K Pharm

A client prescribed to receive a dose of nifedipine has a pulse rate of 50 beats per minute. Which action is the most appropriate for the nurse to take? A. Withhold the medication. B. Check urinary output. C. Administer the medication. D. Increase potassium intake.

A. Withhold the medication. Nifedipine is calcium-channel blocker used as an antihypertensive. Bradycardia is an untoward effect of this medication. The nurse should withhold the medication and notify the health care provider of the client's pulse rate.

The home health nurse evaluates a client's use of a nasal decongestant spray. Which statement by the client to the nurse indicates correct understanding of the procedure? A. "I lie down with my head tilted backward before I use the spray." B. "I close one nostril while I breathe in and squeeze the spray into the other." C. "I keep the tip of the spray container no more than 1/2 inch in front of my nostril." D. "I blow my nose firmly to clear it before and after I administer the medication."

B. "I close one nostril while I breathe in and squeeze the spray into the other." Closing one nostril ensures adequate inhalation and subsequent absorption into the affected nostril.

The nurse observes a client with type 1 diabetes mellitus prepare an injection of 32 units of intermediate-acting insulin and 8 units of short-acting insulin. Which client action requires intervention by the nurse? A. After drawing up 8 units of short-acting insulin, the client adds intermediate-acting insulin to the syringe for a total of 40 units. B. The client draws up 32 units of the intermediate-acting insulin followed by 8 units of short-acting insulin for a total of 40 units. C. Initially, the client injects air into the intermediate-acting insulin vial without drawing up any insulin. D. The client injects air into each bottle of insulin equal to the amount of insulin to be withdrawn.

B. The client draws up 32 units of the intermediate-acting insulin followed by 8 units of short-acting insulin for a total of 40 units. Short-acting insulin is clear and drawn up first followed by the intermediate-acting insulin.

The nurse instructs a client receiving furosemide and digoxin. The nurse determines that teaching is effective when the client selects which drink? A. Whole milk. B. Gatorade. C. Orange juice. D. Water.

C. Orange juice. Orange juice contains 496 mg of potassium per 8 ounces and helps restore potassium lost because of furosemide. Potassium must be maintained within normal limits to avoid digoxin toxicity.

A client receives a prescription for clopidogrel. Which laboratory results are important for the nurse to monitor based on this new prescription? (Select all that apply.) 1. Hemoglobin. 2. Hematocrit. 3. Platelet count. 4. International normalized ratio (INR). 5. Activated partial thromboplastin time (aPTT).

1, 2 1) Clopidogrel is an oral antiplatelet medication that interferes with platelet aggregation. Adverse effects include hemorrhage, bleeding, hematuria, and hemoptysis. A decreased hemoglobin may indicate bleeding. 2) A decreased hematocrit may indicate bleeding. Clopidogrel suppresses platelet aggregation, but it does not decrease platelet count. PT & INR = monitor warfarin effectiveness aPTT = monitor heparin effectiveness

The nurse teaches a client who is prescribed prednisone for systemic lupus erythematosus (SLE). Which information related to prednisone does the nurse include in the teaching plan? (Select all that apply.) 1. Report any symptoms of infection. 2. Do not discontinue medication abruptly. 3. Take medication at bedtime. 4. Report unusual weight gain. 5. Get vaccinated for influenza. 6. Avoid salt substitutes.

1, 2, 4 1) Prednisone causes immunosuppression, and symptoms of infection should be reported. 2) Discontinuing prednisone abruptly can cause adrenal crisis. 4) Prednisone is associated with fluid retention and weight gain in most clients.

The client is diagnosed with heart failure. The nurse receives a new prescription to administer IV chlorothiazide. The nurse questions this prescription based on which laboratory value? (Select all that apply.) 1. Serum sodium = 128 mEq/L (128.0 mmol/L). 2. Serum calcium = 12 mg/dL (3 mmol/L). 3. Serum potassium = 5.3 mEq/L (5.3 mmol/L). 4. Serum pH = 7.48. 5. BUN = 15 mg/dL (5.35 mmol/L). 6. Urine specific gravity = 1.022.

1, 2, 4 1) Thiazide diuretics are prone to produce hyponatremia since they increase sodium excretion without affecting the kidney's ability to concentrate urine. This client's sodium is decreased. Therefore, the nurse questions this prescription. 2) Thiazide diuretics decrease excretion of calcium. This client's calcium level is elevated. Therefore, the nurse questions this prescription. 4) Thiazide and loop diuretics produce metabolic alkalosis because of urinary loss of hydrogen. Therefore, the nurse questions this prescription.

The nurse prepares a teaching plan for a client who is prescribed captopril for hypertension. Which information does the nurse include in the teaching plan? (Select all that apply.) 1. Avoid using salt substitutes. 2. Do not stop the medication abruptly. 3. Take the medication with food. 4. Blood glucose should be tested monthly. 5. Do not report a dry cough because it is common. 6. Change positions slowly.

