NCLEX Review Questions
The nurse is caring for a client who is taking a first-generation antihistamine. What is the most important fact for the nurse to teach the client?
"Do not drive after taking this medication." Rationale: First-generation antihistamines cause drowsiness.
The client questions a nurse about herbal treatments for arthritic pain. What is the nurse's best response?
"Glucosamine sulfate with chondroitin has demonstrated promising results in the treatment of joint stiffness and pain. Consult your health care provider."
Which instruction will the nurse include when teaching a client about the proper use of metered-dose inhalers?
"Hold your breath for 10 seconds if you can after you inhale the medication." Rationale:Holding the breath for 10 seconds allows the medication to be absorbed in the bronchial tree rather than be immediately exhaled.
The clinic nurse is reviewing medication instructions with a client taking Nicorette gum 2 mg for smoking cessation. Which statement by the client indicates a need for further teaching by the nurse?
"I can continue to smoke a cigarette once in a while when taking this drug." Rationale:Cigarette smoking while using nicotine-replacement therapy (NRT) agents such as Nicorette gum may cause nicotine overdose. The client should not smoke cigarettes while taking Nicorette gum. NRT should not be used by pregnant or nursing women, so use of birth control is appropriate while taking NRT. Food and drink should be avoided 15 minutes before and during use of Nicorette gum. While the client is chewing the gum, there should be periods of holding the gum between the cheek and teeth.
A nurse completes an admission history on a client with a history of heart disease, who takes an aspirin a day in addition to prescription medications. Which statement most concerns the nurse?
"I drink wine with dinner each day." Rationale: Aspirin causes platelet dysfunction and inhibits prostaglandin mediated mucus production of the gastric mucosa. Alcohol disrupts the gastric mucosal barrier and suppresses platelet production, so both alcohol and aspirin can prolong bleeding time. Therefore, the nurse should instruct the client who consumes alcohol regularly to watch for signs of gastrointestinal bleeding, such as dark stools, and inform the health care provider if these signs are observed.
A student nurse is preparing to administer a beta blocker to a client. The nursing instructor asks the student to discuss the indications for beta blockers. The student nurse correctly responds that beta blockers are used to treat which disorders? (Select all that apply.)
"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
Correct "If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions." Rationale:"If you take your pulse and it is less than 60, hold your medicine and call your health care provider for instructions."
Which statement best indicates that the nurse understands the meaning of pharmacokinetics?
"It involves the study of physiologic interactions of drugs. "It explains the distribution of the drug between various body compartments. Pharmacokinetics involves the study of how the drug moves through the body, including absorption, distribution, metabolism, and excretion.
A 3-year-old child has been started on a new medication. What is the most important information to convey to the parents?
"Observe the child for potential adverse effects of the medication." Rationale:Adverse effects of medications can be difficult to discern in young children, especially things such as ringing in the ears, because the child might not be able to communicate well. Parents are in the best position to observe the child and note changes in behaviors that might be related to side effects.
Which statement is accurate when the nurse instructs the client about self-treatment options?
"Over-the-counter medications can, at times, be used in place of prescription drugs. It is important to discuss the use of these with your health care provider."
The nurse is developing a teaching plan for a client taking amiodarone. What is the most important information for the nurse to teach this client?
"Stay out of the sun when possible and use sunscreen when you are outside." Rationale: This medication is reported to cause photosensitivity in up to 75% of cases. Not all over-the-counter medications will react with this drug. The client should consult with the health care provider. Milk and vitamin supplements do not reportedly interact with this medication.
A client is prescribed ipratropium and cromolyn sodium. What will the nurse teach the client?
"Take the ipratropium at least 5 minutes before the cromolyn." Rationale:When using an anticholinergic in conjunction with an inhaled glucocorticoid or cromolyn, the ipratropium should be used 5 minutes before the steroid. This causes the bronchioles to dilate so the steroid or cromolyn can get deeper into the lungs.
What would the nurse teach the client who is lactating to minimize drug effects of medications on the infant?
"Take your medications immediately after breastfeeding." Rationale: Taking a medication immediately after breastfeeding allows for the maximum amount of time for drug excretion before the next breastfeeding.
A female client who is experiencing symptoms of menopause tells the nurse, "I am afraid to take conventional treatments for menopause symptoms. Twice I have had benign tumors removed from my breast. I am afraid that conventional treatments will make this problem worse. Can't I just take natural phytoestrogens from the drugstore instead?" What is the nurse's best response?
"The natural phytoestrogens could increase your risk for tumors. We should discuss your concerns related to conventional treatments for menopause so we can determine the best way to alleviate your symptoms." Rationale:Naturally occurring phytoestrogens are contraindicated in women with a history of or risk for hormonally mediated cancers and benign tumors.
