Pharm - Archer Review (3/4) - Endocrine, Analgesics, GI/Nutrition, Urinary/Renal and Electrolytes, Respiratory, Integumentary, Musculoskeletal, Visual/Auditory

Choice D is correct. Aspart insulin is a rapid actin insulin that should be administered to the client no greater than 10-15 minutes prior to the meal or while the client is actively eating. Prior to the administration of this insulin, the client's blood glucose should be obtained.

The nurse is educating a client about newly prescribed aspart insulin. The nurse should instruct the client to self-administer this insulin A. 30-45 minutes before a meal. B. one hour after a meal. C. 20-30 minutes before a meal. D. 10-15 minutes before a meal.

Choice D is correct. Scleroderma is a medical condition that causes fibrosis to the connective tissue. This multisystem disorder causes many clinical manifestations, including skin thickening and hardening (taut and shiny), vasospasms of the digits, arthritis, muscle stiffness, significant fatigue, dysphagia, esophageal reflux, and an insult to the kidneys that may lead to renal failure.

The nurse is assessing a client with scleroderma. Which of the following would be an expected finding? A. Tophi B. Janeway lesions C. Shuffling gait D. Taut and shiny skin

Choice B is correct. Mechanical ventilation may cause a stress ulcer. A proton pump inhibitor (PPI) or a histamine-2 receptor antagonist (H2 blocker) may be utilized to prevent this ulcer which may lead to a gastrointestinal bleed.

The nurse is caring for a client receiving mechanical ventilation. Which prescription from the primary healthcare physician (PHCP) should the nurse anticipate? A. hydroxyzine B. pantoprazole C. rivastigmine D. verapamil

Choices A and E are correct. When a client experiences a myxedema coma, it is because of severe hypothyroidism. These dangerously low levels of thyroid hormone produce symptoms such as altered level of consciousness, hyponatremia, hypothermia, hypoventilation, and hypoglycemia. Treatment is essential and is geared towards the prompt administration of intravenous levothyroxine and liothyronine. Glucocorticoids are usually added to the treatment to help mitigate the hypotension and potential overlook of adrenal dysfunction.

The nurse is caring for a client diagnosed with a myxedema coma. The nurse should anticipate a prescription for which of the following medications? Select all that apply. Levothyroxine Methimazole Tolvaptan Hydrochlorothiazide Hydrocortisone

Choice D is correct. This type of pain with an abrupt onset would best respond to opioid analgesics. Hydromorphone is a potent opioid (one milligram of hydromorphone equates to six milligrams of morphine) that, when given intravenously, provides rapid onset and relief. Prior to administering any opioid, the nurse should assess the client's level of consciousness, respiratory rate, and blood pressure.

The nurse is caring for a client reporting an abrupt onset of severe pain associated with metastatic cancer. The nurse reviews the client's current prescriptions and plans to administer A. Fentanyl via transdermal patch B. Pregabalin C. Ketorolac D. Hydromorphone

Choice C is correct. Oxaprozin is a non-steroidal anti-inflammatory drug (NSAID). This drug is effective in osteoarthritis because this disease causes significant pain, especially when the affected joint is used. Long-term NSAID use may cause renal insufficiency and increase the risk of a gastrointestinal ulcer.

The nurse is caring for a client who has osteoarthritis. Which of the following medications should the nurse expect to be prescribed for the client? A. allopurinol B. etanercept C. oxaprozin D. methotrexate

Choice B is correct. Naproxen should not be administered concomitantly with corticosteroids. These two medications taken together will increase the risk of gastrointestinal bleeding.

The nurse is caring for a client who is receiving newly prescribed prednisone. Which of the following medications should the client avoid while receiving this medication? A. Valsartan B. Naproxen C. Omeprazole D. Acetaminophen

Choices A, B, C, and D are correct. Fentanyl is an opioid analgesic used to manage acute and chronic pain. Common effects associated with this drug include nausea and vomiting, constipation, pruritus, and urinary retention.

