Exam 2

A client is taking aspirin (ASA) for arthritis. The nurse will advise the client to take the medication 1. with a glass of milk. 2. with other medications. 3. with orange juice at bedtime. 4. on an empty stomach in the morning.

(1) Global Rationale: Aspirin is an acid, which can cause GI distress, so it is best to take it with milk or food. Several medications can interact with aspirin. Orange juice is highly acidic, and so can increase the risk for GI distress. Taking aspirin on an empty stomach can increase the risk of gastric acid production.

Which laboratory tests will be performed to determine whether a specific bacterium is resistant to a specific drug? 1. Culture and sensitivity test 2. Complete blood count 3. Blood urea nitrogen 4. Urinalysis

(1) Global Rationale: Culture and sensitivity is the examination for a specific organism and can determine the correct medication. Complete blood count, blood urea nitrogen, and urinalysis would not determine the specific drug for the specific organism.

Following surgery, a client is placed on cefotaxime (Claforan). The assessment for possible adverse effects should include observing for 1. diarrhea. 2. headache. 3. constipation. 4. tachycardia.

(1) Global Rationale: Diarrhea is a frequent adverse effect of cephalosporins. Headache is not an adverse effect. Diarrhea, not constipation, is a common problem. Tachycardia is not an adverse effect.

The elderly client receives diphenhydramine (Benadryl) for allergies. The nurse completes medication education and evaluates that learning has occurred when the client makes which statement? 1. "Drowsiness is common but should lessen within a few doses." 2. "If this medication makes my nose run, I can use a nasal spray." 3. "I need to watch my intake of sodium with this medication." 4. "I cannot take this medication with pseudoephedrine (Sudafed)."

(1) Global Rationale: Drowsiness is a common adverse effect of antihistamines. The client should develop a tolerance to this effect within a few doses. Antihistamines would dry the nasal secretions, not increase them. Sodium intake is not related to antihistamines. Pseudoephedrine (Sudafed) is commonly used with antihistamines.

The client has been taking hydrocortisone (Cortef) for a month and abruptly stops it. What will the best assessment by the nurse include? 1. Fatigue and anorexia 2. Hyperglycemia and depression 3. Dilated pupils and auditory hallucinations 4. Tachycardia and weight gain

(1) Global Rationale: Glucocorticoids must be discontinued gradually. Abrupt withdrawal can result in acute lack of adrenal function. Fatigue and anorexia are signs of adrenal insufficiency. Hyperglycemia, depression, dilated pupils, auditory hallucinations, tachycardia, and weight gain are not signs of adrenal insufficiency.

The clinic nursing manager reviews histamine receptors with the clinic staff and evaluates that further instruction is needed when a staff member makes which statement? 1. "H1-receptors are found in the stomach." 2. "H1-receptors are responsible for allergic symptoms." 3. "H2-receptors increase mucus secretion in the stomach." 4. "H2-receptors are responsible for peptic ulcers."

(1) Global Rationale: H2-receptors are found in the stomach. The histamine receptors responsible for allergic symptoms are called H1-receptors. H2-receptors increase mucus secretion in the stomach. H2-receptors are responsible for peptic ulcers.

The client is prescribed amoxicillin (Amoxil) for 10 days to treat strep throat. After 5 days, the client tells the nurse he plans to stop the medication because he feels better. What is the best response by the nurse? 1. "If you stop the medicine early, you have not effectively killed out the bacteria making you sick." 2. "You should get another throat culture if your symptoms return." 3. "If you stop the medicine early, this could result in resistance to the antibiotic." 4. "You should get another throat culture to see if the infection is gone."

(1) Global Rationale: If all the medication is not taken, there is a strong possibility that not all bacteria have been eliminated. Another throat culture is inappropriate; the client must finish the medication. Stopping the medicine early can result in resistance to the antibiotic, but the client may not care about this unless he can see how it directly affects him. Another throat culture is inappropriate; the client must finish the medication.

The client receives beclomethasone (Beconase) intranasally as treatment for allergic rhinitis. He asks the nurse if this drug is safe because it is a glucocorticoid. What is the best response by the nurse? 1. "Intranasal glucocorticoids produce almost no serious adverse effects." 2. "Intranasal glucocorticoids are safe if you do not swallow any while using them." 3. "Intranasal glucocorticoids are safe if they are not used too long." 4. "Intranasal glucocorticoids are safe only if used once a day."

(1) Global Rationale: Intranasal glucocorticoids produce almost no serious adverse effects. Swallowing glucocorticoids used for intranasal application could potentially cause reactions, but large amounts would need to be swallowed. This option states they are dangerous if swallowed in any quantity. There is no time frame for the use of intranasal glucocorticoids; they produce almost no serious adverse effects. Intranasal glucocorticoids may be used more than once a day; they produce almost no serious adverse effects.

The physician has ordered ipratropium (Atrovent) for the client. What is a priority assessment question for the nurse to ask prior to administering this medication? 1. "Are you allergic to soy?" 2. "Do you have diabetes mellitus?" 3. "Do you have seizures?" 4. "Do you have gout?"

(1) Global Rationale: Ipratropium (Atrovent) is contraindicated in patients with hypersensitivity to soy as soya lecithin is used as a propellant in the inhaler. Anticholinergic drugs do not impact glucose levels, so having diabetes mellitus is not a concern. Anticholinergic drugs do not affect seizure disorders; this is not a concern. Anticholinergic drugs are not contraindicated in clients with gout.

Treatment of tuberculosis usually involves 1. the use of two or more drugs at the same time. 2. surgical removal of tubercular lesions. 3. keeping the client hospitalized. 4. the use of a single drug.

(1) Global Rationale: Multidrug therapy for 6-12 months is the usual pharmacotherapy for tuberculosis. Surgery is not the treatment. It is not necessary to keep the client in the hospital. Use of a single drug is not usual.

A client receives theophylline (Theo-Dur) and calls the clinic to say he has had nausea and vomiting for 2 days. What is the best action by the nurse? 1. Tell the client to come to the clinic for an assessment. 2. Ask the client if he has eaten at any unclean restaurants. 3. Ask the client if he has been exposed to anyone with the flu. 4. Recommend that the client begin a clear liquid diet.

(1) Global Rationale: Nausea and vomiting are symptoms of theophylline toxicity; the client needs to come to the clinic for an assessment. Food poisoning could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity. Flu could be the cause of the client's symptoms, but he needs to be assessed for theophylline toxicity. A clear-liquid diet might help, but the client needs to be assessed for theophylline toxicity.

The nurse teaches clients with rheumatoid arthritis about the side effects of nonsteroidal anti-inflammatory drugs (NSAIDs). The nurse evaluates that education has been effective when the clients make which statement? 1. "Blood tests may be necessary to monitor for side effects of this drug." 2. "We must be careful about falling with this medication because it can cause drowsiness." 3. "We must take the medicine just as the doctor said to take it." 4. "We must be sure and keep all scheduled doctors' appointments."

(1) Global Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause bleeding, so blood tests must be monitored. Nonsteroidal anti-inflammatory drugs (NSAIDs) do not cause sedation, so falling is not a concern. Taking the medication as prescribed is important, but this does not address the side effects. Keeping scheduled doctors' appointments is important, but this does not address the side effects.

The nurse teaches the client about the difference between oral and nasal decongestants. The nurse evaluates that learning has been effective when the client makes which statement? 1. "Oral decongestants can cause hypertension." 2. "Intranasal decongestants are safe to use for a month, if needed." 3. "Oral and nasal decongestants can cause rebound congestion." 4. "Oral decongestants are the most effective at relieving severe congestion."

(1) Global Rationale: One of the side effects of oral decongestants is hypertension. Intranasal decongestants should not be used for longer than 3 to 5 days. Oral decongestants do not cause rebound congestion; nasal decongestants can cause rebound congestion. Intranasal, not oral, decongestants are the most effective at relieving severe congestion.

