MEDSURG PHARM EAQ

A client with epilepsy is prescribed phenytoin for seizure control. Which instruction about phenytoin will the nurse provide during discharge teaching?

"Antiseizure medications will probably be continued for life."

Which instruction would the nurse include when teaching the client about sublingual nitroglycerin?

"Common side effects include headache and low blood pressure."

A female client receiving cortisone therapy for adrenal insufficiency expresses concern that she is developing facial hair. How would the nurse respond?

"The medication contains a hormone that causes male characteristics" - Some cortisol derivatives possess 17-keto-steroid (androgenic) properties, which result in hirsutism. Facial hair is not a sign of the illness; it results from androgens that are present in cortisol. Hirsutism will be a long-term problem because therapy is provided on a long-term, usually lifelong, basis. The response "This is not important as long as you are feeling better" doesn't address the client's concerns.

A client has been receiving digoxin. The client calls the clinic and complains of "yellow vision." Which response would the nurse provide?

"The medication may need to be discontinued. Come to the clinic this afternoon."- Yellow vision indicates digoxin toxicity; the medication should be withheld until the health care provider can assess the client and check the digoxin blood level. Yellow vision is related to digoxin therapy, not the client's underlying medical condition. Yellow vision is a sign of digoxin toxicity; taking more digoxin will escalate the digoxin toxicity.

The health care provider prescribes peak and trough levels after initiation of intravenous antibiotic therapy. The client asks why these blood tests are necessary. Which reason would the nurse provide?

"They determine if the dosage of the medication is adequate." - Medication dose and frequency are adjusted according to peak and trough levels to enhance efficacy by maintaining therapeutic levels. Peak and trough levels reveal nothing about allergic reactions. Blood cultures are obtained when the client spikes a temperature; they are not related to peak and trough levels of an antibiotic. A sustained decrease in fever is the desired outcome, not a reduction just at peak serum levels of the medication.

The nurse needs to administer lidocaine HCl at 1.5 mg per minute. The medication is available as 500 mg in 100 mL of DW. The nurse will set the intravenous (IV) infusion pump to deliver how many milliliters per hour?___ mL/h

18- 1.5 mg per minute is 90 mg an hour. 500 mg in 100 mL is 5 mg per 1 mL. 5x18= 90.

Colchicine 1200 mcg orally is prescribed for client with gout. Each tablet contains 0.6 mg. How many tablets will the nurse administer?

2 - .6mg is 600 mcg

Cyanocobalamin (vitamin B) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. Each vial of the medication contains 100 mcg/mL. How many milliliters will the nurse administer?___mL

2- 0.2 mg is 200mcg

Cyanocobalamin (vitamin B) 0.2 mg intramuscularly (IM) is prescribed for a client with pernicious anemia. Each vial of the medication contains 100 mcg/mL. How many milliliters will the nurse administer?___mL

2- Convert the units of the prescribed dose to match the units of the available dose.

Acyclovir 0.8 g by mouth is prescribed for a client with herpes zoster. The oral suspension contains 200 mg/5 mL. How many milliliters will the nurse administer?___ mL

20 -The prescribed dose is 0.8 g. The available concentration of medication is 200 mg in 5 mL. First, convert the prescribed dose to the available concentration. Then use the dimensional analysis and/or ratio and proportion methods to determine the appropriate amount of medication to be administered.

A client has an intravenous (IV) solution of 5% dextrose in water (DW) 250 mL to which 100 mg of morphine is added. The health care provider prescribes 14 mg of morphine per hour for end-of-life palliative treatment of a client. At how many milliliters per hour will the nurse set the IV pump?___ mL/h

35- 14x250=3500 divided by 100 is 35

Metformin 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets will the nurse administer? Record your answer using a whole number. ____________

4

The nurse prepares to administer oxybutynin 30 mg orally. Each tablet contains 5 mg. How many tablets will the nurse administer?___

6

Phenytoin suspension 200 mg is prescribed for a client with epilepsy. The suspension contains 125 mg/5 mL. How many milliliters will the nurse administer?__ mL

8- 125 divided by 5 is 25. 200 divided by 25 is 8.

The nurse is reviewing a newly admitted client's medication administration record (MAR). Which element, if missing, makes the record incomplete?

Allergies Reasoning: Allergies should be listed on all MARs to prevent the administration of medications to which the client is allergic. Height, weight, and vital signs are part of the initial health history/physical assessment data.

