Archer Pharmacology

While reviewing the client's medication list, the nurse understands which of the following prescribed medication (s) is/ are classified as channel blocker (s)? Select all that apply. A. Nifedipine B. Propranolol C. Verapamil D. Hydralazine

A. Nifedipine C. Verapamil

The nurse is teaching a client about newly prescribed insulin glargine. The nurse recognizes the need for further instruction when the client makes the following statement? Select all that apply. A. "I will take this insulin right before my meals." B. "I should roll this vial of insulin before removing it with the syringe." C. "This insulin will help control my glucose for 24 hours." D. "I can only inject this insulin into my abdomen." E. "I'm glad to know I can mix this with my regular insulin."

A, B, D, E Insulin glargine is a long-acting insulin that provides basal control of a client's glucose. This insulin is given daily and does not have to be given with meals. It is highly unlikely that the client would develop hypoglycemia from this insulin because it has no peak effect. Thus, it is usually safe to be given to a client who is a nothing-by-mouth (NPO) status.

Which of the following drugs is associated with photosensitivity? Select all that apply. A. Ciprofloxacin B. Sulfonamide C. Norfloxacin D. Sulfamethoxazole and Trimethoprim E. Isotretinoin F. Nitro-Dur patch

A,B,C,D,E Photosensitivity is an extreme sensitivity to ultraviolet rays from the sun and other light sources. A type of photosensitivity called phototoxic reactions are caused when medications in the body interact with UV rays from the sun. Anti-biotics are the most common cause of this type of response.

If reported by the patient, which of the following symptoms is expected with the administration of Cisplatin to a patient on the oncology unit? Select all that apply. I A. Lower backache B. Nausea C. Alopecia D. Numbness in hands and feet E. Vision changes F. Diarrhea

A,B,C,E,F A and E: could be signs of dehydration. B and F: are signs of GI upset. C: Alopecia is a possible side effect that is temporary. Cisplatin is an antineoplastic medication used to treat cancers of the testicles, ovaries, or bladder. Cisplatin is available in generic form. Common side effects of Cisplatin include: Nausea and vomiting (may be severe) Diarrhea Temporary hair loss Loss of inability to taste food Hiccups Dry mouth Dark urine Decreased sweating Dry skin and other signs of dehydration

Which of the following should the nurse include in the education provided to a patient who is taking lisinopril? Select All That Apply. A. "It may take several months for your blood pressure to return to normal." B. "You must have your potassium monitored from time to time." C. "This medication may change your vision at times." D. "You may notice a change in your sensation of taste."

A,B,D Angiotensin-converting enzyme (ACE) inhibitors reduce the afterload on the heart and lower blood pressure. They are drugs of choice in the treatment of heart failure. ACE inhibitors have been shown to slow heart failure progression and reduce deaths from heart disease. The first action of ACE inhibitors is to lower blood pressure and reduce blood volume. A: Lisinopril may require 2-3 weeks of adjustment to reach maximum effectiveness, and several months of therapy may be needed for a patient's functional status to return to normal. B: High potassium levels may occur during therapy. The use of potassium supplements or potassium-sparing diuretics should be avoided. Electrolyte levels should be monitored periodically. D: Other side effects associated with lisinopril include cough, taste disturbances, and hypotension.

The nurse is reinforcing medication teaching to a client prescribed sucralfate. Which of the following statements, if made by the client, would require further teaching? Select all that apply. A. "I should take this medication one hour after meals." B. "I will remain upright for 30 minutes after taking this medicine." C. "This medication will help with my peptic ulcer disease." D. "I know this medication works when my nausea and vomiting are gone." E. "I may dissolve this medication in warm water."

A,B,D ✓ Sucralfate is a gastric fortifier intended to help with peptic ulcer disease. ✓ This medication should be taken one hour before meals and at bedtime. ✓ This medication allows the client to eat their meal without the pain of the ulcer. ✓ Constipation is the most common side-effect associated with this medication.

The licensed practical/vocational nurse (LPN/VN) reinforces teaching to a client newly prescribed methotrexate (MTX). Which of the following statements should the nurse include? Select all that apply. A. "This medication may cause you to bruise more easily." B. "You will need to take folic acid with this medication." C. "You will need to remain upright for thirty minutes after taking a dose." D. "This medication may cause your gums to get enlarged." E. "Avoid large crowds and wash your hands frequently."

A,B,E ✓ MTX is a medication approved for the treatment of a variety of conditions, including Rheumatoid Arthritis. ✓ This medication may also be prescribed for clients with ectopic pregnancy (EP) that has not ruptured. ✓ An array of adverse effects may occur at low- and high doses. These include blood dyscrasias, stomatitis, and pulmonary toxicity.

A nurse is reviewing prescriptions for assigned clients. Which prescriptions require follow-up with the primary healthcare provider? A client with Select all that apply. A. congestive heart failure prescribed diltiazem. B. hypertension prescribed clonidine. C. diabetes insipidus prescribed hydrocortisone. D. pulmonary emboli prescribed clopidogrel. E. atrial fibrillation prescribed amiodarone. F. bacterial cystitis prescribed valacyclovir.

A,C,D,F A client with congestive heart failure should not be prescribed calcium channel blockers because of their negative inotropic effects, worsening heart failure. Further, hydrocortisone would be indicated to treat adrenal insufficiency, whereas vasopressin would be used for diabetes insipidus. Additionally, clopidogrel is an antiplatelet medication used to prevent stroke, where a client with a pulmonary embolism requires anticoagulants or thrombolytics. Finally, antibiotics such as ceftriaxone are indicated for bacterial cystitis, not antivirals such as valacyclovir. Choices B and E are incorrect. Clonidine is an antihypertensive used to treat hypertension and psychiatric conditions such as attention deficit hyperactivity disorder. Finally, amiodarone is a drug that may be used for atrial fibrillation.

The nurse has provided medication instructions to a client who has been prescribed venlafaxine. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching? Select all that apply. A. "I may not notice an improvement in my mood right away." B. "This medication may lower my blood pressure." C. "If I have thoughts of harming myself, I should call 911." D. "I will need to have weekly laboratory tests." E. "I may continue taking St. John's Wort."

A. "I may not notice an improvement in my mood right away." C. "If I have thoughts of harming myself, I should call 911." Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI). This medication is used to treat depression and anxiety. Like most serotonergic drugs, the patient may not experience an effect for two to four weeks. If no effect is achieved by six weeks, the prescriber may change the medication. Venlafaxine may increase thoughts of suicidal ideation, and the patient should be educated to seek help if these thoughts should occur.

The licensed practical/vocational nurse (LPN/VN) has reinforced medication instructions to a client who has been prescribed a fentanyl transdermal patch. Which of the following statements, if made by the client, would indicate a correct understanding of the instructions? Select all that apply. A. "I may still need pain medication while this patch is applied." B. "If the patch comes loose, I may reinforce it with a piece of tape." C. "I can apply heat to the patch site to increase the pain relief." D. "I should remove this patch while I am sleeping." E. "The patch will need to be changed every 72 hours."

A. "I may still need pain medication while this patch is applied." B. "If the patch comes loose, I may reinforce it with a piece of tape." E. "The patch will need to be changed every 72 hours." ✓ Fentanyl is an opioid that can be delivered in various preparations (intravenous, transdermal, buccal). ✓ The transdermal patch effectively provides a patient with continuous pain control for 72 hours. ✓ This medication will take 24 hours to reach its peak effect, and the nurse should anticipate the patient to experience breakthrough pain. ✓ Fentanyl patches should be applied to a clean area with minimal hair. Hair may be clipped but not shaven to ensure appropriate adhesion to the skin.

The nurse is reinforcing teaching to a client about newly prescribed doxycycline. Which of the following statements, if made by the client, would require follow-up? Select all that apply. A. "I should take this medication with milk or cheese." B. "If I develop foul-smelling diarrhea I should contact my doctor." C. "I need to wear sunscreen outdoors while taking this medication." D. "I can stop this medication when I feel better." E. "I should take this medication on an empty stomach."

A. "I should take this medication with milk or cheese." D. "I can stop this medication when I feel better." ➢ Premature discontinuation of antibiotics leads to therapeutic failure. Therefore, all antibiotics must be continued for the entire course, not when the symptoms abate. ➢ Doxycycline absorption may decrease when the client takes it with calcium. ➢ The client should be instructed not to take this medication with calcium-rich foods, dairy products, or antacids containing calcium. The client should take this medication on an empty stomach.

The nurse has reinforced medication instruction to a client who has been prescribed enalapril. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching? A. "I will notify my prescriber if I develop swelling of the face." B. "I will need to weigh myself every day while taking this medication." C. "I should eat foods high in potassium while I am taking this medication." D. "I will need lab work done every so often to evaluate my liver function."

A. "I will notify my prescriber if I develop swelling of the face." ACE inhibitors are central in the treatment of heart failure and hypertension. These medications inhibit the deleterious effects associated with angiotensin II. Medications in this class include lisinopril, enalapril, and captopril. The most serious adverse effect is angioedema. A nagging, dry cough is a common side-effect associated with this medication, and if this should occur, a prescriber may switch the patient to an angiotensin renin blocker (ARB) such as valsartan. Finally, these drugs may raise potassium and creatinine.

Which of the following should the nurse include in the education provided to a patient who is taking lisinopril? Select all that apply. A. "It may take several months for your blood pressure to return to normal." B. "You must have your potassium monitored from time to time." C. "This medication may change your vision at times." D. "You may notice a change in your sensation of taste."

A. "It may take several months for your blood pressure to return to normal." B. "You must have your potassium monitored from time to time." D. "You may notice a change in your sensation of taste." A: Lisinopril may require 2-3 weeks of adjustment to reach maximum effectiveness. Several months of therapy may be needed for a patient's functional status to return to normal. B: High potassium levels may occur during therapy. The use of potassium supplements or potassium-sparing diuretics should be avoided. Electrolyte levels should be monitored periodically. D: Other side effects associated with lisinopril include cough, taste disturbances, and hypotension.

The nurse has provided medication instruction to a patient who has been prescribed metformin. Which of the following statements, if made by the patient, would indicate a correct understanding of the teaching? A. "This medication may cause me to have bloating or loose stools." B. "I will need to check my blood glucose prior to taking this medication." C. "If I eat fewer carbohydrates in a day, I should skip a dose." D. "The goal of this medication is to increase my hemoglobin A1C."

A. "This medication may cause me to have bloating or loose stools." The most common side-effect associated with Metformin is gastrointestinal upset. This side-effect typically occurs at the start of the therapy and subsides over time. To minimize these effects, the patient should take this medication with meals.

What would the nurse expect to administer to a client who presents to the emergency department with a toxic acetaminophen level? A. Acetylcysteine B. Deferoxamine mesylate C. Succimer D. Flumazenil

A. Acetylcysteine

The nurse reviews prescriptions for assigned clients. Which prescription should the nurse clarify with the primary healthcare provider (PHCP)? A. Albuterol via nebulizer for a patient with hypokalemia. B. Clozapine for a patient with severe schizophrenia. C. Lisinopril for a patient with congestive heart failure. D. Verapamil for a patient with migraine headaches.

A. Albuterol via nebulizer for a patient with hypokalemia. lbuterol is a bronchodilator that is used for asthma exacerbations. Adversely, this medication may lower serum potassium levels. The nurse should question this order as this medication may decrease the potassium further. ✓ Albuterol is a short-acting bronchodilator. Common side effects of albuterol include tremors, tachycardia, palpitations, and metabolic disturbances such as hypokalemia and hyperglycemia. ✓ This medication is emergently indicated for asthma exacerbations.

