Immune Inflammatory System

1. 1. Atropine works in an opposite manner from the cholinesterase inhibitors administered to treat myasthenia gravis, but atropine in small doses is prescribed to reduce the gastrointestinal side effects of the cholinesterase inhibitor. The nurse would not question this medication. 2. The antimalarial medications are prescribed to treat cutaneous lupus erythematosus. The nurse would not question this medication. 3. The client diagnosed with polymyalgia rheumatica must take the prescribed steroid medication or he or she can become blind. The nurse would not question this medication. 4. Mestinon is prescribed to increase the available amount of acetylcholine for muscle movement. A client in a cholinergic crisis has too much medication on board. The nurse would question administering this medication until the crisis is resolved.

1. The nurse is administering medications to the clients on a medical unit. Which medication should the nurse question administering? 1. Atropine, an antimuscarinic, to a client with myasthenia gravis. 2. Chloroquine, an antimalarial, to a client with a butterfly rash. 3. Prednisone, a corticosteroid, to a client with polymyalgia rheumatica. 4. Mestinon, a cholinesterase inhibitor, to a client in a cholinergic crisis.

10. 1. These symptoms are not part of schizophrenia and should be investigated. 2. The hallucinations the client has are not part of actual physical symptoms. Further investigation is needed to determine if the client is having a reaction to the medication. 3. This is the best response by the nurse. These are symptoms of drug-induced systemic lupus erythematosus. The nurse should make sure the client is seen by the HCP. 4. The nurse should not tell the client that he or she would no longer be able to take medications to control the symptoms of schizophrenia. The Thorazine may need to be changed to a different medication. Medication compliance in clients with psychiatric illnesses can be poor. This statement would give the client a reason not to take any medication.

10. The male client diagnosed with paranoid schizophrenia has been taking the antipsychotic medication chlorpromazine (Thorazine). The client tells the psychiatric clinic nurse that he has frequent joint pain and stiffness and gets a rash when in the sun. Which statement is the nurse's best response? 1. "This is part of your illness and will go away if you don't pay attention." 2. "What have your voices said about the aches and pains and rash?" 3. "Don't take your medication today, and come in to see the HCP." 4. "This is a reaction to medications and you can no longer take medications."

11. 1. If the client does not have insurance to help pay for the medications, the client may have trouble complying with the regimen. The current regimens include four or more daily medications costing more than $6000 per drug per year. 2. Currently, AIDS cannot be managed without the use of medications. With the medications, it is possible to reduce the viral load to undetectable in serum samples. 3. Many over-the-counter medications and herbs interact with the medications used to treat AIDS. The nurse should assess each over-the-counter preparation taken by the client but should not encourage their use. 4. One multiple vitamin is usually sufficient. The body excretes any water-soluble vitamin that is not needed. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client. The nurse should always be the client's advocate.

11. The clinic nurse is discussing medication compliance with a client diagnosed with acquired immunodeficiency syndrome (AIDS). Which information should the nurse discuss with the client? 1. The availability of insurance to pay for the medications. 2. Whether the client wants to try to manage the disease without medications. 3. Include over-the-counter herbs in the medication regimen. 4. The importance of taking multiple vitamins at least twice a day

12. 1. These medications treat actual infections and are sometimes administered prophylactically, but they will not prevent conversion to HIV-positive status. 2. The combination of specific medications depends on the health-care facility's protocol, but most include a combination of two nucleoside reverse transcriptase inhibitors and a protease inhibitor. The Centers for Disease Control and Prevention has a hotline that can be accessed for specific recommendations (800-458-5231 or www.cdc.gov). 3. Single-agent therapy is not recommended because of the speed at which the virus can mutate. 4. There are medications that can possibly prevent conversion to HIV-positive status.

12. The nurse received a needle stick with a contaminated needle from a client diagnosed with acquired immunodeficiency syndrome (AIDS). Which medications should the nurse begin within hours of the needle stick? 1. A combination of antiviral and antifungal medications with an antibiotic. 2. A combination of a protease inhibitor and nucleoside reverse transcriptase inhibitors. 3. Single-agent therapy with a non-nucleoside transcriptase inhibitor. 4. No medications are recommended to prevent the conversion to HIV-positive.

13. 1. Sustiva is not approved for prevention of transmission of HIV in pregnant women. 2. Kaletra is not approved for prevention of transmission of HIV to the fetus. 3. Although AZT is a pregnancy category C drug, research has proved that taking the drug during pregnancy reduces the risk of maternal-to-fetal transmission of the HIV virus by almost 70%. This is the only medication approved for this purpose. 4. Ganciclovir is not approved for prevention of transmission of HIV to the fetus.

13. The pregnant client's HIV test is positive. Which medication should the client take to prevent transmission of the virus to the fetus? 1. Efavirenz (Sustiva), a non-nucleoside reverse transcriptase inhibitor. 2. Lopinavir (Kaletra), a protease inhibitor. 3. Zidovudine (AZT), a nucleoside reverse transcriptase inhibitor. 4. Ganciclovir (Cytovene), an antiviral.

14. 1. This is standard precaution and does not require intervention by the nurse. 2. Many of the protease inhibitors used to treat AIDS interact with grapefruit juice. The nurse should stop the UAP until the nurse can determine if the client is receiving a medication that would interact with the grapefruit juice. 3. The client's meal tray does not have body fluids that can transmit the HIV virus to the UAP; therefore, this action warrants intervention from the nurse. The UAP needs to understand how the HIV virus is transmitted. 4. The client can apply his or her own moisture barrier protection cream. This does not warrant immediate intervention by the nurse. 5. This is a comfort measure and does not warrant intervention by the nurse. MEDICATION MEMORY JOGGER: Grapefruit juice can inhibit the metabolism of certain medications. Specifically, grapefruit juice inhibits cytochrome P450-3A4 found in the liver and the intestinal wall. The nurse should investigate any medications the client is taking if the client drinks grapefruit juice.

14. The nurse is caring for clients diagnosed with acquired immunodeficiency syndrome (AIDS). Which actions by the unlicensed assistive personnel (UAP) warrants immediate action by the nurse? Select all that apply. 1. The UAP uses nonsterile gloves to empty the client's urinal. 2. The UAP is taking a glass of grapefruit juice to the client. 3. The UAP dons gloves to remove the client's meal tray. 4. The UAP provides a tube of moisture barrier cream to a client. 5. The UAP fills the client's water pitcher with ice and water.

15. 1. The current treatment is a combination of HAART (highly active antiretroviral therapy) medications. These medications can decrease HIV detectable levels with current technology. They are not a cure, are expensive, and have serious side effects, but the mortality rate from AIDS has decreased 70% with this therapy. 2. The problem with a retrovirus is that it does not die until the host dies. The medications delay the onset of problems. There is no cure for an HIV infection. 3. The medications can cost $24,000-$30,000 per year, and hospitalization would be more expensive, but this is not the reason for the medications to be prescribed. 4. Protease inhibitors have their own side effects and can complicate the side effects from the other medications.

15. The client diagnosed with acquired immunodeficiency syndrome (AIDS) is prescribed a combination of a protease inhibitor, a non-nucleoside reverse transcriptase inhibitor, and two nucleoside reverse transcriptase inhibitors. Which statement best describes the scientific rationale for combining these medications? 1. The combination prevents or delays the client's complications from HIV infection. 2. Multiple medications are needed to eradicate all of the HIV infection. 3. The combination of medications is less expensive than hospitalization for HIV. 4. Protease inhibitors counteract the side effects of the other medications.

16. 1. The client who is HIV positive could be expected to have a positive viral load. This is a reason to institute HAART (highly active antiretroviral therapy) but not Bactrim. 2. This is a normal WBC count and is not a reason to start a prophylactic antibiotic. 3. This client is showing symptoms of Pneumocystis carinii pneumonia (PCP); any treatment now would not be prophylactic. 4. The client with a CD4 count of less than 300/mm3 is at risk for developing Pneumocystis carinii pneumonia (PCP). Bactrim is prophylaxis for PCP. Normal levels for CD4 are 450-1400/mm3.