After cataract surgery, a client reports feeling nauseated. How can the nurse prevent vomiting?

An antiemetic will prevent vomiting; vomiting increases intraocular pressure and should be avoided. Providing some dry crackers for the client to eat, explaining that this is expected after surgery, and teaching how to breathe deeply until the nausea subsides are unsafe; vomiting increases intraocular pressure, and aggressive intervention is required.

Aspirin is prescribed on a regular schedule for a client with rheumatoid arthritis. The nurse understands that the medication is being used primarily for which property?

Anti- Inflammatory

The health care provider prescribes a blood transfusion for a client with esophageal varices. Place the following nursing actions in the correct order.

Baseline vital signs should be obtained immediately before administering the blood product for future comparison purposes. Before obtaining the blood, it is important to have IV access because if there is difficulty establishing an IV after blood is obtained, the blood cannot be returned to the blood bank. Two licensed nurses would confirm the verifying data between the client and the blood product. The nurse would remain with and monitor the client's vital signs during the first 15 minutes of administration of the blood product and then follow the institution's protocol to monitor for a transfusion reaction or fluid overload.

Which client response indicates to the nurse that a vasodilator medication is effective?

Blood pressure changes from 154/90 to 126/72 mm Hg - Vasodilation will lower the blood pressure. The pulse rate is not decreased and may increase. Breath sounds are not directly affected by vasodilation, although vasodilator medications can decrease preload and afterload, which could indirectly affect breath sounds in heart failure. The urine output is not affected immediately, although control of blood pressure can help preserve renal function over time.

Prednisone is prescribed for a client with an exacerbation of colitis. Which explanation would the nurse provide for administering prednisone?

Decrease inflammation

Which goal is the priority for a client with asthma who has a prescription for an inhaled bronchodilator?

Demonstrates use of a metered-dose inhaler

A client with Hodgkin's disease adds doxorubicin to current therapy. Which advice will the nurse provide about this medication?

Doxorubicin causes the urine to turn red for a few days; the client should be informed of this expectation so as not to become alarmed when it occurs. Discontinuing the intake of vitamin D is true for plicamycin, not the medications in this protocol. It is unnecessary to keep doxorubicin in a dark area, protected from light. Doxorubicin is not given orally, only via the intravenous route.

Which effect of povidone-iodine would the nurse consider when using it on the client's skin before obtaining a specimen for a blood culture?

Eliminates surface bacteria that may contaminate the culture- Povidone-iodine exerts bactericidal action that helps eliminate surface bacteria that will contaminate culture results. Whether it affects blood alcohol results is irrelevant when used to obtain blood for cultures. It does dry the skin. Although povidone-iodine may provide a cool feeling, this is not a reason for its use.

Which life-threatening complication may occur in clients taking high-dose or long-term ibuprofen?

GI bleeding- Ibuprofen irritates the GI mucosa and can cause mucosal erosion while decreasing platelet activity, which can result in GI hemorrhage. Cardiac dysrhythmias and anaphylaxis are not typically associated with high-dose or long-term administration of ibuprofen. Disulfiram reactions are associated with alcohol intake, not ibuprofen.

A client with supraventricular tachycardia (SVT) has a heart rate of 170 beats/minute. After treatment with diltiazem, which assessment indicates to the nurse that the diltiazem is effective?

HR of 98 bpm

Valsartan, an angiotensin II receptor antagonist, is prescribed for a client. The nurse will monitor the client for which adverse effect?

Hyperkalemia

A client is admitted to the hospital for an adrenalectomy. Before the client's replacement steroid therapy is regulated fully, the nurse will monitor the client for which complication?

Hypotension - Because of instability of the vascular system and the lability of circulating adrenal hormones after an adrenalectomy, hypotension frequently occurs until the hormonal level is controlled by replacement therapy. Hyperglycemia is a sign of excessive adrenal hormones; after an adrenalectomy, adrenal hormones are not secreted. Sodium retention is a sign of hyperadrenalism; it does not occur after the adrenals are removed. Potassium excretion is a response to excessive adrenal hormones; after an adrenalectomy, adrenal hormones are decreased until replacement therapy is regulated.

The nurse plans to teach a client with type 1 diabetes about the use of an insulin pump. Which information will the nurse include in client teaching?

Insulin pumps mimic the way a healthy pancreas works.