The client is very frustrated that pseudoephedrine is no longer stocked on pharmacy shelves. The client does not like to go to the pharmacy counter to obtain the drug. What is the best response by the nurse? 1. "This is frustrating, but hopefully it will decrease the amount of methamphetamine being produced." 2. "This is frustrating, but hopefully it will decrease the amount of inhaled heroin being produced." 3. "This is frustrating, but hopefully it will decrease the amount of methylphenidate being produced." 4. "This is frustrating, but hopefully it will decrease the amount of crack cocaine being produced."

(1) Global Rationale: Pseudoephedrine (Sudafed) is a major ingredient in the production of methamphetamine. It is not used in manufacture of heroin, methylphenidate, or crack cocaine.

Which finding is a sign or symptom of inflammation? 1. Redness 2. Cyanosis 3. Dizziness 4. Cold skin

(1) Global Rationale: Redness occurs from antigen reaction. Cyanosis and dizziness are not signs of inflammation. Warm skin, not cold skin, is a sign of inflammation.

The client tells the nurse that the doctor told him his antibiotic did not kill his infection but just slowed its growth. The client is anxious. What is the best response by the nurse to decrease the client's anxiety? 1. "This is okay because your body will help kill the infection too." 2. "This is okay because your doctor is an infectious disease specialist." 3. "This is okay because your blood work is being monitored daily." 4. "This is okay because your infection is not really that serious."

(1) Global Rationale: Some drugs do not kill the bacteria but instead slow their growth and depend on the body's natural defenses to dispose of the microorganisms. These drugs, which slow the growth of bacteria, are called bacteriostatic. Telling the client that the doctor is a specialist does not answer the question and will increase anxiety. Telling the client that his blood work is being monitored does not answer the question and will increase anxiety. Telling a client with an infection that the infection is not serious will increase anxiety because, to the client, all infections are serious.

The client receives prednisone as treatment for his inflammatory disease. He has experienced great relief and asks the nurse if he can just keep taking this medication. What is the best response by the nurse? 1. "No, because this medication has serious adverse effects." 2. "No, your doctor said the best treatment for your illness is to alternate medications." 3. "No, your body would get used to it and it would lose its effectiveness." 4. "No, because your illness is in remission and you don't need medication now."

(1) Global Rationale: Systemic glucocorticoids are reserved for the short-term treatment of severe disease because of potentially serious adverse effects. Medications are alternated due to the serious effects of glucocorticoids, not because this is the best treatment for the illness. The body does not get used to systemic glucocorticoids. There is no evidence that the client's illness is in remission.

Antihistamines block the actions of histamine at the 1. H1 receptor site. 2. B1 receptor site. 3. B2 receptor site. 4. C1 receptor site.

(1) Global Rationale: The H1 receptor site is the site for blocking histamine with the use of antihistamines. B1, B2, and C1 are not receptor sites that play a role in blocking histamine.

Pathogenicity is different than virulence in that pathogenicity can 1. lead to the ability of organisms to cause infection. 2. kill pathogens. 3. cause a disease when pathogens are present. 4. disrupt cell lining.

(1) Global Rationale: The ability of an organism to cause infection is its pathogenicity. Medications that can kill bacteria are called bacteriocidal. A highly virulent microbe is one that can produce disease when present in minute numbers. Cell lining is not disrupted in this process.

The client receives albuterol (Proventil) via inhaler. He asks the nurse why he can't just take a pill. What is the best response by the nurse? 1. "When you inhale the drug the blood supply in your lungs picks it up rapidly, resulting in quicker effects." 2. "Because pills cannot help your illness; you must have inhaled medications for relief of symptoms." 3. "Because pills would produce too many side effects; you will have very few side effects with inhaled medications." 4. "Because this medication cannot be absorbed from your GI tract; the acid in your stomach would destroy it."

(1) Global Rationale: The respiratory system offers a rapid and efficient mechanism for delivering drugs. The enormous surface area of the bronchioles and alveoli, and the rich blood supply to these areas, results in an almost instantaneous onset of action for inhaled substances. Albuterol (Proventil) can be given orally (PO) but has a faster onset of action if inhaled. Inhaled medications also produce side effects. Oral medications are effective with some symptoms of respiratory disorders, but inhaled medications work faster.

The client has MRSA and receives vancomycin (Vancocin) intravenously (IV). The nurse assesses an upper body rash and decreased urine output. What is the nurse's priority action? 1. Hold the next dose of vancomycin (Vancocin) and notify the physician. 2. Obtain a stat X-ray and notify the physician. 3. Administer an antihistamine and notify the physician. 4. Obtain a sterile urine specimen and notify the physician.

(1) Global Rationale: Upper body rash and decreased urine output are most likely symptoms of vancomycin (Vancocin) toxicity, so the medication should be held and the physician notified. There is no reason to obtain a chest x-ray. The nurse should collaborate with the physician regarding medications for treatment of this situation. The client's symptoms are most likely not due to a urinary tract infection, so a sterile urine specimen is not indicated.

The nurse is providing disease management education for a patient who has just been diagnosed with asthma. The nurse provides which information? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Drink additional fluids. 2. Eat small, frequent meals. 3. Sleep in a warm room. 4. Do all activity early in the morning and rest in the afternoon. 5. Avoid foods high in protein.

(1,2) Global Rationale: Drinking sufficient fluids will help to liquefy and mobilize mucus. Small, frequent meals of calorie and nutrient dense foods help to prevent fatigue and maintain nutrition. Cooler room temperatures make breathing easier. Activities and rest should be alternated and balanced. There is no need to avoid foods high in protein.

A patient reports that he has been taking aspirin to treat the muscle pain that results from his new walking routine. The nurse would be concerned about this treatment plan if the patient has which history? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Myocardial infarction at age 61 2. Helicobacter pylori infection treatment last month 3. No influenza vaccine in last 2 years 4. Mild hypertension 5. History of migraine headaches

(1,2) Global Rationale: Patients over age 60 or who have Helicobacter pylori infection are at higher risk of aspirin-induced GI bleeding. There is no association between lack of influenza vaccine, mild hypertension, or migraine headache and use of aspirin.

A patient presents with an intermittent fever of unknown origin. The nurse reviews the patient's medication history and identifies which medications that may be implicated in fever? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Paroxetine (Paxil) 2. Chlorpromazine (Thorazine) 3. Vitamin E 4. Metformin (Glucophage) 5. Furosemide (Lasix)

(1,2) Global Rationale: SSRIs may result in high fever. Conventional antipsychotic drugs can result in neuroleptic malignant syndrome. Vitamin E does not cause fever. Metformin does not directly cause fever. Furosemide does not cause fever.

The patient has been prescribed oxymetazoline (Afrin). What medication information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Be certain to wash your hands after using this spray." 2. "Do not swallow any medication that drips into your mouth." 3. "It may take several days before this medication is effective." 4. "Do not drink grapefruit juice while taking this medication." 5. "Take this medication exactly as directed as there is no antidote if you overdose."

(1,2) Global Rationale: The patient should carefully wash hands after administration to prevent inadvertent exposure of the eyes. The patient may develop systemic effects if extra medication is swallowed. The drug works quickly and should not be used for long periods of time. There is no reason for the patient to avoid grapefruit juice. While there is no specific treatment for overdose, there is no reason to alarm the patient. Instructions are easy to follow, and overdose is very unlikely.

A patient says, "I have such bad seasonal allergies. Is there anything I can take to keep them from happening?" What information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Some antihistamines can help prevent onset of allergies." 2. "Some patients find that intranasal corticosteroids help prevent their allergies." 3. "Drugs that are mast cell stabilizers may help you avoid your seasonal allergies." 4. "Oral decongestants can help you prevent allergies." 5. "Nasal decongestants are very good at preventing allergic response."

(1,2,3) Global Rationale: Antihistamines, intranasal corticosteroids, and mast cell stabilizers are "preventers" of allergies. Oral and nasal antihistamines are "relievers" of allergic symptoms.