16. The home health nurse is caring for a client diagnosed with HIV infection. Which data suggests the need for prophylaxis with trimethoprim sulfa (Bactrim)? 1. The client has a positive HIV viral load. 2. The client's white blood cell count is 5000/mm3. 3. The client has a hacking cough and dyspnea. 4. The client's CD4 count is less than 300/mm3.

17. 1. The medication should be administered daily over 6 hours but not before the nurse knows the client will not have a reaction to the medication. Amphotericin B is compatible only with D5W. 2. Demerol is used as a premedication to prevent an extrapyramidal reaction. 3. The first action by the nurse is to administer a small test dose of Fungizone to assess for the client's potential response. 4. This is done to prevent a febrile reaction to the medication.

17. The client diagnosed with AIDS is to receive an initial dose of amphotericin B (Fungizone), an antifungal agent. Which intervention should the nurse implement first? 1. Administer IVPB in 500 mL of D5W over 6 hours. 2. Administer Demerol 25 mg IVP over 5 minutes. 3. Administer a test dose of 1 mg over 20 minutes. 4. Administer acetaminophen (Tylenol) 650 mg orally.

18. 1. Before HAART (highly active antiretroviral therapy), the client would have had to continue taking ganciclovir for the rest of his or her life to prevent blindness; now with HAART, however, the CD4 counts are able to rebound and the client usually only needs to take the medication for 3-6 months. 2. This is not the regimen for ganciclovir. It is administered daily. 3. Initial therapy is intravenous and care must be taken not to infuse the medication too rapidly. The infusion should be administered on a pump over 1 hour. 4. The medication is incompatible with TPN. MEDICATION MEMORY JOGGER: Nothing should run in the same line as TPN. This is an infection-control issue.

18. The client diagnosed with AIDS and cytomegalovirus retinitis is prescribed the antiviral agent ganciclovir (Cytovene). The client has a single lumen implanted port. Which information about the medication should the home health nurse discuss with the client? 1. The client will have to take the medication for the rest of his or her life. 2. The client will take the medication for 1 week each month. 3. The medication should infuse over 1 hour every day. 4. The medication can run simultaneously with the client's TPN.

19. 1. Diflucan treats fungal infections, and Mycobacterium avium complex (tuberculosis) is a bacterium. 2. Ethambutol is a treatment for tuberculosis. 3. Zovirax treats viral infections, and the causative agent for tuberculosis is a bacterium. 4. This is the newest classification of drugs used to treat HIV viral infections, but it is effective against viruses, not bacteria.

19. The client diagnosed with AIDS has a positive skin test for tuberculosis. Which medication order should the nurse anticipate? 1. Fluconazole (Diflucan), an antifungal. 2. Ethambutol (Myambutol), an anti-infective. 3. Acyclovir (Zovirax), an antiviral. 4. Enfuvirtide (Fuzeon), an HIV fusion inhibitor

2. 1. There is no cure for SLE. The goal of treatment is to prevent or minimize damage to the internal organs. 2. The goal is not death, but to assist the client to live as full a life as possible. 3. The medication may have a side effect of weight gain, but this is not the desired result. 4. The goal of high-dose steroids during an exacerbation is to decrease the inflammatory response in the internal organs and prevent permanent damage.

2. The client diagnosed with systemic lupus erythematosus (SLE) is experiencing an acute exacerbation and the HCP has ordered high doses of glucocorticoid medications. Which statement supports the goal of this therapy? 1. To provide a permanent cure for lupus. 2. To allow a peaceful, dignified death. 3. To help enable the client to maintain weight. 4. To prevent permanent damage to the organs.

20. 1. The medication should infuse over 60-90 minutes, and for best control, the infusion should be placed on an infusion pump. 2. Leucovorin is the "rescue factor" to prevent an adverse reaction to the Neutrexin. The nurse should have both medications infusing simultaneously. 3. The medication can cause myelosuppression and the CBC should be monitored by the nurse. 4. The medication can cause a transient elevation in the client's liver enzymes; therefore, the nurse should monitor this laboratory result. 5. The client does not have to be NPO while receiving this medication.

20. The intensive care nurse is preparing to administer trimetrexate (Neutrexin) to a client diagnosed with AIDS and Pneumocystis carinii pneumonia (PCP). Which interventions should the nurse implement? Select all that apply. 1. Administer IV via gravity infusion. 2. Administer concurrently with leucovorin. 3. Monitor the client's complete blood count. 4. Monitor the client's liver enzymes. 5. Maintain NPO during drug administration.

21. 1. Tinnitus (ringing in the ears) is not a side effect of antihistamines; tinnitus usually occurs with aspirin toxicity. 2. Antihistamines cause drowsiness; therefore, the client should avoid driving or engaging in hazardous activities. 3. A buffalo hump and moon face are side effects of glucocorticoids, not of antihistamines. 4. Benadryl does not require tapering when discontinuing the medication.

21. The client with allergies is prescribed diphenhydramine (Benadryl), an antihistamine. Which statement indicates the client understands the teaching concerning this medication? 1. "If I get any ringing in my ears, I should notify my HCP." 2. "I will probably get drowsy when I take this medication." 3. "It is not uncommon to get a buffalo hump or moon face." 4. "I will have to taper off the medications when I quit taking them."

22. 1. Wearing insect repellent is an appropriate intervention, but if the client has an insect bite, the repellent will not help prevent anaphylaxis. Therefore, this is not the priority intervention. 2. Antihistamines are used in clients with anaphylaxis, but it takes at least 30 minutes for the medication to work, and if the client has an insect bite, it is not the priority medication. 3. Clients with documented severe anaphylaxis should carry an EpiPen, which is a prescribed injectable device containing epinephrine that the client can administer to himself or herself in case of an insect bite. This will save the client's life; therefore, this is the priority intervention. 4. The client should wear an identification bracelet stating the allergy, but it will not help the client if he or she is bitten by an insect; therefore, it is not the priority intervention.

22. The client has a severe anaphylactic reaction to insect bites. Which priority discharge intervention should the nurse discuss with the client? 1. Wear an insect repellent on exposed skin. 2. Keep prescribed antihistamines on their person. 3. Have an "EpiPen" available at all times. 4. Wear a MedicAlert identification bracelet.

23. 1. Glucocorticoid intranasal spray should be used with caution in clients taking herbal supplements such as licorice, which may potentiate the effects of glucocorticoids, but this is not the first intervention the nurse should implement. 2. Therapy usually begins with two sprays in each nostril twice a day and then decreases to one dose per day for a specific period. The nurse should educate the client, but this is not the first intervention. 3. Concomitant use of a local nasal decongestant spray may increase the risk of nasal irritation or bleeding. Both sprays may be used together for a client with chronic rhinitis but not for seasonal allergies. The nurse should educate the client, but this is not the first intervention. 4. The nurse must first assess the client's nares because broken mucous membranes allow direct access to the bloodstream, increasing the likelihood of systemic effects of the drug. Therefore, this is the first intervention the nurse should implement. The HCP may not prescribe the medication if nasal excoriation or bleeding is present. MEDICATION MEMORY JOGGER: Some herbal preparations are effective, some are not, and a few can be harmful or even deadly. If a client is taking an herbal supplement and a conventional medicine, the nurse should investigate to determine if the combination will cause harm to the client. The nurse should always be the client's advocate.

23. The client with seasonal allergic rhinitis is prescribed fluticasone (Flonase), an intranasal glucocorticosteroid. Which intervention should the nurse implement first? 1. Instruct the client not to eat licorice. 2. Explain that this is for short-term use. 3. Instruct not to use other nasal decongestants. 4. Assess the nares for excoriation or bleeding.