The nurse is planning to administer a new medication to a pregnant client. The client is concerned about the effect of the medication on the fetus. What is the nurse's best response?
"This medication is pregnancy drug category A, which means that there has been no evidence of fetal harm when this drug is administered to pregnant clients."
A client is prescribed an antitussive medication. What is the most important thing for the nurse to teach the client?
"This medication may cause drowsiness and dizziness." Rationale:Antitussive medications also affect the CNS, thus causing drowsiness and dizziness.
Which statement indicates that the client understands the teaching about beclomethasone diproprionate (Beconase)?
"This medication will help prevent the inflammatory response of my allergies." rationale:Beclomethasone diproprionate (Beconase) is a steroid spray administered nasally. It is used to prevent allergy symptoms. Its effect is localized, and therefore the client does not have systemic side effects with normal use and does not have to worry about weaning off the medication as with oral corticosteroids.
Client teaching regarding the use of antileukotriene agents such as zafirlukast (Accolate) should include which statement?
"This medication will prevent the inflammation that causes your asthma attack." Rationale:Antileukotriene agents block the inflammatory response of leukotrienes and thus the trigger for asthma attacks. Response to these drugs is usually noticed within 1 week. They are not used to treat an acute asthma attack.
The client tells the nurse, "I have brought along the tea that I drink every day. Members of my family have been drinking this kind of tea for generations because it is meant to promote good health and long life. I hope I can continue drinking this tea while I am on my new medications." What is the nurse's best response?
"We will need to determine what the tea is made of, so we can be sure that none of its ingredients will react badly with your new medications." Rationale:Clients may derive both psychological and physical benefit from taking traditional remedies, but it is essential to ensure that the traditional remedies will not interfere with the action of the conventional medications the client has been prescribed. Because clients may achieve health benefits or psychological comfort from their traditional remedies, they should not be told that the remedies are forbidden or useless; however, they should be instructed not to continue the remedies until it has been determined that the remedies will not affect the action of the client's conventional medications.
A client admitted with angina states "I take dong quai every day, and I don't want to stop." What is the nurse's best response?
"What medications do you currently take?" Rationale: The nurse must first assess to determine if the client's medications may interact with the herbal supplement.
While performing an admission interview, which question would be the most appropriate for the nurse to ask in regard to the use of herbal supplements?
"What supplements do you take, and how often?" Rationale: The nurse needs to assess what herbs the client takes, as this may affect the client's treatment or interfere with medications.
The nurse is caring for a client in the clinic who states that he is afraid of taking antihistamines because he is a truck driver. What is the best information for the nurse to give this client?
"You may be able to safely take a second-generation antihistamine." Rationale: Second-generation antihistamines are often called nonsedating antihistamines. These may be safer for the client to take, but the client should still monitor for signs of excessive sedation.
The nurse is administering a schedule III controlled substance. What is an essential nursing action? (Select all that apply.)
-Count the available doses of medication before administering and record them. -Document the time and date of administration. -Countersign all discarded or wasted medication. rationale:
The nurse is preparing to teach a client newly diagnosed with diabetes mellitus how to inject insulin. Which principle should the nurse include when providing client teaching? (Select all that apply.)
-Include a family member or friend in the teaching process. -Provide simple written materials appropriate for individual client needs. -The nurse should provide contact information on how to reach the health care provider.
A client comes to the emergency department with symptomatic bradycardia. The nurse prepares to administer which dose of atropine intravenously?
0.5 mg Rationale:The recommended dose of atropine to treat symptomatic bradycardia is 0.5 to 1 mg.
Several clients have been recently admitted to the unit. After looking at admission histories, the nurse will call the health care provider about which client history?
A client who takes a vitamin supplement with vitamin K and Coumadin Rationale: Vitamin K has an antagonistic effect with Coumadin and will inhibit its effects. However, stopping the vitamin K may not be the best solution. The nurse should check the patient's latest INR result, because dosage adjustments may have been made to be within the therapeutic range for Coumadin. Aspirin and codeine have an additive effect that would not be undesirable; a diuretic and a beta blocker would have an additive effect that would not be undesirable; and a potassium-sparing diuretic and a loop diuretic would have additive and desirable effects.
Knowing that the albumin in neonates and infants has a lower binding capacity for medications, the nurse anticipates that the health care provider will order which of the following to minimize the risk of toxicity?
A decrease in the dosage of drug given Rationale: A lower binding capacity leaves more drug available for action; thus, a lower dose would be required to prevent toxicity. An increase in the drug dose would result in higher risk of toxicity. A shorter time interval between doses would increase the risk of toxicity. IV administration of a drug may increase the risk of toxicity due to quicker onset of action.