1, 2, 6 1) Salt substitutes contain potassium that can cause hyperkalemia when taken with captopril, an ACE inhibitor. 2) Stopping the medication abruptly can cause rebound hypertension. 6) A sudden change in position can cause orthostatic hypotension that could result in a fall for a client

A client with type 2 diabetes mellitus is prescribed pioglitazone and metformin. Which findings cause the nurse to question the prescription of these medications? (Select all that apply.) 1. Client is attempting to become pregnant. 2. Client has a history of essential hypertension. 3. Client has a history of nonalcoholic fatty liver disease. 4. Client has chronic kidney disease. 5. Client gained 10 pounds over the past 3 months.

1, 3, 4 1) Pioglitazone is contraindicated in pregnancy and metformin must be used with caution. These medications should be questioned before providing to the client. 3) A history of liver disease contraindicates the use of pioglitazone and metformin. 4) A history of kidney disease or renal malfunction contraindicates the use of metformin.

The nurse provides instructions to a client prescribed hydralazine as treatment after a hypertensive crisis. Which client statements indicate to the nurse that the teaching is effective? (Select all that apply.) 1. "I need to tell my health care provider if I lose my appetite." 2. "I need to have my blood drawn twice a week." 3. "I will take my hydralazine with my breakfast." 4. "I will call my health care provider before taking ibuprofen." 5. "I will sit on the edge of my bed for 2 minutes before I stand up in the morning."

1, 3, 4, 5 1) Anorexia is a possible adverse effect of hydralazine. The health care provider should be notified if this occurs. 3) Hydralazine should be taken with food to increase bioavailability of the medication. 4) The client needs to avoid over-the-counter medications unless directed by the health care provider. 5) Orthostatic hypotension is a possible adverse effect of this medication. Sitting on the edge of the bed before standing up in the morning helps prevent this effect.

The nurse provides care for a client diagnosed with heart failure. Which client statement indicates to the nurse that medication therapy is effective? (Select all that apply.) 1. "Since I've been taking captopril, my feet are not as puffy." 2. "Taking spironolactone has kept my pulse less than 60." 3. "Lisinopril seems to help me not be as short of breath." 4. "Now that I'm taking carvedilol, I don't have palpitations." 5. "Before taking valsartan, I had to stop and rest while cooking." 6. "I seem to urinate more when I take digoxin."

1, 3, 5, 6 1) ACE inhibitors, such as captopril, reduce peripheral edema. This statement indicates the medication therapy is effective. 3) ACE inhibitors, such as lisinopril, reduce pulmonary congestion, which will decrease dyspnea. This statement indicates the medication therapy is effective. 5) Angiotensin II receptor blockers (ARBs), such as valsartan, decrease pulmonary congestion and improve cardiac output, which should reduce client's fatigue and dyspnea. This statement indicates the medication therapy is effective. 6) Cardiac glycosides, such as digoxin, improve cardiac output, which increases urine output. This statement indicates the medication therapy is effective

The nurse provides care for the client diagnosed with chronic gastritis. The nurse intervenes if the LPN/LVN administers which medications to this client? (Select all that apply.) 1. Celecoxib. 2. Sucralfate. 3. Clarithromycin. 4. Naproxen. 5. Pantoprazole.

1, 4 1) Use of nonsteroidal anti-inflammatory medications (NSAIDs) is a potential cause of gastritis. Since celecoxib is an NSAID, the nurse needs to intervene if the LPN/LVN attempts to administer this medication. 4) Use of nonsteroidal anti-inflammatory medications (NSAIDs) is a potential cause of gastritis. Since naproxen is an NSAID, the nurse needs to intervene if the LPN/LVN attempts to administer this medication.

The nurse provides discharge teaching for a client being treated with permethrin. Which client statements indicate to the nurse a correct understanding of the medication teaching session? (Select all that apply.) 1. "I leave the cream on my hair for 10 minutes before rinsing it out." 2. "I will use the cream daily until the nits are gone." 3. "I plan to wash all my bed linens with bleach and hot water." 4. "The cream may cause redness on my scalp and skin." 5. "I will check my family members because this condition is easily spread." 6. "This medication should make my itching stop."

1, 4, 5, 6 1) This is an appropriate use of permethrin. 4) Erythema and skin irritation are potential adverse effects of permethrin. 5) Lice and scabies spread easily and all contacts should be checked. 6) Once lice and nits are killed, clients should no longer experience pruritus.

The nurse visits the home of a client prescribed phenytoin 8 weeks ago for tonic-clonic seizure control. Which client statements require immediate intervention by the nurse? (Select all that apply.) 1. "I need to tell my health care provider if I decide to try to get pregnant." 2. "I noticed a rash on my stomach last week." 3. "Lately, I find myself thinking about driving off a cliff." 4. "If I start having adverse effects, I should stop taking the phenytoin immediately." 5. "I take my phenytoin once a day at bedtime."

