NCLEX

A client having an ischemic stroke arrives at the emergency department. The health care provider prescribes tissue plasminogen activator (tPA). Which client statement would be most important to clarify before administering tPA? 1. "I can't believe this is happening right after my stomach surgery." 2. "I had a concussion after a car accident a year ago." 3. "I started noticing my right arm becoming weak approximately an hour ago." 4. "I stopped taking my warfarin 4 weeks ago."

1

A client is admitted to the cardiac care unit with atrial fibrillation. Vital signs are shown in the exhibit. Which prescription should the nurse perform first? Click on the exhibit button for additional information. Exhibit: Vital signs Temperature 98.2 F (36.8 C) Blood pressure 120/80 mm Hg Heart rate 140/min, irregular Respirations 18/min SpO2 98% 1. Administer diltiazem 20 mg IVP 2. Administer rivaroxaban 20 mg PO 3. Draw blood for a thyroid function test 4. Send the client for echocardiogram

1

A client with a history of atrial fibrillation has experienced a cardiac arrest episode with torsades de pointes. The client was successfully resuscitated. Which data collected by the nurse should be reported immediately to the health care provider? 1. Client has a dose of sotalol due this evening 2. Client took rivaroxaban this morning 3. Client's magnesium level is 2.0 mEq/L (1.0 mmol/L) 4. Client's potassium level is 5.0 mEq/L (5.0 mmol/L)

1

A client with a history of heart failure calls the clinic and reports a 3-lb (1.4-kg) weight gain over the past 2 days and increased ankle swelling. The nurse reviews the client's medications and anticipates the immediate need for dosage adjustment of which medication? 1. Bumetanide 2. Candesartan 3. Carvedilol 4. Isosorbide

1

A client with coronary artery disease and atrial fibrillation is being discharged home following coronary artery stent placement. Discharge medications are shown in the exhibit. The nurse identifies which educational topic as the highest priority for this client? Click on the exhibit button for additional information. Exhibit: Discharge medications Aspirin: 81 mg by mouth, once daily Clopidogrel: 75 mg by mouth, once daily Rivaroxaban: 20 mg by mouth, once daily Metoprolol: 25 mg by mouth, twice daily Rosuvastatin: 20 mg by mouth, once daily Lisinopril: 10 mg by mouth, once daily 1. Bleeding risk 2. Bronchospasm 3. Muscle injury 4. Tinnitus

1

A hospitalized client has been treated for the past 48 hours with a continuous heparin infusion for a deep vein thrombosis (DVT). When the nurse prepares to administer the evening dose of warfarin, the client's spouse says "Wait! My spouse can't have that! My spouse is already getting heparin for DVT." How should the nurse respond? 1. "Both medications will be given for several days until the warfarin has time to take effect." 2. "I will be discontinuing the heparin infusion as soon as I give this dose of warfarin." 3. "The two medications work synergistically to help break down the clot in your spouse's leg." 4. "We will hold the medication until I can call the health care provider (HCP) for clarification."

1

A major side effect of angiotensin-converting enzyme (ACE) inhibitors is intractable cough. The nurse recognizes which ethnic group to be at highest risk for this side effect? 1. Asians 2. Hispanics 3. Native Americans 4. Whites

1

The home health nurse visits a client with hypertension whose blood pressure has been well controlled on oral valsartan 320 mg daily. The client's blood pressure is 190/88 mm Hg, significantly higher than it was 2 weeks ago. The client reports a cold, a stuffy nose, and sneezing for 3 days. Which question is most appropriate for the nurse to ask? 1. "Are you taking any over-the-counter medicines for your cold?" 2. "Are you taking extra vitamin C?" 3. "Did you babysit your granddaughter this past week?" 4. "Did you get a flu shot in the past week?"