A client has been taking metoprolol (Lopressor) and states to the homecare nurse, "I can't afford this medication any more, and I stopped it yesterday." What is the nurse's primary intervention?
Abrupt withdrawal of a beta-blocking agent can cause rebound hypertension. These drugs should be gradually decreased. The nurse should immediately check the client's blood pressure, and then proceed with teaching and calling the health care provider.
A client with a history of asthma is short of breath and says, "I feel like I'm having an asthmatic attack." What is the nurse's best action?
Administer a beta2 adrenergic agonist. Rationale: In an acute asthmatic attack, the short-acting sympathomimetics are the first line of defense.
A client is admitted to the emergency department with an expected cholinesterase inhibitor overdose. What is the nurse's primary action?
Administer anticholinergic medication. Rationale:An anticholinergic can act as an antidote to the toxicity caused by cholinesterase inhibitors and organophosphate ingestion.
A client is admitted with the diagnosis of glaucoma. What is the best intervention for this client?
Administer pilocarpine. Rationale:Pilocarpine is a direct-acting cholinergic drug that constricts the pupils of the eyes, thus opening the canal of Schlemm to promote drainage of aqueous humor (fluid). This drug is used to treat glaucoma by relieving fluid (intraocular) pressure in the eye.
The health care provider orders ipratropium bromide (Atrovent), albuterol (Proventil), and beclomethasone (Vanceril) inhalers for a client. What is the nurse's best action?
Administer the albuterol first, wait 5 minutes, and administer ipratropium bromide, followed by beclomethasone several minutes later. Rationale:Administering the bronchodilator albuterol (Proventil) first allows the other drugs to reach deeper into the lungs as the bronchioles dilate. Anticholinergics such as ipratropium bromide (Atrovent) also help bronchodilate, but to a lesser extent. Corticosteroids such as beclomethasone (Vanceril) do not dilate and are therefore given last.
The nurse is preparing to review a client's medication history. Which information is most important when the nurse obtains a medication history from a client?
Allergies Rationale: Knowledge of allergies is the most important information because the client could have a life-threatening reaction. Alcohol can interact with medications, and home remedies and over-the-counter drugs can interfere with medications, but this is not the most important information.
The nurse is planning to administer a narcotic to a client for pain control. The medication order expired the day before. What is the nurse's best action?
Ask the health care provider for a renewal for the medication, but do not administer the medication until the order is renewed.
The nurse is administering PO medications to a 2-year-old child who is belligerent. What action is the best strategy for the nurse to use?
Ask the parents to assist in calming the child. Rationale:The child needs to cooperate in the medication process. At this age, the best strategy is to ask the parents to assist in calming the child so that the child will take the medications. The child is too young to understand reasoning. The parents have given consent for care, so the nurse does not need to ask again before administering the medication. The fact that the child is being uncooperative is not a reason to change the route of administration.
The nurse administers a medication that has a long half-life to an older adult client. What is a priority action for the nurse?
Assess the client for potential drug toxicity. Rationale: Because drug absorption is slowed in the older adult, drugs with a longer half-life may increase the potential for toxicity. The nurse should assess the client, and the dose may need to be decreased. An alternative drug should not be needed. The time of administration will not affect the half-life. The medication should not be halved. This will not affect the half-life.
A nurse is monitoring a client receiving atropine. Which finding requires the nurse to act?
Blood pressure 90/40 mm Hg Rationale:Atropine is an anticholinergic agent that blocks the effects of the parasympathetic nervous system, producing sympathetic nervous system effects. Adverse reactions include nasal congestion, tachycardia, hypotension, pupillary dilation, abdominal distention, and palpitations. This blood pressure is low enough that action is required.
The nurse is caring for a client with a diagnosis of heart failure and a secondary diagnosis of chronic obstructive pulmonary disease (COPD). The client is ordered a nonselective beta blocker. What is the nurse's primary intervention?
Call the health care provider to request a different medication. Rationale:Nonselective beta blockers are used to treat supraventricular dysrhythmias secondary to their negative chronotropic effects (decreasing heart rate). They may exacerbate heart failure and COPD. The client could receive a selective beta blocker instead. The nurse should make the health care provider aware of the client's history of respiratory disease.
The client is ordered to receive a sympathomimetic agent. On review of the client's other medications, the nurse finds the client takes an MAO inhibitor daily. What is the nurse's primary action?
Call the health care provider. Rationale: Adrenergic agents combined with MAO inhibitors can lead to extreme hypertension. The medications cannot be administered together.