2, 3, 4 2) A rash is a symptom of phenytoin hypersensitivity. The medication may need to be changed. 3) Phenytoin can increase suicidal tendencies. Intervention is required for this finding. 4) Abruptly discontinuing phenytoin can cause seizures. Adverse effects should be reported. The health care provider will determine what medication change is required.

The client is on high-dose methotrexate for treatment of non-Hodgkin's lymphoma. Which statement made by the client indicates understanding of appropriate precautions? (Select all that apply.) 1. "I should brush and floss my teeth three times a day." 2. "I should tell my friends and family not to send flowers." 3. "I should plan to bring in a heavy afghan from home because I will probably get cold easily." 4. "I should bring in my electric razor to shave." 5. "If my visitor has a cold, they can visit as long as they wear a mask."

2, 4 2) Fresh flowers and potted plants are a medium for bacterial growth and should be avoided, as this client will be high risk for infection due to myelosuppression. 4) Electric razors should be used instead of razor blades to decrease the risk of bleeding. The client may experience thrombocytopenia secondary to myelosuppression. While oral hygiene is important, flossing the teeth may lead to bleeding. The client's platelet levels may be low due to myelosuppression. Visitors with infections should not visit the client who is immunocompromised.

The nurse provides care for a client receiving chemotherapy. The medication is an alkylating agent. Which action does the nurse implement to minimize adverse effects? (Select all that apply.) 1. Prevent ileus formation by encouraging frequent ambulation. 2. Administer anti-emetics prophylactically and as needed. 3. Offer frequent high fat meals to prevent weight loss. 4. Teach client to use saline mouth rinse before and after meals. 5. Encourage client to increase fluid intake for the next 3 days. 6. Educate client about the benefits of exercise to manage fatigue.

2, 4, 5, 6 2) Nausea and vomiting are common and should be prevented if possible. 4) Stomatitis is a common adverse effect of chemotherapy, and it may be prevented or minimized with meticulous oral care. Salt water, usually mixed with baking soda, is used to rinse the mouth after every meal as a way to reduce particles and reduce oral acidity. 5) Cystitis occurs with many chemotherapeutic agents and may be prevented with increased fluid intake. 6) Mild to moderate exercise, along with frequent rest periods, will help to manage the fatigue often experienced during chemotherapy.

The nurse learns that an older adult client refused a prescribed sleeping medication and was awake most of the night. Which actions will the nurse take? (Select all that apply.) 1. Ask why the medication was refused. 2. Ask if pain or discomfort interrupts sleep. 3. Offer a visit by the hospital chaplain. 4. Obtain information about sleep habits when at home. 5. Instruct nursing staff to administer pain medication at bedtime to promote sleep. 6. Instruct nursing staff to minimize unnecessary noise and talking in the hallway.

2, 4, 6 2) Assessing pain level is a part of every assessment and may impact a hospitalized client's sleep. 4) Information about the client's sleeping habits at home will determine if nighttime wakefulness is normal for this client. 6) Environmental factors, such as alarms and staff conversations, often interrupt sleep in hospitalized clients.

The nurse provides care for a client receiving lithium carbonate 300 mg PO 3 times/day. Which clinical manifestations will the nurse identify as early indications of toxicity? (Select all that apply.) 1. Mild thirst. 2. Nausea and vomiting. 3. Coarse hand tremor. 4. Ataxia. 5. Slurred speech. 6. Muscle weakness.

2, 5, 6 2) Nausea and vomiting are early signs of toxicity. The nurse should withhold the medication and obtain a blood lithium level before the dose will be re-evaluated. 5) Slurred speech is an early sign of toxicity, along with possible diarrhea, thirst, and polyuria. 6) Muscle weakness is an early sign of toxicity, and the nurse should withhold the medication and obtain a blood lithium level.

During a home health visit, an older adult Asian American client reports nausea and anorexia since taking isoniazid for 4 months. Which action will the nurse take first? A. Obtain a sputum specimen. B. Inspect the hard palate. C. Assess skin color on the abdomen. D. Instruct the client to stop the medication.

B. Inspect the hard palate. Due to biocultural skin variations, signs of early jaundice are best observed on the posterior hard palate in people of Asian descent. Even sclera may contain carotene pigments that mimic jaundice in Asian American clients.

The nurse counsels the parent of a school-age client diagnosed with asthma. The health care provider prescribes albuterol and beclomethasone via metered dose inhaler. Which statement by the parent indicates that teaching is effective? A. "Albuterol should be taken as needed when my child is short of breath. The beclomethasone should be taken every day to prevent asthma attacks." B. "Both of the medications should be taken on a regular basis, at the same time each day." C. "The beclomethasone is to be used only when my child is wheezing and is short of breath." D. "Both inhalers should be used immediately before my child participates in physical exercise."

A. "Albuterol should be taken as needed when my child is short of breath. The beclomethasone should be taken every day to prevent asthma attacks." Albuterol is a rapid-acting bronchodilator used to treat acute asthma attacks. Beclomethasone is an anti-inflammatory agent used chronically to prevent asthma attacks by reducing inflammation in the airways.

