer than a week.

A client is being treated with procainamide for a cardiac dysrhythmia. Following intravenous administration of the medication, the client complains of dizziness. What intervention should the nurse take FIRST? 1. Obtain a 12-lead EKG immediately rhythm strip 2. Check patients fingerstick blood glucose level 3. Auscultate the client's apical pulse and obtain a BP 4. measure QRS interval duration on the rhythm strip

3.Auscultate the clients apical pulse and obtain a bp Rationale: Signs of toxicity from procainamide include confusion, dizziness, drowsiness, decreased urination, nausea, vomiting, and tachydysrhythmias. If the client complains of dizziness, the nurse should assess the vital signs first. Although measuring the heart rate on the rhythm strip and obtaining a 12-lead EKG may be interventions, these would be done after the vital signs are taken. Nitroglycerin is a vasodilator and will lower the BP.

The nurse provides discharge instructions to a client who is taking warfarin sodium (Coumadin). Which statement, by the client, reflects the need for further teaching? 1. "I will avoid alcohol consumption" 2. "I will take my pills every day at the same time" 3. "I have already called my family to pick up a Medic-Alert bracelet" 4. " I will take coated Aspirin for my headache because it will coat my stomach"

4. " I will take coated Aspirin for my headache because it will coat my stomach" Rationale: Ecotrin is an aspirin-containing product and should be avoided. Alcohol consumption should be avoided by a client taking warfarin sodium. Taking prescribed medication at the same time each day increases client compliance. The Medic-Alert bracelet provides health care personnel emergency information.

The home health care nurse is visiting a client with Coronary artery disease with elevated triglyceride levels and a serum cholesterol level of 398mg/dl. The client is taking cholestyramine. Which statement, by the client, indicates the NEED FOR FURTHER EDUCATION? 1. "Constipation and bloating might be a problem" 2. "I'll continue to watch my diet and reduce my fats" 3. "Walking a mile each day will help the whole process" 4. "I'll continue my nicotinic acid from the health food store"

4. "I'll continue my nicotinic acid from the health food store" Rationale: Nicotinic acid, even an over-the-counter form, should be avoided because it may lead to liver abnormalities. All lipid-lowering medications also can cause liver abnormalities, so a combination of nicotinic acid and cholestyramine resin needs to be avoided. Constipation and bloating are the two most common side effects/ Walking and the reduction of fats in the diet are therapeutic measures to reduce cholesterol and triglyceride levels.

A client is prescribed nicotinic acid (niacin) for hyperlipidemia and the nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "It is not necessary to avoid the use of alcohol" 2. "The medication should be taken with meals to decrease flushing" 3. "Clay-colored stools are a common side effect and should not be of concern" 4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing"

4. "Ibuprofen (Motrin) taken 30 minutes before the nicotinic acid should decrease the flushing" Rationale: Flushing is a side effect of this medication. Aspirin or a nonsteroidal anti inflammatory drug can be taken 30 minutes prior to taking the medication to decrease flushing. Alcohol consumption needs to be avoided because it will enhance this side effect. The medication should be taken with meals to decrease gastrointestinal upset; however, taking the medication with meals has no effect on the flushing. Clay-colored stools are a sign of hepatic dysfunction and should be immediately reported to the HCP

A client who is receiving digoxin (Lanoxin) daily has a serum potassium level of 3mEq/L and is complaining of anorexia. The health care provider prescribes determination of the serum digoxin level to rule out digoxin toxicity. The nurse checks the results and should recognize which level is outside the therapeutic range? 1. 0.5ng/mL (0.63nmol/L) 2. 0.8ng/mL (1.02nmol/L) 3. 0.9ng/mL (1.14nmol/L) 4. 2.2ng/mL ( 2.8nmol/L)

4. 2.2ng/mL The optimal therapeutic range for digoxin is 0.5-2.0ng/Ml. if the client is experiencing symptoms such as anorexia and is experiencing hypokalemia as evidence by a low potassium level, digoxin toxicity is a concern.