1

The nurse is caring for a client hospitalized for an acute exacerbation of heart failure. The client receives digoxin 0.5 mg orally once daily, furosemide 40 mg orally twice daily, and potassium chloride 20 mEq orally twice daily. The client's daughter tells the nurse that the client has not been eating or drinking well and has had trouble swallowing the large potassium pill. The client's K+ level is 3.7 mEq/L. How should the nurse handle this situation? 1. Call the pharmacy to see if other forms of potassium chloride are available 2. Crush the potassium chloride pill and mix it with applesauce or pudding 3. Hold the potassium chloride until the health care provider (HCP) makes rounds 4. Instruct the client to tuck the chin to the chest when swallowing the pill

1

The nurse is preparing 7:00 AM medications for a client with a urinary tract infection and a history of heart failure and type 2 diabetes. Based on the information from the medical and medication records, which prescription should the nurse question before administering? Click on the exhibit for more information. Exhibit: https://drive.google.com/open?id=0B40rfZ_HhbqwLTVXMlhVN0JTY0E 1. Furosemide 2. Glipizide 3. Levofloxacin 4. Potassium chloride

1

The nurse is reviewing new prescriptions for assigned clients. Which prescription would require further clarification from the health care provider? 1. Alteplase for an acute myocardial infarction in a client with uncontrolled hypertension 2. Amoxicillin for a respiratory infection in a client who is 20 weeks pregnant 3. Fentanyl for moderate to severe pain in a client post appendectomy with an allergy to codeine 4. Sodium chloride 3% infusion for a client with syndrome of inappropriate antidiuretic hormone

1

In which scenarios should the nurse hold the prescribed medication and question its administration? Select all that apply. 1. Client on IV heparin and the platelet count is 50,000/mm3 (50 x 109/L) 2. Client on newly prescribed lisinopril and is at 8 weeks gestation 3. Client on nitroglycerine patch for heart failure and blood pressure is 84/56 mm Hg 4. Client on phenytoin for epilepsy and the nurse notes gingival hyperplasia 5. Client on warfarin and prothrombin time/International Normalized Ratio is 1.5 times control value

1,2,3

The nurse reviews the medication administration record and daily laboratory report of a client with atrial fibrillation. Which laboratory results should the nurse monitor when giving these medications? Select all that apply. Click the exhibit button for more information. Exhibit: Medication administration record Allergies: None Medications || Time Prednisone: 20 mg by mouth, daily || 0900 Metoprolol: 50 mg by mouth, daily || 0900 Digoxin: 0.5 mg by mouth, daily || 1300 Enoxaparin: 40 mg subcutaneously, every 12 hours || 0900 and 2100 1. Complete blood count 2. Digoxin level 3. Glucose 4. International Normalized Ratio 5. Serum potassium

1,2,3,5

The community health nurse prepares a teaching plan for a client with latent tuberculosis who is prescribed oral isoniazid (INH). Which instructions should the nurse include? Select all that apply. 1. Avoid drinking alcohol 2. Expect body fluids to change color to red 3. Report yellowing of skin or sclera 4. Report numbness and tingling of extremities 5. Take with aluminum hydroxide to prevent gastric irritation

1,3,4

The nurse is preparing to administer medications to a client admitted with atrial fibrillation.The nurse notes the vital signs shown in the exhibit.Which medications due at this time are safe to administer? Select all that apply. Click on the exhibit button for additional information. Exhibit: Vital signs Temperature 98.4 F (36.9 C) Blood pressure 116/70 mm Hg Heart rate 46/min and irregularly irregular Respirations 22/min 1. Albuterol inhaler 2. Diltiazem extended-release PO 3. Heparin subcutaneous injection 4. Lisinopril PO 5. Metoprolol PO 6. Timolol eye drops

1,3,4

The emergency department nurse is caring for a client who has been recently prescribed methadone for chronic severe back pain. The client ingested extra tablets tonight because the pain returned. Which assessment findings during discharge require the client to be monitored longer in the hospital setting? Select all that apply. 1. Falls asleep when the nurse is talking 2. Frequently scratches due to pruritus 3. Has third emesis since taking medication 4. Monitor shows occasional premature ventricular contractions 5. Pulse oximetry reading is 92%

1,3,5

The nurse prepares to administer 9:00 AM medications to a client. Which data should the nurse evaluate prior to administration? Select all that apply. Click the exhibit button for additional information. Exhibit: Medication administration record Allergies: None Medications || Schedule Aspirin: 81 mg orally, daily || 0900 Metoprolol: 50 mg orally, twice daily || 0900 & 1700 Quinapril: 10 mg orally, daily || 0900 1. Blood pressure 2. Blood sugar 3. Heart rate 4. International Normalized Ratio 5. Potassium level

1,3,5

A nurse teaches a client who is being discharged on warfarin for atrial fibrillation. Which client statements indicate that teaching has been effective? Select all that apply. 1. "Antibiotics can affect my INR value." 2. "I am going to eat more leafy greens." 3. "I will shoot for my INR value to be between 4 and 5." 4. "I will take warfarin at the same time daily." 5. "If I miss a dose, I can double it on the following day."