When instructing a client on medications, which of the following medications would the nurse indicate are used to treat panic disorders? Select all that apply. A. Amitriptyline B. Amobarbital C. Diazepam D. Phenelzine

A. Amitriptyline C. Diazepam D. Phenelzine Panic disorder is a category of anxiety disorder. It is characterized by intense feelings of immediate apprehension, fearfulness, terror, or impending doom. It is accompanied by increased autonomic nervous system activity. Panic attacks usually last less than 10 minutes. However, many patients may describe them as seemingly endless. Choices A, C, and D are correct. Amitriptyline is an antidepressant that is also used to treat panic disorder. Diazepam is a benzodiazepine that is used to treat anxiety, insomnia, and panic. Phenelzine is an MAOI that is used to treat social anxiety, depression, and panic disorder. Choice B is incorrect. Amobarbital is a barbiturate that is used for sedation and to treat insomnia.

A patient with a crush injury to her left arm calls the nurse's station and requests pain medication. An hour after administration, the patient is still complaining of intense pain. What is the next nursing action? A. Ask the patient to describe the pain in quality and intensity. B. Offer the patient a distraction, such as a book or television. C. Tell the patient she can have more medication in three hours. D. Tell the patient crush injury victims should expect intense pain.

A. Ask the patient to describe the pain in quality and intensity.

The LPN is caring for a client with the following clinical data. Which medication would the LPN clarify with the primary healthcare provider (PHCP) prior to administration based on the vital signs? See the exhibit. View Exhibit: HR 54, BP 10/65, R 16, T 99.5, O2 96% A. Atenolol 50 mg PO Daily B. Simvastatin 40 mg PO Daily C. Albuterol 2.5 mg via nebulizer Daily D. Spironolactone 25 mg PO Daily

A. Atenolol 50 mg PO Daily Atenolol is a beta-blocker that may adversely cause hypotension and/or bradycardia. The nurse should assess blood pressure and pulse before administration. If the pulse is below sixty, and notwithstanding any other parameters outlined by the PHCP, the nurse should clarify the order. This is the same with blood pressure. If the systolic blood pressure is less than 90 mmHg, and no other parameters are defined, the nurse should clarify the prescription.

The nurse is caring for a client with the following clinical data. Based on the vital signs, which medications would the nurse clarify with the primary healthcare provider (PHCP) before administration? See the exhibit. Select all that apply. View Exhibit: P 61, BP 90/60, R 16, T 99.1, O2 95% A. Atenolol 50 mg PO Daily B. Spironolactone 50 mg PO Daily C. Albuterol 2.5 mg via nebulizer Daily D. Fentanyl 50 mcg IV Push q 6 hours PRN Pain E. Modafinil 100 mg PO Daily

A. Atenolol 50 mg PO Daily B. Spironolactone 50 mg PO Daily D. Fentanyl 50 mcg IV Push q 6 hours PRN Pain Atenolol is a beta-blocker that lowers blood pressure and heart rate. The nurse should assess both before administration. Spironolactone is a potassium-sparing diuretic. This medication decreases fluid volume, therefore, reducing blood pressure. Fentanyl is an opioid and causes vasodilation, therefore, lowering blood pressure. The nurse should monitor the client's blood pressure and respiratory rate before and after administration.

Patients with which of the following medical history would be safe to take warfarin? Select all that apply. Correct Answer(s): A,C,D A. Atrial fibrillation B. Hemorrhagic stroke C. Thrombolytic stroke D. Mitral valve replacement

A. Atrial fibrillation C. Thrombolytic stroke D. Mitral valve replacement Anticoagulants, such as warfarin, are drugs that increase clotting time to prevent thrombi from forming or growing larger. Since the thromboembolic disease can be life-threatening, therapy is often begun by administering anticoagulants intravenously or subcutaneously. As the condition stabilizes, the patient is switched to oral anticoagulants. Choice B is incorrect.History of hemorrhagic stroke is a contraindication for taking warfarin.

When providing instructions about the use of an MAO inhibitor to a patient with clinical depression, the nurse should instruct the client to: A. Avoid chocolate and cheese B. Take frequent naps C. Take the medication with milk D. Avoid walking without assistance

A. Avoid chocolate and cheese

This nurse is caring for a client who is receiving prescribed hydralazine. Which of the following findings would indicate a therapeutic response? A. Blood pressure 130/70 mm Hg B. Pulse (P) 67/minute C. Total cholesterol 185 mg/dL D. aPTT 45 seconds

A. Blood pressure 130/70 mm Hg

A patient who is taking Lasix knows that he should increase the intake of what food? A. Cantaloupe B. Iceberg lettuce C. Plums D. Apples

A. Cantaloupe

The nurse is caring for a client newly diagnosed with mastitis. The nurse anticipates a prescription for which medication? A. Cephalexin B. Acyclovir C. Fluconazole D. Imiquimod

A. Cephalexin Mastitis is often caused by Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), E. coli, and streptococci. The bacteria are most often carried on the skin of the mother or in the mouth or the nose of the newborn. The organism enters through an injured area on the nipple, such as a crack or blister. The primary medical treatment is antibiotics and continued emptying of the breast. Comfort measures during mastitis include applying moist heat or ice packs, breast support, bed rest, fluids, and analgesics. Acyclovir is an antiviral and not indicated in the treatment of mastitis. Fluconazole is an antifungal. Imiquimod is indicated in the treatment of genital warts and certain skin cancers.

The nurse receives a prescription from the primary healthcare provider (PHCP) for metoprolol 5 mL intravenous (IV) push x 1 dose. The nurse should take which priority action before administering the medication? A. Clarify the prescription with the primary healthcare provider (PHCP) B. Assess vital signs C. Obtain a 5 mL syringe D. Assess the client's allergies

A. Clarify the prescription with the primary healthcare provider (PHCP) This prescription is inaccurate and requires clarification with the PHCP before moving forward. This medication was prescribed as a volume of 5 mL, not the precise dosage amount to be administered (for example, it is okay to be prescribed 5 mg of metoprolol, not 5 mL). The nurse needs an accurate prescription that is complete before executing other steps in the medication administration process.

Which of the following statements are true regarding the pathophysiology of beta-blockers? A. Decrease blood pressure B. Decrease the workload of the heart C. Increase contractility D. Increase cardiac output

A. Decrease blood pressure B. Decrease the workload of the heart A is correct. Beta-blockers decrease blood pressure by causing vasodilation of the vessels. They block the receptor sites for catecholamines, so they cannot do their job, which is vasoconstriction. B is correct. Beta-blockers decrease the workload of the heart. Vasodilation subsequently decreases the blood pressure and then afterload. Remember, afterload is the pressure against which the left ventricle must pump. With decreased blood pressure, we reduce afterload. With reduced afterload, the left ventricle does not have to work as hard to pump blood to the body. So, beta-blockers decrease the workload of the heart.

The nurse is caring for a client who is receiving prescribed ketorolac. Which of the following findings would indicate a therapeutic response? Select all that apply. A. Decreased pain B. Increased urinary output C. Decreased blood pressure D. Decreased temperature E. Increased muscle coordination

A. Decreased pain E. Increased muscle coordination ✓ Ketorolac is an anti-inflammatory drug that may be administered parenterally (IM/IV). This is helpful if a client is experiencing pain and vomiting and the oral route is not feasible. ✓ This medication is efficacious for pain or pyrexia. ✓ This medication is nephrotoxic; therefore, renal monitoring function (creatinine) is essential while this medication is being taken.

The nurse is caring for a client diagnosed with atrial fibrillation. The nurse should anticipate a prescription for which of the following medications? A. Diltiazem B. Nitroglycerin C. Clonidine D. Atorvastatin E. Warfarin

A. Diltiazem E. Warfarin The primary goal for a patient with atrial fibrillation is to maintain rate control (60-100). Medications such as diltiazem, digoxin, amiodarone, and dronedarone may be utilized. Anticoagulants are also indicated as ischemic strokes are commonly associated with atrial fibrillation. This medication assists in maintaining rate control. While not always indicated, an anticoagulant such as warfarin or rivaroxaban is used in the management of atrial fibrillation as this arrhythmia puts the patient at high risk for a stroke. ✓ Hydralazine is primarily an arteriolar vasodilation. ✓ The nurse should take the client's blood pressure before administering this medication. ✓ The client is at risk for falls with this medication related to orthostatic hypotension. ✓ Hydralazine toxicity or overdose produces hypotension, tachycardia, headache, and generalized skin flushing. ✓ Reflex tachycardia may occur with this medication because as the blood pressure declines, the heart rate will increase to maintain cardiac output.

The client using over-the-counter nasal decongestant drops reports unrelieved and worsening nasal congestion. What is the appropriate instruction for this client? A. Discontinue the medication for several days. B. Use a combination of oral medications and drops for better results. C. Switch to a stronger dose of the decongestant drops. D. Increase the frequency of the nasal decongestant drops.

A. Discontinue the medication for several days. When nasal decongestants are used for longer than 5 days, instead of the nasal membranes constricting, vasodilation occurs, causing an increased stuffy nose and nasal congestion. The nurse should emphasize the importance of limiting the use of nasal sprays and drops.

Common side effects of antidysrhythmic medications include: A. Dizziness, hypotension, and weakness B. Headache, hypertension, and fatigue C. Weakness, fatigue, and hypertension D. Anorexia, diarrhea, and hypertension

A. Dizziness, hypotension, and weakness Hypotension may occur when patients are given antidysrhythmics. Hypotension may result in the patient feeling dizzy or weak. Dysrhythmias are abnormalities of electrical conduction in the heart. They encompass several different disorders that range from harmless to life-threatening. They are classified by their location and the type of rhythm abnormality that they produce. Antidysrhythmic drugs are separated into four primary classes and a diverse group, including: Sodium channel blockers Beta-adrenergic blockers Potassium channel blockers Calcium channel blockers Miscellaneous antidysrhythmic drugs

The nurse is caring for a client diagnosed with Lyme disease. The nurse anticipates the primary healthcare provider (PHCP) prescribe which medication? A. Doxycycline B. Enalapril C. Simvastatin D. Famotidine

A. Doxycycline Doxycycline is an effective treatment for Lyme disease. Lyme disease is an infectious disease caused by the Borrelia bacterium, spread by ticks. The most common sign of infection is an expanding area of redness on the skin, known as erythema migrans, that appears at the tick bite site about a week after it occurred. The rash is typically neither itchy nor painful. The rash is classically referred to as a bullseye rash.

The nurse is preparing to administer a scheduled intramuscular injection to an apprehensive child. Which therapeutic action should the nurse take? A. Draw a "magic circle" on the area before the injection. B. Have another nurse hold down the child. C. Apply EMLA cream to the area immediately before the injection. D. Administer the medication right after the child's nap.