The nurse teaches a client about the dangers of using sodium bicarbonate regularly. Which effect of sodium bicarbonate is the nurse trying to prevent?

Metabolic Alkalosis

The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms?

Nervous and Weak

After surgery for cancer, a client is to receive chemotherapy. When teaching the client about the side effects of chemotherapy, which information will the nurse share about alopecia characteristics?

Not permanent

Enoxaparin 40 mg subcutaneously daily is prescribed for a client who had abdominal surgery. The nurse explains that the medication is given for which purpose?

To provide prophylaxis against postoperative thrombus formation - Enoxaparin, a low-molecular-weight heparin, prevents the conversion of fibrinogen to fibrin and of prothrombin to thrombin by enhancing the inhibitory effects of antithrombin III. Enoxaparin is not an antipyretic. Enoxaparin is not an analgesic. Enoxaparin is not an anti-inflammatory medication.

Which client statement indicates understanding of the side effects of nitroglycerin ointment?

"I may experience a headache." -The most common side effect of nitroglycerin is a headache. Additional cardiovascular side effects are hypotension, not hypertension; tachycardia, not bradycardia; and dizziness, not confusion.

A client with type 1 diabetes receives 30 units of neutral protamine Hagedorn (NPH) insulin at 7:00 AM. At 3:30 PM, the client becomes diaphoretic, weak, and pale. With which condition would the nurse determine that these physiological responses are associated?

Hypoglycemic reaction Reasoning: These are sympathetic nervous system responses to hypoglycemia; the peak action of NPH insulin is 8 to 12 hours after administration, and 8.5 hours have elapsed since it was given. The signs and symptoms of diabetic coma are dry mucous membranes; hot, flushed skin; deep, rapid respirations (Kussmaul breathing); acetone odor to the breath; nausea and vomiting; and, as with hypoglycemia, weakness. Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a hyperglycemic state and this client has symptoms of a hypoglycemic state. Ketoacidosis results from excess use of fats for energy when carbohydrates cannot be used. Lipids are metabolized incompletely, and dehydration, acidosis (both ketotic and lactic), and electrolyte imbalance result. It is not the result of insulin administration.

A client is diagnosed with pulmonary tuberculosis, and the health care provider prescribes a combination of rifampin and isoniazid. The nurse evaluates that the teaching regarding the medications is effective when the client reports which action as most important?

"Continue taking the medicine even after I feel better." -The medication should be taken for the full course of therapy; most regimens last from 6 to 9 months, depending on the state of the disease. Visual changes are not side effects of this medication. The medication should be taken 1 hour before meals or 2 hours after meals for better absorption. Urine or tears turning red-orange is a side effect of rifampin; although this should be reported, it is not an adverse side effect.

The spouse of a client with an intracranial hemorrhage asks the nurse, "Why aren't they administering an anticoagulant?" How will the nurse respond?

"It is not advisable because bleeding will increase." An anticoagulant should not be administered to a client who is bleeding because it will interfere with clotting and will increase hemorrhage. Anticoagulants are unsafe and will not be used to enhance the circulation or prevent pulmonary thrombosis. The response "It is inadvisable because it masks the effects of the hemorrhage" is not the reason why it is contraindicated; if given, it will increase, not mask, the effects of the hemorrhage.

Neomycin is prescribed preoperatively for a client with colon cancer. The client asks why this is necessary. Which response would the nurse provide?

"It kills intestinal bacteria to decrease the risk for infection." - Neomycin is an aminoglycoside antibacterial medication that provides preoperative intestinal antisepsis. Neomycin is not a cancer chemotherapeutic medication; therefore, it does not kill cancer cells. It is not an anti-inflammatory medication; therefore it is not given for that purpose. Antibiotic alteration of body flora increases the risk for superinfections, rather than preventing them

Atenolol 150 mg by mouth is prescribed for a client with hypertension. Each tablet contains 50 mg. How many tablets will the nurse administer? Record your answer using a whole number. ____________tablet(s)

3

One liter of 5% dextrose solution contains 50 grams of sugar. The nurse calculates that 3 L solution/day will supply approximately how many kilocalories?

600 - Carbohydrates provide 4 kcal/g; therefore 3 L × 50 g/L × 4 kcal/g = 600 kcal, only about a third of the basal energy needed. Four hundred kilocalories are less than the kilocalories provided by the prescribed intravenous (IV) fluid. Eight hundred kilocalories and 1000 kilocalories are more than the kilocalories provided by the prescribed IV fluid.