1,4

The nurse is providing discharge teaching to several clients with new prescriptions. Which instructions by the nurse are correct in regards to medication administration? Select all that apply. 1. Avoid salt substitutes when taking valsartan for hypertension 2. Take levofloxacin with an aluminum antacid to avoid gastric irritation 3. Take sucralfate (for a gastric ulcer) PC to minimize gastric irritation 4. When taking ethambutol, notify the health care provider (HCP) for changes in vision. 5. When taking rifampin, notify the HCP if the urine turns red-orange in color

1,4

The nurse reviews the serum laboratory results and medication administration records for assigned clients. Which prescriptions should the nurse question and validate with the health care provider before administering? Select all that apply. 1. Bumetanide in the client with heart failure who has hypokalemia 2. Calcium acetate in the client with chronic kidney disease who has hyperphosphatemia 3. Carvedilol in the client with heart failure who has an elevated B-type natriuretic peptide level 4. Isoniazid in the client with latent tuberculosis who has elevated liver enzymes 5. Metronidazole in the client with Clostridium difficile infection who has leukocytosis

1,4

The nurse is conducting intake interviews at the clinic. Which client situations would require the nurse to intervene? Select all that apply. 1. Client with iron deficiency anemia takes iron supplements with milk 2. Client takes levothyroxine early in the morning on an empty stomach 3. Client taking phenazopyridine for urine infection states that the urine has turned orange 4. Client taking metronidazole mentions going to a wine-tasting party tonight 5. Client with closed-angle glaucoma takes over-the-counter diphenhydramine for a cold

1,4,5

The nurse is preparing to administer medications to an 84-year-old client with dementia, agitation, and heart failure. Knowing that this client does not like to take pills and often allows only a few to be administered, the nurse prioritizes the oral medications by importance to the client's well-being. Which medications would be most important for the client to receive? Select all that apply. 1. Aripiprazole 2. Calcium carbonate 3. Donepezil 4. Furosemide 5. Lisinopril

1,4,5

A client is 6 hours postoperative from hip surgery after receiving regional anesthesia and has epidural continuous anesthesia in place. Which is the most important reason for the nurse to contact the health care provider? 1. Client reports paresthesia bilaterally since the surgery 2. Fondaparinux is prescribed for STAT administration 3. Lower-extremity muscle strength is 3/5 bilaterally 4. Postoperative laboratory results show hemoglobin of 9.9 g/dL (99 g/L)

2

A client with chronic stable angina is reporting chest pain. The nurse notices that the transdermal nitroglycerin patch that was applied 1 hour ago has peeled off. The client's vital signs are stable. What is the nurse's priority action? Click the exhibit button for additional information. Exhibit: Medication administration record Medications || Schedule Aspirin tablet: 81 mg, PO, daily 0800 Metoprolol 25 mg, PO, every 12 hours || 0800 & 2000 Nitroglycerin patch: 0.4 mg, transdermal, daily, remove after 12 hours || 0800 Morphine sulfate: 2 mg, IV push, every 6 hours PRN for pain || PRN Nitroglycerin tablets: 0.4 mg sublingual, q5 minutes PRN, up to 2 additional doses || PRN 1. Administer PRN morphine 2. Administer PRN sublingual nitroglycerin 3. Apply a new transdermal nitroglycerin patch 4. Obtain a 12-lead electrocardiogram

2

A client with long-term hypertension and hypercholesterolemia comes to the clinic for an annual checkup. The client takes nifedipine, simvastatin, and spironolactone and reports some occasional dizziness. Which statement by the client would warrant intervention by the nurse? 1. "I've been better about walking for 20 minutes 3 days a week on my treadmill." 2. "I've been trying to eat more fruits and vegetables. I discovered that I really like grapefruit." 3. "I've heard that having a glass of red wine with dinner every night is good for my heart." 4. "We no longer add salt when preparing meals. It has really been hard to get used to that."

2

A male client with hypertension was prescribed amlodipine. Which of these adverse effects is most important to teach the client to watch for? 1. Erectile dysfunction 2. Dizziness 3. Dry cough 4. Leg edema

2

During a routine office visit, the nurse documents the list of current medications of a client with a history of hypertension. Which statement by the client would cause the mostconcern? 1. "I periodically take docusate sodium for constipation." 2. "I regularly take ibuprofen for chronic low back pain." 3. "I take hydrochlorothiazide to prevent swelling around my ankles." 4. "I take omeprazole daily to prevent heartburn."