The nurse is caring for a client in the emergency department who has been diagnosed with Bell's palsy. The client has been taking acetaminophen, and acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed? 1. Pentostatin 2. Auranofin 3. Fludarabine 4. Acetylcysteine

4. Acetylcysteine Rationale- the antidote for acetaminophen is Acetylcysteine. The normal therapeutic serum level of acetaminophen is 10 to 20mcg/ml. A toxic level is high than 50mcg/ml, and levels higher than 200mcg/ml 4 hours after ingestion indicates that there is risk of liver disease. Auronofin is a gold preparation that may be used to treat Rheumatoid arthritis. Pentostatin and Fludarabine are antineoplastic agents.

The Camp nurse asked the children preparing to swim in the lake if they have applied sunscreen. The nurse reminds the children that chemical sunscreens are most effective when applied at which times? 1. Immediately before swimming 2. 5 minutes before exposure to the sun 3. Immediately before exposure to the sun 4. At least 30 minutes before exposure to the sun

4. At least 30 minutes before exposure to the sun Rationale: sunscreens are most effective when applied at least 30 minutes before exposure to the sun so that they can penetrate the skin. All sunscreen should be reapplied after swimming or sweating.

Which medication, if prescribed for the client with glaucoma, should the nurse question? 1. Betaxolol 2. Pilocarpine 3. Erythromycin 4. Atropine sulfate

4. Atropine sulfate Rationale: Options 1 and 2 are miotic agents used to treat glaucoma. Option 3 is an antiinfective medication used to treat bacterial conjunctivitis. Atropine sulfate is a mydriatic and cycloplegic (also anticholinergic) medication, and its use is contraindicated in clients with glaucoma. Mydriatic medications dilate the pupil and can cause an increase in intraocular pressure in the eye.

Rho (D) immune globulin is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? 1. Having Rh-positive blood 2. Developing a rubella infection 3. Developing physiological jaundice 4. Being affected by Rh incompatibility

4. Being affected by Rh incompatibility Rationale: RH incompatibility can occur when an Rh negative mother become sensitized to the RH antigen. Sensitization May develop when an Rh negative woman becomes pregnant with a fetus who is RH positive. During pregnancy and at delivery, some of the fetus's RH positive blood can enter the maternal circulation, causing the mother's immune system to form antibodies against RH positive blood. Administration of rho immunoglobulin prevents the mother from developing antibodies against RH positive blood by providing passive antibody protection against the RH antigen.

A client with trigeminal neuralgia tells the nurse that acetaminophen is taken daily for the relief of generalized discomfort. Which lab value would indicate toxicity associated with the medication? 1. sodium level of 140 mEq/L 2. platelet count of 400,000 mm3 3. prothrombin time of 12 seconds 4. direct bilirubin level of 2 mg/dL

4. Direct Bilirubin of 2mg/dL in Adults, overdose of acetaminophen causes liver damage. The correct option is an indicator of liver function and is the only option that indicates an abnormal lab value. The normal Direct Bilirubin level is 0.1 to 0.3mg/dl.

Carbidopa-levodopa is prescribed for a client with Parkinson's disease, and the nurse monitors the client for adverse effects of the medication. Which sign/symptom indicates the client is experiencing an adverse effect? 1. Pruritis 2. Tachycardia Hypertension 4. Impaired Voluntary Movement

4. Impaired Voluntary Movement Dyskinesia and impaired voluntary movements may occur with high Carbidopa-levodopa dosages. Nausea, anorexia , dizziness, orthostatic hypotension, bradycardia, and akinesia are frequent side effects of this medication.

The nurse has just administered the first dose of omalizumab to a client. Which statement by the client would alert the nurse that the client may be experiencing a life-threatening effect? 1. I have a severe headache 2. My feet are quite swollen 3. I am nauseated and may vomit 4. My lips and tongue are swollen

4. My lips and tongue are swollen Omalizumab is an anti-inflammatory and monoclonal antibody used for long term control of asthma. anaphylactic reactions can occur with the administration of Omalizumab. nurse should monitor for signs of adverse reactions of the medication. .

A client has an as needed prescription for ondansetron. For which condition should the nurse administer this medication? 1. paralytic ileus 2. incisional pain 3. urinary retention 4. Nausea and Vomiting

4. Nausea and vomiting Rationale- Ondansetron is an antiemetic used to teat postop nausea and vomiting as well as N/V associated with chemotherapy.