The health care provider prescribes 1000 mL of total parenteral nutrition (TPN) to be administered in 12 hours. Based on this prescription, how many milliliters of solution will be administered per hour?

83 mL/h is the correct calculation. 1000 mL of solution divided by 12 hours equals 83.3 mL/h. Always round to the nearest whole number. 100 mL/h is an incorrect calculation; it is too much solution per hour. 108 mL/h is an incorrect calculation; it is too much solution per hour. 125 mL/h is an incorrect calculation; it is too much solution per hour.

A client with type 1 diabetes mellitus has a finger-stick glucose level of 258 mg/dL (14.3 mmol/L) at bedtime. A prescription for sliding-scale regular insulin exists. Which would the nurse do?

A value of 258 mg/dL (14.3 mmol/L) is above the expected range of 70 to 100 mg/dL (3.6-5.6 mmol/L); the nurse would administer the regular insulin as prescribed. Calling the health care provider is unnecessary; a prescription for insulin exists and should be implemented. Encouraging the intake of fluids is insufficient to lower a glucose level this high. Giving the client orange juice is contraindicated, because this will increase the glucose level further; orange juice, a complex carbohydrate, and a protein should be given if the glucose level is too low.

An endoscopic sphincterotomy is scheduled to remove a gallstone lodged in the common bile duct. The client asks the nurse about pain during the procedure. Which statement would the nurse provide?

An IV sedative usually is administered to produce effective sedation (conscious sedation) for the procedure. An oral analgesic is insufficient for this procedure. Epidural anesthesia is not necessary. A local anesthetic is insufficient for this procedure.

The nurse is administering serum albumin intravenously to a client with ascites. In response to this therapy, which client problem would the nurse expect to decrease?

Abdominal Girth: An increased serum albumin level increases the osmotic effect and pulls fluid back into the intravascular compartment. This will increase renal flow and urine output, with a resulting decrease in abdominal girth. Urinary output therapy will increase blood volume and blood flow to the kidney, thereby increasing urinary output. Albumin therapy has no effect on blood ammonia levels. An increased, not decreased, blood ammonia level causes hepatic encephalopathy.

Which medication is often contraindicated when taking warfarin?

Acetylsalicylic acid can cause decreased platelet aggregation, increasing the risk for undesired bleeding that may occur with administration of anticoagulants. It should not be administered unless specifically prescribed, usually by a cardiologist or other specialist, to manage serious risks of thrombosis. Ferrous sulfate does not affect warfarin; it is used for red blood cell synthesis. Atenolol is a beta-blocker that reduces blood pressure; it does not affect bleeding. Chlorpromazine is a neuroleptic; it does not affect bleeding.

A terminally ill client is receiving a morphine drip that exceeds the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. Which action will the nurse take?

Assess the client's pain before increasing the dose of morphine.

A terminally ill client is receiving a morphine drip that exceeds the typical recommended dosage. The client's spouse tells the nurse that the client is again uncomfortable and needs the morphine increased. The prescription states to titrate the morphine to comfort level. Which action will the nurse take?

Assess the client's pain before increasing the dose of morphine. Reasoning: Over time clients receiving morphine develop tolerance and require increasing doses to relieve pain, thus requiring continuing reassessments to ensure that the client does not have signs of toxicity such as respiratory depression. Adding a placebo to the morphine to appease the spouse will not meet the client's need for relief from pain. The client is terminally ill, so the risk for addiction is of no concern. The respiratory, not heart, rate is the significant vital sign to be monitored; morphine depresses the central nervous system, specifically the respiratory center in the brain.

Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Before beginning the infusion, which assessment is the nurse's priority?

Assessment for bleeding is a priority because it is a contraindication for administration of thrombolytic agents; administration in the presence of bleeding can cause life-threatening hemorrhage. All the other options are important, but none pose a life-threatening contraindication to tissue plasminogen activator (t-PA) administration.

A primary health care provider prescribes atenolol 20 mg by mouth four times a day. Which information is important for the nurse to include in the discharge teaching plan for this client?

Avoid abruptly discontinuing the medication. -An abrupt discontinuation of atenolol may cause an acute myocardial infarction. Alcohol is contraindicated for clients taking atenolol because it can cause additive hypotension. Clients should never increase medications without a health care provider's direction. The pulse rate can go much lower as long as the client feels well and is not dizzy.