2

The health care provider (HCP) has prescribed spironolactone to be given in addition to hydrochlorothiazide to a client with hypertension. Which finding by the nurse would indicate that the new medication is having the desired effect? 1. Blood glucose of 95 mg/dL 2. Potassium level of 4.2 mEq/L 3. Reduction in dizziness 4. Sodium level of 138 mEq/L

2

The nurse reviews the medication administration records and laboratory results for assigned clients. Which medication requires that the health care provider be notified before administration? 1. Calcium acetate for a client with a phosphate level of 8.5 mg/dL (2.75 mmol/L) 2. Clopidogrel for a client with a platelet count of 70,000/mm3 (70 × 109/L) 3. Magnesium sulfate for a client with a magnesium level of 1.0 mEq/L (0.5 mmol/L) 4. Metformin for a client with a glycosylated hemoglobin level of 11%

2

The nurse is monitoring a client who has been on clopidogrel therapy. Which assessments are essential? Select all that apply. 1. Assess for bruising 2. Assess for tarry stools 3. Monitor intake and output 4. Monitor liver function tests 5. Monitor platelets

2,3

The nurse provides instructions to a client discharged on warfarin, after being treated for a pulmonary embolism (PE) following surgery. Which statements made by the client indicate the need for further teaching? Select all that apply. 1. "I will need to take my blood thinner for about 3-6 months." 2. "I will place small rugs on my wood floors to cushion a fall." 3. "I will take a baby aspirin if I have mild chest pain." 4. "I will use a soft-bristled toothbrush to clean my teeth." 5. "I will wear a blood thinner MedicAlert tag."

2,3

The nurse is discharging a client who has been prescribed warfarin for chronic atrial fibrillation. The nurse should instruct the client to avoid excess or inconsistent intake of which foods? Select all that apply. 1. Bananas 2. Broccoli 3. Grapefruit juice 4. Red meat 5. Spinach

2,3,5

The nurse is passing the prescribed medications to the assigned clients. Which scheduled administrations should the nurse hold and seek clarification from the health care provider? Select all that apply. 1. Client diagnosed with cirrhosis had 2 stools today; laxative lactulose prescribed daily 2. Client is scheduled for abdominal surgery tomorrow; vitamin E PO prescribed daily 3. Client is receiving IV vancomycin infusion; mild facial flushing noted after 30 minutes 4. Client with diabetes has insulin glargine and aspart prescribed; AM glucose is 100 mg/dL (5.6 mmol/L) 5. Lisinopril PO is prescribed daily; serum potassium level is 5.6 mEq/L (5.6 mmol/L)

2,5

The nurse is reviewing prescriptions for the assigned clients. Which prescriptions should the nurse question? Select all that apply. 1. Allopurinol for a client who developed tumor lysis syndrome from chemotherapy for acute leukemia 2. Dicyclomine for a client with a history of irritable bowel syndrome who develops a postoperative paralytic ileus 3. IV morphine for a client with severe acute renal colic pain who is scheduled for a percutaneous nephrolithotripsy 4. Levofloxacin for a client with a urinary tract infection who has a history of anaphylaxis to penicillin drugs 5. Simvastatin for a client with hypercholesterolemia who is reporting generalized muscle aches and weakness

2,5

A client is admitted with palpitations. The ECG shows supraventricular tachycardia (SVT) with a rate of 220/min. The nurse has received an order to administer adenosine 6 mg IV. Which action should the nurse take? 1. Adenosine is contraindicated for SVT. Verify the order with the health care provider 2. Administer medication only through a central venous access 3. Administer medication rapidly over 1-2 seconds followed by a saline flush 4. Mix medication in 50 mL normal saline and administer over 10 minutes

3

A client is in the cardiovascular clinic for a 3-month follow-up visit. At the first visit, the client was prescribed hydrochlorothiazide and amlodipine for hypertension. Which statement by the client would be concerning to the nurse and should be reported to the primary health care provider (PHCP)? 1. "I like to have a banana every morning with my breakfast." 2. "I occasionally experience slight dizziness when I get up in the morning." 3. "I started taking licorice root for my occasional heartburn." 4. "I usually take my hydrochlorothiazide first thing in the morning."