The nurse performs discharge teaching for a client receiving trifluoperazine. Which client statement indicates to the nurse that teaching is successful? A. "I cannot breastfeed my baby while I am taking this medication." B. "I can take two pills at night if I have difficulty sleeping." C. "This medication may cause my eyes to frequently tear." D. "I will increase my daily calorie intake to maintain my weight."

A. "I cannot breastfeed my baby while I am taking this medication." Trifluoperazine is an antipsychotic and is excreted in the breast milk. Breastfeeding is contraindicated

The nurse instructs a client receiving phenelzine sulfate 11 mg PO daily. Which statement by a client indicates to the nurse that teaching is effective? A. "I will call my health care provider if I begin to have severe headaches." B. "I can drink wine, but I should avoid whiskey." C. "I know I am going to feel better in a couple of days." D. "I can take cold medications that contain pseudoephedrine."

A. "I will call my health care provider if I begin to have severe headaches." Phenelzine is a monoamine oxidase inhibitor (MAOI). A hypertensive crisis may be precipitated by foods containing tyramine. A client should be taught to report problems associated with hypertension, such as a severe headache, dizziness, and fatigue.

The nurse provides care for a client with a history of a heart murmur who has been receiving clozapine for 2 weeks. The nurse reviews discharge instructions. Which client statement indicates that teaching is successful? A. "I will return to the lab in 1 week to have my white blood count taken." B. "I can take two pills the next morning if I miss my dose." C. "I will limit my intake of sodium to 2 mg a day." D. "I will increase my dose if I am feeling 'moody'."

A. "I will return to the lab in 1 week to have my white blood count taken." Clozapine is an atypical antipsychotic. One of the side effects is agranulocytosis, which is potentially life threatening. The drug will be discontinued if the white blood cells (WBCs) fall below 2000/mm3.

A client receives intravenous gentamicin sulfate every 8 hours. Which client statement is most important for the nurse to report to the health care provider? A. "My wife tells me my hearing has changed." B. "My vision is blurred when I read the paper." C. "Food just doesn't taste as good to me." D. "Look at this rash on my arms."

A. "My wife tells me my hearing has changed." Decreased hearing and vertigo occur as a result of irritation of the eighth cranial nerve, which is caused by gentamicin toxicity. This finding should be reported to the health care provider.

A client who is receiving isoniazid, rifampin, and ethambutol asks the nurse why the health care provider has prescribed three medications. Which response should the nurse provide? A. "The combination of medication prevents the development of resistant organisms." B. "The combination of medication kills the bacteria more rapidly." C. "The combination of medication reduces the duration of time you take the medication." D. "The combination of medication reduces the risk of developing side effects from the medication.

A. "The combination of medication prevents the development of resistant organisms." Tuberculosis (TB) is an infectious disease transmitted by droplet infection via airborne route. To prevent resistant strains, two or three medications are usually administered concurrently.

The nurse instructs a client about the correct way to take an oral contraceptive. Which client statement indicates that teaching was effective? A. "The pill is most effective if I take it at the same time each day." B. "If I miss one pill, I will wait and take it with the next day's pill." C. "I will stop taking the pill if I experience nausea and vomiting." D. "I will stop using my diaphragm once I start the pill pack."

A. "The pill is most effective if I take it at the same time each day." Hormone levels may decrease and ovulation may occur if the pill is not taken at the same time daily. The client should take the medication with a meal or at bedtime to serve as a reminder. This statement indicates that client teaching was effective.

An adolescent client presents to the emergency department (ED) for an overdose of aspirin. Which action does the nurse perform first? A. Determine the time of drug ingestion and the amount consumed. B. Initiate an IV and administer protamine sulfate. C. Start an IV and administer vitamin K. D. Obtain an ABG and request respiratory therapy support.

A. Determine the time of drug ingestion and the amount consumed. The nurse first determines when the client consumed the aspirin. Charcoal, if given within two hours, will absorb particles of aspirin.

A client diagnosed with Addison disease comes to the emergency department experiencing nausea, vomiting, diarrhea, and abdominal pain. Which prescription does the nurse expect from the health care provider? A. Dextrose 5% in normal saline IV solution and high-dose steroids. B. Adrenocorticotropic hormone (ACTH) IM injection, 0.9% saline infusion, and potassium. C. Sliding scale insulin asparte subcutaneous injection. D. Oral administration of sodium chloride, potassium chloride, and steroids.

A. Dextrose 5% in normal saline IV solution and high-dose steroids. The client is exhibiting symptoms of Addisonian crisis, in which the client is hypotensive and experiences a severe deficiency of glucocorticosteroids. The nurse expects to administer isotonic fluid to increase fluid volume and to provide high-dose steroids to replenish the client.

