nclex UW prep

the time it takes for the drug to be reduced to half of its original concentration

half-life

When the skin on the lower legs becomes thin, shiny, and taut; hairloss to lower legs.

circulation to the extremities is impaired ; This happens over a period of time.

dull chest pain with radiation down the left arm.

classic heart attack symptoms of

Copious, bile-colored (greenish-brown) drainage is expected in a client with a

small bowel obstruction.

Can epipen be given through cloths

yes

What medications are commonly associated with constipation, urinary retention, flushing, dry mouth, and heat intolerance.

Anticholinergic medications

a tricyclic antidepressant used to treat depression and neuropathic pain; its anticholinergic properties may cause dry mouth, constipation, blurred vision, and dysrhythmias RN will caution in elderly Pt.

Amitriptyline (Elavil)

Immunosuppressed individuals such as those taking corticosteroid medications, clients undergoing chemotherapy or radiation, or clients with immune deficiency states (eg, AIDS) + Clients receiving prolonged or high-dose antibiotic treatment are at increased risk as the normal microbial flora of the mouth is reduced, allowing other opportunistic infections to arise. Individuals with dentures and infants also commonly experience

Oropharyngeal candidiasis, or thrush (moniliasis)

common expected side effect after use of a short-acting beta-agonist metered-dose inhaler.

Palpitations

The best treatment is vagal maneuvers (1st) and then adenosine IV push for

SVT

doxycycline, isotretinoin, and ACE inhibitors.

absolutely contraindicated in pregnancy

A normal hemoglobin level adult women

11.7-15.5 g/dL

normal range for hemoglobin in a 1-month-old is

12.5-20.5 g/dL

Methotrexate (Rheumatrex) Adverse

bone marrow suppression, hepatotoxicity, and gastrointestinal irritation (eg, nausea, vomiting, diarrhea)

What size IV catheter size is best for children and some older adults with small, fragile veins

24-gauge catheter

General guidelines are to hold digoxin in young children

<70/min in older children

The onset of regular insulin is

30 minutes-1 hour with duration of 5-8 hours.

which ethnic group to be at highest risk for this side effect have a high risk (15%-50%) for ACE inhibitor-related cough

Asians, especially those of Chinese descent,

A PaCO2 of 52 mm Hg (6.9 kPa), although elevated from the normal range of 35-45 mm Hg (4.7-6.0 kPa), is not extreme for this pt. with

COPD

Venous thromboembolism includes both

DVT and pulmonary embolism (PE)

pulmonary congestion S/S

Dyspnea tachypnea othrapnea

Teach pt to take K+ with

FULL GLASS OF H20 and sit up

is a proton pump inhibitor used to treat ulcer disease, erosive esophagitis, and gastroesophageal reflux disease.

Lansoprazole (Prevacid)

When descending stairs with a cane ( after hip replacement), the client should:

Lead with the cane Bring the weaker leg down next (in this client, it is the right leg) Finally, step down with the stronger leg

Pt with hypothyroidism should be take _____________ empty stomach, preferably in the morning, separately from other medications.

Levothyroxine

What med treats Trichomonas infection

Metronidazole (Flagyl) is an antibiotic

Why do pt. with a-fib recieve Calcium channel Blockers, Dig, Beta Blocker?

To slow down the heart rate

What is the is the priority in clients with atrial fibrillation

Ventricular rate control diltiazem beta blockers digoxin

Digoxin (Lanoxin) action

a cardiac glycoside that increases cardiac contractility but slows the heart rate and conduction.

Pt. with polycythemia must stay

hydrated.

Tuberculosis is an infection caused by the

the Mycobacterium tuberculosis microorganism

why do we give dig to adults

a-fib / CHF

pyelonephritis

bacteria may continue to ascend the urinary tract to the ureters and kidneys, causing inflammation and infection in the kidneys

Infants with cyanotic cardiac defects can develop polycythemia as a

compensatory mechanism due to prolonged tissue hypoxia

normal CVP is

2-8 mm Hg

Oseltamivir is an appropriate antiviral medication that is most beneficial if given within

48-72 hours after symptom onset

hyperpigmented skin, low blood pressure, weight loss, and muscle weakness ARE S/S OF:

Addison's disease (chronic adrenal insufficiency)

is an antimicrobial medication used to treat IBD and does not convert LTBI to active disease.

Metronidazole (Flagyl)

The rubbing together of the inflamed pericardial layers causes the characteristic high-pitched, leathery, and scratchy sound in what?

Pericardial friction rub is an expected finding with acute pericarditis.

Positive sputum cultures, chest x-rays, and the presence of symptoms confirm that the client has active disease

TB

True or False In congestive heart failure, large changes in clients established dietary habits are necessary to avoid the repeated hospitalizations caused by salt overload

TRUE

QRS complexes are wider than 0.12 seconds

Ventricular tachycardia (VT)

could likely wait 1-2 hours without loss of life or limb.

Yellow

IE causes the formation of vegetations on valve and endocardial surfaces. Embolization to various organ sites can occur. The onset of hemiplegia or painful, pale, cold foot/leg could indicate embolization

and should be reported to the HCP immediately.

A too rapid infusion of potassium chloride can lead to

pain and irritation of the vein and postinfusion phlebitis. Contacting the health care provider to verify this prescription is the priority action not in the normal perimeters

a vasopressor used to treat symptomatic hypotension.

Dopamine

What is the primary form of treatment for individuals with hyperthyroidism

radioactive iodine (RAI)

maximum rate through a central vein /peripheral line is

40 mEq/hr.

What Will RN doc: high-pitched, scratchy sound during S1 or S2 at the apex of the heard heard with the pt. sitting and leaning forward and at the end of expiration.

A pericardial friction rub It occurs when inflamed surfaces of the heart rub against each other

The nurse knows that after a MI

Dysrhythmias are a common complication after an MI.

Triage has the highest priority, indicating a life-threatening injury that a client will survive if treated in the next hour, usually with significant impairment to airway, breathing, or circulation.

Red

What and Why is the universally recommended for the administration of IM injections

The Z-track technique prevents tracking (leakage) of the medication into the subcutaneous tissue

what is the difference in leads between & acute myocardial infarction,

acute pericarditis, ST-segment elevation is seen in almost all leads (as the entire pericardium is inflamed). This is in contrast to acute myocardial infarction, in which ST-segment elevation is seen in localized leads (depending on which vessel is occluded)

Dabigatran . A study sponsored by the manufacturer found that idarucizumab effectively reversed anticoagulation by dabigatran within minutes.[2] It is in the class of a direct thrombin inhibitor. It was developed by the pharmaceutical company Boehringer Ingelheim. Contents [hide] 1 Medical uses 2 Contraindications 3 Adverse effects 4 Pharmacokinetics 5 History 6 Research 7 References 8 External links Medical uses[edit] Dabigatran is used to prevent strokes in those with atrial fibrillation not caused by heart valve issues, as well as deep vein thrombosis and pulmonary embolism in persons who have been treated for 5-10 days with parenteral anticoagulant (usually low molecular weight heparin), and to prevent deep vein thrombosis and pulmonary embolism in some circumstances.[3] It appears to be as effective as warfarin in preventing nonhemorrhagic strokes and embolic events in those with atrial fibrillation not due to valve problems.[4] Contraindications[edit] Dabigatran is contraindicated in patients who have active pathological bleeding, since dabigatran can increase bleeding risk and can also cause serious and potentially life-threatening bleeds.[5] Dabigatran is also contraindicated in patients who have a history of serious hypersensitivity reaction to dabigatran (e.g. anaphylaxis or anaphylactic shock).[5] The use of dabigatran should also be avoided in patients with mechanical prosthetic heart valves due to the increased risk of thromboembolic events (e.g. valve thrombosis, stroke, and myocardial infarction) and major bleeding associated with dabigatran in this population.[5][6][7] Adverse effects[edit] The most commonly reported side effect of dabigatran is gastrointestinal upset. When compared to people anticoagulated with warfarin, patients taking dabigatran had fewer life-threatening bleeds, fewer minor and major bleeds, including intracranial bleeds, but the rate of gastrointestinal bleeding was significantly higher. Dabigatran capsules contain tartaric acid, which lowers the gastric pH and is required for adequate absorption. The lower pH has previously been associated with dyspepsia; some hypothesize that this plays a role in the increased risk of gastrointestinal bleeding.[8] A small but significantly increased risk of myocardial infarctions (heart attacks) has been noted when combining the safety outcome data from multiple trials.[9] Reduced doses should be used in those with poor kidney function.[10] Pharmacokinetics[edit] Dabigatran has a half-life of approximately 12-14 h and exerts a maximum anticoagulation effect within 2-3 h after ingestion.[11] Fatty foods delay the absorption of dabigatran, although the bio-availability of the drug is unaffected.[1] One study showed that absorption may be moderately decreased if taken with a proton pump inhibitor.[12] Drug excretion through P-glycoprotein pumps is slowed in patients taking strong p-glycoprotein pump inhibitors such as quinidine, verapamil, and amiodarone, thus raising plasma levels of dabigatran.[13] History[edit]

anticoagulant medication taken by mouth (some cases is an alternative to warfarin, since it does not have to be monitored by blood tests, but offers similar results in terms of efficacy.)

The ventricular response (pulse rate) can vary. The higher the ventricular rate, the more likely the client will have .

decreased cardiac output (ie, hypotension)

Beneficence is the ethical principle of

doing good. It involves helping to meet the client's (including the family) emotional needs through understanding. This can involve withholding information at times.

barium contrast solution T pt.

encourage fluids, if appropriate, to assist in expulsion of the contrast medium.

Complications from the flu include secondary bacterial infections, particularly

pneumonia

Priapism The nurse should return this call first as the condition is a

prolonged, painful erection (>2 hours) caused by trapping of blood in the penile vasculature that can lead to erectile tissue hypoxia and necrosis.

Teach pt with the flu to

rest, adequate hydration, humidified air, and antipyretics and analgesics. Antiviral medications such as zanamivir (Relenza) and oseltamivir (Tamiflu) are given to clients who are within 48-72 hours of the onset of symptoms. These medications can shorten the duration of the illness by a few days.

When administering furosemide, it is important to closely monitor

the client's vital signs, serum electrolytes (potassium), and kidney function tests (blood urea nitrogen, creatinine) prior to administration to prevent side effects such as hypokalemia, hypotension, and kidney injury.

A client with active, primary TB disease has a positive

tuberculin skin test (TST), usually feels sick, has symptoms, and can spread the disease to others if not treated with medications.

The client with symptomatic bradycardia should be treated initially.

with IV atropine

magnesium level

1.5-2.5

Why do pt with A-fib Anticoagulants (eg, rivaroxaban [Xarelto], dabigatran [Pradaxa], apixaban [Eliquis], and warfarin ?

To decrease the chances of clots PE atrial thrombus and embolic complications

The nurse needs to educate the client with a venous leg ulcer that wearing some kind of compression stockings is

essential for healing and prevention of ulcer recurrence

Clients in ventricular tachycardia (VT) can be

pulseless or have a pulse

___________________ is a high-alert medication that requires an additional double check on all boluses and when a new bag is hung or the rate is changed.

Heparin

Anaphylaxis causes increased capillary permeability, leaking intravascular fluid into free spaces; this places the client at risk for hypotension. TX?

Isotonic IV solutions (eg, 0.9% sodium chloride, lactated Ringer's)

"atypical" symptoms such as nausea, vomiting, belching, indigestion, diaphoresis, dizziness, and fatigue.

MI

client with a long history of type 2 diabetes mellitus for sudden, severe nausea, diaphoresis, dizziness, and fatigue in the emergency department ' What will RN suspect?

MI = Pt c chronic disease might not have the classic s/s

potentially life-threatening complication after an ERCP. Signs and symptoms include (Option 3).

Perforation or irritation of these areas during the procedure can cause acute pancreatitis S/S acute epigastric or left upper quadrant pain, often radiating to the back, and a rapid rise in pancreatic enzymes (eg, amylase, lipase)

a polymorphic ventricular tachycardia characterized by QRS complexes that change size and shape in a characteristic twisting pattern.

Torsades de pointes

Hypomagnesemia (normal: 1.5-2.5 mEq/L [0.75-1.25 mmol/L]) causes a prolonged QT interval that increases the client's susceptibility to ventricular tachycardia. The RN recoginzes this as?

Torsades de pointes is a type of polymorphic ventricular tachycardia coupled with a prolonged QT interval;.

Double- and extra-strength drugs such as sulfamethoxazole and acetaminophen may be

crushed and administered separately through an NG tube as long as they are not enteric-coated. The nurse should flush the tube with water before and after each drug administration.

Where is the preferred areas for IM injection

ventrogluteal site in adults vastus lateralis site in children.

Stomatitis (inflammation of the mouth, oral ulcers) is a common side effect associated with methotrexate.

with folic acid supplementation. Although the condition is uncomfortable, it would not require immediate intervention and is not the most important finding to report.

Jugular venous distension should be assessed

with the client in semi-Fowler's position (ie, head of the bed elevated at a 30- to 45-degree angle).

Early-morning low back stiffness is seen

ankylosing spondylitis

heart rate >90 beats/min, temperature >100.9 F (38.3 C), systolic blood pressure <90 mm Hg, altered mental status, hyperglycemia (>140 mg/dL [7.8 mmol/L]) in the absence of diabetes absent bowel sounds Rn KNOWS these are:

Manifestations characteristic of sepsis

which classically has moving, "ripping" back pain, is a medical emergency. Hypertension is the most important contributing factor!

An aortic dissection, EMERGENT!!!

A client develops sinus bradycardia with blood pressure of 90/40 mm Hg and a heart rate of 46/min. Which of the following actions should the nurse take

The client with symptomatic bradycardia should be treated initially with IV atropine. Transcutaneous pacing or infusion of dopamine or epinephrine may be considered if atropine is ineffective

Sjögren's syndrome is an autoimmune condition.

It causes inflammation of the exocrine glands (eg, lacrimal, salivary), resulting in decreased production of tears and saliva and leading to dry eyes (xerophthalmia) and dry mouth (xerostomia).

normal amylase

0-130

****The goal during anticoagulation therapy is a PTT

1.5-2 times the normal reference range of 25-35 seconds which is 37-70!!!!!

minimum of how many days before the administration of MAOIs and SSRIs

14 days ; to avoid serotonin syndrome; these medications cannot be administered concurrently

When auscultating for a murmur associated with mitral valve stenosis, the nurse should place the stethoscope at the

5th intercostal space, midclavicular line.

indicates that the victim is unlikely to survive transport to definitive clinical care due to either the severity of trauma, insufficient transportation resources, level of available care, etc.

Black

Block Time Remaining: 00:00:13 TUTOR Test Id: 80941960 QId: 31830 (921666) 3 of 53 A A A A client in the intensive care unit is receiving IV vancomycin and gentamicin. The nurse should monitor for which potential complication with the administration of these medications? 1. Blood in nasogastric tube drainage [1%] 2. Decrease in red blood cell (RBC) count [5%] 3. Increase in serum creatinine level [71%] 4. Onset of muscle aches and cramping [21%] Omitted Correct answer 3 Answered correctly 71% Time: 5 seconds Updated: 04/17/2017 Explanation: Vancomycin and aminoglycosides (eg, gentamicin, amikacin, tobramycin) are strong antibiotics that can cause nephrotoxicity and ototoxicity. The client receiving these medications simultaneously would be at an even higher risk for these adverse reactions. The nurse should monitor the client's renal function by assessing blood urea nitrogen (BUN) and creatinine levels and measuring urinary output. Increased levels of BUN and creatinine may indicate kidney damage. The health care provider should be notified before continuing these medications. (Option 1) Blood in the nasogastric tube could be a complication of peptic ulcer disease and the use of nonsteroidal anti-inflammatory drugs and corticosteroids. (Option 2) A decrease in the RBC count may be evidence of bone marrow suppression that can occur with use of certain cancer drugs (eg, methotrexate). (Option 4) Muscle cramping can occur occasionally with use of gentamicin but is not an indication to stop the infusion. Muscle aching and cramping that may signify a complication occur with the use of statins (eg, atorvastatin, rosuvastatin) and fibrates (eg, gemfibrozil, fenofibrate). Educational objective: The nurse should recognize that the risk of nephrotoxicity and ototoxicity is potentiated when vancomycin and aminoglycosides (eg, gentamicin) are administered together. Kidney and hearing functions should be closely monitored in these clients.

Block Time Remaining: 00:00:14 TUTOR Test Id: 80941960 QId: 33899 (921666) 4 of 53 A A A The nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers. Which statement by the client would prompt further instruction? 1. "I can take this medication with food if it hurts my stomach." [7%] 2. "I must use a reliable form of birth control while taking this medication." [10%] 3. "I should continue to take my ibuprofen as prescribed." [44%] 4. "I will take this medicine with an antacid to decrease stomach upset." [37%] Omitted Correct answer 4 Answered correctly 37% Time: 1 seconds Updated: 05/15/2017 Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration. It is often prescribed to prevent gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug (NSAID) therapy. Antacids, especially those that contain magnesium (eg, Gaviscon), can increase the adverse effects of misoprostol (eg, diarrhea, dehydration). If clients require therapy with antacids, they should choose one that does not contain magnesium (eg, calcium carbonate [Tums]) and contact the health care provider if adverse effects occur (Option 4). (Option 1) Taking misoprostol with food can help decrease gastrointestinal side effects (eg, abdominal pain, cramping, diarrhea). (Option 2) Misoprostol is also used for labor induction and is classified as a pregnancy category X drug. Women of childbearing age must be educated on using reliable birth control and the possible sensation of uterine cramping while taking misoprostol. Clients who suspect they are pregnant must stop taking the medication and contact their health care provider immediately. (Option 3) The client can continue taking ibuprofen (an NSAID) with misoprostol because misoprostol is designed to reduce side effects of ibuprofen. Educational objective: Misoprostol prevents gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug therapy. It should not be taken with antacids but can be taken with food to reduce gastrointestinal upset. Women of childbearing age should be educated on using reliable birth control methods as misoprostol can induce labor.

Sjögren's syndrome is an autoimmune condition that can cause dry eyes and mouth

Clients are instructed to use artificial tears and saliva.

Discharge teaching for the client with a permanent pacemaker should include the following

Clients with a pacemaker should --avoid heavy lifting --above-the-shoulder exercises until the HCP approves --They should carry a pacemaker ID card, wear a medic alert bracelet, --avoid MRI scans, never place a cell phone over the pacemaker, and inform airline security personnel -Report fever or any signs of redness, swelling, or drainage at the incision site --Avoid standing near antitheft detectors in store entryways. Walk through at a normal pace and do not linger near the device.

cardiac catheterization uses iodinated contrast to assess for artery obstruction.

Complications include allergic reactions, lactic acidosis, and kidney injury. Contrast should be avoided in clients who have allergies to iodine or shellfish, have taken metformin within 24 hours of the procedure, or have kidney disease.

expected manifestations of PAD

Coolness of the skin and shiny, hairless legs, feet, and toes

used for heart rate control in tachyarrhythmias.

Metoprolol is a beta blocker

signs of deficient fluid volume or dehydration

Dry mucous membranes and hypotension

TRUE OR FALSE African Americans have a higher incidence of osteoporosis

FALSE White and Asian women higher incidence of osteoporosis BUT disease affects all ethnic groups

Can a clean catch urine specimen be delegated to a UAP

Yes

What is a fail chest?

a scenario where multiple ribs sustain multiple fractures and become independent of the chest wall, floating on top of the lung and pleura. The fractured segment moves paradoxically in relationship to the intact chest wall, pushing outward with expiration and inward with inspiration. In addition to being extremely painful, impaired respiration can occur and rib fragments may puncture the pleura or vessels, causing hemothorax and/or pneumothorax at any time.

Propranolol is a nonselective beta-blocker caution in pt with

any history of asthma or respiratory problems

Venous ulcers appear

as edematous, large, superficial wounds with large amounts of exudate. They are commonly found on the medial side of the ankles.

warfarin (Coumadin) is monitored

by the INR. The therapeutic range of INR is 2-3

IV bumetanide (Bumex) or furosemide (Lasix) to promote

diuresis and mobilize excess fluid in the systemic circulation and lungs.

Lorazepam (Ativan) is a benzodiazepine with a long half-life (10-17 hours). Side effects include

drowsiness, dizziness, ataxia, and confusion caution in elderly or pt. decrease excretion function.

The mitral area is located at the

fifth intercostal space, medial to the mid-clavicular line.

Pericardial effusion is a buildup of

fluid in the pericardium

Clubbing is another manifestation of prolonged

hypoxia.

Peripheral artery disease increases the risk of tissue necrosis and limb loss. Management focuses on

improving blood flow and circulation to the extremities through lifestyle changes and medications.

The nurse should ask about a streptococcal throat infection when collecting health history information

in a client suspected of having RF.

Chest pain in an adult, regardless of age,

is a priority

The Trendelenburg position, not the position, is used with clients with hypotension.

reverse Trendelenburg

After a MI Occasional PVCs are not significant, but the nurse should further assess

the client's potassium level and assess the apical-radial pulse for the presence of a pulse deficit.

When speaking with AD clients,

use clear and simple explanations. .

The nurse should teach the client to take potassium tablets

with plenty of water (≥4 oz [120 mL]) and to sit upright after ingestion to prevent pill-induced esophagitis. Potassium should be taken during or immediately following meals to prevent gastric upset. Sustained-release tablets should not be crushed.

PHARM SECTION~~~~~~~~~~~~~~~~~~~~~~~~~~``

PHARM~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~`

rapid-acting insulins (lispro, aspart, glulisine) are typically used with a sliding scale for tighter control of blood glucose throughout the day.

Regular insulin = also the ONLY insulin goes in IV Humlin R Novlin R

Why should nurse anticipate the health care provider transferring to the intensive care unit? 82-year-old with pressure (decubitus) ulcer who has a change in mental status, temperature of 96.4 F (35.8 C), pulse of 110/min, and blood pressure of 96/72 mm Hg [69%]

Sepsis is a potentially life-threatening condition. Physiologic changes related to the aging process, including decreased immune function and inflammatory response (immunosenescence) and altered febrile response to pyrogens, increase the risk for sepsis.

There is a high incidence of IV iron causing hypersensitivity reactions, including anaphylaxis.

Therefore, a test dose needs to be given first. =pt. considered unstable

The nurse should immediately report chest tube drainage >3 mL/kg/hr over 3 consecutive hours or 5-10 mL/kg over 1 hour.

This could indicate postoperative hemorrhage. Cardiac tamponade can occur rapidly in children and can be life-threatening.

Herbal therapy is usually stopped - any surgery.

2-3 weeks before

Where will rn listen to murmur

Erb's point is located at the third left intercostal space (ICS) near the sternum and is an appropriate location to auscultate heart sounds for murmurs.

what is is an important treatment in early acetylsalicylic acid (ASA) toxicity

FIRST: activated charcoal 2ND: IV sodium bicarbonate is an appropriate treatment for aspirin toxicity

is considered walking wounded and clients may wait hours for treatment.

Green

During a weather-related emergency, home care visits are classified as: .

High priority - unstable clients who need care and are at risk for hospitalization if not seen. Moderate priority - clients who are moderately stable and will suffer no harm if a visit is postponed; telephonic care management can be provided to these clients. Low priority - clients who are stable and can engage in self-care and/or have a caregiver who can provide or assist with care.

Dabigatran antidote,

In case of major bleeding = idarucizumab

Intermittent claudication is leg pain caused by decreased blood flow to the muscles that reoccurs during activity such as walking and dissipates with rest. expected

Intermittent claudication

Expected Pt c KD: TEACH PARENTS?

Irritability is a hallmark finding in a child with KD, especially during the acute phase (due to fever and inflammation). Parents should be advised that irritability can last up to 2 months. Temporary joint pain arthritis (eg, stiffness, decreased range of motion) may occur and persist for several weeks. Parents should be informed that range of motion exercises and warm baths will help reduce these symptoms and minimize discomfort. (Option 4) Desquamation (skin peeling) of the hands and feet is an expected finding in KD. Parents should be informed that the peeling itself is not painful but that the new skin underneath may be red and sore.

why is Digoxin (Lanoxin) prescibed?

It is used in heart failure (to increase cardiac output) and atrial fibrillation (to reduce the heart rate).

Pt on cyclobenaprine Rn will monitor

Liver Function In the presence of hepatic impairment (eg, hepatitis), drug metabolism is reduced and results in the accumulation of medication in the body, which leads to toxicity increased CNS depression (eg, weakness, confusion, drowsiness, lethargy)and serious adverse effects.

Which insulin is an intermediate-acting insulin with a duration of 12-18 hours; it is generally prescribed 2 times daily (morning and evening). These are generally taken before meals and at bedtime. Educational objective: NPH is an intermediate-acting insulin with a duration of 12-18 hours and typically prescribed twice a day.

NPH HumliN NovliN

How will RN assess for Electrical capture is verified by a

P wave following an atrial pacemaker spike and/or a widened QRS complex following a ventricular pacemaker spike

Clinical signs of fluid volume overload include the following:

Peripheral edema Increased urine output that is dilute Acute, rapid weight gain Jugular venous distension S3 heart sound in adults Tachypnea, dyspnea, crackles in lungs Bounding peripheral pulses

Kawasaki disease Treatment: parents should be cautioned about the risk of

Reye syndrome cardiopulmonary resuscitation should also be taught to parents of children with coronary artery aneurysms.

is caused by collagen overproduction; it is a lifelong disease without a cure. Treatment is aimed at controlling symptoms and preventing further complications. Renal crisis is life-threatening and should be recognized and treated immediately.

Scleroderma

abnormally high levels of nitrogen-containing compounds

azotemia

In addition to obtaining blood cultures x 2, it is standard procedure to cut off the tip of the discontinued CVC and send it to the lab to

ensure it is the source of the septicemia

Pt. on anticoagulant and has a nerurological acciednt Is HIGH RISK

for HEMORRHAGE Emergency!

In PSVT, the heart rate can be 150-220/min. With prolonged episodes, the client may experience evidence of reduced cardiac output such as

hypotension, palpitations, dyspnea, and angina

Influenza is transmitted by

inhaling droplets that an infected individual exhales into the air when sneezing, coughing, or speaking

what is an arterial bruit?

turbulent blood flow sound heard

UAP =

unlicensed assistive personnel.

implantable cardioverter defibrillator

(ICD)

Treatment is anti fungal medications

(eg, nystatin) and proper oral hygiene.

Suction PRESSURE FOR airway suctioning technique

100-120 mm Hg ADULTS 50-75 mm Hg for children as excess pressure will traumatize the mucosa and can cause hypoxia.

infants age 1-12 months, the normal heart rate is

100-160/min

An MAOI should be withdrawn at least

14 days before starting an SSRI.

levetiracetam has a depressing effect on the central nervous system (CNS), which may cause drowsiness, somnolence, and fatigue as clients adjust to the medication. Clients should be assured that this is common and typically improves within 4-6 weeks

4-6 weeks

A tumor usually grows more slowly than a possible hematoma therefore the priority assessment is

Hematoma

The most reliable indicator for the client's pain is the client's

The most reliable indicator for the client's pain is the client's self-report of symptoms.

later signs of dig toxicity are

arrhythmias, including heart blocks. Therefore, clients at risk for digoxin toxicity require frequent drug level monitoring and dose adjustment.

An immunocompromised client should not

be assigned to a room with a client who is contagious or potentially infected as there is an increased risk for infection.

A-Fib Meds TX:

diltiazem (a calcium channel blocker) is the priority as its purpose is to decrease the ventricular response rate to <100/min. Other medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rate.

Clients with severe aortic stenosis are at risk

for developing syncope and sudden death with exertion. The left ventricle cannot push enough blood into the aorta to meet the body's demands due to the valve stenosis.

Polycythemia will increase blood viscosity, placing an infant at risk

for stroke or thromboembolism

Multiply diastolic blood pressure (DBP) by 2, add systolic blood pressure (SBP), and divide the result by 3; [(DBP x 2) + (SBP)]/3

formula for calculating mean arterial pressure

pt. with acute pericarditis have chest pain that is worse with inspiration/coughing TEACH: expected finding

improves with leaning forward= pt.OK.

complication of thoracentesis days later ?

infection

Clients with sickle cell crisis often have excruciating pain and need large doses of narcotics. The most effective method

is PCA of morphine or hydromorphone (Dilaudid).

Sjögren's syndrome (SjS, SS) is a

long-term autoimmune disease in which the moisture-producing glands of the body are affected.[4] This results primarily in the development of a dry mouth and dry eyes

thyroxine (Synthroid) in pregnancy should be

monitored carefully to provide an appropriate dose for the physiological changes of maternity, but it is not teratogenic

Nasoenteric tubes can become dislodged, causing the tube to enter the stomach or lungs. Feedings should be stopped immediately and tube placement checked if the client develop

signs of aspiration.

Clinical manifestations characteristic of a lower-extremity DVT include

unilateral edema, calf pain or tenderness to touch, warmth and erythema, and low-grade temperature.

a potentially life-threatening complication, can occur following an endoscopic retrograde cholangiopancreatography. Manifestations include acute abdominal pain, often radiating to the back, and a rise in pancreatic enzymes (eg, amylase, lipase).

Acute pancreatitis,

commonly presents with neurologic manifestations such as gait disturbance, slurred speech, and nystagmus. These are expected symptoms of

Phenytoin toxicity

congenital heart defects (eg, cyanotic defects) impede pulmonary blood flow (eg, tetralogy of Fallot, transposition of the great vessels) and cause cyanosis, which is evident shortly after birth and during periods of physical exertion.

Right-to-left

client at risk for embolic stroke due to thrombi formed in the atria from stasis of blood B/C

client at risk for embolic stroke due to thrombi formed in the atria from stasis of blood

Acute-onset dyspnea and cough with frothy, pink-tinged sputum indicate pulmonary edema. Auscultation reveals

crackles at the lung bases.

Hydrochlorothiazide is a weak

diuretic and is commonly used to treat hypertension.

Large pericardial effusion with resultant cardiac tamponade and is

evidenced by jugular venous distension, hypotension, and muffled heart sound

A normal MAP is 70-105 mm Hg. A MAP <60 mm Hg will not allow

for adequate perfusion of vital organs.

Inducing therapeutic hypothermia

indicated in all clients who are comatose or do not follow commands after resuscitation.

Scleroderma is a

long term autoimmune disease that results in hardening of the skin. In the more severe form, it also affects internal organs

Arterial ulcers form at the

most distal ends of the body, where circulation is poorest (eg, tips of the toes). They are usually small, circular, deep ulcers with little exudate. This appearance differentiates arterial ulcers from venous ulcers.

DVT is the most common form and occurs most often (80%) in the

proximal deep veins (iliac, femoral) of the lower extremities

What type of solution would be infused in clients severe hyponatremia and neurologic manifestation

rapid correction of hyponatremia with hypertonic saline (3% saline).

Clients should not drive when taking

sedating medications eg, antihistamines, benzodiazepine.

Suicidal thoughts are commonly associated with

selective serotonin reuptake inhibitors (antidepressants) and varenicline (Chantix), a smoking cessation medication.

in a client who is experiencing an anaphylactic reaction to an IV medication, it is imperative to first i

stop the infusion; ensure airway patency and administer oxygen; give epinephrine and initiate IV fluids; administer adjunctive therapies (antihistamines, bronchodilators, corticosteroids)

Black cohosh main side effects are

thickening of the uterine lining and potential liver toxicity.

MED: hypokalemia can increase the risk of digoxin

toxicity

A client with a LATENT TB infection (LTBI) has a positive TST, negative chest x-ray, is asymptomatic, CANNOT

transmit the disease to others, and can complete a full course of treatment to prevent activation of the disease.

the brachial artery is used to detect a pulse in an

unresponsive client age <1 year.

In disaster/MCI triage, the sickest go first, not

women and children.

The nurse should use the ___________________________ to avoid movement of an unstable spine.

jaw-thrust maneuver

Thickening of the skin

scleroderma

polycythemia

(elevated hemoglobin levels)

Client teaching for MVP includes the following:

-Adopt healthy eating habits and avoid caffeine as it is a stimulant and may exacerbate symptoms -Check ingredients of over-the-counter medications or diet pills for stimulants such as caffeine or ephedrine as they can exacerbate symptoms -Reduce stress and avoid alcohol use -begin or maintain an exercise program, preferably aerobic exercise

lipase

0-160

WHEN any diuretic is being prescribed RN KNOWS to review pt._________________________ before administration on meds

BP K+

Block Time Remaining: 00:00:07 TUTOR Test Id: 80941960 QId: 31324 (921666) 1 of 53 A A A The nurse is preparing to administer IV cefazolin to a client who is newly admitted with cellulitis. The client's allergies include amoxicillin, ciprofloxacin, and sulfa drugs. What should the nurse do first? 1. Administer the medication as ordered [10%] 2. Clarify the order with the health care provider (HCP) [48%] 3. Get more information from the client about the client's allergies [31%] 4. Notify the pharmacy that the drug is inappropriate for this client [9%] Omitted Correct answer 3 Answered correctly 31% Time: 7 seconds Updated: 01/08/2017 Explanation: The nurse should find out more about this client's allergies before giving the medication. Specifically, the nurse must learn what type of reaction the client had to amoxicillin, a penicillin antibiotic. With a history of anaphylaxis to penicillin, cephalosporins (eg, cefazolin) are contraindicated. Penicillin-cephalosporin cross-sensitivity occurs due to the structural similarity between the cephalosporin and penicillin molecules. If this client's reaction to amoxicillin was only a rash or other mild reaction that was not life-threatening, the cephalosporin can be safely administered. However, if the client had an anaphylactic reaction to penicillin, the HCP will need to prescribe a different antibiotic. (Option 1) The nurse should hold the medication until more is known about the client's reaction to amoxicillin. (Option 2) The nurse does not have enough information to determine whether the HCP needs to be called. (Option 4) The nurse does not have enough information to determine whether the medication is appropriate. Educational objective: A client with a penicillin allergy may be allergic to cephalosporin antibiotics. Cephalosporins may be safely administered to clients with a history of mild allergic reaction, such as rash, but they are contraindicated in clients with a history of penicillin anaphylaxis. \

Block Time Remaining: 00:00:08 TUTOR Test Id: 80941960 QId: 31336 (921666) 2 of 53 A A A A client has been on long-term therapy with esomeprazole. What is essential for the nurse to ask the client? 1. "Are you drinking plenty of water with the medication?" [21%] 2. "Are you taking the medication after meals?" [21%] 3. "Have you had a bone density test recently?" [45%] 4. "Have you had your blood pressure taken regularly?" [10%] Omitted Correct answer 3 Answered correctly 45% Time: 1 seconds Updated: 01/19/2017 Explanation: Long-term therapy with a proton pump inhibitor (PPI) (eg, omeprazole, pantoprazole, esomeprazole) may decrease the absorption of calcium and promote osteoporosis. A bone density test can assess if the client already has osteoporosis. Hospitalized clients also have an increased risk of diarrhea caused by Clostridium difficile. PPIs cause suppression of acid that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias. (Option 1) Drinking extra water and being upright for 30 minutes after taking bisphosphonates (eg, risedronate, alendronate) is necessary to prevent esophagitis. However, this is not necessary with PPI use. (Option 2) The medication should be taken prior to meals. (Option 4) PPIs do not affect blood pressure. Educational objective: Long-term use of PPIs (eg, omeprazole, pantoprazole, esomeprazole) is associated with osteoporosis, C difficile infection, and pneumonias. Clients should be encouraged to increase calcium and vitamin D intake to help prevent osteoporosis.

Kawasaki disease (KD), are the most serious potential : Echocardiography is used to monitor these cardiovascular complications

Coronary artery aneurysms sequelae in untreated clients, leading to complications such as myocardial infarction and death.

vasospasm-induced color changes in the fingers, toes, ears, and nose. This requires urgent treatment (eg, immersing hands in warm water) but is not life-threatening.

Raynaud phenomenon

ANY Postoperative clients are at an increased risk for vomit aspiration due to nausea and an altered level of consciousness (caused by anesthesia) RN recognizes: ABC

These clients should be placed on their side and should receive antiemetics to prevent potential airway and breathing complications

Clients with Sjögren's syndrome need measures to combat the effects of damaged moisture-producing glands.

These include eye drops, sugar-free candy or artificial saliva, vaginal lubricants, frequent dental examinations, lukewarm showers with mild soap, and avoiding decongestants

What will RN teach about NTG nitroglycerin Storage?

accessible at all times stored away from light and heat sources including body heat keep the tablets in the original container. replaced every 6 months Do not store in car

Collect an early morning sputum sterile specimen on 3 consecutive days for an .

acid-fast bacilli (AFB) smear and culture. Fluids and/or expectorants can be given at bedtime to help liquefy secretions. It is usually easier for clients to produce a specimen upon awakening as secretions collect in the airways during the night

Endoscopic retrograde cholangiopancreatography (ERCP) is a procedure in which

an endoscope is passed through the mouth into the duodenum to assess the pancreatic and biliary ducts. Using fluoroscopy with contrast media, the ducts can be visualized and treatments including removal of obstructions, dilation of strictures, and biopsies can be performed.

Diphenhydramine (Benadryl), IM epinephrine, inhaled beta agonists, and methylprednisolone (Solu-Medrol) are administered to treat the manifestations associated with

anaphylactic shock. They modify the histamine response and treat pruritus, reverse bronchoconstriction, and decrease airway inflammation, respectively. IM epinephrine can be repeated for poor response.

Epoetin (Procrit) is a synthetic hormone that stimulates the production of erythropoietin and is used to treat

anemia associated with chronic kidney disease

In a client with hypomagnesemia, it is important to assess the QT interval. The client is most at risk for torsades de pointes, a serious complication that can develop quickly into ventricular fibrillation (lethal arrhythmia).

assess the QT interval. The client is most at risk for torsades de pointes, a serious complication that can develop quickly into ventricular fibrillation (lethal arrhythmia).

The nurse should have current assessment data and access to the client's recent laboratory data, diagnostic studies, and medication administration record

before calling the HCP.

prepare for a pericardiocentesis

cardiac tamponade

Asystole is characterized by the absence of all ventricular electrical activity. The client is pulseless, apneic, and unresponsive. Treatment includes

cardiopulmonary resuscitation, oxygenated ventilation, and advanced cardiovascular life-support measures (eg, epinephrine IV, advanced airway, treatment of reversible causes).

If no s/s of shock, Extremity injuries can wait hours for the necessary surgery, what will be the RN interventions?

cover the injury with a sterile dressing, immobilize, and provide pain relief (if available). T

Clients who are bedridden, have undergone major surgery (eg, hip or knee replacement), or are taking estrogen-containing contraceptive pills are at high risk of

developing deep venous thrombosis. This condition can result in subsequent embolus and life-threatening pulmonary embolism. When blood flow is blocked to certain parts of the lung, the area can become infarcted, resulting in chest pain, shortness of breath, and cough. These clients require immediate anticoagulation to prevent extension of the blood clot

Triage in a mass casualty incident also known as,

disaster triage, focuses on saving the greatest number of people with the limited resources available.

Solifenacin Common expected adverse effects

dry mouth and constipation dizziness and blurred vision

The complete blood count (CBC) should be assessed periodically with the administration of The nurse would want to assess the hemoglobin, hematocrit, and platelet count levels. If these levels are low, the client will be at risk for increased bleeding.

enoxaparin, anticoagulant.

Psoriasis is a chronic autoimmune condition characterized by

exacerbations of silver plaques on reddened skin. Although there is no cure, management includes topical and systemic medications, phototherapy, and avoidance of triggers.

IN an Obese Pt at risk for CAD:

focus teaching on reducing this client's BMI, This is the only risk factor that is modifiable as the client's other risk factors (ethnicity, gender, strong family history of cardiovascular disease) are non-modifiable. Teaching should focus on changing eating habits, reducing caloric intake to achieve a BMI of 18.5-24.9 kg/m2, increasing physical activity, avoiding consumption of large heavy meals, and abstaining from fad or crash diets. Ingestion of smaller and more frequent meals should be encouraged.

Therapeutic vancomycin levels range

from 10-20 mg/L

Herpes simplex virus type 2

genital herpes Lesions are painful and appear as multiple small, vesicular lesions.

Adenosine is the drug of choice to treat SVT half-life

has a 5- to 6-second

in the event of an air embolus, the TX: this will cause the air to rise to the right atrium. The health care provider should be notified immediately and the nurse should remain with the client

head of the bed should be lowered (Trendelenburg) and the client positioned on the left side;

Why is dig given to kids?

heart failure It is given to increase myocardial contraction, which increases cardiac output and improves circulation and tissue perfusion.

A large anterior wall MI can affect the pumping ability of the left ventricle, putting the client at risk for developing

heart failure and cardiogenic shock

In a child with atrial septal defect, the nurse would expect to hear a

heart murmur on auscultation of heart sounds.

Abdominal paracentesis is used to remove ascitic fluid from the peritoneal cavity in end-stage liver disease (cirrhosis). The client should be positioned in high Fowler's or sat upright to facilitate the flow of fluid to the bottom of the peritoneal cavity, where the needle will be inserted. The client should void prior to the procedure to decrease the risk of bladder puncture

high Fowler's or sat upright to facilitate the flow of fluid to the bottom of the peritoneal cavity, where the needle will be inserted. The client should void prior to the procedure to decrease the risk of bladder puncture

A burn injury causes tissue damage and increased capillary permeability; this leads to fluid and electrolyte losses related to evaporation and intravascular fluid shifts into the interstitial tissue, which result in EXPECTED S/S TX:

hypovolemia, hemoconcentration (eg, hematocrit >53% [0.53]), and hypotension. TX: An isotonic solution (eg, lactated Ringer's) is prescribed to replace fluid and electrolyte losses.

MEDS: The client taking a statin such as atorvastatin or rosuvastatin should be taught to call the HCP

if generalized muscle aches develop as this may be a symptom of myopathy, a serious adverse effect of this type of medication.

insulin glargine should not be mixed

in a single syringe with any other insulin as the mixture may alter the pharmacodynamics of the drug.

Atropine is given to the client with symptomatic bradycardia. The desired outcome would be an

increase in heart rate, evidence of normal sinus rhythm on the cardiac monitor, and reversal of any clinical symptoms associated with the bradycardia.

Constant headache, decreased mental status, and sudden-onset emesis indicate

increased intracranial pressure a life-threatening situation.

The Valsalva maneuver is contraindicated in the client diagnosed with

increased intracranial pressure, stroke, head injury, heart disease, glaucoma, eye surgery, abdominal surgery, and liver cirrhosis.

IV site has redness, edema, discomfort, drainage, hardness, warmth, or coolness. What will RN do?

infiltration occurs, discontinue the IV line immediately and restart it in another site.

IVPB KCL must be given via an

infusion pump

atrial fibrillation (AF) include an

irregularly irregular rhythm and replacement of P waves by fibrillatory waves

Postoperative client care after general anesthesia requires careful monitoring for hypoxia. One of the first nursing interventions

is the head tilt and chin lift to open an occluded airway.

Large amounts of vitamin K-rich foods can decrease the anticoagulant effects of warfarin therapy. Clients are not instructed to remove those foods from their diet but are encouraged to be consistent in the intake of foods high in vitamin K, including

leafy green vegetables, asparagus, broccoli, kale, Brussels sprout, and spinach. Several beverages also affect warfarin therapy. Green tea, grapefruit juice, and cranberry juice may alter its anticoagulant effects.

muscle relaxants are metabolized by the

liver

EXPECTED common side effects within 24 hours after receiving the influenza vaccine

low-grade temperature, myalgia, headache, congestion, pain, redness, and itching at the injection site are

Levetiracetam (Keppra) is an a

nticonvulsant prescribed for seizure disorders

The influenza virus has an incubation period

of 1-4 days, with peak transmission starting at about 1 day before symptoms appear and lasting up to 5-7 days after the illness stage begins

Unfractionated heparin is one such agent, and its efficacy is measured through

partial thromboplastin time (PTT) levels.

Where would you hear An arterial bruit is a turbulent blood flow sound heard in a peripheral artery

peripheral artery

Proton pump inhibitors (eg, omeprazole) are associated with increased risk of

pneumonia, Clostridium difficile diarrhea, and calcium malabsorption (osteoporosis)

A major problem with long-term management of hypertension is

poor adherence to the treatment plan. The nurse should teach the client the importance of taking blood pressure medications as prescribed.

Chest tube insertion should be performed with the client's arm raised above the head on the affected side. If possible, the head of the bed should be

raised 30-60 degrees to reduce risk of injury to the diaphrag

A serious complication associated with statin medication is

rhabdomyolysis

Methotrexate (Rheumatrex) treat

rheumatoid arthritis (RA)

Heartburn and dysphagia (difficulty swallowing) are common symptoms associated with

scleroderma

Raynaud phenomenon can develop secondary to

scleroderma

The nurse should educate the client about implementing bleeding precautions (eg, using a soft-bristle toothbrush, shaving with an electric razor). Dabigatran capsules

should be kept in their original container or blister pack until time of use to prevent moisture contamination

What is WRONG? DX? Pt has decreased C/O= s/s hypotension tachypnea, tachycardia, jugular venous distension, narrowed pulse pressure, and the presence of a pulsus paradoxus. Pulsus paradoxus is defined as an exaggerated fall in systemic BP >10 mm Hg during inspiration.

signs and symptoms of tamponade

anaphylaxis is a medical emergency requiring rapid assessment and intervention. Symptoms of an anaphylactic reaction include

signs of respiratory compromise (eg, oral and airway swelling, stridor, wheezing, chest tightness) and shock (eg, dizziness, loss of consciousness).

The impaired perfusion from severe atherosclerosis results in

skin atrophy, poor wound healing, and widespread hair follicle death (hair loss).

The central line dressing change is performed using a

sterile technique that includes wearing sterile gloves and mask to prevent contamination of the site with microorganisms or respiratory secretions. During injection cap, tubing, and dressing changes, the client is instructed to turn the head away from the peripherally inserted central venous catheter site to prevent site contamination by the client's respiratory secretions. During cap/tubing changes, the client is instructed to hold the breath (or perform the Valsalva maneuver) to prevent air from entering the line, traveling to the heart, and forming an air embolism.

Levetiracetam is an anticonvulsant prescribed for seizure disorders. It may have depressing effects on the central nervous system (eg, drowsiness) as the body adjusts to therapy. Serious adverse effects include

suicidal ideation and Stevens-Johnson syndrome. Clients with seizure disorders must meet the guidelines of their department of transportation and receive permission from their health care provider prior to legally operating a motor vehicle.

PSVT treatment if adenosine is ineffective?

synchronized cardioversion may be used.

Murmurs are produced by . They can be characterized as musical, blowing, swooshing, or rasping sounds heard between normal heart sounds. The aortic area is located at the second intercostal space, right sternal border

turbulent blood flow across diseased or malformed cardiac valves

barium contrast solution used during the procedure may make the client's stool white for

up to 3 days

Fluticasone propionate (belongs to a class of drugs known as corticosteroids, specifically glucocorticoids). This drug is a C and WILL be prescribed to PREGNANT pt. with severe asthma.

used to treat asthma, allergic rhinitis, nasal polyps, various skin disorders and Crohn's disease and ulcerative colitis. It is also used to treat eosinophilic esophagitis.

~~~~~~~~~~~~~~~~~~Pharm Basic CARE~~~~~~~~~~~~~~````

~~~~~~~~~~~~~~~~~CARE~~~~~~~~~~~~~~````

**Drugs commonly associated with orthostatic hypotension include:

1.)Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (eg, metoprolol) and alpha blockers (eg, terazosin) 2.) Antipsychotic medications (eg, olanzapine, risperidone) and 3.)antidepressants (eg, selective serotonin reuptake inhibitors) 4.)Volume-depleting medications such as diuretics (eg, furosemide, hydrochlorothiazide) 5.)Vasodilator medications (eg, nitroglycerine, hydralazine) Narcotics (eg, morphine)

normal platelet count is

150,000-400,000/mm

Adverse effects of vancomycin toxicity include nephrotoxicity (eg, elevated creatinine levels) and ototoxicity (eg, hearing loss, vertigo, tinnitus). Infuse medication over at least

60 minutes (≤10 mg/min). Faster rates increase the likelihood of complications

Tetralogy of Fallot (TOF) is a cyanotic cardiac defect. Infants with TOF will normally maintain oxygen saturations of

65%-85% until the defect is surgically corrected.

In the setting of SIADH, the nurse should EXPECT:

A prescription for fluid restriction hypERtonic IV solution (eg, 3% NaCl) administered in small quantities would be appropriate to shift fluid back into the vascular compartment and correct hyponatremia.

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 Correct answer 2,3,5 Explanation: Large amounts of vitamin K-rich foods can decrease the anticoagulant effects of warfarin therapy. Clients are not instructed to remove those foods from their diet but are encouraged to be consistent in the intake of foods high in vitamin K, including leafy green vegetables, asparagus, broccoli, kale, Brussels sprout, and spinach. Several beverages also affect warfarin therapy. Green tea, grapefruit juice, and cranberry juice may alter its anticoagulant effects. (Option 1) Certain fruits (eg, bananas, oranges) are rich in potassium and may increase the risk for hyperkalemia with the use of potassium-sparing diuretics (eg, spironolactone, triamterene, eplerenone). However, bananas and oranges are low in vitamin K and are not known to interact with warfarin. (Option 4) Eating less red meat and reducing sodium intake are part of a heart-healthy diet but are not specific to a warfarin regimen. Educational objective: The nurse should teach the client receiving warfarin therapy to be consistent with intake of foods high in vitamin K. Clients do not need to restrict vitamin K-rich foods completely. Leafy green vegetables and grapefruit juice are the most important to teach. .

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 [21%] 2. Blood sugar level is 240 mg/dL (13.3 mmol/L) [6%] 3. Client is taking 20 mg fluoxetine daily [13%] 4. Serum creatinine is 2.3 mg/dL (203 µmol/L) [58%] Correct answer 4 Explanation: Digoxin (Lanoxin) is a cardiac glycoside that increases cardiac contractility but slows the heart rate and conduction. It is used in heart failure (to increase cardiac output) and atrial fibrillation (to reduce the heart rate). The drug is excreted almost exclusively by the kidney. BUN and creatinine levels are measurements of kidney function. The normal range for creatinine is 0.6-1.3 mg/dL (53-115 µmol/L). Elderly clients tend to develop age-related decrease in glomerular filtration rate (GFR). These clients and those with obvious kidney injury (possibly due to diabetes in this client) can accumulate digoxin. The early symptoms of toxicity are nausea and vomiting. Later signs of toxicity are arrhythmias, including heart blocks. Therefore, clients at risk for digoxin toxicity require frequent drug level monitoring and dose adjustment. (Option 1) An apical heart rate is taken for a full minute prior to administration. It is safe to administer the drug when the apical heart rate is ≥60/min. (Option 2) An elevated blood sugar level requires attention but is unrelated to digoxin toxicity. However, hypokalemia can increase the risk of digoxin toxicity. (Option 3) Fluoxetine (Prozac) is an antidepressant drug that is a selective serotonin reuptake inhibitor. It does not usually interact with digoxin and its use is unaltered by cardiac disease. This is a normal dose. Educational objective: Digoxin (Lanoxin) is excreted almost exclusively by the kidneys. Decreased kidney function usually requires decreased digoxin dosage and frequent drug level monitoring. BUN and creatinine are measurements of kidney function. .

disorganization of electrical activity in the atria due to multiple ectopic foci

Atrial fibrillation

Mointer labs pt on dig?

BUN (7-20) and creatinine .07-1.4 .The drug is excreted almost exclusively by the kidney and is the measurement of how well the kidneys are working. RN needs to be mindful and cautious if pt. has a chronic disease that effects the kidneys. ie; diabetes

Digoxin (Lanoxin) is excreted almost exclusively by the kidney, what should RN monitor?

BUN and creatinine levels are measurements of kidney function. The normal range for creatinine is 0.6-1.3 mg/dL

Block Time Remaining: 00:01:01 TUTOR Test Id: 80941960 QId: 31527 (921666) 48 of 53 A A A Which herbal supplements pose an increased risk for bleeding in surgical clients and should be discontinued prior to major surgery? Select all that apply. 1. Black cohosh 2. Garlic 3. Ginger 4. Ginkgo biloba 5. Hawthorn Omitted Correct answer 2,3,4 Answered correctly 40% Time: 1 seconds Updated: 04/02/2017 Explanation: Clients are often aware of the need to discontinue prescription medications such as aspirin and anticoagulants prior to elective surgery, but they may not know that some herbal supplements can increase bleeding risk. The nurse should question the client specifically about the use of herbal supplements. Herbal supplements that can increase risk for bleeding include: Gingko biloba Garlic Ginseng Ginger Feverfew (Option 1) Black cohosh is used for treatment of menopausal symptoms. The main side effect is liver injury. (Option 5) Hawthorn extract is used to control hypertension and mild to moderate heart failure. Hawthorn use does not increase the risk of bleeding. Educational objective: Use of herbal supplements such as ginkgo biloba, garlic, ginseng, ginger, and feverfew should be reported to the health care provider before surgery as they may increase the risk of bleeding.

Block Time Remaining: 00:01:02 TUTOR Test Id: 80941960 QId: 31850 (921666) 49 of 53 A A A The home health nurse reviews the laboratory results for 4 clients. Which laboratory value is most important for the nurse to report to the health care provider? 1. Client with Clostridium difficile infection receiving metronidazole has a white blood cell count of 15,000/mm3 (15.0 x 109/L) [7%] 2. Client with liver cirrhosis has an International Normalized Ratio of 1.5 [19%] 3. Client with mild asthma exacerbation receiving prednisone has a blood glucose of 250 mg/dL (13.9 mmol/L) [39%] 4. Client with rheumatoid arthritis taking adalimumab has a white blood cell count of 14,000/mm3 (14.0 x 109/L) [33%] Omitted Correct answer 4 Answered correctly 33% Time: 1 seconds Updated: 04/02/2017 Explanation: Adalimumab (Humira) is a tumor necrosis factor (TNF) inhibitor, a biologic disease-modifying antirheumatic drug (DMARD) classified as a monoclonal antibody. Its major adverse effects are similar to those of other TNF inhibitor drugs (eg, etanercept [Enbrel], infliximab [Remicade]) and include immunosuppression and infection (eg, current, reactivated). An elevated white blood cell count in this client can indicate underlying infection and should be reported immediately. (Option 1) This client with Clostridium difficile infection will have an elevated white blood cell count. The client is receiving appropriate therapy (eg, metronidazole, oral vancomycin). The nurse will need to monitor the white cell count and, if it keeps increasing, report it. (Option 2) The liver produces most blood clotting factors. Clients with liver cirrhosis will lose this ability and are at risk for bleeding. This client's International Normalized Ratio is mildly elevated (normal 0.75-1.25), which is expected with cirrhosis. (Option 3) Corticosteroids increase blood glucose. This is expected, and the client may need treatment if the glucose levels are markedly increased for a prolonged period. Most clients with asthma exacerbation are expected to take a 5- to 7-day course of steroids. Educational objective: Adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade) are common tumor necrosis factor inhibitor, biologic disease-modifying antirheumatic drugs. Major adverse effects include immunosuppression and infection. .

A brain tumor can also cause increased intracranial pressure; clients report morning headache, nausea, and vomiting.

Dexamethasone (Decadron) can be prescribed short-term to decrease the surrounding edema.

Prednisone is a glucocorticoid that can increase glucose levels.

Glucose levels should be monitored periodically for clients receiving this medication.

Clients who have had major surgery, prolonged immobilization, or are taking estrogen-containing contraceptive pills are at high risk.

Pulmonary embolism is a life-threatening emergency

Sinus tachycardia involves a heart rate of 101-200/min but also has a normal P wave preceding each QRS, with a normal shape and duration. The PR interval is normal (0.10-0.20 second) and the QRS is <0.12 second.

SVT

Tx: for fail chest?

Supplemental oxygen is often necessary, and a chest tube and intubation may be necessary to stabilize the client.

If bleeding occurs at a catheterization site in the groin, the nurse should apply direct pressure

approximately 2.5 cm (1") above the insertion site

Doxycycline (Doryx) should NOT be used

during PREGNANCY as it can impair bone mineralization in the fetus

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is characterized by

excessive release of antidiuretic hormone (vasopressin) from the posterior pituitary gland. The increase in blood volume (hypervolemia) often results in true hyponatremia in which the plasma sodium levels are lowered and total body fluid is increased. Although the sodium level is low, SIADH is brought about by an excess of water rather than a deficit of sodium.

what is a complication of thoracentesis

pneumothorax

Defibrillation is used for treating

ventricular fibrillation and pulseless ventricular tachycardia.

Vitamin K (phytonadione) is a fat-soluble vitamin that is administered as an antidote for

warfarin-related bleeding.

Older individuals, diabetic clients, and women may have atypical angina symptoms rather than the characteristic crushing, substernal type of chest pain These are

atypical pain (jaw or arm), shortness of breath, indigestion, nausea, dizziness, and cold sweats

West Nile virus is transmitted by an infected mosquito bite. RN TEACH:

avoiding mosquitoes USE a mosquito repellent. Prevention also includes keeping arms and legs covered with light-colored clothing and avoiding outdoor activities at dawn and dusk.

Adenosine treats

supraventricular tachycardia.

is a toxin-producing bacterium that proliferates in the lower gastrointestinal tract. Expected s/s include diarrhea, fever, and leukocytosis. First-line treatment metronidazole (Flagyl) and oral vancomycin.

Clostridium difficile s/s include diarrhea, fever, and leukocytosis. TX: metronidazole (Flagyl) and oral vancomycin contact isolation Use soap and H2o

NSAIDs (eg, indomethacin, ibuprofen) are associated with the following:

Gastrointestinal (GI) toxicity - symptoms of GI bleeding such as black tarry stools Gastrointestinal upset (eg, dyspepsia, pain) can be reduced if the medicine is taken with food. Kidney injury - long-term use is associated with kidney injury Hypertension and heart failure - NSAIDs can cause fluid retention, which can exacerbate conditions such as heart failure, cirrhosis/ascites, and hypertension Bleeding risk - clients should notify the HCP if taking concurrently with aspirin, other NSAIDs, or anticoagulant or antiplatelet drugs as they can increase the risk of GI bleeding

During periods of active lesions, abstinence from sexual intercourse is indicated. Condoms should be used during periods of dormancy due to viral shedding.

Genital herpes

in CAD FIRST check for the adequacy of blood flow to the lower extremities by palpating for the presence.

of posterior tibial and dorsalis pedis pulses and their quality

The nurse caring for a client receiving a heparin infusion should monitor the aPTT and follow the heparin infusion protocol for titration. A therapeutic level is 1.5-2 times normal,

or an aPTT of 46-70 seconds.

Can a emptying or recharging a Hemovac or Jackson-Pratt wound drain Be delegated to a UAP

NO needs to be assessed to ensure it is working properly.

Can a specimen collection from a Foley catheter Be delegated to a UAP

NO B/c is considered a sterile procedure and should not be assigned to a UAP.

Should you use hypotonic IV solution (ie, 0.45% sodium chloride) to replace gastrointestinal tract fluid losses ?

NO! I will make fluid volume deficit worse. TX: Isotonic 0.9 sc LR

RN will use this technique when ? (24-26 gauge) IV catheters and correct technique (5-15-degree angle) for insertion of an IV into fragile veins.

Older adults IV therpy

After transurethral resection of the prostate RN EXPECTS:

continuous bladder irrigation for 24-36 hours flushes out small clots and prevents obstruction. Reddish-pink drainage is expected in the immediate postoperative period.

The single most important factor in preventing strokes is

controlling hypertension Teach pt. to take medication

IV mannitol is an

osmotic diuretic that reduces cerebral edema by pulling water from the cerebral cells into the vasculature

TRUE OR FALSE African Americans have a higher incidence of ischemic stroke than whites or Hispanics.

TRUE Risk factors for stroke are related to an increased rate of hypertension, diabetes mellitus, and sickle cell anemia

Preoperative assessment of the character and quality of peripheral pulses provides a baseline for

rapid postoperative assessment and identification of emergent complications (embolization, graft occlusion)

Can a UAP measure the drainage of a Hemovac or Jackson-Pratt?

YES measure the drainage is ok but assessing the functioning of the drain and the drainage, as well as recharging the drain, should be performed by a nurse.