The nurse is caring for a client who is receiving prescribed fentanyl. Which of the following findings would indicate the client is having a side effect? Select all that apply. Nausea and vomiting Constipation Pruritus Urinary retention Nystagmus

Choice A is correct. Sevelamer is a phosphate binder indicated in the treatment of hyperphosphatemia associated with chronic kidney disease. This medication is purported to decrease serum phosphorus levels by binding to food. Thus, this medication is given with meals. Combined with a low phosphorus diet, the goal of this medication is to decrease serum phosphate levels.

The nurse receives a prescription for sevelamer. The nurse plans on administering this medication A. with the client's meals. B. immediately before hemodialysis. C. with a prescribed proton pump inhibitor (PPI). D. right before the client goes to bed.

Choice C is correct. Famotidine is a histamine antagonist that prevents the parietal cells from secreting gastric acid. Indications for using famotidine include peptic ulcer disease, esophagitis, and gastric reflux. Other drugs in this class include cimetidine.

The nurse is caring for a client diagnosed with peptic ulcer disease. The nurse anticipates a prescription for which medication? A. ondansetron B. diphenoxylate with atropine C. famotidine D. psyllium

Choice C is correct. Naproxen is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs have been commonly implicated in causing adverse bleeding episodes. Specifically, bleeding in the gastrointestinal tract. All NSAIDs can be ulcerogenic and induce gastrointestinal bleeding due to their activity against tissue COX-1 which causes an inhibition against platelet aggregation.

The nurse is caring for a client taking a prescribed naproxen. The nurse should assess the client for which adverse effect? A. Low blood glucose B. Agitation C. Bleeding D. Nasal congestion

Choices A and C are correct. The client's blood glucose of 360 mg/dL indicates hyperglycemia. The healthcare provider should be notified, and the client should receive ten units of regular insulin subcutaneously.

The nurse is caring for a client with a prescribed subcutaneous (SQ) regular insulin sliding scale. The client's current blood glucose level is 360 mg/dL(70-110 mg/dL). Which of the following actions should the nurse take? See the exhibit. Select all that apply. View Exhibit Notify the primary health care provider (PHCP). Administer 8 units of regular insulin. Administer 10 units of regular insulin. Recheck the client's blood glucose in one hour. Administer the insulin intravenous (IV) push.

Choice B is correct. Hyperglycemia is common with both pancreatitis and the infusion of TPN. The client's blood glucose shows an elevation pattern, but it is not hyperglycemic. The nurse needs to act to maintain normoglycemia. The blood glucose target for a client receiving TPN is less than 180 mg/dL. It is the trend over the course of the three days that causes the nurse to be concerned about this problem. A sliding scale of insulin combined with insulin added to the TPN

The nurse is caring for a client with acute pancreatitis who is receiving total parenteral nutrition (TPN) for three days. After reviewing the client's laboratory data, the nurse should take which action? See the image below. A. Reduce the infusion rate of the TPN. B. Obtain a prescription for sliding scale insulin. C. Assess for signs and symptoms of hyperglycemia. D. Pause the infusion for two hours and then reassess blood glucose.

Choice D is correct. The World Health Organization ( WHO) recommends using NSAIDS and acetaminophen to treat pain before considering opioids. Long term use of NSAIDS can lead to life-threatening complications, such as gastrointestinal system bleeding and renal dysfunction, with long-term use. However, available evidence indicates that the all-cause mortality was higher in patients receiving opioids than other pain medications.

Select the fact about non-steroidal anti-inflammatory drugs (NSAIDs) that is accurate. Which of the following is true about NSAIDs? A. Vary significantly and greatly in terms of their analgesic effects among the different medications in this classification of medications. B. Vary little in terms of their anti-inflammatory effects among the different medications in this classification of medications. C. Cannot be given with an antacid medication because it will interact with the NSAID in terms of its effectiveness. D. Mortality was lesser among patients receiving NSAIDs compared to opioids.

Choice B is correct. Nebulized racemic epinephrine is an effective medication in moderate to severe laryngotracheobronchitis (croup) because it has a rapid onset of action and acts by reducing airway edema. It decreases the stridor and helps to lessen airway obstruction. Racemic epinephrine is given via nebulizer for over fifteen minutes and can be repeated until symptom reduction.