The nurse enters the room of a client with confusion and angina pectoris. The nurse opens the client's gown to remove the nitroglycerin patch for the night. The nurse does not find the patch where charting indicated it was placed. What action does the nurse take first? A. Find the patch and dispose of it. B. Clean the site thoroughly with alcohol. C. Ask the client what happened to the patch. D. Administer nitroglycerin sublingually.

A. Find the patch and dispose of it. The client who is confused may move a transdermal patch elsewhere on the body. If it remains in the new location and another patch is applied elsewhere, loss of angina-relieving response could occur due to continued exposure and developed tolerance. Also, discarded patches still have sufficient active ingredients to be of harm to persons having contact with them.

A client diagnosed with schizophrenia consistently neglects to take prescribed medication. Which prescription will the nurse expect from the health care provider? A. Fluphenazine decanoate 25 mg intramuscular injection. B. Lithium carbonate 300 mg by mouth. C. Lorazepam 2 mg by mouth. D. Pemoline 75 mg by mouth.

A. Fluphenazine decanoate 25 mg intramuscular injection. Fluphenazine decanoate is a psychotherapeutic medication that is used in the management of psychotic disorders. It is an oil preparation that is given through an intramuscular or subcutaneous injection every 1 to 6 weeks. Onset of action is between 24 to 96 hours. This is the ideal medication since the client neglects to take medications as prescribed.

The nurse obtains a history from a client scheduled to undergo electroconvulsive therapy (ECT). Which finding does the nurse to report to the health care provider (HCP)? A. The client takes alendronate once a day. B. The client reports feelings of lethargy and fatigue. C. The client has received the therapy in the past. D. The client walks for 30 minutes three times per week.

A. The client takes alendronate once a day. Alendronate is used to treat osteoporosis. Osteoporosis places the client at risk for an injury during the contractions of muscles during the ECT procedure. This finding should be reported to the HCP.

The community health nurse cares for a client who is taking multiple medications for constipation. Which medication causes the nurse the least concern? A. Psyllium hydrophilic mucilloid. B. Docusate sodium. C. Magnesium hydroxide. D. Bisacodyl.

A. Psyllium hydrophilic mucilloid. Psyllium is a bulk-forming laxative, the category of laxative that is usually seen as the safest, even when taken on a routine basis. Psyllium is a fiber and works by increasing water absorption or retention within the stool, increasing the bulk and stimulating peristalsis

The nurse assesses the records of an infant scheduled to see the health care provider for the 6-month checkup. Which immunization records are required for the nurse to determine that the infant is up to date on immunizations? A. Two doses of diptheria, tetanus, and acellular pertussis (DTaP). and two doses of inactivated polio vaccine (IPV). B. One dose of measles, mumps, and rubella (MMR). C. A tuberculin skin test and one dose of diptheria, tetanus, and acellular pertussis (DTaP). D. One dose of smallpox vaccine and one dose of measles, mumps, and rubella (MMR).

A. Two doses of diptheria, tetanus, and acellular pertussis (DTaP). and two doses of inactivated polio vaccine (IPV). The infant should receive doses of diphtheria, tetanus, and acellular pertussis (DTaP) at 2 months and 4 months, and will receive a third dose at the 6-month appointment. The inactivated polio is given at 2 months and 4 months.

An older adult client takes dexamethasone 1.5 mg by mouth three times a day. Which client statement causes the nurse the most concern? A. "I take my medication with meals." B. "I have this little sore on my leg that won't go away." C. "I should take a brisk walk several times a week." D. "I avoid public places during the flu season."

B. "I have this little sore on my leg that won't go away." Steroids suppress the immune response. A nonhealing sore should be reported to the health care provider and further assessed.

The nurse in the outpatient clinic assesses a client diagnosed with a seizure disorder. The client states that the seizures are controlled by carbamazepine. The client also takes oral hormonal contraceptive and levothyroxine. Which response by the nurse is most important? A. "Do you take the medications at the same time every day?" B. "Let's talk about other forms of contraceptives." C. "Do you wear sunscreen when you go outdoors?" D. "Taking the medication with food will decrease gastric irritation."

B. "Let's talk about other forms of contraceptives." Carbamazepine interferes with the action of hormonal contraceptives. The client should use another form of birth control to be effective against unintended pregnancy. This is the most important response.

The nurse provides care for a client 24 hours after admission. The client's spouse reports that the client drinks a fifth of vodka daily. The nurse notifies the health care provider that the client is restless, agitated, and irritable. The health care provider prescribes chlorpromazine 25 mg intramuscularly. Which action does the nurse take first? A. Administer the medication as ordered. B. Contact the health care provider. C. Continue to monitor the client. D. Ensure that the lights are on in the client's room.

B. Contact the health care provider. The client has symptoms of alcohol withdrawal. Chlorpromazine is not appropriate for this client. The nurse should contact the health care provider for a benzodiazepine to sedate the client and calm the neurological irritability.