A patient has been prescribed a second 10-day course of a corticosteroid. The nurse should provide which medication education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Make certain you do weight-bearing exercises at least three times each week." 2. "Weigh yourself every day." 3. "Let us know if you development a fever." 4. "Monitor the color of your urine." 5. "If you feel jittery or anxious, discontinue the medication."

(1,2,3) Global Rationale: Corticosteroid may affect bone density. Weight-bearing exercises help to prevent this effect. Corticosteroids may result in fluid retention. Daily weights help to monitor this effect. Corticosteroids can result in immune depression. Urine color is not affected. The patient should not abruptly discontinue this medication. This is the second of two 10-day courses.

The client experienced a sports-related injury to his leg. During the morning assessment, what signs of inflammation will the nurse most likely assess? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Swelling 2. Pain 3. Warmth 4. Pallor 5. Pitting edema

(1,2,3) Global Rationale: Swelling, pain, and warmth are signs of inflammation. Pallor is not a sign of inflammation; redness is. Pitting edema is not a sign of inflammation.

A client presents with a rash and is prescribed an over-the-counter ointment for treatment. The client says, "I thought I would need a shot or an expensive prescription." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Medications that go on your skin don't usually have as many side effects." 2. "Mild rashes often respond well to topical ointments." 3. "Many of the products used on the skin are available over-the-counter." 4. "You should try to discover what caused your rash." 5. "Prescription ointments are usually better at healing."

(1,2,3,4) Global Rationale: Topical drugs should be used when applicable because they cause few adverse effects. Inflammation of the skin is best treated with topical medication if possible. Many products used on the skin are fairly inexpensive and are available over-the-counter. Inflammation is not a disease but is a symptom. The cause of the inflammation should be identified and treated. In this case, the client should avoid the offending substance. Many over-the-counter anti-inflammatory medications exist and do a good job of helping the client heal.

The nurse is explaining inflammation to a patient who has Crohn's disease. Which information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. When cells are damaged nearby vessels get bigger. 2. The vessels in the area allow fluids to escape. 3. Inflammation produces pus. 4. Inflammation causes bleeding and inability to clot. 5. Inflammation causes pain.

(1,2,3,5) Global Rationale: Histamine and other chemical mediators are released and result in vasodilation. Vessels become more permeable. Pus develops from cellular infiltration and death of white cells. Inflammation damages tissues, stimulating nerve endings and causing pain. Clots form in vessels involved in inflammation.

The nurse is providing community education regarding ways to reduce development of antibiotic resistance. Which information should be included? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The best way to prevent antibiotic resistance is to prevent infections from occurring. 2. Do not expect to receive an antibiotic prescription for colds and influenza. 3. Take the full amount of any prescribed medication. 4. Go to the doctor as soon as you feel ill. 5. Use good infection control measures.

(1,2,3,5) Global Rationale: It is much easier to prevent infection than it is to treat an infection. It is not necessary to treat every respiratory illness with antibiotics. Most are viral and do not respond to antibiotics. Stopping antibiotic therapy prematurely allows some pathogens to survive. The ones that survive are the strongest pathogens. Preventing transmission of illnesses is essential. Not all illnesses require physician intervention.

The client has allergic rhinitis and asks the nurse what causes this. How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "It can occur after exposure to animal dander." 2. "Tobacco smoke causes it in some people." 3. "Exposure to pollens from weeds and grass causes an allergic response in some people." 4. "It is caused by asthma." 5. "You inherited the predisposition for this."

(1,2,3,5) Global Rationale: One of the causative factors for allergic rhinitis is animal dander. Tobacco smoke causes the allergic rhinitis reaction in some people. Allergic response to pollen can cause allergic rhinitis in some people. There is a strong genetic predisposition for allergic rhinitis. Although associated with asthma, allergic rhinitis is not caused by asthma.

A patient has been prescribed a short course of high dose aspirin. The nurse would educate the patient to monitor for which findings associated with salicylism? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Tinnitus 2. Excessive sweating 3. Cold chills 4. Headache 5. Bloating

(1,2,4) Global Rationale: Ringing in the ears, excessive sweating, and headache are findings associated with salicylism. Cold chills and bloating do not occur with salicylism.

A patient has been prescribed benzonatate (Tessalon). What medication education should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "This medication should help relieve your cough." 2. "Do not chew this medication." 3. "This medication may increase your blood pressure." 4. "You may be nauseated when taking this medication." 5. "Don't be surprised if you develop headache while taking this medication."

(1,2,4,5) Global Rationale: Benzonatate is used as an antitussive. If chewed, this drug can cause the side effect of numbing the mouth and pharynx. Nausea and headache are possible effects of this medication. Hypertension is not an effect of this medication.

A patient has been prescribed ciprofloxacin (Cipro) for a severe sinus infection. The nurse evaluates that medication education has been effective when the patient makes which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I should avoid milk while taking this medication." 2. "I should avoid coffee while taking this medication." 3. "If this medication upsets my stomach, I can take it with an antacid." 4. "I may have some diarrhea while taking this medication." 5. "If my stomach gets upset, I should take this medication with food."

(1,2,4,5) Global Rationale: Dairy products can decrease the absorption of ciprofloxacin. Ciprofloxacin can increase serum levels of caffeine. Diarrhea can occur while taking ciprofloxacin. Ciprofloxacin may be administered with food to diminish adverse GI effects. Antacids can diminish drug absorption.

The patient has been prescribed dextromethorphan (Delsym) What medication information should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Do not smoke while using this drug." 2. "Do not drink alcohol while using this drug." 3. "This drug takes an hour or so to take effect." 4. "Do not drink grapefruit juice while taking this medication." 5. "If you notice your speech is slurred, stop taking the medicine and call the clinic."

(1,2,4,5) Global Rationale: Pulmonary irritants such as smoking should be avoided as drug effectiveness may be decreased. Sedation may occur if this drug is used concurrently with alcohol. Grapefruit juice may raise serum levels of dextromethorphan and cause toxicity. Slurring speech may indicate CNS toxicity is occurring. The drug works in about 15 to 30 minutes.

A 16-year-old patient is admitted to the emergency room after attempting to commit suicide by overdosing on the isoniazid (INH) prescribed for newly diagnosed tuberculosis. What information does the nurse provide to the family? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. INH overdose is very serious. 2. Large amounts of intravenous lipids will be administered. 3. Treatment will include infusion of vitamin B6. 4. Liver damage may occur. 5. Oral aspirin will be given as an antidote.

(1,3,4) Global Rationale: INH is very serious and may be fatal. Treatment includes infusion of vitamin B6. INH may damage the liver, even in recommended dosages. There is no indication for large amounts of intravenous lipids. Oral aspirin is not the antidote for INH overdose.

The client receives beclomethasone (Beconase). What will the best assessment by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Assess the client's mouth for any sign of fungal infection. 2. Assess the client's blood glucose prior to administration of nasal spray. 3. Assess if the client has blown his nose prior to administration of nasal spray. 4. Assess if the client has had a change in taste. 5. Assess the client for any hoarseness or change in voice.

(1,3,4,5) Global Rationale: Clients may develop candidiasis so the mouth should be assessed. The client should gently blow the nose prior to use to clear the nasal passages. Clients may experience a change in taste. Clients may experience a change in voice as a local effect. There is no need to assess the client's blood glucose.

The client is prescribed a nasal decongestant spray. What information should the nurse include when educating the client about how to use this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Blow your nose immediately before using the medication." 2. "Drink a full glass of water immediately before using this spray." 3. "Limit your use of this spray to no more than 5 days." 4. "Since you are using more than one type of nasal spray, be sure to wait 5-10 minutes between administrations." 5. "You should spit out any excess spray that drains into your mouth."