A. Draw a "magic circle" on the area before the injection.

The nurse is caring for a postoperative client at risk for venous thromboembolism (VTE). The nurse should that the primary healthcare provider (PHCP) will prescribe which medication? A. Enoxaparin B. Verapamil C. Tranexamic acid D. Ropinirole

A. Enoxaparin

The nurse is caring for a client who is receiving prescribed quetiapine. Which of the following findings would indicate the client is having an adverse effect? Select all that apply. A. Fever B. Drowsiness C. Stooped posture D. Shuffling gait E. Increased appetite

A. Fever C. Stooped posture D. Shuffling gait

The licensed practical/vocational nurse (LPN/VN) reviews medication antidotes. It would be appropriate for the nurse to identify the antidote for lorazepam toxicity is which medication? A. Flumazenil B. Phenylephrine C. Epinephrine D. Naloxone

A. Flumazenil Flumazenil is the antidote for benzodiazepine overdose. Lorazepam is a benzodiazepine, so the nurse expects to administer this medication to the client. Choices B, C, and D are incorrect. Phenylephrine is a decongestant used to treat stuffy nose and sinus congestion caused by the common cold, hay fever, or other allergies. There is no indication to give this medication in the case of a benzodiazepine overdose. Epinephrine is a catecholamine that increases heart rate and blood pressure. There is no indication to give epinephrine in a benzodiazepine overdose. Naloxone is the antidote for opioid overdose. Naloxone would be used in the overdose of morphine, fentanyl, oxycodone, or other opioid medications.

The nurse is caring for a client diagnosed with trichotillomania. The nurse anticipates a prescription for which medication from the primary healthcare provider (PHCP)? A. Fluoxetine B. Amphetamine C. Haloperidol D. Bupropion

A. Fluoxetine Trichotillomania is a syndrome that causes a client to engage in hair-pulling. This disorder is categorized as an obsessive-compulsive disorder. Common sites for hair pulling include the eyebrows, scalp hair, and chin. Selective serotonin reuptake inhibitors (SSRIs) combined with psychotherapy are effective treatments for this disorder. Medications that may be used include fluoxetine, citalopram, or paroxetine.

The nurse is caring for a client newly diagnosed with heart failure. Which of the following medications would the nurse anticipate to be prescribed? Select all that apply. A. Furosemide B. Lisinopril C. Diltiazem D. Naproxen E. Prednisone

A. Furosemide B. Lisinopril Heart failure requires extensive client education that focuses on the prescribed medications, low salt diet restrictions, and the encouragement of aerobic exercise. Medications commonly used in heart failure include diuretics, low-dose beta-blockers, ACE inhibitors, and nitrates. Calcium channel blockers are contraindicated because of their effect on further decreasing the ejection fraction (EF). NSAIDs such be avoided because they decrease renal blood flow that may cause fluid retention. Acetaminophen is preferred.

The nurse is caring for a client exhibiting signs of poor muscle coordination, stooped posture, and slow movements. Which medication is most likely to cause these symptoms? A. Haloperidol B. Nifedipine C. Venlafaxine D. Prazosin

A. Haloperidol Haloperidol is a typical antipsychotic which may adversely cause extrapyramidal side effects (EPS). These effects include akathisia, dystonia, pseudo parkinsonism, and/or tardive dyskinesia. Choices B, C, and D are incorrect. Nifedipine is a calcium channel blocker indicated for the treatment of hypertension. It also may be used as a tocolytic to mitigate preterm labor. Venlafaxine is a serotonergic drug used in the management of depressive and anxiety disorders. Prazosin is indicated for the treatment of hypertension as well as PTSD. Additional information: EPS is a concern when a patient is taking antipsychotic medication. The highest risk is associated with typical antipsychotics (haloperidol, fluphenazine, etc.) compared to atypical antipsychotics. The nurse must assess the patient for any abnormal movements during the therapy.

The nurse reviews the laboratory changes associated with loop diuretics. It would be correct for the nurse to state that loop diuretics may cause Select all that apply. A. Hypokalemia B. Hypernatremia C. Hypocalcemia D. Hypercalcemia E. Metabolic acidosis

A. Hypokalemia C. Hypocalcemia Loop diuretics, such as furosemide and bumetanide, cause a large amount of urine to be excreted by acting on the loop of Henle. Due to the large volume of urine lost, there is also a significant amount of electrolyte loss. Two of these are potassium and calcium. This causes the side effects of hypokalemia and hypocalcemia. Loop diuretics, such as furosemide and bumetanide, cause a large amount of urine to be excreted by acting on the loop of Henle. Due to the large volume of urine lost, there is also a significant amount of electrolyte loss. Two of these are potassium and calcium. This causes the side effects of hypokalemia and hypocalcemia.

The nurse is supervising a student nurse administer prescribed medications via a double-lumen nasogastric tube (NGT) with an air vent. Which action by the student requires follow-up? The student A. Irrigates the air vent before medication administration with water B. Contacts the pharmacy to obtain available medications in liquid form C. Flushes the NGT between medications with water D. Administers each medication separately through the NGT

A. Irrigates the air vent before medication administration with water

The nurse is caring for a client who has just been diagnosed with severe acne vulgaris. Which of the following medications should the nurse anticipate the primary health care provider (PHCP) will prescribe? A. Isotretinoin B. Acyclovir C. Ketoconazole D. Ethambutol

A. Isotretinoin

The nurse is caring for a client receiving lorazepam. Which of the following reported herbal supplements would require follow-up? Select all that apply. A. Kava B. Glucosamine C. Valerian D. Garlic E. Saw palmetto

A. Kava C. Valerian Lorazepam is a CNS depressant, and the patient should avoid potentiating the effects of this medication. Herbal products such as kava and valerian are CNS depressant medications that should not be given concurrently while a patient is receiving lorazepam. Lorazepam and one of these medications may cause profound sedation. Choices B, D, and E are incorrect. Glucosamine is an herbal product that may benefit patients with osteoarthritis in the knees, waist, and hips. This medication does not cause CNS depression. Garlic may be taken to assist a patient in reducing their cholesterol and should be avoided if the patient is taking anticoagulants. This medication does not alter the CNS. Saw palmetto may be taken for men who have prostate hyperplasia and do not alter the CNS.

The nurse is caring for a client diagnosed with a myxedema coma. The nurse should anticipate a prescription for which of the following medications? Select all that apply. A. Levothyroxine B. Methimazole C. Tolvaptan D. Vasopressin E. Hydrocortisone

A. Levothyroxine E. Hydrocortisone When a patient experiences a myxedema coma, it is because of severe hypothyroidism. These dangerously low levels of thyroid hormone produce symptoms such as altered level of consciousness, hyponatremia, hypothermia, hypoventilation, and hypoglycemia. Treatment is essential and is geared towards the prompt administration of intravenous levothyroxine and liothyronine. Glucocorticoids are usually added to the treatment to help mitigate the hypotension and potential overlook of adrenal dysfunction.

The nurse is caring for a client who has been prescribed sertraline. The nurse understands that this medication is prescribed for which of the following conditions? Select all that apply. A. Major Depressive Disorder B. Attention Deficit Hyperactivity Disorder C. Obsessive-Compulsive Disorder D. Generalized Anxiety Disorder E. Bipolar Disorder

A. Major Depressive Disorder C. Obsessive-Compulsive Disorder D. Generalized Anxiety Disorder Sertraline is a Selective Serotonin Reuptake Inhibitor (SSRI). This medication is efficacious in depression, anxiety, and obsessive-compulsive disorders. Choices B and E are incorrect. Sertraline is not indicated for bipolar disorder because it may exacerbate the condition. Attention Deficit Hyperactivity Disorder (ADHD) is a condition that is treated with psychostimulants such as amphetamines or methylphenidates. Additional information: Sertraline being serotonergic, requires time to become efficacious. Two to four weeks is usually required for the patient to achieve a response. The nurse should counsel the patient to report worsening of their mood and any suicidal ideations. Gastrointestinal side effects are common with SSRIs and may decrease by taking the medication with food.

Which of the following are correct statements about the proper administration of polyethylene glycol prescribed for constipation? Select all that apply. A. Mix the powder with any beverage that the patient enjoys. B. Administer at the same time every day. C. Administer with meals. D. Dilute the powder with 8 oz of water.

A. Mix the powder with any beverage that the patient enjoys. B. Administer at the same time every day. A is correct. This statement is correct. It is appropriate to mix polyethylene glycol, or Miralax, with any beverage the patient enjoys. Soda and juice are common choices due to their ability to mask the flavor better than water. B is correct. It is preferable to administer polyethylene glycol at the same time every day. This promotes a bowel regimen and routine, which maximizes the success of the medication. It is also useful to help the patient remember to take their medication with a routine established.

The nurse is caring for a client who is receiving prescribed fentanyl. Which findings would indicate the client is experiencing a side effect? Select all that apply. A. Nausea and vomiting B. Constipation C. Pruritus D. Urinary retention E. Nystagmus

A. Nausea and vomiting B. Constipation C. Pruritus D. Urinary retention Fentanyl is an opioid analgesic used to manage acute and chronic pain. Common effects associated with this drug include nausea and vomiting, constipation, pruritus, and urinary retention.

The nurse is caring for a client experiencing labor dystocia. Which medication does the nurse anticipate from the primary healthcare provider (PHCP)? A. Oxytocin B. Terbutaline C. Magnesium sulfate D. Betamethasone

A. Oxytocin Betamethasone is a steroid administered to mothers in preterm labor to help the development of the fetus's lungs in anticipation of preterm delivery. This medication is not indicated for labor dystocia. Labor dystocia describes difficult labor that does not progress as expected. During labor dystocia, uterine contractions are not effective or infrequent. Management of labor dystocia includes Administration of intravenous (IV) or oral fluids to correct any electrolyte imbalances. Frequent maternal position changes. Standing or sitting in a warm shower can be therapeutic. Pain management is important; however, epidural blocks decrease labor progress. Prescriptive treatments such as oxytocin may be used.

The nurse is caring for a patient prescribed enoxaparin. Which laboratory values should the nurse monitor? A. Platelet count B. Activated Partial Thromboplastin Time (aPTT) C. International Normalized Ratio (INR) D. Troponin

A. Platelet count Enoxaparin is a low molecular weight-based heparin, and the platelet count will need to be monitored if the patient should develop heparin-induced thrombocytopenia (HIT). This condition is serious and results in a 50% decrease in the platelet count.

The nurse is precepting a newly hired nurse administer an intramuscular injection to an adult. Which action by the newly hired nurse requires follow-up? A. Prepares to administer the medication in the dorsogluteal. B. Prepares to insert the needle at a 90-degree angle. C. Uses isopropyl alcohol to clean the area prior to injection. D. Washes their hands before and after the procedure.

A. Prepares to administer the medication in the dorsogluteal. This action requires follow-up as the dorsogluteal site is not recommended. The dorsogluteal site is not recommended because of potential damage to nearby nerves and blood vessels.

One of the most serious side effects of selective serotonin reuptake inhibitors (SSRI) is serotonin syndrome. Which of the following signs of serotonin syndrome should the nurse monitor for when a patient begins taking an SSRI? Select all that apply. A. Rapid heartbeat B. Muscle twitches C. Sweating D. Diarrhea

A. Rapid heartbeat B. Muscle twitches A is correct. A rapid heartbeat is a symptom of serotonin syndrome. This patient should seek medical attention right away. B is correct. Muscle twitches or jerking of the muscles is a symptom of serotonin syndrome. This patient should seek medical attention right away.

The nurse cares for a client with a sodium 130 mEq/dl. Which of the following medications may cause this abnormality? Select all that apply. A. Spironolactone B. Hydrochlorothiazide C. Prednisone D. Sodium polystyrene E. Tolvaptan

A. Spironolactone B. Hydrochlorothiazide Spironolactone is a diuretic that retains potassium but causes the loss of water and sodium. Hydrochlorothiazide is a thiazide diuretic that may contribute towards hyponatremia because while it does raise serum calcium levels, it depletes every other electrolyte. Choices C, D, and E are incorrect. Prednisone is a corticosteroid used for inflammatory conditions. This drug causes an increase in aldosterone, which increases sodium and water retention. Sodium polystyrene is used for individuals with hyperkalemia, and its use will not only lower potassium but may also raise sodium. Tolvaptan is a medication used to treat syndrome of inappropriate antidiuretic hormone (SIADH). It depletes the water but not the sodium.