The nurse provides care for a young adult female client undergoing peritoneal dialysis. The nurse notes that the outflow appears red-tinged. Which action does the nurse take first? A. Contact the health care provider. B. Determine if the client is menstruating. C. Obtain the client's vital signs. D. Continue with the peritoneal dialysis

B. Determine if the client is menstruating. Because of the hypertonicity of the dialysate, blood from the uterus can be pulled through the fallopian tubes into the effluent. This is common in premenopausal female clients during menstruation. No intervention is required.

The nurse prepares to administer medications to a newly admitted client. Which intervention by the nurse is most likely to prevent complications for the client? A. Encourage the client to report any new or unusual symptoms to the nurse or health care provider immediately. B. Obtain information regarding the client's allergies, document the information in the chart, and apply an allergy armband. C. Monitor the client's response to prescribed medications and document the information in the chart. D. Offer the client information regarding medications before administration.

B. Obtain information regarding the client's allergies, document the information in the chart, and apply an allergy armband. Accurate history taking and documentation of allergies are the first line of defense in preventing unnecessary reactions in medication administration. This nursing action is most likely to prevent client complications.

A school-aged client injures the right knee and is brought to the outpatient clinic by the parent. During the interview, the nurse learns that the client has been diagnosed hemophilia A. Which medication does the nurse expects the health care provider (HCP) to prescribe? A. Aspirin/oxycodone. B. Oxycodone hydrochloride. C. Enteric-coated aspirin. D. Ibuprofen.

B. Oxycodone hydrochloride. Oxycodone hydrochloride, with or without acetaminophen, is the appropriate HCP prescription. Assess type, location, and intensity of the pain. Regular dosing of the medication may be more effective than PRN dosing. Administer with food or milk to decrease GI irritation. Oxycodone with aspirin is contraindicated for clients diagnosed with hemophilia. Bleeding into the joints is a common occurrence.

The nurse evaluates the progress of a client recently diagnosed with type 1 diabetes mellitus. As part of the treatment plan, the client receives insulin (human recombinant) 32 units and insulin (regular) 8 units each morning. Which action performed by the client requires an intervention by the nurse? A. The client adds the long acting insulin to the syringe, for a total of 40 units after drawing up 8 units of the regular insulin. B. The client draws up 32 units of the clear insulin, followed by 8 units of cloudy insulin for a total of 40 units. C. The client initially injects air into the long-acting vial without drawing up any insulin. D. The client injects air into each vial of insulin equal to the amount of insulin to be withdrawn.

B. The client draws up 32 units of the clear insulin, followed by 8 units of cloudy insulin for a total of 40 units. Regular insulin is clear and drawn up first for 8 units as prescribed. The long-acting insulin is cloudy, and the client needs to draw up 32 units for a total of 40 units of insulin. This action requires an intervention by the nurse.

The home care nurse evaluates a client diagnosed with tuberculosis receiving isoniazid, rifampin, and pyrazinamide. Which client statement requires further assessment by the nurse? A. "I have gained 5 pounds since I started taking the medication." B. "I cover my nose and mouth when I cough or sneeze." C. "I drink a glass of wine with dinner each night." D. "I have stopped eating tuna salad sandwiches."

C. "I drink a glass of wine with dinner each night." An adverse reaction of isoniazid is hepatitis. Instruct a client to avoid ingesting alcohol when taking the drug.

The nurse instructs a client on the use of aluminum hydroxide. Which client statement indicates that teaching has been effective? A. "It is important to take my medicine during the evening." B. "By taking the medication before meals, I will decrease the side effects." C. "I will take the medication after meals." D. "As I start to feel uncomfortable, I will take the medication."

C. "I will take the medication after meals." Antacids are most effective after digestion has started but prior to the emptying of the stomach. 1 hour after meal & bedtime.

A client is prescribed phenazopyridine 200 mg three times a day by mouth. Which information will the nurse include when teaching the client about this medication? A. "Take your medication at least 6 hours before bed so it doesn't cause insomnia." B. "Wear sunglasses when you are outdoors and try to avoid bright lights." C. "If your skin or sclera develops a yellowish tinge, call the health care provider." D. "Avoid driving or activities that require alertness while taking this medication."

C. "If your skin or sclera develops a yellowish tinge, call the health care provider." Yellowish discoloration of the skin or sclera indicates that the drug is accumulating in the body because of renal impairment. This finding should be reported to the health care provider. Phenazopyridine is a urinary tract analgesic.

The nurse provides care for a client diagnosed with ventricular tachycardia and angina. Which medication does the nurse administer first? A. Nitroglycerin. B. Morphine sulfate. C. Amiodarone. D. Metoprolol.

C. Amiodarone. The nurse administers a drug that will terminate the rhythm causing the angina first. Ventricular tachycardia indicates severe myocardial irritability and causes chest pain, dizziness, and fainting. Amiodarone is the drug of choice for hemodynamically unstable ventricular tachycardia. This medication inhibits adrenergic stimulation and prolongs repolarization, allowing for a normal rhythm to occur

The nurse prepares teaching for a client receiving sulfasalazine. Which information will the nurse include in this client's instructions? A. Restrict fluids to 1500 mL per day. B. Expect that stools may become clay-colored. C. Continue the medication even after symptoms subside. D. Discontinue the medication if diarrhea occurs.