(1,3,4,5) Global Rationale: The nasal passages should be cleared by blowing the nose immediately before the medication is administered. Nasal decongestant sprays should not be used for more that 3-5 days. The client should wait 5-10 minutes between administering different nasal sprays to allow the first medication some time to work before the second one is used. Excess spray should not be swallowed as systemic effects may occur. Fluids should be increased, but it is not necessary to drink a glass of water immediately before using the spray.

Which client statement would the nurse evaluate as indicating the goal of treatment with an anti-inflammatory drug has been met? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "My fever went away yesterday." 2. "I've not been coughing up so much phlegm." 3. "The skin over my knee is red and hot to the touch." 4. "The pain in my shoulder is much relieved." 5. "My rash is spreading."

(1,4) Global Rationale: Fever reduction is a goal of treatment with anti-inflammatory drugs. Pain is a sign of inflammation. Reduction of pain indicates that the anti-inflammatory medication is working. Reduction of secretions is not a goal of treatment with anti-inflammatory drugs. Redness and heat are symptoms of inflammation. The therapy may not be working in this client. The goal of anti-inflammatory medications would be that the rash resolved. Since it is spreading, the goal has not been met.

The nurse plans to teach the client with acquired immune deficiency syndrome (AIDS) about bacterial infections. Which information should the nurse include in this teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "If just a few bacteria make you sick, this is virulence." 2. "Most bacteria have developed antibiotic resistance." 3. "Pathogens are divided into two classes, bacteria and viruses." 4. "Pathogenicity means the bacteria can cause an infection." 5. "Actually, most bacteria will not harm us."

(1,4,5) Global Rationale: A highly virulent microbe is one that can produce disease when present in minute numbers. The ability of an organism to cause infection is called pathogenicity. Only a few dozen pathogens commonly cause disease in humans; most are harmless. Antibiotic resistance is a problem; however, only a few, not most, bacteria have developed it. Human pathogens include viruses, bacteria, fungi, unicellular organisms, and multicellular animals.

A client has just been prescribed ibuprofen for a mild ankle sprain. Which health history information should alert the nurse to question this prescription? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client has asthma. 2. The client had a similar ankle strain a year ago. 3. The client reports getting a rash when eating strawberries. 4. The client is allergic to aspirin. 5. The client reports having a peptic ulcer 6 months ago.

(1,4,5) Global Rationale: Clients with asthma are more likely to have hypersensitivity to ibuprofen. Clients who have an allergy to aspirin are more likely to be hypersensitive to ibuprofen. Ibuprofen increases the risk of serious gastrointestinal bleeding, especially in someone with a recent history of this problem. There is no reason a previous injury would change the decision to prescribe ibuprofen. There is no cross-sensitivity between ibuprofen and strawberries.

A client is prescribed an intranasal corticosteroid. What should the nurse include in client education about this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "You may feel a burning sensation when using this drug." 2. "This drug will be most effective if used only when symptoms are present." 3. "Be careful of how hard you squeeze the container as you can inadvertently give yourself too much medication for one dose." 4. "This medication may dry out your nasal passages enough to cause nosebleed." 5. "Do not eat licorice while taking this drug."

(1,4,5) Global Rationale: The most frequently reported adverse effect of this drug is an intense burning sensation in the nose occurring immediately after spraying. Excessive drying of the nasal mucosa may occur, which leads to epistaxis. Licorice may potentiate the effects of corticosteroids. The drug often takes 1 to 3 weeks to achieve peak response and should be started in advance of expected need. The medications are provided in metered-spray devices.

The client receives multiple antibiotics to treat a serious infection. What will the priority assessment of the client by the nurse include? 1. Assessing blood cultures for the presence of bacteria 2. Assessing changes in stool, white patches in the mouth, and urogenital itching or rash 3. Assessing renal and liver function tests 4. Assessing whether or not the client has adequate food and fluid intake

(2) Global Rationale: A superinfection occurs when microorganisms normally present in the body, host flora, are destroyed by antibiotic therapy. A superinfection can be lethal and should be suspected if a new infection appears while the client is receiving antibiotics. Signs of superinfection commonly include diarrhea, white patches in the mouth, urogenital itching, and presence of a blistering itchy rash. Assessing blood cultures is important but not as important as assessing for superinfections. Assessing renal and liver function tests is very important but not as important as assessing for superinfections. Assessing food and fluid intake is very important but not as important as assessing for superinfections.

The physician orders acetaminophen (Tylenol) four time a day for a client with arthritis. The nurse would plan to validate which other order with the physician? 1. Heparin 5000 units subcutaneously every 8 hours 2. Warfarin (Coumadin) 2 mg orally every day 3. Penicillin G benzathine (Bicillin LA) 2.4 million units IM one time 4. Paroxetine (Paxil) 37.5 mg orally every day

(2) Global Rationale: Acetaminophen (Tylenol) inhibits warfarin (Coumadin) metabolism. Concomitant use of these two medications could result in a toxic accumulation of warfarin (Coumadin). There is no contraindication to the use of heparin, penicillin G benzathine (Bicillin LA), or paroxetine (Paxil) and acetaminophen (Tylenol).

A patient who reports severe seasonal allergies has been prescribed fluticasone (Flonase). The nurse providing medication information would collaborate with the prescriber if the patient makes which statement? 1. "I don't like licorice anyway." 2. "My kids all have that head cold that is going around school." 3. "Next appointment I want to talk about treatment for my psoriasis." 4. "I have been eating lots of fresh fruits."

(2) Global Rationale: Corticosteroids should not be used in patients with viral infections. Fluticasone (Flonase) should not be used concurrently with licorice ingestion. This will not be an issue since the patient does not like licorice. There is no contraindication to using this drug in patients with psoriasis. There is no contraindication to eating fresh fruits while taking this medication.

The client asks the nurse why she must continue taking her asthma medication even though she has not had an asthma attack in several months. What is the best response by the nurse? 1. "The medication needs to be taken indefinitely according to your doctor, so you should discuss this with him." 2. "The medication is still needed to decrease inflammation in your airways and help prevent an attack." 3. "The medication needs to be taken or your lungs will be severely damaged, and we will not be able to stop an acute attack." 4. "The medication needs to be taken for at least a year; then, if you have not had an acute attack, you can stop it."

(2) Global Rationale: Effective treatment of asthma includes long-term treatment to prevent attacks and decrease inflammation, as well as short-term treatment when an attack occurs. The nurse is able to answer the client's question; it does not need to be referred to the physician. Telling a client that his or her lungs will be severely damaged is non-therapeutic; the inability to prevent an acute attack in this client is not true. Long-term treatment of asthma continues indefinitely, not for just 1 year.

The nurse conducts group education for clients with seasonal allergies and teaches about the role of histamine. The nurse evaluates that the education has been effective when the clients make which statement? 1. "Histamine is inhibited by nonsteroidal anti-inflammatory drugs (NSAIDs). 2. "Histamine dilates the vessels in the nose, so it is congested and stuffy." 3. "Histamine constricts vessels, causing capillaries to become more permeable." 4. "Histamine is primarily stored in phagocyte cells in the skin."

(2) Global Rationale: Histamine dilates blood vessels causing capillaries to become more permeable. The affected area may become congested with blood. Nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit the synthesis of prostaglandins and do not affect histamine. Histamine dilates, not constricts, vessels, causing capillaries to become more permeable. Histamine is primarily stored in mast cells, not phagocyte cells.

The nurse plans to teach a class on acetaminophen (Tylenol) to mothers with young children. What will the best plan by the nurse include? 1. "It is best to give your child acetaminophen (Tylenol) with a high-carbohydrate meal." 2. "Read the labels of all over-the-counter (OTC) medications for the amount of acetaminophen (Tylenol) in them." 3. "Acetaminophen (Tylenol) will only need to be given once a day because it is long-lasting." 4. "It is okay to substitute a baby aspirin for acetaminophen (Tylenol) if you run out of acetaminophen (Tylenol)."