24. 1. Allegra is contraindicated in clients with asthma and in clients who use nicotine because of its anticholinergic effects on the respiratory system. 2. There are no contraindications for use of H1 receptor antagonist in clients who run daily; therefore, the nurse would not question administering this medication. 3. There are no contraindications for H1 receptor antagonist in clients with antibiotic allergies; therefore, the nurse would not question administering this medication. 4. Allegra is prescribed prophylactically in clients with nasal sneezing and tearing of the eye; therefore, the nurse would not question administering this medication.

24. Which client should the nurse question administering the H1 receptor antagonist fexofenadine (Allegra)? 1. The client who smokes two packs of cigarettes daily. 2. The athlete who runs 2 miles every day. 3. The client diagnosed with an antibiotic allergy. 4. The client experiencing nasal congestion and sneezing.

25. 1. This medication has anticholinergic effects; therefore, a dry mouth is an expected side effect and sucking on hard candy will help relieve the dry mouth. This statement indicates the client understands the teaching. 2. The client is at risk for anticholinergic crisis and should notify the HCP or pharmacist of taking an H1 receptor antagonist. This statement indicates the client understands the teaching. 3. The client should be aware of signs or symptoms of an anticholinergic crisis such as blurred vision, confusion, difficulty swallowing, and fever or flushing. This statement indicates the client needs more teaching concerning this medication. 4. This medication has anticholinergic effects and the client should maintain adequate fluid intake to help prevent dehydration. This statement indicates the client understands the teaching.

25. The client is prescribed clemastine (Tavist), an H1 receptor antagonist, prophylactically for allergies. Which statement indicates the client needs more teaching concerning this medication? 1. "I will suck on hard candy if I have a dry mouth." 2. "I will notify my HCP if I take an over-the-counter medication." 3. "I will experience some blurred vision when taking Tavist." 4. "I need to maintain adequate fluid intake when taking this medication."

26. 1. Prolonged use of sympathomimetic nasal sprays causes hypersecretion of mucous and nasal congestion to worsen once the drug effects wear off. This sometimes leads to a cycle of increased drug use, as the condition worsens. This rebound congestion is why it should not be used for more than 3-5 days. 2. The client should avoid clearing the nose immediately after spraying so that the medication can stay in the nares. 3. The postnasal medication should be spit out, not swallowed. 4. The medication should be administered exactly as prescribed; additional dosing will not speed relief of the nasal congestion.

26. The clinic nurse is discussing over-the-counter (OTC) oxymetazoline (Afrin 12 Hour Nasal Spray), a sympathomimetic, with a client experiencing nasal congestion. Which information should the nurse discuss with the client? 1. Do not use the Afrin spray any longer than 3-5 days. 2. Clear the nose immediately after using the nasal spray. 3. Immediately swallow the postnasal medication residue. 4. Take additional nasal sprays if congestion is not relieved.

27. 1. This is an appropriate question, but it is not the first question the nurse should ask the client. 2. The spray bottle should be shaken thoroughly, but this is not the first question the nurse should ask the client. 3. The client should take the medication as prescribed, but this is not the first question the nurse should ask the client. 4. The medication may take 2- 4 weeks to be effective. Therefore, the nurse should first determine how long the client has been taking the medication.

27. The male client taking a nasal glucocorticoid spray calls the clinic nurse and reports that the medication is not helping his condition. Which question should the nurse ask the client first? 1. "Are you sure you are taking the spray correctly?" 2. "Did you shake the bottle before taking the spray?" 3. "What time of the day are you taking the medication?" 4. "How long have you been using the spray?"

28. 1. Anticholinergic effects of antihistamines may trigger bronchospasms; therefore, the nurse should assess for wheezing or difficulty breathing. 2. Elderly clients are at an increased risk of increased sedation and other anticholinergic effects; therefore, the nurse should assess the level of consciousness. 3. Antihistamines promote urinary retention, and the nurse should ensure adequate intake and output. 4. Antihistamines cause drowsiness; therefore, the nurse should institute safety and fall precautions and not encourage the client to ambulate without assistance. 5. There are no dietary precautions for clients taking antihistamines.

28. Which interventions should the nurse implement for the elderly client receiving antihistamine therapy? Select all that apply. 1. Auscultate the client's breath sounds. 2. Assess the client's level of consciousness. 3. Evaluate the client's intake and output. 4. Encourage the client to ambulate. 5. Provide an acid-ash diet for the client.

29. 1. The area should be washed with warm water before applying the cream; instruct the client not to use soap, which could further irritate the area. 2. The area should be left open after the medication is applied. An adherent dressing may stick to the area and cause further irritation of the affected area. 3. The cream should be applied gently to the inflamed area; it should not be rubbed into the area. 4. The client should have clean hands before applying the cream to the affected area to help prevent infection.

29. The health-care provider has prescribed the topical steroid hydrocortisone for a client experiencing allergic dermatitis. Which instruction should the nurse discuss with the client? 1. Wash the inflamed area with soap and water. 2. Apply an adherent dressing after applying the medication. 3. Rub the cream into the irritated and inflamed area. 4. Wash the hands before applying the topical steroid.

3. 1. This may be asked, but it is not the most important question. 2. This is the most important question. The client reports the pain and stiffness on awakening in the morning. Taking NSAIDs then places the client at risk for developing peptic ulcer disease. The client should be taught to take these medications with food. 3. NSAID medications are frequently taken by female clients to relieve menstrual cramps. This is not the most important question. 4. This is the reason the client is taking the medication. NSAIDs are used to treat the pain and stiffness, but they are also helpful in decreasing the inflammation associated with SLE and in allowing a reduction in the dosage of steroids.

3. The female client diagnosed with systemic lupus erythematosus (SLE) complains to the nurse that she has pain; she is stiff when she gets up in the morning; and she takes ibuprofen, an NSAID, to help ease the pain and stiffness. Which question is most important for the nurse to ask the client? 1. "How often do you have to take the ibuprofen?" 2. "Do you take the medication on an empty stomach?" 3. "Does the medication help with menstrual cramping too?" 4. "Have you noticed an improvement in the pain and stiffness?"

30. 1. The drug of choice for an anaphylactic reaction is epinephrine (Adrenalin) administered subcutaneously, but it is not the first intervention. 2. The nurse should realize that the client is having an allergic reaction to the intravenous antibiotic and immediately discontinue the medication. This is the nurse's first intervention. 3. The nurse should not take time to assess the client when it is apparent the client is having an allergic reaction to the antibiotic. 4. Oxygen should be applied, but it is not the nurse's first intervention in this situation. The antibiotic that is causing the anaphylactic reaction should be discontinued first.

30. The nurse administers a dose of an intravenous antibiotic to the client. Twenty minutes later the client is complaining of shortness of breath, itching, and difficulty swallowing. Which intervention should the nurse implement first? 1. Prepare to administer subcutaneous epinephrine. 2. Discontinue the client's intravenous antibiotic. 3. Assess the client's apical pulse and blood pressure. 4. Administer 10 liters of oxygen via nasal cannula.

31. 1. Plaquenil can cause pigmentary retinitis and vision loss, so the client should have a thorough vision examination every 6 months. The client does not need more teaching. 2. Plaquenil may increase the risk of liver toxicity when administered with hepatotoxic drugs; therefore, alcohol use should be eliminated during therapy. The client does not need more teaching. 3. The medication should be taken with milk to decrease gastrointestinal upset. The client does not need more teaching. 4. The medication takes 3-6 months to achieve the desired response, and many clients do not experience significant benefits. The client needs more teaching. 5. Loss of balance and coordination is an adverse effect of this medication and the client should notify the healthcare provider. The client needs more teaching. MEDICATION MEMORY JOGGER: Drinking alcohol is always discouraged when taking any prescribed or over-the-counter medication because of potential adverse interactions. The nurse should encourage the client not to drink alcoholic beverages.