C. Continue the medication even after symptoms subside. Sulfasalazine decreases bowel inflammation. It should be taken as prescribed.

The nurse provides care for a client in the clinic. The health care provider's (HCPs) prescription reads, "sulindac 200 mg PO bid for 14 days." Which symptom does the nurse instruct a client to report immediately to the HCP? A. Nervousness. B. Photophobia. C. Ecchymosis of the extremities. D. Mild edema of the feet.

C. Ecchymosis of the extremities. Sulindac is a nonsteroidal anti-inflammatory drug (NSAID). A client taking sulindac should notify the HCP if easy bruising or prolonged bleeding occurs.

The nurse provides care for a client who experienced a spinal cord injury at the level of T-2. The nurse enters the room and notes that the client's face is flushed, is sweating profusely, and the blood pressure is 260/160 mm Hg. Which medication does the nurse prepare to administer? A. Docusate sodium 100 mg PO. B. Prochlorperazine 10 mg IM. C. Hydralazine hydrochloride 10 mg IV. D. Diazepam 20 mg IV.

C. Hydralazine hydrochloride 10 mg IV. Symptoms indicate autonomic dysreflexia with the elevated blood pressure as the most critical symptom. Hydralazine hydrochloride is a fast acting antihypertensive and relaxes smooth muscle. Side effects can include headache, angina, tachycardia, palpitations, sodium retention, anorexia, or a lupus erythematosus-like syndrome of sore throat, fever, muscle-joint aches, rash

A client comes to the clinic reporting muscle weakness, breathlessness, and bone pain. The nurse notes that the client takes phenytoin 100 mg three times a day. When providing nutritional counseling, which food grouping best meets this client's needs? A. Bananas, mushrooms, yams. B. Oranges, broccoli, papayas. C. Milk, cantaloupe, kale. D. Soybeans, spinach, pumpkin seeds.

C. Milk, cantaloupe, kale. Anticonvulsants can cause folate and vitamin D deficiencies. The client has symptoms reflective of anemia and bone resorption. Folate deficiency can cause anemia. Good sources of folate are green leafy vegetables, legumes, tomatoes, and various fruits such as oranges and cantaloupe. Good sources of vitamin D include milk. Kale is also a good source of calcium to work with the vitamin D.

The nurse prepares to administer hydroxyzine to a client. For which reason does the nurse use the Z-track method when administering this medication? A. Slows the rate of absorption. B. Is the safest and least painful way to give the injection. C. Reduces irritation to the subcutaneous and skin tissues. D. Prevents the medication from seeping into the venous circulation.

C. Reduces irritation to the subcutaneous and skin tissues. The Z-track method is a variation of the standard intramuscular technique for administering medications that are highly irritating to subcutaneous and skin tissues.

The nurse administers intravenous dopamine to a client. Which parameter will the nurse monitor to evaluate the response to this medication? A. Heart rhythm. B. Central venous pressure. C. Vital signs. D. Daily weights.

C. Vital signs Dopamine is indicated for correction of hemodynamic instability as a result of shock. Monitoring vital signs provides the most appropriate information regarding the effects of the medication.

The nurse prepares a client for a barium enema. Which instruction is most important for the nurse to include? A. "Your stool will be light colored for 2 to 3 days after the test." B. "Once the test is over and you go to the toilet, you will be able to resume normal activities." C. "The x-ray table will be tilted so you can assume various positions." D. "During the test, it is crucial that you take slow, deep breaths through your mouth."

D. "During the test, it is crucial that you take slow, deep breaths through your mouth." For the test to be successful, a client must retain the barium. As barium is introduced, a client may have the urge to defecate. Slow, deep breathing will help ease the discomfort and urge to defecate.

The nurse is preparing to administer the influenza vaccine to a client. Which client statement most concerns the nurse? A. "I am allergic to neomycin." B. "I am allergic to penicillin." C. "I am allergic to shellfish." D. "I am allergic to eggs."

D. "I am allergic to eggs." An allergy to eggs is a contraindication to the flu vaccine. The nurse should not administer the standard vaccination.

The nurse prepares a client newly diagnosed with diabetes for discharge. The client is on a regimen of regular and NPH insulin. Which statement made by the client indicates that teaching is successful? A. "I will take the bottles out of the refrigerator and shake them thoroughly before I withdraw the medication." B. "I will stick with the same types and sources of insulin, but I will stock up whatever insulin syringes I can find on sale." C. "If I see that the injection site becomes red, itchy, and swollen, I will contact the health care provider immediately." D. "I will put a piece of tape with a '1' on it on the regular insulin bottle and a piece of tape with a '2' on it on the NPH insulin bottle."