The nurse cares for a child diagnosed with laryngotracheobronchitis who is assessed to have worsening inspiratory stridor with an oxygen saturation of 92% on room air. The nurse should obtain a prescription for which medication? A. Formoterol via dry powder inhaler B. Nebulized racemic epinephrine C. Albuterol via nebulizer D. Oral montelukast

Choice B is correct. This client was administered regular insulin that peaks within two to four hours. Additionally, this client received NPH insulin which peaks within four to twelve hours. It would be appropriate for the nurse to assess the client for hypoglycemia when the regular insulin peaks as it peaks sooner.

The nurse has administered five units of regular insulin and ten units of NPH insulin. After administering both prescribed insulins, the nurse should assess the client for hypoglycemia A. thirty minutes after administration. B. two to four hours after administration.. C. four to six hours after administration.. D. ten to twelve hours after administration..

Choice A is correct. Clients are often given a loading dose of their ordered pain medication before activating their prescribed (on-demand) dosage. For example, if the client has a PCA of morphine established by the nurse, a prescribed loading dose of 2 mg may be ordered and can be administered by the device to optimize pain control.

The nurse has attended a staff development conference regarding patient-controlled analgesia. Which of the following statements by the nurse indicates effective understanding? A. "A client may be prescribed a loading dose before they are able to activate their own prescribed dosage." B. "PCAs are not recommended for individuals with acute pain." C. "PCAs decrease the need for a client to have pain assessments." D. "When a client receives a PCA via a continuous basal rate, it decreases their risk for adverse effects."

Choice B is correct. Insulin degludec is a long-acting insulin and has no peak. This insulin not having a peak does not require that the client take this insulin with a meal. This novel drug is dosed weekly, increasing glucose control via this basal insulin. This statement is incorrect and requires follow-up.

The nurse has instructed a client scheduled for an injection of dulaglutide for diabetes mellitus (type two). Which of the following statements by the client would require follow-up? A. "I should tell my doctor if I experience abdominal pain and vomiting." B. "I should take this medication within one hour of eating a meal." C. "If this medication works, I should notice a reduction in my hemoglobin A1C (HbA1c)." D. "I will receive this medication once a week."

Choice A is correct. Desmopressin can cause severe hyponatremia because it increases antidiuretic hormone, which causes the client to have decreased urinary output, increasing serum water levels. The increased water levels may cause dilutional hyponatremia. The nurse should expect the physician to order a baseline serum sodium level and monitor the level throughout treatment. The client should be educated to report manifestations of hyponatremia, including confusion, lethargy, and muscle weakness.

The nurse has obtained a prescription for desmopressin to treat diabetes insipidus (DI). The nurse understands that it is essential to monitor the clients A. serum sodium level. B. serum glucose. C. serum magnesium level. D. serum calcium level.

Choices A, B, C, and D are correct. A is correct. Risk for infection related to the intravenous line for TPN. TPN is administered via a central venous line or peripherally inserted central catheter (PICC), a potential entry point for pathogens increasing infection risk. B is correct. Imbalanced nutrition: Less than body requirements related to the inability to take food by mouth. The use of TPN indicates that the client cannot receive adequate nutrition orally or through the gastrointestinal tract. TPN prevents or treats nutritional deficiencies in clients who cannot get their nutrition through eating. C is correct. Risk for electrolyte imbalance related to total parenteral nutrition. TPN solutions can significantly alter the client's electrolyte status. The nurse must monitor laboratory values frequently to identify imbalances promptly. D is correct. Risk for fluid volume overload related to administration of TPN solution. Overly rapid administration of TPN or an excessively high volume of the solution may lead to fluid volume overload. The nurse should monitor the client's fluid balance closely.

The nurse in the ICU is caring for a client receiving total parenteral nutrition (TPN). Which nursing diagnoses are essential to include in the care plan? Select all that apply. - Risk for infection related to intravenous line for TPN. - Imbalanced nutrition: Less than body requirements related to inability to take food by mouth. - Risk for electrolyte imbalance related to total parenteral nutrition. - Risk for fluid volume overload related to administration of TPN solution. - Ineffective airway clearance related to total parenteral nutrition (TPN).

Choice D is correct. This is the priority nursing action and should be completed first. Facial flushing can be an early sign of magnesium toxicity, and halting the infusion is the most immediate action to prevent further administration of magnesium and address the potential adverse reaction.