(2) Global Rationale: It is very easy for parents of young children to overdose them with acetaminophen (Tylenol). All medication labels should be read. There is no indication that Tylenol should be given with high-carbohydrate foods. The duration of action of acetaminophen (Tylenol) is only 3-4 hours. Aspirin is not recommended for children due to the possibility of Reye's syndrome.

The client receives a nonsteroidal anti-inflammatory drug (NSAID) for treatment of arthritis. What is a priority for the nurse to include when doing medication education? 1. "Constipation is common; include roughage in your diet." 2. "Drink at least eight glasses of water a day." 3. "Take your medication with food." 4. "Take your medication on an empty stomach."

(2) Global Rationale: Nonsteroidal anti-inflammatory drugs (NSAIDs) are nephrotoxic; keeping the client well hydrated will help prevent kidney damage. Constipation is not an issue with nonsteroidal anti-inflammatory drugs (NSAIDs). Taking the medication with food will decrease gastrointestinal (GI) irritation, but kidney damage is more of a priority. Taking the medication on an empty stomach will increase gastrointestinal (GI) irritation.

Oral decongestants differ from intranasal decongestants in that oral decongestants 1. are more effective at relieving severe congestion. 2. have more systemic effects. 3. can cause rebound congestion. 4. have high efficacy.

(2) Global Rationale: Oral decongestants can have more systemic effects. Oral decongestants are less effective at relieving severe congestion. Intranasal decongestants can cause rebound congestion after more than 5 days of use. Intranasal decongestants are higher in efficacy.

The nurse works in infection control and teaches a class to staff nurses about the ways that resistance to antibiotics can occur. The nurse evaluates that learning has occurred when the nurses make which statement? 1. "Resistance to antibiotics most often occurs when physicians prescribe too many of them for elderly clients." 2. "Resistance to antibiotics can occur by the common use of them for nosocomial infections." 3. "Resistance to antibiotics most often occurs when physicians prescribe too many of them for children with ear infections." 4. "Resistance to antibiotics can occur by the prophylactic use of them for preoperative clients."

(2) Global Rationale: The organisms that cause nosocomial infections have most likely been treated with antibiotics and are the most likely organisms to develop resistance to antibiotics. The use of antibiotics by physicians with elderly clients is not the major cause of antibiotic resistance. The use of antibiotics by physicians for children with ear infections is not the primary cause of antibiotic resistance. The prophylactic use of antibiotics does not promote antibiotic resistance.

The physician prescribes fluticasone (Flonase) for the client. The nurse would hold the drug and contact the physician with which assessment finding? 1. The client has diabetes mellitus. 2. The client is pregnant. 3. The client has glaucoma. 4. The client has hypertension.

(2) Global Rationale: This is a class C drug so effects on pregnancy are not known; the client should not receive this drug. There is no contraindication for use of this drug in a client who has diabetes mellitus, glaucoma, or hypertension.

The client receives multiple drugs for treatment of tuberculosis. The nurse teaches the client the rationale for multiple drug treatment and evaluates learning as effective when the client makes which statement? 1. "Current research indicates that the most effective way to treat tuberculosis is with multiple drugs." 2. "Multiple drugs are necessary because the bacteria are likely to develop resistance to just one drug." 3. "Treatment for tuberculosis is complex, and multiple drugs must be continued for as long as I am contagious." 4. "Multiple drug treatment is necessary for me to be able to develop immunity to tuberculosis."

(2) Global Rationale: Tuberculosis bacilli are likely to develop resistance to one drug, so multiple drugs must be used. Current research does support multiple drug treatment, but this does not explain the rationale for this to the client. Treatment must be continued long after the client is no longer contagious. Clients cannot develop immunity to bacterial infections.

The client is to receive an injection of penicillin G benzathine (Bicillin LA) in the outpatient clinic. What are the priority nursing actions prior to administering this injection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Have the client lie down and assess vital signs before she leaves. 2. Ask the client if she has ever had an allergy to penicillin before. 3. Inform the client that she will need to wait 30 minutes before leaving the clinic. 4. Inform the client that she must have someone drive her home. 5. Advise the client to rest for the remainder of the day.

(2,3) Global Rationale: It is always important to ask about allergies. The nurse must be aware, however, that no history of allergy does not guarantee there will not be an allergic response with this administration. It is important that the client be reassessed for development of allergic reaction before leaving the clinic. There is no reason to have the client lie down. It is not important to assess vital signs unless a problem has developed. There is no indication that the client will require someone else to drive her home. There is no specific reason the client should rest related to administration of penicillin.

A client has been prescribed trimethoprim-sulfamethoxazole (Septra) for treatment of a urinary tract infection. Which comments, made by the client, would the nurse discuss with the prescriber before allowing the client to leave the clinic? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "My husband and I plan to start a family as soon as possible." 2. "I forgot to take my potassium supplement today." 3. "Is it okay to take this with my warfarin?" 4. "It is so cloudy today." 5. "My 80-year-old mother is coming to visit today."

(2,3) Global Rationale: Potassium supplements should not be taken during therapy unless directed by the health care provider. Sulfa drugs may enhance the effects of oral anticoagulants. Sulfa drugs are contraindicated for use by women at term. Sulfa drugs can result in photosensitivity. There is no reason this visit should be of concern regarding the medication prescribed.

A client who has diabetes mellitus is diagnosed with tuberculosis and has been prescribed multiple-drug therapy. What instruction should the nurse provide to this client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. These medications can cause hypoglycemia, so you should always carry a sugar source. 2. Test your blood glucose more frequently while on these medications. 3. If your blood glucose levels elevate consistently, contact us. 4. Take your medication for diabetes at least 6 hours after taking these medications. 5. While on these medications, you will be more prone to infections in your feet.

(2,3) Global Rationale: These medications may cause hyperglycemia. The client should monitor blood glucose levels more closely. Constant elevation of blood glucose levels may warrant alteration in medication therapy for diabetes. There is no reason to separate the administration of these medications by 6 hours. There is no evidence that medications used to treat tuberculosis will increase the likelihood of infections in the feet.

The nurse is managing care for clients who will receive ibuprofen (Advil) for long-term therapy. What are the primary laboratory tests the nurse will assess prior to initiation of therapy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Electrolytes 2. Hemoglobin and hematocrit 3. Bleeding times 4. Liver function tests 5. Serum amylase

(2,3,4) Global Rationale: Ibuprofen may result in a decrease in hemoglobin and hematocrit. Baseline levels should be documented. Ibuprofen may increase bleeding times. Baseline values should be documented. AST and ALT may be increased so it is important to document baseline levels. There is no specific reason to monitor the clients' electrolytes. It is not necessary to draw baseline serum amylase levels.

A client presents with severe inflammation of the knee. The physician prescribes a corticosteroid and asks the client to return to the office in 10 days for follow-up. How does the nurse explain these instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "We need to check to see if this is the correct treatment." 2. "We need to re-examine the knee after a few days of treatment." 3. "Corticosteroids should only be taken for 1 to 3 weeks." 4. "You may be able to change to an NSAID at that visit." 5. "You may need a 3-month prescription for a stronger corticosteroid at that time."

(2,3,4) Global Rationale: It is necessary to see if the treatment is working. Corticosteroid therapy can have serious adverse effects if taken for extended periods of time. The client should be switched to an NSAID as quickly as possible. There is no evidence that treatment is not correct. Corticosteroid therapy should be discontinued after 1-3 weeks.

The nurse is teaching community education about the major functions of the upper respiratory tract. What will the best plan by the nursing instructor include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Inward airflow from the trachea branches off to the two bronchi. 2. The nose warms the air before it reaches the lungs. 3. The nasal mucosa is the first line of immunological defense. 4. Activation of the parasympathetic nervous system constricts arterioles in the nose. 5. Activation of the sympathetic nervous system constricts arterioles in the nose.