Decrease in blood pressure, increase in pulse rate, output greater than intake, hypernatremia, and decrease in serum potassium are manifestations that can indicate

hypotonic dehydration in a client receiving diuretic therapy.

nurse teaches the client how to use the most advanced gait, the 4-point crutch gait.

**advance right crutch, then left foot, and advance left crutch, then right foot.

The presence of 2 or more of these findings indicates the syndrome SIRS.

Temperature (hyper- or hypothermia), respirations >20/min, heart rate >90/min, and WBC count >12,000/mm3 (12.0 x 109/L) are assessed to document SIRS.

How will RN treat hypomagnesmia (1.5-2.5)

The American Heart Association recommends treatment with IV magnesium sulfate.

TEACH PT. instructions for using a volume-oriented SMI device include:

-Assume a sitting or high Fowler position, which optimizes lung expansion, and exhale normally -While holding the device at an even level, seal the lips tightly on the mouthpiece to prevent leakage of air around it -Inhale deeply through the mouth until the piston is elevated to the predetermined level of tidal volume. -The piston is visible on the device and helps provide motivation. -Hold the breath for at least 2-3 seconds (up to 6 seconds) as this maintains maximal inhalation -Exhale slowly to prevent hyperventilation -Breathe normally for several breaths before repeating the process -Cough at the end of the session to help with secretion expectoration

Genital herpes is a sexually transmitted infection caused by a herpes simplex virus and is highly contagious, especially when lesions are active. It remains dormant in the body even when active lesions are healed. There is no cure for genital herpes; treatment is aimed at relieving symptoms and preventing the spread of infection. Touching the lesions and then rubbing or scratching another part of the body can spread the infection.

Therefore, gloves should be used when applying topical antiviral or analgesic (eg, lidocaine) medications.

Chlorpheniramine (ChlorTrimeton) is a sedating histamine H1 antagonist used to treat allergy symptoms. RN will caution in elderly Pt.

Increased central nervous system effects (eg, drowsiness, dizziness) may occur due to its reduced clearance in the elderly

What may not be prescribed to a premenopausal client without a formal agreement to participate in the iPledge prescription tracking program. A commitment to always use at least 2 forms of birth control to prevent pregnancy is required.

Isotretinoin (Accutane)

What are the late signs of Digoxin (Lanoxin) toxicity?

Later signs of toxicity are arrhythmias, including heart blocks

Home management instructions for PAD include:

Lower the extremities below the heart when sitting and lying down - improves arterial blood flow Engage in moderate exercise (eg, 30- to 45-minute walk, twice daily) - promotes collateral circulation and distal tissue perfusion Perform daily skin care, including application of lotion - prevents skin breakdown from dry skin Maintain mild warmth (eg, lightweight blankets, socks) - improves blood flow and circulation Stop smoking - prevents vessel spasm and constriction Avoid tight clothing and stress - prevents vasoconstriction Take prescribed medications (eg, vasodilators, antiplatelets) - increases blood flow and prevents blood clot development

Regular insulin is short-acting and peaks

2-5 hours after administration.

normal white blood cell (WBC) count is:

4,000-11,000/mm3

which ethnic group is at highest risk for this side effect ACE inhibitor-related angioedema

African descent

any client with a history of severe allergic reaction (sudden blotchy skin rash or swelling of the lips and mouth) should always carry an EpiPen. Epinephrine injection is the only option for treating

Anaphylaxis This is a medical emergency

Block Time Remaining: 00:00:31 TUTOR Test Id: 80941960 QId: 31874 (921666) 17 of 53 A A A A client with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. Which blood test trend is most important for the nurse to review when preparing to administer this medication? 1. Blood cultures [18%] 2. Creatinine levels [63%] 3. Magnesium levels [1%] 4. White blood cell (WBC) count [16%] Omitted Correct answer 2 Answered correctly 63% Time: 3 seconds Updated: 05/19/2017 Explanation: Vancomycin can cause nephrotoxicity, which occurs most often in clients who already have some degree of renal impairment. Serum creatinine levels should be monitored daily during IV vancomycin treatment to look for an increase in level over a few days. If an increasing trend is identified, the nurse should consult with the health care provider (HCP) and/or pharmacist before administering the dose. (Option 1) Blood cultures may be checked periodically during vancomycin therapy, but they are not likely to change this quickly. (Option 3) Magnesium levels are typically not affected by vancomycin therapy. (Option 4) The WBC count may be helpful in determining the effectiveness of vancomycin therapy in treating infection. However, this laboratory result is unlikely to influence the nurse's decision on whether to administer the dose. Therefore, it is not the highest priority. Educational objective: Creatinine levels should be closely monitored for signs of nephrotoxicity in the client receiving IV vancomycin. If increasing creatinine is identified, the nurse should hold the dose and consult with the HCP and/or pharmacist before administration.

Block Time Remaining: 00:00:31 TUTOR Test Id: 80941960 QId: 31874 (921666) 17 of 53 A A A A client with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. Which blood test trend is most important for the nurse to review when preparing to administer this medication? 1. Blood cultures [18%] 2. Creatinine levels [63%] 3. Magnesium levels [1%] 4. White blood cell (WBC) count [16%] Omitted Correct answer 2 Answered correctly 63% Time: 3 seconds Updated: 05/19/2017 Explanation: Vancomycin can cause nephrotoxicity, which occurs most often in clients who already have some degree of renal impairment. Serum creatinine levels should be monitored daily during IV vancomycin treatment to look for an increase in level over a few days. If an increasing trend is identified, the nurse should consult with the health care provider (HCP) and/or pharmacist before administering the dose. (Option 1) Blood cultures may be checked periodically during vancomycin therapy, but they are not likely to change this quickly. (Option 3) Magnesium levels are typically not affected by vancomycin therapy. (Option 4) The WBC count may be helpful in determining the effectiveness of vancomycin therapy in treating infection. However, this laboratory result is unlikely to influence the nurse's decision on whether to administer the dose. Therefore, it is not the highest priority. Educational objective: Creatinine levels should be closely monitored for signs of nephrotoxicity in the client receiving IV vancomycin. If increasing creatinine is identified, the nurse should hold the dose and consult with the HCP and/or pharmacist before administration.

often associated with conduction system disease or drug toxicity (eg, beta blockers, calcium channel blockers).

Mobitz II (type II second-degree atrioventricular block

Pt. @ risk for dig Toxicty:

Older pt. w/ decreased GFR; and Chronic Dieases

regular, narrow QRS complex tachycardia with a rate of around 150-220/min

Supraventricular tachycardia

Clonidine is a potent

antihypertensive agent and is available as a transdermal patch. The patches should be replaced every 7 days and can be left in place during bathing.

Poor circulation to the extremities can place the client at increased risk for

development of arterial ulcers and infection.

The characteristic signs and symptoms associated with pulmonary TB disease include cardinal

(major) signs (eg, cough, sputum production, dyspnea) and constitutional (minor) signs (eg, anorexia, weight loss, fatigue, fever, night sweats).

infective endocarditis (IE) Rn TEACH:

1.to monitor temperature regularly at home. They can be discharged when their (temp is low) Persistent temperature elevations may mean that the antibiotic therapy is ineffective or complications have developed 2.Prophylactic antibiotics for certain high-risk procedures (eg, manipulation of gingival tissue). 3. Slurred speech could indicate that embolization has caused a possible stroke. (IE causes the formation of vegetations on valve and endocardial surfaces. Embolization to various organ sites can occur. 4.IE can require IV antibiotics for up to 4-6 weeks (home health nurse will come to administer the antibiotics through the client's PICC line.)

vaccination provides immunity against influenza in about

2 weeks after inoculation, it does not offer complete protection against all virus strains. Therefore, close contact with others should be avoided during the illness stage, especially those with an impaired immune system.

Block Time Remaining: 00:01:06 TUTOR Test Id: 80941960 QId: 30675 (921666) 52 of 53 A A A A client diagnosed with trichomonal vaginal infection (trichomoniasis) is prescribed metronidazole. Which of the following is essential for the nurse to teach? Select all that apply. 1. Avoid alcohol while taking this medication 2. Perform vaginal douche for 7-10 days 3. Use birth control pills to prevent recurrence of infection 4. Your partner(s) must be treated simultaneously 5. Your urine can change to a deep red-brown color Omitted Correct answer 1,4,5 Answered correctly 47% Time: 1 seconds Updated: 04/29/2017 Explanation: Trichomoniasis is a sexually transmitted infection (STI). Many women with trichomoniasis are asymptomatic but can have profuse frothy gray or yellow-green vaginal discharge with a fishy odor. Small red lesions (strawberry) may be present in the vagina or cervix. Pruritus is common. Metronidazole (Flagyl) is the initial drug of choice. Clients should avoid alcohol while taking metronidazole and for 24 hours after completion of the therapy due to a reaction that includes flushing, nausea/vomiting, and abdominal pain. The medication can cause a metallic taste and turn the urine a deep red-brown color. It is essential to treat the partner(s) at the same time to avoid reinfection. Clients should abstain from sexual intercourse until the infection is cleared, usually about 1 week after treatment. (Option 2) Routine vaginal douching (with a mixture of water and vinegar) is not recommended as it increases the risk of infections such as bacterial vaginosis. (Option 3) Birth control pills do not protect against transmission of STIs. The use of condoms can help prevent the spread of infection. Educational objective: Trichomoniasis is an STI. Expected symptoms include yellow-green, frothy discharge with a fishy odor and an accompanying itch. Metronidazole is the initial drug of choice. Clients should avoid alcohol while on metronidazole, which can make the urine darker and cause a metallic taste. Partners must be treated simultaneously.

Block Time Remaining: 00:01:07 TUTOR Test Id: 80941960 QId: 30762 (921666) 53 of 53 A A A Exhibit The nurse is in the medication room preparing medications due at 1800 for a client who had an aortic valve replacement 5 days ago. Which action should the nurse implement first? Click on the exhibit button for additional information. 1. Assess the client's most recent potassium level [11%] 2. Check the client's INR [57%] 3. Measure the client's vital signs [6%] 4. Verify the client's name and date of birth at the bedside [24%] Omitted Correct answer 2 Answered correctly 57% Time: 1 seconds Updated: 03/08/2017 Explanation: Warfarin (Coumadin) is an anticoagulant given to clients with a mechanical valve replacement. To determine if the client is receiving an appropriate dose, the INR needs to be checked regularly. A therapeutic INR for a client with a mechanical heart valve is 2.5-3.5. The nurse should not administer warfarin without checking the INR first. If the INR is >3.5, the nurse should hold the dose and contact the health care provider for further direction. (Option 1) Although the nurse should assess the client's potassium level prior to administering supplemental potassium, this medication was scheduled at 0900 and is not indicated at this time. There is no pharmacologic interaction between potassium levels and warfarin. (Option 3) The client's vital signs should be measured routinely, but administration of warfarin and simvastatin are not contingent on the results. (Option 4) Verification of the client's name and date of birth is an important safety measure that should be performed at the bedside, immediately before medication administration. Educational objective: The nurse should check the client's most recent INR level prior to administering warfarin. A therapeutic INR is 2.5-3.5 for clients with mechanical heart valves. The nurse should hold the dose and contact the health care provider if the INR is >3.5.

First responders should not manipulate or remove the impaled object.

Manipulation or removal may cause further trauma and bleeding; therefore, stabilization of the object is the first priority to prevent it from moving during initial client assessment and later during transport to a health care facility where skilled trauma care is available.

What must the RN do when a pt is on Digoxin?

Monitor heart rate apical heart rate for full minute prior to administration. It is safe to administer the drug when the apical heart rate is ≥60/min Watch for dig toxicity s/s mointor Creatine and BUN Moiniter dig levels and make dose adjustments as needed. Monitor for HypOK

What S/S pt have serotonin syndrome?

Mydriasis ( dilated pupils) high body temperature Body temperature can increase to greater than (106.0 °F). agitation increased reflexes tremor sweating diarrhea Complications may include seizures and extensive muscle breakdown.

When teaching clients and caregivers, the nurse must keep in mind several principles of adult learning. These include the learner's:

Need to know Readiness to learn Prior experiences Motivation to learn Orientation to learning Self-concept

what is the most common cause of mortality in clients who have had cardiac arrest, particularly ventricular fibrillation or pulseless ventricular tachycardia

Neurologic injury

Normal blood gas levels are

PO2 80-100 mm Hg (10.6-13.3 kPa), pCO2 35-45 mm Hg (4.7-6.0 kPa), and pH 7.35-7.45

What is the only insulin that can be administered IV push

Regular insulin

To assess the apical heart rate, the nurse needs to place the stethoscope diaphragm on the chest at the

apex/mitral area (fifth intercostal space on the midclavicular line)

The RN know that the proper intervention should be to Slow down the rate of administration of total enteral nutrition when giving hypertonic formulas when pt has N/V/D bc?

because of their higher osmolality, hypertonic formulas sometimes cause nausea, vomiting, or diarrhea, especially during the initiation of total enteral nutrition. The gastrointestinal tract will pull fluid from the surrounding intra- and extravascular compartments to dilute the formula, making it similar to body fluid osmolality. This process is similar to dumping syndrome and may cause temporary diarrhea with cramps, nausea, and vomiting.

Discharge education for the client with chronic heart failure should include

daily weights, drug regimens, diet, and exercise plans. The use of any NSAIDS is contraindicated in heart failure as these contribute to sodium retention, and therefore fluid retention. no more than 400mg na+/ meal.

torsades de pointes is usually due to a prolonged QT interval (more than half the RR interval), which is the result of electrolyte imbalances, especially hypomagnesemia, or some medications. The first-line treatment is IV magnesium (Option 3). Treatment may also include defibrillation and discontinuation of any QT-prolonging medications.

electrolyte imbalances, especially hypomagnesemia,

NSAIDs may cause

heart attack, stroke, high blood pressure, and possible heart failure after long-term use. NSAIDs decrease the effectiveness of diuretic and blood pressure medications. Long-term use is also associated with chronic kidney disease and peptic ulcers.

systemic venous congestion S/s

hepatomegaly puffiness around the eyes weight gain acites JVD

In the setting of SIADH, the nurse should question a prescription for a

hyPOtonic solution (eg, 0.45% NaCl; or dextrose water) as it would WORSEN the fluid and electrolyte imbalance.

A STAT order indicates that a medication is to be given

immediately and only once.

lactic acidosis and gastrointestinal disturbances (metallic taste in the mouth, nausea, and diarrhea) are associated with?

metformin

Nose cultures determine

methicillin-resistant Staphylococcus aureus

history of aortic abdominal aneurysm The nurse should listen for a bruit with the bell of the stethoscope over the

periumbilical or epigastric area

A pt. with sea saw respiration is considered in triage

"Red" Fail chest!

Educational objective: Immunosuppressed clients

(eg, taking steroids, undergoing chemotherapy or radiation, with immunodeficient states) and those taking prolonged or high-dose antibiotics are at increased risk of oral candidiasis. Elderly clients with dentures are also at high risk. Infection is treated with antifungals (eg, nystatin) and proper oral hygiene.

Right-sided heart failure S/S

--Peripheral and dependent edema (eg, sacrum, legs, hands), especially in the lower extremities --Jugular venous distension --Increased abdominal girth due to venous congestion of the gastrointestinal tract (eg, hepatomegaly, splenomegaly) and ascites. --Nausea and anorexia may also occur as a result of increased abdominal pressure and decreased gastrointestinal circulation - --Hepatomegaly due to hepatic venous congestion --hepatomegaly, splenomegaly), and ascites

The nurse should teach a client receiving a clonidine patch to:

-Apply patch to a dry hairless area on the upper arm or chest -Wash hands before and after application -Rotate sites with each new patch application -Discard patch away from children or pets with sticky sides folded together -Never wear more than 1 patch at a time -Never stop using the patch abruptly

postoperatively for graft leakage and hemodynamic stability s/s?

-Signs of graft leakage include a decreasing blood pressure and increasing pulse rate -A rigid, distended abdomen would indicate possible blood (graft leakage) in the cavity.

Clients should be taught to prevent tick bites by

-using insect repellent with deet -wearing long pants (light colored easier to see) with closed-toed shoes, -avoiding tall grass and wooded areas. -Ticks should be removed with tweezers, keeping them intact. -Flu-like symptoms and a bull's-eye rash (erythema migrans) should be reported immediately to the health care provider.

What is the nurse's role in informed consent is to

-witness that the client signed the consent voluntarily and was competent at the time of signing - The nurse should ensure that the client received necessary information and has no remaining questions about the procedure. - After obtaining the signature, the nurse should document in the client's medical record that the informed consent was given and the date/time of the signature

How long is Blood donation discourage when pt. stops taking isotrentinion?

1 month afterward to ensure that pregnant women do not receive any donated blood

The PEG tube's tract begins to mature It begins to close within hours of tube dislodgement. The nurse should notify the health care provider who placed the PEG tube as early dislodgement (ie, <7 days from placement) requires either surgical or endoscopic replacement

1-2 weeks and is not fully established until 4-6 weeks

How will RN measure for Pulsus Paradoxus?

1-Place client in semirecumbent (semi fowlers) -position 2-Have client breathe normally 3-Determine the SBP using a manual BP cuff 4-Inflate the BP cuff to at least 20 mm Hg above the previously measured SBP 5-Deflate the cuff slowly, noting the first Korotkoff sound during expiration along with the pressure 6-Continue to slowly deflate the cuff until you hear sounds throughout inspiration and expiration; also note the pressure 7-Determine the difference between the 2 measurements in steps 5 and 6; this equals the amount of paradox The difference is normally <10 mm Hg, but a difference >10 mm Hg may indicate the presence of cardiac tamponade.

The nurse receives notification from the telemetry room that a client appears to be in ventricular fibrillation (VF). The nurse immediately goes to the client's room and finds the client unresponsive and pulseless. Place the interventions in the appropriate order. Educational objective: VF is a lethal dysrhythmia. The client will not recover without immediate treatment. Interventions consist of activation of the emergency response system, CPR, defibrillation, and drug therapy (epinephrine and then amiodarone).

1. Call the emergency response team 2.Initiate cardiopulmonary resuscitation (CPR) 3.Defibrillate the client at 200 joules 4.Administer IV epinephrine 1 mg push 5.Administer intravenous (IV) amiodarone 300 mg push

Parent teaching for administration of digoxin includes the following:

1.Inform parents of the pulse rate at which to hold the medication based on HCP prescription. In general, digoxin is held if pulse <90-110/min for infants and young children or <70/min for an older child. 2.Administer oral liquid in the side and back of the mouth 3.Do not mix the drug with food or liquids as the refusal to take these would result in inaccurate intake of medication 4.If a dose is missed, do not give an extra dose or increase the dose. Stay on the same schedule. 5.If more than 2 doses are missed, notify the HCP If the child vomits, do not give a second dose 6.Nausea, vomiting, or slow pulse rate could indicate toxicity. Notify the HCP . 7.Give water or brush the client's teeth after administration to remove the sweetened liquid.

The maximum rate for infusion of IV potassium chloride through a peripheral vein

10 mEq/hr

A therapeutic INR is

2.5-3.5

RAI has a delayed response and may take up to

3 months to have a maximum effect. For this reason, other medications should be maintained to lower thyroid hormone synthesis and treat symptoms of hyperthyroidism until RAI begins to have maximum effect

Heart failure may develop after surgical repair of tetralogy of Fallot, and infants and children can quickly decompensate hemodynamically when it occurs. Clinical manifestations are grouped into

3 primary categories— impaired myocardial pumping, pulmonary congestion, and systemic venous congestion

How long before a dairy product can be consumed When meat or poultry is consumed Individuals who practice Orthodox Judaism follow Kosher laws

3-6 hours must pass before a dairy product can be consumed

atrial fibrillation, the atrial rate may be increased to

350-600/min

Educational objective: A client prescribed CSII is taught how to self-manage the insulin pump. Key points include the importance of checking blood glucose levels at least

4 times a day, how to administer a bolus dose at mealtime to cover carbohydrate intake, how to administer a supplemental bolus dose to correct pre- and postprandial hyperglycemia, and the importance of balancing diet and exercise to avoid excess weight gain.

Incentive spirometry Guidelines recommend. Volume-oriented or flow-oriented sustained maximal inspiration (SMI) devices can be used.

5-10 breaths per session every hour while awake

Inducing therapeutic hypothermia in these clients within

6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes.

blood urea nitrogen normal 6-20 mg/dL

6-20 mg/dL

A "normal" fasting glucose level (

70-99 mg/dL

The procedure for administering an IM injection using the Z-track technique includes these steps

: 1. Pull the skin 1-1 ½" (2.5-3.5 cm) laterally away from the injection site 2.Hold the skin taut with the nondominant hand, and insert the needle at a 90-degree angle - taut skin facilitates entry of the needle and this angle ensures that the needle will reach the muscle 3. Inject the medication slowly into the muscle while maintaining traction - slow injection promotes comfort and allows time for tissue expansion to facilitate absorption of the medication 4. Wait 10 seconds after injecting the medication and withdraw the needle while maintaining traction on the skin; this allows the medication to diffuse before needle removal and helps to prevent tracking 5.Release the hold on the skin - this allows the tissue layers to slide back to their original position, sealing off the needle track Apply gentle pressure at the injection site, but do not massage as this can cause the medication to seep back up to the skin surface and cause local tissue irritation

Morphine administration can cause respiratory depression. The nurse should hold a dose of morphine for a client whose respiratory rate is

<12/min

Digoxin levels are not often prescribed unless there is suspicion of digoxin toxicity. However, if this value is available, the nurse should assess it. Digoxin toxicity can be seen with levels. Potassium levels should also be monitored in the client receiving digoxin.

>2 ng/mL Hypokalemia can potentiate digoxin toxicity.

When would you want to use a 14 gauge catheter

A 14-gauge (large-bore) catheter may be used for administering fluids and drugs in an emergency or prehospital setting, or for hypovolemic shock

Exhibit 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. 1. Bruising easily, especially on arms [34%] 2. Fatigue [3%] 3. Feeling depressed [3%] 4. Muscle cramps in legs [58%] Omitted Correct answer 4 Explanation: The nurse would be most concerned with the client's report of muscle cramps in the legs. This could be a sign of hypokalemia caused by use of the diuretic furosemide or possibly a reaction from the statin medication atorvastatin. Hypokalemia may manifest as muscle cramps, weakness, or paralysis and typically starts with the leg muscles. Hypokalemia could be dangerous in this client due to possible arrhythmias in the presence of existing cardiac dysfunction. The client may need to be started on supplemental potassium and a high-potassium diet if the serum potassium level is low. If the potassium level is normal, atorvastatin may be responsible for muscle cramps. (Option 1) Bruising, especially on the upper extremities, is common with the use of antiplatelet agents such as aspirin and clopidogrel. The nurse should teach the client to monitor for other, more severe signs of bleeding, such as blood in the stool. (Option 2) The myocardial infarction and heart failure have most likely reduced the client's functional capacity and can cause fatigue. Beta blockers such as metoprolol can also cause fatigue. This will improve with time, and the nurse should talk to the client about possible cardiac rehabilitation. (Option 3) Feeling depressed is common after an acute health-related event such as a myocardial infarction. The client needs to be evaluated further and may need an antidepressant. However, feelings of depression are not immediately life-threatening unless the client exhibits suicidal ideation. Educational objective: The nurse should recognize muscle cramps in the legs as a possible sign of hypokalemia in the client taking diuretics. Muscle cramps should be reported to the health care provider in anticipation of checking a potassium level, adding a potassium supplement, and instructing the client to eat potassium-rich foods.

A A A Exhibit 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. 1. Aspirin [14%] 2. Atorvastatin [18%] 3. Furosemide [13%] 4. Metoprolol [53%] Omitted Correct answer 4 Explanation: Beta blockers, or "lols" (metoprolol, carvedilol, bisoprolol, atenolol), are the mainstay of therapy for clients with chronic heart failure as these improve survival rates for both systolic and diastolic heart failure. However, in certain situations beta blockers can worsen heart failure symptoms by decreasing normal compensatory sympathetic nervous system responses and myocardial contractility. In this client with acute decompensated heart failure (ADHF), marginally low blood pressure (BP), crackles in the lungs, low oxygen saturation, jugular venous distension (JVD), and peripheral edema, the administration of beta blockers can cause the client to further deteriorate. Beta blockers at low doses may be able to be restarted after this client has stabilized and exacerbation of ADHF has resolved with diuresis. (Options 1 and 2) Aspirin is contraindicated if the client has evidence of bleeding. Statins are contraindicated if there is evidence of severe liver or muscle injury. It is appropriate to administer both of these medications to this client who has coronary artery disease and peripheral vascular disease. (Option 3) This client has crackles, JVD, and peripheral edema, indicating the need for furosemide (Lasix). Therefore, the nurse should continue to monitor the client's BP with the administration of furosemide as it can lower BP. When excess fluid is removed through diuresis, the heart will be able to pump more effectively, which will increase cardiac output and BP. Educational objective: The nurse should question administration of beta blockers in a client with symptoms of acute ADHF due to the possibility of further clinical deterioration. Beta blockers are most useful for chronic heart failure.

A A A A client is receiving IV sodium bicarbonate for acute metabolic acidosis. Which of these laboratory values would best indicate that the sodium bicarbonate has been effective? 1. Serum pH 7.32, HCO3- 26 mEq/L (26 mmol/L), potassium 4.9 mEq/L (4.9 mmol/L) [7%] 2. Serum pH 7.34, HCO3- 21 mEq/L (21 mmol/L), potassium 5.1 mEq/L (5.1 mmol/L) [6%] 3. Serum pH 7.39, HCO3- 24 mEq/L (24 mmol/L), potassium 3.8 mEq/L (3.8 mmol/L) [78%] 4. Serum pH 7.41, HCO3- 18 mEq/L (18 mmol/L), potassium 4.3 mEq/L (4.3 mmol/L) [6%] Omitted Correct answer 3 Explanation: Metabolic acidosis is due to an increase in the production or retention of acid (eg, lactic acidosis, ketoacidosis, renal failure) or the depletion of bicarbonate (HCO3-) via the kidneys or gastrointestinal tract. In metabolic acidosis, there is a decrease in pH (<7.35) and HCO3- (<22 mEq [22 mmol/L]). Acidosis damages cells, causing them to release intracellular contents (eg, potassium). Hyperkalemia (potassium >5.0 mEq/L [5 mmol/L]) frequently occurs with acidosis, putting the client at risk for cardiac arrhythmias. Depending on the cause and severity of acidosis, the client can exhibit altered mental status and tachypnea. Management focuses on treating the underlying cause and administering IV sodium bicarbonate to correct the imbalance. Arterial blood gas pH 7.39, HCO3- 24 mEq/L (24 mmol/L), and serum potassium 3.8 mEq/L (3.8 mmol/L) are within normal limits, indicating the sodium bicarbonate has effectively corrected acidosis. (Options 1, 2, and 4) These laboratory values are not within normal limits and do not indicate that the sodium bicarbonate has effectively corrected acidosis. Educational objective: Metabolic acidosis is an acid-base imbalance that occurs when the pH level drops from excess acid accumulation or bicarbonate (HCO3-) loss. Interventions focus on treating the underlying cause and administering IV HCO3-.

A A A Exhibit The nurse is preparing to administer morning medications to a client with type 2 diabetes mellitus and end-stage renal disease who is scheduled for dialysis today. Which medication should the nurse hold for clarification prior to administration? Click the exhibit button for more information. 1. Atenolol [53%] 2. Calcium acetate [17%] 3. Insulin lispro [18%] 4. Vitamin E [10%] Omitted Correct answer 1 Explanation: Medication administration may require modification on days that clients are scheduled to receive dialysis. The nurse should consider whether the medication will be dialyzed out of the client's system or may create adverse effects during dialysis. Fluid is removed during dialysis, which may cause hypotension. Typically, antihypertensives are held before dialysis to prevent hypotension. In addition, some medications are dialyzed out of the client's system and should therefore be held until after dialysis. Commonly held medications are water-soluble vitamins (eg, vitamins B and C), antibiotics, and digoxin. (Option 2) Clients with chronic kidney disease have high phosphorus levels as the kidney is unable to filter the phosphate from the body; dialysis also does not filter it. Therefore, the client should still take phosphate binders prior to dialysis. Phosphate binders (eg, calcium containing [calcium carbonate and calcium acetate]) and non-calcium containing [sevelamer and lanthanum]) block absorption of ingested phosphate from the intestine and excrete it through feces. (Option 3) Lispro is a fast-acting insulin that should be given 15-30 minutes before meals. It is appropriate to give scheduled lispro with breakfast prior to dialysis. (Option 4) Vitamin E is a fat-soluble vitamin that is not affected by dialysis. It is given to some clients to prevent leg cramps that can be experienced by dialysis clients. Educational objective: Unless otherwise indicated by the health care provider, antihypertensives and other blood pressure-lowering medications (eg, furosemide), antibiotics, digoxin, and water-soluble vitamins (B, C, and folic acid) should be held prior to dialysis.

A new graduate nurse is preparing to administer the following analgesics to clients with postoperative pain. Which situation would require intervention by the precepting nurse? 1. Chooses to administer 50 mcg of the prescribed 50-100 mcg of IV fentanyl for the first dose [5%] 2. Dilutes hydromorphone with 5 mL of normal saline and injects IV push over 2 minutes [17%] 3. Injects 1 mg of morphine sulfate undiluted via IV push over 5 minutes [24%] 4. Selects a 25-gauge ½-inch (1.3-cm) needle to inject ketorolac intramuscularly [53%] Omitted Correct answer 4 Explanation: Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) analgesic administered (orally, IV, or intramuscularly [IM]) for short-term relief of mild to moderate pain. Usage should not exceed 5 days due to adverse effects (eg, kidney injury, gastrointestinal ulcers, bleeding). Ketorolac IM should be administered into a large muscle using the Z-track method to mitigate burning and discomfort. A 1- to 1½-in (2.5- to 3.8-cm) needle is recommended to inject medication into the proper muscular space in average-weight individuals. (Option 1) The amount of analgesic to administer of a variable dose medication should be based on the client's pain level, level of consciousness, and history of narcotic use. Selecting a smaller first dose is appropriate if the nurse is unsure of how the client will respond to the medication. If needed, the larger amount can be given the next time a dose is requested or an additional one-time dose can be requested from the health care provider if breakthrough pain occurs (before the next scheduled medication dose is available). (Option 2) Hydromorphone IV push, given undiluted or diluted with 5 mL of sterile water or normal saline, should be administered slowly over 2-3 minutes; rapid infusion increases the risk of opioid-induced adverse reactions (eg, nausea, itching). (Option 3) Undiluted morphine IV push should be administered slowly over 4-5 minutes; rapid infusion increases the risk of opioid-induced adverse reactions (eg, hypotension, flushing). Educational objective: Ketorolac, a nonsteroidal anti-inflammatory drug, is used for short-term (≤5 days) pain relief due to risk of bleeding, gastrointestinal ulcers, and kidney injury. Intramuscular (IM) injections (using Z-track method) should be given deep into a large muscle due to burning and discomfort. A 1- to 1½-in (2.5- to 3.8-cm) needle is used to reach the proper muscle space.

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 [36%] 2. Fondaparinux is prescribed for STAT administration [25%] 3. Lower-extremity muscle strength is 3/5 bilaterally [9%] 4. Postoperative laboratory results show hemoglobin of 9.9 g/dL (99 g/L) [28%] Omitted Correct answer 2 Explanation: Fondaparinux (Arixtra), unfractionated heparin, and low molecular weight heparin (eg, enoxaparin, dalteparin) are anticoagulants commonly used for deep vein thrombosis and pulmonary embolism prophylaxis after hip/knee replacement or abdominal surgery. However, fondaparinux is not administered until more than 6 hours after any surgery, and anticoagulants are not given while an epidural catheter is in place (Option 2). Fondaparinux is associated with epidural hematoma. Any bleeding in the tight epidural space, which does not expand, could result in spinal cord compression. Signs of epidural spinal hematoma can include severe back pain and paralysis. (Option 1) Paresthesia is an expected finding from postoperative analgesia for 2-24 hours after surgery, depending on the agent and location. Continuously administered analgesia usually results in some paresthesia until approximately 4-6 hours after discontinuance. As long as the level remains relatively stable or improves, it is an acceptable finding. However, paresthesia or motor weakness is a concern when the sensory or motor block outlasts the expected duration. (Option 3) Client response to operative analgesia and postoperative continued analgesia can range from minimal to significant. As long as the analgesic is infusing and findings remain stable, reduced muscle strength is expected. (Option 4) Major orthopedic surgery can result in significant blood loss, and it is not unusual for the client to have hemoglobin drop of 1-2 g/dL (10-20 g/L). Blood loss should be monitored over time; transfusion usually is not indicated unless hemoglobin is <7-8 g/dL (70-80 g/L). Educational objective: Residual paresthesia and motor weakness for several hours are expected findings after regional anesthesia. Anticoagulants are not given while an epidural catheter is in place.

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 [24%] 2. Hispanics [23%] 3. Native Americans [29%] 4. Whites [21%] Explanation: Intractable dry cough is a common side effect of ACE inhibitors. It is thought to be related to the accumulations of kinins (bradykinin). Asians, especially those of Chinese descent, have a high risk (15%-50%) for ACE inhibitor-related cough. Persons of African descent are also at high risk of developing cough and angioedema. This information should be incorporated into the teaching that the nurse provides to this client population. Educational objective: The nurse should be aware that certain ethnic groups are at a higher risk for developing intractable dry cough with the use of ACE inhibitors. Asians and African Americans have the highest incidence of ACE inhibitor-related cough. Persons of African descent are also at high risk for angioedema.

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 [21%] 2. Administer medication only through a central venous access [8%] 3. Administer medication rapidly over 1-2 seconds followed by a saline flush [47%] 4. Mix medication in 50 mL normal saline and administer over 10 minutes [22%] Correct answer 3 Explanation: Adenosine is the first-line drug of choice for the treatment of paroxysmal supraventricular tachycardia (SVT; a rapid rhythm exceeding 150/min). The half-life is <5 seconds, so adenosine should be administered rapidly as a 6-mg bolus IV over 1-2 seconds followed by a 20-mL saline flush. Repeat boluses of 12 mg may be given twice if the rapid rhythm persists. The injection site should be as close to the heart as possible (eg, antecubital area). The client's ECG should be monitored continuously. A brief period of asystole is due to adenosine slowing impulse conduction through the atrioventricular node. The client should be monitored for flushing, dizziness, chest pain, or palpitations during and after administration. (Option 1) Adenosine is the first-line drug for paroxysmal SVT. (Option 2) Although the drug should be administered as close to the heart as possible, central venous access is not required. (Option 4) Because of the drug's short half-life (5-10 seconds), it should be administered rapidly, not slowly, and should not be diluted. Educational objective: Adenosine is the drug of choice for the treatment of paroxysmal supraventricular tachycardia. It has a short half-life and should be administered rapidly over 1-2 seconds, followed with a 20-mL saline bolus. A brief period of asystole can be common. Flushing from vasodilation is seen frequently.

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 [4%] 2. Client has a dry hacking cough [24%] 3. Client has noticed that the tongue is swelling slightly [68%] 4. Client has occasional dizziness upon rising in the morning [2%] Correct answer 3 Explanation: Swelling of the tongue can be a sign of angioedema. Angioedema is swelling that can occur in the eyelids, lips, tongue, larynx, hands, feet, gastrointestinal tract, and genitalia. It often starts in the face and then progresses to the airways, which can be life-threatening. This can be an adverse effect of an angiotensin-converting-enzyme (ACE) inhibitor and African Americans are at a higher risk for its occurrence. Unlike other typical drug allergies, this side effect can occur any time after starting the medication (eg, sometimes after 1 year). The nurse should carefully monitor the client and report this immediately to the HCP. (Option 1) The nurse should review the client's log of recorded blood pressure readings over the past month since starting enalapril. The client may need a dosage change or an additional medication. This should be reported, but it is not the priority in this situation. (Option 2) A dry hacking cough is a common side effect of ACE inhibitors. It is not life-threatening, but the medication should be discontinued to resolve the cough. (Option 4) Occasional dizziness upon rising is a common side effect of most antihypertensives. The client should be taught to rise slowly and sit on the side of the bed for a few minutes before rising. Educational objective: Swelling of the tongue can be a sign of angioedema in the client taking ACE inhibitors; this can be potentially life-threatening if the airway becomes compromised. The nurse should report this immediately to the HCP. Angioedema can be a more common occurrence in African Americans.

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 (200 x 109/L) 4. Report of Ginkgo biloba use 5. Report of peptic ulcer disease Correct answer 4,5 Explanation: Antiplatelet agents (eg, clopidogrel, ticagrelor, prasugrel, aspirin) prevent platelet aggregation and are given to clients to prevent stent re-occlusion. They prolong bleeding time and should not be taken by clients with a bleeding peptic ulcer, active bleeding, or intracranial hemorrhage. Ginkgo biloba also interferes with platelet aggregation and can cause increased bleeding time. Antiplatelet agents and Ginkgo biloba should not be taken together. If this were to occur, this client would be at an increased risk for bleeding. This information should be reported to the prescribing health care provider before the client is discharged. (Option 1) This blood pressure is slightly elevated, but is unaffected by antiplatelet agents. (Option 2) Normal heart rate is between 60/min-100/min. (Option 3) This is a normal platelet count (150,000/mm3-400,000/mm3 [150-400 x 109/L]). Educational objective: If a client is prescribed clopidogrel, the nurse should be concerned about a history of peptic ulcer disease and Ginkgo biloba use. In this situation, the client would be at increased risk for bleeding. This data should be reported to the prescribing health care provider before the client is discharged.

A client with a chronic kidney disease has blood laboratory values as shown in the exhibit. The nurse administers sodium polystyrene sulfonate by mouth per the health care provider's prescription. The nurse evaluates that the therapy is effective when which value is noted on the follow-up results? Click on the exhibit button for additional information. 1. Calcium 7.4 mg/dL (1.85 mmol/L) [4%] 2. Creatinine 4.0 mg/dL (353 µmol/L) [10%] 3. Phosphorus 3.9 mg/dL (1.26 mmol/L) [9%] 4. Potassium 4.9 mEq/L (4.9 mmol/L) [76%] Omitted Correct answer 4 Explanation: The client with kidney disease is at risk for both hyperkalemia (normal potassium 3.5-5.0 mEq/L [3.5-5.0 mmol/L]) and hyperphosphatemia due to reduced glomerular filtration rate. Untreated hyperkalemia may cause life-threatening cardiac arrhythmias. Sodium polystyrene sulfonate (Kayexalate) can be used to treat hyperkalemia. It works in the gastrointestinal tract to trade sodium for potassium, thereby eliminating excess potassium through the stool and reducing the serum potassium level. (Option 1) Serum calcium levels (normal 8.6-10.2 mg/dL [2.15-2.55 mmol/L]) may decrease with diminished renal function due to lower activation of vitamin D and subsequent impaired gut absorption of calcium. Calcium supplements are used to increase the serum calcium level. Sodium polystyrene sulfonate does not affect the serum calcium level. (Option 2) Sodium polystyrene sulfonate does not affect serum creatinine levels. Creatinine levels may decrease after dialysis. (Option 3) Phosphorus is also not filtered with kidney injury and the levels increase in serum (normal 2.4-4.4 mg/dL [0.78-1.42 mmol/L]). Phosphate binders (calcium acetate/carbonate) administered orally eliminate phosphorous through stool. Sodium polystyrene sulfonate does not bind phosphorous. Educational objective: Clients with kidney disease are at risk for hyperkalemia. Sodium polystyrene sulfonate (Kayexalate) works in the gastrointestinal tract to trade sodium for potassium, thereby eliminating excess potassium through the stool and reducing the serum potassium level.

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 [4%] 2. Garlic [4%] 3. Glucosamine [2%] 4. St John's wort [88%] Omitted Correct answer 4 Explanation: St John's wort is an herbal supplement commonly used to treat depression and anxiety. Some clients with mild or moderate depression claim that its antidepressant effect is comparable to that of prescription medications. The herbal supplement mimics the action of selective serotonin reuptake inhibitors (SSRIs) by increasing available serotonin in the brain. Taken in combination with an SSRI (eg, sertraline, fluoxetine, citalopram, paroxetine), St John's wort may cause an excess of serotonin, resulting in serotonin syndrome, which is characterized by mental status changes, autonomic dysregulation, and neuromuscular hyperactivity. The client with a newly diagnosed depressive disorder will likely be prescribed an antidepressant. The nurse should teach the client not to take St John's wort concurrently with SSRIs to prevent serotonin syndrome (Option 4). (Option 1) Echinacea is commonly used to prevent or treat the common cold/flu, although there is no evidence of its efficacy. It is thought to work by stimulating the immune system. Worsening asthma and anaphylaxis have been reported. (Option 2) Garlic is used to improve cholesterol and lower blood pressure. Ginkgo, garlic, and ginseng (the 3 Gs) increase bleeding risk when taken with anticoagulants or thrombolytics. (Option 3) Glucosamine is used to improve joint function. Hypoglycemia may result when it is taken with antidiabetic drugs. Educational objective: Selective serotonin reuptake inhibitors and St John's wort increase serotonin levels in the brain. Clients taking both products concurrently are at risk for potentially life-threatening serotonin syndrome (agitation, confusion, tachycardia, diaphoresis, tremors, hyperreflexia).

A A A 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." [11%] 2. "I will not stop taking dabigatran even if I get a stomachache." [56%] 3. "I will place capsules in my pill box so I will not forget to take a dose." [26%] 4. "I will swallow the capsule whole with a full glass of water." [5%] Omitted Correct answer 3 Explanation: Thrombin inhibitors such as dabigatran (Pradaxa) reduce the risk of clot formation and stroke in clients with chronic atrial fibrillation. The nurse should educate the client about implementing bleeding precautions (eg, using a soft-bristle toothbrush, shaving with an electric razor). Dabigatran capsules should be kept in their original container or blister pack until time of use to prevent moisture contamination (Option 3). (Option 1) Red urine or blood in the stool may indicate internal bleeding caused by thrombin inhibitors. The client should report these symptoms to the health care provider. (Option 2) Thrombin inhibitors should only be stopped under the direction of the health care provider. The nurse should educate the client that stopping dabigatran will increase the risk for stroke. Taking the medication with food will not affect how much is absorbed, and food or a full glass of water may prevent gastrointestinal side effects (eg, nausea, indigestion). (Option 4) Thrombin inhibitor capsules should not be crushed or opened as crushing pills increases absorption and risk of bleeding. Educational objective: Thrombin inhibitors such as dabigatran reduce the risk for clots and stroke in clients with chronic atrial fibrillation. The nurse should teach the client to use bleeding precautions and monitor for symptoms of bleeding, swallow capsules whole with a full glass of water, and keep capsules in their original container until time of use.

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 [1%] 2. Review foods high in potassium that client should include in diet [5%] 3. Teach client to count own pulse for 1 minute; hold medication if pulse <60/min [17%] 4. Teach client to rise slowly and sit on side of bed for several minutes before rising [76%] Omitted Correct answer 4 Explanation: Angiotensin converting enzyme (ACE) inhibitors (eg, captopril, enalapril, lisinopril, ramipril) prevent the pathological enlargement of the left ventricle of the heart. They work by blocking a crucial step in the renin-angiotensin-aldosterone system, the main hormonal mechanism involved in blood pressure regulation. Interrupting this step of the renin-angiotensin-aldosterone system has following effects: A shortage of angiotensin II results in an absence of the vasoconstrictive responses (orthostatic reflex, renal blood flow regulation) causing orthostatic hypotension. Clients may be more prone to experiencing orthostatic hypotension early in treatment with ACE inhibitors and should be taught ways to prevent it. A shortage of aldosterone causes hyperkalemia. Aldosterone Saves Sodium and Pushes Potassium out of the body. ACE inhibitors are contraindicated in pregnancy due to teratogenic effects on the fetus (eg, oligohydramnios, fetal kidney injury). The other important side effects of ACE inhibitors, cough and angioedema, are thought to be due to the accumulation of bradykinin. (Option 1) Renal function (blood urea nitrogen, creatinine) is commonly checked during the first week of treatment. Regular measurements to ensure therapeutic drug levels are required for lithium, phenytoin, and digoxin. (Option 2) A common side effect of ACE inhibitor is mild hyperkalemia, which may require a lower intake of foods high in potassium. Clients taking loop diuretics (eg, furosemide) will need to increase their intake of foods high in potassium. (Option 3) ACE inhibitors do not directly affect the heart rate. Clients prescribed digoxin are taught to take their pulse and hold their medication if the heart rate is <60/min. Educational objective: Client education after initiation of an angiotensin converting enzyme inhibitor (eg captopril, lisinopril) includes a discussion on development of a dry cough, taking several minutes to get out of bed, possible allergic reactions (rash, angioedema), and the teratogenic effects of the drug.

The nurse cares for a client following a percutaneous coronary intervention via the right groin. The client received an IV infusion of abciximab during the procedure. Which actions should the nurse implement? Select all that apply. 1. Assess invasive procedure sites for bleeding 2. Check hemoglobin and platelet count 3. Initiate a second large-bore IV line 4. Place the client on continuous cardiac monitoring 5. Report black tarry stools to the health care provider Omitted Correct answer 1,2,4,5 Explanation: Glycoprotein (GP) IIb/IIIa receptor inhibitors (eg, abciximab, eptifibatide, tirofiban) are used as platelet inhibitors to prevent the occlusion of treated coronary arteries during percutaneous coronary intervention procedures and prevent acute ischemic complications. GP IIb/IIIa receptor inhibitors can cause serious bleeding. The nurse should closely monitor the client for any bleeding at the groin puncture site after the percutaneous coronary intervention (Option 1). The nurse should check the client's baseline complete blood count (eg, hemoglobin, platelet count). Some clients may develop serious thrombocytopenia within a few hours, further increasing the bleeding risk (Option 2). Hypotension, tachycardia, changes in heart rhythm, blood in the urine, abdominal/back pain, mental status changes, and black tarry stools may also indicate internal bleeding and should be monitored carefully when GP IIb/IIIa receptor inhibitors are administered (Options 4 and 5). (Option 3) During and after the infusion of GP IIb/IIIa receptor inhibitors, no traumatic procedures (initiation of IV sites, intramuscular injections) should be performed unless absolutely necessary due to the risk of bleeding. Educational objective: Glycoprotein IIb/IIIa receptor inhibitors (eg, abciximab, eptifibatide, tirofiban) inhibit platelet aggregation and increase bleeding risk. Serious thrombocytopenia can occur within few hours, further increasing bleeding risk. After administration, the nurse should monitor the client's blood counts, blood pressure, and heart rate and rhythm, as well as watch for signs of bleeding.

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 [54%] 2. Candesartan [11%] 3. Carvedilol [18%] 4. Isosorbide [16%] Omitted Correct answer 1 Explanation: Most clients with heart failure are prescribed a loop diuretic (eg, furosemide, torsemide, bumetanide) to reduce fluid retention. If the client has signs and symptoms of excessive fluid accumulation, the nurse will need to assess the situation by asking the client about dietary and fluid intake, adherence to prescribed medications, and the presence of any other associated symptoms (eg, shortness of breath). If the client is stable, the nurse may anticipate the need to increase the dosage of the prescribed loop diuretic (eg, bumetanide). (Option 2) Losartan, valsartan, and candesartan (sartans) are the commonly used angiotensin II receptor blockers. They are used in clients who cannot take ACE inhibitors (eg, lisinopril, ramipril). They block the renin-angiotensin-aldosterone system but will not affect the fluid status of the client with acute heart failure. (Option 3) Metoprolol, bisoprolol, and carvedilol (lols) are the commonly used beta blockers for treatment of chronic heart failure. They block the negative effects of the sympathetic nervous system (increased heart rate) and reduce the cardiac workload. However, they can worsen heart failure if used in the acute setting of this condition. (Option 4) Isosorbide (nitrate) and hydralazine are used in African American clients with heart failure; this combination decreases cardiac workload by reducing preload and afterload. However, it does not decrease excess fluid. Educational objective: A client who reports weight gain and edema requires evaluation for additional symptoms of fluid volume overload (eg, shortness of breath) and adherence to the current treatment plan. If the client is stable, an increase in the dosage of loop diuretic (eg, furosemide, torsemide, bumetanide) is anticipated.

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." Correct answer 1,4 Explanation: A therapeutic INR for most conditions is 2-3 but can be up to 3.5 for heart valve disease. However, it is never between 4 and 5 (Option 3). Intestinal bacteria produce vitamin K; most antibiotics kill these bacteria, leading to vitamin K deficiency. Warfarin is a vitamin K antagonist; therefore, INR would overshoot in the setting of vitamin K deficiency, placing the client at risk for bleeding (Option 1). Leafy-green vegetables contain a high amount of vitamin K, which may lower a client's INR and make it difficult to maintain a therapeutic INR. Clients do not have to avoid consumption of leafy-green vegetables, but they should eat a consistent quantity and have their INR checked periodically (Option 2). (Option 4) It is important to take warfarin at the same time daily to maintain a consistent therapeutic drug level. (Option 5) Clients should call their health care provider if they miss or forget to take a warfarin dose. Double dosing is contraindicated. Educational objective: Warfarin must be taken at the same time daily to reach a therapeutic INR of 2-3. A diet high in vitamin K may decrease warfarin's anticoagulant effect. Most antibiotics will increase INR by causing a vitamin K deficiency.

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." [5%] 2. "I can still take this with my vardenafil prescription." [4%] 3. "I can take up to 3 pills in a 15-minute period if I am experiencing chest pain." [86%] 4. "I should stop taking the pills if I experience a headache." [3%] Correct answer 3 Explanation: Current evidence shows that up to 50% of clients lack knowledge about NTG administration procedures, storage, and side effects. Proper teaching can prevent many hospital visits for chest pain due to stable angina. Instructions for proper NTG administration include: Tablets are heat and light sensitive: They should be kept in a dark bottle and capped tightly. An opened bottle should be discarded after 6 months (Option 1). Take up to 3 pills in a 15-minute period: Take 1 pill every 5 minutes (up to 3 doses). Emergency medical services (EMS) should be called if pain does not improve or worsens 5 minutes after the first tablet has been taken. Previously, clients were taught to call after the third dose was taken, but newer studies suggest this causes a significant delay in treatment (Option 3). Avoid fatal drug interactions: Concurrent use of erectile dysfunction drugs (sildenafil, tadalafil, vardenafil) or alpha blockers (terazosin, tamsulosin) is contraindicated due to potentially fatal hypotension (Option 2). Headache may occur: Headache and flushing are common side effects of NTG due to systemic vasodilation and do not warrant medication discontinuation (Option 4). Educational objective: The nurse should instruct the client who is taking sublingual NTG to keep the tablets in a tightly capped, dark bottle away from heat and light. The client should be taught to take 1 tablet every 5 minutes (up to 3 tablets), but notify EMS if the pain does not improve or worsens 5 minutes after the first pill has been taken. These instructions should be reinforced at each appointment.

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." [69%] 2. "I will be discontinuing the heparin infusion as soon as I give this dose of warfarin." [3%] 3. "The two medications work synergistically to help break down the clot in your spouse's leg." [19%] 4. "We will hold the medication until I can call the health care provider (HCP) for clarification." [7%] Correct answer 1 Explanation: Warfarin begins to take effect in 48-72 hours and then takes several more days to achieve a maximum effect. Therefore, an overlap of a parenteral anticoagulant like heparin with warfarin is required. The typical overlap is 5 days or until the INR reaches the therapeutic level. The nurse will need to explain this overlap of the 2 medications to the client and the spouse. (Option 2) The nurse should not discontinue the heparin infusion until the INR is at the therapeutic level. (Option 3) Anticoagulants like heparin and warfarin will not break down or dissolve clots. However, they inhibit any further clot formation and keep the current clot from getting larger. Thrombolytics, such as tissue plasminogen activator, do break down clots. (Option 4) Clarification from the HCP is not needed. The warfarin should be administered to the client after explaining the reasons for its use to the client and the spouse. Educational objective: Warfarin requires an overlap of therapy with unfractionated heparin infusion or low-molecular-weight heparin (eg, enoxaparin, dalteparin) for several days until the INR is in the therapeutic range for the client's condition. .

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." [17%] 2. "I should lie down before taking the medication." [22%] 3. "I should not swallow the tablet." [2%] 4. "I will wait to call 911 if I don't experience relief after the third tablet." [57%] Correct answer 4 Explanation: Current evidence indicates that up to 50% of clients lack knowledge about administration procedures, storage, and side effects of NTG. Proper teaching can prevent many hospital visits for chest pain from stable angina. The client should be instructed to take 1 pill (or 1 spray) every 5 minutes for up to 3 doses, but emergency medical services (EMS) should be called if pain is unimproved or worsening 5 minutes after the first tablet. Previously, clients were taught to call EMS after the third dose, but newer studies suggest that this causes a significant delay in treatment (Option 4). NTG should cause a slight tingling sensation under the tongue if it is potent; otherwise, the medication is likely outdated. The oral mucosa needs to be moist for adequate absorption of NTG, and clients should be instructed to take a drink of water before administration if needed for dry mouth. Sublingual tablets should never be swallowed (Option 3). If using a spray, the client should not inhale it but direct it onto/under the tongue instead. (Option 1) Headache and flushing are common side effects of NTG due to systemic vasodilation. (Option 2) The client should lie down before taking the pill as it can cause dizziness from possible orthostatic hypotension. Educational objective: The nurse should instruct clients taking sublingual NTG that they should call EMS if their chest pain is unrelieved or worsening 5 minutes after the first tablet. The tablet should be allowed to dissolve under the tongue to allow for adequate absorption and should never be swallowed.

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%] 2. Administering via an infusion pump over at least 30 minutes [20%] 3. Drawing a trough level just prior to administration of the vancomycin [71%] 4. Starting a new IV line before administration [5%] Omitted Correct answer 3 Explanation: Vancomycin is a very potent antibiotic that can cause nephrotoxicity and ototoxicity. Measuring for serum concentrations is a way to monitor for risk of nephrotoxicity as well as for therapeutic response. Trough serum vancomycin concentrations are the most accurate and practical method for monitoring efficacy. A trough should be obtained just prior (about 15-30 minutes) to administration of the next dose. (Option 1) Unlike some chemotherapy medications, vancomycin does not commonly cause nausea or vomiting. Premedication with antiemetics is not required. However, premedication with antihistamines (diphenhydramine) is recommended if the client had developed red man syndrome, also known as red neck syndrome, with prior vancomycin infusion. This syndrome is characterized by red blotching of the face, neck, and chest due to too rapid administration. (Option 2) Vancomycin should be administered over a minimum of 60 minutes. Too rapid administration can cause red man syndrome, considered a toxic effect rather than an allergic reaction. (Option 4) The nurse would want to verify patency of the IV line prior to administration as thrombophlebitis is a possibility with vancomycin; however, a new IV line is not necessarily required. Educational objective: To measure for efficacy and risk of nephrotoxicity with vancomycin, the nurse should draw periodic trough levels just prior to administration of the next IV dose.

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." [1%] 2. "I've been trying to eat more fruits and vegetables. I discovered that I really like grapefruit." [70%] 3. "I've heard that having a glass of red wine with dinner every night is good for my heart." [24%] 4. "We no longer add salt when preparing meals. It has really been hard to get used to that." [2%] Correct answer 2 Explanation: The nurse should intervene when the client talks about eating grapefruit. Grapefruit inhibits enzyme CYP3A4. The drugs that are metabolized by the same pathway would not be metabolized, resulting in higher drug levels and serious side effects. Calcium channel blocker (eg, nifedipine) use with grapefruit juice can cause severe hypotension; some statins (eg, simvastatin) may result in myopathy. (Option 1) The nurse should praise and encourage the client to continue exercising and possibly increase the amount. This is a positive lifestyle change. The client should engage in moderate-intensity aerobic exercise for at least 30 minutes most days of the week or vigorous-intensity aerobic exercise for 20 minutes 3 days a week. (Option 3) It is thought that red wine in moderation has some beneficial effects on the heart. The nurse would not encourage a client to start drinking red wine if the client didn't already. Excessive alcohol consumption is strongly associated with hypertension. The nurse should encourage the client to discuss alcohol consumption with the health care provider (HCP). (Option 4) Sodium restriction is important in the management of hypertension. This teaching should be reinforced and the client should be encouraged to restrict the use of salt. Educational objective: The nurse should tell the client not to eat grapefruit or drink grapefruit juice while taking calcium channel blockers due to the possible development of severe hypotension. The nurse should report this client's statement to the HCP.

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 [5%] 2. Insomnia [1%] 3. Morning headache [5%] 4. Muscle aches or weakness [86%] Omitted Correct answer 4 Explanation: Rosuvastatin (Crestor) is a strong statin drug that can cut LDL drastically and reduce total cholesterol and triglycerides. It also increases HDL. A serious complication associated with statin medication is rhabdomyolysis. Rhabdomyolysis is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood. These substances can be harmful to the kidney and often cause kidney damage. The client should immediately report any signs of muscle aches or weakness to the HCP. These could be early signs of rhabdomyolysis, which can be fatal. (Options 1, 2, and 3) These can also be considered side effects of rosuvastatin calcium, but they are minor and do not need to be reported to the HCP immediately. If they persist, the client should consider reporting them. Educational objective: The nurse should teach all clients taking statin drugs (eg, atorvastatin, rosuvastatin) to immediately report any muscle aches or weakness, as these can lead to rhabdomyolysis, a muscle disintegration that can cause serious kidney injury.

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 [4%] 2. Change positions slowly to prevent dizziness [47%] 3. Don't stop taking this medication abruptly [46%] 4. Use an oral moisturizer to relieve dry mouth [1%] Omitted Correct answer 3 Explanation: Central-acting alpha2 agonists (eg, clonidine, methyldopa) decrease the sympathetic response from the brainstem to the peripheral vessels, resulting in decreased peripheral vascular resistance and vasodilation. Clonidine is a highly potent antihypertensive. Abrupt discontinuation (including the patch) can result in serious rebound hypertension due to the rapid surge of catecholamine secretion that was suppressed during therapy. Clonidine should be tapered over 2-4 days. Abrupt withdrawal of beta blockers can also result in rebound hypertension and in precipitation of angina, myocardial infarction, or sudden death. (Option 1) Avoiding high-sodium foods is important for blood pressure control but is not the most important advice for this client as consumption of these is not immediately life-threatening. (Option 2) Dizziness is a side effect of clonidine. The nurse should teach the client to change positions slowly and sit for a few minutes before rising to prevent falls. Drowsiness is also quite common with clonidine. Clients should not use it with alcohol or central nervous system depressants. However, dizziness and drowsiness should diminish with continued use of the medication. (Option 4) Dry mouth is a side effect of clonidine. Use of over-the-counter mouth moisturizers, chewing gum, or hard candy may be helpful for clients with dry mouth. Educational objective: Clonidine is a very potent antihypertensive. Abrupt discontinuation can result in serious rebound hypertensive crisis. Other common side effects of clonidine include dizziness, drowsiness, and dry mouth (the 3 Ds). Beta blockers, another class of blood pressure medications, can result in withdrawal symptoms if discontinued suddenly.

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." [3%] 2. "I should take the patch off when I shower." [2%] 3. "I will remove the patch if I develop a headache." [2%] 4. "I will rotate the site where I apply the patch." [90%] Omitted Correct answer 4 Answered correctly 90% Time: 1 seconds Updated: 04/28/2017 Explanation: Nitroglycerin patches are transdermal patches used to prevent angina in clients with coronary artery disease. They are usually applied once a day (not as needed) and worn for 12-14 hours and then removed. Continuous use of patches without removal can result in tolerance. No more than one patch at a time should be worn. The patch should be applied to the upper body or upper arms. Clean, dry, hairless skin that is not irritated, scarred, burned, broken, or calloused should be used. A different location should be chosen each day to prevent skin irritation. (Option 1) Phosphodiesterase inhibitors used in erectile dysfunction (eg, tadalafil, sildenafil, vardenafil) are contraindicated with the use of nitrates. Both have similar mechanisms and cause vascular smooth muscle dilation. Combined use can result in severe hypotension. (Option 2) Patches may be worn in the shower. (Option 3) Headaches are common with the use of nitrates. The client may need to take an analgesic. Educational objective: Nursing education about transdermal nitroglycerin includes application of the patch to the upper arms or body, rotating the sites daily, removing the patch at night, taking no erectile dysfunction medications, and informing clients that headaches are common. Patches do not need to be removed for bathing.