31. The client with rheumatoid arthritis is prescribed hydroxychloroquine sulfate (Plaquenil), a disease-modifying antirheumatic drug (DMARD). Which statements indicate the client needs more teaching concerning the medication? Select all that apply. 1. "I will get my eyes checked every 6 months." 2. "I should not drink alcohol while taking this drug." 3. "It is important to take this medication with milk." 4. "I will call my HCP if the pain is not relieved in 2 weeks." 5. "It is common to have a loss of balance while taking Plaquenil."

32. 1. Alopecia is a common side effect of Arava. This should be discussed with the client before starting the medication, and methods of coping with hair loss should be explored. This comment would not warrant intervention by the nurse. 2. This medication causes dizziness; therefore, this comment would not warrant intervention by the nurse. 3. This medication is teratogenic. Women must undergo the drug-elimination procedure and men must take 8 grams of cholestyramine three times daily for 11 days to minimize any possible risk of harm to the fetus his partner is carrying. 4. The client should avoid vaccinations with live vaccines during and following therapy; therefore, this comment does not require nursing intervention.

32. The client diagnosed with rheumatoid arthritis is taking the disease-modifying antirheumatic drug (DMARD) leflunomide (Arava). Which comment by the client warrants intervention by the nurse? 1. "I have noticed that I am starting to lose my hair." 2. "I sometimes get dizzy and drowsy." 3. "My spouse and I are trying to start a family." 4. "I will not get any vaccines while taking this medication."

33. 1. Methotrexate causes bone marrow depression, which may lead to abnormal bleeding. Therefore, the client should use a soft-bristled toothbrush. 2. Methotrexate has no effect on the client's response to cold weather. 3. The client is at risk for mouth ulcers and should not use any type of commercially available mouthwash. The client should rinse the mouth with water after eating and drinking. 4. Methotrexate may increase the sensitivity of the skin to sunlight. The client should use a sunscreen of SPF 30 or higher and wear protective clothing when exposure to the sun is unavoidable.

33. Which instruction should the nurse discuss with the client diagnosed with rheumatoid arthritis who is prescribed methotrexate, a disease-modifying antirheumatic drug (DMARD)? 1. Use a soft-bristled toothbrush when brushing teeth. 2. Wear warm clothes when it is less than 40°F. 3. Gargle with mouthwash at least four times a day. 4. Use a sunscreen with an SPF 15 or lower when outside.

34. 1. The most dangerous adverse reaction to this classification of medication is blood dyscrasias, which are manifested in the client by flulike symptoms. 2. Constipation is not a side effect of Butazolidin. The nurse would not question administering the medication. 3. Weight gain is not a side effect of Butazolidin. The nurse would not question administering the medication. 4. Insomnia is not a side effect of Butazolidin. The nurse would not question administering the medication. MEDICATION MEMORY JOGGER: Usually if a client is prescribed a new medication and has flulike symptoms within 24 hours of taking the first dose, the client should contact the HCP. These are signs of agranulocytosis, which indicate the medication has caused a sudden drop in the white blood cell count, leaving the body defenseless against bacterial invasion.

34. The client with rheumatoid arthritis is taking phenylbutazone (Butazolidin), a pyrazoline nonsteroidal anti-inflammatory drug (NSAID). Which statement requires the nurse question administering this medication? 1. "I have had a sore throat and fever the last few days." 2. "I have not had a bowel movement in more than 3 days." 3. "I can't believe I have gained 3 pounds in the last month." 4. "I have been having trouble sleeping at night."

35. 1. This is within the normal range of 0.5 to 1.5 mg/dL for serum creatinine. 2. This RBC count indicates anemia (low red blood cell count and HGB/HCT resulting from low red blood cells), which would warrant intervention by the nurse. The normal RBC is 4.6- 6.0 million/mm for men and 4.0- 5.0 million/mm for women. 3. The white blood cell count is within the normal range of 4500/mm to 10,000/mm. 4. These are within the normal range— hemoglobin (Hgb) 13.5-18 g/dL in males and 12-16 g/dL in females, and hematocrit (Hct) 40%-54% in males and 36%-46% in females.

35. The client with rheumatoid arthritis has been taking methotrexate, a diseasemodifying antirheumatic drug (DMARD), for 2 weeks. Which laboratory data warrants intervention by the nurse? 1. A serum creatinine level of 0.9 mg/dL. 2. A red blood cell count of 2.5 million/mm. 3. A white blood cell count of 9000 mm. 4. A hemoglobin of 14.5 g/dL and hematocrit of 43%.

36. 1. Azulfidine may cause an orange or yellowish discoloration of urine and the skin; this is expected and is not significant. 2. Stomatitis is not an expected side effect of Azulfidine, and the HCP should be notified. 3. Ecchymosis (unexplained bleeding) is not an expected side effect of Azulfidine, and the HCP should be notified. 4. A rash is not an expected side effect, and the HCP should be notified.

36. Which assessment data should the nurse expect for the client with rheumatoid arthritis who is taking sulfasalazine (Azulfidine), an antirheumatic medication? 1. Orange or yellowish discoloration of the urine. 2. Ulcers and irritation of the mouth. 3. Ecchymosis of the lower extremities. 4. A red, raised skin rash over the back.

37. 1. This dose of aspirin is just less than the toxic dose that produces tinnitus and hearing loss, but this is the dose needed to treat RA. The client should reduce the dose by two to three tablets per day until the tinnitus resolves. This statement indicates the client does not need more teaching. 2. Gastrointestinal side effects are common with aspirin therapy; therefore, the client should take aspirin with food. This statement indicates the client does not need more teaching. 3. The aspirin should be taken in divided doses (three to four 325-mg tablets four times a day). This statement indicates the client needs more teaching. 4. Enteric-coated aspirin produces less gastric distress than plain, buffered aspirin. The client's statement does not need more teaching.

37. The client recently diagnosed with rheumatoid arthritis is prescribed 4 grams of aspirin daily. Which statement indicates the client needs more teaching concerning the medication? 1. "I will decrease my dose for a few days if my ears start ringing." 2. "I should take my aspirin with meals, food, milk, or antacids." 3. "I need to take the entire aspirin dose at night before going to bed." 4. "If I have any stomach upset, I will take enteric-coated aspirin."

38. 1. A buffalo hump and moon face are expected side effects, are not life threatening, and would not be a problem if the client took the medication forever. These side effects affect body image, but most individuals in severe pain would rather have body-image problems than pain. 2. Prednisone has serious long-term side effects that can lead to possible lifethreatening complications. Therefore, the client cannot take prednisone forever. 3. An addisonian crisis (adrenal insufficiency) is a complication that may occur when the patient stops the medication abruptly but not if it is tapered off. 4. This response does not answer the client's question; therefore, it is not the best response.

38. The client with rheumatoid arthritis is prescribed prednisone, a glucocorticoid, for an acute episode of pain. The client asks the nurse, "Why can't I be on this forever since it helps the pain so much?" Which statement is the nurse's best response? 1. "The medication will cause you to have a buffalo hump or moon face." 2. "The medication has long-term side effects, such as osteoporosis." 3. "If you continue taking the medication, it may cause an addisonian crisis." 4. "There are other medications that can be prescribed to help the pain."

39. 1. Pain relief lasts only as long as the topical analgesic is applied regularly, not as needed (PRN). 2. Transient burning may occur with application if applied fewer than three to four times daily; burning usually disappears after a few days but may continue for 2-4 weeks or longer. 3. If the pain persists longer than 1 month, the client should discontinue the cream and notify the HCP. 4. The cream should be rubbed into the skin until little or no cream is left on the surface of the skin. The hands should be washed immediately after the cream is applied to the skin.

39. The client with rheumatoid arthritis is prescribed capsaicin (Zostrix), a topical analgesic. Which information should the nurse discuss with the client? 1. Apply the cream as needed for severe arthritic pain. 2. Notify the HCP if burning of the skin occurs after application. 3. It may take up to 3 months for the medication to become effective. 4. Rub the cream into skin until no cream is left on the surface.