(2,3,5) Global Rationale: The nose warms the air before it reaches the lungs. The nasal mucosa is the first line of immunological defense. Activation of the sympathetic nervous system constricts arterioles in the nose. The trachea and bronchi are part of the lower respiratory tract. Activation of the sympathetic nervous system, not the parasympathetic nervous system, constricts arterioles in the nose.

A patient has recurrent skin infections. The nurse anticipates administering an aminopenicillin such as which drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Oxacillin 2. Ampicillin 3. Piperacillin 4. Amoxicillin 5. Dicloxacillin

(2,4) Global Rationale: Ampicillin and amoxicillin are broad-spectrum or aminopenicillins. Oxacillin and dicloxacillin are penicillinase-resistant penicillins. Piperacillin is an extended-spectrum penicillin.

A client receiving chemotherapy has a very low white blood cell count. Antibiotic therapy is initiated. What rationales should the nurse provide for the addition of this drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. You have an infection. 2. We would like to prevent you from developing any infections. 3. Chemotherapy often causes infections. 4. This antibiotic will help your chemotherapy fight off your cancer. 5. If you are developing an infection, this medication will help kill it out early.

(2,5) Global Rationale: Antibiotics are given to those with low WBCs to help prevent or lessen infections. Prophylactic antibiotics are given to kill bacteria while their numbers are small. There is no evidence of infection being present. The chemotherapy does not cause an infection, but does decrease immunity, allowing infection to occur. This antibiotic is not being given to kill cancer cells.

A client has been diagnosed with multidrug-resistant tuberculosis, and drug therapy has been initiated. The nurse evaluates that medication education has been effective when the patient says, "I can expect to take this medication for up to _____ months." Standard Text: Record your answer rounding to the nearest whole number.

(24) Global Rationale: Tuberculosis treatment requires long-term antibiotic therapy for up to 12 months. When the tuberculosis is multidrug-resistant, treatment may extend up to 24 months.

The nurse in the emergency department frequently sees clients who have overdosed on acetaminophen (Tylenol). Which client is at highest risk for developing hemolysis? 1. A Native American client 2. A Jewish client 3. An African American client 4. A Caucasian client

(3) Global Rationale: African Americans have higher rates of G6PD enzyme deficiency. Clients with this deficiency are at risk for developing hemolysis after ingestion of certain drugs, including acetaminophen (Tylenol). Native Americans, Jewish clients, and Caucasians are not known to have a G6PD enzyme deficiency so they are not at risk for developing hemolysis after ingestion of acetaminophen (Tylenol).

The physician orders cefepime (Maxipime) for a client. What is a priority question for the nurse to ask the client prior to administration of this drug? 1. "Are you breastfeeding?" 2. "Are you pregnant?" 3. "Are you allergic to penicillin?" 4. "Are you allergic to tetracycline?"

(3) Global Rationale: Cephalosporins are contraindicated in clients who have experienced a severe allergic reaction to penicillin. Cefepime (Maxipime) is a Pregnancy Category B drug and is safe to use while pregnant or breastfeeding. Cephalosporins are not contraindicated in clients who have experienced an allergic reaction to tetracycline.

The client has experienced a sports-related injury. He asks the nurse how long it will take for him to respond to treatment. What is the best response by the nurse? 1. "With proper care, it will take about a month for symptoms to resolve." 2. "It will depend on your response to the medications." 3. "It will take about a week and a half for symptoms to resolve." 4. "The inflammatory process is too complex to predict a time frame for healing."

(3) Global Rationale: During acute inflammation, 8 to 10 days are normally needed for the symptoms to resolve and repair to begin. A month is longer than it takes for acute symptoms to resolve. Medications will relieve some symptoms, but the time frame for repair to begin is the same. The inflammatory process is complex, but the time frame is still 8 to 10 days.

Which finding is a common adverse effect of anti-inflammatory drugs, such as ibuprofen? 1. Diarrhea 2. Palpitations 3. Heartburn 4. Hypotension

(3) Global Rationale: Heartburn and other GI upset are common adverse effects of these drugs. Diarrhea, palpitations, and hypotension are not common adverse effects.

The drug that would most likely be used in the treatment of tuberculosis is 1. Erythromycin (E-mycin). 2. Vancomycin (Vancocin). 3. Isoniazid (INH). 4. Gentamicin (Garamycin).

(3) Global Rationale: Isoniazid (INH) is the drug of choice for anti-tuberculosis therapy. Erythromycin is most effective against gram-positive bacteria. Vancomycin is used for bactericidal reasons. Gentamicin is used for bactericidal reasons.

After the client begins taking glucocorticoid medications, the nurse would observe for adverse effects of 1. hypoglycemia. 2. hypotension. 3. bruising. 4. weight loss.

(3) Global Rationale: Long-term glucocorticoid use can result in easier bruising. Hyperglycemia, not hypoglycemia, can occur. Hypertension, not hypotension, can occur as a result of Cushing's syndrome. Weight gain, not weight loss, can occur.

The nurse plans care for an older adult receiving nonsteroidal anti-inflammatory drug (NSAID) therapy. What is the best outcome for this client as it relates to side effects of nonsteroidal anti-inflammatory drugs (NSAIDs)? 1. The client will refrain from taking other medications with the nonsteroidal anti-inflammatory drug (NSAID). 2. The client will avoid the use of caffeine while taking the nonsteroidal anti-inflammatory drug (NSAID). 3. The client will report any bleeding or bruising while taking the nonsteroidal anti-inflammatory drug (NSAID). 4. The client will report any mood changes while taking the nonsteroidal anti-inflammatory drug (NSAID).

(3) Global Rationale: Older adults are at risk for increased bleeding with nonsteroidal anti-inflammatory drug (NSAID) therapy. Older adults are often on several medications, and refraining from taking them with nonsteroidal anti-inflammatory drugs (NSAIDs) is an unrealistic outcome. There is no reason for avoiding use of caffeine while using a nonsteroidal anti-inflammatory drug (NSAID). Mood changes are not a side effect of nonsteroidal anti-inflammatory drug (NSAID) therapy.

Centrally acting antitussives, such as opioids, are used to 1. decrease nasal congestion. 2. break down mucus. 3. relieve severe cough. 4. relieve mild cough.

(3) Global Rationale: Opioids relieve severe cough. Decongestants decrease congestion. Expectorants break down mucus. Mild coughs do not require an antitussive.

Which assessment finding, by the nurse, is a priority concern when a client receives pseudoephedrine (Sudafed)? 1. Temperature of 100°F 2. Respiratory rate of 22 3. Heart rate 82 and irregular 4. Complaints of a dry mouth

(3) Global Rationale: Pseudoephedrine may cause dysrhythmias. A high temperature, respiratory rate of 22, or a dry mouth is possible with pseudoephedrine but is not the primary concern.

Discharge planning for the client prescribed tetracycline will include which instruction? 1. Take the medication with antacids. 2. Take the medication with iron supplements. 3. Do not take the medication with milk. 4. Decrease the amount of vitamins.

(3) Global Rationale: Tetracycline effectiveness can be decreased by using milk products. Antacids can decrease the effectiveness of tetracycline. Iron can decrease the effectiveness of tetracycline. It is not necessary to decrease vitamins.

The nurse teaches a group of clients with arthritis about the use of ibuprofen (Motrin), emphasizing the maximum daily amount. The nurse evaluates that education has been most effective when the clients make which statement? 1. "We cannot take over 4000 mg/day." 2. "We cannot take over 3600 mg/day." 3. "We cannot take over 3200 mg/day." 4. "We cannot take over 3000 mg/day."

(3) Global Rationale: The maximum amount of ibuprofen (Motrin) to be taken in 24 hours is 3200 mg.

The nurse presenting community education about the structures of the upper respiratory tract (URT) would include which function? 1. Air cooling 2. Sympathomimetic conditioning 3. Air conditioning 4. Drying

(3) Global Rationale: These structures warm, humidify, and clean the air in a process sometimes referred to as "air conditioning." The air is not cooled or dried by these structures. Sympathomimetic is a class of drugs.