An older adult client suffered a broken leg and had emergency surgery. The client was prescribed meperidine (Demerol) 50 mg PRN for pain. What is the nurse's most important intervention?
Calling the health care provider to change the prescription Rationale:Demerol is not a drug that is recommended for the older adult owing to the incidence and risk of confusion and convulsions. Morphine is preferred.
The nurse is preparing to administer medications. Which intervention will the nurse include when administering medications to clients?
Check the client's wristband before administering the medication. Rationale: Checking the client's wristband is the most accurate method of determining identity; however, at least two identifiers should always be used. The medication label should be checked three times before administering a medication. Some clients may respond to any name or may not be able to respond, so calling the client by name could lead to a medication error. Preparing medications for all clients first and then administering increases the risk for medication errors.
A client with cardiac decompensation is receiving dobutamine as a continuous infusion. The client's blood pressure has increased from 100/80 mm hg to 130/90 mm hg. What is the nurse's primary action?
Continue to assess hourly blood pressure readings. Rationale: The major therapeutic effect of dobutamine is to increase cardiac output. Cardiac output is reflected in the client's heart rate, blood pressure, and urine output. An increase in the blood pressure is the expected therapeutic effect.
The nurse is caring for a client with a theophylline level of 14 mcg/mL. What is the priority nursing intervention?
Continue to assess the client's oxygenation. Rationale: The therapeutic theophylline level is 10 to 20 mcg/mL. The nurse should continue interventions and monitor oxygenation.
The nurse monitors a client prescribed dicyclomine (Bentyl) for which therapeutic effect?
Decrease in GI motility Rationale: Dicyclomine (Bentyl) is an antispasmodic cholinergic blocker used to decrease GI motility in clients with functional GI disorders such as irritable bowel syndrome.
The nurse monitors a client taking oxybutynin (Ditropan) for which therapeutic effect?
Decrease in urinary frequency Rationale: Oxybutynin (Ditropan) blocks the cholinergic receptors in the bladder to decrease urinary frequency and urgency.
Which is the highest priority potential nursing diagnosis for a client who is starting on metoprolol (Lopressor)?
Decreased cardiac output related to effects of medication Rationale: Using the ABCs of prioritization, decreased cardiac output puts the client at highest risk. Although the other nursing diagnoses are pertinent, they are not the priority.
What rule does the nurse apply to the calculation of pediatric medications?
Dosage calculation by body surface area, which is the most accurate method because it takes into account the difference in size of the child and/or neonate Rationale: Clark's rule is based on the weight of the child, not the age. To determine the dose, divide the child's weight in pounds by 150 to get the correct fraction of adult dose. Fried's rule calculates the dose of a drug based on the child's age in months divided by 150, not the child's body weight. Dosage calculation according to body weight is not the most accurate method of dosage calculation. Calculation of drugs by body surface area is the most accurate method of dose calculation as it includes both weight and height calculations.
The physiologic changes that normally occur in the older adult have which implication for the nurse, who is assessing drug response in this client population?
Drug half-life is lengthened. Rationale:Drug half-life is extended secondary to diminished liver and renal function in the older adult. Metabolism is slower, not faster, in the older adult. Drug elimination is also generally slower in the older adult, and protein binding is not more efficient in the older adult.
The nurse reads the initials "USP" after a drug name. What is the nurse's best action?
Drugs included in the USP-NF have met high standards for therapeutic use, client safety, quality, purity, strength, packaging safety, and dosage form. Drugs that meet these standards have the initials "USP" following their official name, denoting global recognition of high quality. The USP-NF is the official publication for drugs marketed in the United States, so designated by the U.S. Federal Food, Drug, and Cosmetic Act.
The nurse is caring for a client who is receiving ergotamine tartrate (Ergostat) and who states, "I have no clue what this medication does for me." What is the nurse's most appropriate response?
Ergotamine tartrate (Ergostat) is classified as an ergot alkaloid; it blocks alpha2 receptors, causing vasoconstriction. Ergot alkaloids are useful in treating vascular headaches caused by vasodilation of vessels in the brain.
The nurse knows that, in general, different cultural groups may have different perceptions of time. For example, which cultural group may be primarily future-oriented, but only secondarily present-oriented?
European Rationale:Europeans and people of European descent are primarily future-oriented and secondarily present-oriented. In contrast, members of the other cultural groups may be primarily present-oriented and secondarily future-oriented.
The nurse is monitoring a client's blood pressure an hour after administering an antihypertensive medication. What is the purpose of this monitoring?
Evaluation of therapeutic effect Therapeutic effect occurs after the administration of the medication, and the nurse should assess for expected outcomes. Tolerance cannot be assessed by taking postadministration blood pressure. Toxicity cannot be assessed by taking blood pressure after administration. Need is determined before the administration of the drug.