4. 5, 2, 3, 1, 4 5. The nurse must determine that the "right" medication is being administered to the "right" client. This is the first step. 2. The nurse should assess the intravenous catheter placement prior to administering the medication. If there is a blood return, the catheter is in the vein. 3. The nurse should flush the saline lock with 2 mL of sterile saline before administering the medication to make sure that any previously administered medication is flushed from the line to avoid inadvertent mixing of medications. 1. Solu-Cortef can be administered safely over 1-2 minutes. 4. The final step is to flush the saline lock to make sure the client receives all the prescribed medication.

4. The client diagnosed with multiple sclerosis (MS) is prescribed the intravenous glucocorticoid hydrocortisone (Solu-Cortef). The client has a saline lock. Which procedures should the nurse follow when administering the medication? Rank in order of performance. 1. Administer the diluted medication intravenously over 1-2 minutes. 2. Aspirate the syringe to obtain a blood return. 3. Flush the saline lock with 2 mL of sterile normal saline. 4. Flush the saline lock again with 2 mL of normal saline. 5. Check the client's identification bands against the MAR.

40. 1. The client should not take aspirin, an NSAID, while taking another NSAID. 2. The client should not receive an additional dose of a routine medication that is being administered for treatment of rheumatoid arthritis. 3. The nurse should administer a nonnarcotic analgesic for a headache, not a narcotic. 4. Acetaminophen, a nonnarcotic analgesic, would be the most appropriate medication to give the client who is experiencing a headache and is taking an NSAID.

40. The client with rheumatoid arthritis is taking etodolac (Lodine), a nonsteroidal anti-inflammatory drug (NSAID). The client is complaining of a headache. Which intervention should the nurse implement? 1. Administer two aspirins to the client. 2. Administer an additional dose of Lodine. 3. Administer one oral narcotic analgesic. 4. Administer two acetaminophen (Tylenol).

41. 1. This may be important information to give to the parent, but it is not the legal requirement for documentation of immunizations. 2. This may be important information to give to the parent, but it is not the legal requirement for documentation of immunizations. 3. The National Childhood Vaccine Act of 1986 requires that a permanent record of the vaccinations a child receives be maintained. The required information is date of the vaccination; route and site of the vaccination; vaccine type, manufacturer, lot number, and expiration date; and the name, address, and title of the person administering the vaccination. 4. This may be important information to give to the parent, but it is not the legal requirement for documentation of immunizations.

41. The nurse in the pediatrician's office is recording a child's immunizations. Which information is the nurse required to document? 1. The vaccinations the client should have received. 2. Centers for Disease Control and Prevention guidelines for the client. 3. The vaccination type, manufacturer, and lot number. 4. The date the next required vaccination should be administered.

42. 1. Potential complications of measles include blindness and deafness. Potential complications of mumps include aseptic meningitis; for adolescent and adult males, orchitis is another complication. Potential complications for rubella include arthritis in women and birth defects or miscarriage for pregnant women. 2. The public school system encourages all children to be immunized according to the Centers for Disease Control and Prevention guidelines, but there are exceptions. The nurse should know the requirements for the state where the nurse is practicing. 3. Immunizations prevent many illnesses. 4. This parent is asking for information, not a therapeutic conversation. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable of accepted standards of practice for disease processes and conditions. If the nurse administers a medication the health-care provider has prescribed and it harms the client, the nurse could be held accountable. The nurse is a client advocate and should provide honest information to the client.

42. The mother of a child scheduled to receive a measles, mumps, and rubella vaccination asks the nurse, "What could happen to my child if I don't let you give the vaccination?" Which statement is the nurse's best response? 1. "If your child gets one of the diseases, it could lead to serious complications." 2. "Your child will not be allowed to attend any public school in the country." 3. "Nothing can happen to you or the child if you don't get the vaccination." 4. "You sound worried. Have you heard of problems associated with the shot?"

43. 1. The parent may have allowed the immunization to take place, but a specific signed permission is not needed. 2. The nurse should teach the parent how to care for the child, not send the child to the emergency department. 3. The problem is probably related to the immunization, not a secondary infection. 4. The varicella vaccine can cause a fever spike to 102°F, a mild rash with a few lesions, and pain and redness at the injection site. The nurse should tell the parents how to care for the child.

43. The parent of a child who received an immunization for varicella earlier in the day calls the clinic and tells the nurse that the child now has chickenpox because the child has a fever of 101°F. Which statement is the nurse's best response? 1. "You signed a permit knowing this might happen as a result." 2. "You need to take the child to the emergency department now." 3. "Has the child been exposed to any illness recently?" 4. "This is a reaction to the injection, but it is not chickenpox."

44. 1. Most children are afraid of being hurt by the injections, but this is not a reason to question administering the injection. 2. The child will shed the vaccine in the urine and feces. The grandparent is immunocompromised as a result of the chemotherapy and could become ill. This child should receive an inactivated vaccine. The nurse should question this vaccine. 3. This is a reason to give the vaccine, not question it. 4. Jehovah's Witnesses do not refuse vaccinations because of religious beliefs. 5. This child is immunocompromised and could become ill and should receive an inactivated vaccine.

44. Which clients should the nurse question administering a live virus vaccine? Select all that apply. 1. The child who is afraid of needles and health-care personnel. 2. The child who lives with a grandparent undergoing chemotherapy. 3. The child who has not received an immunization previously. 4. The child whose parents are Jehovah's Witnesses. 5. The child on prednisone who is immunosuppressed.

45. 1. This is not a safe administration site for a 15-month-old child. 2. This is not the best site for a toddler. 3. Infants and toddlers should receive intramuscular injections in the vastus lateralis muscle, the large muscle of the thigh. This muscle is large and away from any nerves that could be damaged by the injection. 4. The immunizations are given intramuscularly, not subcutaneously.

45. The nurse is preparing to administer measles, mumps, and rubella vaccinations to a 15-month-old child. Which description is the correct administration procedure? 1. Inject the medication into the dorsogluteal muscle. 2. Use the deltoid muscle for the injection. 3. Administer the medication into the vastus lateralis muscle. 4. Give subcutaneously in the abdomen.

46. 1. Infants born to mothers who are positive for hepatitis B surface antigen (HBsAg) should receive hepatitis B immunization within 12 hours of birth. All infants should receive the vaccine prior to discharge, but they may receive the first dose at any time before 2 months old. 2. The injection series should be started by age 2 months. 3. The injection series should be started by age 2 months. 4. The injection series should be started by age 2 months.

46. Which age should the nurse consider safe to administer the hepatitis B vaccine? 1. At birth. 2. At age 12 months. 3. At age 6 years. 4. At age 18 years

47. 1. The child has a chronic disease, and it is very important for the child to receive all immunizations. 2. The child is at greater risk of complications of the illnesses the immunizations prevent because of the diabetes. The child should receive all recommended immunizations. 3. The child does not "get used" to the needles, and the child likely will mind the injections. 4. Children with chronic illnesses are encouraged to receive a yearly flu vaccine.

47. The clinic nurse is discussing immunizations with the parent of a male child diagnosed with type 1 diabetes mellitus. Which information should the nurse teach the client? 1. The child should not receive immunizations because of the diabetes. 2. The child is at greater risk of complications from immunizations. 3. The child will not mind the injections because he is used to them. 4. The child should receive a flu vaccination every year.

48. 1. The injection should be administered, but a single injection is not sufficient for this age child. 2. The correct procedure for a child age 13 or older is to administer two injections at least 4 weeks apart. 3. Two injections are recommended. Three injections are the recommended schedule for hepatitis B. 4. Adults can become ill with varicella.

48. The 14-year-old adolescent has not received the varicella vaccine, and the HCP cannot determine that the teen has ever had chickenpox. Which statement indicates the correct administration procedures? 1. Administer the single-dose injection as soon as possible. 2. Administer two injections at least 4 weeks apart. 3. Administer a series of three injections over 6 months. 4. Do not administer the vaccine because by age 13 the client is immune to varicella.