Chemotherapy induces vomiting by: A. Stimulating neuroreceptors in the medulla. B. Inhibiting the release of catecholamines. C. Autonomic instability. D. Irritating the gastric mucosa.

A. Stimulating neuroreceptors in the medulla. Vomiting (emesis) is initiated by a nucleus of cells located in the medulla called the vomiting center. This center coordinates a complex series of events involving pharyngeal, gastrointestinal, and abdominal wall contractions that lead to the expulsion of gastric contents.

Which of the following are appropriate teaching points for a patient with chronic stable angina on sublingual nitroglycerin? Select all that apply. A. Take one tablet every 5 minutes for 3 doses. B. Swallow the entire pill, do not crush or chew. C. Call the healthcare provider if a headache develops. D. Keep the tablets in a dark bottle.

A. Take one tablet every 5 minutes for 3 doses. D. Keep the tablets in a dark bottle. A patient doesn't need to contact their healthcare provider for a headache that develops after taking sublingual nitroglycerin. This medication is a potent vasodilator, causing venous and arterial dilation.

Which of the following is a priority for the nurse to monitor during acute management of a patient with an aspirin overdose? A. The onset of pulmonary edema B. Metabolic alkalosis C. Respiratory alkalosis D. Symptoms that mimic Parkinson's disease

A. The onset of pulmonary edema Aspirin overdose can lead to metabolic acidosis and cause pulmonary edema development. Early symptoms of aspirin poisoning include tinnitus, hyperventilation, vomiting, dehydration, and fever. Late signs include drowsiness, unsteady gait, bizarre behavior, and coma. Abnormal breathing caused by aspirin overdose is usually deep and rapid. Pulmonary edema may be related to an increase in the lung capillaries' permeability, leading to "protein leakage" and transudation of fluid in both renal and pulmonary tissues. The alteration in renal tubule permeability may lead to a change in colloid osmotic pressure, facilitating pulmonary edema.

The nurse is caring for a client who is receiving prescribed enoxaparin. Which of the following findings would indicate the client is having an adverse effect? A. Thrombocytopenia B. Leukocytosis C. Polycythemia D. Neutropenia

A. Thrombocytopenia Thrombocytopenia is an adverse effect associated with this medication. This effect is linked to Heparin-Induced Thrombocytopenia (HIT). This may occur within five to fourteen days of exposure to the drug and may be hastened by exposure to higher-than-normal doses.

The nurse is planning a staff development conference about measures to reduce medication errors. It would be appropriate for the nurse to state which actions may help reduce medication errors? Select all that apply. A. Timely medication reconciliation B. Delay documentation of medication administration to the end of the shift C. Delegate medication transcription to unlicensed assistive personnel (UAP) D. Limit the use of verbal orders to emergent situations E. Place medication dispensing systems in high-traffic areas

A. Timely medication reconciliation E. Place medication dispensing systems in high-traffic areas

The nurse is caring for a client diagnosed with epilepsy. The nurse should anticipate a prescription for which of the following medications? Select all that apply. A. Topiramate B. Risperidone C. Prazosin D. Hydroxyzine E. Lorazepam

A. Topiramate E. Lorazepam Epilepsy is an idiopathic condition that requires maintenance treatment by using anticonvulsants. Topiramate is an anticonvulsant that may be used in the prevention of seizures. Lorazepam is also indicated in epilepsy in the event of a patient experiencing an acute seizure. The topiramate should be used for maintenance purposes, and the lorazepam would be indicated for an acute seizure. Choices B, C, and D are incorrect. Risperidone is indicated for psychotic disorders such as schizophrenia. Prazosin is an antihypertensive that may be used for high blood pressure. This medication also may be indicated for psychiatric illnesses such as PTSD. Hydroxyzine is indicated for anxiety disorders as well as allergic rhinitis.

The nurse is preparing to administer a prescribed medication to a client. The nurse should take which initial action? A. Verify the client's full name and date of birth B. Ask about any medication allergies C. Review the client's vital sign D. Review medications and potential interactions

A. Verify the client's full name and date of birth

Which of the following medication orders for a patient with pulmonary embolism is a priority to clarify with the physician before administration? A. Warfarin 1.0 mg PO B. Morphine Sulfate 2 to 4 mg IV C. Cephalexin 250 mg PO D. Heparin infusion at 900 units/hr

A. Warfarin 1.0 mg PO The trailing zero in this order could be misread/misinterpreted and result in an accidental overdose of medication.

The nurse is caring for a client who is receiving prescribed pregabalin. The client is experiencing the intended effect when they report less A. neuropathic pain. B. cravings for cigarettes. C. binge eating. D. depressive symptoms.

A. neuropathic pain. Pregabalin is indicated for neuropathic pain and disorders causing neuropathic pain, such as fibromyalgia, herpes zoster, and phantom limb pain. This medication's common side effects include dizziness, drowsiness, and respiratory depression when combined with other CNS depressants. Considering the CNS depressant effects of this medication, the nurse should institute fall precautions for the client.

The nurse receives a prescription for sevelamer. The nurse plans on administering this medication A. with the client's meals. B. immediately before hemodialysis. C. with a prescribed proton pump inhibitor (PPI). D. right before the client goes to bed.

A. with the client's meals. Sevelamer is a phosphate binder indicated in the treatment of hyperphosphatemia associated with chronic kidney disease. This medication is purported to decrease serum phosphorus levels by binding to food. Thus, this medication is given with meals. Combined with a low phosphorus diet, the goal of this medication is to decrease serum phosphate levels.

The patient with testicular cancer is receiving IV cisplatin. What should the nurse assess for? A. Irreversible heart failure B. Bone marrow suppression C. Cardiac toxicity D. Peripheral neuropathy

B. Bone marrow suppression Bone marrow suppression is the most significant adverse reaction of this particular class of drugs. Cisplatin is an alkylating agent. Blood cells are susceptible to alkylating agents and bone marrow suppression is the most important adverse effect of this class. Within days after administration, the numbers of red blood cells, white blood cells, and platelets begin to decline.

The nurse is providing education for a diabetic client who is given a terbinafine prescription for onychomycosis. Which statement(s) by the client demonstrates a good understanding regarding treatment with terbinafine? Select all that apply. A. "Following a successful course of treatment, my chance of getting cured is 90%." B. "I will have to take terbinafine for 3 to 6 months." C. "I will need liver function tests before starting terbinafine." D. "I will take this on an empty stomach to help improve its absorption." E. "It may cause taste or vision changes and, I will report vision changes to my doctor." F. "Dark urine, pale stools, and persistent nausea may indicate a serious side effect."

B,C,E,F Onychomycosis, also known as Tinea unguium,is a fungus infection of the nails (fingernails, toenails) that causes the nails to look thick, discolored, opaque, and crumbling.

The nurse is caring for a client who has just been diagnosed with peritonitis. Which of the following medications should the nurse anticipate the primary health care provider (PHCP) will prescribe? A. Pantoprazole B. Ciprofloxacin C. Lactulose D. Loperamide

B. Ciprofloxacin Clinical manifestations of peritonitis include ✓ Rigid, board-like abdomen ✓ Distended abdomen ✓ High fever ✓ Tachycardia ✓ Diffuse abdominal pain that continues to intensify ✓ Decreased bowel sounds and GI motility Pantoprazole is a proton pump inhibitor used to treat esophageal reflux and peptic ulcer disease. Lactulose is indicated in the management of hepatic encephalopathy that reduces the amount of ammonia by having the client stool more often. Loperamide is an antidiarrheal effective in the treatment of diarrhea. None of these medications are directly used in the management of peritonitis.

The LPN is reinforcing discharge instructions to a client regarding his newly initiated digoxin. Which of the following statements by the client indicates that he correctly understood the instructions? Select all that apply. A. "If I note color vision changes, I will call my eye doctor right away." B. "I will check my pulse before each dose and if the pulse is less than 60 bpm, I will hold digoxin and call my doctor." C. "I will increase my calcium intake significantly." D. "I will make sure I get enough potassium in my daily diet." E. "The water pills that I am on may increase the risk of side effects with digoxin." F. "I should avoid medications that have licorice extract."

B,D,E,F Certain electrolyte imbalances such as hypokalemia (< 3.5 mEq/L), hypercalcemia (>10.2 mg/mL), and hypomagnesemia (<1.5 mg/dL) can increase the toxicity. So, patients who are on diuretics concomitantly for heart failure are prone to more side effects because diuretics tend to cause hypokalemia (Choice E). Such patients need to be educated regarding consuming adequate potassium-richdiets (Choice D). Any action that precipitates hypercalcemia should be avoided because high calcium increases toxicity (there is no need to increase calcium intake significantly, Choice C reflects an incorrect statement by the patient). Elderly patients are at more risk for toxicity because they have an age-dependent decrease in liver and kidney functions. Digoxin is metabolized via the liver and kidney, so lower kidney/liver function predisposes to toxicity. Patients taking calcium channel blockers (CCBs) are also at risk for digoxin toxicity.

The nurse is teaching a caregiver how to administer an injection of enoxaparin. Which statement, if made by the caregiver, would require further teaching? A. "I will give this injection in the abdomen." B. "I should expel the air bubble before administering." C. "Green leafy vegetables are allowed while taking this medication." D. "This medication may increase the risk for bleeding."

B. "I should expel the air bubble before administering." ➢ Enoxaparin comes in prefilled syringes to prevent dosing errors. The bubble should not be expelled before administration. If the drop is expelled, part of the dose would be wasted. ➢ Enoxaparin is administered subcutaneously. It should be injected at either a 90 or 45-degree angle. This medication should only be administered in the abdomen and not rubbed afterward. ➢ Enoxaparin is a low molecular weight-based heparin that does not require monitoring the activated partial thromboplastin time (aPTT). ➢ The nurse still needs to monitor the client for bleeding as well as heparin-induced thrombocytopenia (HIT). HIT would manifest as a reduction of platelets and may seriously cause thrombosis elsewhere. ➢ Contraindications to administering enoxaparin include recent spinal surgery, epidural, peptic ulcer disease, thrombocytopenia, and uncontrolled hypertension. ➢ The antidote for enoxaparin is protamine sulfate.

The licensed practical/vocational nurse (LPN/VN) reinforces medication instructions to a client prescribed phenytoin. Which statements, if made by the client, indicate effective understanding? A. "If my gums get irritated and large, I can stop this medication." B. "I will need laboratory work to monitor the medication level." C. "It is okay for me to increase this medication if I have a seizure." D. "I should take this medication with low protein foods."

B. "I will need laboratory work to monitor the medication level." Phenytoin is an anticonvulsant and is indicated for epilepsy. Therapeutic levels must be maintained to ensure the effectiveness of the drug. The therapeutic drug levels of phenytoin are 10-20 mcg/ml.

The nurse is reinforcing teaching regarding prescribed risperidone. Which statement, if made by the client, requires follow-up? A. "I should report any abnormal movements that I develop." B. "I will need to have weekly tests to monitor my white blood cells." C. "If I get muscle stiffness, I should notify my physician." D. "I will need to chew sugarless gum if I develop a dry mouth."