A client is placed on aspirin. A toxic reaction to this medication that the nurse will teach the client to report is 1. blurred vision. 2. muscle cramps. 3. tinnitus. 4. joint pain.

(3) Global Rationale: Tinnitus, or ringing in the ears, is a common early sign of aspirin toxicity. Blurred vision, muscle cramps, and joint pain are not signs of aspirin toxicity.

The student nurse asks the nursing instructor for help with her microbiology class. The student is studying bacteria. What does the best instruction by the nursing instructor include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Bacteria are either aerobic or anaerobic. 2. Bacteria are multicellular organisms. 3. E. coli are gram-negative bacteria. 4. Gram-staining is one way to identify bacteria. 5. Spherical-shaped bacteria are called cocci.

(3,4,5) Global Rationale: E. coli are gram-negative bacteria. Gram-staining is one way to identify bacteria. Spherical-shaped bacteria are called cocci. Some organisms have the ability to change their metabolism and survive in either aerobic or anaerobic conditions. Bacteria are single-celled organisms.

A client has been prescribed the opioid combination drug Novahistine DM for control of cough. This drug contains codeine, phenylephrine, and chlorpheniramine. Which instructions should the nurse provide as part of medication education? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Drink a full glass of water when taking this medication." 2. "Keep this medication at your bedside so you can take it as needed." 3. "Take this drug exactly as indicated." 4. "If you have head or body aches you may take any over-the-counter analgesic." 5. "Do not make important decisions or operate machinery while taking this drug."

(3,4,5) Global Rationale: Taking too much of this drug can cause oversedation. The client can take an over-the-counter analgesic. The hydrocodone component of this drug will make the client drowsy and may impact the ability to make decisions. The medication should be taken without water, and the client should not drink anything for 30-60 minutes. Hydrocodone is an opioid with the adverse effect of drowsiness. The client may inadvertently overdose if taking as needed or if taking doses while drowsy.

The client receives ipratropium (Atrovent) via inhalation for the treatment of chronic asthma. The nurse plans to do medication education with the client. What will the best plan by the nurse include? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Wait 15 minutes before using any other inhaled medications. 2. The medication may also be used for acute asthma attacks. 3. Report any increased dyspnea. 4. Report any changes in urinary pattern. 5. Use the medication consistently, not occasionally.

(3,4,5) Global Rationale: The client should be advised to report any symptoms of deteriorating respiratory status such as increased dyspnea. Anticholinergic drugs can result in urinary retention, and the client should report any changes in urinary patterns. To get the most benefit from ipratropium (Atrovent), it must be used consistently. It is only necessary to wait 2-3 minutes, not 15 minutes, between inhaled medications. Anticholinergic drugs will not terminate an acute asthma attack, as peak effects may take 1 to 2 hours.

A client comes to the emergency department with a fever of 104°F. The nurse anticipates which actions to help identify the correct antibiotic? 1. Obtaining liver and renal function tests. 2. Obtaining a complete blood count (CBC) test. 3. Obtaining a sterile urine specimen. 4. Obtaining blood for culture and sensitivity.

(4) Global Rationale: A high fever is usually indicative of a systemic infection. Blood cultures are the best way of identifying the causative organism. Liver and renal function tests will not identify the causative organism. The CBC will reveal the impact of infective agents on the immune system but will not identify the agent. Obtaining a urine specimen is not the best method of determining this client's infective agent.

A client comes to the emergency department complaining of a sore throat. He has white patches on his tonsils, and he has swollen cervical lymph nodes. What will the best plan by the nurse include? 1. Plan to administer a narrow-spectrum antibiotic. 2. Plan to administer a broad-spectrum antibiotic. 3. Plan to obtain blood cultures. 4. Plan to obtain a throat culture.

(4) Global Rationale: A throat culture is necessary to identify the causative organism and initiate the best antibiotic treatment. Initial therapy with a narrow-spectrum antibiotic is too specific without knowing the causative organism. A broad-spectrum antibiotic is commonly ordered, but a throat culture should be obtained first. Blood cultures are not necessary at this point because the infection is in the throat; it is not systemic.

Which over-the-counter (OTC) antihistamine combination contains an analgesic property? 1. Sudafed PE Sinus and Allergy 2. Triaminic Cold/Allergy 3. Tavist Allergy 12-hour 4. Actifed Plus

(4) Global Rationale: Actifed Plus contains acetaminophen. Sudafed PE Sinus and Allergy contains chlorpheniramine and phenylephrine. Triaminic Cold/Allergy contains chlorpheniramine and phenylephrine. Tavist Allergy 12-hour contains clemastine.

What is the action of bactericidal drugs? 1. They disrupt normal cell function. 2. They will slow the growth of the bacteria. 3. They have a high potency. 4. They will kill the bacteria.

(4) Global Rationale: Bactericidal drugs kill the bacteria. They do not disrupt normal cell function. Bacteriostatic drugs slow the growth of bacteria. Potency is related to the properties of resistance.

A mother asks the nurse when she should give her child cough medicine. What is the best response by the nurse? 1. "When he is coughing up green secretions." 2. "When he has a temperature over 102°F." 3. "When he has bronchitis." 4. "When he has a dry cough and cannot rest."

(4) Global Rationale: Dry, hacking, and nonproductive cough is irritating to the membranes of the throat and deprives the client of much needed rest, so a cough medicine would be warranted in this case. If the client is coughing up green secretions, he needs to receive an antibiotic, not cough medicine. The child needs to clear these secretions so a cough suppressant would not be used. If a client is febrile, he needs an assessment prior to receiving cough medication. It is not desirable to suppress the cough reflex in a client with bronchitis; the child should not receive cough medicine.

The nurse teaches a medication class on bronchodilators for clients with asthma. The nurse evaluates that learning has occurred when the clients make which statement? 1. "The medication widens the airways because it decreases the production of mucus that narrows them." 2. "The medication widens the airways because it decreases the production of histamine that narrows them." 3. "The medication widens the airways because it acts on the parasympathetic nervous system." 4. "The medication widens the airways because it stimulates the fight-or-flight response of the nervous system."

(4) Global Rationale: During the fight-or-flight response, beta2-adrenergic receptors of the sympathetic nervous system are stimulated, the bronchiolar smooth muscle relaxes, and bronchodilation occurs. Bronchodilators do not decrease the production of mucus or histamine. Bronchodilators act on the sympathetic nervous system, not the parasympathetic nervous system.

Histamine release produces which response? 1. Bronchodilation 2. Vasoconstriction 3. Diarrhea 4. Vasodilation

(4) Global Rationale: Histamine release causes vasodilation due to leaky capillaries. Bronchoconstriction, not bronchodilation, occurs due to smooth muscle responses. Vasodilation, not vasoconstriction, occurs with histamine release. Diarrhea is not a sign of histamine release.

A mother calls the clinic and tells the nurse that her 4-month-old baby has a fever. The mother asks if she can use the liquid acetaminophen (Tylenol) that is used for her 10-year-old child. What is the best response by the nurse? 1. "Infants should not have acetaminophen (Tylenol) because it damages the liver." 2. "It is best if the pediatrician is called; he can be asked this question." 3. "It is fine to use the same medicine for both children." 4. "Infant drops should be used for the baby; they are different from liquid medicine."

(4) Global Rationale: Infant drops should be used for the baby; they have a different concentration of medication than the liquid preparations. Acetaminophen (Tylenol) is the preferred antipyretic drug for infants and children. The nurse can answer the mother's question; it is not necessary to refer to the pediatrician. It is not fine to use the same medicine for both children because the concentration of medication is different.

The nurse is caring for a client receiving gentamicin IV. The nurse would observe for adverse effects of 1. diarrhea. 2. bleeding 3. increased urinary output. 4. ototoxicity.