49. 1. The nurse should be aware of important information regarding the medications being administered so that the nurse can inform the clients. 2. The manufacture of the oral vaccine has been discontinued because several children developed polio from the live virus. The intramuscular vaccine is the only vaccine available. It is an inactivated form of the virus. 3. There is no reason to ask the HCP for a change of order. 4. Both vaccines prevented polio, but the oral route also caused polio in some children.

49. The parent of a child about to receive the intramuscular polio vaccine, inactivated poliovirus vaccine (IPV), asks the nurse "Why can't my child get the oral vaccine like I took when I was a child?" Which statement by the nurse is the best explanation to give the client? 1. "I don't know why, but the manufacturer has stopped making the oral drug." 2. "There were some cases of polio that developed from the oral vaccine." 3. "I will check with your health-care provider and see about changing the order." 4. "The intramuscular route is more effective in preventing polio than the oral route."

5. 1. There is no serum baclofen level. 2. Baclofen can cause urinary urgency so this should be assessed. 3. Baclofen is administered to treat the spasticity associated with MS. The nurse should assess for muscle spasticity, rigidity, movement, and pain to determine the effectiveness of the medication. 4. The medication can affect the liver, but it does not damage the kidneys. 5. Baclofen is administered to treat the spasticity associated with MS. The nurse should assess for muscle spasticity, rigidity, movement, and pain to determine the effectiveness of the medication.

5. The client diagnosed with multiple sclerosis is prescribed baclofen (Lioresal), an antispasmodic. Which data should the nurse assess? Select all that apply. 1. The client's serum baclofen levels. 2. The client's complaint of urinary urgency. 3. The client's muscle rigidity and range of motion. 4. The client's BUN and creatinine levels. 5. The client's muscle spasticity and pain.

50. 1. The parent should notify the HCP if the infant has a high-pitched cry because it is a sign the infant is having an adverse effect to the immunization. 2. Vaccinations should not cause congestion; therefore, a humidifier is not needed. 3. Acetaminophen is the treatment to manage the side effects of sore injection site and fever. 4. The parents do not have to keep the infant in their room. 5. Research in various countries has found no link between vaccines and autism spectrum disorders. See www.vaccines.com.

50. The clinic nurse has administered several recommended vaccinations to a 2-month-old infant. Which discharge instructions should the nurse give to the parents? Select all that apply. 1. Notify the health-care provider if the infant has a high-pitched cry. 2. Use a humidifier in the infant's room to reduce congestion. 3. Give the infant the prescribed amount of acetaminophen for comfort. 4. Keep the infant in the parents' room at night for a few days. 5. Explain research does not support immunizations cause autism.

51. 1. Vitamin C will increase the efficiency of the immune system, but it will not prevent the client from getting hepatitis B. 2. Vaccines provide immunity when administered prior to exposure to hepatitis B, but they are not effective in preventing hepatitis B after exposure. 3. This is a false statement because there is a treatment available. 4. Gamma globulin may be administered to a client exposed to hepatitis B within 24 hours to 7 days of exposure to the virus. This will provide passive immunity to the client.

51. The client presents to the clinic reporting that his girlfriend was diagnosed with hepatitis B yesterday. The client asks the nurse, "Can you give me something so that I won't get hepatitis?" Which statement is the nurse's best response? 1. "You should take 500 mg of over-the-counter vitamin C every day." 2. "You need to have the hepatitis B vaccine injections starting today." 3. "At this time, there is no treatment to make sure you don't get hepatitis." 4. "You need to receive an injection of gamma globulin IM today."

52. 1. While the child is receiving prednisolone, immunizations should not be administered. If a child is immunocompromised, then only attenuated vaccines can be administered. 2. This medication can be crushed because it is not a sustained-release formulation or enteric coated. 3. Children taking prednisolone are more prone to infection and should avoid exposure to measles or chickenpox while taking prednisolone. 4. Steroid medication suppresses the immune system; therefore, an elevated temperature should be reported the HCP.

52. The male 4-year-old is prescribed prednisolone (Pediapred), a glucocorticoid, for juvenile arthritis. Which statement by the child's mother warrants immediate intervention? 1. "My child is current with all the required immunizations." 2. "I can crush the tablet and put it in some of his favorite pudding." 3. "My 2-year-old daughter is at home with chickenpox." 4. "I need to notify my HCP if my son's temperature is higher than 100°F."

53. 1. There is no reason to restrict visitors during the administration of the medication. The client is immunocompromised, which may require restriction of visitors with known infections. 2. Ganciclovir is teratogenic and carcinogenic; therefore, it must be disposed of in a manner that protects the environment. It should be burned at a high temperature to prevent the chemical from reaching the environment. 3. The reconstituted solutions must be stored in the refrigerator to protect their efficacy. 4. The medication is only viable for 24 hours after mixing the solution. Therefore, the pharmacy cannot mix a week at a time.

53. The client diagnosed with AIDS is receiving intravenous acyclovir (Cytogenesis), an antiviral medication. Which intervention should the home health-care nurse implement when administering this medication? 1. Restrict all visitors when administering this medication. 2. Arrange for IV tubing and bag to be incinerated. 3. Store reconstituted solutions at room temperature. 4. Have the pharmacy mix the medication for 1 week at a time.

54. 1. A sulfa allergy with this type of rash develops in up to 60% of clients diagnosed with AIDS. 2. Common side effects of Viracept are hyperglycemia and diarrhea but not allergic rashes. 3. Common side effects of Sustiva are central nervous system symptoms but not allergic rashes. 4. Gastrointestinal intolerance and bone marrow suppression are common side effects of Invirase, but allergic rashes are not. MEDICATION MEMORY JOGGER: Whenever a client develops a rash and is receiving an antibiotic, the nurse should suspect that the antibiotic is the cause of the rash.

54. The client diagnosed with AIDS has a pruritic rash with pinkish-red macules. Which medication should the nurse suspect is causing the rash? 1. The antibiotic trimethoprim-sulfamethoxazole (Bactrim). 2. The antiretroviral medication nelfinavir (Viracept). 3. The non-nucleoside reverse transcriptase inhibitor efavirenz (Sustiva). 4. The nucleoside analog reverse transcriptase inhibitor zidovudine (AZT).

55. 1. The nurse would need further clarification for a steroid because the client is already immunosuppressed, and this medication would further suppress the immune system. 2. The nurse must realize that depression is common in clients with chronic illnesses; therefore, a prescription for Prozac would not need further clarification. 3. Antiviral medications are commonly prescribed for clients with AIDS to suppress the replication of the AIDS virus. 4. Non-nucleoside reverse transcriptase inhibitors are commonly prescribed for clients with AIDS to suppress the replication of the AIDS virus.

55. The home health-care nurse is reviewing the list of daily medications the client diagnosed with AIDS is prescribed. Which medication needs further clarification by the nurse? 1. The glucocorticoid prednisone (Deltasone). 2. The selective serotonin reuptake inhibitor fluoxetine (Prozac). 3. The antiretroviral medication saquinavir (Invirase). 4. The non-nucleoside reverse transcriptase inhibitor nevirapine (Viramune).

56. 5, 4, 2, 3, 1 5. One of the five Rights is the right time, and the nurse must check PRN medications to make sure it is within the prescribed time frame. 4. Narcotics are locked up and must be signed out and accounted for prior to administering. 2. If the client's respiratory rate is less than 12 breaths a minute, the medication should be questioned. 3. The Joint Commission has mandated that the nurse must identify the client with two identifiers prior to administering the medication. 1. The nurse should dilute the medication to help prevent pain during administration, to increase the longevity of the vein, and to allow administration of the medication over the 5-minute period.