The nurse is providing instructions to a client who will be self-administering eye drops. To minimize systemic absorption of the eye drops, the nurse should instruct the client to take which action? 1. Eat before instilling the drops. 2. Swallow several times after instilling the drops. 3. Blink vigorously to encourage tearing after instilling the drops. 4. Occlude the nasolacrimal duct with a finger after instilling the drops.

4. Occlude the nasolacrimal duct with a finger after instilling the drops. Rationale: Applying pressure on the nasolacrimal duct prevents systemic absorption of the medication. Options 1, 2, and 3 will not prevent systemic absorption.

A client with a gastric ulcer has a prescription for sucralfate 1 gram by mouth 4 times daily. The nurse should schedule the medication for which times? 1. with meals and at bedtime 2. every 6 hours around the clock 3. one hour after meals and at bedtime 4. one hour before meals and at bedtime

4. One hour before meals and at bedtime. Sucralfate is a gastric protectant. The medication should be scheduled for administration 1 hr before meals and at bedtime. The medication is timed to allow it to form a protective coating over the ulcer before food intake stimulates gastric acid production and mechanical irritation.

Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse should contact the healthcare provider who prescribed the medication if which condition is documented in the client's medical history? 1. Hypotension 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease

4. Peripheral vascular disease Rationale: methylergonovine is in the ergot alkaloid used to treat postpartum Hemorrhage. Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, pre-eclampsia, or a clamp Sia. These conditions are worsened by the basil constrictive effects of herbal alkaloids. Options 1, 2, and 3 are not contraindications related to the use of ergot alkaloids.

Prior to administering a client's daily dose of digoxin, the nurse reviews the client's laboratory data and notes the following results: serum calcium 9.8mg/dl; serum magnesium 1.2mg/d; serum potassium 4.1mg/dl; serum creatinine 0.9mg/dl. Which result should alert the nurse that the client is at risk for digoxin toxicity? 1. Serum calcium level 2. Serum potassium level 3. Serum creatinine level 4. Serum magnesium level Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6-2.6mg/dl and the results in the correct option are reflective of hypomagnesemia.

4. Serum Magnesium level Rationale: An increased risk of toxicity exists in clients with hypercalcemia, hypokalemia, hypomagnesemia, hypothyroidism, and impaired renal function. The calcium, creatinine, and potassium levels are all within normal limits. The normal range for magnesium is 1.6-2.6mg/dl and the results in the correct option are reflective of hypomagnesemia.

The nurse administered intravenous bumetanide to a client being treated for heart failure. Which outcome indicates the medication has achieved the expected effect? 1. Cough becomes productive of frothy pink sputum 2. Urine output increases from 10ml/hr to greater than 50ml/hr 3. The serum potassium level changes from 3.8 to 3.1mEq/L 4. B-natriuretic peptide (BNP) factor increases from 200 tp 262pg/ml

4. Urine output increases from 10ml/hr to greater than 50ml/hr Rationale: Bumetanide is a diuretic and expected outcomes include increased urine output, decreased crackles, and decreased weight. Options 1, 2, and 3 are incorrect.

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for follow-up by the nurse? 1. Glucose level of 99 mg/dL2. 2. Magnesium level of 1.5 mEq/L3. 3. Platelet level of 300,000. 4. White blood cell count of 3000

4. White blood cell count of 3000 Rationale: silver sulfadiazine is used for the treatment of burn injuries. Adverse effects of this medication include rash and itching, blue green or gray skin discoloration, leukopenia, and interstitial nephritis. The nurse should monitor a complete blood count, particularly the white blood cells, frequently for the client taking this medication. If leukopenia develops, the healthcare provider is notified and the medication is usually discontinued. The white blood cell count noted an option for is indicative of leukopenia. The other laboratory values are not specific to this medication, and are also within normal limits.

A client with myasthenia gravis has become increasingly weaker. The HCP prepares to identify whether the client is reacting to an overdose of the medication (cholinergic crisis) or an increasing severity of the disease (myasthenic crisis). An injection of edrophonium is administered. Which finding would indicate that the client is in cholinergic crisis? 1. no change in the condition 2. complaints of muscle spasms 3. an improvement of the weakness 4. a temporary worsening of the condition

4. a temporary worsening of the condition an Edrophonium injection makes the client in cholinergic crisis temporarily worse. An improvement in the weakness indicates myasthenia crisis. Muscle spasms are not associated with this test.