3

A client receives an injection of botulinum toxin type A for facial and neck rejuvenation. What complications of this procedure should the nurse be aware of for monitoring and teaching? 1. Abdominal rigidity and diarrhea 2. Back pain and urge incontinence 3. Difficulty swallowing and breathing 4. Difficulty walking and hand tremor

3

A client with a diagnosis of atrial fibrillation has just been placed on warfarin therapy. The registered nurse (RN) overhears a student nurse teaching the client about potential food-drug interactions. Which statement made by the student nurse requires an intervention by the RN? 1. "Do you take any nutritional supplements?" 2. "You will need to monitor your intake of foods containing vitamin K." 3. "You will not be able to eat green, leafy vegetables while taking this medication." 4. "Your blood will be tested at regular intervals."

3

A client with coronary artery disease and stable angina is being discharged home on sublingual nitroglycerin (NTG). The nurse has completed discharge teaching related to this medication. Which statement by the client indicates that the teaching has been effective? 1. "I can keep a few pills in a plastic bag in my pocket in case I need them while I'm out." 2. "I can still take this with my vardenafil prescription." 3. "I can take up to 3 pills in a 15-minute period if I am experiencing chest pain." 4. "I should stop taking the pills if I experience a headache."

3

A client with uncontrolled hypertension is prescribed clonidine. What instruction is most important for the clinic nurse to give this client? 1. Avoid consuming high-sodium foods 2. Change positions slowly to prevent dizziness 3. Don't stop taking this medication abruptly 4. Use an oral moisturizer to relieve dry mouth

3

A nurse in the emergency department is titrating a continuous infusion of nitroglycerin to a client admitted for acute coronary syndrome. The client's vital signs, including blood pressure (BP), heart rate (HR), and pain level, are being monitored frequently. Which assessment findings indicate that the current rate of administration should be maintained? 1. BP 80/50 mm Hg, HR 110/min; client reports pain is 0 out of 10 2. BP 100/60 mm Hg, HR 90/min; client reports pain is 3 out of 10 3. BP 110/70 mm Hg, HR 80/min; client reports pain is 0 out of 10 4. BP 120/80 mm Hg, HR 70/min; client reports pain is 5 out of 10

3

An 80-year-old client is receiving amikacin, an aminoglycoside antibiotic, IVPB every 12 hours. Which data obtained by the nurse is most important to report to the health care provider before hanging the next dose? 1. Blood pressure 104/62 mm Hg 2. Blood urea nitrogen 20 mg/dL (7.1 mmol/L) 3. Client report of tinnitus 4. Urine output of 400 mL since last dose

3

An 80-year-old client with hypertension and type 2 diabetes has recently started taking chlorthalidone. Which report by the client is most concerning to the office nurse? 1. Dizziness on standing 2. Fasting blood sugar of 160 mg/dL 3. Presence of muscle cramps 4. Sunburn

3

An African American client comes to the clinic for a follow-up visit 2 months after starting enalapril for hypertension. Which data collected during the health history should be reported to the health care provider (HCP) immediately? 1. Blood pressure taken in the clinic is 158/84 mm Hg 2. Client has a dry hacking cough 3. Client has noticed that the tongue is swelling slightly 4. Client has occasional dizziness upon rising in the morning

3

The nurse is conducting a hospital admission history and assessment. The client informs the nurse of taking the herb black cohosh (Actaea racemosa) daily. What is the bestnursing response? 1. Ask the client about menopausal symptoms 2. Ask the health care provider to write a prescription for use of the herb during hospitalization 3. Contact the pharmacy to see if the herb interacts with the client's medications 4. Tell the client to stop taking it

3

The nurse is discharging a client hospitalized for a new diagnosis of heart failure. The discharge medications include lisinopril 10 mg and spironolactone 25 mg. The client has also been started on a 2000 mg low-sodium diet. Which statement by the client indicates teaching on discharge instructions has been effective? 1. "I will be sure to take my medications before bedtime." 2. "I will eat more fresh fruits like bananas and oranges." 3. "I will limit my intake of cheeses, breads, and canned foods." 4. "I will use a salt substitute to season my food."