Which statement indicates that the nurse understands a principle of caring for clients with drug dependency?
Genetics may play a role in contributing to the cause of substance abuse. rationale: Genetics may play a role in contributing to substance abuse. Clients do not have brain disorders; however, their brains do become altered over time due to repeated ingestion of certain drugs. Addictive disorders are treatable. Clients with addictive disorders may not be addicted to narcotics and therefore can take narcotics.
The nurse reads that the half-life of the medication being administered is 12 hours. What assumption will guide the nurse's care of this client?
Half-life refers to the time it takes to excrete a drug from the body. Administering the medication every 6 hours would not be appropriate; it would be too soon. Half-life does not refer to onset of action or to the number of doses in 24 hours.
A client taking an oral theophylline preparation is due for her next dose and has a blood pressure of 100/50 mm Hg and a heart rate of 110. The client is irritable. What is the best action for the nurse to take?
Hold the next dose of theophylline. Rationale:The client is displaying adverse reactions to theophylline, and her blood level should be assessed before another dose of the medication. The nurse should hold the medication.
Which is a priority nursing diagnosis for a client receiving an anticholinergic (parasympatholytic) medication?
Impaired gas exchange related to thickened respiratory secretions Rationale:Although all of these nursing diagnoses are appropriate, the priority is determined by remembering the ABCs. Anticholinergic drugs decrease respiratory secretions, which could lead to mucous plugs and resultant impaired gas exchange.
Which is the best instruction for the nurse to include when teaching a client about the use of expectorants?
Increase fluid intake in order to decrease viscosity of secretions. Rationale: Expectorant drugs are used to decrease viscosity of secretions and allow them to be more easily expectorated. Increasing fluid intake helps this action.
The nurse is caring for a client who is taking a cholinergic (parasympathomimetic) drug. Which assessment will indicate that the medication is having a desired effect?
Increased GI motility rationale:Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process.
The nurse is caring for a client who is receiving epinephrine (Adrenalin) for treatment of Stokes-Adams syndrome. Which assessment will indicate the client is having the expected therapeutic effect of this medication?
Increased heart rate and strong pulse
The nurse understands that there are several mechanisms by which drugs can exert their action on the body, including which mechanisms? (Select all that apply.)
Interacting with specific receptors Inhibiting the action of a specific enzyme Altering metabolic chemical processes Nonspecific binding to a macromolecular receptor
The nurse realizes that a drug administered by this route will require the most immediate evaluation of therapeutic effect.
Intravenous medications are not altered by first pass effect and enter the system quickly. Oral medications are absorbed in the stomach and small intestine, travel through the portal system, and are metabolized by the liver before they reach general circulation. Subcutaneous medications need to be absorbed into the bloodstream before entering the circulation to exert effect. Topical medications need to be absorbed through the skin before entering the blood stream and exerting an effect.
What will the nurse expect to find that would indicate a therapeutic effect of acetylcysteine (Mucomyst)?
Liquefying and loosening of bronchial secretions Rationale:Acetylcysteine is a mucolytic drug used to liquefy and loosen bronchial secretions in order to enhance their expectoration.
Which nursing intervention will best enhance the absorption of an intramuscular injection?
Massaging the site increases circulation to the area and thus increases absorption. Cold will cause vasoconstriction and will not enhance absorption. Administration in the leg and the Z-track method will not enhance absorption.
The pharmacist states that the client's biotransformation of a drug was altered. What does the nurse realize has affected the drug?
Metabolism connotes a breakdown of a product. Biotransformation is actually a more accurate term because some drugs are actually changed into an active form in the liver in contrast to being broken down for excretion.
What is the most important thing for the nurse to teach the client with a history of diabetes and asthma who has started on albuterol PRN?
Monitor blood glucose levels every 4 hours when taking albuterol. Rationale:Beta2 agonists may increase blood glucose levels. Clients with diabetes should monitor serum glucose levels frequently while taking this medication.
A nurse reviews a client's medication history and notes that the client is taking a nonselective adrenergic agonist bronchodilator and has a history of coronary artery disease. What is a priority nursing intervention?
Monitor client for potential chest pain. Rationale:Nonselective adrenergic agonist bronchodilators stimulate beta1 receptors in the heart and beta2 receptors in the lungs. Stimulation of beta1 receptors can increase heart rate and contractility, increasing oxygen demand. This increased oxygen demand may lead to angina or myocardial ischemia in client with coronary artery disease. Cautious use of these agents is indicated if the client has coronary artery disease.
A client has taken metaproterenol. What is the nurse's priority action?