The nurse administers a parenteral preparation of potassium slowly to avoid which complication?

Cardiac Arrest - Too rapid an administration can cause hyperkalemia, which contributes to a long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias and arrest. Although acidosis can cause hyperkalemia, hyperkalemia will not lead to acidosis. Hyperkalemia causes muscle flaccidity and weakness, not seizures. Respiratory depression can occur with too rapid intravenous (IV) magnesium administration, not potassium administration

The health care provider prescribes an oral hypoglycemic medication for the client with type 2 diabetes. Which statement will the nurse need to consider when developing the teaching plan?

Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Reasoning: Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the medication prescribed. Oral hypoglycemic medications can have serious adverse effects.

The nurse provides discharge teaching to a client with tuberculosis. Which treatment measure would the nurse reinforce as the highest priority?

Consistently taking prescribed medication

For the client taking clopidogrel, the nurse will monitor for which adverse effect?

Epistaxis- Clopidogrel is a platelet aggregation inhibitor; therefore bleeding can occur as an adverse effect. The high vascularity of the nose, combined with its susceptibility to trauma (e.g., sneezing, nose blowing), makes it a frequent site of hemorrhage. Nausea, chest pain, and elevated temperature are not associated with anticoagulant therapy.

The nurse prepares to administer extended-release metformin to an older adult who has asked that it be crushed because it is difficult to swallow. Which rationale will prompt the nurse to ask the provider for a different form of metformin?

Extended-release formulations are designed to be released slowly and crushing the tablet will prevent this from occurring. - The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this medication should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

Which food would the nurse instruct a client taking diltiazem to avoid? Select all that apply. One, some, or all responses may be correct.

Grapefruit juice- Clients taking calcium-channel blockers such as diltiazem would be instructed to avoid drinking grapefruit juice or eating grapefruit because it can interfere with metabolism of the medication. Clients taking acetaminophen would be instructed to avoid alcohol. Aged cheese and meat, such as sausage, should be avoided in clients taking monoamine oxidase inhibitors (MAOIs). Clients taking anticoagulants, such as warfarin, should avoid dark green vegetables.

The nurse teaches a client about the dangers of using sodium bicarbonate regularly. Which effect of sodium bicarbonate is the nurse trying to prevent?

Metabolik Alkalosis Reasoning: Prolonged use of sodium bicarbonate may cause systemic alkalosis, as well as retention of sodium and water. Gastric distention is not an effect of sodium bicarbonate. Chronic constipation is not an effect of sodium bicarbonate. Cardiac dysrhythmias are not an effect of sodium bicarbonate.

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about which potential side effect?

Mild Abdominal Cramping

The postoperative prescriptions for a client who had repair of an inguinal hernia include docusate sodium daily. Before discharge, the nurse instructs the client about which potential side effect?

Mild abdominal cramping is the only side effect of docusate sodium; this emollient laxative permits water and fatty substances to penetrate and mix with fecal material. Rectal bleeding is more likely to occur with a saline-osmotic laxative. Docusate sodium promotes defecation, not constipation. Nausea and vomiting are more likely to occur with a saline-osmotic laxative.

A client with a diagnosis of anemia is receiving packed red blood cells. Which nursing action is important when administering the transfusion?

Monitoring the client's response, particularly within the first 10 minutes -Transfusion reactionsusually occur early during the administration of a blood transfusion (first 30 mL of blood); early detection of a transfusion reaction will permit a quick termination of the infusion. The risk of fluid overload is unlikely, and this information can be frightening. The donor's, not the recipient's, blood is tested for HIV. The flow rate will be slower during the first 10 to 15 minutes of the infusion to limit the amount of blood infused; this allows time to assess the client's response for signs and symptoms of a transfusion reaction before too much of the blood is infused.

A client with a myocardial infarction is admitted to the cardiac intensive care unit. Which pain relief medication would the nurse expect to find on the plan of care for this client?

Morphine is the medication of choice for a myocardial infarction because it relieves pain quickly and reduces anxiety. It also decreases cardiac workload. Diazepam is a muscle relaxant that may be used for its sedative effect; it is not effective for the severe pain associated with a myocardial infarction. Midazolam is a hypnotic that may be used to reduce fear and restlessness; it is not effective for the severe pain associated with a myocardial infarction. Oxycodone is an orally administered analgesic; an analgesic that is administered via the intravenous, not the oral, route provides more immediate pain relief.