D. "I will put a piece of tape with a '1' on it on the regular insulin bottle and a piece of tape with a '2' on it on the NPH insulin bottle." If insulins are to be mixed, the regular or short-acting insulin should be withdrawn first and then the NPH or intermediate-acting. Writing "1" and "2" on the bottles will remind the client of the order in which the insulins' should be withdrawn.

The nurse in the outpatient clinic provides care for a client diagnosed with peptic ulcer disease and gout. Which health care provider prescription does the nurse question? A. "Colchicine 1 mg every 2 hours up to a dose of 8 mg." B. "Allopurinol 100 mg daily." C. "Probenecid 250 mg twice daily." D. "Indomethacin 50 mg four times daily."

D. "Indomethacin 50 mg four times daily." Indomethacin is a nonsteroidal anti-inflammatory that is used cautiously in clients with peptic ulcer disease.

The nurse instructs a client receiving olanzapine. Which statement made by the client to the nurse requires further teaching? A. "This medication will help my thoughts and behavior." B. "I must report restlessness to the health care provider." C. "I will tell the health care provider if I am planning to get pregnant." D. "Stiffness and tremors are expected for the first 2 weeks."

D. "Stiffness and tremors are expected for the first 2 weeks." Stiffness and tremors are extrapyramidal symptoms and are reported immediately. This statement indicates a need for further teaching.

The nurse provides care for a client who needs fluorescein angiography. Which client statement indicates to the nurse that further teaching is required? A. "I'll have to wear dark glasses for a while." B. "I may notice yellow staining of my skin, but it will disappear." C. "I will have to drink more fluids immediately after the test." D. "The test determines the amount of pressure within my eyes."

D. "The test determines the amount of pressure within my eyes." Tonometry measures pressure in the eye. Fluorescein angiography measures circulation in the retina

The nurse provides care for clients in the psychiatric unit. The nurse is concerned if a client receiving phenelzine sulfate eats which menu item? A. Roast beef sandwich on white bread. B. Fried chicken and green beans. C. Boiled fish and whole milk. D. Grilled cheddar cheese on wheat bread.

D. Grilled cheddar cheese on wheat bread. Phenelzine sulfate (Nardil) is an MAOI, and eating aged cheese may cause a hypertensive crisis.

The nurse provides care for a client receiving haloperidol by IM injection. The client develops a fever of 103.6°F (40°C), pulse 110 beats/min, muscle rigidity, and incontinence. Which reaction does the nurse suspect the client is experiencing? A. Tardive dyskinesia. B. Pseudoparkinsonism. C. Acute dystonic reaction. D. Neuroleptic malignant syndrome.

D. Neuroleptic malignant syndrome. Neuroleptic malignant syndrome is a severe reaction to antipsychotic medication as a result of dopamine blockade in the hypothalamus. It is fatal in approximately 10% of cases. Stop the medication, and transfer client to a medical unit. Cool the body, and administer bromocriptine to treat the muscle rigidity and dantrolene to reduce the muscle spasms.

A neonate is treated in the newborn nursery for hyperbilirubinemia using phototherapy lights. Which situation requires immediate intervention by the nurse? A. The parent turns off the phototherapy lights and removes the newborn's eye patches in preparation for feeding. B. The parent is worried because the newborn experiences frequent loose, greenish stools and increased urine output. C. A laboratory technician turns off the phototherapy lights to draw the newborn's blood. D. The jaundice observed around the newborn's eyes and nose has begun to disappear.

D. The jaundice observed around the newborn's eyes and nose has begun to disappear. This indicates that the eye patches are not adequately placed or are not of adequate opaqueness and are allowing light to enter. With phototherapy, eyes must be completely shielded with patches or an opaque mask in order to prevent exposure to the light, which could result in eye damage, especially of the retina.

The nurse manager observes the new graduate nurse apply a transdermal patch on a client. Which observation causes the nurse manager to determine that care is appropriate ? A. The nurse wears sterile gloves when applying the patch. B. The nurse cleanses the skin with alcohol before applying the patch. C. The nurse places a heat lamp over the patch for 20 minutes. D. The nurse folds the old patch in half with sticky sides together.

D. The nurse folds the old patch in half with sticky sides together. Transdermal patches retain enough medication to be hazardous to pets and children. Folding in this manner ensures that the medication is sealed inside before disposal

The office nurse manager observes client and nurse interactions to assess staff education needs. The nurse administers iron dextran intramuscularly (IM) to the client with iron deficiency anemia. Which action alerts the manager to an education need? A. The nurse adds 0.2 mL of air to the syringe after withdrawing the medication from the container. B. The nurse pulls the skin to one side of the injection site and holds it while injecting the medication. C. The nurse waits 10 seconds after injecting the medication before removing the needle. D. The nurse penetrates the deltoid muscle site and injects the medication slowly and smoothly.

D. The nurse penetrates the deltoid muscle site and injects the medication slowly and smoothly. Iron dextran needs to be injected into a large muscle, if this route is used. IV administration is preferred. The deltoid would be too small for this medication.