56. The client diagnosed with Guillain-Barré syndrome is complaining of pain. The client has an order for morphine 2 mg IVP. Which interventions should the nurse implement? Rank in order of performance. 1. Administer the morphine diluted over 5 minutes. 2. Assess the client's respiratory status. 3. Check the two identifiers against the MAR. 4. Sign out the medication as per hospital policy. 5. Check the last time the morphine was administered.

57. 1. There is no medication that can cure GB. 2. There is no medication that can cure GB. 3. At this time, the medical treatment for GB is supportive until the Guillain- Barré resolves on its own. 4. Amevive is a medication used to treat psoriasis.

57. The wife of the client diagnosed with Guillain-Barré (GB) syndrome asks the nurse, "Don't you have something that will cure this disease?" Which statement is the nurse's best response? 1. "Long-term steroid therapy will help reverse the paralysis." 2. "High doses of intravenous antibiotics may help cure GB." 3. "There is no medication known that will cure this disease." 4. "A medication called Amevive has side effects, but it can cure GB."

58. 1. WBCs in the CSF indicate an infection such as meningitis, not multiple sclerosis. 2. Interferon can reduce the frequency of relapse by 30% and decrease the appearance of new lesions on the MRI by 80%. The decrease in the appearance of new lesions indicates the medication is effective. 3. The EMG would not help determine if the medication was effective because the results will be skewed from previous damage. 4. The EEG would not help determine if the medication was effective because it measures the brain activity, not appearance of plaque. MEDICATION MEMORY JOGGER: The nurse must be knowledgeable about accepted standards of practice for medication administration, including which client assessment data, laboratory data, or diagnostic test should be monitored to determine the effectiveness of a medication.

58. The client with multiple sclerosis is being treated with the biologic response modifier interferon beta-1a (Avonex). Which diagnostic test should the nurse monitor to determine the effectiveness of the medication? 1. The cerebrospinal fluid white blood cell count. 2. The magnetic resonance imaging (MRI) scan. 3. An electromyogram (EMG). 4. An electroencephalogram (EEG).

59. 1. Dulcolax is a stimulant laxative and should not be taken every day because it will cause a decrease in the bowel tone. A client with MS already has difficulty with bowel tone. 2. The client with MS is at risk for constipation, fecal incontinence, and fecal impaction because of decreased bowel tone. A fiber laxative increases the bulk of the stool and helps prevent constipation; therefore, the medication teaching is effective. 3. The client with MS is at risk for constipation, fecal incontinence, and fecal impaction because of decreased bowel tone. A stool softener will help prevent constipation and can be taken at any time of the day; therefore, the medication teaching is effective. 4. Increasing the fluid intake will help the bulk laxative to work and will help soften the stool; therefore, the client understands the medication teaching.

59. The female client diagnosed with multiple sclerosis (MS) tells the nurse, "I am having problems having regular bowel movements." Which statement by the client indicates the client needs more medication teaching? 1. "I am taking a Dulcolax tablet every day." 2. "I am taking a fiber laxative daily." 3. "I take the stool softener Colace at bedtime." 4. "I keep a glass of water with me at all times."

6. 1. This medication must be administered exactly on time to maintain muscle movement and ability to swallow in clients diagnosed with MG. This is the priority medication. 2. This medication can be administered within the 30-minute acceptable time frame. 3. A pain medication is a priority but not over prevention of aspiration and maintaining the client's ability to use the muscles of respiration. 4. Etanercept (Enbrel) can be administered within the 30-minute acceptable time frame.

6. The nurse is administering 0800 medications on a medical floor. Which medication should the nurse administer first? 1. Prostigmin, a cholinesterase inhibitor, to a client diagnosed with myasthenia gravis. 2. Methylprednisolone, a glucocorticoid, to a client diagnosed with lupus erythematosus. 3. Morphine, a narcotic analgesic, to a client diagnosed with Guillain-Barré syndrome. 4. Etanercept, a biologic response modifier, to a client with rheumatoid arthritis.

60. 1. The client's blood glucose level is not affected by Imuran; therefore, there is no need to monitor the glucose level. 2. Bone marrow depression may occur when taking Imuran. The client must have a CBC and platelet counts every week the first month of therapy, then biweekly for 2-3 months, and monthly thereafter. 3. Low-grade fever is not expected and is a sign of infection and must be reported to the HCP. 4. Kidney function is monitored through laboratory tests, not the client's urine output.

60. The client has systemic lupus erythematosus and is prescribed azathioprine (Imuran). Which medication teaching should the nurse discuss with the client? 1. Instruct the client on how to use a glucometer. 2. Tell the client to come to the office for lab tests. 3. Explain that low-grade fevers are expected initially. 4. Discuss the need for recording an accurate urinary output.

61. 1. The medication is prescribed to prevent organ damage and the client must receive it, even though it has side effects. 2. Steroids interfere with glucose metabolism, and blood glucose levels should be monitored. The client understands the medication teaching. 3. The client needs the medication to prevent permanent organ damage. The medication should not be abruptly discontinued. It should be tapered off. The client needs more teaching about the medication so that the client takes the medication. 4. Steroids do increase the client's appetite. The client understands the medication teaching.

61. The client diagnosed with systemic lupus erythematosus is experiencing an acute exacerbation and is prescribed a high dose of intravenous steroid. Which statement by the client indicates the need for further teaching? 1. "I must take this medication even though I hate the side effects." 2. "My glucose levels may go up while I am on this medication." 3. "I will not allow you to administer this medication to me today." 4. "My appetite increases whenever I am taking steroids."

62. 1. The client should take the medication with meals or milk to reduce gastrointestinal distress. 2. Alcohol should be avoided because it will increase the possibility of liver toxicity. 3. Constipation is not a side effect of this medication; therefore, the client does not need to increase fluid intake. Diarrhea is a side effect. 4. Weight gain or loss would not be an indicator of medication compliance. 5. Plaquenil can cause retinopathy, blurred vision, and difficulty focusing; therefore, the client should have periodic eye examinations.

62. The client diagnosed with rheumatoid arthritis is undergoing long-term therapy with hydroxychloroquine (Plaquenil). Which actions by the client indicate compliance with the medication teaching? Select all that apply. 1. The client takes the medication with food. 2. The client does not drink any alcoholic beverages. 3. The client drinks at least 3000 mL of water daily. 4. The client has not had any unexplained weight loss. 5. The client sees the ophthalmologist every 6 months.

63. 1. Rheumatrex takes up to 6 weeks to be therapeutic; therefore, this is not an appropriate response. 2. This is a therapeutic response used to encourage the client to ventilate feelings, but it is not the best response because the client needs factual information. 3. This comment does not address the client's concern that the medication is not working. 4. Methotrexate is the most rapid-acting DMARD, but therapeutic effects may not develop for 3-6 weeks.

63. The client with rheumatoid arthritis is prescribed the disease-modifying antirheumatic drug (DMARD) methotrexate (Rheumatrex). After 3 days, the client reports that the medication is not working. Which statement is the clinic nurse's best response? 1. "I will make you an appointment with the health-care provider immediately." 2. "You are concerned that this medication is not going to work like the other ones." 3. "Have you lost any more range of motion in your upper extremities?" 4. "That is normal because it takes 3-6 weeks for the medication to work."

64. 1. After the initial gold salt injection, the next injection is scheduled for 7 days later, the next is 14 days later, and then it is weekly until a cumulative dose of 1 gram of gold salt has been administered. 2. Two weeks would be the second follow-up visit. 3. This is not correct. 4. This is not correct.

64. The clinic nurse is scheduling the follow-up appointment for the client diagnosed with rheumatoid arthritis who received the initial IM injection of gold salts. Which date should the nurse schedule the next appointment? 1. In 7 days. 2. In 2 weeks. 3. In 1 month. 4. In 3 months.