3

The nurse is performing discharge teaching for the parents of a 4-year-old with heart failure. Which statement by the parents indicates the need for further teaching related to the administration of digoxin? 1. "If our child vomits after a dose, we won't give a second one." 2. "Symptoms of nausea and vomiting should be reported to our health care provider (HCP)." 3. "We will hold the dose if our child's heart rate is above 90/min." 4. "We will not mix the medication with other foods or liquids."

3

The nurse is preparing to administer the fourth dose of vancomycin IVPB to a client with infective endocarditis. Which intervention does the nurse anticipate? 1. Administering PRN antiemetic prior to the infusion 2. Administering via an infusion pump over at least 30 minutes 3. Drawing a trough level just prior to administration of the vancomycin 4. Starting a new IV line before administration

3

The nurse is working in the emergency department. Which client should the nurse see first? 1. 12-year-old with severe neck muscle spasms who is taking haloperidol for Tourette syndrome 2. 80-year-old with irritability and agitation who has taken alprazolam for 2 weeks 3. Client taking clozapine who has sudden onset of high fever, diaphoresis, and change in mental status 4. Client taking olanzapine who has dry mouth, blurry vision, and constipation

3

The nurse provides discharge teaching for the parent of a child newly prescribed methylphenidate for attention-deficit hyperactivity disorder (ADHD). The nurse advises the parent that the child might experience which side effects? 1. Decreased blood pressure and growth delays 2. Heart palpitations and weight gain 3. Loss of appetite and restlessness 4. Trouble sleeping and a dry cough

3

The nurse reinforces teaching a client on prescribed dabigatran for chronic atrial fibrillation. Which statement by the client indicates a need for further teaching? 1. "I will call my health care provider if I notice red urine or blood in my stool." 2. "I will not stop taking dabigatran even if I get a stomachache." 3. "I will place capsules in my pill box so I will not forget to take a dose." 4. "I will swallow the capsule whole with a full glass of water."

3

The nurse teaches the client taking atorvastatin to call the health care provider (HCP) if experiencing which symptom associated with a serious adverse effect of atorvastatin? 1. Diarrhea 2. Headache 3. Muscle aches 4. Numbness in the feet

3

A newly admitted client describes symptoms of dizziness and feeling faint on standing. The client has a history of type 2 diabetes, coronary artery disease, and bipolar disorder. Which medications may be contributing to the client's symptoms? Select all that apply. 1. Atorvastatin 2. Metformin 3. Metoprolol 4. Olanzapine 5. Omeprazole

3,4

The nurse evaluating a 52-year-old diabetic male client's therapeutic response to rosuvastatin would notice changes in which laboratory values? Select all that apply. 1. Alanine aminotransferase from 20 U/L (0.33 µkat/L) to 80 U/L (1.34 µkat/L) 2. High-density lipoprotein cholesterol from 48 mg/dL (1.24 mmol/L) to 30 mg/dL (0.78 mmol/L) 3. Low-density lipoprotein cholesterol from 176 mg/dL (4.61 mol/L) to 98 mg/dL (2.54 mmol/L) 4. Total cholesterol from 250 mg/dL (6.47 mmol/L) to 180 mg/dL (4.66 mmol/L) 5. Triglycerides from 180 mg/dL (2.03 mmol/L) to 149 mg/dL (1.68 mmol/L)

3,4,5

A 45-year-old client with atrial fibrillation has been prescribed diltiazem. Which client outcome would best indicate that the medication has had its intended effect? 1. Atrial fibrillation is converted to sinus rhythm 2. Blood pressure is 126/78 mm Hg 3. No signs or symptoms of stroke 4. Ventricular rate decreased from 158/min to 88/min

4

A client diagnosed with stable angina is being discharged home on the cholesterol-lowering drug rosuvastatin. The nurse should teach the client to report which side effect to the health care provider (HCP) immediately? 1. Abdominal discomfort 2. Insomnia 3. Morning headache 4. Muscle aches or weakness

4

A client recently diagnosed with a major depressive disorder reports use of herbal supplements. It is most important for the nurse to provide education about which supplement reported by the client? 1. Echinacea 2. Garlic 3. Glucosamine 4. St John's wort

4

A client recently diagnosed with heart failure is being discharged with a prescription for lisinopril. Which client teaching related to this new medication is important to review at discharge? 1. Instruct client to report for monthly blood work to monitor drug levels 2. Review foods high in potassium that client should include in diet 3. Teach client to count own pulse for 1 minute; hold medication if pulse <60/min 4. Teach client to rise slowly and sit on side of bed for several minutes before rising