A cromolyn sodium inhaler is prescribed for a client with allergic asthma. The nurse provides instructions regarding the adverse effects of this medication and should tell the client that which undesirable effect is associated with this medication? 1. insomnia 2. constipation 3. hypotension 4. bronchospasm

4. bronchospam is a inhaled nonsteroidal antiallergy agent and a mast cell stabilizer. undesirable effects associated with this are bronchospasms, cough, nasal congestion, throat irritation, and wheezing

The nurse has given a client taking ethambutol information about the medication. The nurse determines that the client understands the instructions if the client states that he or she will immediately report which finding? 1.impaired sense of hearing 2. gastrointestinal side effects 3. orange-red discoloration of body secretions 4. difficulty in discriminating the color red from green

4. difficultly in discriminating the color red from green ethambutol causes optic neuritis, which decreases visual acuity and the ability to discriminate between the colors red and green. this poses a potential safety hazard when a client is driving. client needs to report symptom to the doctor ASAP. impaired hearing is from streptomycin not ethambutol.

A client has a new prescription for metoclopramide. On review of the chart, the nurse identifies that this medication can be safely administered with which condition? 1. intestinal obstruction 2. peptic ulcer with melena 3. diverticulitis with perforation 4. vomiting following cancer chemotherapy

4. vomiting following cancer chemotherapy metoclopramide is a GI stimulant and antiemetic. Because its a GI Stimulant, it is contraindicated with GI obstruction, hemorrhage, or perforation. It is used in the treatment of vomiting after surgery, chemotherapy or radiation.

the nurse is preparing to administer a dose of naloxone intravenously to a client with an opioid overdose. Which supportive medical equipment should the nurse plan to have at the client's bedside if needed? 1. nasogastric tube 2. paracentesis tray 3. resuscitation equipment 4. central line insertion tray.

Resuscitation equipment the nurse administering naloxone for suspected opioid overdose should have the resuscitation equipment readily available to support naloxone therapy if needed.

Salicylic acid is prescribed for a client whit a diagnosis of psoriasis. The nurse monitors the client, knowing that which finding indicates the presence of systemic Toxicity from this medication? 1. Tinnitus 2. Diarrhea 3. Constipation 4. Decreased respirations

Tinnitus Rationale: salicylic acid is absorbed readily through the skin, and systemic toxicity can result period symptoms include tinnitus, dizziness, hyperpnea comma and psychological disturbances period constipation and diarrhea are not associated with salicylism.

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase (Elspar), an antineoplastic agent. The nurse contacts the health care provider before administering the medication if which disorder is documented in the client's history? a) Pancreatitis b) Diabetes mellitus c) Myocardial infarction d) Chronic obstructive pulmonary disease

a) Pancreatitis Rationale: Asparaginase (Elspar) is contraindicated if hypersensitivity exists, in pancreatitis, or if the client has a history of pancreatitis. The medication impairs pancreatic function and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administrations. The client needs to be monitored for signs of pancreatitis, which include nausea, vomiting, and abdominal pain. The conditions noted in options 2, 3, and 4 are not contraindicated with this medication.

The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has slowed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. a) Stop the infusion. b) Notify the health care provider (HCP). c) Prepare to apply ice or heat to the site. d) Restart the IV at a distal part of the same vein. e) Prepare to administer a prescribed antidote into the site. f) Increase the flow rate of the solution to flush the skin and subcutaneous tissue.

a) Stop the infusion. b) Notify the health care provider (HCP). c) Prepare to apply ice or heat to the site. e) Prepare to administer a prescribed antidote into the site. Rationale: Redness and swelling and a slowed infusion indicate signs of extravasation. If the nurse suspects extravasation during the intravenous administration of an antineoplastic medication, the infusion is stopped and the HCP is notified. Ice or heat may be prescribed for application to the site and an antidote may be prescribed to be administered into the site. Increasing the flow rate can increase damage to the tissues. Restarting an IV in the same vein can increase damage to the site and vein.

Tamoxifen Citrate is prescribed for a client with Metastatic breast Cancer. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? a. The medication can only be used to treat Breast cancer b. Yes, your family can take this medication for bladder cancer as well c. This medication can be taken to prevent and treat breast cancer d. This medication can be taken by anyone with cancer as long as their health care provider approves it

a. This medication can be taken to prevent and treat breast cancer Rationale: Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. Tamoxifen is used to treat metastatic breast carcinoma in women and men. Tamoxifen is also effective in delaying the recurrence of cancer following mastectomy and preventing breast cancer in those that are high risk.