The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms?

Nervousness and weakness are the most commonly reported symptoms of hypoglycemia and are related to increased sympathetic nervous system activity. Feeling flushed and short of breath are adaptations of hyperglycemia. Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of hyperglycemia.

After teaching a family member how to administer subcutaneous enoxaparin sodium, how will the nurse evaluate the effectiveness of the training?

Observe the family member administering the enoxaparin sodium

A client takes furosemide and digoxin for heart failure. Why would the nurse advise the client to drink a glass of orange juice every day?

Orange juice is an excellent source of potassium. Furosemide promotes excretion of potassium, which can result in hypokalemia. Digoxin toxicity can occur in the presence of hypokalemia. Neither medication increases sodium levels. Digoxin does not potentiate the action of furosemide; therefore the client should not experience dehydration. Orange juice will not prevent an interaction between digoxin and furosemide.

Sublingual nitroglycerin has been prescribed for a client with unstable angina. Which client response indicates that nitroglycerin is effective?

Pain subsides as a result of arteriole and venous dilation. - Nitroglycerin causes vasodilation, increasing the flow of blood and oxygen to the myocardium and reducing anginal pain. An increased pulse rate does not indicate effectiveness; it is a side effect of nitroglycerin. The tingling indicates that the medication is fresh; relief of pain is the only indicator of effectiveness. Nitroglycerin does not promote the formation of new blood vessels.

A client is admitted to the hospital after general paresis develops as a complication of syphilis. Which therapy is indicated for treatment of this condition?

Penicillin Therapy - Massive doses of penicillin may limit central nervous system damage if treatment is started before neural deterioration from syphilis occurs. Tranquilizers are used to modify behavior, not to treat general paresis. Behavior, not paresis, is treated with behavior modification. Electroconvulsive therapy is used to treat certain psychiatric disorders.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops an infection with anorexia. Which advice will the nurse provide to the client? Select all that apply. One, some, or all responses may be correct.

Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration; monitoring of glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic agent may precipitate hyperglycemia. Food intake will be attempted to prevent acidosis. Delaying an oral hypoglycemic agent may precipitate hyperglycemia.

A client who had a myocardial infarction receives 15 mg of morphine sulfate for chest pain. Fifteen minutes after receiving the medication, the client complains of feeling dizzy. Which action will the nurse take?

Place the client in the supine position and take the vital signs. Reasoning: Dizziness is a symptom of hypotension, a side effect of morphine sulfate. The supine position increases venous return, cardiac output, and blood flow to the brain. Dizziness is a symptom of hypotension that is a side effect, not an allergic response, to morphine sulfate. Raising the client's head may aggravate dizziness. Dizziness is a typical side effect of morphine sulfate.

Which responses indicate that the client receiving total parenteral nutrition is experiencing hyperglycemia? Select all that apply. One, some, or all responses may be correct.

Polyuria, Polydipsia, RR 26 breaths/m - Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia (excessive thirst) and fluid intake are the responses to excess fluid loss related to osmotic diuresis. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced; 24 breaths per minute is characteristic of hyperventilation. Paralytic ileus is not associated with hyperglycemia. Serum glucose of 105 mg/dL (5.8 mmol/L), by most standards, is within the expected range of 60 to 110 mg/dL (3.3-6.1 mmol/L).

Which medication is unsafe to administer as an intravenous (IV) bolus?

Potassium chloride given as an IV bolus can cause cardiac arrest. It must be diluted and infused slowly through an IV infusion pump. Saline flush, naloxone, and adenosine are appropriate to be given as an IV bolus undiluted.

A client diagnosed with tuberculosis is taking isoniazid. To prevent a food and medication interaction, the nurse will advise the client to avoid which food item?

Red Wine- Clients taking isoniazid should avoid foods containing tyramine such as red wine, tuna fish, and hard cheese. Hot dogs, sour cream, and grapefruit juice do not contain tyramine and are not contraindicated. Grapefruit juice slows metabolism of many medications, but isoniazid is not one of them.

The nurse is caring for a client who is receiving azathioprine, cyclosporine, and prednisone before receiving a kidney transplant. Which medication action would the nurse identify as the purpose of these medications?