65. 1. All nurses must wear gloves when exposed to blood and body fluids, regardless of work setting. 2. According to Standard Precautions, the nurse must wear gloves when exposed to blood and body fluids. 3. The hospital must provide the nurse with nonlatex gloves and the nurse must keep them available for use when the nurse may be exposed to blood and body fluids. 4. This is not a workers' compensation issue. The nurse has not been injured.

65. The hospital nurse has developed a latex allergy. Which action should the hospital nurse implement? 1. Investigate working for a home health-care agency. 2. Wash hands thoroughly instead of wearing gloves. 3. Request a box of nonlatex gloves from the hospital. 4. File workers' compensation with the employee health nurse.

66. 1. Baths cannot be given at school. 2. Caladryl is calamine lotion and Benadryl combined. The lotion dries the lesions, and the topical Benadryl decreases the itching. This medication can be administered at school. 3. Oral Benadryl could have the systemic effect of drowsiness, which would interfere with the child's ability to function. 4. Polymyxin is a combination antibiotic, but it is not administered for a topical dermatitis.

66. The mother of an 8-year-old boy brings her son to the clinic, where the child is diagnosed with poison ivy. She is worried about him attending school. Which medication should the nurse recommend to help decrease pruritus while in school? 1. Aveeno, an oatmeal bath. 2. Caladryl, a topical antihistamine. 3. Oral diphenhydramine (Benadryl), an H1 antagonist. 4. Polymyxin, an antibiotic ointment.

67. 1. A 16-year-old female who is sexually active does not have to have parental permission to be treated for sexually transmitted diseases or to receive a vaccine designed to prevent an STD. 2. This is the first vaccine developed to prevent HPV infections and is administered in a series of injections. The nurse must discuss this with the patient to ensure that she will return for the entire series. 3. The Gardasil vaccine can prevent infection from HPV types 6, 11, 16, and 18 but not from every type of HPV. 4. The Gardasil vaccine is given in a series of injections; it is not an oral medication to be taken for life. 5. There is currently no vaccine that prevents a person from getting a sexually transmitted disease.

67. The 16-year-old female who is sexually active is being seen in the clinic for a Pap test. She has requested to receive Gardasil, a vaccine for human papillomavirus. Which information should the nurse discuss with the client? Select all that apply. 1. "You must ask your parents if you can take this medication." 2. "The medication is administered in a series of injections." 3. "Gardasil will guarantee you won't get cervical cancer." 4. "This medication must be taken for the rest of your life." 5. "This vaccine will not prevent sexually transmitted diseases."

68. 1. The nurse would not question administering a broad-spectrum antibiotic. The client has had surgery, and antibiotics are prescribed prophylactically. 2. Lovenox is prescribed to prevent deep vein thrombosis, and the nurse would not question administering this medication. 3. Cyclosporine is not an expected medication to be prescribed for a client with total knee replacement. The nurse should determine why the client is receiving this medication. The client taking cyclosporine has had some type of organ transplant. 4. The nurse would expect the postoperative client to receive pain medication.

68. The nurse is preparing to administer the morning medications to the client who is 1-day postoperative total knee replacement. Which medication should the nurse question administering? 1. The ceftriaxone (Rocephin), a broad-spectrum antibiotic. 2. The enoxaparin (Lovenox), a low-molecular-weight heparin. 3. The cyclosporine (Neoral), an immunosuppressant. 4. The morphine, a narcotic analgesic.

69. 9 tablets. To determine how many tablets should be administered the nurse should first determine that the client weighs 100 kg (220 ÷ 2.2 = 100). Then, the nurse multiplies 9 mg times 100 kg, which equals 900 mg a day. Then 900 mg divided by 100 mg = 9. The nurse would administer 9 tablets.

69. The client post-kidney transplant is prescribed cyclosporine (Gengraf), an immunosuppressant. The HCP prescribes 9 mg/kg daily. The client weighs 220 pounds. The hospital has 100-mg tablets on hand. How many tablets would the nurse administer?

7. 1. Tensilon is used to help diagnose MG and to determine if a client diagnosed with MG is in a cholinergic versus a myasthenic crisis. A client losing the ability to breathe without mechanical support when given Tensilon is in a cholinergic crisis in which too much medication is in the body. 2. This response is the response that is diagnostic of myasthenia gravis. 3. This is a nonpharmacologic test that can be performed to assess for MG. This is a positive finding, but it does not apply to edrophonium. 4. An unlabeled use for edrophonium is to terminate paroxysmal atrial tachycardia, but this does not diagnose MG.

7. The nurse administered edrophonium (Tensilon), a cholinesterase inhibitor, to a client diagnosed with rule-out myasthenia gravis (MG). Which response by the client indicates the client has myasthenia gravis? 1. The client loses the ability to breathe without mechanical support. 2. The client's strength improves briefly without signs of fasciculations. 3. The client cannot gaze at the ceiling for 2 minutes without fatigue. 4. The client's paroxysmal atrial tachycardia converts to normal sinus rhythm.

70. 1. Pain medication is priority but not over a medication that will prevent a potentially life-threatening event. 2. Lasix would be administered to treat the edema, but it is not priority for someone with 2+ edema. 3. Glucophage is not given for a life-threatening condition; therefore, it can be administered after the Prostigmin. 4. A client with MG must take medications on time to ensure muscle function while eating or performing ADLs. Prostigmin is one of the few medications that must be administered exactly on time.

70. The nurse is preparing to administer morning medications. Which medication should the nurse administer first? 1. Hydrocodone (Vicodin), a narcotic analgesic, to the client with pain rated a 7 on pain scale of 1-10. 2. Furosemide (Lasix), a loop diuretic, IVP to a client with 2+ pitting edema. 3. Metformin (Glucophage), a biguanide, po to a client diagnosed with Type 2 diabetes. 4. Neostigmine (Prostigmin), a anticholinesterase, orally to the client diagnosed with myasthenia gravis.

8. 1. There are four phases of gout. Phase 1 is asymptomatic hyperuricemia; phase 2 is acute gouty arthritis; phase 3 is intercritical gout; and phase 4 is chronic tophaceous gout. Being asymptomatic after an acute attack indicates the client is in phase 3, intercritical gout; it does not indicate that the medication is effective. 2. Zyloprim does not cause an aversion reaction to alcohol. The client should be instructed not to consume alcoholic beverages because alcohol can induce an attack. 3. The main problem in gout is hyperuricemia. A normal value indicates a suppression of the production of uric acid by the body and that the medication is effective. 4. Tophi are accumulations of sodium urate crystals, which are deposited in peripheral areas of the body. The presence of tophi indicates the medication is not effective. MEDICATION MEMORY JOGGER: The nurse determines the effectiveness of a medication by assessing for the symptoms, or lack thereof, for which the medication was prescribed.

8. The client diagnosed with an acute gout attack is prescribed allopurinol (Zyloprim). Which data indicates the medication is effective? 1. The client has been symptom free for several days. 2. The client has developed an aversion reaction to alcohol. 3. The serum uric acid levels are within normal limits. 4. The client develops tophi in the joints of the feet.

9. 1. The nurse should not tell the client to decrease the dose of medication. Achieving the correct dose is extremely difficult and may require frequent modification, especially when the client is under stress or has an illness. Only the HCP should advise the client about the correct dose. 2. Holding the medication could result in respiratory compromise. The nurse should teach the client how to minimize the side effects of the medication. 3. The nurse should teach the client how to minimize the side effects of the medication. Taking the medication with milk or crackers will reduce the gastrointestinal effects. The HCP can prescribe small doses of atropine to counteract the side effects if this suggestion is not successful, but the client must take the medication. 4. The client does not need an overthe- counter medication to counteract the side effect of nausea.

9. The female client diagnosed with myasthenia gravis complains that the anticholinesterase medication makes her nauseated. Which information should the nurse teach the client? 1. Decrease the dose of the medication. 2. Hold the medication and notify the HCP. 3. Take the medication with milk and crackers. 4. Take an over-the-counter proton-pump inhibitor.