A home health nurse is preparing to start a milrinone infusion via a peripherally inserted central catheter for a client with end-stage heart failure. What equipment is most important to be present in the home? Select all that apply. 1. Bathroom scale for daily weights 2. Blood pressure cuff 3. Central line dressing change kits 4. Infusion pump 5. Intermittent urinary catheterization kits Omitted Correct answer 1,2,3,4 Answered correctly 27% Time: 1 seconds Updated: 05/14/2017 Explanation: Milrinone (Primacor) is a phosphodiesterase-3 inhibitor given via IV infusion to increase contractility and promote vasodilation. Milrinone, an inotropic agent, is often prescribed to clients with heart failure unresponsive to other pharmacologic therapies. The medication is usually infused over 48-72 hours in a hospital setting; however, home infusion through a central line is becoming more common as a palliative measure for end-stage heart failure. Milrinone infusion requires central venous access (eg, peripherally inserted central catheter) as the medication is a vesicant and can cause extravasation if infused through a peripheral IV line. The home health nurse should perform the following: Ensure that an infusion pump is used to control the rate, and instruct the family on basic troubleshooting (Option 4). Evaluate medication effectiveness and possible side effects. Monitor the central line insertion site for infection. Change the central line dressing as prescribed (Option 3). Monitor daily weight (Option 1). Monitor blood pressure for possible hypotension (Option 2). Implement safety precautions as hypotension increases the client's risk of falling. (Option 5) Milrinone causes vasodilation, which may result in increased urinary output; however, intermittent catheterization is not indicated. Educational objective: A client may receive a milrinone infusion in the home for palliative treatment of end-stage heart failure. The infusion is set up via an infusion pump and infused through a central line. The client and family should be instructed on basic pump troubleshooting as well as the importance of measuring daily weight and blood pressure.

What type of solution would be infused in clients with ICP.

A hypertonic

The health care provider 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 (5.3 mmol/L) [1%] 2. Potassium level of 4.2 mEq/L (4.2 mmol/L) [76%] 3. Reduction in dizziness [10%] 4. Sodium level of 138 mEq/L (138 mmol/L) [12%] Omitted Correct answer 2 Explanation: Spironolactone, amiloride, triamterene, and eplerenone are potassium-sparing diuretics. In general, these are very weak diuretics and antihypertensives and are used mainly in combination with thiazide diuretics to reduce potassium (K+) loss. The K+ level of 4.2 mEq/L (4.2 mmol/L) would indicate that this medication has been effective in preventing hypokalemia in a client receiving a thiazide diuretic such as hydrochlorothiazide or chlorthalidone. (Option 1) Blood glucose levels can be increased by thiazide diuretics but are not affected by potassium-sparing diuretics. (Option 3) All diuretics, including spironolactone, have the potential to cause dizziness. (Option 4) Potassium-sparing diuretics exchange sodium for potassium in the kidneys; potassium is saved but sodium is lost. Therefore, a normal sodium level is not a desired side effect. Educational objective: Potassium-sparing diuretics (eg, spironolactone, amiloride, triamterene, eplerenone) are often combined with thiazide diuretics to reduce potassium loss during hypertension treatment.

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 [22%] 2. Dizziness [42%] 3. Dry cough [16%] 4. Leg edema [18%] Omitted Correct answer 2 Explanation: Calcium channel blockers (nifedipine, amlodipine, felodipine, nicardipine) are vasodilators used to treat hypertension and chronic stable angina. They promote relaxation of vascular smooth muscles leading to decreased systemic vascular resistance and arterial blood pressure. The most important adverse effects of calcium channel blockers include dizziness (Option 2), flushing, headache, peripheral edema (Option 4), and constipation. The reduced blood pressure may initially cause orthostatic hypotension. The client should be taught to change positions slowly to prevent falls. Leg elevation and compression can help to reduce the edema. Constipation should be prevented with daily exercise and increased intake of fluids, fruits/vegetables, and high-fiber foods. (Option 3) Angiotensin-converting enzyme (ACE) inhibitors prevent the breakdown of bradykinin, which may produce a nonproductive cough in susceptible individuals. Discontinuation of the medication stops the cough. (Option 1) Adverse effects of beta-blockers include bradycardia, bronchospasm, depression, and decreased libido with erectile dysfunction. Educational objective: Calcium channel blockers are utilized to treat hypertension and chronic stable angina. Adverse effects of these medications include dizziness, flushing, headache, peripheral edema, and constipation. .

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 [4%] 2. BP 100/60 mm Hg, HR 90/min; client reports pain is 3 out of 10 [5%] 3. BP 110/70 mm Hg, HR 80/min; client reports pain is 0 out of 10 [67%] 4. BP 120/80 mm Hg, HR 70/min; client reports pain is 5 out of 10 [22%] Correct answer 3 Explanation: Acute coronary syndrome (ACS) is a broad term that encompasses a range of cardiac events, including unstable angina and myocardial infarction (with or without ST-segment elevation). Clients with ACS require immediate treatment to prevent continued ischemia of cardiac muscle. Intravenous nitroglycerin (glyceryl trinitrate) is used to increase cardiac blood flow and provide pain relief for clients with ACS until a definitive treatment plan (eg, percutaneous coronary intervention, thrombolytic therapy, bypass surgery) is determined. Because nitroglycerin is a vasodilator, continuous hemodynamic monitoring is required to prevent severe hypotension. The infusion rate is titrated by the nurse based on pain level and blood pressure (BP), usually every 3-5 minutes until pain is relieved and BP is stable. If systolic BP drops to <90 mm Hg or falls >30 mm Hg below client baseline, the infusion rate should be decreased or stopped. (Option 1) The client is hypotensive (systolic BP <90 mm Hg) and tachycardic. The infusion rate should be decreased or stopped. (Option 2) The client's BP is low, but in an acceptable range. However, complete pain relief has not been achieved. The nurse should continue to increase the infusion rate while closely observing BP. (Option 4) Although the BP is acceptable, pain relief has not been achieved. The nurse should continue titrating to a higher dose until the client's pain is relieved. Educational objective: Nitroglycerin and other nitrates increase cardiac blood flow and provide relief from the pain of ischemia in acute coronary syndrome by causing vasodilation. Their infusion should not cause systolic blood pressure to fall to <90 mm Hg or to drop >30 mm Hg below baseline.

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 Correct answer 3,4 Explanation: Drugs commonly associated with orthostatic hypotension include: Most antihypertensive medications, particularly sympathetic blockers such as beta blockers (eg, metoprolol) and alpha blockers (eg, terazosin) (Option 3) Antipsychotic medications (eg, olanzapine, risperidone) and antidepressants (eg, selective serotonin reuptake inhibitors) (Option 4) Volume-depleting medications such as diuretics (eg, furosemide, hydrochlorothiazide) Vasodilator medications (eg, nitroglycerine, hydralazine) Narcotics (eg, morphine) Clients at risk for developing orthostatic hypotension should be instructed to: Take medications at bedtime, if approved by the health care provider Rise slowly from a supine to standing position, in stages (especially in the morning) Avoid activities that reduce venous return and worsen orthostatic hypotension (eg, straining, coughing, walking in hot weather) Maintain adequate hydration (Option 1) Muscle cramps and liver injury, not orthostatic hypotension, are the major adverse effects of statin medications (eg, atorvastatin). (Option 2) Major side effects of metformin are lactic acidosis and gastrointestinal disturbances (metallic taste in the mouth, nausea, and diarrhea). Unlike insulin, metformin does not usually cause hypoglycemia. Orthostatic hypotension is not a common side effect. (Option 5) Proton pump inhibitors (eg, omeprazole) are associated with increased risk of pneumonia, Clostridium difficile diarrhea, and calcium malabsorption (osteoporosis), but not orthostatic hypotension. Educational objective: Medications commonly associated with orthostatic hypotension include most antihypertensives, most antipsychotics and antidepressants, and volume-depleting agents. Clients are instructed to rise slowly when standing to prevent a drop in blood pressure.

Educational objective: A client with signs of a potential allergic reaction should be assessed quickly, including allergy history and physical assessment (face, trunk, and limbs) with attention to signs of anaphylaxis. The health care provider should then be notified to assess the client, and the client's allergies should be updated in the medical record.

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? 4. Report excessive urination and increased thirst [62%] Explanation: Lithium is a mood stabilizer most often used to treat bipolar affective disorders. It has a narrow therapeutic index (0.6-1.2 mEq/L [0.6-1.2 mmol/L]). Risk factors for lithium toxicity include dehydration, decreased renal function (in the elderly), diet low in sodium, and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs [NSAIDS] and thiazide diuretics). Chronic toxicity can result in: Neurologic manifestations - ataxia, confusion or agitation, and neuromuscular excitability (tremor, myoclonic jerks) Nephrogenic diabetes insipidus - polyuria and polydipsia (increased thirst) (Option 4) Clients should be educated about monitoring for these symptoms and obtaining serum lithium levels at regular intervals. (Option 1) Dietary potassium should be avoided when taking drugs such as potassium-sparing diuretics (eg, spironolactone, triamterene, amiloride) and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. (Option 2) Regular exercise and a high-fiber diet can prevent constipation, which is not a known side effect of lithium. Opioids, anticholinergics, and iron supplements are medications that cause constipation. (Option 3) Good oral hygiene is ideal for every client but is not specially indicated for those taking lithium. Clients taking phenytoin should maintain oral hygiene to prevent gingival hyperplasia. Educational objective: Risk factors for lithium toxicity include dehydration, decreased renal function, low-sodium diet, and drug-drug interactions (eg, NSAIDs and thiazide diuretics). Chronic toxicity manifests with neurologic symptoms (ataxia, confusion or agitation, and neuromuscular excitability) and/or diabetes insipidus (polyuria and polydipsia).

A client has a serum potassium level of 2.8 mEq/L, and the health care provider (HCP) prescribes intravenous (IV) potassium chloride (KCL). The nurse administers 10 mEq KCL/100 mL 5% dextrose in water at 100 mL/hr through the client's peripheral IV line using an infusion pump. Shortly after initiation of the infusion, the client reports feeling burning and discomfort at the IV site. What is the nurse's priority action? 1. Notify HCP to request a peripherally inserted central catheter (PICC) [1%] 2. Notify HCP to request an oral preparation of KCL [1%] 3. Slow the rate of the KCL infusion [49%] 4. Stop the infusion of KCL immediately [48%] Omitted Correct answer 3 Explanation: KCL, an electrolyte replacement to correct hypokalemia, is a high-alert drug that is never administered by the IV push, intramuscular, or subcutaneous routes. The recommended peripheral infusion rate is 5-10 mEq/hr. However, the nurse should always follow institution IV guidelines and policy and procedure for administering KCL. The nurse's priority action is to slow the infusion rate if the client feels a burning discomfort at the IV site shortly after initiation of the infusion. KCL irritates the vein, and irritation and discomfort at the site is expected. Slowing the infusion rate is effective in alleviating discomfort. (Option 1) KCL in concentrations 20-40 mEq/100 mL at a maximum rate of 40 mEq/hr should be administered through a central venous access device (CVAD) (eg, PICC, centrally inserted catheter) to prevent postinfusion phlebitis. A concentration of 10 mEq KCL/100 mL can be administered through a peripheral vein at the recommended infusion rate. (Option 2) The IV infusion is preferred over the oral preparation to decrease the risk for dysrhythmias when hypokalemia must be corrected quickly. Some clients may need both oral and IV forms if the serum potassium levels are markedly low. However, this action is not a priority. (Option 4) Rapid correction of this client's hypokalemia (2.8 mEq/L) is necessary due to risk for hypokalemia-associated dysrhythmias. Stopping the infusion when not necessary further increases risk. The nurse assesses the site at least every hour for adverse reactions (eg, redness, pain, swelling, phlebitis, thrombosis, extravasation or infiltration), and stops the infusion if any occur. Educational objective: Potassium chloride (KCL) administered by the IV route is prescribed for rapid correction of hypokalemia (<3.5 mEq/L). It is irritating to the vein but can be administered slowly through a peripheral vein at recommended infusion rates (5-10 mEq/hr). KCL concentrations 20-40 mEq/100 mL at a maximum rate of 40 mEq/hr should be administered through a CVAD to prevent postinfusion phlebitis or infiltration.

A nurse is preparing an educational presentation on herbal supplements for the local community center. Saw palmetto is one herbal medicine being discussed. Which audience participants would find this information beneficial? 1. Clients diagnosed with heart failure [6%] 2. Clients experiencing major depressive disorder [13%] 3. Elderly clients with benign prostatic hyperplasia [50%] 4. Perimenopausal clients experiencing hot flashes [29%] Omitted Correct answer 3 Explanation: Herbal preparations are not regulated by governmental agencies and are generally classified as food or dietary supplements. Manufacturers are therefore able to avoid the scientific scrutiny exercised when prescription drugs are readied for the market. Saw palmetto is one such herbal preparation, and clients most often use it to treat benign prostatic hyperplasia. (Option 1) Hawthorn extract is used to treat heart failure and in some countries (eg, Germany) is an approved treatment for this purpose. (Option 2) St John's wort has been used for centuries to treat depression. It may cause hypertension and serotonin syndrome when used with other antidepressants. (Option 4) Black cohosh is an herbal supplement often used by perimenopausal clients experiencing hot flashes. Educational objective: Saw palmetto, a herbal preparation, is often used to treat benign prostatic hyperplasia. St John's wort has been used for centuries to treat depression.

Arterial blood gases (ABGs) indicate the acid-base balance in the body and how well oxygen is being carried to the tissues. It is common to measure

ABGs after a ventilator change to assess how well the client has tolerated it. Factors such as changes in the client's activity level or oxygen settings, or suctioning within 20 minutes prior to the blood draw can cause inaccurate results. Unless the client's condition dictates otherwise, the nurse should avoid suctioning as it will deplete the client's oxygen level and cause inaccurate test results.

What Expected adverse effects can occur after a colonoscopy due to air inflation during the procedure.

Abdominal cramps

The assessment findings most important for the nurse to report to the health care provider include the following when pt suspected of shock:

Absent bowel sounds. Paralytic ileus occurs in the presence of sepsis and hypoxia as blood is shunted away from the gastrointestinal tract to the vital organs. Capillary refill 5 seconds. Prolonged capillary refill (>3-4 seconds in an adult) indicates inadequate blood flow to peripheral tissues. Serum glucose >140 mg/dL (7.8 mmol/L). Gluconeogenesis occurs in response to the physiologic stress of infection. Insulin resistance is associated with anaerobic metabolism

treat herpes infection as they shorten the duration and severity of active lesions

Acyclovir (Zovirax), famciclovir, and valacyclovir

Placing the IV line as close as possible, not distal, to the heart is essential for the drug to have full effect. ________________ is given rapidly over 1-2 seconds and then followed by rapid 20-mL normal saline flush. Expected: Transient asystole is common, and clients often experience flushing and dizziness.

Adenosine

The nurse should follow the ABCs of assessment with the heart failure client who is short of breath and coughing.

Airway, breathing, and circulation should be assessed, including auscultation of breath sounds, measurement of respiratory rate, and oxygen saturation.

A client has a follow-up checkup in the urology clinic. Six months ago, the client started taking tolterodine. What data collected from the client should the nurse report to the health care provider? 1. Client excitedly reports being able to go an entire work day without having to urinate [71%] 2. Client is using an over-the-counter artificial saliva product for dry mouth [10%] 3. Client reports occasional dizziness in the morning and when changing positions [14%] 4. Client reports symptoms of constipation [4%] Omitted Correct answer 1 Explanation: Tolterodine (Detrol LA), oxybutynin (Ditropan), and solifenacin (Vesicare) are antimuscarinic/anticholinergic medications used for overactive bladder and urge urinary incontinence. They decrease urinary urgency and frequency. The most common side effects are anticholinergic (eg, dry mouth, constipation, cognitive dysfunction). The client's report of not urinating the entire day while at work may indicate that the dosage is too high and is causing urinary retention. Urinary retention can lead to bladder infections and distension. This information should be reported to the health care provider (HCP). (Option 2) Artificial saliva products and sugar-free hard candy and gum are acceptable ways to manage dry mouth caused by anticholinergic medications. (Option 3) Occasional dizziness is a side effect of tolterodine. The client should rise and change positions slowly. However, if this client is receiving too high a dose, reduction of the dose may alleviate the dizziness. Severe dizziness should be reported to the HCP. (Option 4) Constipation can be managed with increased fiber in the diet, fluids, stool softeners, or laxatives. Educational objective: Anticholinergic medications (eg, tolterodine, oxybutynin, solifenacin) are commonly used for overactive bladder. The client should experience a reduction in the number of times needed to urinate, but the number should not decrease below typical urination frequency. The nurse should also teach the client how to manage the common side effects of dry mouth, constipation, and mild dizziness.

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%] 2. Blood urea nitrogen 20 mg/dL (7.1 mmol/L) [9%] 3. Client report of tinnitus [78%] 4. Urine output of 400 mL since last dose [9%] Omitted Correct answer 3 Explanation: Serious adverse reactions to aminoglycosides (eg, gentamicin, tobramycin, amikacin) include ototoxicity and nephrotoxicity. Age, renal function, and drug dose affect the occurrence of these adverse reactions. Careful dosing is especially important for older clients. Tinnitus and vertigo are early signs of ototoxicity. The nurse should carefully assess for changes in the client's hearing, balance, and urinary output. (Option 1) The blood pressure is low, but the nurse should compare it to previous readings. Blood pressure is not generally affected by IV antibiotics. The client may be taking antibiotics for sepsis. (Option 2) The blood urea nitrogen (BUN) is within normal range (6-20 mg/dL [2.1-7.1 mmol/L]), but is at the high end of normal and should continue to be monitored. (Option 4) Urine output is adequate (>30 mL/hr) but should be closely monitored. Educational objective: The nurse should closely monitor renal function and assess for any changes in hearing or balance in a client receiving aminoglycoside antibiotics. Ototoxicity and nephrotoxicity are serious adverse reactions related to this type of medication.

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 [1%] 2. In the morning on an empty stomach [25%] 3. In the morning with breakfast [26%] 4. With the evening meal [46%] Correct answer 4 Explanation: Statin drugs (eg, simvastatin, atorvastatin, rosuvastatin) are prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. Most of the cholesterol in the body is synthesized by the liver during the fasting state, at night. Trials have found greater reductions in total and LDL cholesterol when statins (especially those that are short-acting; eg, simvastatin) are taken in the evening or at bedtime as opposed to during the day. (Options 1 and 3) Medications that can cause stomach upset (eg, NSAIDs) should be taken with food. (Option 2) Medications such as levothyroxine should be taken on an empty stomach in the morning. Acid-suppressing medications (eg, proton pump inhibitors, H2 blockers) should also be taken 30 minutes before the meal. Educational objective: The client taking a statin drug such as simvastatin should be taught to take the medication with the evening meal or at bedtime to promote maximal effectiveness.

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 [23%] 2. Fasting blood sugar of 160 mg/dL (8.9 mmol/L) [12%] 3. Presence of muscle cramps [59%] 4. Sunburn [4%] Correct answer 3 Explanation: Hydrochlorothiazide and chlorthalidone are the most commonly used thiazide diuretics for treating hypertension. The major side effects of thiazide diuretics include: Hypokalemia (manifests as muscle cramps) Hyponatremia (manifests as altered mental status and seizures) Hyperuricemia (may worsen gout attacks) Hyperglycemia (requires adjustment of diabetic medications) Of the above side effects, hypokalemia is the most serious as it can lead to life-threatening cardiac arrhythmias. (Option 1) Orthostatic hypotension may be a side effect of many diuretics. The nurse should teach the client to rise slowly and sit for a few minutes before standing. The elderly client may need to use a cane or walker to prevent falls. Additionally, the nurse should check that the client's blood pressure is not too low. (Option 2) Mild to moderate hyperglycemia is common with thiazides and needs to be addressed. However, it is not life-threatening and therefore not a priority. (Option 4) Most thiazide diuretics are sulfa derivatives. Therefore, they can cause photosensitivity. The nurse should encourage the client to use sunscreen and wear protective clothing. Educational objective: The nurse should suspect hypokalemia in the presence of muscle cramps in a client taking diuretics. Hypokalemia can lead to dangerous ventricular dysrhythmias.

It is a low-pitched sound heard in early diastole that is similar to the sound of a horse's gallop.

An S3 gallop is an extra heart sound that occurs closely after S2.

when a client dies by suicide, homicide, accident, or within 24 hours of admission to a health care facility. Consent from the family is not required. During postmortem care, all tubes and IV lines should be left in place upon

An autopsy is often performed

often present in SLE

Anemia, mild leukopenia (white blood cell count <4,000/mm3 [4.0×109/L]), and thrombocytopenia (platelet count <150,000/mm3 [150×109/L])

What Med will NOT be safe for a PREGNANT pt. with Hypertension to be prescribed?

Angiotensin-converting enzyme (ACE) inhibitors such as lisinopril (Prinivil) as they can affect kidney development in the fetus.

It is very important to rapidly diagnose and treat the client with chest pain and potential myocardial infarction to preserve cardiac muscle. Initial interventions in emergency management of chest pain are as follows:

Assess airway, breathing, and circulation (ABCs) Position client upright unless contraindicated Apply oxygen, if the client is hypoxic Obtain baseline vital signs, including oxygen saturation Auscultate heart and lung sounds Obtain a 12-lead electrocardiogram (ECG) Insert 2-3 large-bore intravenous catheters Assess pain using the PQRST method Medicate for pain as prescribed (eg, nitroglycerin) Initiate continuous electrocardiogram (ECG) monitoring (cardiac monitor) Obtain baseline blood work (eg, cardiac markers, serum electrolytes) Obtain portable chest x-ray Assess for contraindications to antiplatelet and anticoagulant therapy Administer aspirin unless contraindicated

A client in complete heart block is often bradycardic and hemodynamically unstable. Transcutaneous pacing should be used until a permanent pacemaker can be inserted.

Atropine, dopamine, or epinephrine may be used to increase heart rate and blood pressure until temporary pacing is started.

RAI should be taught to use the following precautions for up to 1 week:

Avoid close proximity to pregnant women or children Do not breastfeed as RAI may be excreted through breast milk and could harm the infant Do not share utensils with others or use bare hands to handle food that is to be served to others Isolate personal laundry (eg, bed linens, towels, daily clothes) and wash it separately Use a separate toilet from the rest of the family and flush 2-3 times after each use Wash hands frequently and thoroughly, especially after restroom use Drink plenty of fluids Sleep in a separate bed from others and do not sit near others in an enclosed area for a prolonged period of time (eg, train or flight travel)

Herpes simplex virus type 2 (HSV-2)rpes. NI:

Avoid sexual activity when lesions are present as the virus spreads through contact with the lesion; barrier contraception is not sufficient during an outbreak . After the outbreak has resolved, condoms should be used in future sexual encounters as transmission is possible even in the absence of active lesions. Keep the area with lesions clean and dry. Avoid use of perfumed soaps and bubble baths. Maintain proper hand hygiene and avoid touching the lesions to prevent spreading. Use sitz baths and oatmeal baths to provide comfort and relief of itching and burning. Vesicles contain numerous virus particles, leading to the possibility of self-inoculation. This can be prevented by avoidance of hand contact with lesions during an outbreak. Use of a hair dryer on a cool setting is an effective means of drying the lesions and promoting client comfort. Warm water provides symptomatic relief.

Block Time Remaining: 00:00:01 TUTOR Test Id: 80944027 QId: 30982 (921666) 1 of 54 A A A The home health nurse reviews the serum laboratory test results for a client with seizures. The phenytoin level is 27 mcg/mL. The client makes which statement that may indicate the presence of dose-related drug toxicity and prompt the nurse to notify the health care provider? 1. "I am feeling unsteady when I walk." [30%] 2. "I am getting up to urinate about 4 times during the night." [4%] 3. "I have a metallic taste in my mouth when I eat." [25%] 4. "My gums are getting so puffy and red." [40%] Omitted Correct answer 1 Answered correctly 30% Time: 1 seconds Updated: 12/08/2016 Explanation: Phenytoin (Dilantin) is an anticonvulsant drug used to treat generalized tonic-clonic seizures. The therapeutic serum phenytoin reference range is between 10-20 mcg/mL. Levels are measured when therapy is initiated, periodically throughout treatment to guide dosing until a steady state is attained (3-12 months), and if seizure activity increases. Early signs of toxicity include horizontal nystagmus and gait unsteadiness. These may be followed by slurred speech, lethargy, confusion, and even coma. Bradyarrhythmias and hypotension are usually seen with intravenous phenytoin. (Option 2) Nocturia is an expected side effect of diuretics but not phenytoin. Nocturia is also seen with diabetes mellitus and benign prostatic hyperplasia. (Option 3) Metallic taste in the mouth is often seen with metronidazole but not with phenytoin. (Option 4) Gingival hyperplasia is a common expected side effect of phenytoin and does not indicate drug toxicity. It occurs more often in clients <23 years of age who are prescribed >500 mg/day. Good oral hygiene can limit symptoms. Educational objective: Phenytoin, an anticonvulsant drug, is used to treat generalized tonic-clonic seizures. Common symptoms of phenytoin drug-induced toxicity involve the central nervous system and include ataxia, nystagmus, slurred speech, and decreased alertness.

Block Time Remaining: 00:00:02 TUTOR Test Id: 80944027 QId: 31857 (921666) 2 of 54 A A A A client with generalized anxiety disorder has received a new prescription for sertraline. The nurse should teach this client about which possible side effect? 1. Constipation [12%] 2. Sedation [31%] 3. Sexual dysfunction [50%] 4. Weight loss [4%] Omitted Correct answer 3 Answered correctly 50% Time: 1 seconds Updated: 04/29/2017 Explanation: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat major depression and anxiety disorders. SSRIs (eg, fluoxetine, paroxetine, citalopram, escitalopram, sertraline) are generally well tolerated except for sexual dysfunction. Clients often underreport this side effect. However, when asked specifically, over 50% of clients taking SSRIs may be experiencing some type of sexual dysfunction. This can be a decrease in sexual desire, arousal, or orgasm and may vary by gender. The nurse should discuss this with the client. The side effect may decrease or cease after a 2- to 4-week waiting period for the therapeutic effect, or the client may be able to switch to a different antidepressant medication (eg, bupropion). (Option 1) Constipation is uncommon with SSRIs. Drugs with anticholinergic activity (eg, tricyclic antidepressants such as amitriptyline) may result in constipation or urinary retention. (Option 2) Sedation is a common side effect of benzodiazepines (eg, alprazolam, lorazepam, diazepam, and chlordiazepoxide), first generation antihistamines, and narcotic medications. SSRIs may cause insomnia. (Option 4) Weight gain is a common side effect of most SSRIs, especially with long-term therapy. Educational objective: SSRIs (eg, fluoxetine, paroxetine, citalopram, escitalopram, sertraline) can cause sexual dysfunction. The client should be encouraged to report this to the health care provider if they are still present 2-4 weeks after treatment initiation.

Block Time Remaining: 00:00:04 TUTOR Test Id: 80944027 QId: 31138 (921666) 3 of 54 A A A A client was prescribed phenytoin 100 mg orally 3 times a day a month ago. The serum phenytoin level is 32 mcg/mL and the nurse notifies the health care provider (HCP). Which action is anticipated from the HCP? 1. Administer phenytoin as prescribed [11%] 2. Decrease phenytoin daily dose [72%] 3. Increase phenytoin daily dose [3%] 4. Repeat serum phenytoin level in 2 hours [12%] Omitted Correct answer 2 Answered correctly 72% Time: 2 seconds Updated: 12/12/2016 Explanation: Phenytoin (Dilantin), an anticonvulsant drug, is used to treat generalized tonic-clonic seizures. The therapeutic serum phenytoin reference range is 10-20 mcg/mL. In the presence of an elevated reference range (32 mcg/mL), if no seizure activity is observed, the nurse would anticipate the HCP to prescribe a decreased daily dose. The nurse will continue to monitor for signs of toxicity (eg, ataxia, nystagmus, slurred speech, decreased mentation). (Options 1 and 3) The serum phenytoin level is elevated, so administering the prescribed dose or increasing the dose can raise the level and further increase the risk for drug-induced toxicity. (Option 4) Repeating the serum phenytoin level in 2 hours will not result in a significant change as the average half-life of the drug is 22 hours. Educational objective: Phenytoin (Dilantin) is used to treat generalized tonic-clonic seizures. Common symptoms of phenytoin-induced toxicity involve the central nervous system (eg, nystagmus, ataxia, slurred speech, decreased mentation) and can occur when phenytoin plasma levels exceed the therapeutic reference range (10-20 mcg/mL).

Block Time Remaining: 00:00:07 TUTOR Test Id: 80944027 QId: 31937 (921666) 4 of 54 A A A Exhibit The nurse working on the inpatient psychiatric unit is preparing to administer 9:00 AM medications to a client. The medication administration record is shown in the exhibit. On assessment, the client is tremulous, exhibits muscle rigidity, and has a temperature of 101.1 F (38.4 C). Which action should the nurse take? Click on the exhibit button for additional information. 1. Give all medications, including acetaminophen, and reassess in 30 minutes [10%] 2. Hold the haloperidol, give acetaminophen, and reassess in 30 minutes [14%] 3. Hold the haloperidol and notify the health care provider (HCP) immediately [61%] 4. Hold the hydrochlorothiazide and notify the HCP immediately [13%] Omitted Correct answer 3 Answered correctly 61% Time: 3 seconds Updated: 01/10/2017 Explanation: This client is exhibiting signs and symptoms of neuroleptic malignant syndrome (NMS), a rare but potentially life-threatening reaction. NMS is most often seen with the "typical" antipsychotics (eg, haloperidol, fluphenazine). However, even the newer "atypical" antipsychotic drugs (eg, clozapine, risperidone, olanzapine) can cause the syndrome. NMS is characterized by fever, muscular rigidity, altered mental status, and autonomic dysfunction (eg, sweating, hypertension, tachycardia). Treatment is supportive and is directed at reducing fever and muscle rigidity and preventing complications. Treatment in an intensive care unit (ICU) may be required. The most important intervention is to immediately discontinue the antipsychotic medication and notify the HCP for further assessment. (Option 1) Administering acetaminophen may be appropriate, but it is more important to discontinue the haloperidol and notify the HCP immediately. (Option 2) Due to the life-threatening nature of NMS, the HCP should be informed immediately. The HCP may order muscle enzymes, administer IV fluids/medications, and move the client for close monitoring (eg, to the ICU). (Option 4) Hydrochlorothiazide is a diuretic commonly used for hypertension. It does not cause NMS symptoms. Educational objective: NMS is characterized by fever, muscle rigidity, altered mental status, and autonomic dysfunction. The most important intervention is to discontinue the antipsychotic medication.

Block Time Remaining: 00:00:08 TUTOR Test Id: 80944027 QId: 31302 (921666) 5 of 54 A A A An elderly client with depression is given trazodone. Which statement by the client indicates that additional teaching is needed? 1. "I will call the health care provider if I develop a prolonged erection." [3%] 2. "I will get up slowly, in stages, from supine to standing." [2%] 3. "I will take this medication at night to avoid daytime drowsiness." [3%] 4. "It is okay to drink 2 glasses of wine at night." [90%] Omitted Correct answer 4 Answered correctly 90% Time: 1 seconds Updated: 05/20/2017 Explanation: Trazodone (Oleptro), a serotonin modulator, is used to treat major depressive disorders. In addition to affecting serotonin levels, the drug blocks alpha and histamine (H1) receptors. Blockade of alpha receptors can cause orthostatic hypotension similar to that from other alpha blockers (eg, terazosin, tamsulosin) used to treat benign prostatic hyperplasia. Blockade of H1 receptors leads to sedation. Therefore, this drug is particularly effective in treating insomnia associated with depression. However, concurrent intake of other medications or substances that cause sedation can be detrimental; these include benzodiazepines (eg, alprazolam, lorazepam, diazepam), sedating antihistamines (eg, chlorpheniramine, hydroxyzine), and alcohol (Option 4). (Option 1) Priapism is a known serious side effect of trazodone. A client with an erection lasting several hours should go to the hospital. (Option 2) Clients should be advised to rise from supine to standing slowly, in stages, due to the risk of orthostatic hypotension. (Option 3) The drug should be taken at bedtime to avoid daytime sedation. Educational objective: Trazodone modulates serotonin levels in the brain. In addition, it blocks alpha and H1 receptors, leading to orthostatic hypotension and sedation, respectively. Priapism is another serious side effect, though rare.

Block Time Remaining: 00:00:08 TUTOR Test Id: 80944027 QId: 32922 (921666) 6 of 54 A A A The nurse is assessing a client diagnosed with tuberculosis who started taking rifapentine a week ago. Which statement by the client warrants further assessment and intervention by the nurse? 1. "I do not want to get pregnant, so I restarted my oral contraceptive last month." [65%] 2. "I have been taking my medications with breakfast every morning." [11%] 3. "I should alert my health care provider if I notice yellowing of my skin." [11%] 4. "Since I started this medicine, my saliva has become a red-orange color." [11%] Omitted Correct answer 1 Answered correctly 65% Time: 0 seconds Updated: 06/04/2017 Explanation: Rifapentine (Priftin), a derivative of rifampin, is an antitubercular agent used with other drugs (eg, isoniazid) as a combination therapy in active and latent tuberculosis infections. Both rifampin and rifapentine reduce the efficacy of oral contraceptives by increasing their metabolism; therefore, this client will need an alternate birth control plan (non-hormonal) to prevent pregnancy during treatment (Option 1). (Option 2) Rifapentine should be taken with meals for best absorption and to prevent stomach upset. (Option 3) Hepatotoxicity may occur; therefore, liver function tests are required at least every month. Signs and symptoms of hepatitis include jaundice of the eyes and skin, fatigue, weakness, nausea, and anorexia. (Option 4) Rifapentine may cause red-orange-colored body secretions, which is an expected finding. Dentures and contact lenses may be permanently stained. Educational objective: Clients taking rifampin or rifapentine (Priftin) as part of antitubercular combination therapy should be taught to prevent pregnancy with non-hormonal contraceptives, notify the health care provider of any signs or symptoms of hepatotoxicity (eg, jaundice, fatigue, weakness, nausea, anorexia), and expect red-orange-colored body secretions.

Block Time Remaining: 00:00:10 TUTOR Test Id: 80944027 QId: 30691 (921666) 7 of 54 A A A The nurse administers the prescribed dose of hydromorphone 2 mg to a client who is 2 days postoperative from a colostomy. Which assessment finding is most important for the nurse to follow-up? 1. Client has 1 emesis of green fluid [12%] 2. Client has had no bowel movement for 2 days [18%] 3. Client falls asleep while talking to the nurse [46%] 4. Client reports experiencing pruritus [22%] Omitted Correct answer 3 Answered correctly 46% Time: 2 seconds Updated: 05/19/2017 Explanation: Pasero opioid-induced sedation scale Level of sedation Nursing intervention S - Sleeping, easy to rouse No action necessary 1 - Awake, alert No action necessary May increase sedation 2 - Slightly drowsy but easy to rouse Acceptable, no action necessary 3 - Falls asleep during conversation Unacceptable Monitor respiratory status Notify health care provider to decrease sedation by 25%-50% 4 - Somnolent, minimal or no response to verbal & physical stimuli Stop sedation Consider using naloxone Notify health care provider Monitor respiratory status Respiratory depression is the most serious side effect of narcotic medication. Sedation precedes respiratory depression. Falling asleep during a conversation scores "3" on the Pasero Opioid-Induced Sedation Scale (POSS); no additional narcotics should be given to the client. Other classes of drugs (eg, non-steroidal anti-inflammatory medications) can be given if the client is still in pain. The client will also be at increased risk for respiratory depression if the pain is completely relieved and/or it is night time. No additional narcotics should be given until the client is at level 2 sedation on POSS (eg, slightly drowsy, easily aroused). (Option 1) Nausea or vomiting is a typical side-effect of narcotic administration, especially when it is given in a larger dose or to the opioid-naïve client. It usually lessens with time and repeat administration. Nausea or vomiting would not be a concern unless it is excessive or severe. The nurse should ensure that the client receives adequate hydration (eg, intravenous fluids, clear liquids, antiemetics). (Option 2) Constipation is a known side effect of opioid administration and does not lessen with long-term administration. Proactive measures are needed as long as the client is on narcotics. However, large intestine peristalsis does not usually start until 2-3 days after surgery. (Option 4) Pruritus (itching) is a known side effect of narcotic administration. It is usually treated with diphenhydramine (Benadryl) or some other antihistamine. Educational objective: Sedation precedes respiratory depression in narcotic administration. A client (especially if on high doses) should be assessed for sedation level. Level 3 sedation on POSS requires that no additional narcotics be administered to the client.

Block Time Remaining: 00:00:11 TUTOR Test Id: 80944027 QId: 31829 (921666) 8 of 54 A A A Exhibit A client with a history of degenerative arthritis is being discharged home following an exacerbation of chronic obstructive pulmonary disease. After reviewing the discharge medications, the nurse should educate the client about which topics? Select all that apply. Click on the exhibit button for additional information. 1. Dryness of the mouth and throat may occur 2. Ringing in the ears is an expected, transient side effect 3. The albuterol canister should not be shaken before use 4. The health care provider should be notified if stools are black and tarry 5. Tiotropium capsules should not be swallowed Omitted Correct answer 1,4,5 Answered correctly 52% Time: 1 seconds Updated: 02/17/2017 Explanation: A common side effect of tiotropium (Spiriva) and other anticholinergics (eg, ipratropium, benztropine) is xerostomia (dry mouth) due to the blockade of muscarinic receptors of the salivary glands, which inhibits salivation. Sugar-free candies or gum may be used to alleviate dry mouth and throat (Option 1). Tiotropium capsules should not be swallowed. These capsules are placed inside the inhaler device, and the capsule is pierced, allowing the client to inhale its contents (Option 5). Glucocorticoids (eg, prednisone), when taken in combination with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen, can increase the risk of gastrointestinal ulceration and bleeding. The client should report black, tarry stools (ie, melena) to the health care provider as they could indicate gastrointestinal bleeding (Option 4). (Option 2) Tinnitus (ie, ringing in the ears) is an uncommon side effect of NSAID (eg, naproxen) use. Tinnitus is commonly associated with toxicity related to salicylate-containing NSAIDs (eg, aspirin) or aminoglycosides (eg, gentamicin, neomycin, tobramycin); its onset should be reported by a client taking these medications. The medication may need to be discontinued to prevent permanent hearing loss. (Option 3) The albuterol canister should be shaken prior to inhalation to ensure appropriate medication delivery. Educational objective: The nurse should teach the client taking glucocorticoids with aspirin or nonsteroidal anti-inflammatory drugs about the risk for gastrointestinal bleeding or ulceration. Xerostomia is a common side effect of anticholinergic drugs that can be alleviated with sugar-free candies or gum. Tiotropium capsules should not be swallowed.

Block Time Remaining: 00:00:12 TUTOR Test Id: 80944027 QId: 30736 (921666) 9 of 54 A A A The nurse in an ambulatory care center is teaching a client with a diagnosis of persistent depressive disorder (dysthymia) about the appropriate use of bupropion hydrochloride SR. Which statement made by the client indicates a need for further teaching? 1. "If I have a sudden change in my mood, I should call my physician immediately." [9%] 2. "If I have trouble swallowing the tablet, I can cut it in half." [81%] 3. "If I miss a dose, I should not double the next dose to catch up." [5%] 4. "It may take several weeks before I get better." [3%] Omitted Correct answer 2 Answered correctly 81% Time: 1 seconds Updated: 01/22/2017 Explanation: Bupropion hydrochloride (Wellbutrin) is an atypical antidepressant used to treat depressive disorders, including major depressive disorder, seasonal affective disorder, and persistent depressive disorder (dysthymia). Preparations of bupropion hydrochloride include immediate-release, sustained release (SR), and extended-release (XL) tablets. Any medication marked SR or XL should not be chewed, cut, or crushed due to the risk of adverse effects from too rapid absorption of the drug. No form of bupropion hydrochloride should be altered; tablets should be swallowed whole, with or without food. Seizures are of particular concern if a client takes a high or toxic dose of bupropion hydrochloride. Clients on any kind of antidepressant need to be monitored closely for worsening depression, sudden or unusual behavior or mood changes, and the emergence of suicidal thoughts and behaviors. Clients with a diagnosis of depression and/or their family members need education and information on the increased risk of suicide (Option 1). Additional instructions to a client about the use of bupropion hydrochloride include the following: Limit alcohol; inform the health care provider if you are used to consuming large amounts of alcohol Do not double up on the medication if a scheduled dose is missed (Option 3) Take the medication at the same time each day It may take several weeks to feel the effects of bupropion hydrochloride (Option 4) Weight loss may occur when taking this medication Educational objective: No form of bupropion hydrochloride should be crushed, chewed, or cut due to the risk of seizures and other adverse effects caused by the more rapid absorption and resulting higher serum levels of the drug. No medications labeled SR or XL should be altered before they are administered. This type of medication preparation should be swallowed whole.

Block Time Remaining: 00:00:13 TUTOR Test Id: 80944027 QId: 32021 (921666) 10 of 54 A A A A child with attention-deficit hyperactivity disorder (ADHD) has been taking methylphenidate for a year. What are the priority nursing assessments when the client comes to the clinic for a well-child visit? 1. Attention span and activity level [28%] 2. Dental health and mouth dryness [7%] 3. Height/weight and blood pressure [52%] 4. Progress with schoolwork and in making friends [11%] Omitted Correct answer 3 Answered correctly 52% Time: 1 seconds Updated: 12/16/2016 Explanation: Methylphenidate (Ritalin, Concerta) is a central nervous system stimulant used to treat ADHD and narcolepsy. It affects neurotransmitters (dopamine and norepinephrine) in the brain that contribute to hyperactivity and lack of impulse control. A common side effect of methylphenidate is loss of appetite with resulting weight loss. Parents and caregivers should be instructed to weigh the child with ADHD at least weekly due to the risk of temporary interruption of growth and development. It is very important to compare weight/height measures from one well-child checkup to the next. If weight loss becomes a serious problem, methylphenidate can be given after meals; however, before meals is preferable. Another side effect of methylphenidate is increased blood pressure and tachycardia. These should be monitored before and after starting treatment with stimulants. (Option 1) Therapeutic effects of methylphenidate include increased attention span and improvement in hyperactivity. These would be important components of a well-child assessment, but not the priority. (Option 2) Evaluating dental health is part of any well-child assessment. Dry mouth is not a common side effect of methylphenidate. (Option 4) Expected outcomes of methylphenidate therapy include improvement in schoolwork and social relationships. These would be important components of a well-child assessment, but not the priority. Educational objective: Side effects of methylphenidate therapy that require on-going monitoring are delayed growth and development and increased blood pressure. Children with ADHD should be weighed regularly at home or school; weight loss trends should be reported and discussed with the health care provider. Blood pressure and cardiac function also should be monitored on an on-going basis.

Block Time Remaining: 00:00:14 TUTOR Test Id: 80941960 QId: 33899 (921666) 4 of 53 A A A The nurse reinforces teaching to a female client about taking misoprostol to prevent stomach ulcers. Which statement by the client would prompt further instruction? 1. "I can take this medication with food if it hurts my stomach." [7%] 2. "I must use a reliable form of birth control while taking this medication." [10%] 3. "I should continue to take my ibuprofen as prescribed." [44%] 4. "I will take this medicine with an antacid to decrease stomach upset." [37%] Omitted Correct answer 4 Answered correctly 37% Time: 1 seconds Updated: 05/15/2017 Explanation: Misoprostol (Cytotec) is a synthetic prostaglandin that protects against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration. It is often prescribed to prevent gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug (NSAID) therapy. Antacids, especially those that contain magnesium (eg, Gaviscon), can increase the adverse effects of misoprostol (eg, diarrhea, dehydration). If clients require therapy with antacids, they should choose one that does not contain magnesium (eg, calcium carbonate [Tums]) and contact the health care provider if adverse effects occur (Option 4). (Option 1) Taking misoprostol with food can help decrease gastrointestinal side effects (eg, abdominal pain, cramping, diarrhea). (Option 2) Misoprostol is also used for labor induction and is classified as a pregnancy category X drug. Women of childbearing age must be educated on using reliable birth control and the possible sensation of uterine cramping while taking misoprostol. Clients who suspect they are pregnant must stop taking the medication and contact their health care provider immediately. (Option 3) The client can continue taking ibuprofen (an NSAID) with misoprostol because misoprostol is designed to reduce side effects of ibuprofen. Educational objective: Misoprostol prevents gastric ulcers in clients receiving long-term nonsteroidal anti-inflammatory drug therapy. It should not be taken with antacids but can be taken with food to reduce gastrointestinal upset. Women of childbearing age should be educated on using reliable

Block Time Remaining: 00:00:16 TUTOR Test Id: 80941960 QId: 31862 (921666) 6 of 53 A A A A client with ulcerative colitis is prescribed the drug sulfasalazine. Which information should the nurse discuss with the client concerning this drug? Select all that apply. 1. Drinking 8 glasses of water daily 2. Stopping the medicine if blood is present in stool 3. Stopping the medicine if urine turns an orange-yellow color 4. Taking folic acid supplements 5. Wearing sunscreen when outdoors Omitted Correct answer 1,4,5 Answered correctly 37% Time: 1 seconds Updated: 05/05/2017 Explanation: Sulfasalazine (Azulfidine) is a sulfonamide (salicylate and sulfa antibiotic) and nonbiologic disease-modifying antirheumatic drug (DMARD) used for mild to moderate chronic inflammatory rheumatoid arthritis (RA) and inflammatory bowel disease (eg, ulcerative colitis). It inhibits the production of prostaglandin, a mediator in the body's inflammatory response. Most "sulfa" medications (eg, trimethoprim, sulfamethoxazole) share common side effects, including: Crystalluria causing kidney injury - client should drink 8 glasses of water daily to maintain adequate urine output (eg, 1200-1500 mL/day) Photosensitivity and risk for sunburn - client should avoid sun exposure and apply sunscreen Folic acid deficiency (megaloblastic anemia and stomatitis) - client should eat folate-rich foods and take 1 mg/day folic acid supplement Rarely life-threatening agranulocytosis (leukopenia) - client should be monitored for complete blood count at the start of therapy and report fever or sore throat immediately Stevens-Johnson syndrome - client should stop the medicine if rash develops (Option 2) Ulcerative colitis is characterized by bloody diarrhea, and the medication is taken to reduce this effect. (Option 3) Urine and skin can turn an orange-yellow color but will return to normal when the drug is discontinued. This is an expected finding. Educational objective: Sulfasalazine (Azulfidine) is used for mild to moderate chronic inflammatory RA and inflammatory bowel disease. Important adverse effects include crystalluria with kidney injury, yellow-orange skin and urine discoloration, folic acid deficiency, and photosensitivity. .

Block Time Remaining: 00:00:15 TUTOR Test Id: 80944027 QId: 34477 (921666) 12 of 54 A A A A client diagnosed with vaginal candidiasis is instructed on self-care management techniques and proper administration of the prescribed miconazole vaginal cream. Which statement by the client indicates that further teaching is needed? 1. "Each time I use the bathroom, I will wipe myself from the front to the back." [2%] 2. "I should choose loose-fitting cotton underwear instead of nylon undergarments." [6%] 3. "I will refrain from having sex until my partner is also tested and treated for the infection." [67%] 4. "Prior to going to bed at night, I will apply miconazole cream using the vaginal applicator." [23%] Omitted Correct answer 3 Answered correctly 67% Time: 1 seconds Updated: 05/14/2017 Explanation: Candida albicans (yeast) can colonize and cause infections of the vulvovaginal region. Vaginal candidiasis often causes itching and painful urination due to urine stinging the inflamed areas of the vulva. Assessment shows a thick, white, curd-like vaginal discharge and reddened vulvar lesions. Miconazole (Monistat), an antifungal cream commonly prescribed to treat vaginal candidiasis, is inserted high into the vagina using an applicator. It is best applied at bedtime so that it will remain in the vagina for an extended period (Option 4). Sexual intercourse is avoided until the inflammation is resolved, typically for the duration of treatment, approximately 3-7 days (Option 3). However, sexual activity is not a significant cause of infection or reinfection of candida, and partner evaluation is not needed. Trichomoniasis, syphilis, gonorrhea, and HIV are mainly sexually transmitted; therefore, partners should be evaluated and treated. Other teaching points for this client should include: Ensuring proper hygiene of the perineum - cleansing from anterior to posterior (front to back) to prevent accidental introduction of fecal organisms (Option 1) Wearing loosely fitted cotton underwear and avoiding synthetic undergarments to promote ventilation, decrease friction, and reduce moisture (Option 2) Refraining from douching, which can introduce organisms higher up into the vaginal canal and cervix Educational objective: Miconazole cream is commonly prescribed to treat vaginal candidiasis. Miconazole is best applied at bedtime so that it will remain in the vagina longer. Clients being treated for vaginal candidiasis should wear loose-fitting cotton underwear and refrain from sexual intercourse for the duration of treatment.

Block Time Remaining: 00:00:16 TUTOR Test Id: 80944027 QId: 30772 (921666) 13 of 54 A A A A pediatric client is diagnosed with an acute asthma attack. Which immediate-acting medications should the nurse prepare to administer to this client? Select all that apply. 1. Albuterol 2. Ibuprofen 3. Ipratropium 4. Montelukast 5. Tobramycin Omitted Correct answer 1,3 Answered correctly 49% Time: 1 seconds Updated: 04/23/2017 Explanation: Asthma is an inflammatory condition in which the smaller airways constrict and become filled with mucus. Breathing, especially on expiration, becomes more difficult. Pharmacologic treatment for acute asthma includes the following: Oxygen to maintain saturation >90% High-dose inhaled short-acting beta agonist (albuterol or levalbuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 minutes Systemic corticosteroids (Solu-Medrol) to control the underlying inflammation. These will take some time to show an effect. (Option 2) Nonsteroidal anti-inflammatory agents (eg, ibuprofen, naproxen, indomethacin) and aspirin can worsen asthma symptoms in some clients and are not indicated unless necessary. (Option 4) Montelukast (Singulair) is a leukotriene (chemical mediator of inflammation) inhibitor and is not used to treat acute episodes. It is given orally in combination with beta agonists and corticosteroid inhalers (eg, fluticasone, budesonide) to provide long-term asthma control. (Option 5) Tobramycin is an aminoglycoside antibiotic. It is used in aerosolized form to treat cystic fibrosis exacerbation when Pseudomonas is the predominant organism causing lung infection. Educational objective: Inhaled corticosteroids and leukotriene inhibitors are typically used to achieve and maintain control of inflammation for long-term management of asthma. Quick-relief medications (eg, albuterol, ipratropium) are used to treat acute symptoms and exacerbations.

Block Time Remaining: 00:00:17 TUTOR Test Id: 80941960 QId: 30257 (921666) 7 of 53 A A A A client has nausea, abdominal cramping, and persistent mucus-like, watery diarrhea that is positive for Clostridium difficile. The nurse anticipates the client will be prescribed which medication to treat this condition? 1. Ceftriaxone [46%] 2. Fluconazole [8%] 3. Metronidazole [43%] 4. Pantoprazole [2%] Omitted Correct answer 3 Answered correctly 43% Time: 1 seconds Updated: 05/04/2017 Explanation: C difficile is often associated with antibiotic therapy but can also be a nosocomial hospital-acquired infection. Antibiotics, especially broad-spectrum, reduce normal bacteria in the body. This allows other bacteria, such as C difficile, to take over and cause a superinfection. It grows in the intestinal tract and causes antibiotic-associated diarrhea. Metronidazole (Flagyl) is an anti-infective drug commonly used to treat C difficile. For severe C difficile infection, oral vancomycin may be used; intravenous vancomycin is ineffective. (Option 1) Ceftriaxone (Rocephin) is a cephalosporin antibiotic; its use could cause C difficile infection. (Option 2) Fluconazole (Diflucan) is a broad-spectrum antifungal agent; it is not indicated to treat C difficile. (Option 4) Pantoprazole (Protonix) is a proton pump inhibitor agent; its use has been associated with development of C difficile infection. Educational objective: Antibiotics reduce normal bacteria in the body, allowing other bacteria or fungi, such as C difficile, to take over. C difficile is a toxin-producing microorganism that grows in the intestinal tract and causes antibiotic-associated diarrhea. Metronidazole (Flagyl) and oral vancomycin are commonly used to treat this condition.

Block Time Remaining: 00:00:18 TUTOR Test Id: 80941960 QId: 30863 (921666) 8 of 53 A A A A client has a deep vein thrombosis and is receiving a heparin drip. The client's activated partial thromboplastin time (aPTT) has been in the therapeutic range for the past 24 hours. The most recent laboratory value shows that the current aPTT equals the control value. What explanation should the nurse consider? 1. The client became tolerant to heparin [34%] 2. The client consumed spinach [13%] 3. The client developed thrombocytopenia [23%] 4. The client's intravenous (IV) line is infiltrated [27%] Omitted Correct answer 4 Answered correctly 27% Time: 1 seconds Updated: 05/25/2017 Explanation: With a heparin drip infusion, the goal is to reach the therapeutic range of the drug's effect and not the "normal" or "control value." Once the therapeutic effect range has been reached (usually 1.5-2.0 times the control value), it usually remains within this range without titrating the heparin infusion rate. Heparin has a short duration (approximately 2-6 hours IV). Therefore, if it is not being infused, the aPTT level will go back to the control value (aPTT level without administration of anticoagulants). In addition, the volume of heparin being infused is small (because the standard concentration is 100 units/mL) so it is possible to miss an infiltration. (Option 1) Clients do not develop tolerance to heparin. However, tolerance is typically seen with other medications such as nitroglycerine and opioids. (Option 2) Consumption of dark-green leafy vegetables is an issue related to therapeutic levels of warfarin (Coumadin). These foods have vitamin K, the antagonist for warfarin. However, this is not an issue related to heparin administration. (Option 3) Low platelets (heparin-induced thrombocytopenia) are a risk for clients on heparin; this can typically result in clot formation rather than bleeding (paradoxic effect) but has no effect on aPTT. Educational objective: PTT is used to measure the therapeutic effect of heparin IV infusion (should be 1.5-2.0 times the control value). Due to the short half-life, the possibility of infiltration should be assessed if the PTT level suddenly drops despite heparin administration.

Block Time Remaining: 00:00:19 TUTOR Test Id: 80941960 QId: 30924 (921666) 9 of 53 A A A A client with active pulmonary tuberculosis is prescribed 4-drug therapy with ethambutol. The community health nurse instructs the client to notify the health care provider immediately if which adverse effect associated with ethambutol occurs? 1. Blurred vision [46%] 2. Dark-colored urine [4%] 3. Difficulty hearing [25%] 4. Yellow skin [23%] Omitted Correct answer 1 Answered correctly 46% Time: 1 seconds Updated: 04/09/2017 Explanation: Ethambutol (Myambutol) is used in combination with other antitubercular drugs (eg, isoniazid, rifampin, pyrazinamide) to treat active tuberculosis. The client must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect. The client is instructed to report signs of decreased visual acuity and loss of color (red-green) discrimination. (Options 2 and 4) Dark-colored urine and yellow skin can indicate the presence of hepatotoxicity, which is associated with many drugs used to treat tuberculosis (eg, isoniazid, pyrazinamide, rifampin). However, hepatotoxicity is not common with ethambutol. (Option 3) Difficulty hearing (tinnitus, subjective hearing loss) is an adverse reaction to streptomycin. Streptomycin, an aminoglycoside antibiotic, is a second-line drug sometimes used to treat multi-drug-resistant tuberculosis, with ototoxic and nephrotoxic adverse effects. Educational objective: Clients taking ethambutol must have baseline and periodic eye examinations during therapy as optic neuritis is a potentially reversible adverse effect.

Block Time Remaining: 00:00:20 TUTOR Test Id: 80941960 QId: 30354 (921666) 10 of 53 A A A A client is receiving a blood transfusion. Fifteen minutes after the transfusion starts, the nurse notes a drop in blood pressure from 110/70 to 84/50 mm Hg. The client reports "feeling a little cold." Based on this assessment, in what order should the nurse complete the following actions? All options must be used. Your Response/ Incorrect Response Correct Response Stop the blood transfusion Using new tubing, infuse normal saline into the vein Administer prescribed vasopressor Collect urine specimen Document the occurrence Omitted Correct answer 4,5,1,2,3 Answered correctly 69% Time: 1 seconds Updated: 02/15/2017 Explanation: It is important for the nurse to remain with the client for 15 minutes after starting a blood transfusion to monitor for signs of a reaction. These signs include fever, chills, nausea, vomiting, pruritus, hypotension, decreased urine output, back pain, and dyspnea. The client may report a variety of symptoms ranging from none to a feeling of impending doom. If signs of a transfusion reaction occur, the nurse should: Stop the transfusion immediately (Option 4). Using new tubing, infuse normal saline to keep the vein open (Option 5). Continue to monitor hemodynamic status and notify the health care provider and blood bank. Administer any emergency or prescribed medications to treat the reaction; these may include vasopressors, antihistamines, steroids, or IV fluids (Option 1). Collect a urine specimen to be assessed for a hemolytic reaction (Option 2). Document the occurrence and send the remaining blood and tubing set back to the blood bank for analysis (Option 3). Educational objective: If signs or symptoms of a blood transfusion reaction occur, the nurse should stop the infusion immediately and use new tubing to keep the vein open with normal saline. The nurse should continue to monitor the client's hemodynamic status, and administer prescribed drugs. The nurse should also collect a urine specimen to be assessed for a hemolytic reaction. ved.

Block Time Remaining: 00:00:22 TUTOR Test Id: 80941960 QId: 32035 (921666) 11 of 53 A A A A 64-year-old client is prescribed ciprofloxacin for a urinary tract infection (UTI). The nurse instructs the client to observe for and notify the health care provider (HCP) immediately about which of the following? 1. Brown-colored urine [6%] 2. Hearing and balance problems [66%] 3. Pain in the Achilles tendon area [23%] 4. Sunburn [3%] Omitted Correct answer 3 Answered correctly 23% Time: 2 seconds Updated: 12/23/2016 Explanation: Use of fluoroquinolones (ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, ofloxacin), especially ciprofloxacin, places clients at increased risk for tendinitis and tendon rupture that most often occur in the Achilles tendon. This class of antibiotics carries a black box warning about this risk. The Food and Drug Administration recommends that at the first sign of tendon pain or swelling, clients should stop taking the fluoroquinolone, abstain from moving the affected area, and contact their HCP promptly for further evaluation and a change of antibiotic. (Option 1) Turning urine into a harmless brown color is a common side effect of nitrofurantoin, another antibiotic commonly used for UTI treatment. (Option 2) Hearing and balance problems (vertigo) result from aminoglycoside ototoxicity (eg, gentamicin). (Option 4) Ciprofloxacin can cause photosensitivity. The client should be instructed to avoid sun exposure and use sunscreen while taking the medication. Educational objective: Fluoroquinolones (ciprofloxacin) carry a black box warning citing an increased risk of tendinitis and rupture, especially of the Achilles tendon.

Block Time Remaining: 00:00:23 TUTOR Test Id: 80941960 QId: 31846 (921666) 12 of 53 A A A A client has received a new prescription for nystatin to treat oral candidiasis. Which instructions should the nurse give this client? 1. Apply the ointment inside the mouth with a cotton-tipped applicator [12%] 2. Chew, then swallow the lozenge [0%] 3. Swish liquid in mouth for as long as possible, then spit it out [47%] 4. Swish liquid in mouth for several minutes, then swallow it [38%] Omitted Correct answer 4 Answered correctly 38% Time: 1 seconds Updated: 04/23/2017 Explanation: Nystatin is used to treat oral candidiasis, or thrush, that can be caused by medications such as antibiotics, corticosteroids, or oral contraceptive pills. Medical conditions that make oral candidiasis more likely include HIV, immunosuppression, uncontrolled diabetes, denture use, and hormonal changes during pregnancy. Nystatin is available in the form of powders, suspensions, creams, ointments, and lozenges. Oral suspensions are the more common form of nystatin used for oral candidiasis. The client should be directed to swish the solution within the mouth, making contact with all the mucous membranes, and then swallow the solution after several minutes. Swallowing would help to clear any unseen esophageal candidiasis. (Option 1) Ointments are used on Candida infections of the skin. (Option 2) Lozenges are available for oral candidiasis but should be allowed to dissolve in the mouth. (Option 3) The liquid should be swallowed, not spit out. Educational objective: The nurse should teach the client taking nystatin solution for oral candidiasis to swish it in the mouth for several minutes and then swallow the solution. Swallowing would help to clear any unseen esophageal candidiasis.