The nurse is administering IV magnesium to a client with a magnesium level of 1.5 mEq/L(1.5-2.5 mEq/L). You check on them halfway through the infusion, and they report that their face feels flushed. What is the prioritynursing intervention? A. Slow down the infusion rate. B. Notify the healthcare provider. C. Reassess the patient when the infusion finishes. D. Stop the infusion.

Choice C is correct. Phosphorous and calcium have an inverse relationship, meaning that as one level rises, the other decreases. Phosphate ions bind with calcium to form insoluble calcium salts in the serum. Therefore, decreasing the serum phosphate increases ionized calcium in the blood. Since this patient has hypocalcemia or low calcium, decreasing serum phosphorus through phosphate-excreting medications will inversely increase serum calcium.

The nurse is administering phosphate excreting medications to her patient with hypocalcemia because she understands what core information about calcium and phosphorous? A. As phosphorous exits the body so does calcium. B. Calcium is managed by the excretion of phosphorous. C. When serum phosphorous decreases, serum calcium increases. D. Phosphorous must be above 4.5 mg/dL before calcium can increase.

Choice B is correct. Gout is a disease that develops when high uric acid levels form crystals that accumulate in joints. Allopurinol is commonly prescribed to decrease uric acid levels, reducing the risk of acute gout attacks. This medication is taken daily to manage this chronic condition. During an acute attack, an NSAID such as colchicine is prescribed. Other strategies to mitigate an acute gouty attack include the client staying well hydrated and reducing the consumption of foods rich in purines.

The nurse is caring for a client diagnosed with chronic gout. The nurse anticipates a prescription for which medication to minimize exacerbations? A. Colchicine B. Allopurinol C. Naproxen D. Prednisone

Choice B is correct. Famotidine is a histamine antagonist often referred to as an H2-blocker. This class of drugs treats and prevents duodenal and gastric ulcers caused by increased acid production in the stomach. For a client who is critically ill or being mechanically ventilated, the client is at risk for developing a stress ulcer, which can be prevented with parenteral famotidine.

The nurse is caring for a client in the intensive care unit (ICU) being mechanically ventilated via an endotracheal tube (ETT) for head trauma following a mechanical vehicle crash. The primary healthcare provider (PHCP) prescribes famotidine 20 mg intravenous (IV) push. The nurse understands that this medication is intended to A. decrease any gagging by the ETT. B. prevent the formation of stress ulcers. C. provide sedation. D. increase gastric motility.

Choice B is correct. Diabetic nephropathy is marked by the client having proteinuria (> 300 mg in a 24-hour urine collection). This is evidence that the client's diabetes is progressing and causing vascular damage. Treatment is aimed at reinforcing good glycemic control by advising the client to manage their diet by controlling their intake of carbohydrates. Prescriptive therapies include ACE inhibitors such as enalapril because of their ability to cause increased blood flow to the kidneys. ACE-I's may be nephrotoxic, but they provide a benefit, and treatment is guided based on the client's eGFR and creatinine.

The nurse is caring for a client newly diagnosed with diabetic nephropathy. The nurse anticipates a prescription for which medication? A. Ciprofloxacin B. Enalapril C. Sevelamer D. Epoetin alfa

Choice A is correct. Fentanyl is an opioid. A clinical feature of opioid toxicity includes central nervous system depression that manifests as lethargy leading to somnolence. Further, the client will have pupillary constriction, bradypnea, and decreased gastrointestinal motility. While opioids cause pupillary constriction, this would also be a finding in toxicity. Since this client receives mechanical ventilation, respiratory depression would not be a reliable finding.

The nurse is caring for a client receiving mechanical ventilation receiving fentanyl and midazolam. Which of the following assessment findings would indicate fentanyl toxicity? A. Constricted pupils B. Hypertension C. Coarse Tremors D. Diarrhea

Choice B is correct. TPN should be tapered to avoid the client developing hypoglycemia when discontinued. The recommendation is to taper the TPN's infusion rate by 50% for two hours; then, the infusion can be stopped. Choice D is correct. Eating while receiving a TPN infusion is not a contraindication. Often, TPN is used to adjunctively provide the client with additional protein, calories, and vitamins while the client still has PO (by mouth) intake.