B. "I will need to have weekly tests to monitor my white blood cells." Risperidone is a second-generation antipsychotic used in delirium, schizophrenia, and some childhood disorders. Weekly white blood cell tests are not required with risperidone as this is appropriate teaching for an individual receiving clozapine. Clozapine may cause neutropenia.

The nurse is caring for a client receiving buspirone. Which of the following client statements would indicate a therapeutic response? A. "I am less depressed and able to spend time with my friends." B. "My anxiety has lessened, and I have started going out more." C. "I noticed an improvement in my concentration." D. "I have been able to fall asleep without any problem."

B. "My anxiety has lessened, and I have started going out more." Buspirone is a medication indicated for anxiety disorders. This medication modulates serotonin and does not have a sedative effect compared to benzodiazepines. The client should be educated to take this medication on time and to expect a response within four to six weeks. Buspirone has many drug-to-drug interactions, and completing a thorough inventory of the client's current medications is essential.

The nurse is reinforcing teaching to a client about newly prescribed carbamazepine. Which of the following information should the nurse include? A. This medication will require weekly dosage adjustments B. Avoid taking this medication with grapefruit C. This medication may make your emotions more intense D. Take this medication if you feel like you are going to have a seizure

B. Avoid taking this medication with grapefruit Carbamazepine is an anticonvulsant medication indicated in the treatment of epilepsy and bipolar disorder This medication requires therapeutic drug monitoring, and the level should be maintained between 8-12 mcg/mL Grapefruit should not be taken concurrently with carbamazepine because it may induce drug toxicity The medication should be taken with at least 6 to 8 ounces of fluid, preferably water, and with food, meals, or a snack to help decrease the risk for gastrointestinal upset The most common adverse finding associated with this medication is sedation

The nurse is caring for a client receiving nifedipine. Which of the following findings would indicate a therapeutic response? A. Sinus rhythm on the electrocardiogram B. Blood pressure 128/77 mm Hg C. Total cholesterol 180 mg/dl D. Weight loss of 2 kilograms

B. Blood pressure 128/77 mm Hg Calcium channel blockers are medications such as amlodipine, verapamil, nifedipine, and diltiazem. Verapamil and diltiazem are heart rate-lowering calcium channel blockers, and these specific calcium channel blockers are indicated for arrhythmias such as atrial fibrillation. Nifedipine does not lower the heart rate when compared to verapamil or diltiazem. Nifedipine may be used for clients at risk for preterm labor as it is a tocolytic. Calcium channel blockers are contraindicated in heart failure and should not be taken concurrently with grapefruit products.

The nurse is caring for a client who is receiving prescribed methylergonovine. Which of the following findings would indicate a therapeutic response? A. Increased blood pressure B. Decreased post-partum bleeding C. Decreased uterine tone D. Increased urinary output

B. Decreased post-partum bleeding Methylergonovine is an alkaloid medication used to manage postpartum hemorrhage (PPH). This medication causes vasoconstriction, therefore, decreasing postpartum bleeding. ✓ PPH may be treated with oxytocin, misoprostol, and/or methylergonovine. ✓ These medications specifically work by contracting the uterus and decreasing bleeding. ✓ The nurse should monitor the client's cardiovascular status closely while taking this medication because of the risk of severe hypertension. ✓ This medication is given intramuscularly (IM).

The nurse cares for a client diagnosed with pelvic inflammatory disease (PID). The nurse anticipates the primary healthcare provider (PHCP) to prescribe which medication? A. Voriconazole B. Doxycycline C. Phenazopyridine D. Famciclovir

B. Doxycycline Pelvic inflammatory disease (PID) is most likely caused by sexually transmitted infections or bacterial vaginosis. Doxycycline is an effective antibiotic utilized in PID. Choices A, C, and D are incorrect. Voriconazole is an antifungal agent and is not utilized in PID. Phenazopyridine is a urinary analgesic and may be indicated for pain associated with urinary infections. Famciclovir is an antiviral agent and is indicated for viral infections such as herpes simplex.

Which of the following medications may be prescribed to control hypertension associated with nephroblastoma? A. Propranolol B. Enalapril C. Nitroprusside D. Digoxin

B. Enalapril Enalapril is an ACE inhibitor used to lower blood pressure. Since patients with nephroblastoma are hypertensive due to increased renin levels, this medication is commonly prescribed to decrease their blood pressure. Propranolol is a beta-blocker used to slow the heart rate. While it can decrease blood pressure in specific patient populations, it is not prescribed to patients with nephroblastoma to reduce their hypertension.

The nurse is reviewing newly prescribed medications for a patient taking lithium. Which medication requires further follow-up? A. Venlafaxine B. Hydrochlorothiazide C. Gabapentin D. Losartan

B. Hydrochlorothiazide A patient taking lithium should be instructed to avoid dehydration and hyponatremia. Lithium is a salt, and when the patient has decreased fluid volume, the drug will accumulate and raise the lithium level. HCTZ is a thiazide diuretic and is contraindicated for a patient taking lithium because of its ability to decrease fluid and sodium levels. Choices A, C, and D are incorrect. Venlafaxine is a serotonin-norepinephrine reuptake inhibitor and has no contraindication with lithium. Further, gabapentin and losartan have no contraindications as gabapentin is indicated neuropathy, and losartan is indicated for hypertension. Additional information: Key teaching points for a patient taking lithium include the avoidance of dehydration, adhering to the dosing schedule to maintain a therapeutic level of 0.6-1.2 mEq/L, and reporting signs of toxicity such as nausea, vomiting, and ataxia. The patient should be instructed that the drug level should be obtained

The nurse is caring for a client receiving prescribed lactulose. Which of the following finding would indicate a therapeutic response? A. Increased liver enzymes B. Increased level of consciousness C. Decreased urinary calcium D. Increased gastric pH

B. Increased level of consciousness Lactulose is intended to decrease ammonia levels - not liver enzymes. Urinary calcium is not impacted by lactulose, and medications such as hydrochlorothiazide will lower urinary calcium. Gastric pH is not raised by lactulose. ✓ Hepatic encephalopathy can cause a client to make irrational decisions, as excessive ammonia is a neurotoxin. ✓ The high levels of ammonia can be treated by administering lactulose and correcting hypokalemia (hypokalemia contributes towards the accumulation of ammonia).

The nurse reviews a client's medication record who takes prescribed sildenafil. Which medication should the nurse clarify with the primary healthcare provider (PHCP)? A. Lisinopril B. Isosorbide C. Atorvastatin D. Losartan

B. Isosorbide Isosorbide is a nitrate medication and should not be taken concurrently with phosphodiesterase inhibitors such as sildenafil. The combination of the two may result in profound hypotension. Phosphodiesterase inhibitors such as sildenafil, tadalafil, and vardenafil are indicated to treat erectile dysfunction and pulmonary hypertension. The client should not take these medications concurrently with nitrates.

The licensed practical/vocational nurse (LPN/VN) is caring for a client with the following clinical data. Which prescription would the LPN/VN request from the primary healthcare provider (PHCP) based on the clinical data? See the exhibit. View Exhibit: Patient is intoxicated with alcohol A. Diphenhydramine B. Lorazepam C. Phenytoin D. Clozapine

B. Lorazepam Lorazepam is a benzodiazepine used in the management of alcohol withdrawal symptoms. The client exhibits these symptoms, evidenced by perspiration on the forehead, nystagmus, coarse tremors, and visual hallucinations. Choices A, C, and D are incorrect. Diphenhydramine is an anticholinergic medication for insomnia, allergic rhinitis, and other mild to moderate allergic reactions. Anticholinergics worsen delirium and should be avoided. This medication would not assist the client in the reduction of their withdrawal symptoms. Phenytoin is a maintenance anticonvulsant used in epilepsy. This has no clinical utility in alcohol withdrawal. Antipsychotics, such as, may be useful in alcohol withdrawal. However, clozapine is not used because this medication is reserved for treatment-resistant psychotic disorders.

Your client is experiencing severe, acute anxiety before a scheduled endoscopy procedure. Which of the following medications is most likely to be ordered by the physician? A. Oxycodone B. Midazolam C. Clonazepam D. Haloperidol

B. Midazolam Midazolam (Versed) is a benzodiazepine used for acute anxiety attacks. Midazolam is preferred in this setting because of its rapid onset (2 to 5 minutes after IV administration) and short duration of action (3 to 8 hours). Clonazepam is a long-acting benzodiazepine often used in anxiety attacks after a traumatic event, panic disorders, or generalized anxiety disorder. Your client needs an anxiolytic with a rapid onset of action and a shorter duration. Midazolam fits that criteria well. Haloperidol is an antipsychotic and is often used in mental health settings to address acute and severe agitation/aggression associated with psychiatric disorders (Schizophrenia, Substance intoxication).

The nurse is caring for a client who has influenza. Which of the following prescriptions may be prescribed by the primary healthcare provider (PHCP)? A. Valacyclovir B. Oseltamivir C. Azithromycin D. Omeprazole

B. Oseltamivir Oseltamivir is an antiviral agent approved for the treatment of influenza. This medication should be initiated within 48 hours of symptom onset.

George, age 8, is admitted with rheumatic fever. Which clinical finding indicates to the nurse that George needs to continue taking the salicylates he had received at home? A. Chorea B. Polyarthritis C. Subcutaneous nodules D. Erythema marginatum

B. Polyarthritis Polyarthritis is characterized by swollen, painful, hot joints that respond to salicylates. Rheumatic fever is an inflammatory disease that can develop when strep throat or scarlet fever, caused by streptococcus bacteria, isn't adequately treated. It most often affects children between 5 and 15 years old, though it can develop in younger children and adults. Although strep throat is frequent, rheumatic fever is rare in the United States and other developed countries. However, rheumatic fever remains common in many developing nations. Rheumatic fever can cause permanent damage to the heart, including damaged heart valves and heart failure. Treatments can reduce inflammation, lessen pain and other symptoms, and prevent the recurrence of rheumatic fever.

The nurse is caring for a client who is receiving prescribed doxorubicin. Which of the following findings would indicate the patient is having an adverse effect? A. Urine discoloration B. Pulmonary congestion C. Hirsutism D. Pruritus

B. Pulmonary congestion Doxorubicin is an antineoplastic that is indicated for a variety of cancers. Doxorubicin is highly cardiotoxic, which may cause cardiomyopathy. The cardiotoxicity may cause a decrease in left ventricular ejection fraction, therefore, causing pulmonary congestion and, at worse life-threatening pulmonary edema. The patient may present with leg edema, cough, and worsening shortness of breath.

The nurse is caring for a client who was newly prescribed warfarin. Which medication on the client's medication list requires follow-up with the primary healthcare provider (PHCP)? A. Loratidine B. Saw Palmetto C. Furosemide D. Pantoprazole

B. Saw Palmetto aw Palmetto is an over-the-counter supplement purported to decrease symptoms of benign prostatic hyperplasia. This medication should be used with caution if it is administered with warfarin. Warfarin is an anticoagulant; if the client takes both concurrently, it may potentiate the anticoagulant effect. The primary healthcare provider (PHCP) must be made aware of this interaction. Choices A, C, and D are incorrect. Loratidine is a histamine antagonist used for allergies. Furosemide is a loop diuretic used for edema and hypertension. Pantoprazole is used for peptic ulcer disease and GERD. None of these medications interact with saw palmetto.