Reduce antibody production- These drugs suppress the immune system, decreasing the body's production of antibodies in response to the new organ, which acts as an antigen. These medications decrease the risk of rejection. These medications inhibit leukocytosis. These medications do not provide immunity; they interfere with natural immune responses. Because these medications suppress the immune system, they increase the risk of infection.

Dexamethasone has been prescribed for a client after a craniotomy for a brain tumor. Which physiological response is responsible for this medication's therapeutic effect?

Reduced Cerebral Edema Reasoning: Dexamethasone is a corticosteroid with anti-inflammatory effects, which will reduce cerebral edema. Dexamethasone will not keep the tumor from growing; it will reduce fluid content and therefore cell size, not the number of cells. Dexamethasone does not promote fluid reabsorption, which is undesirable because it increases fluid retention and therefore cerebral edema. Dexamethasone does not promote sedation; sedation is not desired because it may mask the client's adaptations to the craniotomy.

Which instruction would the nurse include in a teaching plan for nitroglycerin patches?

Removing the previous patch before applying the next patch ensures that the client receives just the prescribed dose. Ideally, a patch should be removed after 12 to 14 hours to avoid the development of tolerance. The patch should be rotated among hair-free and scar-free sites; acceptable sites include the chest, upper abdomen, proximal anterior thigh, or upper arm. The patch should be gently pressed against the skin to ensure adherence; it should not be massaged. Applying a warm compress to the site before attaching the patch is unnecessary and can result in excessive absorption of the medication.

Which condition would the nurse monitor for in the client on aminoglycoside therapy and skeletal muscle relaxants?

Respiratory Arrest- Aminoglycosides can intensify the effect of skeletal muscle relaxants, placing the client at risk for respiratory arrest. Aminoglycoside therapy with muscle relaxants does not increase the risk of stroke, myocardial infarction, or abdominal discomfort.

A client who takes rifampin tells the nurse, "My urine looks orange." Which action would the nurse take?

Rifampin causes a reddish-orange discoloration of secretions such as urine, sweat, and tears. Although liver enzymes should be monitored because of the risk of hepatitis, this action is not addressing the client's statement. A urinalysis is not indicated for an anticipated finding. The medication, not food, is responsible for the urine color.

A client with arthritis takes large doses of aspirin. Which symptom would the nurse include when teaching the client about the clinical manifestations of aspirin toxicity?

Ringing in the ears occurs because of aspirin's effect on the eighth cranial nerve and is a classic symptom of aspirin toxicity. Feelings of drowsiness are not side effects of aspirin; aspirin promotes comfort, which may permit rest. Aspirin may cause diarrhea, nausea, and vomiting, not intermittent constipation. A metallic taste in the mouth is not a side effect of salicylates such as aspirin.

A client who takes four 325-mg tablets of buffered aspirin four times a day for severe arthritis complains of dizziness and ringing in the ears. Which complication would the nurse conclude that the client probably is experiencing?

Salicylate Toxicity- Aspirin is a salicylate; excessive aspirin ingestion can influence the vestibulocochlear nerve (cranial nerve VIII), causing tinnitus and dizziness. The client is experiencing symptoms of toxicity, not an allergic response. Withdrawal symptoms occur when a medication is no longer being administered. Tolerance describes a condition in which additional medication is needed to achieve an effect; it is not associated with the development of new symptoms.

Tissue plasminogen activator (t-PA) is to be administered to a client in the emergency department. Before beginning the infusion, which assessment is the nurse's priority?

Signs of bleeding

A client with heart failure is to receive digoxin. Which therapeutic effect is associated with this medication?

Slows and strengthens cardiac contractions. Reasoning: Digoxin improves cardiac function by increasing the strength of myocardial contractions (positive inotropic effect) and, by altering the electrophysiological properties of the heart, slows the heart rate (negative chronotropic effect). Digoxin increases the strength of the contractions but decreases the heart rate. Although a reduction in edema may result from the increased blood supply to the kidneys, it is not the reason for administering digoxin. Digoxin decreases, not increases, cardiac impulses through the conduction system of the heart.

The provider prescribes one unit of packed red blood cells to be administered to a client. To ensure the client's safety, which action will the nurse take during administration of blood products?

Stay with the client during first 15 minutes.

A client with rheumatoid arthritis asks the nurse why it is necessary to inject hydrocortisone into the knee joint. Which reason would the nurse include in a response to this question?