4

A client with chronic heart failure developed an intractable cough and an incident of angioedema after starting enalapril. Which prescription does the nurse anticipate for this client? 1. Alprazolam 2. Dextromethorphan 3. Lisinopril 4. Valsartan

4

A client with chronic heart failure is being discharged home on furosemide and supplementary potassium chloride tablets. Which instructions related to the potassium supplement should the nurse give to the client? 1. "A diet rich in protein and vitamin D will help with absorption." 2. "If the tablet is too large to swallow, crush and take it in applesauce or pudding." 3. "Potassium tablets should be taken on an empty stomach." 4. "Take it with plenty of water and sit upright for a period of time afterward."

4

A client with coronary artery disease was discharged home with a prescription for sublingual nitroglycerin (NTG) to treat angina. Which statement by the client indicates that further teaching is required? 1. "I may experience flushing but will continue to take the medication as prescribed." 2. "I should lie down before taking the medication." 3. "I should not swallow the tablet." 4. "I will wait to call 911 if I don't experience relief after the third tablet."

4

A client with stable angina is being discharged home with a prescription for a transdermal nitroglycerin patch. The nurse has reviewed discharge instructions on the medication with the client. Which statement by the client indicates that teaching has been effective? 1. "I can continue to take my prescription of sildenafil." 2. "I should take the patch off when I shower." 3. "I will remove the patch if I develop a headache." 4. "I will rotate the site where I apply the patch."

4

A home health nurse visits a client 2 weeks after discharge from the hospital. The client experienced an acute myocardial infarction and subsequent heart failure. Home medications are listed in the exhibit. Which symptom reported by the client is most concerning to the nurse? Click on the exhibit button for additional information. Exhibit: Home medications Aspirin: 81 mg by mouth, daily Clopidogrel: 75 mg by mouth, daily Metoprolol XL: 50 mg by mouth, daily Furosemide: 40 mg by mouth, twice daily Lisinopril: 5 mg by mouth, daily Atorvastatin: 40 mg by mouth, daily 1. Bruising easily, especially on arms 2. Fatigue 3. Feeling depressed 4. Muscle cramps in legs

4

A nurse has completed teaching a client who is being discharged on lithium for a bipolar disorder.Which statement by the client indicates aneed for further teaching? 1. "I need to drink 1-2 liters of fluid daily." 2. "I need to have my blood levels checked periodically." 3. "I should not limit my sodium intake." 4. "I should use ibuprofen for pain relief."

4

A nurse in the cardiac intermediate care unit is caring for a client with acute decompensated heart failure (ADHF). The client also has a history of coronary artery disease and peripheral vascular disease. The nurse is preparing to administer medications. Based on the assessment data, the nurse should question which medication? Click on the exhibit button for additional information. Exhibit: Vital signs Blood pressure 110/60 mm Hg Pulse 80/min Respirations 22/min Oxygen saturation 90% on room air Assessment data Crackles in middle & lower lung fields Moderate jugular venous distension 3+ pedal edema Medications Aspirin 81 mg daily Metoprolol 50 mg twice daily Furosemide 40 mg IV daily Atorvastatin 20 mg daily 1. Aspirin 2. Atorvastatin 3. Furosemide 4. Metoprolol

4

A nurse is discharging a client who is receiving lithium for treatment of a bipolar disorder. It is most important for the nurse to provide which instruction to the client? 1. Avoid a high-potassium diet 2. Exercise regularly and maintain a high-fiber diet 3. Maintain oral hygiene 4. Report excessive urination and increased thirst

4

After receiving shift report, the nurse is assessing a client started on trimethoprim-sulfamethoxazole 2 days ago for treatment of a urinary tract infection. The client reports itching, and the nurse notices a diffuse maculopapular rash on the client's face. What should the nurse do first? 1. Administer diphenhydramine 2. Administer injectable epinephrine 3. Examine the client's trunk and limbs 4. Reassess the client's allergy history

4

An elderly client with depression, diabetes mellitus, and heart failure has received a new digoxin prescription for daily use. Which client assessment indicates that the nurse should follow up on serum digoxin levels frequently? 1. Apical heart rate is 62/min 2. Blood sugar level is 240 mg/dL (13.3 mmol/L) 3. Client is taking 20 mg fluoxetine daily 4. Serum creatinine is 2.3 mg/dL (203 µmol/L)