A client with metastatic breast cancer is receiving tamoxifen. The nurse specifically monitors which laboratory value while the client is taking this medication? a) Glucose level b) Calcium level c) Potassium level d) Prothrombin time

b) Calcium level Rationale: Tamoxifen may increase calcium, cholesterol, and triglyceride levels. Before the initiation of therapy, a complete blood count, platelet count, and serum calcium level should be assessed. These blood levels, along with cholesterol and triglyceride levels, should be monitored periodically during therapy. The nurse should assess for hypercalcemia while the client is taking this medication. Signs of hypercalcemia include increased urine volume, excessive thirst, nausea, vomiting, constipation, hypotonicity of muscles, and deep bone and flank pain.

The nurse is providing medication instructions to a client with breast cancer who is receiving cyclophosphamide. The nurse should tell the client to take which action? a) Take the medication with food. b) Increase fluid intake to 2000 to 3000 mL daily. c) Decrease sodium intake while taking the medication. d) Increase potassium intake while taking the medication.

b) Increase fluid intake to 2000 to 3000 mL daily. Rationale: Hemorrhagic cystitis is an adverse effect that can occur with the use of cyclophosphamide. The client needs to be instructed to drink copious amounts of fluid during the administration of this medication. Clients also should monitor urine output for hematuria. The medication should be taken on an empty stomach, unless gastrointestinal upset occurs. Hyperkalemia can result from the use of the medication; therefore, the client would not be told to increase potassium intake. The client would not be instructed to alter sodium intake.

A client with acute myelocytic leukemia is being treated with busulfan (Myleran, Busulfex). Which laboratory value would the nurse specifically monitor during treatment with this medication? a) Clotting time b) Uric acid level c) Potassium level d) Blood glucose level

b) Uric acid level Rationale: Busulfan (Myleran, Busulfex) can cause an increase in the uric acid level. Hyperuricemia can produce uric acid nephropathy, renal stones, and acute kidney injury. Options 1, 3, and 4 are not specifically related to this medication.

A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? a) "You can take aspirin (acetylsalicylic acid) as needed for headache." b) "You can drink beverages containing alcohol in moderate amounts each evening." c) "You need to consult with the health care provider (HCP) before receiving immunizations." d) "It is fine to receive a flu vaccine at the local health fair without HCP approval because the flu is so contagious."

c) "You need to consult with the health care provider (HCP) before receiving immunizations." Rationale: Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without an HCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.

The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? a) A clotting time of 10 minutes b) An ammonia level of 20 mcg/dL c) A platelet count of 50,000 cells/mm3 d) A white blood cell count of 5000 cells/mm3

c) A platelet count of 50,000 cells/mm3 Rationale: Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000 cells/mmc) When the platelet count decreases, the client is at risk for bleeding. The normal white blood cell count is 4500 to 11,000 cells/mmc) When the white blood cell count drops, neutropenic precautions need to be implemented. The normal clotting time is 8 to 15 minutes. The normal ammonia value is 10 to 80 mcg/dL.

The nurse is analyzing the laboratory results of a client with leukemia who has received a regimen of chemotherapy. Which laboratory value would the nurse specifically note as a result of the massive cell destruction that occurred from the chemotherapy? a) Anemia b) Decreased platelets c) Increased uric acid level d) Decreased leukocyte count

c) Increased uric acid level Rationale: Hyperuricemia is especially common following treatment for leukemias and lymphomas because chemotherapy results in massive cell kill. Although options 1, 2, and 4 also may be noted, an increased uric acid level is related specifically to cell destruction.

Megestrol acetate (Megace), an antineoplastic medication, is prescribed for a client with metastatic endometrial carcinoma. The nurse reviews the client's history and should contact the health care provider if which diagnosis is documented in the client's history? a) Gout b) Asthma c) Venous Thromboembolism d) Myocardial infarction

c) Venous Thromboembolism Rationale: Megestrol acetate (Megace) suppresses the release of luteinizing hormone from the anterior pituitary by inhibiting pituitary function and regressing tumor size. Megestrol is used with caution if the client has a history of venous thromboembolism. Options 1, 2, and 4 are not contraindications for this medication.