Block Time Remaining: 00:00:25 TUTOR Test Id: 80941960 QId: 30954 (921666) 13 of 53 A A A A child with cystic fibrosis is to receive a dose of pancrelipase at 12:00 PM. The client states that he is not hungry and will eat his lunch in an hour. Which action is appropriate for the nurse to take? 1. Administer the prescribed pancrelipase [13%] 2. Hold the pancrelipase until the client eats [83%] 3. Notify the health care provider [3%] 4. Skip this dose of the pancrelipase [0%] Omitted Correct answer 2 Answered correctly 83% Time: 2 seconds Updated: 05/10/2017 Explanation: Cystic fibrosis affects the pancreatic excretion of digestive enzymes. Without these enzymes, the client is unable to absorb fats, starches, and some proteins from the diet. Pancrelipase provides these enzymes to the client and must be given with every snack and meal so that the client can digest and absorb the nutrients eaten. If the client is not eating when the medication is scheduled, there are no nutrients to digest. Therefore, the dose should be held until the client eats. Educational objective: Pancrelipase is a medication containing lipase, protease, and amylase. In cystic fibrosis, the client's pancreas does not excrete these necessary enzymes. To prevent malabsorption syndrome, the enzymes must be taken with every snack and every meal. Copyright © UWorld. All rights reserved.

Block Time Remaining: 00:00:26 TUTOR Test Id: 80941960 QId: 31844 (921666) 14 of 53 A A A A parent calls the after-hours triage nurse about a 3-year-old who is sick with the flu. Which report by the parent would necessitate intervention by the nurse? 1. Acetaminophen being given every 4 hours for fever [17%] 2. Bismuth subsalicylate being used for nausea [52%] 3. Ibuprofen being given every 6 hours for body aches [20%] 4. Popsicles and gelatin desserts being used for hydration [10%] Omitted Correct answer 2 Answered correctly 52% Time: 1 seconds Updated: 04/21/2017 Explanation: The nurse should tell the parent to discontinue the use of bismuth subsalicylate (Pepto-Bismol) as it contains a salicylate (same class as aspirin) and could possibly cause Reye syndrome. Reye syndrome can develop in children with a recent viral illness such as varicella or influenza. It can cause acute encephalopathy and hepatic dysfunction. Children with viral infections should not be given aspirin or products containing salicylates. (Options 1 and 3) Acetaminophen and ibuprofen are being used appropriately. (Option 4) Sufficient fluids are important to maintain hydration in the child with influenza. Water and fluids should be offered frequently; popsicles and gelatin desserts (eg, Jell-O) provide a palatable means of getting children to ingest fluids. Educational objective: The nurse should tell the parent not to administer any product containing aspirin or salicylates to a child with a viral infection (eg, influenza, varicella) to prevent Reye syndrome.

Block Time Remaining: 00:00:25 TUTOR Test Id: 80944027 QId: 32006 (921666) 15 of 54 A A A The clinic nurse evaluates a client who was prescribed lithium therapy a month ago for bipolar disorder. Which client statement would cause the most concern? 1. "I've felt the need for an afternoon nap most days this week." [9%] 2. "I've gained 3 lb (1.36 kg) since I began taking this medication." [11%] 3. "I've had the stomach flu for the past couple of days." [55%] 4. "My mouth seems to be drier than usual lately." [24%] Correct Answered correctly 55% Time: 8 seconds Updated: 01/22/2017 Explanation: Lithium is often used in the treatment of bipolar disorder. It has expected, mild side effects as well as potentially serious ones related to drug toxicity. Drowsiness, weight gain, dry mouth, and gastrointestinal upset are expected, mild side effects. Lithium toxicity occurs with dehydration, hyponatremia, decreased renal function, and drug-drug interactions (eg, nonsteroidal anti-inflammatory drugs, thiazide diuretics). Lithium and sodium are closely related in the body. Acute viral gastroenteritis (stomach flu) presents with abrupt onset of diarrhea, nausea, vomiting, and abdominal pain. Clients with vomiting and diarrhea are at risk of developing dehydration and/or low serum sodium, increasing the risk for lithium toxicity (Option 3). (Option 1) Drowsiness is an expected side effect. The nurse should advise the client to avoid hazardous activities and driving until the effects of lithium are known or this side effect subsides. (Option 2) Weight gain is an expected side effect. The nurse should provide client education about healthy food choices and proper exercise and/or provide for a dietary consult. (Option 4) Dry mouth is an expected side effect. The nurse should provide client teaching about measures to counteract this side effect (eg, ice chips, sugarless gum or candy, drinking plenty of water). However, excessive urination and polydipsia indicate nephrogenic diabetes insipidus from lithium toxicity. Educational objective: Dehydration and sodium loss from vomiting and diarrhea can lead to toxic lithium levels in clients receiving lithium therapy.

Block Time Remaining: 00:00:26 TUTOR Test Id: 80944027 QId: 30277 (921666) 16 of 54 A A A The nurse is caring for a client with asthma exacerbation. Blood pressure is 146/86 mm Hg, pulse is 110/min, and respirations are 32/min. The respiratory therapist administers nebulized albuterol as prescribed. One hour after the treatment, the nurse assesses which finding that indicates the drug is producing the therapeutic effect? 1. Constricted pupils [1%] 2. Heart rate of 120/min [4%] 3. Respirations of 24/min [91%] 4. Tremor [2%] Omitted Correct answer 3 Answered correctly 91% Time: 1 seconds Updated: 04/26/2017 Explanation: Albuterol (Proventil) is a short-acting inhaled beta-2 agonist used to control airway obstruction caused by chronic obstructive pulmonary disease, asthma, or bronchitis. It also is used to prevent exercise-induced asthma. The therapeutic effect is relaxation of the smooth muscles of the airways, which results in immediate bronchodilation. Bronchodilation decreases airway resistance, facilitates mucus drainage (expectorates mucus plugs), decreases the work of breathing, and increases oxygenation. As a result of these actions, the respiratory rate will decrease and peak flow will be increased (if tested). However, short-acting beta-2 agonists are associated with the following side effects (not therapeutic effects): tremor (most frequent), tachycardia and palpitations, restlessness, and hypokalemia. These side effects are due to the oral deposition of medication (subsequent systemic absorption) and can be reduced with the use of a spacer or chamber device. (Option 1) The presence of constricted pupils is neither a side effect nor therapeutic effect of the drug. Constricted pupils are often seen with opioid medications (eg, morphine, oxycodone). Educational objective: Albuterol (Proventil) is a short-acting beta-2 agonist that produces immediate bronchodilation by relaxing smooth muscles. Bronchodilation decreases airway resistance, facilitates mucus drainage, decreases the work of breathing, and increases oxygenation. Peak flow will improve. The most frequent side effects are tremor, tachycardia, restlessness, and hypokalemia.

Block Time Remaining: 00:00:27 TUTOR Test Id: 80941960 QId: 31816 (921666) 15 of 53 A A A The nurse provides teaching about methotrexate to a client with rheumatoid arthritis. It is most important to address which topic regarding this drug? 1. Need for an eye examination [13%] 2. Need for sunblock [10%] 3. Risk for infection [50%] 4. Risk for kidney injury [25%] Omitted Correct answer 3 Answered correctly 50% Time: 1 seconds Updated: 03/15/2017 Explanation: Methotrexate (Rheumatrex) is classified as a folate antimetabolite, antineoplastic, immunosuppressant drug used to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and psoriasis. Methotrexate can cause bone marrow suppression resulting in anemia, leukopenia, and thrombocytopenia. Leukopenia and its immunosuppressant effects can increase susceptibility to infection. Clients should be educated about obtaining routine killed (inactivated) vaccines (eg, influenza, pneumococcal) and avoiding crowds and persons with known infections. Live vaccines (eg, herpes zoster) are contraindicated in clients receiving immunosuppressants, such as methotrexate. Alcohol should be avoided in clients taking methotrexate as it is hepatotoxic and drinking alcohol increases the client's risk for hepatotoxicity. (Option 1) Regular eye examinations every 6 months are indicated for clients prescribed the nonbiological DMARD antimalarial hydroxychloroquine (Plaquenil) as it can cause retinal damage. Ethambutol, used to treat tuberculosis, also requires frequent eye examinations. (Options 2 and 4) Photosensitivity (common with tetracycline, thiazide diuretics, and sulfonamides) and nephrotoxicity (common with aminoglycosides, vancomycin, and nonsteroidal anti-inflammatory drugs) can occur, but immunosuppression is more likely and potentially fatal. Educational objective: Methotrexate is a nonbiologic disease-modifying antirheumatic drug used to treat rheumatoid arthritis. The major adverse effects associated with its use include bone marrow suppression, hepatotoxicity, and gastrointestinal .

Block Time Remaining: 00:00:28 TUTOR Test Id: 80941960 QId: 31867 (921666) 16 of 53 A A A A client with fibromyalgia refuses to take the prescribed drug duloxetine. When the nurse asks, why, the client responds, "Because I'm not depressed!" What is the nurse's most appropriate response? 1. "Depression is common with fibromyalgia, but a low dose of this drug can prevent it." [12%] 2. "It can relieve your chronic pain and help you sleep better at night." [58%] 3. "It helps to relieve the adverse effects of your other prescribed drugs." [11%] 4. "You have the right to refuse. I will notify your health care provider (HCP)." [17%] Omitted Correct answer 2 Answered correctly 58% Time: 1 seconds Updated: 05/05/2017 Explanation: Fibromyalgia (FM) results from abnormal central nervous system pain transmission and processing. It is characterized by chronic, bilateral musculoskeletal axial pain (above and below the waist), multiple tender points, fatigue, and sleep/cognitive disturbances. Duloxetine (Cymbalta) is a serotonin-norepinephrine reuptake inhibitor that has both antidepressant and pain-relieving effects. It is used to relieve chronic pain that interferes with normal sleep patterns in clients with FM. With the restoration of normal sleep patterns, fatigue often improves as well (Option 2). Other effective drugs to treat the chronic pain associated with FM include pregabalin and amitriptyline (Elavil), an older tricyclic antidepressant drug. (Option 1) Although depression often accompanies chronic pain, duloxetine can be prescribed specifically to treat the chronic pain associated with FM. (Option 3) Duloxetine is prescribed for major depressive disorder and to relieve pain associated with diabetic neuropathy and FM. It is not given to relieve the adverse effects of other drugs. (Option 4) A client has the right to refuse any drug. However, the nurse should first explain the purpose of the drug to the client before notifying the HCP. Educational objective: Medications such as duloxetine, pregabalin, and amitriptyline have neuropathic pain-relieving effects. They are commonly used for treating pain associated with diabetic neuropathy and FM. Duloxetine is particularly effective for treating both depression and pain.

The nurse in the same-day surgery unit admits a client who will receive general anesthesia. The client has never had surgery before. Which question is most critical for the nurse to ask the client during the preoperative assessment and health history? 1. "Has any family member ever had a bad reaction to general anesthesia?" [59%] 2. "Have you ever experienced low back pain?" [2%] 3. "Have you ever had an anaphylactic reaction to a bee sting?" [19%] 4. "Have you ever received opioid pain medications?" [18%] Omitted Correct answer 1 Answered correctly 59% Time: 2 seconds Updated: 01/06/2017 Explanation: Malignant hyperthermia (MH) is a rare but life-threatening inherited muscle abnormality that is triggered by specific, inhaled anesthetic agents and the depolarizing muscle relaxant succinylcholine (Anectine) used to induce general anesthesia. In MH-susceptible clients, the triggering agent leads to excessive release of calcium from the muscles, leading to sustained muscle contraction and rigidity (usually of the jaw and upper body [early sign]), increased oxygen demand and metabolism, and dangerously high temperature (later sign). As MH is an inherited condition, proper screening and a thorough preoperative nursing assessment and health history can help minimize the client's risk (Option 1). (Option 2) Cervical spine problems should be assessed before the intubation. Low back pain history is not a priority for general anesthesia. (Option 3) It would be appropriate to ask about allergies (eg, drugs, latex). However, asking about an anaphylactic reaction to a bee sting is not the most critical question. (Option 4) History of prior opioid intake may be helpful, but the most important question is to ask about side effects and allergies. Educational objective: Malignant hyperthermia (MH) is a rare, life-threatening inherited muscular abnormality that is triggered by specific drugs used to induce general anesthesia. Therefore, it is critical for the perioperative nurse to screen for MH susceptibility by asking if any of the client's blood relatives had ever experienced an adverse reaction to general anesthesia, including unexplained death.

Block Time Remaining: 00:00:29 TUTOR Test Id: 80944027 QId: 31841 (921666) 18 of 54 A A A A client with asthma was recently prescribed fluticasone/salmeterol. After the client has received instructions about this medication, which statement would require further teaching by the nurse? 1. "After taking this medication, I will rinse my mouth with water." [7%] 2. "At the first sign of an asthma attack, I will take this medication." [73%] 3. "I have been smoking for 12 years, but I just quit a month ago." [9%] 4. "I received the pneumococcal vaccine about a month ago." [9%] Omitted Correct answer 2 Answered correctly 73% Time: 1 seconds Updated: 04/29/2017 Explanation: Fluticasone/salmeterol (Advair) is a combination drug containing a corticosteroid (fluticasone) and a bronchodilator (salmeterol). Salmeterol is a long-acting inhaled β2-adrenergic agonist that promotes relaxation of the bronchial smooth muscles over 12 hours. Fluticasone decreases inflammation. This medication is used as part of the treatment plan for prevention and long-term control of asthma. Client instructions include: After inhalation, rinse the mouth with water without swallowing to reduce the risk of oral/esophageal candidiasis Avoid smoking and using tobacco products Receive the pneumococcal and influenza vaccines if there is a risk for infection (Option 2) Fluticasone/salmeterol is not a rescue inhaler and does not treat acute exacerbations of asthma. The client should always have a rescue inhaler (eg, albuterol [short-acting β2-adrenergic agonist] or ipratropium [Atrovent]) for sudden changes in breathing and call 911 if the rescue inhaler does not relieve the breathing problem. Educational objective: Fluticasone/salmeterol (Advair) is a long-acting inhaled β2-adrenergic agonist combination drug containing a corticosteroid (fluticasone) and a bronchodilator (salmeterol). It is used for long-term control of asthma but not for acute attacks.

Block Time Remaining: 00:00:32 TUTOR Test Id: 80941960 QId: 31851 (921666) 18 of 53 A A A A client with chronic rheumatoid arthritis (RA) says, "I am so frustrated, tired, and stiff. I just can't keep up with my young children anymore." The client is prescribed adalimumab, a tumor necrosis factor (TNF) inhibitor. What is the priority nursing diagnosis (ND) for this client regarding the new prescription? 1. Disturbed body image [2%] 2. Hopelessness [9%] 3. Impaired physical mobility [35%] 4. Risk for infection [53%] Omitted Correct answer 4 Answered correctly 53% Time: 1 seconds Updated: 04/28/2017 Explanation: Infection is a major adverse effect of TNF inhibitors (eg, etanercept [Enbrel], infliximab [Remicade], adalimumab [Humira]) as these drugs interfere with the body's normal immune response and cause immunosuppression. This increases the risk for a new infection or reactivation of a previous infection (eg, latent tuberculosis, hepatitis B virus). Nursing interventions should focus on preventing infection (eg, reducing risk factors, promoting wellness) as it can be life-threatening in the setting of immunosuppression. This ND poses the greatest threat to the client's survival and is therefore the priority diagnosis (Option 4). (Option 1) Disturbed body image related to physical and psychological changes secondary to chronic RA is an appropriate ND. Nursing interventions should focus on client adaptation and acceptance of changes due to the illness. However, this does not pose the greatest risk to the client's survival and is not the priority ND. (Option 2) Hopelessness related to activity restriction and worsening physiological status secondary to chronic RA is an appropriate ND. Interventions should focus on setting short-term goals to change behaviors and promoting a more positive attitude. However, this is not the priority ND. (Option 3) Impaired physical mobility related to decreased physical endurance and joint stiffness secondary to chronic RA is an appropriate ND. Interventions should focus on improving joint function and resuming the client's usual activities. However, this is not the priority ND. Educational objective: TNF inhibitors (eg, etanercept, infliximab, adalimumab) interfere with the body's normal immune response and cause immunosuppression. This increases the risk for a new infection or reactivation of a previous infection (eg, latent tuberculosis, hepatitis B virus).

Block Time Remaining: 00:00:33 TUTOR Test Id: 80941960 QId: 31753 (921666) 19 of 53 A A A A client comes to the emergency department following a bee sting. The client has a diffuse rash, hypotension, and throat tightness. One injection of IM epinephrine does not improve the client's condition. What action should the nurse take next? 1. Administer IV fluid bolus [7%] 2. Administer methylprednisolone [20%] 3. Prepare for emergency cricothyrotomy [14%] 4. Repeat IM epinephrine injection [57%] Omitted Correct answer 4 Answered correctly 57% Time: 1 seconds Updated: 04/09/2017 Explanation: Anaphylactic shock has an acute onset, and manifestations usually develop quickly (20-30 minutes). Circulatory failure and respiratory manifestations, including laryngeal edema (from inflammation) and bronchoconstriction (primarily from release of histamine), can lead to cardiac/respiratory arrest. The management of anaphylactic shock includes: Ensure patent airway, administer oxygen Remove insect stinger if present IM epinephrine is the drug of choice and should be given to this client. Epinephrine stimulates both alpha- and beta-adrenergic receptors and dilates bronchial smooth muscle (beta 2) and provides vasoconstriction (alpha 1). The IM route (mid anterior lateral thigh) is better than the subcutaneous route. Repeat dose every 5-15 minutes. Place in recumbent position and elevate legs Maintain blood pressure with IV fluids, volume expanders or vasopressors Bronchodilator (inhaled beta agonist) such as albuterol is administered to dilate the small airways and reverse bronchoconstriction Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction Anticipate cricothyrotomy or tracheostomy with severe laryngeal edema (Option 1, 2, and 3) These are appropriate responses that should come after a repeat dose of epinephrine has been given. Educational objective: IM epinephrine is the single most important medication to be given in anaphylactic shock. The dose should be repeated every 5-15 minutes if symptoms are still present. Antihistamines, corticosteroids, and IV fluids are other supportive treatments. .

Block Time Remaining: 00:00:34 TUTOR Test Id: 80941960 QId: 30373 (921666) 20 of 53 A A A A client is receiving chemotherapy for acute myeloid leukemia. The health care provider prescribes allopurinol to prevent tumor lysis syndrome (TLS). Which laboratory value indicates a therapeutic response to the medication? 1. Serum calcium 9.5 mg/dL (2.38 mmol/L) [11%] 2. Serum phosphate 4.0 mg/dL (1.29 mmol/L) [5%] 3. Serum potassium 4.5 mEq/L (4.5 mmol/L) [13%] 4. Serum uric acid level 6.0 mg/dL (357 µmol/L) [69%] Omitted Correct answer 4 Answered correctly 69% Time: 1 seconds Updated: 03/17/2017 Explanation: A potential complication of chemotherapy is acute tumor lysis syndrome (TLS), a rapid release of intracellular components into the bloodstream. Massive cell lysis releases intracellular ions (potassium and phosphorus) and nucleic acids into the bloodstream. Catabolism of the nucleic acids produces uric acid, resulting in severe hyperuricemia. Released phosphorus binds calcium, producing calcium phosphate mixture but lowering serum calcium levels. Both calcium phosphate and uric acid are deposited into the kidneys, causing renal injury. Allopurinol (Zyloprim) blocks the nucleic acid catabolism and prevents hyperuricemia but would not affect potassium, phosphate, and calcium levels. Chronic gout and uric acid calculi also require the administration of allopurinol to decrease uric acid accumulation. A normal blood uric acid level for an adult male is 4.4-7.6 mg/dL (262-452 µmol/L) and female is 2.3-6.6 mg/dL (137-393 µmol/L). (Option 1) The normal calcium level for adults is 8.6-10.2 mg/dL (2.15-2.55 mmol/L). The client with this complication would experience hypocalcemia. (Option 2) The normal phosphate level for adults is 2.4-4.4 mg/dL (0.78-1.42 mmol/L). In this condition, the phosphate level would show hyperphosphatemia. (Option 3) The normal potassium level for adults is 3.5-5.0 mEq/L (3.5-5.0 mmol/L). Hyperkalemia is usually present in a client with this chemotherapy-induced complicatin. Educational objective: The therapeutic effect of allopurinol (Zyloprim) is to decrease hyperuricemia caused by TLS. Laboratory values of significance in TLS include rising blood uric acid, potassium, and phosphate levels, with decreasing calcium levels.

Block Time Remaining: 00:00:35 TUTOR Test Id: 80941960 QId: 31934 (921666) 21 of 53 A A A A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat systemic lupus erythematosus. Which intervention related to the drug's adverse effects should the nurse include in the teaching plan? 1. Have an ophthalmologic examination every 6 months [52%] 2. Take the medication on an empty stomach [6%] 3. Take vitamin D and calcium supplements [26%] 4. Wear a MedicAlert bracelet [15%] Omitted Correct answer 1 Answered correctly 52% Time: 1 seconds Updated: 12/10/2016 Explanation: Hydroxychloroquine (Plaquenil) is an antimalarial drug, but it is more commonly prescribed to reduce fatigue and treat the skin and arthritic (eg, joint inflammation, pain) manifestations of systemic lupus erythematosus (SLE). Hydroxychloroquine can also help to reduce lupus exacerbations in clients with inactive to mild disease, but several months can pass before its therapeutic effects become apparent. Although rare, serious adverse drug reactions such as retinal toxicity and visual disturbances can occur with hydroxychloroquine. Therefore, clients are instructed to undergo regular ophthalmologic examination every 6-12 months (Option 1). (Option 2) Hydroxychloroquine should be taken with food to decrease gastrointestinal upset (common side effect). (Option 3) Some clients with severe SLE are prescribed long-term corticosteroid (prednisone) therapy to prevent organ damage and are at risk for adverse reactions, such as accelerated osteoporosis. Osteoporosis is not an adverse reaction of hydroxychloroquine, and vitamin D and calcium supplementation is not required. (Option 4) There are no effects of hydroxychloroquine that would require wearing a MedicAlert bracelet. Educational objective: Hydroxychloroquine (Plaquenil) is used to treat the skin and arthritic manifestations of SLE. Taking the medication with food can help alleviate gastrointestinal upset. Serious adverse drug reactions include retinopathy and visual disturbances; therefore, regular ophthalmologic examination every 6-12 months is required. Copyright © UWorld. All rights reserved.

Block Time Remaining: 00:00:39 TUTOR Test Id: 80941960 QId: 31831 (921666) 22 of 53 A A A The nurse is caring for a client receiving IVPB azithromycin. Which client data obtained by the nurse should be reported to the health care provider (HCP) prior to administering any additional doses? 1. Currently nauseated and vomited once [10%] 2. Decreased white blood cell (WBC) count [17%] 3. Prolonged QT interval [61%] 4. Temperature of 101.4 F (38.6 C) [11%] Omitted Correct answer 3 Answered correctly 61% Time: 4 seconds Updated: 12/09/2016 Explanation: All macrolide antibiotics (eg, azithromycin, erythromycin, clarithromycin) can cause a prolonged QT interval, which may lead to sudden cardiac death due to torsades de pointes. Therefore, an electrocardiogram (ECG) should be monitored. Concurrent use of macrolide antibiotics with other drugs that prolong QT interval (eg, amiodarone, sotalol, haloperidol, ziprasidone, azole antifungals) will further increase this risk. Macrolides can also cause hepatotoxicity when taken in high doses or in combination with other hepatotoxic medications such as acetaminophen, phenothiazines, and sulfonamides. Elevation of aspartate transaminase and alanine transaminase levels (liver enzymes) may indicate that hepatotoxicity is occurring, and the nurse should report these results to the HCP. (Option 1) Nausea and vomiting can be side effects of azithromycin. They are not as concerning as the adverse reaction of prolonged QT interval. (Option 2) A decrease in the WBC count would be expected as infection is resolving. (Option 4) Fever may be present in a client with an infection. The nurse should use as-needed acetaminophen cautiously in a client also receiving azithromycin due to the risk of hepatotoxicity. Educational objective: Macrolide antibiotics (eg, erythromycin, azithromycin, clarithromycin) can cause QT prolongation, which can lead to life-threatening arrhythmias (eg, torsades de pointes). They can also be hepatotoxic; therefore, the nurse should monitor liver function tests and an ECG and report

Block Time Remaining: 00:00:40 TUTOR Test Id: 80941960 QId: 34498 (921666) 23 of 53 A A A The nurse is reviewing new prescriptions for assigned clients. Which prescription would require further clarification from the health care provider? 1. Alteplase for an ischemic stroke in a client with a blood pressure of 192/112 mm Hg [16%] 2. Amoxicillin for a respiratory infection in a client who is 20 weeks pregnant [28%] 3. Fentanyl for moderate to severe pain in a client post appendectomy with an allergy to codeine [19%] 4. Sodium chloride 3% infusion for a client with syndrome of inappropriate antidiuretic hormone [34%] Omitted Correct answer 1 Answered correctly 16% Time: 1 seconds Updated: 04/19/2017 Explanation: Thrombolytic agents (eg, alteplase, tenecteplase, reteplase) are often prescribed to resolve acute thrombotic events (eg, ischemic stroke, myocardial infarction, massive pulmonary embolism). They are recombinant plasminogen activators that activate the blood fibrinolytic system and dissolve thrombi. Thrombolytic agents are contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension (blood pressure >180/110 mm Hg). Therefore, the health care provider should be consulted for clarification. Administering alteplase in the presence of these conditions can cause hemorrhage, including life-threatening intracerebral hemorrhage (Option 1). (Option 2) Most penicillin derivates (eg, ampicillin, amoxicillin) and cephalosporins (eg, cephalexin, ceftriaxone) are generally considered safe for use by women who are pregnant or lactating. (Option 3) Fentanyl is appropriate in postoperative clients with moderate to severe pain, even those with a history of allergies to codeine. Both drugs have opiate agonist effects but are chemically different. Codeine is a derivative of natural opiates (eg, morphine), whereas fentanyl is completely synthetic. (Option 4) Syndrome of inappropriate antidiuretic hormone (SIADH) secretion results in water retention and dilutional hyponatremia. Clients with SIADH often require hypertonic saline for sodium repletion to increase serum sodium levels with a minimal infused volume of water. Educational objective: Thrombolytic agents (eg, alteplase, tenecteplase, reteplase) place clients at risk for bleeding. Therefore, they are contraindicated in clients with active bleeding, recent trauma, aneurysm, arteriovenous malformation, history of hemorrhagic stroke, and uncontrolled hypertension. .

Block Time Remaining: 00:00:38 TUTOR Test Id: 80944027 QId: 30454 (921666) 19 of 54 A A A A client has been on lithium carbonate therapy for 7 days. Which of the following findings would be most important to report to the health care provider? 1. Diarrhea, vomiting, and mild tremor [52%] 2. Dry mouth and mild thirst [3%] 3. Hyperactivity and auditory hallucinations [25%] 4. Lithium level of 1.3 mEq/L (1.3 mmol/L) [18%] Omitted Correct answer 1 Answered correctly 52% Time: 9 seconds Updated: 01/29/2017 Explanation: Lithium carbonate is used for the initial and maintenance treatment of bipolar mania. Typical symptoms of mania include extreme hyperactivity, delusions and hallucinations, grandiosity, elation, poor judgment, aggressiveness, impulsivity, pressure of speech, insomnia, flight of ideas, and sometimes hostility. Acute lithium toxicity presents primarily with gastrointestinal side effects such as persistent nausea and vomiting and diarrhea. Neurologic symptoms typically manifest later and include tremor, confusion, ataxia, and sluggishness. Severe toxicity results in seizures and encephalopathy (Option 1). Serum lithium levels and clinical condition must be monitored before medication administration. Serum levels ≥1.5 mEq/L (1.5 mmol/L) and/or even the mildest symptoms of lithium toxicity must be reported to the health care provider. (Option 2) Dry mouth and thirst are common and expected side effects of lithium when treatment is initiated. They will resolve spontaneously and lithium need not be discontinued. (Option 3) Hyperactivity and auditory hallucinations are clinical findings associated with bipolar mania. Because lithium may take up to 3 weeks to become effective, it would not be unusual for a client to experience these symptoms after only 7 days of treatment. (Option 4) Lithium has a very narrow range of therapeutic serum levels; the usual ranges are 1.0-1.5 mEq/L (1.0-1.5 mmol/L) for treatment of acute mania and 0.6-1.2 mEq/L (0.6-1.2 mmol/L) for maintenance therapy. Educational objective: Acute lithium toxicity (>1.5 mEq/L [1.5 mmol/L]) presents primarily with gastrointestinal side effects such as persistent nausea and vomiting and diarrhea. Neurological symptoms typically manifest later and include tremor, confusion, ataxia, and sluggishness. The health care provider must be notified at the earliest indication of lithium toxicity.

Block Time Remaining: 00:00:40 TUTOR Test Id: 80944027 QId: 30218 (921666) 20 of 54 A A A A client is admitted to the ambulatory care unit for an endoscopic procedure. The gastroenterologist administers midazolam 1 mg intravenously for sedation and titrates the dosage upward to 3.5 mg. The client becomes hypotensive (86/60 mm Hg), develops severe respiratory depression (SpO2 86%), and has periods of apnea. The nurse anticipates the administration of which antidote drug? 1. Benztropine [10%] 2. Flumazenil [36%] 3. Naloxone [46%] 4. Phentolamine [7%] Omitted Correct answer 2 Answered correctly 36% Time: 2 seconds Updated: 04/26/2017 Explanation: Midazolam (Versed) is a benzodiazepine commonly used to induce conscious sedation in clients undergoing endoscopic procedures. The initial dose is 1 mg and is titrated up slowly (eg, 2 minutes before each 1-mg increment) until speech becomes slurred. Usually no more than 3.5 mg is necessary to induce conscious sedation. It is commonly administered with an opioid analgesic (eg, morphine, Fentanyl) because of their synergistic effects. Side effects can include airway occlusion, apnea, hypotension (especially in the presence of an opioid), and oxygen desaturation with resultant respiratory arrest. Flumazenil (Romazicon) is the antidote drug used to reverse the sedative effects of benzodiazepines. (Option 1) Benztropine (Cogentin) is used in the treatment of extrapyramidal side effects associated with antipsychotic medications or metoclopramide. (Option 3) Naloxone (Narcan) is the antidote drug to reverse the effects of opioids. (Option 4) Phentolamine (Regitine) is the antidote drug used to treat a norepinephrine (Levophed) extravasation. Educational objective: Flumazenil is a drug used to reverse the sedative effects of benzodiazepines such as midazolam. Copyright © UWorld. All rights reserved.

Block Time Remaining: 00:00:41 TUTOR Test Id: 80944027 QId: 34633 (921666) 21 of 54 A A A A behavioral health clinic nurse assesses a 23-year-old client who started taking paroxetine 3 weeks ago. Which statement made by the client is most important for the nurse to investigate? 1. "I don't have much of an appetite since starting this medication." [4%] 2. "I have a lot more energy, but I'm feeling just as depressed." [43%] 3. "I have been feeling dizzy when I walk around at home." [24%] 4. "I have experienced frequent headaches lately." [28%] Omitted Correct answer 2 Answered correctly 43% Time: 1 seconds Updated: 04/12/2017 Explanation: Selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, paroxetine, sertraline, citalopram) are used to treat a number of psychiatric conditions (eg, major depressive disorder, generalized anxiety disorder). Clients usually see therapeutic effects in 1-4 weeks. SSRIs may increase the risk of suicide, especially in young adults (age 18-24) during initial therapy or after a dosage increase. A client who reports increased energy without a change in depressive feelings needs to be assessed and monitored for suicidal ideation or actions as the client may now have the energy to execute the suicide plan (Option 2). Common, expected side effects of SSRIs include: Loss of appetite; weight loss or weight gain (Option 1) Gastrointestinal disturbances (nausea, vomiting, diarrhea) Headaches, dizziness, drowsiness, insomnia (Options 3 and 4) Sexual dysfunction Side effects should gradually diminish over 3 months, although some may persist. If symptoms are intolerable or a particular SSRI is ineffective, the client may be switched to a different antidepressant. Educational objective: Selective serotonin reuptake inhibitors (eg, fluoxetine, paroxetine, sertraline, citalopram) are used to treat psychiatric conditions (eg, major depressive disorder, generalized anxiety disorder). A client reporting increased energy with little or no reduction of depression needs immediate assessment for suicide risk.

Block Time Remaining: 00:00:42 TUTOR Test Id: 80944027 QId: 30986 (921666) 22 of 54 A A A A client with seizure activity is receiving a continuous tube feeding via a small-bore enteral tube. The nurse prepares to administer phenytoin oral suspension via the enteral route. What is the nurse's priority action before administering this medication? 1. Check renal function laboratory results [31%] 2. Flush tube with normal saline, not water [19%] 3. Stop the feeding for 1 to 2 hours [29%] 4. Take the blood pressure (BP) [19%] Omitted Correct answer 3 Answered correctly 29% Time: 1 seconds Updated: 12/08/2016 Explanation: Phenytoin (Dilantin) is an anticonvulsant drug commonly used to treat seizure disorders. Steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity. The nurse's priority action is to stop the feeding for 1 to 2 hours before and after administering phenytoin as products containing calcium (eg, antacids, calcium supplements) and/or nutritional enteral tube feedings can decrease the absorption and the serum level of this drug. (Option 1) Unless clients have renal insufficiency, renal function tests are not routinely monitored during prescribed phenytoin therapy. Phenytoin is metabolized in the liver and can cause liver damage. Monitoring of liver function test during therapy is recommended. (Option 2) Flushing the tube with 30-50 mL of water before and after administering phenytoin is recommended to minimize drug loss and drug-drug incompatibility. Flushing with normal saline before and after drug administration is recommended in clients receiving intravenous (IV) phenytoin. (Option 4) BP is not usually affected in clients prescribed oral phenytoin therapy for seizure disorders. However, IV phenytoin can cause hypotension and arrhythmias. Educational objective: Phenytoin is an anticonvulsant drug commonly used to treat seizure disorders. Steady absorption is necessary to maintain a therapeutic dosage range and drug level to control seizure activity. Administration of phenytoin concurrent with certain drugs (eg, antacids, calcium) and/or enteral feedings can affect the absorption of phenytoin.

Block Time Remaining: 00:00:43 TUTOR Test Id: 80941960 QId: 31541 (921666) 28 of 53 A A A The emergency department nurse prepares a male client for surgery. The client was admitted with a traumatic open fracture of the femur, hematocrit of 36% (0.36), and hemoglobin of 12 g/dL (120 g/L). Which prescription should the nurse validate with the health care provider before administration? 1. Cefazolin [8%] 2. Enoxaparin [75%] 3. Morphine [4%] 4. Tetanus toxoid [10%] Omitted Correct answer 2 Answered correctly 75% Time: 0 seconds Updated: 03/19/2017 Explanation: The Joint Commission Surgical Improvement Project CORE measure set has shown that preventives (eg, heparin, enoxaparin, aspirin) in select surgical procedures, given 24 hours before and after surgery, reduce the risk of venous thromboembolism. However, the estimated blood loss in a client with a fracture can be significant depending on the site (eg, 250-1200 mL). Although this client's admission hematocrit (36% [0.36]) and hemoglobin (12 g/dL [120 g/L]) are only slightly low for an adult male (normal: 39%-50% [0.39-0.50], 13.2-17.3 g/dL [132-173 g/L]), the blood loss may not yet be evident. Therefore, the nurse would validate the prescription for enoxaparin (Lovenox) with the health care provider before administration. Medications commonly prescribed for a client with an open fracture include: Cefazolin (Ancef), a bone-penetrating cephalosporin antibiotic that is active against skin flora (Staphylococcus aureus); it is given prophylactically before and after surgery to prevent infection (Option 1) Cyclobenzaprine (Flexeril), a central and peripheral muscle relaxant given to treat pain associated with muscle spasm; carisoprodol (Soma) or methocarbamol (Robaxin) can also be prescribed Tetanus and diphtheria toxoid, an immunization given prophylactically to prevent infection (Clostridium tetani) if immunizations are not up to date (>10 years), unavailable, or unknown (Option 4) Ketorolac (Toradol), a nonsteroidal anti-inflammatory drug given to decrease inflammation and pain Opioids (eg, morphine, hydrocodone [Vicodin]), given for analgesia (Option 3) Educational objective: Medications commonly prescribed for a client with an open fracture to prevent infection and treat pain and muscle spasm include cefazolin (Ancef), tetanus toxoid, ketorolac (Toradol), opioids, and cyclobenzaprine (Flexeril).

Block Time Remaining: 00:00:43 TUTOR Test Id: 80941960 QId: 30032 (921666) 29 of 53 A A A A client who has been on long-term omeprazole therapy for gastroesophageal reflux disease is admitted to the hospital for a urinary tract infection. The nurse recognizes that this client is at highest risk for which complication due to omeprazole use? 1. Clostridium difficile infection [61%] 2. Gait disturbance [13%] 3. Jaw necrosis [7%] 4. Tremor [18%] Omitted Correct answer 1 Answered correctly 61% Time: 0 seconds Updated: 06/02/2017 Explanation: Long-term use of proton pump inhibitors (PPIs) is common as these medications are available over the counter. PPIs impair intestinal calcium absorption and therefore are associated with decreased bone density, which increases the possibility of fractures of the spine, hip, and wrist. PPIs cause acid suppression that otherwise would have prevented pathogens from more easily colonizing the upper gastrointestinal tract. This leads to increased risk of pneumonias. PPI use may also increase the risk for clostridium difficile-associated diarrhea (CDAD); currently the cause is unclear. A safety alert has been issued by the US Food and Drug Administration (FDA) advising health care providers to consider CDAD for unresolved diarrhea in PPI users. This client would be receiving antibiotics for a urinary tract infection, further increasing the risk for C difficile infection (Option 1). (Option 2) Gait disturbance (ataxia) is commonly seen with phenytoin toxicity. (Option 3) Jaw necrosis is associated with long-term bisphosphonate (eg, alendronate, risedronate) therapy. (Option 4) Tremor is seen with lithium toxicity and albuterol (short-acting beta agonist) use. Educational objective: Long-term use of PPIs (Prazoles - omeprazole, lansoprazole, pantoprazole, rebeprazole) has been associated with decreased bone density (calcium malabsorption) and increased risk for C difficile-associated diarrhea and pneumonia.

Block Time Remaining: 00:00:42 TUTOR Test Id: 80941960 QId: 31228 (921666) 24 of 53 A A A A client with deep vein thrombosis (DVT) is receiving a continuous infusion of unfractionated heparin. The client asks the nurse what the heparin is for. How should the nurse respond? 1. "Heparin is a blood thinner that will help to dissolve the clot in your leg." [27%] 2. "Heparin will help stabilize the clot in your leg and prevent it from breaking off and traveling to your lungs." [6%] 3. "Heparin will keep the current clot from getting bigger and help prevent new clots from forming." [65%] 4. "I'm sorry. This is something that your health care provider (HCP) can answer better upon arriving." [0%] Omitted Correct answer 3 Answered correctly 65% Time: 2 seconds Updated: 03/18/2017 Explanation: Venous thrombosis involves the formation of a thrombus (clot) and the inflammation of the vein. Anticoagulant therapy such as heparin does not dissolve the clot. The clot will be broken down by the body's intrinsic fibrinolytic system over time. The heparin slows the time it takes blood to clot, thereby keeping the current clot from growing bigger and preventing new clots from forming. (Option 1) Anticoagulants do not dissolve clots. Thrombolytic agents (fibrinolytics), such as tissue plasminogen activator (tPA), are used to break the clots, but they also carry the risk of serious intracranial hemorrhage and are used only for acute life-/organ-threatening conditions. The body will break down the clot over a period of time. (Option 2) Heparin does not prevent the clot from breaking off but will deter the clot from growing larger. (Option 4) The nurse should be able to answer client questions regarding medications being administered. The HCP can answer any further questions the client may have. Educational objective: The nurse should teach the client that the purpose of unfractionated heparin infusion in the treatment of DVT is to slow the time it takes blood to clot, thereby keeping the current clot from getting bigger and preventing new clots from forming.

Block Time Remaining: 00:00:43 TUTOR Test Id: 80941960 QId: 30433 (921666) 25 of 53 A A A Which client finding would be a contraindication for the nurse to administer dicyclomine hydrochloride for irritable bowel syndrome? 1. Bladder scan showing 500 mL urine [32%] 2. Hemoglobin of 11 g/dL (110 g/L) [9%] 3. History of cataracts [32%] 4. Reporting frequent diarrhea today [25%] Omitted Correct answer 1 Answered correctly 32% Time: 1 seconds Updated: 12/11/2016 Explanation: Dicyclomine hydrochloride (Bentyl) is an anticholinergic medication. Anticholinergics are used to relax smooth muscle and dry secretions. Anticholinergic side effects include pupillary dilation, dry mouth, urinary retention, and constipation. Therefore, the classic contraindications are closed-angle glaucoma, bowel ileus, and urinary retention. The urge to urinate is normally present at 300 mL; pain is usually felt around 500 mL. This client has urinary retention and should not have the bladder smooth muscle further relaxed. (Option 2) Anticholinergic drugs do not affect the blood count. The normal reference range for hemoglobin is 11.7-15.5 g/dL (117-155 g/L) for females and 13.2-17.3 g/dL (132-173 g/L) for males. (Option 3) The common eye contraindication is narrow-angle glaucoma as it could worsen the condition. Cataracts are a clouding of the lens and are not related to drainage flow. (Option 4) Diarrhea is an expected finding with irritable bowel syndrome or other increased peristalsis and is a common reason for the drug to be prescribed. Anticholinergic drugs are contraindicated in the presence of a bowel ileus or atony as constipation is a side effect and further relaxation of the intestines could worsen these conditions. Educational objective: Anticholinergic drugs are contraindicated when smooth muscle relaxation is already a concern. Commonly cited contraindications include narrow-angle glaucoma, urinary retention (including benign prostatic hyperplasia), and bowel ileus/obstruction.

Block Time Remaining: 00:00:43 TUTOR Test Id: 80941960 QId: 30367 (921666) 26 of 53 A A A A client with latent tuberculosis has been taking oral isoniazid (INH) 300 mg daily for 2 months. The client tells the nurse that for the past week she has had numbness, a burning sensation, and tingling in her hands and feet. Additional intake of which of the following would most likely have prevented this? 1. Folic acid [14%] 2. Vitamin B6 [43%] 3. Vitamin B12 [29%] 4. Vitamin D [12%] Omitted Correct answer 2 Answered correctly 43% Time: 0 seconds Updated: 04/26/2017 Explanation: INH interferes with the action of vitamin B6 (pyridoxine), resulting in peripheral neuropathy; it manifests as ataxia and paresthesia. Individuals who are most predisposed to becoming neurotoxic from taking INH include older adults, those who are malnourished, diabetic clients, pregnant or breastfeeding clients, alcoholics, children, those with liver or renal disease, and HIV-positive individuals. To prevent these complications, a vitamin B6 supplement at a dose of 25-50 mg/day is recommended for those at high risk. (Option 1) Folic acid deficiency does not cause peripheral neuropathy. It is associated with macrocytic anemia and neural tube defects in children. (Option 3) Vitamin B12 deficiency can cause peripheral neuropathy; however, it is not seen with INH therapy. (Option 4) Vitamin D deficiency causes osteomalacia but not peripheral neuropathy. Educational objective: High-risk clients on isoniazid therapy for treatment of tuberculosis may experience neurological side effects due to a decrease in the body's ability to utilize vitamin B6 (pyridoxine). A vitamin B supplement will prevent these effects.

Block Time Remaining: 00:00:43 TUTOR Test Id: 80941960 QId: 31968 (921666) 27 of 53 A A A The nurse is caring for a client who started receiving chemotherapy 10 days ago. Today, the health care provider prescribes filgrastim. Which of the following is an expected outcome of this medication? 1. Decrease in serum uric acid [12%] 2. Increase in hemoglobin level [8%] 3. Increase in neutrophil count [63%] 4. Increase in platelet count [15%] Omitted Correct answer 3 Answered correctly 63% Time: 0 seconds Updated: 12/12/2016 Explanation: Chemotherapy can cause suppression of rapidly reproducing cells, including bone marrow suppression. This can result in decreased red blood cells, white blood cells, and platelets, all manufactured in the bone marrow. It is most likely to be seen with chemotherapy (versus radiation), with the lowest counts (the nadir) usually at 7-10 days after therapy initiation. Leukopenia is a decrease in total circulating white blood cell count (<4,000/mm3) and neutropenia is a decrease in circulating neutrophils (usually <1500/mm3). Filgrastim (Neupogen) and pegfilgrastim (Neulasta) stimulate neutrophil production and are given prophylactically or if the client has an infection and more neutrophils are needed to fight it (Option 3). (Option 1) Cancer chemotherapy causes cell lysis, which results in tumor lysis syndrome due to massive release of nucleic acid and its metabolic product, uric acid. Uric acid deposition leads to acute kidney injury. Medications such as allopurinol or rasburicase and aggressive IV hydration are used to prevent this complication. (Option 2) Anemia is also common with chemotherapy. Epoetin (Procrit), a form of erythropoietin, stimulates the body to make additional red blood cells. (Option 4) Low platelet count is not considered an urgent need until it is at <50,000/mm3. Usually, platelet transfusions are given. Educational objective: Bone marrow suppression from chemotherapy can cause decreased red blood cells, white blood cells, and platelets. Erythropoietin is used to increase red blood cell production, and filgrastim is administered to stimulate neutrophil production.

Block Time Remaining: 00:00:44 TUTOR Test Id: 80941960 QId: 35142 (921666) 30 of 53 A A A A community health nurse evaluates several clients' vaccination status. Which clients would the nurse recommend receive the influenza vaccine injection? Select all that apply. 1. 9-month-old with no known medical conditions 2. 5-year-old with congenital heart defect 3. 23-year-old recently diagnosed with HIV 4. 45-year-old caretaker of elderly parent 5. 75-year-old with end-stage renal failure Omitted Correct answer 1,2,3,4,5 Answered correctly 5% Time: 1 seconds Updated: 01/31/2017 Explanation: Influenza is a respiratory illness common during the cooler months of the year. Each year, a new influenza vaccine is created to help protect against specific viral strains. The Centers for Disease Control and Prevention and Public Health Agency of Canada recommend that all clients age ≥6 months receive the influenza vaccine annually unless the client has a life-threatening allergy to the vaccine or one of its ingredients. Special emphasis should be placed on vaccinating the following high-risk individuals: Clients with chronic conditions (eg, asthma, heart failure, cancer) may experience exacerbation of symptoms if infected (Options 2 and 5). Immunocompromised clients (eg, HIV) have decreased ability to fight infection (Option 3). Health care workers and caretakers are at greater risk for acquiring and transmitting infection to other clients (Option 4). Healthy children age 6-23 months and clients age ≥65 are at greatest risk for serious, flu-related complications (eg, pneumonia, dehydration) (Option 1). Pregnant women are at increased risk for premature labor/delivery or influenza complications due to pregnancy-related physiologic changes. Please note: The NCLEX now includes multiple-response questions with all options correct. Educational objective: Annual vaccination during influenza season is recommended for all clients age ≥6 months without life-threatening allergy to the vaccine or its ingredients. High-risk groups include clients who have chronic conditions, those who work in health care or as caretakers, those age 6-23 months or ≥65, and pregnant women.

Block Time Remaining: 00:00:45 TUTOR Test Id: 80941960 QId: 31840 (921666) 31 of 53 A A A The nurse provides teaching about methotrexate to a 28-year-old client with rheumatoid arthritis. Which client statement indicates the need for further instruction regarding this drug? 1. "I know my resistance to germs will be lower, so I should get a flu shot this year." [23%] 2. "I should take precautions to prevent pregnancy while I take this medicine." [16%] 3. "I will have an eye examination every 6 months to check for damage caused by my medication." [38%] 4. "It will be a difficult change for me, but I will not have wine with dinner anymore." [21%] Omitted Correct answer 3 Answered correctly 38% Time: 1 seconds Updated: 04/24/2017 Explanation: Methotrexate (Rheumatrex) is classified as a folate antimetabolite, antineoplastic, immunosuppressant drug to treat various malignancies and as a nonbiologic disease-modifying antirheumatic drug (DMARD) to treat rheumatoid arthritis and psoriasis. The client's statement about getting an eye examination every 6 months indicates that further teaching is necessary as these examinations are not indicated for clients prescribed methotrexate (Option 3). However, frequent eye examinations are required for clients prescribed the nonbiologic antimalarial DMARD hydroxychloroquine (Plaquenil) as it can cause retinal damage. (Option 1) Methotrexate is an immunosuppressant and can cause bone marrow suppression. Clients are at risk for infection. They should avoid crowded places and individuals with known infection and should receive appropriate killed (inactivated) vaccines (eg, influenza, pneumococcal). Live vaccines (eg, herpes zoster) are contraindicated. (Option 2) Clients should not become pregnant while taking methotrexate or for at least 3 months after it is discontinued as the drug is teratogenic and can cause congenital abnormalities and fetal death. (Option 4) Clients taking methotrexate should avoid alcohol as the prescription drug is hepatotoxic and drinking alcohol increases the risk for hepatotoxicity. Educational objective: Methotrexate is a disease-modifying antirheumatic drug used to treat rheumatoid arthritis and psoriasis. The major adverse effects associated with methotrexate include bone marrow suppression, hepatotoxicity, congenital abnormalities, and fetal death.

Block Time Remaining: 00:00:43 TUTOR Test Id: 80944027 QId: 31374 (921666) 23 of 54 A A A The nurse is caring for a client admitted with serotonin syndrome after taking citalopram and tramadol. Which assessment findings does the nurse expect to find? Select all that apply. 1. Absent deep tendon reflexes 2. Cold, clammy skin 3. Muscle rigidity 4. Restlessness and agitation 5. Sinus tachycardia Omitted Correct answer 3,4,5 Answered correctly 33% Time: 1 seconds Updated: 03/19/2017 Explanation: Serotonin syndrome, a potentially life-threatening condition, develops when drugs affecting the body's serotonin levels are administered simultaneously or in overdose. Drugs, which may trigger this reaction, include selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), dextromethorphan, ondansetron, St. John's wort, and tramadol. The diagnosis is primarily clinical and based on medication history and clinical findings. Symptoms may include mental status changes (eg, anxiety, agitation, disorientation), autonomic dysregulation (eg, hyperthermia, diaphoresis, tachycardia/hypertension), and neuromuscular hyperactivity (eg, tremor, muscle rigidity, clonus, hyperreflexia). (Option 1) The client experiencing serotonin syndrome would exhibit hyperreflexia. (Option 2) The client experiencing serotonin syndrome would exhibit warm moist skin and a fever. Educational objective: Clinical manifestations of serotonin syndrome include mental status changes (eg, anxiety, agitation, disorientation), autonomic dysregulation (eg, hyperthermia, diaphoresis, tachycardia/hypertension), and neuromuscular hyperactivity (eg, tremor, muscle rigidity, clonus, hyperreflexia).

Block Time Remaining: 00:00:45 TUTOR Test Id: 80944027 QId: 30549 (921666) 24 of 54 A A A A client with bronchial asthma and sinusitis has increased wheezing and decreased peak flow readings. During the admission interview, the nurse reconciles the medications and notes that which of the following over-the-counter medications taken by the client could be contributing to increased asthma symptoms? 1. Guaifenesin 600 mg orally twice a day as needed [36%] 2. Ibuprofen 400 mg orally every 6 hours for pain as needed [38%] 3. Loratadine 1 tablet orally every day as needed [21%] 4. Vitamin D 2,000 units orally every day [3%] Omitted Correct answer 2 Answered correctly 38% Time: 2 seconds Updated: 04/26/2017 Explanation: Two groups of commonly used drugs, nonsteroidal anti-inflammatory drugs and beta-adrenergic antagonists (beta blockers), have the potential to cause problems for clients with asthma. Ibuprofen (Motrin) and aspirin are common over-the-counter anti-inflammatory drugs that are effective in relieving pain, discomfort, and fever. About 10%-20% of asthmatics are sensitive to these medications and can experience severe bronchospasm after ingestion. This is prevalent in clients with nasal polyposis. (Option 1) Guaifenesin (Mucinex) is an expectorant used to facilitate mobilization of mucus and should not have the potential to exacerbate asthma or cause an attack. (Option 3) Loratadine (Claritin) is an antihistamine and should not have the potential to exacerbate asthma or cause an attack. (Option 4) Vitamin D is used to help maintain bone density and should not have the potential to exacerbate asthma or cause an attack. Educational objective: Ibuprofen and aspirin are common over-the-counter anti-inflammatory drugs that can cause bronchospasm in some clients with asthma.

Block Time Remaining: 00:00:45 TUTOR Test Id: 80944027 QId: 30549 (921666) 24 of 54 A A A A client with bronchial asthma and sinusitis has increased wheezing and decreased peak flow readings. During the admission interview, the nurse reconciles the medications and notes that which of the following over-the-counter medications taken by the client could be contributing to increased asthma symptoms? 1. Guaifenesin 600 mg orally twice a day as needed [36%] 2. Ibuprofen 400 mg orally every 6 hours for pain as needed [38%] 3. Loratadine 1 tablet orally every day as needed [21%] 4. Vitamin D 2,000 units orally every day [3%] Omitted Correct answer 2 Answered correctly 38% Time: 2 seconds Updated: 04/26/2017 Explanation: Two groups of commonly used drugs, nonsteroidal anti-inflammatory drugs and beta-adrenergic antagonists (beta blockers), have the potential to cause problems for clients with asthma. Ibuprofen (Motrin) and aspirin are common over-the-counter anti-inflammatory drugs that are effective in relieving pain, discomfort, and fever. About 10%-20% of asthmatics are sensitive to these medications and can experience severe bronchospasm after ingestion. This is prevalent in clients with nasal polyposis. (Option 1) Guaifenesin (Mucinex) is an expectorant used to facilitate mobilization of mucus and should not have the potential to exacerbate asthma or cause an attack. (Option 3) Loratadine (Claritin) is an antihistamine and should not have the potential to exacerbate asthma or cause an attack. (Option 4) Vitamin D is used to help maintain bone density and should not have the potential to exacerbate asthma or cause an attack. Educational objective: Ibuprofen and aspirin are common over-the-counter anti-inflammatory drugs that can cause bronchospasm in some clients with asthma.

Block Time Remaining: 00:00:46 TUTOR Test Id: 80944027 QId: 30525 (921666) 25 of 54 A A A A client with schizophrenia that is resistant to other antipsychotic medications is about to start on a course of clozapine. Which of these periodic measurements has the highest priority in this client? 1. Complete blood count (CBC) and absolute neutrophil count (ANC) [59%] 2. Electrocardiogram [22%] 3. Fasting blood sugar and fasting lipids [8%] 4. Height, weight, and waist circumference [8%] Omitted Correct answer 1 Answered correctly 59% Time: 1 seconds Updated: 01/22/2017 Explanation: Clozapine is an atypical antipsychotic medication used to treat schizophrenia that has not responded to standard, more traditional treatment. Clozapine is associated with a risk for agranulocytosis and is therefore used only in clients with treatment-resistant schizophrenia. A client must have a white blood cell (WBC) count of ≥3500/mm3 and an ANC of ≥2000/mm3 before starting clozapine treatment, and so it is most important to first obtain a baseline CBC and ANC. Agranulocytosis is reversible if caught early. Therefore, clients taking clozapine must have their WBC and ANC monitored regularly throughout the course of therapy (initially once every week). Clients should also contact the health care provider (HCP) immediately if fever or a sore throat develops, as this may indicate an underlying infection from neutropenia. Other potential adverse effects of clozapine requiring baseline assessment prior to treatment and ongoing monitoring include: Weight gain—a baseline height, weight, and waist circumference should be obtained, and a BMI can be calculated Hyperglycemia—symptoms of hyperglycemia (eg, increased thirst and urination, weakness, increased blood glucose) should be monitored Dyslipidemia—a lipid profile should be obtained (Options 2, 3, and 4) These are important but not priority actions. Educational objective: Agranulocytosis is the most serious adverse effect of clozapine. Pretreatment assessment and ongoing monitoring of WBC and ANC are necessary. Clients are advised to contact their HCP if fever or a sore throat develops. Clozapine can also cause metabolic syndrome (weight gain, hyperlipidemia, insulin resistance/diabetes) and seizures. Copyright © UWorld. All rights reserved.

Block Time Remaining: 00:00:46 TUTOR Test Id: 80941960 QId: 31557 (921666) 32 of 53 A A A The nurse is caring for a client with an inflammatory bowel disease exacerbation. The client is prescribed sulfasalazine. Which finding would require a priority follow-up by the nurse? 1. Elevated erythrocyte sedimentation rate [33%] 2. Hemoglobin 10.5 g/dL (105 g/L) [27%] 3. Urine with yellow-orange discoloration [6%] 4. Urine specific gravity 1.035 [32%] Omitted Correct answer 4 Answered correctly 32% Time: 1 seconds Updated: 01/17/2017 Explanation: Sulfasalazine (Azulfidine) contains sulfapyridine and aspirin (5-ASA) and is used as a topical gastrointestinal anti-inflammatory and immunomodulatory agent in inflammatory bowel disease (IBD). When the 5-ASA is combined with the sulfa preparation, the drug does not become absorbed until it reaches the colon. Dehydration is a risk with IBD as the client can have up to 20 diarrheal stools a day. The client usually does not feel thirsty until after there is a fluid volume deficit. Sulfa can crystallize in the kidney if the client is dehydrated. Normal urine specific gravity is 1.003-1.030. Elevated specific gravity can indicate concentrated urine and be a sign of dehydration (Option 4). (Option 1) Due to the inflammatory nature of IBD, erythrocyte sedimentation rate, C-reactive protein, and white blood cells can be elevated. This is an expected finding during an exacerbation. (Option 2) Mild to moderate anemia (normal hemoglobin 13.2-17.3 g/dL [132-173 g/L] for males, 11.7-15.5 g/dL [117-155 g/L] for females) is common with most chronic inflammatory conditions (eg, rheumatoid arthritis, IBD) as the body cannot use the available iron in bone marrow with active inflammation. In addition, IBD exacerbation usually includes bloody stools, resulting in blood loss iron deficiency anemia. This needs follow-up but is not a priority. (Option 3) Yellow-orange discoloration of the client's skin and urine is an expected side effect from the drug. Educational objective: Dehydration is a concern with sulfasalazine and most other "sulfa" medications due to the risk of crystal formation in the kidney. It is also a potential complication of inflammatory bowel disease.

Block Time Remaining: 00:00:47 TUTOR Test Id: 80941960 QId: 30961 (921666) 33 of 53 A A A The nurse teaches a parent how to administer an oral liquid medication to a 2-month-old client. The nurse knows that the parent understands the teaching when the parent does which of the following? 1. Allows the client to sip the medication from a cup [0%] 2. Expels the medication from a dropper onto the back of the tongue [13%] 3. Mixes the medication in the infant's bottle of formula [1%] 4. Using a syringe, administers the medication in small amounts into the back of the cheek [83%] Omitted Correct answer 4 Answered correctly 83% Time: 1 seconds Updated: 04/08/2017 Explanation: Using a syringe to measure the medication is the most accurate technique to ensure that the proper amount of medication is being administered. The correct procedure for administering oral medication to an infant is to place small amounts of the medication at the back of the cheek, allowing time for the infant to swallow each amount. This technique decreases the risk for choking and ensures that all the medication is consumed. (Option 1) Although cup feeding may be a method used to feed infants in specific cases, medication administration requires a more accurate measurement. A syringe can provide an accurate measurement and decrease the risk of waste due to the infant's spitting or drooling. (Option 2) Infants have a decreased gag reflex. Dispensing medication onto the back of the tongue would increase the risk for aspiration of the medication. (Option 3) It is very important for the infant to receive the entire dose of the medication. Medication should never be mixed in a bottle of formula as the infant may not consume the entire amount. Educational objective: The extrusion reflex and a decreased gag reflex in infants less than 4 months old increase the risk for choking and aspiration. Instilling the medication using a syringe at the back of the cheek decreases the risk for choking and ensures that the correct amount of medication is consumed.