Monitor for heart rate >100 beats/min. Rationale:The beta1 properties of this drug can cause increased heart rate and palpitations. The drug should not cause sedation or elevated blood pressure.
What is included in the nurse's role in the development of new and investigational drugs?
Monitoring for and reporting any adverse effects noted during Phase IV studies Rationale: Phase IV studies rely on the health care professionals to report adverse effects that may not have been apparent in previous phases of drug development. The nurse does not select clients to participate in studies. If he or she is not the investigator, the nurse does not control who is to receive placebo drugs or inform clients of the specific drug they are receiving during the double-blind, placebo-controlled phase of the study.
Which activity is the nurse's responsibility during the evaluation phase of drug administration?
Monitoring the client continuously for therapeutic as well as adverse effects rationale:Ongoing monitoring of the client is necessary to evaluate the effect of the drug. Preparation and planning of outcomes are not done during the evaluation phase, and gathering a history is done before the evaluation phase.
A client is complaining of pain rated "10" on a scale of 1 to 10. The nurse has several choices of pain medication to administer. Which order is the best for the nurse to administer at this time?
Morphine sulfate 1 mg IV (intravenous) When a drug is administered intravenously, it does not need to be absorbed because it is placed directly into general circulation.
The nurse is caring for a client with a history of secobarbital (Seconal) abuse. The client last took the drug 12 hours ago. Which assessment finding requires immediate action?
Muscle cramps Rationale: Withdrawal symptoms in the first 12 to 16 hours after the last dose of the barbiturate secobarbital (Seconal) include anxiety, nausea or vomiting, increased reflexes, muscle cramps, tremors, or weakness. Headache is a withdrawal symptom with caffeine abuse. Bradycardia, not tachycardia, is a physiologic effect of barbiturates. Reflexes are increased with withdrawal of secobarbital, not decreased.
Which adverse reaction will the nurse monitor in a client taking bethanechol (Urecholine) for treatment of urinary retention?
Muscle weakness Rationale:Adverse reactions to bethanechol (Urecholine) include abdominal cramps, diarrhea, orthostatic hypotension, bradycardia, and muscle weakness.
The nurse is caring for a client with a history of alcoholism who is undergoing long-term alcohol treatment. Which intervention is the highest priority?
Nausea and vomiting are likely with this drug. Orthostatic hypotension and hyperthermia are not a concern with this drug. Avoidance of sunlight is not necessary while on this medication. Rationale:In addition to cognitive-behavioral therapy, disulfiram (Antabuse) may be ordered because it prevents alcohol consumption by causing an unpleasant reaction if alcohol is taken. Flumazenil (Romazicon) is a benzodiazepine antagonist and is used to treat benzodiazepine overdose. Methadone (Dolophine) is an opioid agonist used during opioid detoxification to decrease symptoms, and is used in long-term management of opioid addiction. Propranolol (Inderal), an adrenergic beta blocker, is indicated in treating elevated blood pressure and tachycardia, which may occur with amphetamine toxicity.
A client complains of worsening nasal congestion despite the use of oxymetazoline (Afrin) nasal spray every 2 hours. What is the nurse's best response?
Overuse of nasal decongestants results in rebound congestion." Rationale: Oxymetazoline (Afrin) is an effective nasal decongestant, but overuse results in worsening or "rebound" congestion. It should not be used more than every 4 hours. To avoid future rebound congestion with nasal sprays, it is recommended that they be used for no more than 3 to 5 days.
A basic concept of pharmacology that the nurse must understand is how the drug influences cell physiology. What is the term for this concept?
Pharmacodynamics:Pharmacodynamics refers to what the drug does to the body; that is, how it influences cellular physiology. Pharmacokinetics is the study of what the body does to the drug. Pharmacotherapeutics refers to the study of the therapeutic use of drugs. Pharmacology is the study of drugs.
The nurse has administered several oral medications to the client which may alter the rate of absorption?
Presence of food in the stomach pH of the stomach Pain Explanantion: The presence of food in the stomach usually decreases absorption of drugs but may increase absorption for a few specific medications. The pH of the stomach affects absorption of drugs dependent on the pH of the drug. Alkaline drugs are absorbed more readily in an alkaline environment, and acidic drugs are absorbed more readily in an acidic environment. The form of the drug also affects absorption, with liquid drugs being absorbed the fastest and enteric-coated tablets the slowest. Pain can affect absorption by slowing gastric emptying time. Position will not influence absorption. Amount of saliva will not influence absorption.
A client demonstrates understanding of flunisolide (AeroBid) by saying that he will do what?