The nurse is collecting data on a client receiving prescribed lamotrigine. Which client finding requires immediate follow-up? A. Abnormal dreams B. Skin blistering C. Dyspepsia D. Xerostomia

B. Skin blistering Skin blistering associated with lamotrigine therapy is a critical finding to report. This is a feature of Steven-Johnson syndrome (SJS). Lamotrigine has been implicated as causing this adverse finding. ✓ Lamotrigine is a mood stabilizer and antiepileptic. ✓ This medication may adversely cause SJS, manifested by tender skin lesions that appear as blisters. ✓ These skin eruptions may also involve the eyes and mouth. ✓ Prompt treatment is necessary because of the risk of sepsis that may result from skin erosion. ✓ These lesions often spread fast, underlining the necessity of prompt treatment. If this should occur, the offending agent should be withdrawn.

Which of the following foods should the LPN reinforce to avoid while the patient is taking warfarin? Select all that apply. A. Peanut butter B. Spinach C. Kale D. Almonds

B. Spinach C. Kale

The LPN is assisting the nurse in caring for a patient who is receiving a continuous opioid infusion. The LPN should understand which of the following, if detected, is a concerning finding? A. The patient has a respiratory rate of 10 breaths/min with normal depth. B. The patient's sedation level is 4. C. The patient experiences mild confusion. D. The patient reports constipation.

B. The patient's sedation level is 4 Sedation level is more indicative of respiratory depression because a drop in level usually precedes respiratory depression. A sedation level of 4 calls for immediate action because the patient has minimal or no response to stimuli. Opioids, formerly called narcotic analgesics, are generally considered the primary class of analgesics used to manage moderate to severe pain because of their effectiveness. With sufficient dosage, they are deemed capable of relieving the pain of virtually every type. Opioids produce analgesia by attaching to opioid receptors in the brain.

Which of the following is the reason a patient receives nitrous oxide in addition to thiopental sodium? A. To provide the additional anesthesia to put him in a sleep-like state. B. To increase the effectiveness of each drug at a lower dosage. C. Thiopental sodium is not effective when used alone. D. Nitrous oxide is not effective when used alone.

B. To increase the effectiveness of each drug at a lower dosage. Nitrous oxide may be used for dental procedures or brief obstetrical or surgical procedures. It may also be used together with other general anesthetics, making it possible to decrease its dosage with greater effectiveness. There are two primary methods of causing general anesthesia. IV agents are usually administered first because they act within a few seconds. After the patient loses consciousness, inhaled agents are used to maintain the anesthesia.

The nurse is preparing to administer prescribed medications to a client via a nasogastric tube connected to low-intermittent suction. The nurse should take which appropriate action? Select all that apply. Incorrect Correct Answer(s): B,C A. Position the patient in Trendelenburg position. B. Verify correct placement of the tube before medication administration. C. Turn off the suction during medication administration. D. Resume low-intermittent wall suction immediately after medication administration. E. Irrigate the nasogastric tube (NGT) with sterile water.

B. Verify correct placement of the tube before medication administration. C. Turn off the suction during medication administration.

The nurse is caring for a patient diagnosed with pernicious anemia. The nurse should anticipate a prescription for which medication? A. Thiamine B. Vitamin B12 C. Iron dextran D. Folic acid

B. Vitamin B12

Which of the following is a priority for assessing a patient who is taking digoxin and lasix? A. Night sweats and headache. B. Vomiting and halos around lights. C. Stomach upset and headache. D. Low blood pressure and dark urine.

B. Vomiting and halos around lights. Lasix causes the patient to lose potassium. If taken with a low potassium level, Digoxin can become toxic and show signs/symptoms of nausea, vomiting, and halos around lights. Furosemide and digoxin are often used together but may require more frequent evaluation of digoxin, potassium, and magnesium levels. Patients are encouraged to notify their healthcare provider if they experience any symptoms such as weakness, tiredness, muscle pains or cramps, nausea, decreased appetite, visual problems, or irregular heartbeats.

The nurse is educating a client about the newly prescribed oxymetazoline nasal spray. It would be appropriate for the nurse to instruct the client to A. sit upright for thirty minutes after taking this medication. B. do not use this medication for more than three days. C. change positions slowly while taking this medication. D. rinse your mouth out after taking this medication.

B. do not use this medication for more than three days. Oxymetazoline is a nasal spray used for individuals who have nasal congestion. This medication works by constricting the vasculature in the nasal passages, thereby decreasing congestion. The client should be instructed not to use this medication for more than three days to prevent rebound congestion.

The nurse is reviewing a new prescription for amphotericin b. The nurse understands that this medication treats A. autoimmune infections. B. fungal infections. C. viral infections. D. bacterial infections.

B. fungal infections. Amphotericin B is a powerful antifungal indicated in treating systemic fungal infections. This medication requires pre-medication with isotonic saline, diphenhydramine, and acetaminophen to help decrease the symptoms of fever, chills, and rigors associated with the infusion.

A diabetic patient receives ten units of Regular insulin and 20 units of NPH insulin each day after breakfast. After following the usual preparation steps for administering insulin, what should the nurse do next? A. Draw up NPH insulin first because it is clear. B. Either insulin can be drawn first as long as 30 units are given. C. Draw up Regular insulin first because it is clear. D. Administer each type of insulin separately for accuracy.

C. Draw up Regular insulin first because it is clear.

The licensed practical/vocational nurse (LPN/VN) reinforces teaching to a client prescribed tamsulosin. Which of the following statements should the nurse include? A. "This medication may turn your urine reddish/orange." B. "You will urinate more often with this medication." C. "Change positions slowly while you take this medication." D. "Avoid calcium-containing foods while on this medication."

C. "Change positions slowly while you take this medication." ✓ Tamsulosin is an alpha-1 antagonist which induces vasodilation. ✓ Tamsulosin enables smooth muscle to relax, therefore improving urine flow and decreasing the symptoms of BPH. ✓ Orthostatic hypotension is the most common effect associated with this medication. ✓ This medication may contribute to a client falling because of the orthostasis.

The nurse is caring for a client who is receiving prescribed mirtazapine. Which of the following statements, if made by the client, would indicate a therapeutic response? Select all that apply. A. "I am not smoking cigarettes anymore." B. "My blood glucose has decreased." C. "My depression has gotten better." D. "I am sleeping eight hours a night." E. "My blood pressure is back to normal."

C. "My depression has gotten better." D. "I am sleeping eight hours a night." Mirtazapine is a tetracyclic antidepressant that causes an increase in serotonin and norepinephrine. This medication is used for depressive and anxiety disorders. Mirtazapine is quite sedating and is often used for insomnia associated with depressive disorders. ✓ Mirtazapine is an agent used to treat depressive and anxiety disorders. ✓ This medication causes sedation and is dosed at night. ✓ This may be helpful for those with depressive disorders and who suffer from concomitant insomnia. ✓ Mirtazapine has the following side effects - Increased appetite Weight gain Sedation Dizziness Confusion

You receive an order to administer 600 mg ibuprofen to your patient as needed every 6 hours. You retrieve the medication, which comes in 200 mg tablets. How many tablets do you administer to your patient? A. 1 tablet B. 5 tablets C. 3 tablets D. 2 tablets

C. 3 tablets

The nurse is caring for a client with the following clinical data. Which medication would the nurse clarify with the primary healthcare provider (PHCP) before administration based on the vital signs? See the image below. Exibite: P 123, R 18, BP 149/85, T 97.5, O2 95% A. Metoprolol 50 mg PO Daily B. Lisinopril 40 mg PO Daily C. Albuterol 2.5 mg via nebulizer Daily D. Diltiazem XR 120 mg PO Daily

C. Albuterol 2.5 mg via nebulizer Daily The vital signs (VS) are all within normal limits except the pulse, which is 123 bpm, and the blood pressure is slightly elevated. This should cause the nurse to clarify the prescription of albuterol with the PHCP as this medication increases heart rate. This would foreseeably worsen the tachycardia that the client is already experiencing.

The nurse receives a prescription for donepezil. The nurse understands that this medication is used to treat A. Guillain Barré syndrome B. Parkinson's disease C. Alzheimer's disease D. Meniere's disease

C. Alzheimer's disease Alzheimer's disease is the most common form of dementia. Treatment options are limited but may include donepezil which is approved to treat mild, moderate, or severe Alzheimer's disease. This medication is an acetylcholinesterase Inhibitor.

The nurse is educating a patient with glaucoma. Which of the following classifications of medications should the nurse instruct the patient to avoid? A. Osmotic diuretics B. Beta-adrenergic blockers C. Anticholinergics D. Alpha 2-adrenergic blockers

C. Anticholinergics Anticholinergic medications can increase the IOP and worsen patients' condition with glaucoma. Anticholinergic agents also can produce central side effects, such as confusion, unsteady gait, or drowsiness in adults. Children may become restless or spastic. Glaucoma is one of the leading causes of blindness in the United States. In some cases, it is genetic. In others, it may occur due to eye injury or disease. Some medications may contribute to glaucoma development, such as long-term use of topical glucocorticoids, some antihypertensives, antihistamines, and antidepressants. The primary risk factor associated with glaucoma includes high blood pressure. Choices A, B, and D are incorrect. A is incorrect. Osmotic diuretics are most often used in cases of eye surgery or acute closed-angle glaucoma. B is incorrect. Beta-adrenergic blockers are used more than any other anti-glaucoma medication. D is incorrect. Alpha 2-adrenergic agents are used less frequently than other antiglaucoma medications. They produce minimal cardiovascular and pulmonary side effects. They may cause drowsiness, dry mucosal membranes, irritated eyelids, and headaches.

Chronic pain is most effectively relieved when analgesics are administered in what manner? A. On a PRN basis B. Conservatively C. Around the clock D. Intramuscularly

C. Around the clock

Which of the following over-the-counter (OTC) medications is Reye's syndrome associated with? A. Acetaminophen B. Ibuprofen C. Aspirin D. Brompheniramine/pseudoephedrine

C. Aspirin Reye's syndrome is a potentially fatal illness that can lead to liver failure and encephalopathy. Virus-infected children who are given aspirin to manage pain, fever, and inflammation are at an increased risk of developing Reye's syndrome.

The nurse is caring for a client diagnosed with Generalized Anxiety Disorder (GAD). The nurse should anticipate a prescription for which of the following medications? A. Haloperidol B. Fluphenazine C. Buspirone D. Methylphenidate

C. Buspirone Buspirone is a serotonergic agent that is efficacious in the treatment of anxiety. This medication takes time to work (approximately two to four weeks), and the patient should be counseled accordingly. Choices A, B, and D are incorrect. Haloperidol and fluphenazine are typical antipsychotics indicated in the treatment of schizophrenia. These medications do not modulate serotonin; therefore, they have no use in anxiety disorders. Methylphenidate is indicated in the treatment of ADHD. Its stimulating effects may even worsen anxiety. Additional information: Buspirone is a non-controlled medication indicated in the treatment of anxiety. This medication does not cause dependence or withdrawal symptoms. Essential patient teaching points include - The time of onset may be delayed up to two weeks to four weeks. This medication should be taken consistently with or without food. The medication is not a benzodiazepine and should not be taken during acute anxiety. Rather, this medication helps attenuate the response to triggers of anxiety. Sexual dysfunction is unlikely with this medication.

The LPN is reinforcing teaching to a client who is taking phenytoin. To make sure phenytoin does not fail, which over the counter (OTC) medication should the nurse advise the patient not to take at the same time? A. Acetaminophen B. Ibuprofen C. Calcium carbonate D. Ranitidine

C. Calcium carbonate Calcium carbonate (Tums) should not be taken simultaneously as phenytoin because taking them together can decrease the effects of phenytoin. Antacids containing calcium carbonate reduce the bioavailability of phenytoin by reducing both the rate of absorption and the amount of intake.