Block Time Remaining: 00:00:47 TUTOR Test Id: 80944027 QId: 30302 (921666) 26 of 54 A A A The nurse is providing discharge instructions on the proper use of prescribed short-acting beta agonist and inhaled corticosteroid metered-dose inhalers to a client with newly diagnosed asthma. Which instructions should the nurse include? Select all that apply. 1. "Omit the beclomethasone if the albuterol is effective." 2. "Rinse your mouth well after using the beclomethasone inhaler and do not swallow the water." 3. "Take the albuterol inhaler apart and wash it after every use." 4. "Use the albuterol inhaler first if needed, then the beclomethasone inhaler." 5. "Use the beclomethasone inhaler first, then the albuterol, if needed." Omitted Correct answer 2,4 Answered correctly 41% Time: 1 seconds Updated: 05/30/2017 Explanation: Asthma is a disorder of the lungs characterized by reversible airway hyper-reactivity and chronic inflammation of the airways. Albuterol (Proventil) is a short-acting beta agonist (SABA) administered as a quick-relief, rescue drug to relieve symptoms (eg, wheezing, breathlessness, chest tightness) associated with intermittent or persistent asthma. Beclomethasone (Beconase) is an inhaled corticosteroid (ICS) normally used as a long-term, first-line drug to control chronic airway inflammation. When using an ICS metered-dose inhaler (MDI), small particles of the medication are deposited and can impact the tongue and mouth. Rinsing the mouth and throat well after using the MDI and not swallowing the water are recommended to help prevent a Candida infection (thrush) (white spots on tongue, buccal mucosa, and throat), a common side effect of ICSs. The use of a spacer with the inhaler can also decrease the risk of developing thrush (Option 2). When both MDIs are to be taken at the same time, clients are instructed to take the SABA first to open the airways and then the ICS to provide better delivery of the medication. It is important for the nurse to clarify indications and sequencing as the SABA is a rescue drug taken on an as-needed basis and is not always taken with the ICS (Options 4 and 5). (Option 1) Inhaled corticosteroids (eg, fluticasone, beclomethasone) are not rescue drugs. They are prescribed to be taken on a regular schedule (eg, morning, bedtime) on a long-term basis to prevent exacerbations and should not be omitted even if the SABA is effective. (Option 3) Taking the albuterol (Proventil) inhaler apart, washing the mouthpiece (not canister) under warm running water, and letting it air dry at least 1-2 times a week is recommended. Medication particles can deposit in the mouthpiece and prevent a full dose of medication from being dispensed. Taking the ICS inhaler apart and cleaning it every day is recommended. Educational objective: Proper use of the short-acting beta agonist (SABA) inhaler includes taking it apart and rinsing the mouthpiece with warm water 1-2 times a week. Proper use of the inhaled corticosteroid (ICS) inhaler includes taking it apart and rinsing the mouthpiece with warm water daily and rinsing the mouth and throat after each use to prevent a Candida infection (thrush). When these medications are administered together, the sequence is SABA first to open the airways and ICS second.

Block Time Remaining: 00:00:48 TUTOR Test Id: 80944027 QId: 32022 (921666) 27 of 54 A A A The parent of a child diagnosed with attention-deficit hyperactivity disorder (ADHD), predominantly inattentive type, says to the nurse, "I hate the idea of my child taking a drug that's a stimulant. How will I know that the methylphenidate is even working?" Which is the best response by the nurse? 1. "Methylphenidate is generally a safe and effective drug for children with ADHD." [9%] 2. "Methylphenidate will increase the levels of neurotransmitters in your child's brain." [8%] 3. "You should see your child's school grades improve." [4%] 4. "Your child should be able to more easily complete school assignments and other tasks." [77%] Omitted Correct answer 4 Answered correctly 77% Time: 1 seconds Updated: 12/18/2016 Explanation: Although methylphenidate (eg, Ritalin, Concerta) is classified as a stimulant, in children with ADHD it improves attention, decreases distractibility, helps maintain focus on an activity, and improves listening skills. For many years, the effects of methylphenidate in children were labeled as paradoxical. Now, research has shown that methylphenidate significantly increases levels of dopamine in the central nervous system (CNS) that lead to stimulation of the inhibitory system of the CNS. Methylphenidate works quickly; symptom relief is often seen after the first dose. (Option 1) This is a true statement; methylphenidate is generally safe for most children, adolescents, and adults. Methylphenidate can cause adverse reactions, but these affect a very small percentage of users. However, this response does not address the parent's question about how the drug works. (Option 2) This is a true statement but does not give the parent information about the benefits of methylphenidate. In addition, it contains language that most clients would not understand. (Option 3) A child's school grades may improve due to the benefits of methylphenidate. This would be seen over time as a secondary benefit; the immediate therapeutic effects are often observed with the first dose. Educational objective: The therapeutic effects of methylphenidate can be observed very quickly in children with ADHD. Methylphenidate improves attention, decreases distractibility, helps maintain focus on an activity, and improves listening skills.

Block Time Remaining: 00:00:48 TUTOR Test Id: 80941960 QId: 34034 (921666) 34 of 53 A A A A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. Which statement made by the student would require intervention by the nurse? 1. "Take this in the morning 1 hour before breakfast." [18%] 2. "Take this with your other stomach medications." [61%] 3. "Take your heart medication 2 hours after sucralfate." [12%] 4. "You might experience constipation while taking this." [7%] Omitted Correct answer 2 Answered correctly 61% Time: 1 seconds Updated: 03/25/2017 Explanation: Sucralfate is an oral medication that forms a protective layer in the gastrointestinal mucosa, which provides a physical barrier against stomach acids and enzymes. It doesn't neutralize or reduce acid production. It is prescribed to treat and prevent both stomach and duodenal ulcers. This medication is generally prescribed 1 hour before meals and at bedtime and, for effective results, is administered on an empty stomach with a glass of water (Option 1). Sucralfate also binds with many other medications (eg, digoxin, warfarin, phenytoin) and reduces their bioavailability. Therefore, all other medications are generally administered at least 1-2 hours before or after sucralfate administration (Option 3). Constipation is a common side effect of this medication (Option 4). (Option 2) Sucralfate forms a better protective layer at low pH. Therefore, antacids or other acid-reducing medications (eg, proton pump inhibitors or H2 blockers) should not be taken 30 minutes before or after taking sucralfate to avoid altered absorption. Educational objective: Sucralfate should be taken on an empty stomach with a glass of water. Sucralfate forms a better protective layer at low pH. Therefore, acid-reducing agents (eg, antacids, proton pump inhibitors, H2 blockers) should be avoided 30 minutes before and after administration to avoid altered absorption. Other medications should be administered 1-2 hours before or after sucralfate.

Block Time Remaining: 00:00:49 TUTOR Test Id: 80941960 QId: 32209 (921666) 35 of 53 A A A 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) [11%] 2. Clopidogrel for a client with a platelet count of 70,000/mm3 (70 × 109/L) [72%] 3. Magnesium sulfate for a client with a magnesium level of 1.0 mEq/L (0.5 mmol/L) [8%] 4. Metformin for a client with a glycosylated hemoglobin level of 11% [7%] Omitted Correct answer 2 Answered correctly 72% Time: 1 seconds Updated: 02/17/2017 Explanation: Clopidogrel (Plavix) is a platelet aggregation inhibitor used to prevent blood clot formation in clients with recent myocardial infarction, acute coronary syndrome, cardiac stents, stroke, or peripheral vascular disease. Because it can cause thrombocytopenia and increase the risk for bleeding, the nurse should notify the health care provider (HCP) of the low platelet count (normal: 150,000-400,000/mm3 [150-400 × 109/L]) before administering clopidogrel. (Option 1) Calcium acetate (PhosLo) is used to control hyperphosphatemia in clients with end-stage kidney disease by binding to phosphate in the intestines and excreting it in the stool. Because the phosphate level is high (normal adult: 2.4-4.4 mg/dL [0.78-1.42 mmol/L]), it is not necessary to notify the HCP. (Option 3) Magnesium sulfate is used to correct hypomagnesemia and treat torsades de pointes and seizures associated with eclampsia. Because the magnesium level is low (normal adult: 1.5-2.5 mEq/L [0.75-1.25 mmol/L]), it is not necessary to notify the HCP. (Option 4) Metformin (Glucophage) is a first-line drug for the control of blood sugar in clients with type 2 diabetes mellitus. Glycosylated hemoglobin (A1C) measures the total hemoglobin that has glucose attached to it, expressed as a percentage. Glucose remains attached to the red blood cell for the life of the cell (about 120 days) and reflects glycemic control over an extended period. The recommended A1C level for a client with diabetes is <7%. Although the A1C level is elevated, the medication would be administered regardless of the result (unless the client is hypoglycemic), so it is not necessary to notify the HCP. Educational objective: Clopidogrel (Plavix) can cause thrombocytopenia (platelet count <150,000/mm3 [150 × 109/L]) and increase a client's risk for bleeding.

Block Time Remaining: 00:00:49 TUTOR Test Id: 80944027 QId: 31845 (921666) 28 of 54 A A A A client with seizure disorder is prescribed a moderately high dose of phenytoin. Which teaching topic should the nurse discuss with this client? 1. Diet high in iron [4%] 2. Good oral care and dental follow-up [65%] 3. Shaving with an electric razor [8%] 4. Use of sunglasses for eye protection [21%] Omitted Correct answer 2 Answered correctly 65% Time: 1 seconds Updated: 01/16/2017 Explanation: The nurse should discuss the need to perform good oral hygiene with a soft-bristle toothbrush and to visit the dentist regularly as phenytoin can cause gingival hyperplasia (overgrowth of the gum tissues or reddened gums that bleed easily), especially in high doses. Folic acid supplementation can also reduce this side effect. The other major side effects of phenytoin use are an increase in body hair, rash, folic acid depletion, and decreased bone density (osteoporosis). (Option 1) Long-term use of phenytoin can cause folic acid deficiency and decreased bone density. Therefore, a diet high in folic acid and calcium should be recommended. (Option 3) Clients who use anticoagulants (eg, warfarin, rivaroxaban, apixaban) should avoid cuts and preferably use an electric razor for shaving. (Option 4) Exposure of the eyes to ultraviolet light and use of corticosteroids are risk factors for cataract development. Educational objective: The nurse should encourage the client taking phenytoin to perform good oral hygiene and visit the dentist regularly to prevent gingival hyperplasia. The other major side effects of phenytoin use are an increase in body hair, rash, folic acid depletion, and decreased bone density (osteoporosis).

Block Time Remaining: 00:00:50 TUTOR Test Id: 80944027 QId: 31957 (921666) 29 of 54 A A A A client is receiving lithium carbonate 900 mg/day for a schizoaffective disorder. The laboratory notifies the nurse that the client's lithium level is 1.0 mEq/L (1.0 mmol/L). Based on this result, which prescription does the nurse anticipate receiving from the health care provider? 1. Continue at the current dosage [77%] 2. Decrease the dosage [9%] 3. Discontinue the medication [3%] 4. Increase the dosage [10%] Omitted Correct answer 1 Answered correctly 77% Time: 1 seconds Updated: 02/25/2017 Explanation: Lithium carbonate is used as a mood stabilizer in clients with schizoaffective disorder (combination of schizophrenia and a mood disorder) and bipolar disorders. Lithium has a very narrow therapeutic index (0.6-1.2 mEq/L [0.6-1.2 mmol/L]); levels >1.5 mEq/L (1.5 mmol/L) are considered toxic. Lithium toxicity can be acute (eg, ingesting a bottle of lithium tablets in a suicide attempt) or chronic (eg, slow accumulation due to decreased renal function or drug-drug interactions). Acute or acute-on-chronic toxicity presents predominantly with gastrointestinal symptoms (eg, nausea, vomiting, diarrhea); neurologic manifestations occur later. However, neurologic manifestations occur early in chronic toxicity. Common neurologic manifestations include ataxia, confusion, or agitation, and neuromuscular excitability (eg, tremor, myoclonic jerks). Chronic toxicity also manifests as diabetes insipidus (eg, polyuria, polydipsia). (Options 2, 3, and 4) No dose adjustment is needed as this client's lithium level is therapeutic. Educational objective: Lithium levels should be checked frequently given the narrow therapeutic index (0.6-1.2 mEq/L [0.6-1.2 mmol/L]). A level >1.5 mEq/L (1.5 mmol/L) is considered toxic. Chronic toxicity manifests with neurologic symptoms (eg, confusion, tremor, ataxia) and/or diabetes insipidus (eg, polyuria, polydipsia).

Block Time Remaining: 00:00:50 TUTOR Test Id: 80941960 QId: 34029 (921666) 36 of 53 A A A The nurse is assessing a client with rheumatoid arthritis who is being considered for adalimumab therapy. Which statement made by the client needs further investigation? 1. "I am taking an antibiotic for a urinary tract infection." [41%] 2. "I had a negative tuberculosis skin test 2 weeks ago." [8%] 3. "I just received my yearly flu shot a week ago." [10%] 4. "I will continue taking naproxen at night to help with pain." [39%] Omitted Correct answer 1 Answered correctly 41% Time: 1 seconds Updated: 03/27/2017 Explanation: Infliximab, adalimumab, and etanercept are tumor necrosis factor (TNF) inhibitors that suppress the inflammatory response in autoimmune diseases such as rheumatoid arthritis, Crohn disease, and psoriasis. Due to the immunosuppressive action of TNF inhibitors, clients taking these drugs are at increased risk for infection. A client with current, recent, or chronic infection should not take a TNF inhibitor (Option 1). (Option 2) The immunosuppressive action of TNF inhibitors can activate latent tuberculosis (TB). Therefore, a tuberculin skin test (TST) should be administered prior to beginning TNF inhibitor therapy, and clients who test positively for latent TB must also undergo treatment for TB before starting therapy. Clients should have a TST every year while receiving the drug. (Option 3) Clients taking immunosuppressive TNF inhibitors (eg, adalimumab) should receive an annual inactivated (injectable) influenza vaccine to reduce the risk of contracting the flu virus. Clients taking TNF inhibitors or other immunosuppressants are at risk for infection and therefore should not receive live attenuated vaccines. (Option 4) Many clients with rheumatoid arthritis use nonsteroidal anti-inflammatory medications (eg, celecoxib, naproxen) in conjunction with antirheumatic and/or targeted therapies (eg, methotrexate, adalimumab, etanercept) to effectively treat pain and minimize inflammation. Educational objective: Clients with infection should not take tumor necrosis factor (TNF) inhibitors (eg, infliximab, adalimumab, etanercept) as these suppress the immune response. Before starting drug therapy, clients should be tested for tuberculosis and receive the inactivated (injectable) influenza vaccine. Clients taking TNF inhibitors should avoid live vaccines.

Block Time Remaining: 00:00:51 TUTOR Test Id: 80941960 QId: 30649 (921666) 37 of 53 A A A A client is being discharged on enoxaparin therapy following total knee replacement surgery. Which teaching instruction does the nurse include in the teaching plan? 1. "Eliminate green, leafy, vitamin K-rich vegetables from your diet." [18%] 2. "Mild bruising or redness may occur at the injection site." [44%] 3. "You can take over-the-counter drugs such as ibuprofen to relieve mild discomfort." [4%] 4. "You will need PT/INR assessments at regular intervals while on enoxaparin therapy." [31%] Omitted Correct answer 2 Answered correctly 44% Time: 1 seconds Updated: 03/21/2017 Explanation: Enoxaparin (Lovenox) is a low molecular weight heparin (LMWH) that may be prescribed for up to 10-14 days following hip and knee surgery to prevent deep venous thrombosis. Discharge teaching for the client on enoxaparin therapy includes: Pinch an inch of skin upwards and insert the needle at a 90-degree angle into the fold of skin. Continue to hold the skin fold throughout the injection and then remove the needle at a 90-degree angle. Mild pain, bruising, irritation, or redness of the skin at the injection site is common. Do NOT rub the site with the hand. Using an ice cube on the injection site can provide relief (Option 2). Avoid taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and herbal supplements (Ginkgo biloba, vitamin E) without health care provider approval as these can increase the risk of bleeding (Option 3). Monitor complete blood count to assess for thrombocytopenia. (Option 1) Vitamin K-rich foods do not need to be eliminated from the diet during enoxaparin therapy; prothrombin time (PT) and international normalized ratio (INR) are not affected. However, PT and INR are decreased when a vitamin K antagonist (eg, warfarin [Coumadin]) is taken with vitamin K-rich foods. (Option 4) Routine coagulation studies (eg, PT, INR, partial thromboplastin time [PTT]) do not need to be monitored in a client who is taking enoxaparin. However, periodic assessment of complete blood count (CBC) is usually required to monitor for hidden bleeding and thrombocytopenia (especially in older clients with renal insufficiency). Educational objective: LMWH (Enoxaparin) requires monitoring of CBC (thrombocytopenia) but not coagulation studies. Administration of unfractionated heparin requires monitoring with PTT, whereas warfarin requires PT/INR monitoring. Clients on these medications should avoid aspirin and NSAIDs.

Block Time Remaining: 00:00:51 TUTOR Test Id: 80941960 QId: 30932 (921666) 38 of 53 A A A The nurse develops a teaching plan for a client prescribed isoniazid, rifampin, ethambutol, and pyrazinamide to treat active tuberculosis (TB). Which of the following instructions associated with the adverse effects of rifampin is most important for the nurse to include? 1. Notify the health care provider if your urine is red [16%] 2. Take acetaminophen every 6 hours for drug-associated joint pain while taking this medication [9%] 3. Wear eyeglasses instead of soft contact lenses while taking this medication [70%] 4. You can stop taking the medications as soon as one sputum culture comes back normal [3%] Omitted Correct answer 3 Answered correctly 70% Time: 0 seconds Updated: 05/28/2017 Explanation: Active TB is treated with combination drug therapy. Isoniazid causes hepatotoxicity and peripheral neuropathy. Rifampin (Rifadin) also causes hepatotoxicity. Therefore, baseline liver function tests should be obtained. Clients should be advised to watch for signs and symptoms of hepatotoxicity (eg, jaundice, anorexia). Ethambutol causes ocular toxicity, and clients will need frequent eye examinations. A teaching plan for a client prescribed rifampin includes these additional instructions: Rifampin changes the color of body fluids (eg, urine, sweat) due to its body-wide distribution. Tears can turn red, making contact lenses appear discolored. Client should wear eyeglasses instead of soft contact lenses while taking this medication. Women should use nonhormonal birth control methods while taking this drug as it can decrease the effectiveness of oral contraceptives. (Option 1) Red urine is an expected finding with rifampin use; clients should not be concerned. (Option 2) Clients should be advised to not consume alcohol and drugs that can increase the risk for hepatotoxicity (eg, acetaminophen) during long-term use of this drug. (Option 4) The effectiveness of treatment for active TB is determined by 3 negative sputum cultures and chest x-ray. If the entire course of therapy (6-9 months) is not completed, reinfection, spread to others, and development of resistant strains of TB bacteria can result. Educational objective: Common potential side effects of rifampin include hepatotoxicity, red-orange discoloration of body fluids, and increased metabolism of some drugs (eg, oral contraceptives, hypoglycemics, warfarin). .

Block Time Remaining: 00:00:52 TUTOR Test Id: 80941960 QId: 31764 (921666) 39 of 53 A A A The health care provider prescribes amoxicillin/clavulanate (liquid) twice a day for a child with acute sinusitis. What instructions are most important for the parents? Select all that apply. 1. Administer it with food if nausea or diarrhea develops 2. Complete the medication course even if the child is better 3. Expect a rash, which is normal, as a side effect 4. Shake the medicine well before use 5. Use a household spoon to measure the dose Omitted Correct answer 1,2,4 Answered correctly 60% Time: 1 seconds Updated: 04/20/2017 Explanation: Amoxicillin/clavulanate belongs to aminopenicillin group and is often used to treat respiratory infections. Instructions for parents about amoxicillin include: The medication may be taken with or without food as food does not affect absorption The most common side effects of this medication are nausea, vomiting, and diarrhea. If nausea or diarrhea develops, the medicine may be administered with food to decrease the gastrointestinal side effects (Option 1). Shake the liquid well prior to administration. Administer at evenly spaced intervals throughout the day to maintain therapeutic blood levels (Option 4). Ensure that the child receives the full course of therapy; do not discontinue the medication if the child is feeling better or symptoms have resolved (Option 2). (Option 3) Rash, itching, dyspnea, or facial/laryngeal edema may indicate an allergic reaction, and the medication should be discontinued. (Option 5) Pediatric liquid medications are often dispensed with a measuring device designed to administer the exact dose prescribed. The following calibrated devices may be included: dropper, oral syringe, plastic measuring cup, or measuring spoon. Educational objective: Amoxicillin/clavulanate in liquid form should be shaken well prior to administration; the correct dose is administered using a calibrated measuring device. It is taken with or without food, at evenly spaced intervals, and until all the medication is consumed. If nausea or diarrhea develops, the medication may be administered with food. .

Block Time Remaining: 00:00:52 TUTOR Test Id: 80941960 QId: 31758 (921666) 40 of 53 A A A The nurse is caring for a client on IV heparin infusion and oral warfarin. Current laboratory values indicate that the client's aPTT is 5 times the control value and the PT/INR is 2 times the control value. What action does the nurse anticipate? 1. Clarify vegetable consumption with client [7%] 2. Decrease the heparin rate [63%] 3. Decrease the warfarin dose [5%] 4. Obtain an order for vitamin K injection [24%] Omitted Correct answer 2 Answered correctly 63% Time: 0 seconds Updated: 04/03/2017 Explanation: The anticoagulant heparin has to be administered intravenously or subcutaneously. The duration is 2-6 hours intravenously and 8-12 hours subcutaneously. It is measured by the aPTT (activated partial thromboplastin time) laboratory value. Warfarin (Coumadin) is taken orally, with onset/therapeutic effects reached after 2-7 days. It is measured by prothrombin time (PT) or International Normalized Ratio (INR). The therapeutic range for aPTT or PT/INR is generally 1.5-2.0 times the control value (up to 3 times the control value at times). An aPTT value above the therapeutic range places the client at risk for excess bleeding. The heparin administration would need to be stopped or decreased. (Option 1) Clients on warfarin must eat the same amount of dark green leafy vegetables because these foods contain vitamin K and will alter the effects of warfarin. The PT/INR is at therapeutic level so there is no concern related to this client's diet. (Option 3) The warfarin dose has achieved the therapeutic range for PT/INR and does not need adjustment. (Option 4) Vitamin K is the antidote for warfarin; the antidote for heparin is protamine sulfate. However, due to the short half-life of heparin, usually the dose is just held instead of administering an antidote when the values are too high. Educational objective: The therapeutic effect from heparin or warfarin (Coumadin) is 1.5-2.0 times the control value. Heparin is measured with aPTT and warfarin is measured with PT/INR. Vitamin K is the antidote for warfarin; protamine sulfate is the antidote for heparin.

Block Time Remaining: 00:00:52 TUTOR Test Id: 80941960 QId: 31848 (921666) 41 of 53 A A A The clinic nurse reviews the medical record of a client who was prescribed etanercept, a tumor necrosis factor (TNF) inhibitor. Which test result is most important for the nurse to check before initiating this treatment? 1. C-reactive protein (CRP) [46%] 2. Prothrombin time (PT) [29%] 3. Serum LDL cholesterol [3%] 4. Tuberculin skin test (TST) [20%] Omitted Correct answer 4 Answered correctly 20% Time: 0 seconds Updated: 04/28/2017 Explanation: TNF inhibitor drugs (eg, etanercept [Enbrel], infliximab [Remicade], adalimumab [Humira]) block the action of TNF, a mediator that triggers a cell-mediated inflammatory response in the body. These drugs reduce the manifestations of rheumatoid arthritis (RA) and slow the progression of joint damage by inhibiting the inflammatory response. The medication causes immunosuppression and increased susceptibility for infection and malignancies. Clients should have a baseline TST before initiating therapy and yearly skin tests thereafter. Those with latent tuberculosis (TB) must be treated with antitubercular agents before initiating treatment with these drugs. Otherwise, TB reactivation would occur (Option 4). (Option 1) CRP is a non-specific test used to detect acute or chronic inflammation in the body. CRP can be used to evaluate the effectiveness of medications that decrease inflammation. An elevation would be expected in clients with RA, especially during a flare, but it is not the most important test result to check before initiating therapy. (Options 2 and 3) LDL cholesterol and PT are unrelated to the administration of these medications. Educational objective: Major adverse effects of biologic disease-modifying TNF inhibitor drugs (eg, etanercept, infliximab, adalimumab) include severe infections and bone marrow suppression. TB reactivation is a major concern. Therefore, all clients must receive a TST to rule out latent TB.

Block Time Remaining: 00:00:51 TUTOR Test Id: 80944027 QId: 30758 (921666) 30 of 54 A A A The health care provider (HCP) has prescribed amitriptyline 25 mg orally every morning for an elderly client with recent herpes zoster infection (shingles) and severe postherpetic neuralgia. What is the priority nursing action? 1. Encourage increased fluid intake [19%] 2. Provide frequent rest periods [10%] 3. Teach the client to get up slowly from the bed or a sitting position [55%] 4. Tell the client to wear sunglasses when outdoors [14%] Omitted Correct answer 3 Answered correctly 55% Time: 1 seconds Updated: 05/07/2017 Explanation: Tricyclic antidepressants (eg, amitriptyline, nortriptyline, desipramine, imipramine) are commonly used for neuropathic pain. Side effects are especially common in elderly clients. Due to the increased risk of falling, the priority nursing action is to teach the client to get up slowly from the bed or a sitting position. (Options 1, 2, and 4) These are important instructions but not priority ones. Educational objective: The most common side effects experienced by clients taking tricyclic antidepressants include dizziness, drowsiness, dry mouth, constipation, photosensitivity, urinary retention, and blurred vision. The priority nursing action is to teach caution in changing positions due to the increased risk for falls from dizziness and orthostatic hypotension, especially in elderly clients.

Block Time Remaining: 00:00:52 TUTOR Test Id: 80944027 QId: 30718 (921666) 31 of 54 A A A The client is brought to the emergency department in handcuffs by the police. Witnesses said that the client became violent and confused after consuming large amounts of alcohol at a party. The client is placed in 4-point restraints, and ziprasidone hydrochloride is administered. The client is sleeping 30 minutes later. What is a priority action for the nurse at this time? 1. Check for a history of bipolar disease [1%] 2. Determine if restraints can now be removed [26%] 3. Monitor for widened QT intervals and hypotension [54%] 4. Obtain blood for the current blood alcohol level [18%] Omitted Correct answer 3 Answered correctly 54% Time: 1 seconds Updated: 02/18/2017 Explanation: Ziprasidone hydrochloride (Geodon) is an atypical antipsychotic drug that is used for acute bipolar mania, acute psychosis, and agitation. Its use carries a risk for QT prolongation leading to torsade de pointes. A baseline electrocardiogram and potassium are usually checked. At a minimum, the client should be placed on a cardiac monitor. The client should also be monitored for hypotension and seizures, especially if the previous medical history is not known or obtainable. The risk for adverse effects is increased with the interaction of alcohol. (Option 1) Although knowing past psychiatric history will assist in determining the cause of this episode, this knowledge is not essential when caring for this client's current needs. Any physical reasons for the behavior should be ruled out before focusing on psychiatric history. Risk for suicide also needs to be assessed after the client is alert and sober. (Option 2) This should be reassessed after the drug is wearing off, not before the medication is peaking. The client could suddenly wake up and become violent again. Also, it is a priority to perform restraint monitoring per protocol, including checks on circulation and hydration/elimination needs. The client's physiological response is priority. (Option 4) It would be beneficial to know the current alcohol (ethanol) level in order to estimate the client's level of intoxication and when the client will be sober. The body normally clears alcohol at a rate of 25-50 mg/dL per hour. However, there is a reliable history that the client had been drinking, and the presence of alcohol in the blood carries a risk for drug interaction. Therefore, it is more important to monitor the client for any negative effects (adverse physiological responses) from the drug than to quantify the current alcohol level. Educational objective: After ziprasidone hydrochloride administration, clients should be monitored for cardiac effects (including prolonged QT interval), hypotension, and/or seizure activity. Alcohol interacts with ziprasidone and increases the potential for an adverse effect from the drug.

Block Time Remaining: 00:00:53 TUTOR Test Id: 80944027 QId: 34636 (921666) 32 of 54 A A A The nurse develops a teaching care plan for the client with a prescription to change antidepressant medications from imipramine to phenelzine. Which instruction is appropriate to include in the teaching? 1. Continue avoiding foods high in tyramine until the imipramine withdrawal period is over [19%] 2. Skip the nighttime dose of imipramine and start the phenelzine the next morning [2%] 3. Taper down the imipramine, then discontinue for 2 weeks before starting phenelzine [45%] 4. Taper down the imipramine while gradually increasing the phenelzine [32%] Omitted Correct answer 3 Answered correctly 45% Time: 1 seconds Updated: 03/09/2017 Explanation: When a client switches from a tricyclic antidepressant (TCA) (eg, imipramine, amitriptyline, nortriptyline) to a monoamine oxidase inhibitor (MAOI) (eg, phenelzine, isocarboxazid, tranylcypromine), a drug-free period of at least 2 weeks should elapse between the tapered discontinuation of the TCA and the initiation of the MAOI. This timing is based on the half-life value and allows for the first medication to leave the system. Without a washout period, the client could experience hypertensive crisis (eg, blurred vision, dizziness, severe headache, shortness of breath). If the TCA is withdrawn abruptly, the client may experience a discontinuation syndrome. (Option 1) A tyramine-restricted diet is indicated for clients on an antidepressant regimen containing an MAOI to decrease the risk of hypertensive crisis. Because this client is starting an MAOI, the diet should be initiated 2 weeks prior to starting the medication. If the switch was from an MAOI inhibitor to another antidepressant, the client would need to continue to follow the dietary restrictions for 2 weeks after discontinuing the MAOI. (Option 2) An overnight washout period is inadequate to clear the imipramine from the client's system before starting the phenelzine. (Option 4) TCAs and MAOIs cannot be taken at the same time due to the risk of a hypertensive crisis. Educational objective: Caution must be taken when a client switches from a tricyclic antidepressant to a monoamine oxidase inhibitor to avoid adverse reactions (eg, hypertensive crisis, discontinuation syndrome). Usually, antidepressants are withdrawn gradually with a drug-free period before the new antidepressant is initiated.

Block Time Remaining: 00:00:54 TUTOR Test Id: 80944027 QId: 31864 (921666) 33 of 54 A A A The nurse is teaching a client with advanced chronic obstructive pulmonary disease who was prescribed oral theophylline. Which client statement indicates that additional teaching is required? 1. "I need to avoid caffeinated products." [4%] 2. "I need to get my blood drug levels checked periodically." [11%] 3. "I need to report anorexia and sleeplessness." [9%] 4. "I take cimetidine rather than omeprazole for heartburn." [74%] Omitted Correct answer 4 Answered correctly 74% Time: 1 seconds Updated: 05/08/2017 Explanation: Theophylline is a bronchodilator with a low therapeutic index and a narrow therapeutic range (10-20 mcg/mL). The serum level should be monitored frequently to avoid severe adverse effects. Toxicity is likely to occur at levels >20 mcg/mL. Individual titration is based on peak serum theophylline levels, so it is necessary to draw a blood level 30 minutes after dosing. Theophylline can cause seizures and life-threatening arrhythmias. Toxicity is usually due to intentional overdose or concurrent intake of medications that increase serum theophylline levels. Cimetidine and ciprofloxacin can dramatically increase serum theophylline levels (>80%). Therefore, they should not be used in these clients. (Option 1) Caffeinated products (eg, coffee, cola, chocolate) should be avoided as they would intensify the adverse effects (eg, tachycardia, insomnia, restlessness) of theophylline. (Option 2) The best way to prevent toxicity is to monitor drug levels periodically and adjust the dose. (Option 3) The signs of toxicity that should be reported are anorexia, nausea, vomiting, restlessness, and insomnia. Educational objective: Theophylline can cause seizures and life-threatening arrhythmias due to its narrow therapeutic range (10-20 mcg/mL). The dose is adjusted based on peak drug levels, obtained 30 minutes after the dose is given. Clients should avoid caffeinated products and medications that increase serum theophylline levels (eg, cimetidine, ciprofloxacin).

Block Time Remaining: 00:00:53 TUTOR Test Id: 80941960 QId: 30874 (921666) 42 of 53 A A A Exhibit A client with cancer is to receive a third dose of cisplatin. The client's laboratory results are shown in the exhibit. Which factor would be important for the nurse to assess before confirming the dose with the health care provider? Click on the exhibit button for additional information. 1. Blood pressure [7%] 2. Capillary refill [1%] 3. Skin turgor [1%] 4. Urine output [88%] Omitted Correct answer 4 Answered correctly 88% Time: 1 seconds Updated: 03/15/2017 Explanation: Urine output is a good indicator of renal function. Cisplatin is an antineoplastic medication that can cause renal toxicity. The client's elevated BUN (normal 6-20 mg/dL [2.1-7.1 mmol/L]) may be due to dehydration (prerenal disease) or decreased kidney function. The creatinine is also elevated (normal 0.6-1.3 mg/dL [53-115 µmol/L]), an indication of kidney injury. In addition to laboratory results, the health care provider will also need to know urine output. The medication dosage may then be adjusted or discontinued. (Option 1) Blood pressure may be part of the assessment of kidney function, but multiple disorders can cause changes in blood pressure. Urine output is a better indicator of renal function. (Option 2) Capillary refill is used to assess the circulatory system and is not a good indicator of a decrease in renal function. (Option 3) Skin turgor is important in assessing hydration status. However, this client's laboratory results indicate the possibility of renal toxicity from the cisplatin. Urine output is a better indicator of renal function. Educational objective: Cisplatin is an antineoplastic drug that may cause kidney injury. Assessment of renal function includes laboratory values and urine output.

Block Time Remaining: 00:00:55 TUTOR Test Id: 80941960 QId: 32020 (921666) 43 of 53 A A A The nurse assesses a client 5 minutes after initiating a blood transfusion. The client has shortness of breath, itching, and chills. The nurse immediately turns off the transfusion and disconnects the tubing at the catheter hub. What action should the nurse take next? 1. Check vital signs [38%] 2. Maintain IV access with normal saline [54%] 3. Notify the health care provider [6%] 4. Recheck identification labels and numbers [0%] Omitted Correct answer 2 Answered correctly 54% Time: 1 seconds Updated: 03/13/2017 Explanation: Signs of a transfusion reaction include chills, fever, low back pain, flushing, and itching. Nursing interventions include: Stop transfusion immediately and disconnect tubing at the catheter hub. Maintain IV access with normal saline, using new tubing to prevent hypotension and vascular collapse (Option 2). Notify health care provider (HCP) and blood bank. Monitor vital signs. Recheck labels, numbers, and the client's blood type. Treat client's symptoms according to the HCP's prescription. Collect blood and urine specimens to evaluate for hemolysis. Return blood and tubing set to the blood bank for additional testing. Complete necessary facility paperwork to document the reaction. (Option 1) Monitoring vital signs would be the step after ensuring IV access, administering normal saline, and notifying the HCP. (Option 3) The nurse should ensure continued IV access before notifying the HCP. The HCP will likely prescribe IV medications (eg, vasopressors, antihistamines, corticosteroids) to treat the transfusion reaction, so a patent IV is critical. (Option 4) Mislabeling blood and administering the wrong blood type are the most common causes of a transfusion reaction. However, maintaining IV access takes priority over investigating a potential clinical error. Educational objective: During a blood transfusion reaction, the nurse should immediately stop the transfusion and initiate normal saline to maintain IV access and prevent hypotension and vascular collapse.

Block Time Remaining: 00:00:56 TUTOR Test Id: 80944027 QId: 31519 (921666) 34 of 54 A A A A nurse is preparing for a medical relief trip to West Africa and is concerned about a disruption in circadian rhythm from traveling across several time zones. Which herbal supplement might help synchronize the body to environmental time? 1. Evening primrose [14%] 2. Ginseng [9%] 3. Melatonin [70%] 4. St. John's wort [6%] Omitted Correct answer 3 Answered correctly 70% Time: 2 seconds Updated: 12/13/2016 Explanation: Melatonin supplements are thought to help the body adjust quickly to new surroundings and time zones (jet lag). Most practitioners agree that the lowest possible dose should be used and should be taken only for a short time. There are no long-term studies on the safety of melatonin. Higher doses may cause side effects such as vivid dreams and nightmares. Research suggests that taking melatonin once a person has reached the travel destination is sufficient and that starting it prior to or during air travel may actually slow the recovery of jet lag, energy, and alertness. (Option 1) Evening primrose may be used for eczema or skin irritations. (Option 2) Ginseng is used to promote mental alertness and enhance the immune system. (Option 4) St. John's wort is used for treatment of depression. It has many interactions with other prescription medications. Educational objective: Short-term use of low-dose melatonin may be considered to treat jet lag and fatigue from traveling across time zones.

Block Time Remaining: 00:00:57 TUTOR Test Id: 80944027 QId: 32066 (921666) 35 of 54 A A A The nurse reviews a client's medical record and notes the following PRN medication prescriptions: acetaminophen, haloperidol, and benztropine. The nurse would administer a dose of benztropine on assessing which client behavior? 1. Muscle rigidity and shuffling gait [70%] 2. Nihilistic delusions [15%] 3. Tangentiality [5%] 4. Waxy flexibility [8%] Omitted Correct answer 1 Answered correctly 70% Time: 1 seconds Updated: 02/25/2017 Explanation: Benztropine (Cogentin) is an anticholinergic medication used to treat some extrapyramidal symptoms, which are side effects of some antipsychotic medications. These side effects include: Pseudoparkinsonism: Symptoms that resemble parkinsonism (eg, masklike face, shuffling gait, rigidity, resting tremor, psychomotor retardation [bradykinesia]) Dystonia: Abnormal muscle movements of the face, neck, and trunk caused by sustained muscular contractions (eg, torticollis, oculogyric crisis, opisthotonos) (Options 2, 3, and 4) Delusions are a symptom of schizophrenia. Tangentiality (deviating from the original topic of discussion) is an abnormal thought process seen in schizophrenia. Waxy flexibility (tendency to remain in an immobile posture) is a motor disturbance seen in schizophrenia. All are treated with antipsychotic medications. Educational objective: Benztropine (Cogentin) is an anticholinergic drug used to treat extrapyramidal symptoms, which are side effects of some antipsychotic medications.

Block Time Remaining: 00:00:58 TUTOR Test Id: 80937794 QId: 31865 (921666) 25 of 53 A A A A client with chronic heart failure is being discharged home on furosemide and sustained-release 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." [13%] 2. "If the tablet is too large to swallow, crush and mix it with applesauce or pudding." [9%] 3. "Potassium tablets should be taken on an empty stomach." [15%] 4. "Take it with a full glass of water and stay sitting upright afterward." [61%] Omitted Correct answer 4 Answered correctly 61% Time: 2 seconds Updated: 05/19/2017 Explanation: Loop diuretics (eg, furosemide [Lasix], bumetanide [Bumex]) are "potassium-wasting" diuretics, meaning that clients may experience potassium loss and hypokalemia. Hypokalemia in a client with heart failure creates a risk for life-threatening cardiac dysrhythmias. Therefore, clients taking loop diuretics usually require potassium supplementation. Potassium is an erosive substance that can cause pill-induced esophagitis. To prevent esophageal erosion, the client should take potassium tablets with plenty of water (at least 4 oz [120 mL]) and remain sitting upright for ≥30 minutes after ingestion. This prevents the tablet from becoming lodged in the esophagus or refluxing from the stomach (Option 4). Pill-induced esophagitis is also common with tetracyclines (eg, doxycycline) and bisphosphonates ("dronates": alendronate, ibandronate, pamidronate, risedronate), so clients taking these medications should be given similar instructions. (Option 1) A diet rich in protein and vitamin D helps with calcium-supplement, not potassium, absorption. (Option 2) Sustained-release medications should never be crushed as this would cause the client to absorb the medication too rapidly. (Option 3) Potassium should be taken during or immediately following meals to prevent gastric upset. Educational objective: The nurse should teach the client to take potassium tablets with plenty of water (≥4 oz [120 mL]) and to sit upright after ingestion to prevent pill-induced esophagitis. Potassium should be taken during or immediately following meals to prevent gastric upset. Sustained-release tablets should not be crushed.

Block Time Remaining: 00:00:58 TUTOR Test Id: 80937794 QId: 30319 (921666) 26 of 53 A A A 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?" [7%] 2. "You will need to monitor your intake of foods containing vitamin K." [17%] 3. "You will not be able to eat green, leafy vegetables while taking this medication." [71%] 4. "Your blood will be tested at regular intervals." [4%] Omitted Correct answer 3 Answered correctly 71% Time: 0 seconds Updated: 04/26/2017 Explanation: Warfarin (Coumadin) works by blocking the availability of vitamin K, which is essential for blood clotting. As a result, the clotting mechanism is disrupted, reducing the risk of a stroke, venous thrombosis, or pulmonary embolism. Sudden increases or decreases in the consumption of vitamin K-rich foods could inversely alter the effectiveness of warfarin. An increase in vitamin K could decrease the effectiveness of warfarin, placing the client at increased risk of blood clot formation; a decrease could increase the effectiveness of warfarin, placing the client at increased risk for bleeding. (Option 1) Many medications can interfere with warfarin metabolism. Nutritional supplements may contain vitamin K, and so any new medication or nutritional supplement should be approved by the health care provider. Cranberry juice, grapefruit, green tea, and alcohol may also interfere with the effectiveness of warfarin. (Option 2) Rather than avoid vitamin K-rich foods, the client needs to keep vitamin K intake consistent from day to day to keep International Normalized Ratio (INR)/prothrombin time (PT) stable and within the recommended therapeutic range. If the client enjoys vitamin K-rich foods (eg, kale, broccoli, spinach, Brussels sprouts, cabbage, green leafy vegetables), these may be consumed in the same amounts, consistently on a daily basis. There is some evidence that a very low intake of vitamin K could decrease the overall effectiveness of warfarin. (Option 4) INR/PT will be monitored on an ongoing basis to determine the safest, most therapeutic warfarin dosage. Educational objective: Sudden increases or decreases in the consumption of vitamin K-rich foods could inversely alter the effectiveness of warfarin. Rather than avoid vitamin K-rich foods, the client needs to keep vitamin K intake consistent from day to day to keep INR/PT stable and within the recommended therapeutic range. INR/PT is monitored at regular intervals. Pharmacy personnel and dieticians can provide additional teaching. Copyright © UWorld. All rights reserved.

Block Time Remaining: 00:00:56 TUTOR Test Id: 80941960 QId: 31368 (921666) 44 of 53 A A A A client is receiving a continuous heparin infusion and the most recent aPTT is 140 seconds. The nurse notices blood oozing at the surgical incision and IV insertion sites. What interventions should the nurse implement? Select all that apply. 1. Continue heparin infusion and recheck aPTT in 6 hours 2. Prepare to administer vitamin K 3. Redraw blood for laboratory tests 4. Review guidelines for administration of protamine 5. Stop infusion of heparin and notify the health care provider (HCP) Omitted Correct answer 4,5 Answered correctly 34% Time: 1 seconds Updated: 02/06/2017 Explanation: Depending on the institution and HCP, a therapeutic aPTT level for a client being heparinized is somewhere between 46-70 seconds (1.5-2.0 times the baseline value). An aPTT of 140 seconds is too long and this client is showing signs of bleeding. The nurse should stop the heparin infusion, notify the HCP, and review administration guidelines for possible administration of protamine (reversal agent for heparin). (Option 1) Continuing the heparin infusion will put the client at risk for a severe bleeding episode. (Option 2) Vitamin K is the reversal agent for warfarin. (Option 3) There is no reason to redraw blood for laboratory workup at this time as the abnormal aPTT result is consistent with the client's bleeding. Laboratory studies may need to be redone within 1 hour of stopping the infusion or giving a reversal agent. Educational objective: The nurse should stop the infusion of heparin when there is evidence of bleeding. The HCP should be notified immediately and the nurse should be prepared to give protamine if ordered.

Block Time Remaining: 00:00:58 TUTOR Test Id: 80941960 QId: 34410 (921666) 45 of 53 A A A The nurse is caring for a client taking tamoxifen for breast cancer. Which client statement is most concerning and a priority to report to the health care provider? 1. "I don't have much interest in sex lately." [1%] 2. "I feel like I might be getting a cold." [46%] 3. "My periods have been heavy lately." [39%] 4. "These hot flashes are occurring a lot." [12%] Omitted Correct answer 3 Answered correctly 39% Time: 2 seconds Updated: 05/22/2017 Explanation: Selective estrogen receptor modulators (eg, tamoxifen) have differential action in different tissues (mixed agonist/antagonist). In the breast, they block estrogen (antagonist) and are therefore helpful in inhibiting the growth of estrogen-receptive breast cancer cells. However, tamoxifen has estrogen-stimulating (agonist) activity in the uterus, resulting in excessive endometrial proliferation (endometrial hyperplasia). This hyperplasia can eventually lead to cancer. Irregular or excessive menstrual bleeding in premenopausal woman or any bleeding in postmenopausal women can be a sign of endometrial cancer (Option 3). Due to its estrogen-agonist actions, tamoxifen also poses a risk for thromboembolic events (eg, stroke, pulmonary embolism, deep vein thrombosis). Clients with breast cancer take tamoxifen for several (5-10) years to prevent recurrence. Therefore, monitoring for life-threatening side effects is very important. (Options 1 and 4) Because tamoxifen blocks estrogen receptors, it can cause symptoms of menopause. Vaginal dryness, hot flashes, and decreased libido (sexual dysfunction) are common and would be discussed after addressing more concerning symptoms. (Option 2) Tamoxifen is not associated with significant immunosuppression although it may rarely cause leukopenia. Educational objective: Tamoxifen has mixed agonist and antagonist activity on estrogen receptors in various tissues. It is used for several years in estrogen-responsive breast cancer. However, it is associated with increased risk of endometrial cancer and venous thromboembolism. Menopausal symptoms (eg, vaginal dryness, hot flashes) are the most common side effect.

Block Time Remaining: 00:00:58 TUTOR Test Id: 80944027 QId: 31856 (921666) 36 of 54 A A A The health care provider (HCP) prescribes paroxetine to a client with depression. What statement by the client indicates proper understanding of the medication? 1. "I can discontinue the medication if my symptoms improve." [1%] 2. "I need a healthy diet and regular exercise to combat weight gain." [84%] 3. "If I don't feel better in 1-2 weeks, then the medication is not working." [6%] 4. "This medication might increase my sexual performance." [7%] Omitted Correct answer 2 Answered correctly 84% Time: 1 seconds Updated: 04/28/2017 Explanation: Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI) often prescribed for major depression and anxiety disorders. Other SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), and sertraline (Zoloft). Weight gain is a common side effect of long-term SSRI use. The nurse should teach the client to eat a healthy diet and engage in regular exercise to combat the weight gain. Other major side effects of SSRIs include increased suicide risk (at the beginning of therapy), sexual dysfunction, and serotonin syndrome when taken in excess doses. (Option 1) SSRIs should not be stopped abruptly without discussion with the HCP. Dosages should be gradually tapered before discontinuation to avoid withdrawal symptoms. (Option 3) Most clients will start to see symptom improvement in 1-2 weeks. However, some may take several weeks and require dose adjustments. Clients should continue to take the medication and discuss it with the HCP. (Option 4) SSRIs can cause sexual dysfunction. Clients should notify the HCP for a change of medication or to add medications to increase sexual performance. Educational objective: The major side effects of SSRIs include increased suicide risk (at the beginning of therapy), sexual dysfunction, weight gain, and serotonin syndrome (excess doses). It may take several weeks for the therapeutic effects of SSRIs to begin; they should never be discontinued abruptly.

Block Time Remaining: 00:00:59 TUTOR Test Id: 80944027 QId: 31155 (921666) 37 of 54 A A A A client with a brain tumor is admitted for surgery. The health care provider prescribes levetiracetam. The client asks why. What is the nurse's response? 1. "It destroys tumor cells and helps shrink the tumor." [16%] 2. "It prevents seizure development." [59%] 3. "It prevents blood clots in legs." [3%] 4. "It reduces swelling around the tumor." [20%] Omitted Correct answer 2 Answered correctly 59% Time: 1 seconds Updated: 02/04/2017 Explanation: Levetiracetam (Keppra) is a medication often used to treat seizures in various settings. It has minimal drug-drug interactions compared to phenytoin and is often the preferred antiepileptic medication. (Option 1) Chemotherapy and radiation therapy would kill tumor cells and reduce tumor size. (Option 3) Hospitalized clients and clients with malignancy are at higher risk for venous thromboembolism. These clients would benefit from anticoagulation (eg, heparin, enoxaparin, rivaroxaban, apixaban). (Option 4) Dexamethasone, a corticosteroid, is used to treat cerebral edema associated with a brain injury/tumor by decreasing inflammation. Educational objective: Levetiracetam (Keppra) is a medication often used to treat seizures in various settings. Corticosteroids are used to reduce inflammation and cerebral edema in clients with brain injury and tumors.

Block Time Remaining: 00:00:59 TUTOR Test Id: 80941960 QId: 32043 (921666) 46 of 53 A A A The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks "What is that for? I don't take it at home." Which reply by the nurse is most appropriate? 1. "Omeprazole helps prevent nausea by making your stomach empty faster." [6%] 2. "Omeprazole helps prevent you from developing an ulcer due to the stress of surgery." [64%] 3. "Omeprazole protects you from getting an infection while on antibiotics." [2%] 4. "This medication will treat your gastroesophageal reflux disease (GERD)." [26%] Omitted Correct answer 2 Answered correctly 64% Time: 1 seconds Updated: 12/20/2016 Explanation: Omeprazole is a proton pump inhibitor (PPI) that suppresses the production of gastric acid by inhibiting the proton pump in the parietal cells of the stomach. In most hospitalized clients without a history of GERD or ulcers, PPIs are prescribed to prevent stress ulcers from developing during surgery or a major illness. Although evidence has shown that two-thirds of clients who receive PPIs do not need them, these medications are still widely prescribed in hospitalized clients. PPIs can be identified by their "-prazole" ending (eg, pantoprazole, lansoprazole, esomeprazole). (Option 1) Metoclopramide (Reglan) is not a PPI. It decreases postoperative nausea by promoting gastric emptying. (Option 3) PPIs may be associated with an increased risk of Clostridium difficile infection with antibiotic use. (Option 4) The client does not take this medication at home. The nurse is assuming that the client has a history of GERD rather than assessing for this condition first. Educational objective: PPIs such as omeprazole are often prescribed to hospitalized clients without GERD or ulcers to prevent stress ulcers from developing during surgery or a major illness.

Block Time Remaining: 00:01:00 TUTOR Test Id: 80941960 QId: 31752 (921666) 47 of 53 A A A The nurse is caring for a client with cirrhosis who has hepatic encephalopathy. The client is prescribed lactulose. Which assessment by the nurse will most likely indicate that the medication has achieved the desired therapeutic effect? 1. Higher potassium level [2%] 2. Improved mental status [70%] 3. Looser stool consistency [13%] 4. Reduced abdominal distension [13%] Omitted Correct answer 2 Answered correctly 70% Time: 1 seconds Updated: 04/30/2017 Explanation: Hepatic encephalopathy in cirrhosis results from higher serum ammonia levels that cause neurotoxic effects, including mental confusion. Oral lactulose is given to reduce the ammonia by trapping it in the gut and then expelling it with a laxative effect. Improved mental status implies reduction of ammonia levels. (Option 1) Clients with cirrhosis typically have hypokalemia due to hyperaldosteronism (as aldosterone is not metabolized by the damaged liver). Hypokalemia can also result from diuretics used to treat the fluid retention and ascites. Lactulose is not intended to treat this pathology. (Option 3) Lactulose is a laxative. In cirrhosis, constipation (which allows more ammonia to be absorbed) and hard stool (which irritates hemorrhoids) are to be avoided. However, the main purpose of lactulose is expelling the ammonia, with resulting benefits. (Option 4) Abdominal distension (ascites) in cirrhosis is treated with diuretics (eg, furosemide, spironolactone) and paracentesis. Lactulose does not influence this pathology or symptom. Educational objective: Lactulose is a laxative used to trap and expel ammonia in clients with cirrhosis who have hepatic encephalopathy. Elevated ammonia levels cause mental confusion.

Block Time Remaining: 00:01:02 TUTOR Test Id: 80937794 QId: 30608 (921666) 27 of 53 A A A 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?" [87%] 2. "Are you taking extra vitamin C?" [0%] 3. "Did you babysit your granddaughter this past week?" [1%] 4. "Did you get a flu shot in the past week?" [9%] Omitted Correct answer 1 Answered correctly 87% Time: 4 seconds Updated: 05/16/2017 Explanation: Clients with hypertension should be instructed not to take potentially high-risk over-the-counter (OTC) medications such as high-sodium antacids, appetite suppressants, and cold and sinus preparations. It is appropriate to ask a client with hypertension about taking OTC cold medications as many cold and sinus medications contain phenylephrine or pseudoephedrine. These sympathomimetic decongestants activate alpha-1 adrenergic receptors, producing vasoconstriction. The resulting decreased nasal blood flow relieves nasal congestion. These agents have both oral and topical forms. With systemic absorption, these agents can cause dangerous hypertensive crisis. (Option 2) Taking extra vitamin C may offer some protection for the immune system, but it does not cause an increase in blood pressure. (Option 3) Exposure to young children increases the risk for contracting a contagious respiratory illness, but it does not directly increase blood pressure. (Option 4) A flu shot would not offer protection against the flu within a week and does not cause an increase in blood pressure. Educational objective: Clients with hypertension should be instructed not to take potentially high-risk over-the-counter medications, including high-sodium antacids, appetite suppressants, and cold and sinus preparations, as they can increase blood pressure.

Block Time Remaining: 00:01:04 TUTOR Test Id: 80937794 QId: 31350 (921666) 28 of 53 A A A 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) Omitted Correct answer 3,4,5 Answered correctly 50% Time: 2 seconds Updated: 03/13/2017 Explanation: Statins (rosuvastatin, atorvastatin, simvastatin) are the most preferred agents to reduce low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglyceride levels. This client's LDL level has decreased to a target range (diabetic client <100 mg/dL [2.6 mmol/L]), total cholesterol has decreased to a normal range (adult <200 mg/dL [5.2 mmol/L]), and triglyceride level has decreased to a normal range (adult <150 mg/dL [1.7 mmol/L)); all these changes indicate a therapeutic response (Options 3, 4, and 5). (Option 1) The adult therapeutic range of alanine aminotransferase (ALT) is 10-40 U/L (0.17-0.68 µkat/L). Increased aspartate aminotransferase (AST) and ALT may indicate hepatic dysfunction, a potential adverse effect of statin medication. (Option 2) The therapeutic range of high-density lipoprotein (HDL) cholesterol for adult men is >40 mg/dL (1.04 mmol/L). HDL is good cholesterol. This client's HDL level is below the therapeutic range, indicating a nontherapeutic response. Educational objective: A therapeutic response to statin medication includes a decrease in a client's LDL cholesterol, total cholesterol, and triglyceride levels to within normal range. An increase in HDL cholesterol to within normal range is also an expected outcome. Potential adverse effects include hepatic dysfunction and muscle injury.

Block Time Remaining: 00:01:03 TUTOR Test Id: 80941960 QId: 30008 (921666) 50 of 53 A A A A diabetic client is prescribed metoclopramide. Which of the following side effects must the nurse teach the client to report immediately to the health care provider? Select all that apply. 1. Excess blinking of eyes 2. Dry mouth 3. Dull headache 4. Lip smacking 5. Puffing of cheeks Omitted Correct answer 1,4,5 Answered correctly 30% Time: 1 seconds Updated: 04/30/2017 Explanation: Metoclopramide (Reglan) is prescribed for the treatment of delayed gastric emptying, gastroesophageal reflux (GERD), and as an antiemetic. Similar to antipsychotic drugs, metoclopramide use is associated with extrapyramidal adverse effects, including tardive dyskinesia (TD). This is especially common in older adults with long-term use. The client should call the health care provider immediately if TD symptoms develop, including uncontrollable movements such as: Protruding and twisting of the tongue Lip smacking Puffing of cheeks Chewing movements Frowning or blinking of eyes Twisting fingers Twisted or rotated neck (torticollis) (Options 2 and 3) Common side effects of metoclopramide such as sedation, fatigue, restlessness, headache, sleeplessness, dry mouth, constipation, and diarrhea need not be reported to the health care provider. Educational objective: Both antipsychotic medication and metoclopramide use can be associated with significant extrapyramidal side effects (eg, tardive dyskinesia). The nurse should teach the client the importance of immediately communicating these to the health care provider.

Block Time Remaining: 00:01:05 TUTOR Test Id: 80941960 QId: 34086 (921666) 51 of 53 A A A A client in the emergency department is being discharged with a prescription for trimethoprim-sulfamethoxazole. Which statement by the client would indicate a need for further evaluation? 1. "I developed a whole-body rash while on glyburide." [47%] 2. "I drink at least 5 large bottles of water daily." [3%] 3. "I had to stop using lisinopril due to a bad cough." [19%] 4. "I have a birth control implant in place." [29%] Omitted Correct answer 1 Answered correctly 47% Time: 2 seconds Updated: 02/27/2017 Explanation: Trimethoprim-sulfamethoxazole (Bactrim) is a sulfonamide antibiotic, commonly referred to as a sulfa drug. These antibiotics are prescribed to treat bacterial infections (eg, urinary tract infections). Contraindications include hypersensitivity to sulfa drugs, and pregnancy or breastfeeding. Glyburide is a sulfonylurea and has the potential to cause a sulfa cross-sensitivity reaction. Commonly used diuretics (eg, thiazides, furosemide) are also sulfa derivatives and can cause cross-sensitivity reaction. Although this reaction is uncommon, an alternate antibiotic, if possible, can be prescribed by the health care provider. (Option 2) Crystalluria is a potential adverse effect of sulfa medications. Clients should drink at least 2-3 L of water daily to prevent crystalluria. (Option 3) Angiotensin-converting enzyme inhibitors (eg, lisinopril) can produce an intractable cough. The only way to relieve this adverse effect is to discontinue the medication. There is no cross-reactivity with sulfa medications. (Option 4) Birth control implants (eg, IMPLANON, NEXPLANON) are progestin rods placed subdermally in the upper arm that provide contraception for up to 3 years. They are not contraindicated with concurrent trimethoprim-sulfamethoxazole use. Educational objective: Clients prescribed sulfa antibiotics (eg, trimethoprim-sulfamethoxazole [Bactrim]) should be assessed for allergies to sulfa drugs and sulfonylurea medications, such as glyburide, due to potential cross-sensitivity reactions. .

Block Time Remaining: 00:01:05 TUTOR Test Id: 80937794 QId: 30458 (921666) 29 of 53 A A A 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 [9%] 2. Dextromethorphan [32%] 3. Lisinopril [10%] 4. Valsartan [47%] Omitted Correct answer 4 Answered correctly 47% Time: 1 seconds Updated: 04/26/2017 Explanation: Major side effects of angiotensin-converting enzyme (ACE) inhibitors include: Symptomatic hypotension Intractable cough Hyperkalemia Angioedema (allergic reaction involving edema of the face and airways) Temporary increase in serum creatinine For clients unable to tolerate ACE inhibitors, angiotensin II receptor blockers (ARBs) such as valsartan or losartan are recommended. ARBs prevent the vasoconstrictor and aldosterone-secreting effects of angiotensin II by binding to the angiotensin II receptor sites. (Option 1) Alprazolam is an anxiolytic. It is not used in the treatment of heart failure. (Option 2) Dextromethorphan is a cough suppressant. A cough caused by an ACE inhibitor will not be improved by a cough suppressant. (Option 3) Lisinopril is an ACE inhibitor. This client has been unable to tolerate this class of drug. Educational objective: ARBs are recommended for clients unable to tolerate ACE inhibitors.