Rinse his mouth with water after each use. Rationale: Flunisolide (AeroBid) is an inhaled corticosteroid. Rinsing the mouth will help prevent oral candidal infections. It is not used to treat an acute asthma attack and should be taken with the client's bronchodilator medications. If the client is taking oral prednisone, it needs to be tapered off to prevent acute adrenal crisis because flunisolide is minimally absorbed systemically.
The nurse is developing a nursing care plan for a newly diagnosed adult male client with hypertension who is to begin taking metoprolol/hydrochlorothiazide (Lopressor HCT) 50 to 25 mg daily. The client has many questions about his diagnosis and medication. Which nursing diagnoses would be the highest priority for this client?
Risk for ineffective therapeutic regimen management related to new diagnosis Rationale: Risk for ineffective therapeutic regimen management related to new diagnosis is the most appropriate diagnosis. The client is newly diagnosed with hypertension and has many questions about his diagnosis and medication. Clients with hypertension do not necessarily have fluid volume excess. No signs and symptoms are presented. The client is not showing signs of ineffective coping. The client is being started on a diuretic; however, at this dose there may be little risk for fluid volume deficit.
The nurse is instructing a client about the advantages of salmeterol (Serevent) over other beta2 agonists such as albuterol (Proventil). How will the nurse explain to the client the difference in these two medications?
Salmeterol has a longer duration of action. Rationale: Salmeterol (Serevent) has a longer duration of action, requiring the client to use it only twice a day instead of four times a day with albuterol (Proventil).
The nurse instructs the client to avoid which over-the-counter products when taking theophylline (Theo-Dur)?
St. John's wort has been shown to decrease serum theophylline levels. The other substances do not interact with theophylline.
The nurse assesses the peripheral intravenous infusion site of a client receiving intravenous dopamine and suspects extravasation. What is the nurse's primary action?
Stop the infusion. Rationale: The nurse's first action is to stop the infusion. Next, the nurse would infuse Phentolamine (Regitine) into the area to counteract the vasoconstrictive effects of the dopamine.
Discharge teaching to a client receiving a beta-agonist bronchodilator should emphasize reporting which side effect?
Tachycardia Rationale: A beta-agonist bronchodilator stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia, bronchodilation, hyperglycemia (if severe), and alertness.
The nurse is caring for a young child who has been prescribed an inhaler for control of her asthma. The child is having difficulty using the inhaler. What is the nurse's best action?
Teach the child to use a spacer. Rationale:If a child is unable to use the inhaler, the medication will be trapped in the mouth. Using a spacer helps the medication to be deposited to the lungs.
The nurse is caring for a client who has just been diagnosed with hypertension. The client has received one dose of atenolol (Tenormin). What is the nurse's primary intervention?
Teach the client about nonselective beta blockers. rationale: At therapeutic dosages, atenolol selectively blocks only the beta1 receptors in the heart, not the beta2 receptors located in the lungs.
Varenicline (Chantix) is prescribed for a middle-aged client for smoking cessation. What is a priority nursing action for this client?
Tell the client that nausea and vomiting are likely. Rationale:Nausea and vomiting are likely with this drug. Orthostatic hypotension and hyperthermia are not a concern with this drug. Avoidance of sunlight is not necessary while on this medication.
The nurse administered donepezil (Aricept) to a client. Which finding indicates that the medication is therapeutic?
The client has increased cognition. Rationale:Donepezil (Aricept) is used to treat Alzheimer's disease, a disorder of decreased acetylcholine levels in the brain. It can increase cognition.
The client tells the nurse that she has a bad cold, is coughing, and feels like she has "stuff" in her lungs. What should the nurse do?
The client needs an expectorant. This medication will help the client cough the "stuff" out of her lungs. Dextromethorphan and fluticasone will not help the client expectorate. There is no information about the client's fluid intake, so hourly fluids may be too much.
Which client will the nurse assess first?
The client scheduled for surgery who is taking dong quai Rationale: Dong quai increases the risk of bleeding. Garlic will reportedly decrease high cholesterol and may help a client with a cardiac history. Gingko is purported to help clients diagnosed with dementia. Ginger is purported to help decrease the risk of vomiting in nausea.
Which client has the highest priority teaching need in relation to over-the-counter medication use?
The client who is taking pseudoephedrine and has a thyroid disorder Rationale: Pseudoephedrine is a sympathomimetic that may interfere with thyroid medication and cause nervousness. Over-the-counter cold medications are safe for 15-year-olds. Analgesics and antihistamines should not produce an undesirable effect, and Tylenol and over-the-counter cold medications do not have undesirable effects.
The nurse is caring for clients on the pulmonary unit. Which client should not receive epinephrine if ordered?