The nurse administered prescribed six units of regular insulin. Which data collection finding requires follow-up? A. Rapid, labored breathing B. Increase appetite C. Cold sweats D. Increased urination

C. Cold sweats Regular insulin may be given subcutaneously and peaks within two to four hours after administration. The peak effects of the medication raise the client's risk for hypoglycemia. Cold sweats are a clinical feature of hypoglycemia. Choices A, B, and D are incorrect. These assessment findings are consistent with hyperglycemia. Common manifestations associated with hyperglycemia include Polyuria (increased urination) Polyphagia (increased hunger) Polydipsia (increased thirst) Dry mouth Blurred vision

A patient is prescribed a calcium channel blocker to treat primary hypertension. When teaching the patient about the medication, which of these foods will the healthcare provider advise the patient to avoid? A. Eggs B. Milk C. Grapefruit D. Bananas

C. Grapefruit Grapefruit and its juice contain furanocoumarins, which block the enzymes involved in metabolizing many drugs, including calcium channel blockers. Grapefruit can interfere with other drugs too, including statins (atorvastatin, lovastatin, simvastatin), some antibiotics, and some cancer drugs. Medication blood levels can increase, resulting in toxicity. The calcium channel blockers' levels are increased when grapefruit or grapefruit juice is consumed, potentially causing hypotension.

The nurse is caring for a client who is newly prescribed cimetidine. The nurse understands that this medication is prescribed to treat which condition? A. Cystic fibrosis B. Clostridium difficile C. H. pylori D. Crohn's disease

C. H. pylori Histamine receptor antagonists include medications such as cimetidine and famotidine These medications work by blocking the H2 receptor of acid-producing parietal cells. This makes the parietal cell less responsive to histamine and the stimulation of ACh and gastrin. All of these medications are available over the counter (OTC) Cimetidine has multiple drug-to-drug interactions Cimetidine may cause drowsiness, and an increase in prolactin levels which may, in turn, cause gynecomastia and sexual dysfunction Cimetidine may increase the risk of falls, especially in older adults These drugs may be given in a single dose at bedtime to suppress nocturnal gastric acid secretion These drugs should not be given concurrently with antacids

The patient is using topical glucocorticoids. The nurse should assess for all the following systemic effects of the medication except: A. Mood changes B. Osteoporosis C. Liver toxicity D. Adrenal insufficiency

C. Liver toxicity Liver toxicity is not a systemic effect associated with the use of glucocorticoids. Topical glucocorticoids or corticosteroids are used in cases of dermatitis and eczema to treat symptoms of burning, itching, and inflammation. They may also be used in conjunction with other medical therapies for the treatment of psoriasis.

The nurse is caring for a client diagnosed with attention deficit hyperactivity disorder (ADHD). The nurse should anticipate a prescription for which of the following? A. Citalopram B. Risperidone C. Methylphenidate D. Carbamazepine

C. Methylphenidate ADHD may be treated by psychostimulants such as amphetamines or methylphenidate. These medications work by projecting the dopamine and norepinephrine in the front of the brain to ameliorate the symptoms of inattention, impulsivity, and hyperactivity. Methylphenidate is a drug commonly indicated for ADHD. Client education should include the dosing of the medication, which should be earlier in the day. It is important to limit caffeine and chocolate. The nurse should monitor the client's weight as this medication has appetite suppressant effects. Choices A, B, and D are incorrect. Citalopram is a serotonergic drug used in the treatment of depressive and anxiety disorders. Risperidone is indicated for psychotic disorders such as schizophrenia. Carbamazepine is an anticonvulsant indicated for bipolar disorders as it has a mood-stabilizing effect.

The nurse recognizes which of the following anticholinergics is appropriate for a patient diagnosed with urinary bladder urgency and incontinence? A. Dicyclomine B. Ipratropium C. Oxybutynin D. Scopolamine

C. Oxybutynin Oxybutynin is an anticholinergic drug. It is used to treat urinary bladder urgency and incontinence. It works as a bladder relaxant and has 10 times more potent antispasmodic effect than atropine. Anticholinergics are drugs that have actions opposite those of the parasympathetic branch. Their work mimics the fight-or-flight response. A is incorrect. Dicyclomine is used to treat irritable bowel syndrome. B is incorrect. Ipratropium is used to treat asthma. D is incorrect. Scopolamine is used to treat irritable bowel syndrome and

The nurse is caring for a client with a potassium of 3.2 mEq/dl. Which of the following medications may cause this abnormality? A. Spironolactone B. Triamterene C. Prednisone D. Lisinopril

C. Prednisone Prednisone is a corticosteroid that increases aldosterone, responsible for sodium retention and potassium elimination. Therefore, a client's potassium level will decrease while taking this medication. ✓ Hypokalemia is potassium less than 3.5 mEq/l and may be induced by medications such as albuterol, furosemide, prednisone, and bumetanide. ✓ Manifestations of hypokalemia include muscle cramping, decreased GI motility, and electrocardiogram changes such as ST-segment depression and the presence of a U-wave. ✓ The priority when dealing with a client who has a disturbance in their potassium is to obtain a 12-lead electrocardiogram.

The nurse is caring for a client who is receiving prescribed trazodone. Which of the following findings would indicate the client is having an adverse effect? A. Dizziness B. Sedation C. Priapism D. Dry mouth

C. Priapism Trazodone is a serotonergic agent used frequently for the treatment of insomnia. The nurse must implement fall precautions with this medication because sedation and dizziness are likely to occur. Adversely, this medication has caused priapism in males. This condition causes a painful, persistent erection that requires emergent medical care.

The nurse is preparing to administer ear drops to a client who is six years old. The nurse should perform which action? A. Pull the ear pinna down and back B. Position the client on their side with the ear to be treated against a pillow C. Pull the ear pinna up and back D. Place cotton directly into the ear canal after ear drop administration

C. Pull the ear pinna up and back

The nurse has attended a continuing education conference regarding medication administration and meal times. Which statement, if made by the nurse, would indicate correct understanding? A. Proton pump inhibitors (PPIs) should be given as the client eats their breakfast. B. Glucocorticoids should be given on an empty stomach to prevent gastrointestinal irritation. C. Rapid-acting insulins should be administered approximately 10-15 minutes before meals D. Levodopa-Carbidopa should be administered with a high-protein snack to enhance its absorption.

C. Rapid-acting insulins should be administered approximately 10-15 minutes before meals

A patient is scheduled to have a thyroidectomy. The nurse understands that the primary reason for giving Lugol's solution to a patient preoperatively is: A. Decrease the risk of agranulocytosis postoperatively. B. Prevent tetany while the client is under general anesthesia. C. Reduce the size and vascularity of the thyroid and prevent hemorrhage. D. Potentiate the other preoperative medication's effect so less medicine can be used while the client is under anesthesia.

C. Reduce the size and vascularity of the thyroid and prevent hemorrhage. Hyperthyroidism is related to hemodynamic variations, including increased heart rate and cardiac contractility, and decreased peripheral resistance due to serum thyroid hormone excess. Preoperative preparation of the patient is crucial to avoid intraoperative or postoperative complications and decrease the gland's vascularity. The incidence of complications is low in experienced hands; however, a small amount of intraoperative bleeding can reduce the visualization and preservation of the surrounding nerves, vasculature, and parathyroid glands. Lugol's solution (inorganic iodide) has been given preoperatively to patients to limit intraoperative bleeding and related complications resulting from thyroid gland vascularization.

The nurse is reinforcing teaching with a patient who has hypertension about the newly prescribed medication, furosemide. Which of the following should the nurse include in the teaching? A. Limit intake of bananas, cantaloupe, and potatoes. B. Avoid taking the medication with grapefruit juice. C. Take this medication in the early part of the day. D. A nagging cough can occur as a side effect of the medication.

C. Take this medication in the early part of the day. Furosemide is a loop diuretic and may be indicated for conditions such as heart failure or hypertension. The patient should be instructed to take this medication in the earlier part of the day to avoid nocturia.

The LPN is reinforcing teaching to a client about the newly prescribed medication, epoetin alfa. Which of the following should the LPN include? A. This medication will decrease your risk for infection. B. You may notice black tarry stools while on this medication. C. This medication may raise your blood pressure. D. Take this medication with food rich in Vitamin C.

C. This medication may raise your blood pressure.

The nurse caring for a three-year-old with congestive heart failure recognizes which of the following as an early sign of digitalis toxicity? A. Bradypnea B. Tachycardia C. Vomiting D. Failure to thrive

C. Vomiting

Why would a patient on IV heparin be started on warfarin? A. Additional medication is needed. B. Warfarin is more effective than heparin. C. Warfarin is not effective until 12-24 hours after the first dose. D. Heparin has a low molecular weight and is only effective for a short time.

C. Warfarin is not effective until 12-24 hours after the first dose. Unlike heparin, warfarin's anticoagulant activity can take several days to reach maximum effect. For this reason, heparin and warfarin therapy are often overlapped.

Your client is receiving a non-steroidal anti-inflammatory drug (NSAID) in addition to a narcotic analgesic. The client wonders why an NSAID is necessary since the narcotic analgesic offers better pain relief. How would you respond to the client's question? A. I don't know and I suggest that you ask your doctor when you see her the next time. B. You are getting the NSAID because we are trying to wean you off the narcotic analgesic for moderate to severe pain. C. You are getting the NSAID, so the effects of the narcotic analgesic to combat your pain are more effective. D. You are getting the NSAID because it is a placebo, and it is proven to be effective for severe pain.

C. You are getting the NSAID, so the effects of the narcotic analgesic to combat your pain are more effective. An NSAID is an "adjuvant" medication used in combination with narcotic analgesics to treat moderate to severe pain. Adjuvant pain medications are used to enhance pain relief provided by other analgesics. The primary function of NSAIDs is to reduce inflammation. Therefore, NSAIDs are helpful in treating the pain caused by inflammation.

The nurse is preparing a client for a scheduled colonoscopy. Which prescription should the nurse anticipate from the primary healthcare provider (PHCP) while the client is preparing for this procedure? A. docusate B. loperamide C. polyethylene glycol 3350 D. famotidine

C. polyethylene glycol 3350 Polyethylene glycol 3350 is a stimulant laxative commonly used before a colonoscopy. This powder is typically dissolved in a sports drink and can be consumed by the client. Efficacy is usually within one hour. Fluid and electrolyte disturbance is unlikely as the powdered solution contains electrolytes. Choices A, B, and D are incorrect. Docusate is a stool softener and is not used to prepare for a colonoscopy. This medication would help prevent constipation. Loperamide is a medication to slow peristalsis and is indicated in the treatment of diarrhea. Famotidine is a histamine blocker and is used to manage peptic ulcer disease.

The nurse is caring for a client prescribed dutasteride. The nurse understands this medication had achieved its therapeutic effect when the client reports decreased symptoms of A. pyrosis. B. hypothyroidism. C. urinary retention. D. anxiety.

C. urinary retention. BPH is often treatable with a 5-alpha reductase inhibitor. There are currently two such drugs: finasteride and dutasteride. Finasteride (Proscar), the prototypical drug for this class, works by inhibiting this enzyme, which normally converts testosterone to 5-alpha dihydrotestosterone (DHT). DHT is a more potent form of testosterone and is the principal androgen responsible for stimulating prostatic growth, as well as the expression of other male primary and secondary sex characteristics. Because these medications suppress DHT, the biggest adverse effect for men is decreased libido and erectile dysfunction. Caution must be taken when handling these medications because they are quite teratogenic, and pregnant women should handle the drug while wearing gloves.