Block Time Remaining: 00:01:06 TUTOR Test Id: 80937794 QId: 31915 (921666) 30 of 53 A A A 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 [42%] 2. Blood pressure is 126/78 mm Hg [17%] 3. No signs or symptoms of stroke [4%] 4. Ventricular rate decreased from 158/min to 88/min [35%] Omitted Correct answer 4 Answered correctly 35% Time: 1 seconds Updated: 05/29/2017 Explanation: Atrial fibrillation is characterized by disorganized electrical activity in the atria due to multiple ectopic foci. It leads to loss of effective atrial contraction and places the client at risk for embolic stroke as a result of the thrombi formed in the atria. During atrial fibrillation, the atrial rate may be increased to 350-600/min. The ventricular response can vary. The higher the ventricular rate, the more likely the client will have symptoms of decreased cardiac output (ie, hypotension). The treatment goals are to reduce the ventricular rate to <100/min and prevent stroke. Ventricular rate control is the priority. Medications used for rate control include calcium channel blockers (ie, diltiazem), beta blockers (ie, metoprolol), and digoxin. (Option 1) Diltiazem is unlikely to convert atrial fibrillation to sinus rhythm. Antiarrhythmic medications such as amiodarone or ibutilide will be used for conversion of the rhythm. (Option 2) Calcium channel blockers such as diltiazem may reduce blood pressure, but the nurse is not evaluating this client in atrial fibrillation for this outcome. In this case, diltiazem is being used for ventricular rate reduction. (Option 3) Having no signs or symptom of stroke is a positive outcome in this client; however, it is not a specific outcome of diltiazem. Anticoagulants (eg, warfarin, dabigatran, rivaroxaban, apixaban) are used for this purpose. Educational objective: The nurse should monitor for a reduction in ventricular rate in the client with atrial fibrillation who is receiving diltiazem, metoprolol, or digoxin. Anticoagulants are used to prevent embolic complications.

Block Time Remaining: 00:01:00 TUTOR Test Id: 80944027 QId: 31361 (921666) 38 of 54 A A A An elderly client is prescribed codeine for a severe cough. The home health nurse teaches the client how to prevent the common adverse effects associated with codeine. Which client statements indicate an understanding of how to prevent them? Select all that apply. 1. "I'll be sure to apply sunscreen if I go outside." 2. "I'll drink at least 8 glasses of water a day." 3. "I'll drink decaffeinated coffee so I can sleep at night." 4. "I'll sit on the side of my bed for a few minutes before getting up." 5. "I'll take my medicine with food." Omitted Correct answer 2,4,5 Answered correctly 51% Time: 1 seconds Updated: 02/04/2017 Explanation: Codeine is an opioid drug prescribed as an analgesic to treat mild to moderate pain and as an antitussive to suppress the cough reflex. Although the antitussive dose (10-20 mg orally every 4-6 hours) is lower than the analgesic dose, clients can still experience the common adverse effects (eg, constipation, nausea, vomiting, orthostatic hypotension, dizziness) associated with the drug. Codeine decreases gastric motility, resulting in constipation. Increasing fluid intake and fiber in the diet and taking laxatives are effective measures to prevent constipation (Option 2). Changing position slowly is effective in preventing the orthostatic hypotension associated with codeine, especially in the elderly (Option 4). Taking the medication with food is effective in preventing the gastrointestinal irritation (eg, nausea, vomiting) associated with codeine (Option 5). (Options 1 and 3) These statements are inaccurate as photosensitivity, insomnia, palpitations, and anxiety are not adverse effects associated with codeine. Educational objective: The common adverse effects of codeine, an opioid drug, include constipation, nausea, vomiting, orthostatic hypotension, and dizziness. Interventions to help prevent them include increasing fluid intake and bulk in the diet, laxatives, taking the medication with food, and changing position slowly.

Block Time Remaining: 00:01:13 TUTOR Test Id: 80944027 QId: 31955 (921666) 39 of 54 A A A A client is receiving scheduled doses of carbidopa-levodopa. The nurse evaluates the medication as having the intended effect if which finding is noted? 1. Improvement in short-term memory [15%] 2. Improvement in spontaneous activity [65%] 3. Reduction in number of visual hallucinations [10%] 4. Reduction of dizziness with standing [8%] Omitted Correct answer 2 Answered correctly 65% Time: 13 seconds Updated: 12/11/2016 Explanation: Parkinson disease is caused by low levels of dopamine in the brain. Levodopa is converted to dopamine in the brain, but much of this drug is metabolized before reaching the brain. Carbidopa helps prevent the breakdown of levodopa before it can reach the brain and take effect. This combination medication is particularly effective in treating bradykinesia (generalized slowing of movement). Tremor and rigidity may also improve to some extent. Carbidopa-levodopa (Sinemet) once started should never be stopped suddenly as this can lead to akinetic crisis (complete loss of movement). However, prolonged use can also result in dyskinesias (spontaneous involuntary movements) and on/off periods when the medication will start or stop working unpredictably. (Option 1) Carbidopa-levodopa does not improve memory. Medications for the treatment of Alzheimer disease, such as donepezil and rivastigmine, are used to improve cognition and memory. (Options 3 and 4) Orthostatic hypotension and neuropsychiatric disturbances (eg, confusion, hallucinations, delusions, agitation, psychosis) are serious and important adverse effects of carbidopa-levodopa. Health care providers usually start the medications at low doses and gradually increase them to prevent these effects. Educational objective: The combination medication carbidopa-levodopa is most helpful for treating bradykinesia in Parkinson disease and can also improve tremor and rigidity to some extent. It is started in low doses to prevent orthostatic hypotension and neuropsychiatric adverse effects. Carbidopa-levodopa once started should never be stopped suddenly as doing so can lead to akinetic crisis (complete loss of movement).

Block Time Remaining: 00:01:14 TUTOR Test Id: 80944027 QId: 30376 (921666) 40 of 54 A A A A client with stable chronic obstructive pulmonary disease (COPD) has been prescribed extended-release oral theophylline for the past 2 years. The nurse reviews the serum laboratory results. Which value would the nurse report to the health care provider immediately? 1. Theophylline level 23.6 mcg/mL [84%] 2. Theophylline level 10.4 mcg/mL [9%] 3. Theophylline level 15.3 mcg/mL [2%] 4. Theophylline level 18.0 mcg/mL [2%] Omitted Correct answer 1 Answered correctly 84% Time: 1 seconds Updated: 06/01/2017 Explanation: Theo-24 (theophylline) is a long-acting, slow-release methylxanthine bronchodilator that relaxes bronchial smooth muscles, improves contractility of the diaphragm, and facilitates mucus transport by the cilia. Methylxanthines (eg, aminophylline, theophylline) are sometimes administered in addition to first-line drugs (eg, beta agonists, anticholinergics, corticosteroids) to prevent and treat reversible bronchospasm in clients with long-standing COPD. Theophylline has a narrow therapeutic index, and toxicity can occur from accumulation by reduced clearance or decreased metabolism. Medications, diet, underlying disease, and smoking can affect plasma theophylline clearance. To provide the desired effect of the drug and limit side effects, serum theophylline levels are monitored periodically (every 6 months) to maintain a target blood level of 10-20 mcg/mL. In some cases, symptom management may be attained at a lower target range (8-15 mcg/mL). (Options 2, 3, and 4) All values are within the normal adult target range (10-20 mcg/mL). Educational objective: Theophylline relaxes bronchial smooth muscles, improves contractility of the diaphragm, and facilitates mucus transport by the cilia in clients with COPD. However, due to its narrow therapeutic index, theophylline levels are monitored periodically to maintain a target blood level of 10-20 mcg/mL.

Block Time Remaining: 00:01:15 TUTOR Test Id: 80944027 QId: 30761 (921666) 41 of 54 A A A The hospice nurse is caring for an actively dying client who is unresponsive and has developed a loud rattling sound with breathing ("death rattle") that distresses family members. Which prescription would be most appropriate to treat this symptom? 1. Atropine sublingual drops [33%] 2. Lorazepam sublingual tablet [13%] 3. Morphine sublingual liquid [48%] 4. Ondansetron sublingual tablet [4%] Omitted Correct answer 1 Answered correctly 33% Time: 1 seconds Updated: 01/16/2017 Explanation: The "death rattle" is a loud rattling sound with breathing that occurs in a client who is actively dying. When the client cannot manage airway secretions, the movement of these secretions during breathing causes a noisy rattling sound. This can distress family and friends at the bedside of the dying client. The "death rattle" can be treated using anticholinergic medications to dry the client's secretions. Medications include atropine drops administered sublingually or a transdermal scopolamine patch. (Option 2) Lorazepam is a benzodiazepine that is used to treat anxiety and restlessness in terminally ill clients. It can be effective for alleviating dyspnea exacerbated by anxiety, but it is ineffective for controlling secretions (the cause of the "death rattle"). (Option 3) Morphine is an opioid analgesic that is effective for pain treatment as well as terminal dyspnea. The client is not exhibiting these symptoms, so morphine would be inappropriate. (Option 4) Ondansetron will help the nausea and vomiting but is not very effective for treating the "death rattle." Educational objective: The "death rattle" is a noisy rattling sound with breathing commonly seen in a dying client who is unresponsive and no longer able to manage airway secretions. Anticholinergic medications such as transdermal scopolamine or atropine sublingual drops effectively treat this symptom by drying up the excess secretions.

Block Time Remaining: 00:01:16 TUTOR Test Id: 80944027 QId: 30540 (921666) 42 of 54 A A A A client is having a severe asthma attack lasting over 4 hours after exposure to animal dander. On arrival, the pulse is 128/min, respirations are 36/min, pulse oximetry is 86% on room air, and the client is using accessory muscles to breathe. Lung sounds are diminished and high-pitched wheezes are present on expiration. Based on this assessment, the nurse anticipates the administration of which of the following medications? Select all that apply. 1. Inhaled albuterol nebulizer every 20 minutes 2. Inhaled ipratropium nebulizer every 20 minutes 3. Intravenous methylprednisolone 4. Montelukast 10 mg by mouth STAT 5. Salmeterol metered-dose inhaler every 20 minutes Omitted Correct answer 1,2,3 Answered correctly 25% Time: 1 seconds Updated: 04/26/2017 Explanation: Clinical manifestations characteristic of moderate to severe asthma exacerbations include tachycardia (>120/min), tachypnea (>30/min), saturation <90% on room air, use of accessory muscles to breathe, and peak expiratory flow (PEF) <40% of predicted or best (<150 L/min). Pharmacologic treatment modalities recommended by the Global initiative for Asthma (2014) to correct hypoxemia, improve ventilation, and promote bronchodilation include the following: Oxygen to maintain saturation >90% High-dose inhaled short-acting beta agonist (SABA) (albuterol) and anticholinergic agent (ipratropium) nebulizer treatments every 20 minutes Systemic corticosteroids (Solu-Medrol) (Option 4) Montelukast (Singulair) is a leukotriene receptor blocker with both bronchodilator and anti-inflammatory effects; it is used to prevent asthma attacks but is not recommended as an emergency rescue drug in asthma. (Option 5) A long-acting beta agonist (Salmeterol) is administered with an inhaled corticosteroid for long-term control of moderate to severe asthma; it is not used as an emergency rescue drug in asthma. Educational objective: Clinical manifestations characteristic of moderate to severe asthma exacerbations include tachycardia, tachypnea, saturation <90% on room air, use of accessory muscles of respiration, and PEF <40% predicted. Management includes the administration of high-dose inhaled SABA and ipratropium nebulizer, systemic corticosteroids, and oxygen to maintain saturation >90%.

Block Time Remaining: 00:01:17 TUTOR Test Id: 80944027 QId: 31962 (921666) 43 of 54 A A A The nurse has provided education for a client newly prescribed alprazolam for generalized anxiety disorder. Which client statement indicates that teaching has been effective? 1. "Eliminating aged cheeses and processed meats from my diet is essential." [23%] 2. "I can skip doses on days that I am not feeling anxious." [10%] 3. "I will take my daily dose at bedtime." [37%] 4. "Using sunscreen is important as this drug will make me sensitive to sunlight." [28%] Omitted Correct answer 3 Answered correctly 37% Time: 1 seconds Updated: 12/09/2016 Explanation: Benzodiazepines (eg, alprazolam [Xanax], lorazepam [Ativan], clonazepam, diazepam) are commonly used antianxiety drugs. They work by potentiating endogenous GABA, a neurotransmitter that decreases excitability of nerve cells, particularly in the limbic system of the brain, which controls emotions. Benzodiazepines may cause sedation, which can interfere with daytime activities. Giving the dose at bedtime will help the client sleep. (Option 1) Eliminating aged cheeses and processed meats, which contain tyramine, is necessary with monoamine oxidase inhibitors (eg, tranylcypromine, phenelzine), which are used for depressive disorders. It is not necessary with benzodiazepines. (Option 2) A benzodiazepine should never be stopped abruptly. Instead, it should be tapered gradually to prevent rebound anxiety and a withdrawal reaction characterized by increased anxiety, confusion, and more. (Option 4) Photosensitivity is a problem with most antipsychotics and many antidepressants, but not with benzodiazepines. Educational objective: Benzodiazepines have a sedative effect and should be administered at bedtime when possible. Benzodiazepines should never be stopped abruptly in long-term users as this can precipitate withdrawal symptoms.

Block Time Remaining: 00:01:19 TUTOR Test Id: 80944027 QId: 34106 (921666) 44 of 54 A A A 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." [42%] 2. "I had a concussion after a car accident a year ago." [14%] 3. "I started noticing my right arm becoming weak approximately an hour ago." [18%] 4. "I stopped taking my warfarin 4 weeks ago." [24%] Omitted Correct answer 1 Answered correctly 42% Time: 2 seconds Updated: 12/21/2016 Explanation: Tissue plasminogen activator (tPA) dissolves clots and restores perfusion in clients with ischemic stroke. It must be administered within a 3- to 4½-hour window from onset of symptoms for full effectiveness. The nurse assesses for contraindications to tPA due to the risk of hemorrhage. The client should not have a history of intracranial hemorrhage or be actively bleeding. Surgery within the last 2 weeks is a contraindication as tPA dissolves all clots in the body and may disrupt the surgical site. This client indicates a recent stomach surgery, which would need further clarification to determine eligibility to receive tPA (Option 1). (Option 2) A client's history of stroke or head trauma in the last 3 months could exclude tPA use. (Option 3) The nurse should determine when the client first developed stroke symptoms. tPA can be administered if symptoms started within the last 3 to 4½ hours or based on facility guidelines. (Option 4) Current anticoagulant use may exclude a client from receiving tPA. The duration of action for warfarin is 2-5 days; this client can safely receive tPA as warfarin was discontinued 4 weeks ago. However, if pending coagulation studies drawn prior to tPA administration are elevated, the infusion may be discontinued. Educational objective: Tissue plasminogen activator (tPA) dissolves clots in an ischemic stroke and must be administered within a 3- to 4½-hour window from onset of symptoms. The nurse assesses for contraindications to tPA due to the risk of hemorrhage.

Block Time Remaining: 00:01:20 TUTOR Test Id: 80944027 QId: 34025 (921666) 45 of 54 A A A A 21-year-old client is being evaluated in the outpatient psychiatric clinic after starting isocarboxazid 2 weeks ago. Which of the client's statements needs to be addressed first? 1. "I am not sleeping well at night and would like a sleeping aid." [7%] 2. "I do not know how well I will do on this restricted diet." [9%] 3. "I have been having quite a bit of nausea and constipation." [15%] 4. "This medicine is not working; I am so tired of being depressed." [67%] Omitted Correct answer 4 Answered correctly 67% Time: 1 seconds Updated: 04/10/2017 Explanation: Commonly used monoamine oxidase inhibitors (MAOIs) include isocarboxazid, phenelzine, and tranylcypromine. These first-generation antidepressants are used only for resistant depression due to serious adverse affects. These medications inhibit the enzyme that breaks up norepinephrine, serotonin, and dopamine, thereby increasing their availability in the body. Clients taking MAOIs or other antidepressants are at increased risk for suicidal ideation, particularly children, adolescents, and young adults. The risk of suicidal thoughts can be more prevalent when starting the medication or with dose increases. Feelings of hopelessness or despair must be evaluated to assess if suicidal ideation or thoughts of self-harm are present (Option 4). (Option 1) MAOIs should be administered in the morning, as sleep dysfunction is common. This client statement should prompt a discussion of current medication habits, but is not the priority. (Option 2) Clients taking MAOIs need to avoid tyramine-containing foods (eg, cheese, overripe fruit, liquor, beef/chicken liver, fermented products) due to risk of hypertensive crisis. A medication change might be considered if a client is unable to adhere to the restrictions, but would not be priority. (Option 3) Nausea and constipation are adverse effects of MAOIs. Although strategies for management of adverse effects should be discussed, this is not priority. Educational objective: MAOIs and other antidepressants are associated with increased risk of suicidal ideation during the first few weeks of treatment. Clients taking MAOIs need to avoid tyramine-containing foods due to risk of hypertensive crisis. .

Block Time Remaining: 00:01:21 TUTOR Test Id: 80944027 QId: 31953 (921666) 46 of 54 A A A The clinic nurse is assessing the client's understanding of tiotropium, which has been prescribed for chronic obstructive pulmonary disease (COPD). Which statement indicates that the client has a correct understanding of this medication? 1. "A capsule holds the powdered medication that I have to put in a special inhaler." [43%] 2. "I do not need to rinse my mouth with water after taking tiotropium." [3%] 3. "I have been taking tiotropium every time I have difficulty breathing." [6%] 4. "Tiotropium helps control my COPD by reducing inflammation in my airway." [46%] Omitted Correct answer 1 Answered correctly 43% Time: 1 seconds Updated: 01/19/2017 Explanation: Tiotropium (Spiriva) is a long-acting, 24-hour, anticholinergic, inhaled medication used to control chronic obstructive pulmonary disease (COPD). It is administered most commonly using a capsule-inhaler system called the HandiHaler. The powdered medication dose is contained in a capsule. The client places the capsule in the inhaler device and pushes a button on the side of the device, which pokes a hole in the capsule. As the client inhales, the powder is dispersed through the hole. Unlike most inhaled medications, tiotropium looks like an oral medication because it comes in a capsule. Therefore, it is important to teach the client proper administration prior to the first dose, emphasizing that the capsule should not be swallowed and that the button on the inhaler must be pushed to allow for medication dispersion. During future appointments, the nurse should assess/reassess the client's ability to use this medication correctly. (Option 2) Clients should rinse the mouth after using tiotropium and inhaled steroids (eg, beclomethasone, budesonide, fluticasone) to remove any medication remaining in the mouth, which decreases the risk of developing thrush. (Option 3) Tiotropium is a controller medication for COPD with a peak effect of approximately 1 week; therefore, it should not be used as a rescue medication. Instead, short-acting bronchodilators (eg, albuterol and/or ipratropium) should be used for symptom rescue. Clients must discontinue ipratropium before taking tiotropium as both are anticholinergic. (Option 4) Anticholinergic inhaled medications (eg, ipratropium, tiotropium, umeclidinium) do not reduce inflammation in the airway. Instead, they relax the airway by blocking parasympathetic bronchoconstriction. They also help dry up airway secretions. Educational objective: Tiotropium and umeclidinium are long-acting, 24-hour, anticholinergic medications. Ipratropium is a short-acting anticholinergic used as a rescue medication for COPD and asthma. Tiotropium is typically administered as a powder via a special inhaler.

Block Time Remaining: 00:01:22 TUTOR Test Id: 80944027 QId: 30321 (921666) 47 of 54 A A A A client with an asthma exacerbation has been using her albuterol rescue inhaler 10-12 times a day because she cannot take a full breath. What possible side effects of albuterol does the nurse anticipate the client will report? Select all that apply. 1. Constipation 2. Difficulty sleeping 3. Hives with pruritus 4. Palpitations 5. Tremor Omitted Correct answer 2,4,5 Answered correctly 51% Time: 1 seconds Updated: 04/26/2017 Explanation: Albuterol is a short-term beta-adrenergic agonist used as a rescue inhaler to treat reversible airway obstruction associated with asthma. Dosing in an acute asthma exacerbation should not exceed 2-4 puffs every 20 minutes x 3. If albuterol is not effective, an inhaled corticosteroid is indicated to treat the inflammatory component of the disease. Albuterol is a sympathomimetic drug. Expected side effects mimic manifestations related to stimulation of the sympathetic nervous system, and commonly include insomnia, nausea and vomiting, palpitations (from tachycardia), and mild tremor. (Option 1) Constipation is not a common side effect of inhaled beta-agonist drugs. (Option 3) Hives can occur as a sign of an allergic reaction and are not a common anticipated side effect of an inhaled beta-agonist drug. Educational objective: Albuterol is a short-term beta-agonist rescue drug used to control symptoms of airway obstruction and promote bronchodilation. It is a sympathomimetic drug; common expected side effects include insomnia, nausea and vomiting, palpitations (tachycardia), and mild tremor.

Block Time Remaining: 00:01:23 TUTOR Test Id: 80944027 QId: 30520 (921666) 48 of 54 A A A An unresponsive client is brought to the emergency department after a party. Friends report that the client drank beer, may have taken some kind of pills, and then passed out. Blood pressure is 90/62 mm Hg, pulse is 64/min, and respirations are 8/min. Which priority action is expected to be taken following the initial assessment? 1. Administer IV naloxone [58%] 2. Administer Ringer's lactate at 125 mL/hr [29%] 3. Collect a urine sample for a urine drug screen [7%] 4. Draw blood for a blood alcohol content test [3%] Omitted Correct answer 1 Answered correctly 58% Time: 1 seconds Updated: 02/11/2017 Explanation: The characteristic clinical features of opioid intoxication include the following: Depressed mental status Decreased respiratory rate (<12/min) (most notable) Constricted (miotic) pupils (may not be present in every client) Decreased/absent bowel sounds Mild hypotension from histamine release and bradycardia from central nervous system (CNS) depression may also be present. Concurrent intake of other CNS depressants (eg, alcohol) can worsen the respiratory depression. Naloxone (Narcan) is a potent narcotic antagonist that can reverse symptoms (respiratory depression, sedation, hypotension) associated with suspected opioid overdose without producing any opioid-like effects. The usual dose is 0.4 mg IV (in non-opioid dependent clients), typically given via IV push. The therapeutic effect is rapid, within 1-2 minutes, and dosing may be repeated in 2-3 minutes. It is the priority action to reverse CNS and respiratory depression (Option 1). (Option 2) IV fluids will be administered, but the priority action is to address the client's respiratory depression. (Option 3) A urine sample will be obtained for a urine drug screen and toxicology tests. It is not necessary to wait for the results before administering naloxone as delaying care could result in further CNS or respiratory depression and subsequent death. (Option 4) Blood for a blood alcohol content test will be drawn, but this is not the priority action. Educational objective: The administration of IV naloxone (Narcan), a potent narcotic antagonist, is a priority action to reverse depression of the respiratory and central nervous systems in a client with suspected opioid overdose. A respiratory rate <12/min is the most notable feature of opioid overdose.

Block Time Remaining: 00:01:24 TUTOR Test Id: 80944027 QId: 30606 (921666) 49 of 54 A A A A client diagnosed with trigeminal neuralgia is given a prescription of carbamazepine by the health care provider. Which intervention does the nurse add to this client's care plan? 1. Encourage client to drink cold beverages [1%] 2. Encourage client to eat a high-fiber diet [12%] 3. Encourage client to perform facial massage [17%] 4. Encourage client to report any fever or sore throat [68%] Omitted Correct answer 4 Answered correctly 68% Time: 1 seconds Updated: 01/13/2017 Explanation: Trigeminal neuralgia is sudden, sharp pain along the distribution of the trigeminal nerve. The symptoms are usually unilateral and primarily in the maxillary and mandibular branches. Clients may experience chronic pain with periods of less severe pain, or "cluster attacks" of pain between long periods without pain. Triggers can include washing the face, chewing food, brushing teeth, yawning, or talking. Pain is severe, intense, burning, or electric shock-like. The primary intervention for trigeminal neuralgia is consistent pain control with medications and lifestyle changes. The drug of choice is carbamazepine. It is a seizure medication but is highly effective for neuropathic pain. Carbamazepine is associated with agranulocytosis (leukopenia) and infection risk. Clients should be advised to report any fever or sore throat. Behavioral interventions include the following: Oral care - use a small, soft-bristled toothbrush or a warm mouth wash Use lukewarm water; avoid beverages or food that are too hot or cold (Option 1) Room should be kept at an even and moderate temperature Avoid rubbing or facial massage. Use cotton pads to wash the face if necessary. Have a soft diet with high calorie content; avoid foods that are difficult to chew. Chew on the unaffected side of the mouth. (Option 2) A high-fiber diet is not required for a client with trigeminal neuralgia, and the additional chewing with higher-fiber foods may serve as a pain trigger. (Option 3) Clients with trigeminal neuralgia are encouraged not to massage the face as this can trigger pain. Educational objective: The primary intervention for trigeminal neuralgia includes pain control and limiting pain triggers. The drug of choice is carbamazepine. Triggers can include washing the face, chewing food, brushing teeth, yawning, or talking. Carbamazepine is associated with agranulocytosis (leukopenia) and infection risk. Clients should be advised to report any fever or sore throat.

Block Time Remaining: 00:01:25 TUTOR Test Id: 80944027 QId: 32025 (921666) 50 of 54 A A A The registered nurse is counseling the parent of a child who was diagnosed with attention-deficit hyperactivity disorder (ADHD) and received a prescription of methylphenidate. Which statement by the parent best demonstrates that teaching has been effective? 1. "An additive-free, low-sugar diet will reduce my child's symptoms." [27%] 2. "I can now manage my child's condition on my own." [4%] 3. "My child should take the last daily dose of methylphenidate before 6:00 PM." [66%] 4. "Once the medication is started, I will not have to monitor my child anymore." [1%] Omitted Correct answer 3 Answered correctly 66% Time: 1 seconds Updated: 12/17/2016 Explanation: Stimulants (eg, methylphenidate, dextroamphetamine, lisdexamfetamine) are first-line agents in the treatment of ADHD. Methylphenidate (Ritalin) is administered in divided doses 2 or 3 times daily, usually 30-45 minutes before meals. As a stimulant, methylphenidate may interfere with sleep and should be given no later than around 6:00 PM. The sustained-release preparation should be given in the morning. The dosage in children is usually started low and titrated to the desired response. Children should be monitored closely during initial treatment for development of tics and continuously for adherence and response to therapy (Option 4). (Option 1) Contrary to popular myth, sugar does not increase hyperactivity; although an additive-free diet may be a healthy approach for children, eliminating additives or food colorings does not decrease the symptoms of ADHD. (Option 2) A team approach (parents, teachers, and health care providers) is the most effective way to help a child with ADHD. School-based interventions may include specific classroom modifications or accommodations to be incorporated into the treatment plan. Educational objective: Methylphenidate is a stimulant drug with the potential to cause insomnia. Parents are instructed to administer the last dose no later than 6:00 PM to prevent sleep disruption. .

Block Time Remaining: 00:01:26 TUTOR Test Id: 80944027 QId: 31315 (921666) 51 of 54 A A A Which medication prescriptions should the nurse question? Select all that apply. 1. Cephalexin for a client with severe allergy to penicillin 2. Fexofenadine for a client with hives 3. Ibuprofen for a client with asthma and nasal polyps 4. Lisinopril for a client with diabetes mellitus 5. Propranolol for a client with asthma Omitted Correct answer 1,3,5 Answered correctly 23% Time: 1 seconds Updated: 12/20/2016 Explanation: Cephalexin is a cephalosporin, which is chemically similar to penicillin. If a client has had a severe allergic reaction to penicillin, there is a 1%-4% chance of an allergic reaction (cross-sensitivity) to a cephalosporin (Option 1). Clients with nasal polyps often have sensitivity to nonsteroidal anti-inflammatory drugs (NSAIDS), including aspirin. In addition, NSAIDs can exacerbate asthma symptoms. Therefore, acetaminophen may be a better choice for these clients (Option 3). The selective beta blockers (eg, metoprolol, atenolol, bisoprolol) are generally given for heart failure and hypertension control due to their beta1-blocking effect. The nonselective beta blockers (eg, propranolol, nadolol), in addition, have a beta2-blocking effect that results in bronchial smooth muscle constriction. Therefore, nonselective beta blockers are generally contraindicated in clients with asthma (Option 5). (Option 2) H1 receptor antagonists (eg, fexofenadine, cetirizine, levocetirizine, loratadine) decrease the inflammatory response by blocking histamine receptors. Histamine is released from mast cells during a type I (immediate) hypersensitivity reaction (ie, allergic rhinitis, allergic conjunctivitis, and hives). (Option 4) Angiotensin-converting (ACE) inhibitors (ending in "pril") are the drugs of choice in diabetic clients with hypertension or proteinuria. This would be an appropriate administration. Educational objective: Clients with asthma and nasal polyps can have sensitivity to NSAIDs; those with an allergy to penicillin can have a cross-sensitivity to cephalosporins. Nonselective beta blockers are contraindicated in clients with asthma. H1 receptor antagonists block histamine in an allergic reaction. ACE inhibitors are protective for diabetic nephropathy.

Block Time Remaining: 00:01:27 TUTOR Test Id: 80944027 QId: 31409 (921666) 52 of 54 A A A The registered nurse and practical nurse are conducting a workshop on contraceptive methods for a group of outpatient clients. Which instructions should the nurses include when discussing combined estrogen-progestin oral contraceptives? Select all that apply. 1. Consult the health care provider (HCP) if you experience leg pain or swelling 2. Discontinue contraceptives if you experience spotting between menses 3. Do not smoke while taking combined contraceptives 4. Immediately report any breast tenderness to the HCP 5. Seek immediate medical treatment if you experience vision loss Omitted Correct answer 1,3,5 Answered correctly 71% Time: 1 seconds Updated: 03/12/2017 Explanation: The use of hormonal contraception (ie, estrogen with or without progestin) places women at a 2- to 4-fold increased risk for developing blood clots due to resulting hypercoagulability. Hormone levels vary among contraceptives, and higher levels of hormone content correlate to an increased risk of adverse thrombotic events (eg, stroke, myocardial infarction). Clients who are prescribed oral contraceptive pills (OCPs) containing estrogen should be educated on potential warning signs (eg, chest pain, vision loss, severe leg pain) (Options 1 and 5). In addition, clients should be instructed not to smoke while taking combined OCPs due to an increased risk of blood clots (Option 3). (Option 2) Irregular bleeding and spotting between menses are common side effects of combined OCPs. These side effects may be bothersome but are not serious and may improve within 3 months of initiation. If the client cannot tolerate side effects, a different OCP may be considered. (Option 4) Clients should be counseled that breast tenderness is a common side effect of combined OCPs and does not warrant emergent reporting to the health care provider. Educational objective: Clients who are prescribed oral estrogen contraceptives (with or without progestin) have an increased risk for developing blood clots. Clients should be educated on warning signs to report to the health care provider (eg, severe leg pain, vision loss) versus common side effects (eg, breast tenderness, spotting).

Block Time Remaining: 00:01:28 TUTOR Test Id: 80944027 QId: 32018 (921666) 53 of 54 A A A A client presents to the emergency department with alcohol intoxication. Assessment shows nystagmus, ataxia, and confusion. The client's breath smells of alcohol. Which prescription from the health care provider should the nurse implement first? 1. Blood draw for liver function tests [15%] 2. D5 1/2 normal saline [41%] 3. Folic acid, IV [2%] 4. Thiamine, IV [40%] Omitted Correct answer 4 Answered correctly 40% Time: 1 seconds Updated: 12/19/2016 Explanation: Clients with alcoholism can have hypoglycemia. They can also have thiamine (vitamin B1) deficiency related to poor nutrient intake (a healthy diet contains enough thiamine) and alcohol-induced suppression of thiamine absorption. Thiamine deficiency can result in Wernicke encephalopathy (WE). Untreated WE can lead to death or neurologic morbidity (Korsakoff psychosis). In the setting of alcoholism, administered glucose is oxidized by using all the existing thiamine in the body; this can worsen thiamine deficiency, which in turn can precipitate the development of WE in a previously unaffected individual. Because the signs of alcohol intoxication and WE are similar, all intoxicated clients should be given IV thiamine before or with IV glucose (Options 2 and 4). (Option 1) A blood draw for liver functions tests to rule out alcoholic hepatitis is important but not a priority. (Option 3) Clients with alcoholism usually have additional nutritional deficiencies (eg, folic acid, magnesium). Magnesium and multiple vitamins should also be given to these clients. However, thiamine is the essential vitamin to administer before or with IV glucose in a client with suspected alcoholism. Educational objective: IV thiamine is given before or with IV glucose to a client with alcohol intoxication to prevent Wernicke encephalopathy. Clients with alcoholism often have thiamine deficiency. .

Block Time Remaining: 00:09:43 TUTOR Test Id: 80931650 QId: 32609 (921666) 39 of 48 A A A 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 [9%] 2. 80-year-old with irritability and agitation who has taken alprazolam for 2 weeks [1%] 3. Client taking clozapine who has sudden onset of high fever, diaphoresis, and change in mental status [88%] 4. Client taking olanzapine who has dry mouth, blurry vision, and constipation [1%] Omitted Correct answer 3 Answered correctly 88% Time: 1 seconds Updated: 01/10/2017 Explanation: The client taking clozapine is exhibiting classic signs of neuroleptic malignant syndrome (NMS), an uncommon but life-threatening adverse reaction to anti-psychotic medications. NMS is characterized by high fever, muscular rigidity, altered mental status, and autonomic dysfunction. Treatment includes supportive care (eg, rehydration, cooling body temperature) and immediate discontinuation of the medication. Due to the life-threatening nature of NMS, this client needs to be seen first to assess for generalized muscle rigidity. (Option 1) Severe neck spasms in an individual taking haloperidol (and other psychotropic medications) indicate a dystonic reaction. This client is in no immediate danger but needs treatment with IV benztropine (Cogentin) as soon as possible. The client should be seen second. (Option 2) Benzodiazepines can cause paradoxical worsening of agitation in elderly clients. This client needs a change in medication but does not need to be seen immediately. (Option 4) Dry mouth, blurry vision, and constipation are common anti-cholinergic side effects of olanzapine (and other psychotropic medications). These symptoms usually resolve after the client has taken the medication for a few weeks; treatment is symptomatic (eg, increased fluids, sugar-free chewing gum, high-fiber foods, avoidance of driving). This client can be seen last. Educational objective: Neuroleptic malignant syndrome (NMS) usually presents with mental status changes, fever, muscle rigidity, and autonomic instability after starting antipsychotic medications. Treatment involves discontinuation of the medication and supportive care (eg, rehydration, cooling body temperature). NMS is a life-threatening condition.

Block Time Remaining: 00:09:44 TUTOR Test Id: 80931650 QId: 30994 (921666) 40 of 48 A A A 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 Omitted Correct answer 4,5 Answered correctly 41% Time: 1 seconds Updated: 01/15/2017 Explanation: The nurse would question the prescriptions for the following clients: Client with hypertension and BP 94/40 mm Hg, prescribed metoprolol succinate SR (Toprol-XL) 50 mg PO: This client's mean arterial pressure (MAP) is only 58 mm Hg ({[2x diastolic] + systolic} ÷ 3). A MAP >60-65 mm Hg is necessary to perfuse the vital organs (eg, brain, coronary arteries, kidneys). Toprol-XL is a long-acting beta blocker and will continue to drop the client's BP over a 24-hour period. Client with otitis media and penicillin allergy prescribed ampicillin 500 mg PO: Ampicillin is classified as a penicillin antibiotic and is contraindicated in clients with a penicillin allergy. (Option 1) C difficile colitis is treated with metronidazole or vancomycin, depending on severity and number of relapses. Vancomycin is typically given orally in this situation, unlike other nonintestinal infections in which IV is the standard route. There is no reason to question this prescription. (Option 2) A sliding insulin (correction) scale is used to prescribe rapid-acting lispro (Humalog) to control postprandial hyperglycemia. The nurse would not question this prescription. (Option 3) Proton pump inhibitors (eg, pantoprazole, omeprazole) are prescribed for gastroesophageal reflux disease, and ulcer treatment and prophylaxis. The IV preparation is administered when the oral route is contraindicated. The nurse would not question this prescription. Educational objective: IV proton pump inhibitors are used for gastric ulcer bleeding. Oral vancomycin can be used for C difficile colitis. Ampicillin or amoxicillin are contraindicated in clients with a penicillin allergy. Antihypertensives are held if the client has borderline low BP. .

Block Time Remaining: 00:09:47 TUTOR Test Id: 80931650 QId: 34325 (921666) 41 of 48 A A A The home health hospice nurse visits a client who is newly prescribed extended-release oxycodone 40 mg orally, scheduled every 12 hours to treat severe chronic cancer pain. Which information is most important to reinforce to the client's caregiver? 1. Administer the medication around the clock even if the client denies having pain [50%] 2. Avoid administering with immediate-release opioids to prevent respiratory depression [38%] 3. Change the dosage and frequency to 20 mg every 6 hours if breakthrough pain occurs [2%] 4. Request a tapered dose from the health care provider if pain decreases to prevent tolerance [9%] Omitted Correct answer 1 Answered correctly 50% Time: 3 seconds Updated: 01/09/2017 Explanation: Extended-release oxycodone (Oxycontin) is a long-acting opioid agonist prescribed to manage severe chronic pain when nonopioids and immediate-release opioids (eg, immediate-release oxycodone, hydrocodone) are inadequate. The nurse should teach the client's caregiver to administer extended-release oxycodone as scheduled, even if the client does not report pain. Administration twice daily is necessary to maintain a therapeutic level and provide continuous relief as the duration of the analgesic effect is 12 hours. (Option 2) Immediate-release opioids and nonopioids are coadministered with long-acting opioids for relief of breakthrough pain. Respiratory status should be monitored; however, clients who receive long-term therapy become opioid tolerant and are less likely to experience adverse effects. Because the goal of hospice care is comfort, this client should be relieved of breakthrough pain regardless of respiratory status. (Option 3) The dose and frequency cannot be changed without a prescription. Also, breakthrough pain is best treated with short-acting opioids. (Option 4) Long-term opioid therapy leads to drug tolerance and physical dependence; higher doses are eventually required for therapeutic effect. In the dying client, it is not appropriate to taper the dose. Rather, it should be titrated upward for effective pain relief. Educational objective: Long-acting controlled-release opioid drugs for chronic pain require regularly scheduled dosing to maintain a therapeutic drug level. Immediate-release opioids may be required for breakthrough pain. Long-term opioid use leads to tolerance and physical dependence; higher doses are eventually required for therapeutic effect.

Block Time Remaining: 00:09:48 TUTOR Test Id: 80931650 QId: 33787 (921666) 42 of 48 A A A A nurse is preparing to administer 2 continuous IV medications concurrently via a 20-gauge IV. What is the nurse's priority action? 1. Assess the condition of the IV site [15%] 2. Check 2 client identifiers before administering medications [14%] 3. Consult a medication guide for compatibility [61%] 4. Wash hands prior to administering medications [8%] Omitted Correct answer 3 Answered correctly 61% Time: 1 seconds Updated: 02/25/2017 Explanation: The priority when administering 2 IV medications concurrently is to determine drug compatibility. Incompatible drugs given through the same IV line will deteriorate or form a precipitate. This change is visualized through either a color change, a clouding of the solution, or the presence of particles. If 2 or more drugs are not compatible, the nurse may consider inserting a second IV or consulting the pharmacist and the health care provider to determine the safest and most beneficial plan for the client. (Option 1) Assessing the IV site for complications (eg, infiltration, phlebitis) should always be performed before giving any IV medication. This will be completed after determining drug compatibility. (Option 2) Verification using 2 client identifiers pertains to the "right client" in the "6 rights" of medication administration. Drug compatibility should be determined prior to entering the client's room and verifying identity. (Option 4) Hand hygiene is a standard precaution taken before any type of client interaction to prevent contamination and infection; hand washing will be completed after checking for drug compatibility. Educational objective: Checking for drug compatibility is a priority before administering 2 IV medications concurrently in the same IV site. Incompatible drugs will deteriorate or form a precipitate that is visible as a color change, cloudiness, or particulates.

Block Time Remaining: 00:09:54 TUTOR Test Id: 80931650 QId: 30741 (921666) 43 of 48 A A A The nurse performs medication reconciliation for a 94-year-old client who has type 2 diabetes, hypothyroidism, and heart failure caused by a previous myocardial infarction. Due to risks outweighing benefits, the nurse plans to talk with the health care provider about discontinuing which medication? 1. Aspirin 81 mg PO once a day [30%] 2. Furosemide 40 mg PO once a day [25%] 3. Glyburide 10 mg PO once a day [29%] 4. Levothyroxine 50 mcg PO once a day [14%] Omitted Correct answer 3 Answered correctly 29% Time: 6 seconds Updated: 02/09/2017 Explanation: Beers Criteria lists medications that may be inappropriate for the geriatric population due to risks outweighing benefits. The nurse collaborates with the health care provider to minimize polypharmacy and reduce adverse effects (eg, falls, confusion). Sulfonylureas (eg, glyburide) stimulate insulin release via the pancreas and carry a risk for severe and prolonged hypoglycemia in the geriatric population due to potential delayed elimination. Avoidance of these drugs is recommended by the Beers Criteria. Instead, other medications that are at lower risk for hypoglycemia should be used (eg, metformin) (Option 3). (Option 1) Aspirin is used to prevent platelet aggregation in clients with a history of stroke or myocardial infarction. Aspirin and other nonsteroidal anti-inflammatory medications (eg, ibuprofen) have an increased risk of gastrointestinal bleeding. Therefore, aspirin is used cautiously in the older adult population, and doses should not exceed 325 mg/day. (Option 2) Furosemide is a loop diuretic used to treat fluid overload in heart failure, making it an important part of symptom management. This drug may cause dehydration if the client is not ingesting food and fluids well; otherwise, it should be continued. (Option 4) Levothyroxine is required to maintain thyroid hormone levels in clients with hypothyroidism. Major side effects typically occur only with improper dosing (eg, elevated levels). Educational objective: The Beers Criteria can be used to identify potentially inappropriate drugs that contribute to adverse events (eg, falls, confusion) and drug toxicity in older adults. Sulfonylureas (eg, glyburide) should be avoided due to potential delayed elimination causing risk for prolonged hypoglycemia.

Block Time Remaining: 00:09:55 TUTOR Test Id: 80931650 QId: 30896 (921666) 44 of 48 A A A A nurse is giving medications to a client who is being evaluated for a brain malignancy. The health care provider (HCP) has ordered a computed tomography (CT) scan with intravenous (IV) iodinated contrast for the next morning. Which medication should the nurse plan to withhold from this client? 1. Amlodipine [7%] 2. Gabapentin [8%] 3. Metformin [66%] 4. Phenytoin [16%] Omitted Correct answer 3 Answered correctly 66% Time: 1 seconds Updated: 05/28/2017 Explanation: IV iodinated contrast used for CT scan or cardiac catheterization can cause kidney injury (contrast-induced nephropathy). The side effect of metformin (Glucophage) is lactic acidosis. If the client takes metformin and develops kidney injury from contrast, then the lactic acidosis will worsen. As a result, most HCPs discontinue metformin on the day of IV iodine contrast exposure (regardless of baseline creatinine) and restart the drug at least 48 hours later, after stable renal function has been documented. (Options 1, 2, and 4) Amlodipine (Norvasc) is a calcium channel blocker commonly used to treat hypertension. Gabapentin (Neurontin) is commonly used for neuropathic pain. Phenytoin (Dilantin) is an antiseizure medication. None of these medications interact with the iodinated contrast or worsen kidney injury. Therefore, these can be safely administered. Educational objective: Iodinated contrast used for CT scan or cardiac catheterization can cause kidney injury. Metformin (Glucophage) can worsen lactic acidosis in the presence of kidney injury. Metformin should be withheld prior to the contrast exposure and can be resumed when kidney function is within normal limits.

Block Time Remaining: 00:09:57 TUTOR Test Id: 80931650 QId: 31984 (921666) 46 of 48 A A A 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 [18%] 2. Heart palpitations and weight gain [16%] 3. Loss of appetite and restlessness [51%] 4. Trouble sleeping and a dry cough [14%] Omitted Correct answer 3 Answered correctly 51% Time: 1 seconds Updated: 12/16/2016 Explanation: Stimulant medications are commonly used to treat ADHD in children and adults. Methylphenidate (Ritalin) and amphetamines (eg, dextroamphetamine, lisdexamfetamine) are the most commonly used stimulants. The major problems with stimulant medications include: Decreased appetite and weight loss - can lead to growth delays Cardiovascular effects - hypertension and tachycardia (particularly in adults) Appearance of new or exacerbation of vocal/motor tics Excess brain stimulation - restlessness, insomnia Abuse potential - misuse, diversion, addiction (Option 1) Growth delays are a common side effect. The medications may cause hypertension, not hypotension. (Option 2) Heart palpitations are a common side effect; weight loss, not weight gain, can be a problem. (Option 4) Trouble sleeping is a common side effect, but the medications do not cause a dry cough. Educational objective: Methylphenidate (Ritalin) is a central nervous system stimulant with the following potential side effects: anorexia and weight loss/growth delays, restlessness and insomnia, hypertension and tachycardia, vocal or motor tics, and abuse potential.

Block Time Remaining: 00:10:02 TUTOR A nurse is discontinuing patient-controlled analgesia per the health care provider's prescription and notes that there is 10 mL of morphine sulfate left in the syringe. No other nurse is available to witness the waste of the medication. What is the best action by the nurse? 1. Ask the unlicensed assistive personnel on the unit to waste the medication [1%] 2. Document that another nurse was not available to waste the medication [6%] 3. Wait until another nurse is available to witness the waste [90%] 4. Waste the medication and have another nurse sign off on it later [1%] Omitted Correct answer 3 Answered correctly 90% Time: 5 seconds Updated: 05/15/2017 Explanation: Opioids (eg, morphine, hydromorphone, fentanyl) are controlled medications, regulated in the United States by the Controlled Substances Act and in Canada by the Controlled Drugs and Substances Act. These laws contain regulations for various controlled substances. To properly dispose of leftover medication, the nurse must have a second licensed nurse witness the waste of the medication to comply with facility policy and procedure as well as government regulations. The nurse must wait for another nurse to become available to appropriately dispose of the medication (Option 3). (Option 1) Unlicensed assistive personnel (UAP) cannot witness a medication waste as 2 licensed nurses must document the waste. This is outside the scope of practice for UAP. (Option 2) The nurse cannot document that another nurse is unavailable as the waste of medication legally requires a second nurse witness. (Option 4) It is never appropriate to waste a controlled substance without the witness of another nurse. In addition, nurses should never document or sign off on anything that was not personally witnessed or completed as this constitutes falsified documentation. Educational objective: Waste of controlled substances must be witnessed by 2 nurses to comply with facility policy and government regulations.

A nurse has completed teaching a client who is being discharged on lithium for a bipolar disorder. Which statement by the client indicates a need for further teaching? 1. "I need to drink 1-2 liters of fluid daily." [8%] 2. "I need to have my blood levels checked periodically." [3%] 3. "I should not limit my sodium intake." [49%] 4. "I should use ibuprofen for pain relief." [39%] Correct answer 4 Explanation: Lithium is a mood stabilizer most often used to treat bipolar affective disorders. It has a very narrow therapeutic serum range of 0.6-1.2 mEq/L (0.6-1.2 mmol/L). Levels >1.5 mEq/L (1.5 mmol/L) are considered toxic. Lithium toxicity usually occurs with the following: Dehydration Decreased renal function (eg, elderly clients) Diet low in sodium Drug-drug interactions (nonsteroidal anti-inflammatory drugs [NSAIDs] and thiazide diuretics) Lithium is cleared renally. Even a mild change in kidney function (as seen in elderly clients) can cause serious lithium toxicity. Therefore, drugs that decrease renal blood flow (eg, NSAIDs) should be avoided. Acetaminophen would be a better choice for pain relief (Option 4). (Options 1 and 3) Sodium, water, and lithium are normally filtered by the kidneys. Restriction of dietary sodium/water or dehydration signals renal sodium and water reabsorption which will also increase lithium absorption, resulting in toxicity. Therefore, clients should never restrict their sodium or water intake while taking lithium; instead, they should maintain a consistent sodium intake. (Option 2) Blood should be drawn frequently to monitor for therapeutic lithium levels and toxicity. Educational objective: Dehydration, decreased renal function, diet low in sodium, and drug-drug interactions (eg, NSAIDs and thiazide diuretics) can cause lithium toxicity.

CARDIOVASCULAR PHARM <3 <3 <3 <3 <3

what does CVP tell RN:

CVP is a measurement of right ventricular preload (volume within the ventricle at the end of diastole) and reflects fluid volume problems.

The management of anaphylactic shock includes:

Call for help (activate emergency management systems) - first action Maintain airway and breathing - administer high-flow O2 via non-rebreather mask Epinephrine, intramuscular - the drug of choice and should be given next. Epinephrine stimulates both alpha- and beta-adrenergic receptors, dilates bronchial smooth muscle (beta 2), and provides vasoconstriction (alpha 1). The IM route is better than the subcutaneous route. The dose should be repeated every 5-15 minutes if there is no response. Elevate the legs Volume resuscitation with IV fluids Bronchodilator such as albuterol is administered to dilate the small airways and reverse bronchoconstriction Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction

Buerger's disease is a nonatherosclerotic vasculitis involving small to medium arteries and veins of the upper and lower extremities. Young male smokers are typically affected.

Clients should avoid exposure to cold weather and cease using tobacco and marijuana in all forms. Smoking cessation can be achieved with bupropion or varenicline but not with nicotine replacement products.

Educational objective: Constipation is an expected long-term side effect of opioid use; clients will not develop tolerance to this side effect. It is important to teach aggressive preventive measures (eg, defecate when the urge is felt, drink 2-3 L of fluid/day, high-fiber diet, exercise) and simultaneous use of a stool softener and a stimulant.

Clients will not develop tolerance to this side effect. Although clients with idiopathic chronic constipation are not commonly advised to take laxatives, opioid-induced constipation is treated with simultaneous use of senna (stimulant) and docusate (stool softener).

Apical heart rate is taken for a full minute prior to administration. It is safe to administer the drug when the apical heart rate is ≥60/min.

Digoxin

When administering IV vancomycin, the nurse should assess for and work to prevent possible complications by performing the following in detail:

Draw the prescribed trough level prior to administration. Therapeutic vancomycin levels range from 10-20 mg/L (6.9-13.8 µmol/L) for hemodynamically stable clients. Adverse effects of vancomycin toxicity include nephrotoxicity (eg, elevated creatinine levels) and ototoxicity (eg, hearing loss, vertigo, tinnitus). Monitor blood pressure during the infusion. Hypotension is a possible adverse effect Assess for hypersensitivity. Red man syndrome is a nonallergic histamine reaction characterized by sudden onset of severe hypotension, flushing, and/or maculopapular rash of the face, neck, chest, and upper extremities Monitor for anaphylaxis (eg, rash, pruritus, laryngeal edema, wheezing Observe IV site every 30 minutes for pain, redness, or swelling. Vancomycin is a vesicant and may cause thrombophlebitis or, if extravasation occurs, tissue necrosis. Administration using a central venous catheter is preferred; however, a peripheral IV may be used for short-term therapy

What objective assessment can be present in the client with PAD. It is a chronic condition of PAD and is not the priority assessment.

Dry, scaly skin

To ensure proper shoulder sling fit, the nurse should assess for the following:

Elbow is flexed at 90 degrees Hand is held slightly above the level of the elbow Bottom of the sling ends in the middle of the palm with the fingers visible Sling supports the wrist joint

Caution the use of Digoxin (Lanoxin) in elderly and diabetics b/c ?

Elderly clients tend to develop age-related decrease in glomerular filtration rate (GFR). These clients and those with obvious kidney injury (possibly due to diabetes in this client) can accumulate digoxin.

pericardial effusion LIFE THREATING TX:

Emergency pericardiocentesis

Women with myocardial ischemia and acute myocardial infarction (AMI) often have atypical pain and nonspecific symptoms. NI

Evaluation and treatment for a suspected AMI are critical as it can be life-threatening.

Common adverse effects of chemotherapy are bone marrow suppression (eg, anemia, leukopenia, thrombocytopenia) and immunosuppression.

Even a low-grade fever should be taken seriously in clients who are immunosuppressed or have neutropenia

A nurse has received new medication prescriptions for a client admitted with hypertension and an exacerbation of chronic obstructive pulmonary disease. Which prescription should the nurse question? 1. Amlodipine [12%] 2. Codeine [63%] 3. Ipratropium [13%] 4. Methylprednisolone [11%] Omitted Correct answer 2 Explanation: Codeine is a narcotic analgesic used for acute pain or as a cough suppressant. Depressing the cough reflex can cause an accumulation of secretions in the presence of chronic obstructive pulmonary disease (COPD), leading to respiratory difficulty. In general, sedatives (eg, narcotics, benzodiazepines) can also depress the respiratory center and effort; therefore, they should not be given to clients with respiratory diseases (eg, asthma, COPD). (Option 1) Calcium channel blockers (eg, amlodipine, nifedipine) are used to treat hypertension and do not worsen bronchoconstriction, unlike beta blockers (eg, metoprolol, atenolol). (Option 3) Ipratropium (Atrovent) is a short-acting inhaled anticholinergic often used in combination with a short-acting beta-agonist (eg, albuterol) to promote bronchodilation and reduce bronchospasm. (Option 4) Methylprednisolone (Solu-Medrol) is a systemic glucocorticoid that improves respiratory symptoms and overall lung function in clients experiencing an exacerbation of COPD. Educational objective: Codeine is a narcotic medication with antitussive properties that can cause an accumulation of secretions in clients with chronic obstructive pulmonary disease and lead to respiratory distress. Caution is advised when sedatives are prescribed for clients with respiratory diseases.

Exhibit A client with chronic kidney disease is admitted with pneumonia and pleurisy. The client's laboratory results are shown in the exhibit. Which prescription will the nurse question? Click on the exhibit button for additional information. 1. Acetaminophen 500 mg PO every 6 hours, as needed for fever [21%] 2. Epoetin alfa 15,000 units subcutaneus injection, once weekly [21%] 3. Ketorolac 15 mg IV every 6 hours, as needed for pain [29%] 4. Levofloxacin 500 mg IV, once daily [26%] Omitted Correct answer 3 Explanation: This client has chronic kidney disease with an elevated serum creatinine level. Ketorolac (Toradol) is a highly potent nonsteroidal anti-inflammatory drug (NSAID) often used for pain and available in intravenous form. However, NSAIDs (eg, indomethacin, ibuprofen, naproxen, ketorolac) are nephrotoxic and should be avoided in clients with kidney disease. Also, the client should not be given 2 types of NSAIDs simultaneously (eg, naproxen plus ibuprofen) as they can be toxic to the stomach and kidneys. (Option 1) Prescribing acetaminophen as needed is appropriate to treat fever. (Option 2) Clients with chronic kidney disease often have anemia due to erythropoietin deficiency. Recombinant erythropoietin injections are often prescribed to treat anemia. (Option 4) Levofloxacin is an appropriate antibiotic to use for treating pneumonia. Educational objective: Nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, indomethacin, ibuprofen, naproxen, ketorolac) are nephrotoxic and should be avoided in clients with kidney disease. In addition, clients taking a NSAID medication should not take a different NSAID medication at the same time. d.

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 most concern? 1. "I periodically take docusate sodium for constipation." [12%] 2. "I regularly take ibuprofen for chronic low back pain." [41%] 3. "I take hydrochlorothiazide to prevent swelling around my ankles." [29%] 4. "I take omeprazole daily to prevent heartburn." [17%] Omitted Correct answer 2 Explanation: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can cause cardiovascular side effects, including heart attack, stroke, high blood pressure, and heart failure from fluid retention. These drugs also decrease the effectiveness of diuretics and other blood pressure medications. The risks can be even higher in the client who already has cardiovascular disease or takes NSAIDs routinely or for a long time. In addition, long-term use of NSAIDs is associated with peptic ulcers and chronic kidney disease. These clients should use NSAIDs cautiously, at the lowest dose necessary and for a short time. The nurse should notify the health care provider that this client is routinely taking ibuprofen. (Option 1) Taking docusate sodium occasionally for constipation is appropriate. (Option 3) Hydrochlorothiazide is a weak diuretic and is commonly used to treat hypertension. (Option 4) Omeprazole for heartburn is appropriate for this client. Educational objective: NSAIDs may cause heart attack, stroke, high blood pressure, and possible heart failure after long-term use. NSAIDs decrease the effectiveness of diuretic and blood pressure medications. Long-term use is also associated with chronic kidney disease and peptic ulcers.

Exhibit 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. 1. Bleeding risk [76%] 2. Bronchospasm [13%] 3. Muscle injury [4%] 4. Tinnitus [5%] Omitted Correct answer 1 Explanation: This client is on 3 different medications that affect bleeding risk (aspirin, clopidogrel, and rivaroxaban); this drug combination places the client at increased risk for bleeding. Teaching the client about the signs and symptoms of bleeding and risk reduction is the highest priority. The nurse should instruct the client to monitor for black, tarry stools, bleeding gums, and excessive bruising. The client should also use a soft bristle toothbrush, shave with an electric razor, and refrain from playing contact sports. (Option 2) Bronchospasm rarely occurs with high doses of aspirin and metoprolol. This client is on low-dose aspirin and metoprolol. Although this should be a teaching topic for the client, bleeding is more likely to occur than this adverse reaction. (Option 3) Muscle cramps can be common with statins (eg, rosuvastatin, atorvastatin, simvastatin). However, muscle injury is rare and not as high in priority as bleeding risk. (Option 4) Tinnitus may occur with aspirin toxicity. However, this client is on baby aspirin (81 mg) and is very unlikely to experience adverse effects. Educational objective: Clients taking a combination of antiplatelet agents (eg, aspirin, clopidogrel, ticagrelor, prasugrel) and anticoagulants (eg, warfarin, rivaroxaban, apixaban) are at very high risk for life-threatening bleeding complications. The nurse should teach the client how to recognize and prevent signs and symptoms of increased bleeding.

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." [8%] 2. "I occasionally experience slight dizziness when I get up in the morning." [8%] 3. "I started taking licorice root for my occasional heartburn." [79%] 4. "I usually take my hydrochlorothiazide first thing in the morning." [2%] Correct answer 3 Explanation: Licorice root is an herbal remedy sometimes used for gastrointestinal disorders such as stomach ulcers, heartburn, colitis, and chronic gastritis. Clients with heart disease or hypertension should be cautious about using licorice root. When used in combination with a diuretic such as hydrochlorothiazide, it can increase potassium loss, leading to hypokalemia. Hypokalemia can cause dangerous cardiac dysrhythmias. Thiazide diuretics are considered "potassium-wasting" diuretics, so this client is already at risk for hypokalemia. The addition of licorice root could potentiate the potassium loss. The nurse should discourage the client from using this herbal remedy and report the client's use to the PHCP. (Option 1) Bananas are rich in potassium. Eating one each morning is beneficial. (Option 2) Diuretics and calcium channel blockers (eg, nifedipine, amlodipine, felodipine) commonly cause postural hypotension or dizziness on rising. The nurse should encourage the client to rise slowly and sit on the side of the bed for a few minutes before getting up. Persistent dizziness should be reported to the PHCP. (Option 4) Diuretics should be taken in the morning as nighttime dosing will cause nocturia and interrupted sleep. Educational objective: The nurse should discourage the client from using the herbal remedy licorice root when taking thiazide diuretics. Licorice root can potentiate potassium loss and increase the client's risk for hypokalemia. Use of licorice root should be reported to the PCHP.