4

The health care provider prescribes simvastatin for a client with hyperlipidemia.The nurse instructs the client to take this medication in which manner? 1. At noon with a meal 2. In the morning on an empty stomach 3. In the morning with breakfast 4. With the evening meal

4

The home health nurse visits a client with atrial fibrillation who is newly prescribed digoxin 0.25 mg orally on even-numbered days. Which client statement would require further teaching about digoxin? 1. "I will call the health care provider (HCP) if I don't feel like eating." 2. "I will call the HCP if I feel dizzy and lightheaded." 3. "I will call the HCP if I have trouble reading." 4. "I will take my blood pressure before taking my medicine."

4

The nurse has just completed discharge teaching about sublingual nitroglycerin (NTG) tablets to a client with stable angina. Which statement by the client indicates the need for further teaching? 1. "I will call 911 if my chest pain isn't relieved by NTG." 2. "If I have chest pain, I can take up to 3 pills 5 minutes apart." 3. "I'll call my doctor if I start having chest pain at night." 4. "I'll keep one bottle in the house and one in the car."

4

The nurse is assessing a client with hypertension and essential tremor 2 hours after receiving a first dose of propranolol. Which assessment is most concerning to the nurse? 1. Client reports a headache 2. Current blood pressure is 160/88 mm Hg 3. Heart rate has dropped from 70/min to 60/min 4. Slight wheezes auscultated during inspiration

4

The nurse is preparing to administer 160 mg of furosemide via IV piggyback to a client with chronic kidney disease and fluid overload. The nurse plans to give the dose slowly over 40 minutes to prevent which adverse effect? 1. Bradycardia 2. Hypokalemia 3. Nephrotoxicity 4. Ototoxicity

4

The nurse is preparing to administer the fourth dose of IV vancomycin to a client. Which set of laboratory values would alert the nurse to hold the vancomycin and notify the health care provider? 1. Vancomycin trough 10 mg/L (6.9 µmol/L), creatinine 1.1 mg/dL (97.2 µmol/L), BUN 6 mg/dL (2.1 mmol/L) 2. Vancomycin trough 14 mg/L (9.7 µmol/L), creatinine 1.2 mg/dL (106.1 µmol/L), BUN 10 mg/dL (3.6 mmol/L) 3. Vancomycin trough 18 mg/L (12.4 µmol/L), creatinine 0.6 mg/dL (53 µmol/L), BUN 18 mg/dL (6.4 mmol/L) 4. Vancomycin trough 23 mg/L (15.9 µmol/L), creatinine 1.5 mg/dL (132.6 µmol/L), BUN 24 mg/dL (8.6 mmol/L)

4

The nurse reviews the analgesia prescriptions for assigned clients. The nurse should question the health care provider about which prescription? 1. Lidocaine 5% patch over intact skin for a client with chronic postherpetic neuralgia who reports intolerable, persistent, burning pain 2. Hydromorphone IV for a client who has a fractured femur, is a known IV heroin abuser, and rates pain as 9 on a 0-10 scale 3. Tramadol for a client who is being prepared for discharge following a laparoscopic cholecystectomy and rates abdominal pain as 6 on a 0-10 scale 4. Transdermal fentanyl patch for a client who is 1 day postoperative above-the-knee amputation and reports intermittent, throbbing stump pain

4

A client is being discharged after having a stent placed in the left anterior descending coronary artery. The client is prescribed clopidogrel. Which client data obtained by the nurse would be concerning in relation to this new medication? Select all that apply. 1. Blood pressure of 140/84 mm Hg 2. Heart rate of 98/min 3. Platelet count of 200,000/mm3 4. Report of Ginkgo biloba use 5. Report of peptic ulcer disease

4,5

Which prescriptions for these clients does the nurse question? Select all that apply. 1. Client with Clostridium difficile colitis, prescribed vancomycin 125 mg PO 2. Client with diabetes and elevated mealtime glucose, prescribed lispro insulin scale 6 units subcutaneously 3. Client with gastrointestinal bleed and nasogastric tube, prescribed pantoprazole 40 mg intravenous 4. Client with hypertension and blood pressure (BP) 94/40 mm Hg, prescribed metoprolol succinate SR 50 mg PO 5. Client with otitis media and penicillin allergy, prescribed ampicillin 500 mg PO

4,5