The nurse is reinforcing education to a client about newly prescribed aspart insulin. The nurse should instruct the client to self-administer this insulin A. 30-45 minutes before a meal. B. one hour after a meal. C. 20-30 minutes before a meal. D. 10-15 minutes before a meal.

D. 10-15 minutes before a meal. The three rapid-acting insulins are lispro, aspart, and glulisine. The client needs to take this insulin 10-15 minutes before a meal or while actively eating. A rapid-acting insulin is utilized as correctional insulin before meals to prevent post-prandial hyperglycemia. This type of insulin is commonly loaded into an insulin pump.

The nurse is caring for a patient newly diagnosed with an abdominal aortic aneurysm. The nurse should anticipate a prescription for which of the following medications? A. Naproxen B. Digoxin C. Prednisone D. Atenolol

D. Atenolol An abdominal aortic aneurysm (AAA) is a serious condition that may lead to potential rupture. Depending on the size of the aneurysm, patients may be taken in for emergent or elective surgery. A priority for all individuals is to maintain appropriate blood pressure control. Thus, beta-blockers such as atenolol are utilized to reduce the size of the aneurysm as well as reduce the risk of rupture.

The nurse is caring for a client diagnosed with Multiple Sclerosis (MS). The nurse should anticipate a prescription for which medication? A. Topiramate B. Risperidone C. Prazosin D. Baclofen

D. Baclofen Multiple Sclerosis (MS) may produce symptoms such as muscle spasticity, optic neuritis, fatigue, heat intolerance, and symptoms that seem to intensify occasionally (relapses). Muscle spasticity is best controlled with muscle relaxers such as baclofen. Other muscle relaxers include cyclobenzaprine, diazepam, and tizanidine.

The nurse is caring for a client with end-stage renal disease who is receiving prescribed sevelamer. Which of the following findings would indicate a therapeutic response? A. Decreased serum calcium levels B. Increased hemoglobin and hematocrit C. Decreased serum potassium levels D. Decreased serum phosphorus levels

D. Decreased serum phosphorus levels Sevelamer is a phosphate binder indicated in the treatment of hyperphosphatemia associated with chronic kidney disease. This medication is purported to decrease serum phosphorus levels by binding to food. Thus, this medication is given with meals. Combined with a low phosphorus diet, the goal of this medication is to decrease serum phosphate levels. Hyperphosphatemia is a common problem associated with chronic kidney disease and end-stage renal disease, and medications such as sevelamer are used in its management. ➢ Management is with restricting dietary phosphorus combined with oral phosphate binders. ➢ Food sources with high levels of phosphorus include beans, fish, and nuts. ➢ These phosphate binders may be calcium-containing (calcium carbonate) and noncalcium-containing (sevelamer). ➢ These medications are only effective when taken with meals. ➢ Major side effects of these medications include constipation which may lead to paralytic ileus. ➢ Other side effects include vitamin deficiencies which is why a renal vitamin may be prescribed. ➢ Calcium and phosphorus levels should be monitored closely during the treatment.

This nurse is caring for a client who is receiving prescribed citalopram. Which of the following findings would indicate a therapeutic response? A. Improved muscle coordination B. Circumstantial speech pattern C. Longer attention span D. Increased self-esteem

D. Increased self-esteem Citalopram is an antidepressant. This selective serotonin reuptake inhibitor (SSRI) is prescribed for depressive and anxiety disorders. If a client has depression, one of the associated manifestations is decreased self-esteem/self-worth. This may cause clients to reduce their ability to engage with others and become socially withdrawn.

The nurse is caring for a client with newly prescribed zolpidem. The nurse understands that this medication is indicated for which condition? A. Attention Deficit Hyperactivity Disorder B. Generalized Anxiety Disorder C. Narcolepsy D. Insomnia

D. Insomnia Zolpidem is a non-benzodiazepine indicated in the treatment of insomnia. Choices A, B, and C are incorrect. ADHD is characterized by the inability to sustain attention, impulsivity, and hyperactivity. It is treated with stimulants or non-stimulants. Generalized anxiety disorder is characterized by excessive worry and is treated with antidepressants such as SSRIs. Narcolepsy is a disorder characterized by sleep attacks. The client should be prescribed psychostimulants such as modafinil.

The patient with tuberculosis is now on isoniazid. Which laboratory test should be monitored at least monthly? A. PT and PTT B. CBC C. BUN D. Liver enzymes

D. Liver enzymes Although it is rare, liver toxicity is a severe adverse effect of Isoniazid. Healthcare providers should monitor for signs of jaundice, fatigue, elevated liver enzymes, and loss of appetite. Liver enzyme tests are usually performed monthly during therapy to identify early hepatotoxicity. Isoniazid is bacteriocidal for actively growing organisms and bacteriostatic for dormant mycobacteria. It is selective for M. tuberculosis. Isoniazid is used alone for chemoprophylaxis or in combination with other antitubercular drugs when treating active disease.

A pregnant client at 16 weeks gestation developed a pulmonary embolism and was initiated on intravenous heparin therapy two days ago. She is now getting discharged. The nurse has provided medication education and you are assigned to reinforce the medication teaching. Which of the following medications do you expect the physician to order at discharge? A. Warfarin B. Rivaroxaban C. Apixaban D. Low Molecular Weight Heparin (LMWH)

D. Low Molecular Weight Heparin (LMWH) LMWH does not cross the placenta and, therefore, does not cause fetal harm. LWMH and unfractionated heparin are the anticoagulants of choice during pregnancy. LMWH will provide therapeutic anticoagulation for the rest of the pregnancy. Most venous thromboembolism events need therapeutic anticoagulation for at least 3 to 6 months. However, pregnancy is a hypercoagulable state. The client, therefore, is at risk for recurrent thromboembolism throughout her pregnancy and at least six weeks post-partum.

The nurse is caring for a patient newly diagnosed with Rheumatoid Arthritis. The nurse should anticipate a prescription for which of the following medications? A. Calcitonin B. Glucosamine C. Allopurinol D. Methotrexate

D. Methotrexate

The licensed practical/vocational nurse (LPN/VN) assists the registered nurse (RN) in caring for a client who overdosed on hydromorphone. The nurse anticipates that the primary healthcare provider (PHCP) will prescribe which medication? A. Sodium bicarbonate B. Flumazenil C. Diphenhydramine D. Naloxone

D. Naloxone

The nurse is caring for a client who was newly placed on a clozapine prescription. Which of the following teaching points should the nurse reinforce? A. Maintain a healthy diet because of weight gain B. Exercise regularly and maintain hydration C. Expect excessive secretions in the mouth D. Obtain follow-up laboratory work

D. Obtain follow-up laboratory work follow-up laboratory work is essential for a client taking clozapine. The medication may adversely cause neutropenia. The client will be instructed to obtain this necessary laboratory work to ensure they are not experiencing agranulocytosis, which may make the client susceptible to infection. ✓ Clozapine is an atypical (second-generation) antipsychotic reserved for those who have not responded to other agents. ✓ This medication treats schizophrenia and mood disorders that may cause significant aggression or violence. ✓ This medication carries serious effects, including agranulocytosis, myocarditis, sialorrhea, and weight gain. ✓ The client will require frequent laboratory work to monitor their neutrophil count.

The nurse is caring for a patient with schizophrenia. The nurse should anticipate a prescription for which medication? A. Lithium B. Bupropion C. Sertraline D. Risperidone

D. Risperidone Schizophrenia is treated with antipsychotic medications. Typical (or first-generation) antipsychotic drugs include haloperidol, fluphenazine, and chlorpromazine. Atypical (second generation) antipsychotic medications include quetiapine, ziprasidone, and risperidone. Choices A, B, and C are incorrect. Lithium is indicated for the treatment of Bipolar disorder. Bupropion is an atypical antidepressant indicated in major depressive disorder. Sertraline is a selective serotonin reuptake inhibitor and is indicated for major depressive and anxiety disorders. Additional information: Schizophrenia is a psychotic disorder characterized by positive (hallucinations) and negative symptoms (lack of motivation). Most cases of schizophrenia have an onset in adolescence. Acute stabilization and maintenance treatment is accomplished by prescribed antipsychotic medications such as risperidone, haloperidol, or fluphenazine.

When observing a patient on antivirals, the nurse notices the patient has developed bruising. This could indicate which of the following? A. The patient is being abused by a family member. B. The patient is experiencing minor adverse reactions C. The patient is not taking the medications as ordered. D. The patient may be experiencing bone marrow suppression.

D. The patient may be experiencing bone marrow suppression. Bruising or bleeding when taking antivirals could indicate possible bone marrow suppression which may require dosage adjustments or a medication change.

You are witnessing a nurse waste available morphine. You should be aware of which of the following correct legal mandates in terms of controlled substances? Select all that apply. A. Signatures of 2 registered nurses but not of practical nurses when a narcotic is wasted. B. Prohibitions against the use of a placebo for pain management. C. The signatures of 3 registered nurses or practical nurses when a narcotic is wasted. D. The verification of the narcotic count at the beginning and the end of the shift. E. Checking the controlled substance at least 3 times before its administration. F. The secure locking of controlled substances to prevent diversion and theft.

D. The verification of the narcotic count at the beginning and the end of the shift. F. The secure locking of controlled substances to prevent diversion and theft.

Which of the following is least likely to influence a client's potential to comply with lithium therapy after discharge? A. The impact of lithium on the client's energy level and lifestyle. B. The need for consistent blood level monitoring. C. The potential side effects of lithium. D. What the client's friends think of his need to take medication.

D. What the client's friends think of his need to take medication. Although a patient's social network may influence compliance, this influence is typically secondary compared to the other factors listed. Lithium is believed to alter neurons' activity containing dopamine, norepinephrine, and serotonin by influencing their release, synthesis, and reuptake. Therapeutic actions are stabilization of mood during periods of depression. It is neither antimanic nor antidepressant in individuals without bipolar disorder. Choice A is incorrect. Clients who are on lithium therapy are usually greatly affected by lithium, which can be a significant determinant of compliance. Choice B is incorrect. Many patients become non-compliant, especially after an extended period, due to the frequency of physician and lab visits. Choice C is incorrect. Side effects of lithium are another deterrent to compliance. Potential side effects include fine tremors, drowsiness, diarrhea, and weight gain.

The nurse is caring for a client who is receiving prescribed risperidone. Which of the following findings would indicate a therapeutic response? The client demonstrates A. a reduction in weight. B. increased mood lability. C. an appropriate gait pattern. D. decreased thoughts of persecution.

D. decreased thoughts of persecution. Risperidone is an atypical (second generation) antipsychotic indicated in psychotic disorders such as schizophrenia. If the client reported decreasing thoughts of persecution (and was observed to have fewer thoughts of persecution), this would be a therapeutic effect.

Place the following instructions for the use of a Metered Dose Inhaler (MDI) without a spacer in the correct order: Tilt your head back and breathe out fully. Remove the inhaler cap and shake the inhaler. Open your mouth and place the mouthpiece 1 to 2 inches away from the mouth. Press down firmly on the canister and breathe deeply through the mouth. Hold your breath for at least 10 seconds. Wait at least 1 minute between puffs.

Remove the inhaler cap and shake the inhaler. Open your mouth and place the mouthpiece 1 to 2 inches away from the mouth. Tilt your head back and breathe out fully. Press down firmly on the canister and breathe deeply through the mouth. Hold your breath for at least 10 seconds. Wait at least 1 minute between puffs.