Exhibit 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. 1. Albuterol inhaler 2. Diltiazem extended-release PO 3. Heparin subcutaneous injection 4. Lisinopril PO 5. Metoprolol PO 6. Timolol eye drops Correct answer 1,3,4 Explanation: Clients with atrial fibrillation can have either bradycardia (slow ventricular response) or tachycardia (rapid ventricular response). This client's vital signs are significant for bradycardia (heart rate <60/min). Therefore, the medications that can decrease heart rate should be held and the health care provider (HCP) should be notified. The reason for holding the medication (heart rate 46/min) and an HCP contact note should be documented. Albuterol, a short-acting beta-adrenergic inhaler to control asthma, can increase the heart rate and is a safe choice (Option 1). Heparin is an anticoagulant; the subcutaneous injection is most commonly used to prevent deep venous thrombosis in hospitalized clients on bed rest. This medication will not affect the vital signs and so is also safe to administer (Option 3). Lisinopril, an ACE inhibitor, does not lower the heart rate and is not contraindicated in clients with bradycardia (Option 4). This client's blood pressure is considered normal and lisinopril is safe to administer. Withholding this medication could cause rebound hypertension. (Option 2) Diltiazem is a calcium channel blocker that can decrease the heart rate and so should be held. Verapamil, another calcium channel blocker, can also cause bradycardia. (Options 5 and 6) This client is on 2 beta blockers, oral metoprolol and timolol eye drops that can be absorbed systemically. All beta blockers can further decrease the heart rate and should be held untilBlock Time Remaining: 00:00:29 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. 1. Albuterol inhaler 2. Diltiazem extended-release PO 3. Heparin subcutaneous injection 4. Lisinopril PO 5. Metoprolol PO 6. Timolol eye drops Correct answer 1,3,4 Explanation: Clients with atrial fibrillation can have either bradycardia (slow ventricular response) or tachycardia (rapid ventricular response). This client's vital signs are significant for bradycardia (heart rate <60/min). Therefore, the medications that can decrease heart rate should be held and the health care provider (HCP) should be notified. The reason for holding the medication (heart rate 46/min) and an HCP contact note should be documented. Albuterol, a short-acting beta-adrenergic inhaler to control asthma, can increase the heart rate and is a safe choice (Option 1). Heparin is an anticoagulant; the subcutaneous injection is most commonly used to prevent deep venous thrombosis in hospitalized clients on bed rest. This medication will not affect the vital signs and so is also safe to administer (Option 3). Lisinopril, an ACE inhibitor, does not lower the heart rate and is not contraindicated in clients with bradycardia (Option 4). This client's blood pressure is considered normal and lisinopril is safe to administer. Withholding this medication could cause rebound hypertension. (Option 2) Diltiazem is a calcium channel blocker that can decrease the heart rate and so should be held. Verapamil, another calcium channel blocker, can also cause bradycardia. (Options 5 and 6) This client is on 2 beta blockers, oral metoprolol and timolol eye drops that can be absorbed systemically. All beta blockers can further decrease the heart rate and should be held until the prescriptions can be clarified by the HCP. Educational objective: Medications that decrease the heart rate should be held in clients with bradycardia. These include beta blockers such as metoprolol (including eye drops) and some types of calcium channel blockers (eg, diltiazem, verapamil). the prescriptions can be clarified by the HCP. Educational objective: Medications that decrease the heart rate should be held in clients with bradycardia. These include beta blockers such as metoprolol (including eye drops) and some types of calcium channel blockers (eg, diltiazem, verapamil).

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." [4%] 2. "If I have chest pain, I can take up to 3 pills 5 minutes apart." [5%] 3. "I'll call my doctor if I start having chest pain at night." [26%] 4. "I'll keep one bottle in the house and one in the car." [62%] Omitted Correct answer 4 Explanation: NTG is a vasodilator used to treat stable angina. It is a sublingual tablet or spray that is placed under the client's tongue. It usually relieves pain in about 3 minutes and lasts 30-40 minutes. The recommended dose is 1 tablet or 1 spray taken sublingually for angina every 5 minutes for a maximum of 3 doses (Option 2). If symptoms are unchanged or worse 5 minutes after the first dose, emergency medical services (EMS) should be contacted (Option 1). Previously, clients were taught to call EMS after the third dose was taken, but newer studies suggest that this leads to a significant delay in treatment. The NTG should be easily accessible at all times. Tablets are packaged in a light-resistant bottle with a metal cap. They should be stored away from light and heat sources, including body heat, to protect from degradation. Clients should be instructed to keep the tablets in the original container. Once opened, the tablets lose potency and should be replaced every 6 months. The car is not a good place to store NTG due to heat (Option 4). (Option 3) Waking up at night with chest pain can signify that angina is occurring at rest and is no longer considered stable angina. This should be reported to the health care provider. Educational objective: Education about sublingual NTG should include placing the tablet or spray under the tongue; repeating the dose every 5 minutes, with up to 3 total doses if angina is not relieved; notifying EMS if the first dose does not improve the symptoms; keeping the tablets in the original container away from light and heat; and replacing the bottle every 6 months once opened.

Exhibit 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. 1. Complete blood count 2. Digoxin level 3. Glucose 4. International Normalized Ratio 5. Serum potassium Omitted Correct answer 1,2,3,5 Explanation: The complete blood count (CBC) should be assessed periodically with the administration of enoxaparin, an anticoagulant. The nurse would want to assess the hemoglobin, hematocrit, and platelet count levels. If these levels are low, the client will be at risk for increased bleeding. Digoxin levels are not often prescribed unless there is suspicion of digoxin toxicity. However, if this value is available, the nurse should assess it. Digoxin toxicity can be seen with levels >2 ng/mL. Potassium levels should also be monitored in the client receiving digoxin. Hypokalemia can potentiate digoxin toxicity. Prednisone is a glucocorticoid that can increase glucose levels. Glucose levels should be monitored periodically for clients receiving this medication. (Option 4) Low-molecular-weight heparins, such as enoxaparin, produce a stable response at recommended dosages and negate the need for frequent monitoring of activated partial thromboplastin time (aPTT) or International Normalized Ratio (INR) levels. aPTT is monitored when administering unfractionated heparin. INR is monitored if the client is receiving warfarin. Educational objective: The nurse should routinely monitor laboratory values prior to administering medications. A CBC should be assessed periodically in the client receiving enoxaparin. Digoxin and potassium levels should be assessed with the administration of digoxin. Glucose levels should be monitored in the client receiving glucocorticoids.

A client calls the nurse to report exacerbation of chronic lower back pain after working in the yard all weekend. Knowing that this worsened back pain is probably due to acute inflammation, the nurse recommends which nonpharmacologic intervention? 1. Heating pad [46%] 2. Positioning for comfort [7%] 3. Rest from pain-aggravating activities [39%] 4. Stretching exercises [6%] Omitted Correct answer 3 Answered correctly 39% Time: 3 seconds Updated: 05/25/2017 Explanation: Acute exacerbation of chronic back pain is usually associated with inflammation triggered by (strenuous and/or repetitive) activities that stress the previously injured area. Interventions should be directed toward reducing inflammation. Nonpharmacologic intervention to treat the inflammation includes rest from pain-aggravating activities which may continue to promote inflammation and delay healing. (Option 1) Applying heat to the injured area can promote the inflammatory process (via vasodilation); therefore, this is not the best intervention at this time. However, after the acute inflammation has resolved (usually within a few days) heat application would be appropriate to reduce pain and muscle spasms. (Option 2) Although the nurse should teach the client to ensure positioning for comfort to reduce pain, this is less likely to impact the inflammatory processes causing the pain. (Option 4) Stretching exercises can also be helpful for back pain but should begin after the acute pain and inflammation have subsided. Educational objective: Rest from activities that aggravate pain and inflammation is a nonpharmacologic comfort intervention to decrease the inflammation due to acute pain.

FUNDAMENTALS SECTION-----------------

The nurse should closely monitor the medication administration record of clients receiving acetaminophen to ensure that the total 24-hour dose from all sources does not exceed 4 g. Why?

Hepatotoxicity may develop with >4 g/day.

can occur in clients with a history of chickenpox (varicella-zoster virus exposure). The vesicular rash has a characteristic, linear dermatomal distribution and can present with severe pain. Vaccination prevents shingles.

Herpes zoster (shingles) CDC& Prevention recommends shingle vaccine for use in people 60 years old and older to prevent shingles

The incidence of cervical cancer is higher among

Hispanics, American Indians, and African Americans. The mortality rate for cervical cancer among African American women is twice as high as that for white American women

is a malignant cancer of the lymphatic system? Expected Early S/S

Hodgkin lymphoma S/S: include painless enlarged lymph nodes, fatigue, fever, weight loss, and drenching night sweats.

The major side effects of thiazide diuretics include:

Hypokalemia (manifests as muscle cramps) Hyponatremia (manifests as altered mental status and seizures) Hyperuricemia (may worsen gout attacks) Hyperglycemia (requires adjustment of diabetic medications) Of the above side effects, hypokalemia is the most serious as it can lead to life-threatening cardiac arrhythmias.

Signs and symptoms of cardiac tamponade include:

Hypotension with narrowed pulse pressure (Option 1) Muffled or distant heart tones (Option 4) Jugular venous distension (Option 5) Pulsus paradoxus Dyspnea, tachypnea Tachycardia

can be the presenting feature of sepsis in elderly clients.

Hypothermia

Clients with advanced heart failure often have low cardiac output with resultant low blood pressure but remain asymptomatic. WHAT MEDS WILL RN CAUTION:

IV diuretics can worsen the hypotension.

TX for KD

IV immunoglobulin and aspirin to prevent coronary artery aneurysms.

Cold and clammy skin indicates that the sympathetic nervous system compensatory mechanism is failing and may mark the progression from the compensatory (II) to the progressive (III) stage of shock.

Immediate intervention is necessary to prevent further progression and is the most important finding for the nurse to report.

RN must consider what when initiating IV therapy and caring for an older adult receiving IV therapy?

Important considerations include the following: -The age-related cardiovascular and renal function changes that can occur in the elderly, such as a mild increase in the size and thickness of the heart, prolonged filling time, and declined glomerular filtration rate, may put the client at risk for rapid development of hypervolemia. Use of an infusion pump is recommended, even in clients with dementia, as they are at increased risk for fluid imbalance Older adults with fragile veins are at increased risk for IV infiltration; therefore, the site should be monitored carefully by the nurse every 1-2 hours. Fragile skin may tear easily; use nonporous tape, skin protectant solutions, and minimal tourniquet pressure. Because hearing and visual impairments may pose a problem for client education, the nurse should speak clearly and face the client when speaking. Use the smallest gauge catheter (24-26 gauge) indicated for the client's therapy as veins are more fragile. Consider vein sites to promote client independence (non-dominant arm, avoiding back of the hand). Use a 5-15-degree angle on insertion as veins of the elderly are usually more superficial

A client is being discharged after having a coronary artery bypass grafting (CABG) x 5. The client asks questions about the care of chest and leg incisions. Which instructions should the registered nurse include

Incisions may take 4-6 weeks to heal. The nurse should instruct clients on how to care for their incisions; these instructions are as follows: Wash incisions daily with soap and water in the shower. Gently pat dry Itching, tingling, and numbness around the incisions may be present for several weeks due to damage to the local nerves Tub baths should be avoided due to risk of introducing infection Do not apply powders or lotions on incisions as these trap the bacteria at the incision Report any redness, swelling, and increase in drainage or if the incision has opened Wear a supportive elastic hose on the legs. Elevate legs when sitting to decrease swelling

Epistaxis tx:

Initial management of epistaxis includes tilting the client's head forward; applying direct, continuous pressure to the nose for 5-10 minutes; and holding a cold cloth to the nasal bridge.

Donepezil (Aricept) is an acetylcholinesterase inhibitor used to treat Alzheimer dementia.

It does not place the elderly at increased risk of adverse effects.

Intractable dry cough is a common side effect of ACE inhibitors.

It is thought to be related to the accumulations of kinins (bradykinin).

Culturally competent nursing care involves recognizing certain cultural and religious beliefs. A health-related belief of Jehovah's Witnesses is that transfusions containing blood in any form are not acceptable. Witnesses do not accept transfusions of whole blood or any of its 4 major components (ie, red cells, white cells, platelets, and plasma) Shock prevention is a major concern in the setting of blood loss and can be accomplished with the use of non-blood volume expanders such as saline, lactated Ringer's, dextran, and hetastarch. These can be administered safely to clients who refuse blood products Recombinant human erythropoietin (eg, epoetin alfa) and IV iron are accepted by most Jehovah's Witnesses. These medications stimulate the bone marrow to produce more red blood cells, resulting in increased hematocrit and hemoglobin levels

Jehovah's Witnesses will not take any 4 components of blood = RBC WBC Platlets Plasma.

The nurse should teach the client receiving warfarin therapy to be consistent with intake of foods high in vitamin K. Clients do not need to restrict vitamin K-rich foods completely. are the most important to teach.

Leafy green vegetables and grapefruit juice

cardiac shunts (eg, patent ductus arteriosus, atrial septal defect, ventricular septal defect) result in excess blood flow to the lungs. Manifestations include heart murmur, poor weight gain, diaphoresis with exertion, and signs of heart failure

Left-to-right

TB, regardless of location, commonly presents with constitutional symptoms, including:

Low-grade fever Night sweats Anorexia and weight loss Fatigue

A client with heart failure is prescribed a continuous IV infusion of dobutamine at 10 mcg/kg/min. He weighs 70 kg. The concentration of dobutamine is 250 mg in 500 mL D5W. For how many milliliters per hour should the nurse program the IV pump? Record your answer as a whole number. Answer: (mL/hr) Correct answer 84 Answered correctly Explanation: Dobutamine hydrochloride (Dobutrex) is a positive inotropic drug that increases cardiac muscle contractility. The dosage is weight-based and is prescribed in micrograms per kilogram per minute (mcg/kg/min) and administered with an IV pump. Because IV pumps are set by milliliters per hour (mL/hr), the nurse must be able to calculate the drug dose and the infusion rate in mL/hr. Dobutrex can be diluted in dextrose or normal saline, and concentrations usually range from 500-2,000 micrograms per milliliter (mcg/mL) depending on client status. This medication may be administered in acute or long-term facilities or in the home. It is most often administered in the emergency department, intensive care unit, and step-down units. The nurse must always follow institution policy and procedure in relation to its dilution, dosage, administration, and titration. The Joint Commission and Institute for Safe Medical Practices discourage the use of abbreviations for medication prescriptions and dosage calculations. They are used here to conserve space. Convert mg to micrograms: 250 mg = 250,000 mcg Calculate concentration: 250,000 mcg = 500 mcg/mL 500 mL Calculate weight-based dose: 10 mcg x 70 kg/min = 700 mcg/min Calculate the dose (10 mcg/kg/min) in mcg/mL: 500 mcg = 700 mcg = 1.4 mL/min 1 mL X mL Calculate how many milliliters are to be infused over one hour: 1.4 mL x 60 minutes = 84 mL/h Set the pump at 84 mL/h The following formula may also be used to calculate the pump setting in mL/hr if a given dose is prescribed: _______ mcg/kg/min x________ kg x 60 min/h ÷ ___________ mcg/mL = ____________mL/h dosage client weight concentration pump setting 10 mcg/kg/min x 70 kg x 60 min = 84 mL/h 500 mcg/mL Educational objective: The nurse must be able to calculate weight-based titrated drug dosages and flow rates accurately because the administration of an incorrect dose or infusion rate can be life-threatening.

MATH

A continuous regular insulin IV infusion of 0.2 units/kg/hr is prescribed for a 10-year-old weighing 48 lb with new-onset diabetes mellitus. How many units would the nurse administer to this client per hour? Record your answer using one decimal place. Answer: 1 (units/hr) Incorrect Correct answer 4.4 Answered correctly 70% Time: 4 seconds Updated: 02/15/2017 Explanation: It is critical for the nurse to calculate insulin correctly due to its being a high-risk medication (eg, can cause severe hypoglycemia). Step 1: Convert weight from pounds to kilograms: 2.2 lb = 1 kg Child weighs 48 lb; divide 48 lb by 2.2 = 21.8182 kg Step 2: Calculate amount of medication needed: 0.2 units/kg/hr Child weighs 21.8182 kg; multiply 21.8182 kg by 0.2 units/hr = 4.3636 units/hr Then, round this answer to the nearest tenth to get 4.4 units/hr. Educational objective: Insulin is a high-risk medication (eg, can cause severe hypoglycemia), and exact dosages are critical. To calculate a weight-based insulin infusion rate, the nurse should first convert the client's weight from pounds to kilograms. Next, the nurse should multiply the weight in kilograms by the amount of insulin prescribed per kilogram.

MATH

An IV infusion of norepinephrine at 8 mcg/min is prescribed for a client in shock. The concentration of norepinephrine is 4 mg in 250 mL D5W. For how many mL per hour should the nurse program the IV pump? Record your answer using a whole number. Answer: 1 (mL/hr) Incorrect Correct answer 30 Answered correctly 56% Time: 5 seconds Updated: 03/17/2017 Explanation: Many IV drugs for critically ill clients are prescribed using units per hour, micrograms per minute (mcg/min), milligrams per minute (mg/min), and micrograms per kilogram per minute (mcg/kg/min). Intravenous pumps are set by milliliters per hour (mL/hr). As a result, the nurse must be able to calculate the drug dose and infusion rate in mL/hr. Due to the potency of these drugs and the hemodynamic instability of critically ill clients, it is imperative that the nurse be able to calculate the appropriate dosages and infusion rates. Convert the prescribed dose to milligrams: 1000 mcg = 1 mg 8 mcg/min × 1 mg/1000 mcg = 0.008 mg/min Convert the prescribed dose from milligrams to milliliters: Norepinephrine concentration is 4 mg per 250 mL 0.008 mg/min × 250 mL/4 mg = 0.5 mL/min Convert the time from minutes to hours: 60 min = 1 hour 0.5 mL/min x 60 min/hr = 30 mL/hr As an alternative, the following formula can be used to calculate pump setting in mL/hr if a given dose is prescribed: Dosage (mg/min) × 60 min/hr ÷ concentration (mg/mL) = pump setting (mL/hr) Concentration = 4 mg/250 mL= 0.016 mg/mL 0.008 mg/min × 60 min/hr ÷ 0.016 mg/mL = 30 mL/hr Educational objective: The nurse must be able to accurately calculate titrated medication drug dosages and flow rates as administration of an incorrect dose or infusion rate can be catastrophic.

MATH

The health care provider prescribes a continuous IV insulin infusion for a client. The insulin drip is initiated with 50 units of regular insulin in 100 mL of normal saline solution at 5 units/hr. At what rate in milliliters per hour does the nurse set the IV pump? Record your answer using a whole number. Answer: Correct answer 10 Answered correctly 65% Time: 47 seconds Updated: 01/16/2017 Explanation: The steps below should be performed to calculate the infusion pump rate in milliliters per hour: Calculate the concentration of the insulin solution: 50 units ÷ 100 mL = 0.5 units/mL Calculate the dose in mL/hr: Desired x Quantity method Available 5 units x 1 mL = 10 mL/hr 0.5 units OR Ratio/proportion method 0.5 units = 5 units 1 mL X mL 0.5X = 5 X = 10 = 10 mL/hr Educational objective: To set the IV pump in mL/hr for a prescribed dose of insulin in units/hr, the nurse first calculates the concentration of the insulin infusion, and then calculates the dose in mL/hr.

MATH

The health care provider prescribes a therapeutic heparin protocol for a client who weighs 198 lb and has a pulmonary embolus. The nurse initiates the infusion with 25,000 units of heparin in 500 mL dextrose 5% in water at 18 units/kg/hr. At what rate per hour does the nurse set the intravenous (IV) pump? Record your answer as a whole number. Answer: Correct answer 32 Explanation: Convert pounds to kilograms: 198 ÷ 2.2 = 90 kg Calculate concentration of heparin solution: 25,000 units ÷ 500 mL = 50/mL Calculate dose in units/hour: 18 units X 90 kg = 1620 units/hr Calculate dose in mL/hour: 1620 units X 1 mL = 32.4 mL/hr 50 Units or X mL = 1620 units 1 mL 50 units 50 X = 1620 X = 32.4 = 32 mL/hr Educational objective: To set the IV pump in milliliters per hour, the nurse calculates the amount of heparin to be administered by converting the client's weight in pounds to kilograms, calculates concentration of the heparin infusion, calculates total dose in units per kilograms per hour, and calculates the dose in milliliters per hour.

MATH

The nurse is preparing to administer an antibiotic to a child with a severe respiratory infection. The prescription reads: 7.5 mg/kg every 24 hours divided into 2 doses, to be given by mouth in liquid form. Recommended dosage is 250-500 mg every 24 hours. The client weighs 78 lb. The pharmacy has supplied the drug in 125 mg/5 mL. How many mL should the client receive for each dose? Record your answer using one decimal place. Correct answer 5.3 Explanation: 1. Calculate weight in kg 78 lb ÷ 2.2 = 35.4545 kg 2. Calculate the total dose in mg the client should receive in 24 hr 35.4545 kg x 7.5 mg/kg = 265.9088 mg 3. Determine if the ordered dosage is safe 265.9088 mg falls in the safe range of 250-500 mg/24 hr 4. Calculate the 2 individual dosages to be given in a 24-hr period 265.9088 mg ÷ 2 doses = 132.9544 mg 5. Calculate the amount of medication the client will receive in mL for each dose 132.9544 mg x 5 mL ÷ 125 mg = 5.3182 mL (round down 5.3 mL) Educational objective: Correct dosage calculations are very important for all age groups. However, due to lower body weight and immaturity of body systems, an incorrect drug calculation could be more harmful in a child than in an older person.

MATH

he steps below should be used to calculate the amount of cefuroxime that needs to be administered per dose: 1. Convert pounds to kilograms (1 kg = 2.2 lb) 32 lb ÷ 2.2 lb = 14.545454 kg 2. Calculate prescribed amount per day in milligrams 30 mg/kg x 14.545454 kg = 436.36362 mg 3. Calculate prescribed amount per dose in milligrams 436.36362 mg ÷ 2 daily doses = 218.1818 mg 4. Convert prescribed dose from milligrams to milliliters: Desired x Quantity Available OR Ratio/proportion 218.1818 mg x 5 mL ÷ 250 mg = 4.3636 mL 250 mg ÷ 5 mL = 218.1818 mg ÷ X mL X = 4.3636 mL 5. Round answer based on directions Rounding rules are applied after all calculations have been made. 4.3636 mL recorded using one decimal place is 4.4 mL.

MATH To calculate pediatric doses that are prescribed in mg/kg/day format, the nurse should convert pounds to kilograms, calculate the prescribed amount per day in milligrams, calculate the prescribed dose in milligrams, and then convert the prescribed dose from milligrams to milliliters.

*******The same frameworks that guide nurses to prioritize nursing care can guide them to prioritize returning client phone calls as well. These include (in order)********

Maslow's hierarchy of needs; and airway, breathing, cardiac status, circulation, and vital signs (ABC plus V).

Is KD contagious?

NO

Is giving a pt during A-fib Anticoagulants a priority?

NO, You want to slow the heart rate down 1st. Then anticoagulants will be given .

What meds can cause urinary retention; by increasing the bladder sphincter tone and/or relax bladder muscle. What is RN NI?

Opioids (eg, morphine sulfate), anticholinergic medications, and tricyclic antidepressants The nurse should assess the client's suprapubic area to determine if the client has urinary retention. If the area is distended and dull to percussion, the nurse should proceed with interventions.

The fungus causes pearly, "milk-curd" lesions on the oral or laryngeal mucosa that may bleed when removed.

Oropharyngeal candidiasis, or thrush (moniliasis), is an infection of the mucous membranes generally caused by the yeastlike fungus Candida albicans

While preparing to insert a peripheral IV line, the nurse notices scarring near the client's left axilla. The client confirms a history of left breast cancer and modified radical mastectomy. Which actions should the nurse take? Select all that apply. 1. Advance the entire stylet into the vein upon venipuncture 2. Insert the IV line into the most distal site of the right arm 3. Place an appropriate precaution sign above the bed 4. Review the medical record for history of mastectomy 5. Teach the client to keep the left arm in a dependent position Incorrect Correct answer 2,3,4 Answered correctly 33% Time: 52 seconds Updated: 01/17/2017 Explanation: A modified radical mastectomy includes removal of axillary lymph nodes that are involved in lymphatic drainage of the arm. Any trauma (eg, IV extravasation) to the arm on the operative side can result in lymphedema, characterized by painful and lengthy swelling, as normal lymphatic circulation is impaired by scarring. Therefore, starting an IV line in this arm is contraindicated. The nurse should insert the IV line into the most distal site of the unaffected side (Option 2). For client safety, it is also important to ensure documentation of the mastectomy history, place a restricted extremity armband on the affected arm, and place a sign above the client's bed notifying hospital staff of necessary mastectomy precautions (eg, no blood pressure measurements, venipuncture, or IV lines) (Options 3 and 4). In general, venipuncture is contraindicated in upper extremities affected by: Weakness Paralysis Infection Arteriovenous fistula or graft (used for hemodialysis) Impaired lymphatic drainage (prior mastectomy) (Option 1) The stylet should be advanced until blood return is seen (approximately ¼ inch). If advanced fully, the stylet may penetrate the posterior wall of the vein and cause a hematoma. (Option 5) Keeping the affected arm in a dependent position for a long time can increase lymphedema. The client should be reminded that raising the limb helps drainage. Educational objective: IV line insertion is contraindicated on the operative side of clients with a prior mastectomy. Additional contraindications for IV line insertion include weakness, paralysis, or infection of the arm; or presence of an arteriovenous fistula.

PERIPHERAL KNOWLEDGE

EMERGENCY that can result in permanent erectile dysfunction; it requires urgent treatment in the emergency department.

PRIAPISM >2HRS

Adenosine is the drug of choice for PSVT treatment.

PSVT treatment

Clients with chronic obstructive pulmonary disease typically have elevated

PaCO2 levels secondary to air trapping.

loud, machine-like systolic and diastolic murmur heard on a premature newborn with

Patent ductus arteriosus (PDA) acyanotic congenital defect more common in premature infants

The condition is usually idiopathic, secondary to prescription medications (eg, sildenafil, trazodone) or a preexisting medical condition (eg, sickle cell disease, cocaine use).

Priapism

Pt With active DVT is a HIGH

Priority

When cleaning a trach, When will RN put on sterile gloves?

Remove soiled dressing and also remove clean gloves.

RN T= treatment is aimed at managing complications in Scleroderma

Renal crisis is a life-threatening complication that causes malignant hypertension due to narrowing of the vessels that provide blood to the kidneys. Early recognition and treatment of renal crisis is needed to prevent acute organ failure. Even with treatment, this can be fatal.

Block Time Remaining: 00:00:24 TUTOR Test Id: 80620147 QId: 30907 (921666) 1 of 75 A A A The nurse is assessing a client's peripheral pulses. The nurse palpates the top portion of the client's foot. The right pulse is easily palpable, and the left pulse is diminished but still palpable. How should the nurse document these findings? 1. Bilateral dorsalis pedis (DP) pulses palpable. Right DP 2+, left DP 1+. [76%] 2. Bilateral DP pulses palpable. Right DP 3+, left DP 2+. [14%] 3. Bilateral popliteal pulses palpable. Right foot > left foot. [4%] 4. Bilateral posterior tibial (PT) pulses palpable. Right PT 2+, left PT 1+. [4%] Correct Answered correctly 76% Time: 24 seconds Updated: 03/16/2017 Explanation: The DP pulse is located on the top or dorsal part of the foot. The nurse should compare the characteristics of the arteries on the right and left extremities simultaneously to determine symmetry. The force of the pulse should be rated on the following scale. 0 Absent 1+ Weak 2+ Normal 3+ Increased, full, bounding (Option 2) DP is the correct artery being assessed, but 3+ would indicate a full, bounding pulse and 2+ would indicate a normal pulse. (Option 3) The popliteal pulse is assessed just behind the knee area, not on the foot. The description of the right foot being greater than the left foot does not indicate the force of the individual pulse. (Option 4) Posterior tibial pulses are palpated just behind the medial malleolus bone on the foot. The description of 2+ and 1+ is accurate. Educational objective: The nurse should palpate and compare the characteristic and quality of the pulses on the right and left extremities simultaneously to determine symmetry. The force of the pulse should be rated as 0, absent; 1+, weak; 2+, normal; and 3+, increased, full, bounding. These descriptions should be documented in the client's record.

SKILLS !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

an overproduction of collagen that causes tightening and hardening of the skin and connective tissue.

Scleroderma This is a progressive disease without a cure

What to meds cannot be given together b/c Risk for serotonin syndrome.

Selective serotonin reuptake inhibitors (SSRIs) (eg, escitalopram) cannot be combined with monoamine oxidase inhibitors (MAOIs) (eg, phenelzine)

a medical emergency requiring immediate, specialized examination to identify and treat any physical injuries and emotional trauma. Delaying a medical-forensic examination can interfere with evidence retrieval and preservation.

Sexual assault

When ascending stairs with a cane, the client should:

Step up with the stronger leg first Move the cane next while bearing weight on the stronger leg Finally, move the weaker leg

In IE, the vegetations over the valves can break off and embolize to various organs, resulting in life-threatening complications. These include the following:

Stroke - paralysis on one side Spinal cord ischemia - paralysis of both legs Ischemia to the extremities - pain, pallor, and cold foot or arm Intestinal infarction - abdominal pain Splenic infarction - left upper-quadrant pain

regular, narrow QRS complex tachycardia with a rate of around 150-220/min. The best treatment is vagal maneuvers and adenosine IV push

Supraventricular tachycardia

What is associated with hypervolemia and dilutional hyponatremia and the rn will tx: Fluid restriction and hypertonic IV solutions (eg, 3% saline) are prescribed to correct hyponatremia.

Syndrome of inappropriate antidiuretic hormone secretion

A PT is exhibiting signs and symptoms (narrowed pulse pressure, hypotension, and jugular venous distension) of developing cardiac tamponade, WHAT WILL RN DO?

THIS IS a LIFE THREATENING complication of pericardial effusion. fluid builds up in the pericardial sac and compresses the heart. The heart is unable to contract effectively against the fluid, and cardiac output can drop drastically. Other important manifestations of tamponade include muffled or distant heart tones, pulsus paradoxus, dyspnea, tachypnea, and tachycardia.

TRUE OR FALSE The mortality rate for hypertension among African American women is higher than that for white American women

TRUE African Americans have the highest incidence of hypertension in the world, and this condition is more prevalent among the women than men in this ethnic group.

TRUE OR FALSE Melanoma of the skin is more common in people who are of white ancestry, light-skinned, and over age 60 with frequent sun exposure.

TRUE The incidence of melanoma is 10 times higher in white Americans than African Americans.

Left-to-right shunting results in pulmonary congestion, causing increased work of breathing and decreased lung compliance. Compensatory mechanisms (eg, tachycardia, diaphoresis) result from sympathetic stimulation. Clinical manifestations of acyanotic defects may include

Tachypnea Tachycardia, even at rest Diaphoresis during feeding or exertion Heart murmur or extra heart sounds Signs of congestive heart failure Increased metabolic rate with poor weight gain

SAFETY: Teach pt. at risk for developing orthostatic hypotension to:

Take medications at bedtime, if approved by the health care provider Rise slowly from a supine to standing position, in stages (especially in the morning) Avoid activities that reduce venous return and worsen orthostatic hypotension (eg, straining, coughing, walking in hot weather) Maintain adequate hydration

During assessment, the nurse notes bubbling in the suction control chamber. Which nursing action is appropriate?

Take no action the chest tube is functioning properly.

Systemic inflammatory response syndrome Finding Value

Temperature >100.4 °F or <96.8 °F Heart rate >90/min Respiratory rate >20/min or PaCO2<32 mmHg (4.3 kPa) WBC <4000/mm³, >12x109/L (>12,000/mm³), or 10% ban

Inducing therapeutic hypothermia What is the process ?

The client is cooled to 89.6-93.2 F (32-34 C) for 24 hours before rewarming. Cooling is accomplished by cooling blankets; ice placed in the groin, axillae, and sides of the neck; and cold IV fluids. The nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, blood pressure (mean arterial pressure to be kept >80 mm Hg), and skin for thermal injury. The nurse must also apply neuroprotective strategies such as keeping the head of the bed elevated to 30 degrees. After 24 hours, the client is slowly rewarmed. generally kept NPO during therapeutic hypothermia and rewarming

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 Omitted Correct answer 1,4,5 Explanation: Iron is absorbed better on an empty stomach; ascorbic acid (vitamin C), such as found in citrus fruits and juices, increases the absorption of iron. However, milk products decrease iron absorption and should be avoided (Option 1). Metronidazole (Flagyl) is used to treat trichomoniasis and amebiasis. Consuming alcohol while taking the medication may elicit a disulfiram (Antabuse)-like reaction. Alcohol should be avoided for at least 48 hours after treatment is completed (Option 4). Many antihistamines also have anticholinergic effects. Anticholinergics have an antimuscarinic effect that can increase intraocular pressure and are therefore contraindicated in closed-angle glaucoma. Other contraindications include urinary retention (benign prostatic hyperplasia) and bowel obstruction related to the anticholinergic drug's effect on the smooth muscle in the urinary and gastrointestinal tract (Option 5). (Option 2) Enteral nutrition decreases levothyroxine absorption; as a result, it should be taken early in the morning on an empty stomach (at least 30 minutes before food intake). (Option 3) Phenazopyridine (Pyridium) is used as a local anesthetic in the treatment of urinary tract infection. The azo dye turns the urine an orange-red color. The client needs to be reassured that this is an expected result and could stain clothing. Educational objective: Clients taking metronidazole (Flagyl) should avoid alcohol. Those with glaucoma or urinary retention should avoid anticholinergic drugs. Oral iron is better absorbed on an empty stomach and with vitamin C. Phenazopyridine (Pyridium) will turn urine an orange-red color.

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 Omitted Correct answer 1,3,4 Explanation: Isoniazid (INH) is a first-line antitubercular drug prescribed as monotherapy to treat latent tuberculosis infection. Combined with other drugs, INH is also used for active tuberculosis treatment. Two serious adverse effects of INH use are hepatotoxicity and peripheral neuropathy. A teaching plan for a client prescribed INH includes the following: Avoid intake of alcohol and limit use of other hepatotoxic agents (eg, acetaminophen) to reduce risk of hepatotoxicity (Option 1) Take pyridoxine (vitamin B6) if prescribed to prevent neuropathy Avoid aluminum-containing antacids (eg, aluminum hydroxide (Maalox)) within 1 hour of taking INH Report changes in vision (eg, blurred vision, vision loss) Report signs/symptoms of severe adverse effects such as: Hepatoxicity (eg, scleral and skin jaundice, vomiting, dark urine, fatigue) (Option 3) Peripheral neuropathy (eg, numbness, tingling of extremities) (Options 4) (Option 2) Rifampin, another antitubercular drug, often causes a red-orange discoloration of body fluids (ie, urine, sweat, saliva, tears). However, this effect is not associated with INH use. (Option 5) Concurrent use of antacids containing aluminum decreases INH absorption. The medication may be taken with food if gastric irritation is a concern. Educational objective: Common potential side effects of INH include hepatotoxicity (eg, jaundice, vomiting, dark urine, fatigue) and peripheral neuropathy (eg, numbness, tingling of extremities). Clients should avoid alcohol use and aluminum-containing antacids, and report any experienced side effects to the health care provider immediately. Copyright © UWorld. All rights reserved.

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 Incorrect Correct answer 1,2,3 Explanation: Heparin is a natural anticoagulant. Its risk is heparin-induced thrombocytopenia (HIT), also known as heparin-associated thrombocytopenia. Normal platelet range is 150,000-400,000/mm3 (150-400 x 109/L). A mild lowering of platelets may occur and resolve spontaneously around the 4th day of administration. The danger is type II HIT, a more severe form in which there is an acute drop in the number of platelets (more than 50% from baseline), which requires discontinuing heparin (Option 1). Angiotensin-converting enzyme (ACE) inhibitors such as lisinopril are teratogenic. Lisinopril can cause embryonic/fetal developmental abnormalities (cardiovascular and central nervous system) if taken during pregnancy, especially during the first 13 weeks of gestation. During the 2nd and 3rd trimesters, ACE inhibitors interfere with fetal renal hemodynamics, resulting in low fetal urine output (oligohydramnios) and fetal growth restriction (Option 2). Nitroglycerine causes vasodilation and can lower blood pressure. Systolic blood pressure should be >90 mm Hg to ensure renal perfusion (Option 3). (Option 4) Gingival hyperplasia or hypertrophy is a known side effect of phenytoin (Dilantin) and is not a reason to stop the drug. Vigorous dental hygiene beginning within 10 days of initiation of phenytoin therapy can help control it. Signs and symptoms that require discontinuation include toxic levels or phenytoin hypersensitivity syndrome (fever, skin rash, and lymphadenopathy). (Option 5) Warfarin (Coumadin) is used to prolong clotting so that the desired result is a "therapeutic" range rather than the client's "normal" control value when not on the drug. Therapeutic range is considered roughly 1.5-2.5 times the control (International Normalized Ratio [INR] of 2-3), but up to 3-4 times the control (INR of 2.5-3.5) in high-risk situations such as an artificial heart valve. Educational objective: Heparin should be held when there is significant thrombocytopenia. Angiotensin-converting enzyme inhibitors are not administered to pregnant women, and nitrates are not administered when a client is hypotensive. Prothrombin time/International Normalized Ratio is expected to be 1.5-2.5 (up to 4) times the control value when therapeutic effects are reached. Gingival hyperplasia is a side effect of phenytoin (Dilantin) administration and is not a reason to stop the drug.

The emergency department nurse is caring for a client who has recently been 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. Client falls asleep while the nurse is talking 2. Client frequently scratches due to pruritus 3. Client has third emesis since taking medication 4. Monitor reveals one premature ventricular contraction 5. Pulse oximeter shows oxygen saturation is 90% Correct answer 1,3,5 Explanation: Methadone is a potent narcotic with a longer half-life than its duration of action due to its lipophilic properties. The risk for overdose exists as clients can inadvertently take too many tablets for additional pain relief even though fat cells will continue to release high amounts of the drug into circulation. Early signs of toxicity include nausea/vomiting and lethargy. A client who falls asleep with stimulation (ie, is obtunded) requires additional observation/monitoring. Sedation precedes respiratory depression, a life-threatening complication of severe toxicity (Options 1 and 3). An acceptable pulse oximetry reading for a normal, healthy nonsmoking adult is considered 95%-100%. A reading of 90% is low and indicates inadequate depth or rate of respiration with possible respiratory depression (Option 5). (Option 2) Itching sensation (pruritus) is an expected finding with narcotic use, especially in opioid-naïve clients. It can be managed with an antihistamine. (Option 4) Occasional premature ventricular contractions are a common, insignificant finding in most adults. The client should have cardiac monitoring in the setting of methadone use/overdose as there is a risk of QT interval prolongation (normal 0.34-0.43 sec, or less than half the RR interval), which can lead to cardiac arrhythmias (eg, torsades de pointes). Educational objective: Methadone is a potent narcotic with a long half-life. Early signs of toxicity include nausea/vomiting and lethargy. The nurse should monitor the client's respiratory rate, pulse oximetry, and electrocardiogram tracing. Respiratory depression and QT interval prolongation can lead to life-threatening complications.

TX: for torsades de pointes

The first-line treatment is IV magnesium Treatment may also include defibrillation and discontinuation of any QT-prolonging medications

A client suffering from chronic kidney disease is scheduled to receive recombinant human erythropoietin and iron sucrose. An assessment of laboratory work shows hemoglobin of 9.7 g/dL (97 g/L) and hematocrit of 29% (0.29). What is the best nursing action? 1. Administer the erythropoietin in the client's abdominal area [46%] 2. Check the client's blood pressure prior to administering the erythropoietin [36%] 3. Hold the client's next scheduled iron sucrose dose [2%] 4. Hold the erythropoietin dose and inform the health care provider [14%] Omitted Correct answer 2 Explanation: Anemia associated with chronic kidney disease is treated with recombinant human erythropoietin (Epogen/Procrit, epoetin). Therapy is initiated to achieve a target hemoglobin of 10-11.5 g/dL (100-115 g/L) and to alleviate the symptoms of anemia (eg, fatigue) and the need for blood transfusions. However, higher hemoglobin concentrations, especially >13 g/dL (130 g/L), are associated with venous thromboembolism and adverse cardiovascular outcomes. Hypertension is a major adverse effect of erythropoietin administration. Therefore, uncontrolled hypertension is a contraindication to recombinant erythropoietin therapy. Blood pressure should be well controlled prior to administration of erythropoietin. (Option 1) Erythropoietin is administered intravenously or in any subcutaneous area. However, checking the client's blood pressure must be done prior to administering. (Option 3) Iron in the form of iron sucrose (Venofer) or ferric gluconate (Ferrlecit) may be prescribed to promote an adequate response to erythropoietin. Adequate stores of iron, vitamin B-12, and folic acid are required for the erythropoietin to work. There is no reason to hold iron therapy at this time. (Option 4) The dose is held if the client has higher target hemoglobin or uncontrolled hypertension. Educational objective: The kidneys release erythropoietin to stimulate the production of red blood cells. Anemia of chronic kidney disease is treated with recombinant erythropoietin for a target hemoglobin of 10-11.5 g/dL (100-115 g/L). Hemoglobin levels >13 g/dL (130 g/L) are associated with thromboembolic and cardiovascular events. Uncontrolled hypertension is a contraindication to recombinant erythropoietin therapy. .

The health care provider is starting an elderly client on terazosin to treat benign prostatic hyperplasia (BPH). Which information should be included when teaching this client about the new medication? 1. Change positions slowly when going from lying to standing [44%] 2. Do not drink grapefruit juice when taking this drug [44%] 3. Take this medication first thing in the morning, before breakfast [7%] 4. Your stool may become darker and that's normal [3%] Omitted Correct answer 1 Explanation: Terazosin is an alpha-adrenergic blocker that can relieve urinary retention in clients with BPH. It relaxes the smooth muscle in the bladder neck and prostate gland; however, it also relaxes smooth muscle in the peripheral vasculature, which can cause orthostatic hypotension, syncope (blacking out), and falls. This is particularly common when the drug is started (first-dose hypotension) or when the dosage is increased. The serious effects can be avoided by instructing the client to take the medication at bedtime, change positions slowly when going from lying to standing, and avoid any medications that also increase smooth muscle relaxation (eg, phosphodiesterase-5 inhibitors [sildenafil or vardenafil] used to treat erectile dysfunction). Some clients may also experience ejaculatory dysfunction (decreased or absent ejaculation). (Option 2) Grapefruit juice can cause significant interactions with drugs such as calcium channel blockers and sildenafil. However, it does not appear to interact with alpha blockers such as terazosin. (Option 3) Alpha-1-adrenergic antagonists (eg, terazosin, doxazosin, tamsulosin, alfuzosin) should be taken at bedtime, not in the morning, to avoid orthostatic hypotension. (Option 4) Oral iron tablets and bismuth salts (Pepto-Bismol) can turn stools dark, an expected side effect. This can be confused with upper gastrointestinal bleeding, which can also cause melena. Educational objective: Alpha blockers are commonly used to treat symptoms of urinary retention in clients with BPH. Orthostatic hypotension is a common side effect that can be avoided by teaching the client to take the medication at bedtime, avoid abrupt position changes, and avoid medications for erectile dysfunction, which can worsen hypotension.

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 [4%] 2. Back pain and urge incontinence [1%] 3. Difficulty swallowing and breathing [91%] 4. Difficulty walking and hand tremor [2%] Omitted Correct answer 3 Explanation: Botulinum toxin type A (Botox) blocks neuromuscular transmission by inhibiting acetylcholine release from nerve endings. The drug is used for treating wrinkles, blepharospasm, and cervical dystonia. Complications are uncommon when Botox is used for cosmetic purposes but can be life-threatening if they occur. The toxin can also relax the muscles used for swallowing and breathing, resulting in dysphagia (aspiration risk) and respiratory paralysis. (Options 1 and 2) Botulism can be associated with constipation and urinary retention due to relaxation of smooth muscle. Unlike in Clostridium tetani infection (tetanus), painful rigidity and spasms of the neck, back, and abdominal muscles are absent. (Option 4) Ataxia and hand tremor usually indicate drug toxicity (eg, phenytoin, lithium). Educational objective: Botulinum toxin type A (Botox) inhibits the release of acetylcholine from nerve endings and causes relaxation of skeletal/smooth muscles. On occasion, surrounding muscle weakness can lead to dysphagia and respiratory paralysis.

The health care provider prescribes phenazopyridine hydrochloride for a client with a urinary tract infection. What would the office nurse teach the client to expect while taking this medication? 1. Constipation [5%] 2. Difficulty sleeping [2%] 3. Discoloration of urine [75%] 4. Dry mouth [16%] Omitted Correct answer 3 Explanation: Phenazopyridine hydrochloride (Pyridium) is a urinary analgesic prescribed to relieve the pain and burning associated with a urinary tract infection. The urine will turn bright red-orange while on this medication; other body fluids can be discolored as well. Because staining of underwear, clothing, bedding, and contact lenses can occur, the nurse should suggest that the client use sanitary napkins and wear eyeglasses while taking the medication. Phenazopyridine hydrochloride provides symptomatic relief but no antibiotic action, and so it is important that the client take a full course of antibiotics. (Options 1, 2, and 4) Constipation, difficulty sleeping, and dry mouth are not common adverse effects of phenazopyridine hydrochloride. Educational objective: Phenazopyridine hydrochloride (Pyridium) is a urinary analgesic prescribed to relieve symptoms of dysuria associated with a urinary tract infection. An expected side effect of the drug is orange-red discoloration of urine.

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." [33%] 2. "I will call the HCP if I feel dizzy and lightheaded." [10%] 3. "I will call the HCP if I have trouble reading." [13%] 4. "I will take my blood pressure before taking my medicine." [42%] Omitted Correct answer 4 Explanation: Digoxin (Lanoxin) is a cardiac glycoside with positive inotropic and negative chronotropic effects. It is used to treat atrial fibrillation because at therapeutic levels (0.5-2.0 ng/mL) it decreases conduction through the sinoatrial node (SA) and ventricular heart rate. However, drug toxicity is common due to digoxin's narrow therapeutic range. Clients are instructed to recognize and report signs and symptoms of digoxin toxicity. These include the following: Gastrointestinal symptoms, including anorexia, nausea, vomiting, and abdominal pain, are frequently the earliest symptoms (Option 1) Neurologic manifestations - lethargy, fatigue, weakness, and confusion Visual symptoms are characteristic and include alterations in color vision, scotomas, or blindness (Option 3) Cardiac arrhythmias are the most dangerous symptoms. Digoxin toxicity can result in bradycardia and heart block, which can cause dizziness or lightheadedness. Clients are instructed to check their pulse and tell the HCP if it is low or has skipped beats (Option 2). (Option 4) There is no need to routinely check blood pressure before taking the medicine. Clients should check their pulse. Educational objective: Clients receiving digoxin are instructed to measure their pulse before taking the medication and withhold digoxin if the heart rate is <60/min. Clients should also be taught to recognize and report gastrointestinal (eg, anorexia, nausea, diarrhea), neurologic, and cardiac symptoms and visual changes (eg, altered color vision, scotomas) that suggest

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 [11%] 2. Current blood pressure is 160/88 mm Hg [12%] 3. Heart rate has dropped from 70/min to 60/min [17%] 4. Slight wheezes auscultated during inspiration [58%] Omitted Correct answer 4 Explanation: Propranolol is a nonselective beta-blocker that inhibits beta1 (heart) and beta2 (bronchial) receptors. It is used for many indications (eg, essential tremor) in addition to blood pressure control. Blood pressure decreases secondary to a decrease in heart rate. Bronchoconstriction may occur due to the effect on the beta2 receptors. The presence of wheezing in a client taking propranolol may indicate that bronchoconstriction or bronchospasm is occurring. The nurse should assess for any history of asthma or respiratory problems with this client and notify the health care provider (HCP). (Option 1) A headache is a common occurrence with hypertension. The nurse may administer an analgesic as needed. (Option 2) This is the first dose of propranolol that the client has received. It may take several days of treatment for the blood pressure to reduce to a more normal reading. (Option 3) A reduction in heart rate is expected with a beta-blocker. The nurse should continue to monitor it for further reduction. Educational objective: The nurse should be concerned about the presence of wheezing in a client taking a nonselective beta-blocker like propranolol. Wheezing may indicate bronchoconstriction or bronchospasm. The nurse should assess for any history of asthma or other respiratory problems and report to the HCP.

Exhibit 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. 1. Administer diltiazem 20 mg IVP [69%] 2. Administer rivaroxaban 20 mg PO [8%] 3. Draw blood for a thyroid function test [2%] 4. Send the client for echocardiogram [19%] Omitted Correct answer 1 Updated: 01/04/2017 Explanation: Atrial fibrillation is characterized by a disorganization of electrical activity in the atria due to multiple ectopic foci. It results in loss of effective atrial contraction and places the client at risk for embolic stroke due to thrombi formed in the atria from stasis of blood. During atrial fibrillation, the atrial rate may be increased to 350-600/min. The ventricular response (pulse rate) can vary. The higher the ventricular rate, the more likely the client will have symptoms of decreased cardiac output (ie, hypotension). Ventricular rate control is a priority in clients with atrial fibrillation. This client has an irregular heart rate of 140/min and is not currently hypotensive. However, if the high ventricular response is allowed to continue, it is likely that the client will begin to show signs and symptoms of decreased cardiac output such as hypotension. Therefore, giving the client diltiazem (a calcium channel blocker) is the priority as its purpose is to decrease the ventricular response rate to <100/min. Other medications such as beta blockers (metoprolol) or digoxin may also be used to control the ventricular rate. (Option 2) Anticoagulants (eg, rivaroxaban [Xarelto], dabigatran [Pradaxa], apixaban [Eliquis], and warfarin) are used for long-term prevention of atrial thrombus and embolic complications. This is not a priority. (Option 3) The HCP will investigate possible causes of the atrial fibrillation; one of these is an overactive thyroid gland (hyperthyroidism). The thyroid function test would be useful for confirmation, but it is not a priority. (Option 4) An echocardiogram can be obtained once the rate is controlled, but it is not a priority. Educational objective: Ventricular rate control is a priority in the client with atrial fibrillation; therefore, the nurse should administer the medication (diltiazem, metoprolol, or digoxin) that will accomplish this first.

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." [5%] 2. "I will eat more fresh fruits like bananas and oranges." [12%] 3. "I will limit my intake of cheeses, breads, and canned foods." [67%] 4. "I will use a salt substitute to season my food." [14%] Omitted Correct answer 3 Explanation: Poor adherence to a low-sodium diet (Choice 3) and failure to take prescribed medications as directed (Choice 1) are the most common reasons for readmission of heart failure clients to the hospital setting. The edema associated with heart failure is often treated by dietary restriction of sodium. The nurse or dietician should assess the client's diet history, teach how to read food labels and plan for dining out, and develop an overall diet plan. Diet recommendations should be individualized and culturally sensitive for the client to make the needed changes successfully. The Dietary Approaches to Stop Hypertension (DASH) diet is widely used for clients with heart failure. All foods high in sodium (>400 mg/serving) should be avoided. General principles of a low-sodium diet are as follows: Do not add salt or seasonings containing sodium when preparing meals Do not use salt at the table Avoid high-sodium foods (eg, canned soups, processed meats, cheese, frozen meals) Limit milk products to 2 cups daily (Option 1) Medications such as spironolactone are diuretics. Taking them at bedtime would cause the client to have nocturia. Spironolactone should be taken in the morning. (Option 2) Hyperkalemia is a side effect of angiotensin-converting enzyme (ACE) inhibitors such as lisinopril. Spironolactone is a potassium-sparing diuretic. Although fresh fruit is a good option for a low-sodium diet, bananas and oranges are high in potassium, which could put this client at increased risk for hyperkalemia. (Option 4) Many salt substitutes are high in potassium. This client is already at risk for hyperkalemia due to the ACE inhibitor lisinopril and the potassium-sparing diuretic spironolactone. The nurse should encourage the client to substitute lemon juice or other spices for salt or a salt substitute. Educational objective: The client in heart failure on a low-sodium diet should be encouraged to limit the intake of such foods as processed meats, cheese, canned soups and vegetables, frozen meals, breads, and milk products.

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." Omitted Correct answer 2,3 Explanation: Clients discharged on warfarin (Coumadin) are taught interventions to prevent injury, such as removing scatter rugs in the home to reduce the risk of tripping and falling (especially in elderly) (Option 2). Clients are educated to avoid aspirin, drugs containing aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and alcohol when taking warfarin due to an increased risk for bleeding (Option 3). (Option 1) Warfarin is usually administered for 3-6 months following PE to prevent further thrombus formation. A longer duration (lifelong) of anticoagulation is recommended in clients with recurrent PE. Prothrombin time and INR must be monitored regularly to adjust the dose and maintain a therapeutic anticoagulant level. (Option 4) Clients should be taught to avoid trauma or injury to decrease the risk for bleeding. Preventive measures include gently brushing teeth with a soft-bristled toothbrush, avoiding use of alcohol-based mouthwash, avoiding contact sports or rollerblading, and using a straight razor. Flossing should also be avoided in general, but waxed dental floss may be used with care in some clients. (Option 5) Clients are instructed to wear a MedicAlert tag (eg, necklace, bracelet) when taking anticoagulants (eg, warfarin, heparin). Educational objective: Clients on warfarin or heparin should avoid using aspirin or nonsteroidal anti-inflammatory drugs, wear a MedicAlert device, avoid activities that increase the risk for bleeding, and limit alcohol intake.

The nurse is preparing medications for a group of clients. Which prescription should the nurse clarify with the health care provider before administering? 1. Client diagnosed with cirrhosis had 2 stools today; laxative lactulose prescribed daily [8%] 2. Client is prescribed lisinopril PO daily; serum potassium level is 5.6 mEq/L (5.6 mmol/L) [59%] 3. Client is receiving vancomycin IV; mild facial flushing noted after 30 minutes [25%] 4. Client with diabetes has insulin glargine prescribed; current blood glucose is 100 mg/dL (5.6 mmol/L) [7%] Omitted Correct answer 2 Explanation: ACE inhibitors ("-prils") and angiotensin II receptor blockers (ARBs) ("-sartans") may potentiate hyperkalemia. ACE inhibitors decrease the excretion of aldosterone. Aldosterone promotes sodium retention and causes potassium excretion. However, when the ACE inhibitor suppresses aldosterone, potassium rises, placing clients at risk for hyperkalemia, especially in the presence of impaired renal function. The nurse should question the administration of an ACE inhibitor in a client with hyperkalemia (Option 2). (Option 1) Lactulose is administered to clients with cirrhosis and hepatic encephalopathy to promote excretion of ammonia via fecal elimination and not solely for the treatment of constipation. The dose is adjusted to achieve 2-3 soft stools each day. (Option 3) Vancomycin should be infused over at least 60 minutes (100 minutes if infusing ≥1 gram). When the infusion is given too fast, the client may develop red man syndrome, which is characterized by facial and upper body flushing. If this occurs, the infusion should be slowed or stopped and restarted at a slower rate after 30 minutes. Facial flushing in isolation is not indicative of an allergic or anaphylactic reaction, and the nurse can independently manage this side effect. (Option 4) Basal insulin glargine (Lantus) is used for glucose control in diabetic clients. Insulin glargine has no peak and should be administered even if the current blood glucose level is within normal limits. Educational objective: Clients receiving ACE inhibitors should be monitored for hyperkalemia, especially in the presence of renal insufficiency. The nurse should clarify a prescription for ACE inhibitor administration in a client with hyperkalemia. d.

A A A The nurse is preparing to administer medications through a client's feeding tube. Which actions should the nurse implement? Select all that apply. 1. Combine all medications before administering 2. Crush each medication separately before administration 3. Determine if the medications are available in liquid form 4. Flush the tube with sterile water before and after medication administration 5. Mix medications with enteral feeding formula before administration Omitted Correct answer 2,3,4 Explanation: Failure to correctly administer medications through feeding tubes (eg, nasogastric, gastrostomy) can result in obstruction of the tube, reduced medication absorption or efficacy, and medication toxicity. Before administering medications through a feeding tube, the nurse should determine if any of the medications are available in a liquid form as liquid medications are less likely to clog the tube (Option 3). Medications should be crushed, dissolved, and administered separately to prevent interactions (chemical reactions) between medications or interference with absorption (Option 2). A feeding tube should be flushed with sterile water to avoid drug interactions and eliminate contaminants found in tap water. The feeding tube should be flushed before and after each medication is given (Option 4). (Option 1) When using a feeding tube, each medication should be administered individually to prevent interactions between medications. (Option 5) Medications mixed with enteral feedings may form a thick consistency and clog the tube. Educational objective: When a feeding tube is used, medications should be crushed, dissolved, and administered separately to prevent interactions. Sterile water should be used to dissolve medications and flush the feeding tube. Liquid medications should be used if possible.

The nurse is preparing to administer a sodium polystyrene sulfonate retention enema. Which explanation by the nurse best describes the purpose of this type of enema? 1. "A contrast medium is administered rectally to visualize the colon via x-ray." [10%] 2. "Bedridden clients receive this enema to stimulate defecation and relieve constipation." [18%] 3. "This enema assists the large intestines in removing excess potassium from the body." [58%] 4. "This enema is administered before bowel surgery to decrease bacteria in the colon." [12%] Omitted Correct answer 3 Explanation: Sodium polystyrene sulfonate (Kayexalate) retention enema is a medicated enema administered to clients with high serum potassium levels. The resin in Kayexalate replaces sodium ions for potassium ions in the large intestine and promotes evacuation of potassium-rich waste from the body, thereby lowering the serum potassium level. Kayexalate can also be given orally and is much more effective. Kayexalate can rarely be associated with intestinal necrosis. (Option 1) A barium enema uses contrast medium (barium) administered rectally to visualize the colon using fluoroscopic x-ray. (Option 2) A fleet enema relieves constipation by infusing a hypertonic solution into the bowel, pulling fluid into the colon and causing distension and then defecation. (Option 4) A neomycin enema is a medicated enema that reduces the number of bacteria in the intestine in preparation for colon surgery. Educational objective: Kayexalate retention enemas are medicated enemas administered to clients with high serum potassium levels. The resin in Kayexalate replaces sodium ions for potassium ions in the large intestine and promotes evacuation of potassium-rich waste from the body, thereby lowering the serum potassium level.

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." [9%] 2. "Symptoms of nausea and vomiting should be reported to our health care provider (HCP)." [6%] 3. "We will hold the dose if our child's heart rate is above 90/min." [79%] 4. "We will not mix the medication with other foods or liquids." [4%] Omitted Correct answer 3 Explanation: Digoxin is a cardiac glycoside given to infants and children in heart failure. It is given to increase myocardial contraction, which increases cardiac output and improves circulation and tissue perfusion. Digoxin is a potentially dangerous drug due to its narrow margin of safety in dosage. Parents should receive thorough education and in return demonstrate appropriate administration procedures for this medication. Parent teaching for administration of digoxin includes the following: Inform parents of the pulse rate at which to hold the medication based on HCP prescription. In general, digoxin is held if pulse <90-110/min for infants and young children or <70/min for an older child. Administer oral liquid in the side and back of the mouth Do not mix the drug with food or liquids as the refusal to take these would result in inaccurate intake of medication (Option 4) If a dose is missed, do not give an extra dose or increase the dose. Stay on the same schedule. If more than 2 doses are missed, notify the HCP If the child vomits, do not give a second dose (Option 1). Nausea, vomiting, or slow pulse rate could indicate toxicity. Notify the HCP (Option 2). Give water or brush the client's teeth after administration to remove the sweetened liquid Educational objective: Nausea, vomiting, or slow pulse rate can indicate digoxin toxicity. General guidelines are to hold digoxin for pulse <90-110/min in infants and young children and <70/min in older children.