The client with atrial fibrillation with a rate of 100 Rationale:The side effects of epinephrine include tachycardia, dysrhythmias, and palpitations. This client should not receive epinephrine.
An older adult client has been diagnosed with hypertension. A diuretic has been prescribed. Which assessment finding will most concern the nurse?
The client's heart rate is irregular. Rationale:Diuretics are frequently prescribed for the older adult. They can cause electrolyte imbalances and must be prescribed in smaller doses. An irregular heart rate could be a sign of potassium imbalance.
The nurse is administering medications to a client with chronic renal failure. What is a priority action of the nurse?
The kidneys are responsible for the majority of drug excretion. With excretion impaired, the medication can remain in the system longer and there is more chance for toxicity to develop.
An older adult client has been having difficulty sleeping. If medications are ordered, what is a primary principle that guides the care of the client?
The older adult client should be prescribed a drug with a short half-life. rationale: The older adult client may have difficulty with elimination of drugs, so a drug with a short half-life is preferable. If used correctly, sedative hypnotics are safe for the older adult. There is no benefit to giving two different sedatives to a client. Alternative therapies and herbal remedies may be tried; however, there is no indication they are better than traditional therapies.
What is the most important thing for the nurse to teach a client who is switching allergy medications from diphenhydramine (Benadryl) to loratadine (Claritin)?
This medication has fewer sedative effects. Rationale: Loratadine (Claritin) does not affect the central nervous system and therefore is nonsedating.
A client is admitted with multiple bruises over the arms and legs. What is the nurse's first action?
To ask the client for a list of medications and herbal supplements Rationale:The nurse should first assess before acting. Medications as well as supplements can cause a client to be susceptible to bruising.
A client is admitted for elective surgery. The client declares a belief in herbs and natural remedies. What is the nurse's priority action?
To determine what herbs the client takes on a regular basis Rationale: The nurse should first determine what herbs the client takes on a regular basis. It could be that the herbs will not interfere with the client's surgery and medications. Once the nurse determines what herbs the client takes, then the nurse should ask about the last time the client took the herbs.
A physician has ordered a new medication for a client and states, "The client must take this medication or she will not recover. If she knows about the side effects, she probably will not want to take it." When attempting to administer the medication, the client states "This pill is new. I don't want to take it. What does it do?" What is the nurse's best response?
To refuse to give the medication unless the client is taught about the medication and its side effects rationale:The nurse's code of ethics requires that the nurse respect the rights, dignity, and wishes of clients. It is the nurse's legal responsibility as well as ethical responsibility to make sure the client understands the treatment. The nurse is responsible for teaching the client about medications. Providing limited information or asking the client to take a medication without knowledge is not ethical.
Which action is the nurse's ethical responsibility?
To transfer care of a client to another professional nurse if caring for the client would violate personal ethical principles Rationale: If providing required care to a certain type of client would violate the nurse's personal ethics, then it is the nurse's responsibility to transfer care of that client to another professional nurse rather than not perform necessary care, which would be a form of abandonment. Beneficence is the duty to do good, not the duty to do no harm. Withholding information from a client is not only unethical but also illegal.
The client is prescribed bethanechol. What assessment will assist the nurse in determining if the medication was therapeutic?
Urinary assessment rationale:This medication increases the tone of the detrusor urinae muscle and causes the client to void.
The client is receiving dopamine at 2 mcg/kg/min. The nurse should monitor for what effect at this dose?
Urinary output increased to 40 mL/hr
The nurse assesses a client receiving an adrenergic (sympathomimetic) agent. Which finding will most concern the nurse?
Weak peripheral pulses, decreased heart rate Rationale: Adrenergic agents stimulate the sympathetic nervous system, which increases heart rate (positive chronotropic effect), contractility (positive inotropic effect), and conductivity (positive dromotropic effect). The nurse would be most concerned that the pulses remain weak and heart rate decreased after receiving this drug, as the therapeutic effect is not being achieved.
A nurse is administering two highly protein-bound drugs. Which is the safest course of action for the nurse to take?
When administering two drugs that are protein-bound, one of the drugs will have fewer sites to which to bind and thus more drug available for activity, thereby increasing the risk of toxicity. Food or water will not change the outcome of administration. Hepatic function is a concern at this time.
The nurse is caring for a client who is prescribed propranolol (Inderal). Which assessment finding assists the nurse in determining whether the medication is having a therapeutic effect?
he client's blood pressure is 130/75 mm Hg. Rationale: Propranolol (Inderal) is nonselective—it blocks both beta1 and beta2 receptors at therapeutic doses. The medication is administered to treat hypertension. The client's blood pressure is within normal limits, which indicates therapeutic effect.