Steroids have an anti-inflammatory effect that can reduce arthritic pannus formation. Injecting hydrocortisone into the joint does not provide lubrication. Injection of a medication into a joint is not physiotherapy. Ankylosis refers to fusion of joints. It is only indirectly influenced by steroids, which exert their major effect on the inflammatory process.

A client has a prescription for a sublingual nitroglycerin tablet. Which technique will the nurse teach the client to use?

Sublingual medication is placed under the tongue and is quickly absorbed through the mucous membranes into blood. The buccal route requires placing medication between the cheek and gums. Chewing the pill and then swallowing it may be done for oral administration of some large pills, but not with the sublingual route of administration. Taking the pill with water is required with the oral route of administration of medication, but not with sublingual. In addition, a full glass of water may be an excessive amount of fluid to swallow one pill.

After a surgical thyroidectomy a client exhibits carpopedal spasm and tremors. The client reports tingling in the fingers and around the mouth. The nurse suspects a deficiency in which mineral?

The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia. Deficits in potassium, magnesium, and sodium do not cause these classic manifestations.

A client hospitalized for uncontrolled hypertension and chest pain was started on a daily diuretic 2 days ago upon admission, with prescriptions for a daily basic metabolic panel. The client's potassium level this morning is 2.7 mEq/L (2.7 mmol/L). Which action will the nurse take next?

The health care provider should be notified immediately because the client's potassium is below normal. The normal potassium level range is 3.5 mEq/L to 5.0 mEq/L (3.5-5.0 mmol/L). Clients on diuretic therapy require close monitoring of their electrolytes because some can cause hypokalemia, whereas others spare potassium, which can cause hyperkalemia. Retesting the serum potassium level is unnecessary and will delay the treatment required by the client.

For which circumstance would the nurse use the Z-track technique to administer a medication?

The medication is irritating to subcutaneous tissue- The Z-track method seals the puncture at the intramuscular level, preventing seepage of irritating medication up the needle track and thereby avoiding injury to subcutaneous tissue and skin. The Z-track technique is unrelated to the volume of medication to be administered. The Z-track technique is not required for administration of depot medications. Whether or not a medication is lipophilic has no bearing on the need for using the Z-track technique.

A pain scale of 1 to 10 is used by the nurse to assess a client's degree of pain. The client rates the pain as an 8 before receiving an analgesic and a 7 after being medicated. Which conclusion would the nurse make regarding the client's response to pain medication?

The medication is not adequately effective.

Nitroglycerin sublingual tablets are prescribed for a client with the diagnosis of angina. The nurse advises the client to anticipate pain relief will begin within which period of time?

The onset of action of sublingual nitroglycerintablets is rapid (1-3 minutes); duration of action is 30 to 60 minutes. If nitroglycerin is administered intravenously, the onset of action is immediate, and the duration is 3 to 5 minutes. It takes longer than 30 to 45 seconds for sublingual nitroglycerin tablets to have a therapeutic effect. Sustained-release nitroglycerin tablets start to act in 20 to 45 minutes, and the duration of action is 3 to 8 hours.

After several days of intravenous (IV) therapy for chloroquine-resistant malaria, the health care provider replaces the IV medication with oral quinine, 2 g per day in divided doses. The nurse advises the client to take this medication immediately after meals for which purpose?

To minimize gastric irritation- Quinine administered orally can cause gastric irritation, resulting in nausea and vomiting. Administration of the medication immediately after meals minimizes its irritating effect. Absorption of the medication is not significantly affected by administration after meals. The appetite is not affected by this medication as long as gastric irritation is avoided. Quinidine, not quinine, is given for its antidysrhythmic effect.

A client with gastric ulcer disease asks the nurse why the health care provider has prescribed metronidazole. Which purpose would the nurse provide?

To treat Helicobacter pylori infection - Approximately two thirds of clients with peptic ulcer disease are found to have Helicobacter pylori infecting the mucosa and interfering with its protective function. Antibiotics do not augment the immune response, potentiate the effect of antacids, or reduce hydrochloric acid secretion.

Which clinical indicator would the nurse monitor to determine if the client's simvastatin is effective?

Triglycerides - Therapeutic effects of simvastatin include decreased levels of serum triglycerides, low-density lipoprotein (LDL), and cholesterol. INR is not related to simvastatin; it is a measure used to evaluate blood coagulation. Heart rate and blood pressure are not related to simvastatin.