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 Omitted Correct answer 1,4,5 Explanation: Aripiprazole (Abilify) is an atypical antipsychotic that acts as a dopamine system stabilizer. It helps stabilize mood and control symptoms such as agitation and hallucinations in clients with dementia, making it an important drug for this client (Option 1). The combination of lisinopril (an ACE inhibitor) and furosemide (Lasix, a loop diuretic) is normally used to control heart failure symptoms, particularly in clients with fluid overload. If these medications are not taken, the client will be at risk for exacerbation of heart failure and hospitalization. Therefore, these medications are also high priority (Options 4 and 5). (Options 2 and 3) Medications used for their preventive benefits are lower priority and so would be administered after the medications more critical to the client's short-term well-being. Donepezil (Aricept) is used to prevent worsening of symptoms in Alzheimer dementia, and it does not decrease agitation. It is a preventive medication and so would be a lower priority. Calcium carbonate is used as a calcium supplement for osteoporosis. It would be the lowest priority. Educational objective: Some clients with dementia may not want to take medications. It is common for these clients to take a few pills and then decide they do not want any more. Therefore, it is important to administer the highest priority medications first. Those that provide an immediate physiologic and symptomatic benefit, including those used to control behavioral issues and heart problems, should be the highest priority.

The nurse precepts a nursing student caring for a client with glaucoma and observes the student administer timolol maleate, an ophthalmic medication. Which student action indicates that further instruction is needed? 1. Instructs client to close eyelid and move eye around; applies pressure to the lacrimal duct for 30-60 seconds [15%] 2. Pulls lower eyelid down gently with thumb or forefinger against bony orbit to expose the conjunctival sac [4%] 3. Removes dried secretions with moistened sterile gauze pads by wiping from the outer to inner canthus [73%] 4. Rests hand on client's forehead and holds dropper 1-2 cm (1/2-3/4 in) above the conjunctival sac [6%] Omitted Correct answer 3 Explanation: If applicable, the nurse requests that the client remove contact lenses. The nurse then dons clean gloves and uses aseptic technique to administer ophthalmic medications (eg, eye drops, lubricant) that lubricate the eye and treat eye conditions (eg, glaucoma, infection). The Joint Commission disallows the use of abbreviations for right eye (OD), left eye (OS), and both eyes (OU). The nurse must verify the prescription if the health care provider (HCP) uses these abbreviations. The general procedure for the administration of ophthalmic medications includes the following steps in sequence: Remove dried secretions with moistened (warm water or normal saline) sterile gauze pads by wiping from the inner to outer canthus to keep eyelid and eyelash debris from entering the eye and to prevent transfer of debris into the lacrimal (tear) duct (Option 3) Place client in the supine or sitting position with head tilted back toward side of the affected eye to prevent excess medication from flowing into the lacrimal duct and minimize systemic absorption through the nasal mucosa Rest hand on client's forehead and hold dropper 1-2 cm (1/2-3/4 in) above the conjunctival sac, which keeps the dropper away from the eye globe and avoids contamination (Option 4) Pull lower eyelid down gently with thumb or forefinger against bony orbit to expose the conjunctival sac (Option 2) Instruct client to look upward and then instill drops of medication into the conjunctival sac. This minimizes the blink reflex and retracts the cornea up and away from the conjunctival sac to avoid instillation onto the cornea Instruct client to close the eyelid and move the eye around (if able). Then apply pressure to the lacrimal duct for 30-60 seconds if medication has systemic effects (eg, beta blocker, timolol maleate [Timoptic]). This will distribute the medication, prevent overflow into the lacrimal duct, and reduce possible systemic absorption (Option 1) Remove excess medication from each eye with a new tissue or gauze pad to prevent cross-contamination Wait 5 minutes before instilling a different medication into the same eye Educational objective: To administer ophthalmic medications, follow these steps: (1) Remove secretions from the eyelid by wiping from the inner to outer canthus; (2) pull lower eyelid downward, have client look upward, and instill drops into the conjunctival sac; and (3) apply pressure to the lacrimal duct if medication has systemic effects (eg, beta blocker, timolol maleate). .

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) [6%] 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) [1%] 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%] 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) [87%] Omitted Correct answer 4 Explanation: Vancomycin (Vancocin) is a potent antibiotic used to treat gram-positive bacterial infections (eg, Staphylococcus aureus, Clostridium difficile). To lower the risk of dose-related nephrotoxicity, especially in clients with renal impairment and those who are >60 years of age, serum vancomycin trough levels should be monitored to assess for therapeutic range (10-20 mg/L [6.9-13.8 µmol/L]). A vancomycin trough level above the normal range and/or elevated creatinine and blood urea nitrogen (BUN) values should be reported to the health care provider (HCP) as this may indicate nephrotoxicity. (Options 1, 2, and 3) Normal laboratory values do not need to be reported to the HCP. Baseline and ongoing monitoring for normal levels of creatinine (0.6-1.3 mg/dL [53-115 µmol/L]) and BUN (6-20 mg/dL [2.1-7.1 mmol/L]) are necessary in clients receiving vancomycin. Educational objective: The normal therapeutic level of vancomycin is 10-20 mg/L (6.9-13.8 µmol/L). Elevated vancomycin trough levels (>20 mg/L [>13.8 µmol/L]), creatinine (>1.3 mg/dL [>115 µmol/L]), and blood urea nitrogen (>20 mg/dL [>7.1 mmol/L]) are associated with nephrotoxicity and should be reported to the health care provider.

Femoral-popliteal bypass surgery[NI]

The nurse performs neurovascular assessments on the affected extremity (ie, pulses, color and skin temperature, capillary refill, pain, movement) and compares the findings with the preoperative baselinen. on palpable pedal pulse that is present only with Doppler distal to the graft (ie, post-tibial, pedal) can indicate compromised blood flow or graft occlusion and should be reported to the health care provider immediately!!!!!

The nurse reviews assigned clients' medical and medication administration records. Which prescription should the nurse validate with the health care provider before administering? 1. Acetaminophen IV for a postoperative client with temperature of 101 F (38.3 C) who reports incisional pain of 6 on a 0-10 scale [21%] 2. Azathioprine for a client with Crohn disease who reports fatigue and nausea and has leukopenia [47%] 3. Baclofen for a client with multiple sclerosis and muscle spasms who reports dizziness when changing positions [15%] 4. Colchicine for a client with an acute gout attack who reports burning pain in the great toe of 10 on a 0-10 scale [14%] Omitted Correct answer 2 Explanation: Azathioprine (Imuran) is an immunosuppressant drug that can cause bone marrow depression and increase the risk for infection. It is prescribed to treat autoimmune conditions such as inflammatory bowel disease and to prevent organ transplant rejection. Fatigue and nausea can be expected as minor adverse effects or may be associated with the disease. Leukopenia (white blood cell count <4,000/mm3 [4.0 × 109/L]) can be a severe adverse effect of the drug and should be reported to the health care provider before administering the medication. (Option 1) Acetaminophen IV (Ofirmev) blocks the production of prostaglandins and has both antipyretic and analgesic properties. It is effective in relieving mild to moderate pain and can be prescribed in combination with opioid analgesia to relieve moderate to severe pain. (Option 3) Baclofen (Lioresal) is an antispasmodic drug that promotes skeletal muscle relaxation by interfering with the transmission of impulses that cause muscle spasticity. It is effective in decreasing pain and cramping associated with muscle tightness and spasticity in clients with multiple sclerosis and in those with spinal cord injury. Orthostatic hypotension is an expected adverse effect. (Option 4) Colchicine is prescribed for clients with an acute attack of gout as it decreases the inflammation and pain associated with deposition of uric acid crystals in the joints. Educational objective: Azathioprine (Imuran) is an immunosuppressant drug that can cause bone marrow suppression and increase the risk for infection. Leukopenia, a severe adverse effect of azathioprine, should be reported to the health care provider before the medication is administered.

The nurse prepares to administer morning medications to assigned clients. Which prescription should the nurse clarify with the health care provider? 1. Clopidogrel for client with history of stroke and platelet count of 154,000/mm3 (154 × 109/L) [12%] 2. Losartan for client with hypertension who is 8 weeks pregnant [61%] 3. Prednisone for client with herpes simplex lesions and Bell palsy [17%] 4. Tiotropium for client with pneumonia and chronic obstructive pulmonary disease [8%] Omitted Correct answer 2 Losartan is an angiotensin II receptor blocker (ARB) prescribed to treat hypertension. ACE inhibitors (eg, lisinopril, enalapril) and ARBs are teratogenic, causing renal and cardiac defects or death of the fetus. ARBs and ACE inhibitors have black box warnings that indicate contraindication in pregnancy. The nurse should not give an ARB to a pregnant client (Option 2). The health care provider should be notified so that an alternate antihypertensive may be prescribed that is safe to take during pregnancy (eg, labetalol, methyldopa). (Option 1) Antiplatelet agents (eg, clopidogrel) are prescribed to prevent thromboembolic events in clients with increased risk for stroke or myocardial infarction. Laboratory values are monitored periodically as these drugs increase bleeding time (normal, 2-7 minutes [120-420 seconds]) and, rarely, may lower platelet count (normal, 150,000-400,000/mm3 [150-400 × 109/L]) (Option 3) Bell palsy presents as acute onset of unilateral facial paralysis related to inflammation of the facial nerve (ie, cranial nerve VII) that may be triggered by a viral illness (eg, herpes simplex virus). Standard treatment includes corticosteroids (eg, prednisone) within 72 hours of symptom onset. (Option 4) Tiotropium is an inhaled anticholinergic drug that inhibits receptors in the smooth muscles of the airways. It is prescribed daily for the long-term management of bronchospasm in clients with chronic obstructive pulmonary disease. Educational objective: Angiotensin II receptor blockers and ACE inhibitors are teratogenic, causing fetal injury or death, and are contraindicated in pregnancy. .

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 Incorrect Correct answer 2,5 Explanation: The nurse should question these prescriptions and contact the health care provider: Dicyclomine, an anticholinergic/antispasmodic drug prescribed to manage irritable bowel syndrome, is contraindicated with paralytic ileus, as it decreases intestinal motility and would exacerbate the condition (Option 2). Statins (eg, atorvastatin, simvastatin) lower LDL cholesterol. Myopathy, a possible adverse effect, may lead to life-threatening rhabdomyolysis (Option 5). (Option 1) Tumor lysis syndrome is due to rapid lysis of cells and the resulting release of intracellular ions potassium and phosphorous into serum. Phosphorus binds calcium and causes hypocalcemia. Metabolism (catabolism) of released cellular nucleic acids leads to severe hyperuricemia. IV hydration and hypouricemic medications (eg, allopurinol) are usually prescribed to promote excretion of purines and prevent acute kidney injury. (Option 3) IV opioids (eg, morphine) or nonsteroidal anti-inflammatory agents (eg, ketorolac) are used to treat severe renal colic pain. Percutaneous nephrolithotripsy breaks and removes stones and can lead to severe pain. Therefore, pain medications are appropriate. (Option 4) Levofloxacin, a fluoroquinolone antibiotic prescribed to treat urinary tract infections, has no known cross-sensitivity to penicillin. However, cross-sensitivity with other fluoroquinolones can occur. Educational objective: Dicyclomine is an antispasmodic drug that decreases intestinal motility and is contraindicated with paralytic ileus. For clients with myopathy, statins should be withheld and the health care provider called. Prior to and during chemotherapy, allopurinol helps prevent hyperuricemia in clients at risk for tumor lysis syndrome.

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 Omitted Correct answer 1,4 Explanation: Bumetanide is a potent loop diuretic (eg, furosemide, torsemide) used to treat edema associated with heart failure and liver and renal disease. The diuretic inhibits reabsorption of sodium and water from the tubules and promotes renal excretion of water and potassium. The nurse should question the bumetanide prescription as the client with heart failure has hypokalemia (potassium <3.5 mEq/L [3.5 mmol/L]) and is already at increased risk for life-threatening cardiac dysrhythmias associated with this electrolyte imbalance (Option 1). Isoniazid is a first-line antitubercular drug used to treat latent or active tuberculosis. The nurse should question this prescription as increased liver function tests (eg, alanine aminotransferase, aspartate aminotransferase) can indicate development of drug-induced hepatitis (Option 4). (Option 2) Calcium acetate (PhosLo) is a phosphate binder used to treat hyperphosphatemia (normal phosphorous: 2.4-4.4 mg/dL [0.78-1.42 mmol/L]) in clients with chronic kidney disease. Calcium acetate lowers the serum phosphorous level by binding to dietary phosphate and excreting it in feces. (Option 3) Carvedilol (Coreg) is a beta blocker used to improve cardiac output and slow the progression of heart failure. B-type natriuretic peptide (BNP) (normal: <100 pg/mL [100 pmol/L]) is secreted from the ventricles in response to the increased ventricular stretch. Elevated BNP is expected in a client with heart failure; the nurse need not question this prescription. (Option 5) Metronidazole (Flagyl) is the first-line anti-infective drug used to treat infectious diarrhea caused by Clostridium difficile. Leukocytosis is expected with this bacterial infection. Educational objective: Loop diuretics (eg, bumetanide, furosemide, torsemide) can cause hypokalemia (potassium <3.5 mEq/L [3.5 mmol/L]). Elevated liver enzymes in clients receiving the antitubercular drug isoniazid can indicate development of drug-induced hepatitis.

Any rash in a client taking allopurinol, even if mild, should be reported immediately to the HCP.

The nurse should direct the client to stop taking the medication immediately, schedule an appointment, and notify the HCP. A rash caused by allopurinol may be followed by more severe hypersensitivity reactions that can be fatal, including Stevens-Johnson syndrome and toxic epidermal necrolysis

pt. with atrial fibrillation may also be taking anticoagulants (eg, warfarin, rivaroxaban, apixaban, dabigatran), making a life-threatening intracranial bleed even more dangerous.

The nurse should perform a neurologic assessment (eg, level of consciousness, pupil response, vital signs) immediately.

Exhibit 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. 1. Blood pressure 2. Blood sugar 3. Heart rate 4. International Normalized Ratio 5. Potassium level Omitted Correct answer 1,3,5 Explanation: Beta blockers (eg, metoprolol, carvedilol) and angiotensin-converting enzyme (ACE) inhibitors (eg, quinapril, lisinopril, enalapril) are antihypertensive medications. The nurse should assess blood pressure prior to administration (Option 1). Beta blockers lower heart rate by blocking the action of beta receptors that increase heart rate and contractility. The nurse should assess blood pressure and heart rate prior to administration (Option 3). ACE inhibitors increase serum potassium by decreasing urinary potassium excretion. The nurse should assess blood pressure and serum potassium levels prior to administration (Option 5). (Option 2) Clients with diabetes require blood sugar checks, but administration of beta blockers, ACE inhibitors, or antiplatelet medications will not require monitoring of blood sugar. (Option 4) Aspirin, an antiplatelet medication, reduces clot formation and can increase the risk for bleeding. The nurse assesses for bruising, bleeding gums, blood in stool, and gastrointestinal upset. International Normalized Ratio should be monitored in clients taking warfarin. Educational objective: Beta blockers lower blood pressure and heart rate. Angiotensin-converting enzyme inhibitors lower blood pressure and increase potassium. Aspirin, an antiplatelet medication, increases the risk for bleeding.

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 [3%] 2. Headache [5%] 3. Muscle aches [66%] 4. Numbness in the feet [24%] Omitted Correct answer 3 Answered correctly 66% Time: 1 seconds Updated: 02/19/2017 Explanation: Atorvastatin (Lipitor) is a statin drug, or HMG-CoA reductase inhibitor, prescribed to lower cholesterol and reduce the risk of atherosclerosis and coronary artery disease. A serious adverse effect of statins, including atorvastatin and rosuvastatin (Crestor), is myopathy with ongoing generalized muscle aches and weakness. A client who develops muscle aches while on a statin drug should call the HCP who will then obtain a blood sample to assess the creatine kinase (CK) level. If myopathy is present, CK will be significantly elevated (≥10x normal), and the drug will then be discontinued. (Option 1) Diarrhea is not a side effect of statin drugs. Colchicine used for gout and acute pericarditis commonly leads to diarrhea. Many antibiotics can induce diarrhea, and some may cause Clostridium difficile infection. (Option 2) Headache is not a serious side effect of statin drugs. It is often a bothersome side effect of nitrates and calcium channel blockers as they dilate intracranial vessels; however, tolerance usually develops over time. (Option 4) Numbness in the feet (neuropathy) is not a common side effect of statin drugs. It is commonly associated with isoniazid, amiodarone, and chemotherapy agents (eg, vincristine, cisplatin). Educational objective: The client taking a statin such as atorvastatin or rosuvastatin should be taught to call the HCP if generalized muscle aches develop as this may be a symptom of myopathy, a serious adverse effect of this type of medication.

Chest tube drainage >3 mL/kg/hr for 3 consecutive hours or 5-10 mL/kg in 1 hour should be reported immediately to the HCP Why?

This could indicate postoperative hemorrhage and needs immediate intervention. Cardiac tamponade can develop rapidly in children and can be life-threatening. This child weighs 4 kg and an output of 30 mL in 1 hour is excessive.

Risk factors associated with DVT formation include the following:

Trauma (endothelial injury and venous stasis from immobility) Major surgery (endothelial injury and venous stasis from immobility) Prolonged immobilization (eg, stroke, long travel) causing venous stasis Pregnancy (induced hypercoagulable state and some venous stasis by the pressure on inferior vena cava) Oral contraceptives (estrogen is thrombotic) Underlying malignancy (cancer cells release procoagulants) Smoking (produces endothelial damage by inflammation) Old age Obesity and varicose veins (venous stasis) Myeloproliferative disorders (increase blood viscosity)

A prolonged episode of SVT with a heart rate >180/min will cause decreased cardiac output and hypotension. The client may also experience palpitations, dyspnea, and angina What will RN do?

Treatment includes vagal stimulation and drug therapy. Common vagal maneuvers include Valsalva, coughing, and carotid massage. IV adenosine is the drug of choice to convert SVT to a sinus rhythm. If vagal stimulation and drug therapy are ineffective and the client becomes hemodynamically unstable, synchronized cardioversion is used. Recurrent SVT may require radiofrequency catheter ablation.

How will the nurse collect a urine sample for urinalysis and culture from a pt. with an indwelling urinary catheter

Urine specimens must be collected aseptically from the port located on the catheter tubing of an indwelling urinary catheter

A lumbar puncture (spinal tap) is a sterile procedure used to gather a specimen of cerebrospinal fluid (CSF) for diagnostic purposes (eg, meningitis). A needle is inserted into the vertebral spaces between L3 and L4 or L4 and L5, and a sample of CSF is drawn. The nurse's role when assisting with a lumbar puncture includes the following:

Verify informed consent Gather the lumbar puncture tray and needed supplies Explain the procedure to older child and adult Have client empty the bladder Place client in the appropriate position (eg, side-lying with knees drawn up and head flexed or sitting up and bent forward over a bedside table) Assist the client in maintaining the proper position (hold the client if necessary) Provide a distraction and reassure the client throughout the procedure Label specimen containers as they are collected Apply a bandage to the insertion site Deliver specimens to the laboratory Educational objective: When assisting with a lumbar puncture, the nurse verifies informed consent, gathers supplies, explains the procedure, has the client void, and then assists the client into position. During the procedure, the nurse provides a distraction, helps the client stay in position (if needed), and labels specimens as they are collected. Afterward, the nurse applies a bandage and ensures that the specimens are delivered to the laboratory.

percutaneous endoscopic gastrostomy (PEG) tube

a minimally invasive procedure performed under conscious sedation. Using endoscopy, a gastrostomy tube is inserted through the esophagus into the stomach and then pulled through an incision made in the abdominal wall. To keep it secured, the PEG tube has an outer bumper and an inner balloon or bumper.

CVCs are warranted to provide important treatment for many clients, they are often

a source of infection that can lead to sepsis and septic shock

What is Kawasaki disease (KD)

a systemic vasculitis of childhood that presents with ≥5 days of fever, nonexudative conjunctivitis, lymphadenopathy, mucositis, hand and foot swelling, and a rash. First-line treatment consists of

Factors that increase risk for respiratory depression related to opioid use for pain control include

advanced age, underlying pulmonary disease, snoring, obesity, smoking, opiate naïve, and surgery.

Influenza is a highly contagious respiratory infection transmitted by

airborne droplets and direct contact. It has an incubation period of 1-4 days, with peak transmission starting at about 1 day before symptoms appear and lasting up to 5-7 days after the illness stage begins. Vaccination does not offer complete protection against all virus strains.

Digoxin (Lanoxin) is excreted

almost exclusively by the kidneys. Decreased kidney function usually requires decreased digoxin dosage and frequent drug level monitoring. BUN and creatinine are measurements of kidney function.

what IV catheter size is preferred in STABLE adult clients who require large amounts of fluids or blood,

an 18-gauge catheter is preferred.

Waking up at night with chest pain can signify that

angina is occurring at rest and is no longer considered stable angina. This should be reported to the health care provider

warfarin, rivaroxaban, apixaban, dabigatran

anticoagulants

electrolyte disturbances increase the likelihood of developing AF, clients can have this chronic condition managed with

anticoagulation therapy. AF is usually associated with an underlying heart disease and is rarely immediately life-threatening.

Clients with pulmonary embolism or deep venous thrombosis are treated with anticoagulation. Unfractionated heparin is one such agent, and its efficacy is measured through partial thromboplastin time (PTT) levels. The goal during anticoagulation therapy is a PTT 1.5-2 times the normal reference range of 25-35 seconds. A PTT of 127 seconds is much too prolonged, and spontaneous bleeding could occur.

anticoagulation. Unfractionated heparin is one such agent

Fluoxetine (Prozac) is an

antidepressant drug that is a selective serotonin reuptake inhibitor.

Bruising, especially on the upper extremities, is common with the use of

antiplatelet agents such as aspirin and clopidogrel. The nurse should teach the client to monitor for other, more severe signs of bleeding, such as blood in the stool.

he Beers criteria provide a list that classifies potentially harmful drugs to avoid or administer with caution in the elderly due to the high incidence of drug-induced toxicity, cognitive dysfunction, and falls. Some commonly used medications in this list include

antipsychotics, anticholinergics, antihistamines, antihypertensives, benzodiazepines, diuretics, opioids, and sliding insulin scales.

Nursing education about transdermal nitroglycerin includes

application of the patch to the upper arms or body, rotating the sites daily, removing the patch at night, taking no erectile dysfunction medications, and informing clients that headaches are common. Patches do not need to be removed for bathing.

Peripherally inserted central venous catheters (PICC) Complications related to the PICC are occlusion of the catheter, phlebitis, air embolism, and infection due to bacterial contamination.

are commonly used for long-term antibiotic administration, chemotherapy treatments, and nutritional support with total parenteral nutrition (TPN).

Aspirin and other NSAIDs inhibit platelet aggregation, resulting in GI bleeding complications. They also promote development of gastric ulcers with long-term use. Tinnitus (ringing in the ears) is the earliest sign of

aspirin toxicity.

Murmurs indicate turbulent blood flow across diseased or malformed cardiac valves. They are often described as musical, blowing, or swooshing sounds that occur between normal heart sounds. They may be auscultated

at the aortic, pulmonic, tricuspid, or mitral areas.

Orthostatic hypotension is common with

blood pressure medications (eg, ACE inhibitors, alpha blockers)

Where would RN know to look for an air leak would cause

bubbling in the air leak gauge (section C) or WATER SEAL CHAMBER not in the suction control chamber.

crushing, substernal type of chest pain. symptoms include atypical pain (jaw or arm), shortness of breath, indigestion, nausea, dizziness, and cold sweats. Nurse needs immediate evaluation and intervention

cardiac medical emergency (myocardial ischemia or acute myocardial infarction) that requires .

muffled or distant heart tones, narrowed pulse pressure, jugular venous distension, pulsus paradoxus, dyspnea, tachypnea, and tachycardia

cardiac tamponade

Somogyi rebound AKA Somogyi effect and posthypoglycemic hyperglycemia,

contested explanation of phenomena of elevated blood sugars in the morning it is a rebounding high blood sugar that is a response to low blood sugar

Intravenous immunoglobulin (IVIG) along with aspirin is used to prevent . (KD is one of the few pediatric illnesses in which aspirin therapy is warranted due to its antiplatelet and anti-inflammatory properties.)

coronary aneurysms and subsequent occlusion Tell parents this is being given to prevent heart disease.

Treatment of hypokalemia may require an IV infusion of potassium chloride (KCL). IV infusion of potassium must be administered via a pump to prevent too rapid infusion b/c

could cause cardiac arrest.

Tetralogy of Fallot (TOF) is a

cyanotic congenital heart defect. Right-sided (venous) blood is shunted through the left ventricle via the ventricular septal defect due to the resistance at the pulmonary artery (pulmonary stenosis, one of the components of TOF). This will cause abnormally low oxygen saturation (often in the range of 65%-85%), which is expected until the defect is repaired surgically.

Thrombin inhibitors such as_________________________ reduce the risk for clots and stroke in clients with chronic atrial fibrillation. The nurse should teach the client to use bleeding precautions and monitor for symptoms of bleeding, swallow capsules whole with a full glass of water, and keep capsules in their original container until time of use.

dabigatran

Nausea, vomiting, or slow pulse rate can indicate .

digoxin toxicity

Lyme disease develops after a bite from a tick infected with Borrelia burgdorferi. Initial symptoms are flu-like (eg, headache, fever, myalgia, fatigue). Many clients develop a bull's-eye rash; however, it is not always present. How will TX:

doxycycline, amoxicillin

Nursing care of clients receiving IV vancomycin includes:

drawing prescribed trough levels before drug administration, infusing the drug over at least 60 minutes, monitoring the client during administration (eg, blood pressure, respiratory status, signs of hypersensitivity/anaphylaxis), and assessing the IV site during and after administration

priority over the daily need to increased fluids for the nurse to educate the client taking allopurinol

drinking a full glass of water with each dose and increasing overall fluid intake. Increased fluids help to prevent renal stones and promote diuresis and uric acid excretion.

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 [16%] 2. Hypokalemia [49%] 3. Nephrotoxicity [15%] 4. Ototoxicity [18%] Omitted Correct answer 4 Answered correctly Explanation: IV furosemide may cause ototoxicity, particularly when high doses are administered in clients with compromised renal function. The rate of administration should not exceed 4 mg/min in doses >120 mg. To determine the correct rate of administration for the dose above, use the following formula: (160 mg) / (4 mg/min) = 40 min (Option 1) Bradycardia is an adverse effect of beta blockers (eg, metoprolol, atenolol), calcium channel blockers (eg, verapamil), and digoxin. It is not an adverse effect of furosemide. (Option 2) Hypokalemia is common with furosemide administration due to the potassium-wasting effects of this loop diuretic. However, slower infusion is unlikely to prevent this adverse effect. (Option 3) Although nephrotoxicity can occur with IV furosemide administration, it is dependent on the dose, not the rate of administration. Educational objective: High doses of IV furosemide should be administered slowly to prevent ototoxicity.

e 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 Omitted Correct answer 1,2,5 Answered correctly Explanation: Antiplatelet therapy (eg, aspirin, clopidogrel, prasugrel, ticagrelor) is initiated to prevent platelet aggregation in clients at risk for myocardial infarction, stroke, or other thrombotic events. This therapy increases bleeding risk, so clients should be assessed for bruising, tarry stools, and other signs of bleeding (eg, hematuria, bleeding gums, epistaxis) (Options 1 and 2). Clients should be taught to self-monitor for these signs. In addition, clopidogrel may cause thrombotic thrombocytopenic purpura, so platelets should be monitored periodically (Option 5). (Option 3) Monitoring intake and output is indicated while a client is on diuretic medications (eg, furosemide, torsemide, bumetanide) but not for antiplatelet agents. (Option 4) Baseline liver enzymes are obtained for clients taking statins (eg, rosuvastatin, atorvastatin) and isoniazid (for tuberculosis). Elevated liver enzymes are an infrequent side effect of clopidogrel, and regular monitoring is usually not required in clients without hepatic impairment. Educational objective: Antiplatelet therapy (eg, aspirin, clopidogrel, prasugrel, ticagrelor) can pose a risk for serious bleeding. Clients should be monitored for bruising, signs of bleeding (eg, tarry stools, hematuria), and decreased platelet counts.

Defibrillation is not indicated when

electrical activity is absent (asystole) or when pulseless electrical activity is present.

Following permanent pacemaker insertion, the nurse should assess for electrical and mechanical capture. e. Mechanical capture is

electrical and mechanical capture

During sodium polystyrene sulfonate therapy, severe hypokalemia (palpitations, lethargy, cramping) can develop. RN will need to MONITOR Frequent

electrolyte status Because potassium exchanges with sodium content of the resin, excess sodium absorption could put clients at risk of developing volume overload (water follows sodium). fluid overload (eg, crackles, jugular venous distension, edema) and have daily weights and intake and output assessment bedside commode frequent stools watch skin intergerty

What holds the highest priority for intervention when a client is experiencing chest pain.

elevated troponin value positive troponin levels are indicative of myocardial injury and require immediate attention by the nurse. Normal values are <0.5 ng/mL (<0.5 mcg/L) for troponin I and <0.1 ng/mL (<0.1 mcg/L) for troponin T.

S/S of KD and NI

expected finding: Polymorphous rash of the trunk and extremities is an in a child with KD. Lymphadenopathy (usually a single palpable anterior cervical node >1.5 cm) splenomegaly NI:Cool compresses, unscented lotions, and loose-fitting clothing can minimize discomfort. expected finding

The electronic record is a legal document and should contain

factual, descriptive, objective information that the nurse sees, feels, hears, and smells. It must include direct observation and measurement.

Influenza (flu) is a contagious viral infection that affects the nose, throat, and lungs. Symptoms of flu include

fever and chills, severe muscle aches, headache, cough, sore throat, nasal congestion, and general malaise.

Multiple tender points are characteristic

fibromyalgia

Open aneurysm repair involves a large abdominal incision and requires cross-clamping the aorta proximally and distally to the aneurysm. Establishing baseline data is essential .

for comparison with postoperative assessments the nurse should pay special attention to the character and quality of peripheral pulses and renal and neurologic status. Dorsalis pedis and posterior tibial pulse sites should be marked for easy location postoperatively. A decreased or absent pulse with cool, pale, mottled, or painful extremity postoperatively can indicate embolization or graft occlusion. Graft occlusion may require reoperation

A client with head trauma is at risk

for increased intracranial pressure due to inflammation and cerebral edema

When elder abuse is suspected, the nurse needs to perform further assessment to validate and confirm any initial findings and to determine the extent of the abuse and/or neglect. Areas of assessment for elder abuse include the client's

general hygiene, clothing, nutritional and hydration status, presence of other injuries, inappropriate medication administration, signs of depression, and other statements suggesting neglect.

Clients experiencing an outbreak of______________ ____________ should abstain from sexual activity when lesions are present and use condoms in future sexual encounters as transmission is possible even in the absence of active lesions.

genital herpes Herpes simplex virus type 2

in the client who has had minimally invasive endovascular repair of an abdominal aneurysmThe nurse needs to monitor

groin puncture sites, peripheral pulses, urine output, and kidney function

The nurse should recognize muscle cramps in the legs as a possible sign of

hypokalemia in the client taking diuretics. Muscle cramps should be reported to the health care provider in anticipation of checking a potassium level, adding a potassium supplement, and instructing the client to eat potassium-rich foods.

hyperglycemia / diabetic ketoacidosis results in osmotic diuresis and dehydration. TX:

immediate initial treatment is IV fluid resuscitation with isotonic 0.9% sodium chloride to replace fluid losses, stabilize vital signs, reestablish urine output, and dilute the serum glucose concentration before initiating insulin therapy.

Incentive spirometry is recommended in postoperative clients to prevent atelectasis associated with

incisional pain, especially in upper abdominal incisions (close to the diaphragm)

Following thoracentesis, the nurse should monitor for signs of pneumothorax Which could turn into a Tension pneumothorax

increased respiratory rate, increased respiratory effort, respiratory distress, low oxygen saturation, and absent breath sounds on the side where the procedure was done (where the lung is collapsed). Tension pneumothorax may also develop, with tracheal shift to the unaffected side, severe respiratory distress, and cardiovascular compromise. Altered level of consciousness may occur due to decreased oxygenation and blood flow to the brain . A tension pneumothorax may be prevented by early detection of pneumothorax through appropriate monitoring..

Absent or decreased volume in the peripheral pulses distal to the graft can

indicate compromised circulation or graft occlusion and should be reported to the health care provider immediately!!!!! ABC!

Acute cholecystitis Expected S/S NI The client is scheduled for surgery and is likely on antibiotics. Even if the client is not on antibiotics, neutropenia is a priority over acute cholecystitis

inflammation of the gallbladder s/s upper quadrant pain that can radiate to the right shoulder, nausea, vomiting, fever, and leukocytosis NI:The client is scheduled for surgery and is likely on antibiotics

antiplatelet drugs are different from anticoagulants bc:

inhibit platelet aggregation (clumping together) and anticoagulants inhibit the coagulation cascade by clotting factors that happens after the initial platelet aggregation

Peripheral arterial disease (PAD)

is a chronic, atherosclerotic disease caused by buildup of plaque within the arteries. PAD commonly affects the lower extremities and can lead to tissue necrosis (gangrene).

Mantoux test,

is administered to screen for tuberculosis (TB). The forearm is injected with 0.1 mL of the PPD, and the client returns in 48-72 hours to have the site assessed for induration (a raised area). Redness alone is not read as a positive response. An area of induration >15 mm is considered a positive response in any client (Option 1). However, a positive PPD test does not mean that the client has active TB infection but rather that the client has been exposed to TB and has developed an immune response.

Rhabdomyolysis ( ass. with statin meds)

is the breakdown of muscle tissue that leads to the release of muscle fiber contents into the blood These substances can be harmful to the kidney and often cause kidney damage. The client should immediately report any signs of muscle aches or weakness to the HCP. These could be early signs of rhabdomyolysis, which can be fatal.

How does radioactive iodine (RAI) treat Hyperthyroidism?

it destroys or damages the thyroid gland (or a part of it).

Torsades de pointes

it is a lethal cardiac arrhythmia that leads to decreased cardiac output and can develop quickly into ventricular fibrillation

Major side effects of metformin are

lactic acidosis and gastrointestinal disturbances (metallic taste in the mouth, nausea, and diarrhea).

Epistaxis can often be prevented by avoiding

local trauma and maintaining hydration of the mucosa with saline nasal spray or a humidifier.

how will rn perform a thorough pain assessment

location, quality, radiation, severity, and associated factors (eg, nausea, diaphoresis) for the severe pain. The assessment data will guide the nurse's subsequent interventions

The dawn phenomenon, sometimes called the dawn effect, is an early-morning (usually between 2 a.m. and 8 a.m.) increase in blood sugar (glucose)

managed in many patients by avoiding carbohydrate intake at bedtime, adjusting the dosage of medication or insulin, switching to a different medication, or by using an insulin pump to administer extra insulin during early-morning hours.

What S/S would RN know are adverse effects pt. on Methotrexate?

marrow suppression can lead to anemia, leukopenia, and thrombocytopenia. Anemia manifests as fatigue, dyspnea on exertion, and pallor. Leukopenia increases the risk for infection. Thrombocytopenia presents as petechiae, purpura, or bleeding. Petechiae are small, purplish hemorrhagic skin spots that occur when the platelet count is <150,000/mm3 Bone marrow suppression is managed with dose reduction or discontinuation of the medication.

Black cohosh is used by some clients for

menopausal hot flashes

In neonatal resuscitation, the nurse's fingers/thumbs are placed at the

middle third of the sternum, slightly below the nipple line. The xiphoid portion of the sternum should not be compressed as it may damage the neonate's liver.

Sodium polystyrene sulfonate (Kayexalate) is used to treat

mild to moderate hyperkalemia. Potassium is exchanged for sodium in the intestines and excreted in the stool, thereby lowering the serum potassium.

When teaching a client about risk factor modification related to CAD development, the nurse should focus on

modifiable risk factors such as control of hypertension, diabetes, elevated serum lipid levels, cessation of tobacco use, reduction of BMI if client is overweight, increase in physical activity, and management of psychological state.

The half-life of naloxone (Narcan) is shorter than most narcotics. When naloxone is used to reverse the effects of narcotics, the nurse must

monitor the client to ensure that the client does not fall again into excessive sedation and/or respiratory depression.

Hydrochlorothiazide and chlorthalidone are the

most commonly used thiazide diuretics for treating hypertension

Kawasaki disease (KD), also known as, is characterized by Coronary artery aneurysms are the most serious potential sequelae in untreated clients, leading to complications such as myocardial infarction and death. Echocardiography is used to monitor these cardiovascular complications

mucocutaneous lymph node syndrome

Epistaxis CAUSES

mucosal irritation from dryness, local injury (eg, nose-picking), a foreign body, or rhinitis. Most bleeding arises from a highly vascular network on the anterior nasal septum. Epistaxis generally resolves spontaneously or with simple home management.

.The nurse should teach all clients taking statin drugs (eg, atorvastatin, rosuvastatin) to immediately report any

muscle aches or weakness, as these can lead to rhabdomyolysis, a muscle disintegration that can cause serious kidney injury.

Cyclobenzaprine (Flexeril) is a common, centrally acting skeletal muscle relaxant prescribed for

muscle spasticity, muscle rigidity, and acute or chronic muscle pain/injury.

They can be characterized as sounds:

musical, blowing, swooshing, or rasping sounds heard between normal heart sounds

TEACH PT. ON Warfarin

must be taken at the same time daily to reach a therapeutic INR of 2-3. A diet high in vitamin K may decrease warfarin's anticoagulant effect. Most antibiotics will increase INR by causing a vitamin K deficiency.

Clients receiving sodium polystyrene sulfonate

must have normal bowel function to avoid the risk of intestinal necrosis. The nurse must assess for constipation, signs of impaction, and recent bowel patterns.

Digoxin is a potentially dangerous drug due to its

narrow margin of safety in dosage

What are the early signs of Digoxin (Lanoxin) toxicity?

nausea and vomiting

The early symptoms of dig toxicity are nausea and vomiting. L

nausea and vomiting.

Ondansetron may be administered for

nausea symptoms.

after a A large anterior wall MI the nurse should monitor for

new development of pulmonary congestion on x-ray, auscultation of a new S3 heart sound, crackles on auscultation of breath sounds, or jugular venous distension can signal heart failure and should be reported immediately to the hcp

Rest from activities that aggravate pain and inflammation is a

nonpharmacologic comfort intervention to decrease the inflammation due to acute pain.

Naproxen indomethacin, ibuprofen

nonsteroidal anti-inflammatory drug (NSAID) commonly prescribed to decrease joint pain and inflammation.

Signs of adequate hydration are

normal urine specific gravity (1.003 to 1.030), adequate volume of urine output (>30 mL/hr), and capillary refill of less than 3 seconds. Pulse pressure narrows in shock, and positive orthostatic vital signs (decreasing systolic blood pressure and rising heart rate) with position change indicate dehydration.

Epistaxis,

nosebleed, is rarely serious and is usually due to

The outcomes of a quality improvement program should be .

objective and measureable

Coarctation of the aorta (COA) is an

obstructive congenital heart defect resulting in decreased cardiac output. Children with COA will have stronger pulses in the upper extremities and diminished pulses in the lower extremities. This is expected until the obstruction is repaired surgically.

patent ductus arteriosus (PDA)

occurs when fetal circulation persists after birth. A continuous machinery-like murmur is a normal finding with a PDA.

After a liver biopsy, the client should lie on the right side for a minimum

of 2 hours (to apply pressure and splint the puncture site) and then supine for an additional 12-14 hours. The risk for bleeding is increased due to the high vascularity of the liver, but correct positioning reduces this risk.

Isosorbide mononitrate is a nitrate-class drug used for the prophylactic treatment

of angina pectoris; that is, it is taken in order to prevent or at least reduce the occurrence of angina

Thrombin inhibitors such as dabigatran (Pradaxa) reduce the risk.

of clot formation and stroke in clients with chronic atrial fibrillation

pt. taking an inhaled corticosteroid (eg, budesonide, fluticasone) are at increased risk for : TEACH:

oral candidiasis To reduce this risk, the client should rinse the mouth after each inhaled dose and maintain good oral hygiene.

Solifenacin (VESicare) is a cholinergic antagonist prescribed to treat. Common expected adverse effects include dry mouth and constipation. The nurse should caution the client about safety when performing activities until the response to the medication is determined, as it can also cause dizziness and blurred vision. This is not a medical emergency. Educational objective:

overactive bladder (eg, urge incontinence, frequency).

When there is new, sudden onset of restlessness/agitation, the nurse should first think about

oxygenation (or blood glucose).

Signs of graft leakage that are important to monitor after repair of an abdominal aortic aneurysm include

pain in the back, pelvis, or groin; ecchymosis of the groin, scrotum, or penis; tachycardia; weak or absent peripheral pulses; decreasing hematocrit and hemoglobin; increased abdominal girth; and decreased urinary output.

Tamponade, a serious complication of

pericardial effusion, develops as the effusion increases in volume and results in compression of the heart. The heart struggles to contract effectively against the fluid, and cardiac output can decrease drastically. This life-threatening complication requires an emergency pericardiocentesis (a needle inserted into the pericardial sac to remove fluid).

New onset of dependent edema in an elderly client ;assessment finding requires immediate intervention why?

possible heart failure the client needs further assessment for characteristic signs such as lung crackles and increased body weight (fluid retention)

after abdonminal aortic aneurysm are sugically repaired RN will monitor?

postoperatively for graft leakage and hemodynamic stability. Adequate blood pressure is necessary to maintain graft patency, and prolonged hypotension can lead to the formation of graft thrombosis

General guidelines are to hold digoxin in infants and young children

pulse <90-110/min

Sodium polystyrene sulfonate (Kayexalate) is a sodium exchange resin administered to

reduce elevated serum potassium levels in clients with chronic kidney disease and hyperkalemia

Postoperative blood loss >100 mL/hr should be

reported to the HCP immediately. The client may have a compromised suture site and can rapidly become hemodynamically unstable

Abdominal examination is done in the following sequence - stand on

right side, inspect, auscultate, percuss, then palpate.

What does a elevated CVP can indicate

right ventricular failure or fluid volume overload.

RN TX: for Jehovah's Witnessess who is lossing blood will be givein?

saline, lactated Ringer's, dextran, and hetastarch Recombinant human erythropoietin (eg, epoetin alfa) and IV iron

Atrial flutter is characterized by

sawtooth-shaped flutter waves.

When walking with a client who is legally blind, the nurse uses the sighted-guide technique by walking

slightly ahead of the client with the client holding the nurse's elbow.

The nurse should watch for signs and symptoms of electrolyte imbalances (hypokalemia), dehydration, and metabolic alkalosis pt. with

small bowel obstruction.

When communicating with clients who have hearing loss,

speak loudly, stand close to the person, and touch the person before speaking

Muscle cramps and liver injury, are the major adverse effects of

statin medications (eg, atorvastatin).

interventions to prevent wound dehiscence include use of

stool softeners and antiemetics, application of an abdominal binder, and tight blood glucose control.

The nurse should report______________________________________ immediately in a client with a thoracic aortic aneurysm. This could indicate that the aneurysm has increased in size and may require treatment.

swallowing difficulty

Transcutaneous pacing or infusion of dopamine or epinephrine may be considered if atropine is ineffective in

symptomatic bradycardia

When should Isosorbide be held?

systolic blood pressure is <90 mm Hg. Perfusion to the kidneys is inadequate if the systolic blood pressure is <80 mm Hg. Because the pressure is so low, the nurse does not want to lower it further by giving the drug.

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. 1. Administer PRN morphine [5%] 2. Administer PRN sublingual nitroglycerin [51%] 3. Apply a new transdermal nitroglycerin patch [25%] 4. Obtain a 12-lead electrocardiogram [17%] Omitted Correct answer 2 Explanation: Angina is chest pain due to myocardial ischemia. A client with chronic stable angina experiences intermittent chest pain relieved with rest or administration of nitroglycerin. The priority action for acute angina is administration of rapid-acting (1-3 minutes) sublingual nitroglycerin to restore cardiac perfusion. Nitroglycerin is a vasodilator that decreases cardiac workload (decreasing oxygen consumption), reduces preload, and increases myocardial perfusion. Onset and duration of action of nitroglycerin varies with route of administration. (Option 1) Morphine sulfate relieves pain and has a mild vasodilator effect that decreases cardiac workload. Morphine is given if nitroglycerin does not relieve chest pain. (Option 3) Transdermal nitroglycerin patches have a delayed onset of action (40-60 minutes) and are not effective in the treatment of acute anginal pain. If a patch is accidentally removed, a new one may be applied after the nurse first administers sublingual nitroglycerin. (Option 4) A client with known stable angina is expected to have exertional chest pain if the pain is not prevented with nitroglycerin (eg, transdermal patch, prophylactic sublingual dose). Restoration of myocardial perfusion with sublingual nitroglycerin should not be delayed to obtain an electrocardiogram (ECG). The nurse should consider obtaining an ECG and implementing emergency measures if the pain does not resolve after 3 doses of sublingual nitroglycerin (unstable angina). Educational objective: Acute stable angina is managed with nitroglycerin, which causes vasodilation and restores myocardial perfusion. Sublingual nitroglycerin has a rapid onset and is used to treat acute angina by increasing myocardial perfusion; transdermal patches have a delayed onset and are used prophylactically.

t A nurse receives an electrocardiogram of a client with type 2 diabetes, heart failure, and hypothyroidism. Based on the findings, which of the following medications should the nurse suspect as the most likely cause? Click the exhibit button for more information. 1. Captopril [19%] 2. Carvedilol [60%] 3. Glimepiride [5%] 4. Levothyroxine [13%] Omitted Correct answer 2 Explanation: The client has sinus bradycardia, which can be caused by: Drugs (eg, beta blockers, calcium channel blockers, digoxin). Consider withholding beta blockers if systolic blood pressure <100 mm Hg or heart rate <60 and notify the provider. Vagal stimulation (eg, carotid sinus massage, Valsalva maneuver) Diseases (eg, hypothyroidism, myocardial infarction, increased intracranial pressure) The clinical significance of sinus bradycardia depends on how the client tolerates the effect of slow heart rate on cardiac output. Sinus bradycardia is usually asymptomatic. However, symptomatic bradycardia can manifest as pale, cool skin; hypotension; weakness; confusion; dyspnea; chest pain; and syncope. (Options 1, 3, and 4) The side effects of these drugs include tachycardia (Table). Educational objective: Sinus bradycardia may be caused by drugs (eg, beta blockers), vagal stimulation, hypothyroidism, inferior wall myocardial infarction, and increased intracranial pressure. It is normal in some people (eg, trained athletes).

impaired myocardial pumping S/S

tachycardia cool/pale extremities weak peripheral pulses decreased BP decreased urine output activity intolerance/ weakness and fatigue Loss of appetite

Clients with any form of prosthetic material in their heart valves or who have unrepaired cyanotic congenital heart defect or prior history of IE should

take prophylactic antibiotics prior to dental procedures to prevent development of IE.

First responders (EMS providers) may remove the impaled object if it obstructs

the airway and prevents effective cardiopulmonary resuscitation.

During a lumbar puncture, the client is positioned side-lying, with the head, back, and knees flexed. A small pillow may be placed between the legs and under the head for comfort and to maintain the spine in a horizontal position. Following the procedure,

the client will be positioned according to the health care provider's prescription (usually supine or with head of the bed elevated 30 degrees).

Adequacy of tissue perfusion in a client with shock syndrome and possible organ dysfunction is assessed by

the level of consciousness, urine output, capillary refill, peripheral sensation, skin color, extremity temperature, and peripheral pulses

Sepsis is a complication of pneumonia that can progress to septic shock and/or multisystem organ dysfunction syndrome. To limit progression,

the nurse assesses oxygenation (pulse oximeter, arterial blood gases), airway (patency), breathing (respiratory pattern and rate), circulation (vital signs), tissue perfusion (eg, level of consciousness, capillary refill, skin temperature and color, bowel sounds), and urine output.

Gentle, continuous bubbling in the suction control chamber of a chest tube drainage unit indicates

the presence of suction in the system and is an expected finding.

Isotretinoin is a vitamin A derivative prescribed to treat severe and/or cystic acne. Side effects include birth defects, skin changes (eg, dry skin, skin fragility, cutaneous atrophy), and risk for increased intracranial pressure. Clients need to be instructed

to avoid tetracycline, excess sun and tanning, and vitamin A supplements. Women of child-bearing age should use 2 forms of contraception to prevent pregnancy.

Once children with KD are discharged home, parents should be instructed

to check their temperature every 6 hours for the first 48 hours following the last fever and then daily until the follow-up visit. The health care provider should be notified if the child has fever as this may indicate a need for further treatment.

RN Will teach pt on anitchloinergic to

to prevent these side effects increasing intake of fluids bulk-forming foods (prevents dry mouth and constipation) avoiding locations or activities that may lead to hyperthermia.

NTG is a vasodilator used to treat stable angina. It is a sublingual tablet or spray that is placed

under the client's tongue. It usually relieves pain in about 3 minutes and lasts 30-40 minutes. The recommended dose is 1 tablet or 1 spray taken sublingually for angina every 5 minutes for a maximum of 3 doses (Option 2). If symptoms are unchanged or worse 5 minutes after the first dose, emergency medical services (EMS) should be contacted

During a thoracentesis, a needle is inserted into the pleural space to remove fluid for diagnostic or therapeutic purposes. Before the procedure, the nurse places the client in an

upright sitting position on the side of the bed, leaning forward over the bedside table, with arms supported on pillows. This position ensures that the diaphragm is dependent, facilitates access to the pleural space through the intercostal spaces, and promotes client comfort.

Treatment PSVT

vagal maneuvers such as Valsalva, coughing, and carotid massage Beta blockers, calcium channel blockers, and amiodarone can also be considered as alternatives.

How will RN assess for mechanical capture

verified by palpating the client's pulse rate and comparing it to the heart rate recorded by the cardiac monitor.

Due to its very short half-life, adenosine is administered rapidly An increased dose may be given twice if previous administration is ineffective. Beta blockers, calcium channel blockers, and amiodarone can also be considered as alternatives. If vagal maneuvers and drug therapy are unsuccessful, synchronized cardioversion may be used.

via IVP over 1-2 seconds and followed by a 20-mL saline bolus. An increased dose may be given twice if previous administration is ineffective. Beta blockers, calcium channel blockers, and amiodarone can also be considered as alternatives. If vagal maneuvers and drug therapy are unsuccessful, synchronized cardioversion may be used.

Abdominal aortic aneurysms are surgically repaired when they measure about 6 cm or are causing symptoms. Repair can be done via femoral percutaneous placement of a stent graft (endovascular aneurysm repair) or The client must be monitored. Signs of graft leakage include a decreasing blood pressure and increasing pulse rate

via femoral percutaneous placement of a stent graft (endovascular aneurysm repair) or via an open surgical incision of the aneurysm with synthetic graft placement.

When caring for the client on a ventilator, the nurse may consider delegating the following tasks to unlicensed assistive personnel:

vital sign measurement, oral care, personal hygiene, blood glucose testing, passive or active range-of-motion exercises, and measurement of urine output

Educational objective: The topical analgesic capsaicin relieves minor peripheral pain (eg, osteoarthritis, neuralgia) with regular use. Local irritation (burning, stinging, erythema) is quite common. The client should

wait at least 30 minutes before washing the affected area to ensure adequate absorption.

INR is monitored if the client is receiving

warfarin.

The nurse should be concerned about the presence of_________________________________ in a client taking a nonselective beta-blocker like propranolol.

wheezing Wheezing may indicate bronchoconstriction or bronchospasm. The nurse should assess for any history of asthma or other respiratory problems and report to the HCP.

The unstable client in VT with a pulse is treated

with synchronized cardioversion. The stable client in VT with a pulse is treated with antiarrhythmic medications (eg, amiodarone, procainamide, sotalol).

Kawasaki disease (KD), is characterized by

≥5 days of fever, bilateral nonexudative conjunctivitis, mucositis, cervical lymphadenopathy, rash, and extremity swelling.

creatinine normal

0.6-1.3 mg/dL

A normal hemoglobin level of in adult men;

13.2-17.3 g/dL

streptococcal pharyngitis complication

2-3 weeks after. RF (rheumatic fever) is an acute inflammatory disease of the heart

Gangrene of the foot is a complication of ________ ________ ______ associated with decreased blood flow to the extremity.

peripheral arterial disease (PAD)

The client is exhibiting signs and symptoms OF fever, chills, nausea ,subnormal body temperature instead of fever, hypotension, tachycardia, decreased urine output, and confusion

The client is exhibiting signs and symptoms of septicemia (blood infection)

When the infection ascends to the kidneys (pyelonephritis), clients become very ill. What are the EXPECTED S/S & HALLMARK SIGN upon ASS:

They develop nausea, vomiting, fever with chills, and flank pain Assessment shows costovertebral angle tenderness clients can become septic

Serum vancomycin trough level is monitored before the 4th dose (15-20 mg/L [10.4-13.8 µmol/L] is optimal) OF

Vancomycin

potentially serious complication of SLE

lupus nephritis (occurring in 50%) NI: Early recognition and aggressive immunosuppressive treatment are essential to preserve renal function and prevent irreversible kidney damage

Immediate postoperative nursing care focuses on

management of the airway, breathing, circulation, bleeding, and pain.

Before administering this VANCOMYCIN, the nurse should The normal range for BUN is 6-20 mg/dL (2.1-7.1 mmol/L) and creatinine is 0.6-1.3 mg/dL (53-115 µmol/L).

notify the HCP that the client's BUN and creatinine are increased.

A client with LTBI who begins treatment with a corticosteroid (Prednisone) is at increased risk for conversion to active TB disease. Therefore, the nurse should recognize this and:

notify the HCP.

IF dislodgement, the nurse should

notify the health care provider who placed the PEG tube as early dislodgement (ie, <7 days from placement) requires either surgical or endoscopic replacement DO NOT: Attemptto reinsert a tube through an immature tract can result in improper placement into the peritoneal cavity, leading to peritonitis and sepsis!!!!!!!

When signs of infection or sepsis occur, the nurse should

obtain cultures prior to antibiotic administration. Identification of the specific pathogen helps the HCP determine the best antibiotic for treatment. If the culture is obtained after antibiotic administration, the culture results will be altered.

The nurse receives report on 4 clients. Which client should the nurse see first? 1. Client admitted 12 hours ago with acute asthma exacerbation who needs a dose of IV methylprednisolone [21%] 2. Client admitted 2 days ago with congestive heart failure who is reporting shortness of breath and had an extra dose of furosemide prescribed recently [55%] 3. Client admitted with intestinal obstruction who is reporting abdominal pain and distention and needs nasogastric tube placement [17%] 4. Client who had cardiac valve surgery 8 days ago but was readmitted with a sternal wound infection and needs antibiotics and a dressing change [6%]

Although it is not a STAT order, an extra dose of furosemide was prescribed for the client with congestive heart failure. The shortness of breath is most likely due to a change in fluid status, and this client is the priority. Furosemide works immediately and should be given urgently. (Option 1) Even though this client has asthma exacerbation, steroids (methylprednisolone [Solu-Medrol]) do not show their effect immediately. These drugs control underlying inflammation but take several hours/days to take effect. Bronchodilators such as albuterol or ipratropium work immediately. Educational objective: A client who is experiencing symptoms that could compromise airway, breathing, or circulation should be seen first.

descending flaccid paralysis (starting from the face), dysphagia, and constipation (smooth muscle paralysis).

Botulism (The main source is improperly canned or stored food)

the inability of the leg veins to efficiently pump blood back to the heart. It can lead to venous stasis, increased hydrostatic pressure, and venous leg ulcers. Edema and thick skin with brown pigmentation are expected manifestations

Chronic venous insufficiency

60-year-old with chronic kidney disease who has a blood pressure of 168/88 mm Hg, serum creatinine level of 5.0 mg/dL (442 µmol/L), and reports nausea and itching [15%]

EXPECTED Hypertension, elevated serum creatinine level (normal: 0.6-1.3 mg/dL [53-115 µmol/L]), nausea associated with azotemia, and pruritus associated with dry skin are expected for chronic kidney disease clients.

is a gastrointestinal anti-inflammatory medication used to treat IBD

Sulfasalazine (Azulfidine)

an autoimmune disorder in which an abnormal immune response leads to chronic inflammation of different parts of the body. Ranges in severity from mild: eg, affecting skin, muscles, joints to severe: eg, affecting kidneys, heart, lung, blood vessels, central nervous system) disease. I

Systemic lupus erythematosus (SLE)

A 59-year-old client comes to the clinic due to a blistering, linear rash on the left chest. The client reports itching and pain around the rash. What is the priority question for the nurse to ask the client? 1. "Did the rash start after taking a new medication?" 2. "Have you been keeping the rash covered?" 3. " 4. "What have you tried to help the pain?" Correct Answered correctly

Have you ever had chickenpox?" {NI} f this rash is determined to be due to shingles, the affected area should be covered to prevent the spread of infection. Therefore, it is a priority to ask if this client has had chickenpox. AIRBORN ISOLATION N-95

A pt with SLE has Anemia, mild leukopenia, thrombocytopenia, Lupus nephritis, which is the GREATEST CONCERN?

Increased serum creatinine >1.3 mg/dL, increased blood urea nitrogen >20 mg/dL, and an abnormal urinalysis can indicate the presence of LUPUS NEPHRITIS potentially serious complication of SLE in which inflammation of the kidney can lead to renal injury. Early recognition and treatment are essential to preserve renal function and prevent irreversible kidney damage.

Sjögren's syndrome NI

Treatment with over-the-counter, preservative-free artificial tears can relieve eye dryness, burning, itching, irritation, pain, and a gritty sensation in the eyes. Wearing goggles can protect the eyes from outdoor wind and dust. Dry mouth is treated with artificial saliva. Using a room humidifier and not sitting in front of fans and air vents can also help

early recognition of sepsis is critical to survival, atypical presentation associated with immunosenescence and absence of fever can delay diagnosis and treatment.

early sepsis

cystis Expected S/S

hyperemia tissue hemorrhage pus formation This inflammatory process leads to burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfort

Femoral-popliteal bypass surgery

involves circumventing a blockage in the femoral artery with a synthetic or autogenous (artery or vein) graft to restore blood flow.

cystitis

is the most common community-acquired UTI. It is an infection of the lower urinary tract and involves inflammation of the bladder mucosa, leading to hyperemia, tissue hemorrhage, and pus formation. This inflammatory process leads to burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfort (

diagnosed with SLE

positive antinuclear antibody (ANA) titer (>1:40) indicates the presence of ANAs, which the body produces against it own DNA and nuclear material

Pulmonary fibrosis is a progressive complication of that is defined as scarring of lung tissue, which then causes reduced function, dry cough, and dyspnea. Some clients may be placed on oxygen. This is not immediately life-threatening.

scleroderma

Vancomycin is a glycopeptide antibiotic that is excreted by the kidneys. It is used to treat

serious infections with gram-positive microorganisms (Staphylococcus aureus [methicillin-resistant Staphylococcus aureus]) and diarrhea associated with Clostridium difficile.

Children under age 1 year should not be given honey b/c

their immature gut system makes them prone to developing infant botulism.

A pt. who has Malignancy, immunosuppressant medications, including chemotherapy, and prolonged debilitating disease (eg, HIV), is at RISK convert LATENT TB infection

to active disease

Isotonic IV solutions (eg, 0.9% sodium chloride, lactated Ringer's) have the same osmolality as plasma and are administered

to expand intravascular fluid volume. TX: vomiting and diarrhea, burns, and traumatic injury.

Urinary tract infections (UTIs) are (Options 1 and 2) When the infection ascends to the kidneys (pyelonephritis), clients become very ill. They develop nausea, vomiting, fever with chills, and flank pain. Assessment shows costovertebral angle tenderness. If the infection is not recognized and treated, clients can become septic. Educational objective: Cystitis is an infection of the bladder mucosa. Clients develop burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfort. However, if the infection extends to the kidneys (pyelonephritis), clients become seriously ill with nausea, vomiting, fever with chills, and flank pain.

usually bacterial in origin and are most often caused by Escherichia coli

Blood urea nitrogen (BUN) and creatinine levels are monitored regularly (usually 2-3 times/week) in clients receiving the drug due to increased risk of nephrotoxicity, and ototoxicity especially in those

with impaired renal function, receiving aminoglycosides, and who are >60 years old

What works immediately ASTHMA

work immediately ASTHMABronchodilators such as albuterol or ipratropium