(4) Global Rationale: Ototoxicity is an adverse effect that could occur while receiving gentamicin. This could become permanent with continued use. Diarrhea, bleeding, and increased urinary output are not common adverse effects of gentamicin.

The client tells the nurse that her symptoms have become worse since she has been using oxymetazoline (Afrin) for nasal congestion. What is the best assessment question for the nurse to ask? 1. "How old is the bottle you are using?" 2. "May I take your temperature?" 3. "Are you using any other inhaled medications?" 4. "How long have you been using the medication?"

(4) Global Rationale: Oxymetazoline (Afrin) can cause rebound congestion if used for too long, so length of treatment is the best assessment question. While it is possible that the client is using outdated medication, this is not the best question. Asking to take the client's temperature is not the best question. The use of other inhaled medications will not cause or prevent rebound congestion, so this question is unnecessary.

The physician orders penicillin for a female client who has a sinus infection. What is a priority question to ask the client prior to administering the medication? 1. "Are you pregnant?" 2. "Do you plan to become pregnant?" 3. "Are you breastfeeding?" 4. "Are you taking birth control pills?"

(4) Global Rationale: Penicillin can cause birth control pills to lose their effectiveness. Penicillin is a Pregnancy Category B drug and is safe to take if a client is pregnant, plans to become pregnant, or is breastfeeding.

The nurse completes medication education for the client receiving antihistamines. The nurse evaluates that learning has occurred when the client makes which statement? 1. "I can still have my after-dinner drink." 2. "I need to increase fluids while taking this medication." 3. "This medication is safe because it is sold over-the-counter (OTC)." 4. "This medication could make me very sleepy."

(4) Global Rationale: Sedation is a common side effect of antihistamines. Alcohol will increase the sedative effects of antihistamines, so the client should not drink while taking antihistamines. There is no need to increase fluids when taking antihistamines. Just because a medicine is sold over-the-counter (OTC) does not mean it is safe.

The client takes diphenhydramine (Benadryl) but forgets to tell the physician about this drug when a monoamine oxidase inhibitor (MAOI) drug is prescribed for depression. What will the best assessment by the nurse reveal? 1. The depression will not subside. 2. The client may develop seizures. 3. The diphenhydramine (Benadryl) will not control allergies. 4. The client may develop a hypertensive crisis.

(4) Global Rationale: The combination of diphenhydramine (Benadryl) and a monoamine oxidase inhibitor (MAOI) drug can result in a hypertensive crisis. Depression, seizures, and control of allergies are not the concern with this combination.

The nurse plans to teach an adolescent about inhalation therapy as part of the treatment plan for the client's asthma. What does the best plan by the nurse include? 1. Inhalation therapy is effective because it provides around-the-clock therapy, as opposed to oral medications. 2. Inhalation therapy is the preferred treatment for adolescents because it is easier for them to manage. 3. Inhalation therapy is effective because it provides systemic relief of symptoms as well as local relief. 4. Inhalation therapy is effective because it goes to the direct site of action in the respiratory tract.

(4) Global Rationale: The major advantage of aerosol therapy is that it delivers the drugs to their direct site of action. Inhalation therapy does not provide around-the-clock therapy. Inhalation therapy does not provide systemic relief of symptoms. Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage. Inhalation therapy does not provide around-the-clock therapy. Inhalation therapy is used for adolescents because it is effective, not because it is easier for them to manage. Inhalation therapy does not provide systemic relief of symptoms.

The nurse teaches the client about the use of a metered-dose inhaler (MDI) and spacer. The nurse evaluates that additional teaching is required when the client makes which statement? 1. "I need to follow the instructions about using the metered-dose inhaler (MDI)." 2. "I need to rinse my mouth each time after using the metered-dose inhaler (MDI)." 3. "I need to drink a lot of fluids while I am using the metered-dose inhaler (MDI)." 4. "I should keep the spacer moist between uses by storing it in a plastic zip bag."

(4) Global Rationale: The spacer and inhaler should be rinsed with water and allowed to air-dry. Following instructions indicates compliance with use of the metered-dose inhaler (MDI). Rinsing the mouth after using the metered-dose inhaler (MDI) is correct; it will help reduce oral absorption of the drug. Fluids are encouraged to liquefy pulmonary secretions when using the metered-dose inhaler (MDI).

The client receives diphenhydramine (Benadryl) to control allergic symptoms. Which common symptom does the nurse teach the client to report to the physician? 1. Sedation 2. Diarrhea 3. Projectile vomiting 4. Urinary hesitancy

(4) Global Rationale: Urinary hesitancy is an anticholinergic effect of diphenhydramine (Benadryl) and should be reported to the physician. Sedation is a common side effect but does not need to be reported. Diarrhea is not a common side effect. Projectile vomiting is not a common side effect.

A client calls the nurse help-line and says, "My friend and I have been swimming and drinking beer all day and he took a couple of swigs of Robitussin DM (dextromethorphan) about 15 minutes ago. Now he is acting funny and seeing things." What should the nurse consider when formulating a response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The patient will need dialysis treatment to reverse overdose. 2. This is an opioid drug. 3. Dextromethorphan is very addicting. 4. Dizziness is one of the adverse effects of this drug. 5. Abuse of this drug can result in coma.

(4,5) Global Rationale: Dizziness and drowsiness occur in some patients. In abuse situations, dextromethorphan can cause CNS toxicity and coma. There is no specific treatment for overdose. Dextromethorphan is a nonopioid. This drug is not addictive.

A client with chronic bronchitis is to start receiving breathing treatments with acetylcysteine (Mucomyst). Which information should the nurse include in teaching about this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Your pharmacist can order this for you to purchase as an over-the-counter drug." 2. "Stop the treatment if you start to cough." 3. "This drug has a very short shelf life, so if it smells bad, do not use it." 4. "This drug is designed to break down and thin the mucus in your lungs." 5. "You might experience nausea while using this drug."

(4,5) Global Rationale: This drug is a mucolytic and is designed to thin mucus by breaking down the chemical structure. One of the adverse effects of acetylcysteine is nausea. This drug is by prescription only. This medication is designed to thin mucus to make it easier to remove by coughing. Coughing is a desired effect. Acetylcysteine has the odor of rotten eggs. This is not an indication that it is past the recommended use date or that it has gone bad.

Acetaminophen reduces fever by 1. directly acting on the hypothalamus. 2. inhibiting prostaglandins. 3. blocking impulses to the brain. 4. affecting nerve fibers.

(1) Global Rationale: Acetaminophen (Tylenol) directly acts on the fever center of the hypothalamus and dilates peripheral blood vessels. Anti-inflammatory drugs such as ibuprofen (Advil) inhibit prostaglandins. Blocking impulses to the brain is not a mechanism of action of drugs for inflammation and fever. Acetaminophen dilates blood vessels, not nerve fibers.

The client receives gentamicin (Garamycin) intravenously (IV) in the clinical setting. What is a priority nursing action? 1. Monitor the client for hearing loss. 2. Draw daily blood chemistries. 3. Decrease the fluids for the client during therapy. 4. Place the client on isolation precautions.

(1) Global Rationale: Aminoglycosides are ototoxic drugs, and the client should be monitored for hearing loss. Serum levels of the drug are indicated, but not blood chemistries. Decreasing fluids during therapy is not indicated. Isolation is determined by the causative organism, not the drug used for treatment.

A patient has been changed from a first generation H1 receptor antagonist to a second generation H1 receptor antagonist. The nurse evaluates that the patient understands the benefit of this change when which statement is made? 1. "I can drink a few beers over the weekend and still take this drug." 2. "This drug will not dry out my mouth." 3. "This drug will not affect my ability to urinate." 4. "This drug will not make me as sleepy."

(4) Global Rationale: Second generation H1 receptor antagonists have less of a sedative effect than do first generation drugs. Alcohol use is still discouraged because of the additive sedation effects. This drug will still have some anticholinergic effects.