A client with non-Hodgkin's lymphoma is receiving daunorubicin (DaunoXome). Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? a) Fever b) Sores in the mouth and throat c) Complaints of nausea and vomiting d) Crackles on auscultation of the lungs

d) Crackles on auscultation of the lungs Rationale: Cardiotoxicity noted by abnormal electrocardiographic findings or cardiomyopathy manifested as heart failure (lung crackles) is an adverse effect of daunorubicin. Bone marrow depression is also an adverse effect. Fever is a frequent side effect and sores in the mouth and throat can occur occasionally. Nausea and vomiting is a frequent side effect associated with the medication that begins a few hours after administration and lasts 24 to 48 hours. Options 1, 2, and 3 are not adverse effects.

Chemotherapy dosage is frequently based on total body surface area (BSA), so it is important for the nurse to perform which assessment before administering chemotherapy? a) Measure the client's abdominal girth. b) Calculate the client's body mass index. c) Ask the client about his or her weight and height. d) Measure the client's current weight and height.

d) Measure the client's current weight and height. Rationale: To ensure that the client receives optimal doses of chemotherapy, dosing is usually based on the total body surface area (BSA), which requires a current accurate height and weight for BSA calculation (before each medication administration). Asking the client about his or her height and weight may lead to inaccuracies in determining a true BSA and dosage. Calculating body mass index and measuring abdominal girth will not provide the data needed.

A client with small cell lung cancer is being treated with etoposide (Toposar). The nurse monitors the client during administration, knowing that which adverse effect is specifically associated with this medication? a) Alopecia b) Chest pain c) Pulmonary fibrosis d) Orthostatic hypotension

d) Orthostatic hypotension Rationale: An adverse effect specific to etoposide is orthostatic hypotension. Etoposide should be administered slowly over 30 to 60 minutes to avoid hypotension. The client's blood pressure is monitored during the infusion. Hair loss occurs with nearly all the antineoplastic medications. Chest pain and pulmonary fibrosis are unrelated to this medication.

A client with ovarian cancer is being treated with vincristine (Vincasar). The nurse monitors the client, knowing that which manifestation indicates an adverse effect specific to this medication? a) Diarrhea b) Hair loss c) Chest pain d) Peripheral neuropathy

d) Peripheral neuropathy Rationale: An adverse effect specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. Depression of the Achilles tendon reflex may be the first clinical sign indicating peripheral neuropathy. Constipation rather than diarrhea is most likely to occur with this medication, although diarrhea may occur occasionally. Hair loss occurs with nearly all the antineoplastic medications. Chest pain is unrelated to this medication.

A client with squamous cell carcinoma of the larynx is receiving bleomycin intravenously. The nurse caring for the client anticipates that which diagnostic study will be prescribed? a) Echocardiography b) Electrocardiography c) Cervical radiography d) Pulmonary function studies

d) Pulmonary function studies Rationale: Bleomycin is an antineoplastic medication that can cause interstitial pneumonitis, which can progress to pulmonary fibrosis. Pulmonary function studies along with hematological, hepatic, and renal function tests need to be monitored. The nurse needs to monitor lung sounds for dyspnea and crackles, which indicate pulmonary toxicity. The medication needs to be discontinued immediately if pulmonary toxicity occurs. Options 1, 2, and 3 are unrelated to the specific use of this medication.

A client receiving thrombolytic therapy with a continuous infusion of alteplase suddenly becomes extremely anxious and complains of itching; The nurse hears stridor and notes generalized urticaria and hypotension. Which interventions should the nurse anticipate Select all that apply. 1. Stop the infusion 2. Raise the head of the bed 3. Administer protamine sulfate 4. Administer diphenhydramine 5. Call for the rapid response team (RRT)

stop the infusion, administer diphenhydramine and call for rapid response team. Rationale- the client is experiencing an anaphylactic reaction, therefor, the priority action is to the stop the infusion and notify the RRT. The client may be treated with antihistamines. Raising the head of the bed would not be helpful, as that may exacerbate the hypotension. Protamine sulfate is the antidote for heparin, so it is not helpful for a client receiving alteplase.