The nurse is caring for a client receiving total parenteral nutrition (TPN). The physician ordered the client's TPN to be discontinued and a soft diet. The nurse should take which action? Select all that apply. - Stop the TPN infusion without tapering. - Taper the TPN infusion and then stop the infusion. - Delay feeding the client until the TPN has been discontinued. - Offer the client dietary items from a soft diet. - Assess the client for hyperglycemia after the TPN infusion has been stopped. - Infuse dextrose 5% in water (D5W) at 30 mL/hr for two hours after discontinuing the TPN.

Choice C is correct. For a client scheduled for thyroidectomy, potassium iodide-iodine (Lugol's solution) may be prescribed to decrease the risk of gland vascularity and surgical blood loss. A complication following thyroidectomy is significant blood loss, and having this medication taken 10 days before surgery will mitigate this risk.

The nurse is caring for a client scheduled for a thyroidectomy. The primary healthcare provider prescribes potassium iodide-iodine. The nurse understands that this medication is intended to A. decrease the risk of agranulocytosis postoperatively. B. prevent postoperative hypocalcemia. C. reduce the size and vascularity of the thyroid. D. decrease postoperative blood glucose levels.

Choice B is correct. Naproxen is a nonsteroidal anti-inflammatory drug (NSAID) indicated in treating musculoskeletal disorders such as rheumatoid arthritis, osteoarthritis, strains, and sprains. NSAIDs carry several adverse effects, including edema, renal failure, gastrointestinal irritation leading to an ulcer, myocardial infarction, and stroke. If the client has congestive heart failure, this would be contraindicated because naproxen would lead to further fluid accumulation.

The nurse is caring for a client who has been newly prescribed naproxen. Which condition in the client's medical history would require clarification with the primary healthcare provider (PHCP)? A. Rheumatoid arthritis (RA) B. Congestive heart failure (CHF) C. Osteoarthritis D. Psoriatic arthritis

Choices A, B, and E are correct. Prednisone is a corticosteroid and is indicated for various conditions, including exacerbations of rheumatoid arthritis. The medication potentiates aldosterone causing sodium and water retention, thereby allowing the client to gain weight. Steroids are best taken in the morning with food. Taking it with food decreases gastrointestinal upset. If the steroid is taken at nighttime, it may cause insomnia. The cessation of this drug should be tapered to avoid adrenal insufficiency. This medication should not be abruptly discontinued.

The nurse is caring for a client who has been prescribed a 14-day course of prednisone. Which of the following statements, if made by the nurse, would be correct? Select all that apply. "This medication may make you gain weight." "It is best to take this medication in the morning with food." "If you have further pain, it is okay to take naproxen." "Your blood pressure may decrease while taking this medication." "Do not abruptly stop taking this medication."

Choices A, B, and E are correct. Corticosteroids cause fluid retention because of their effects on aldosterone (sodium retention; potassium elimination). Therefore, as the client retains sodium, their weight increases because of water retention. Prednisone is best dosed early in the day. Prednisone commonly causes insomnia; therefore, taking it in the morning with food is recommended. Food is recommended because it will decrease gastric irritation. Prednisone can cause mood alterations, such as irritability, and may destabilize the client if they have mood disorders such as bipolar.

The nurse is caring for a client who has been prescribed prednisone. Which of the following statements, if made by the nurse, would be correct? Select all that apply. "This medication may make you gain weight." "It is best to take this medication in the morning with food." "If you have pain, it is okay to take ibuprofen." "Your blood pressure may decrease while taking this medication." "You may experience mood changes while on this medicine."

Choice B is correct. Lactulose is indicated for clients with hyperammonemia secondary to cirrhosis of the liver. Increased ammonia levels cause a patient to develop altered mental status (hepatic encephalopathy). A client receiving this medication will have increased bowel movements as that is the primary way of excreting the excess ammonia. The client's increased bowel movements cause the ammonia level to decrease, thereby increasing the client's level of consciousness.

The nurse is caring for a client who has cirrhosis of the liver receiving lactulose. Which of the following finding would indicate a therapeutic response? A. Increased liver enzymes B. Increased level of consciousness C. Decreased urinary calcium D. Increased gastric pH

Choice B is correct. Peritonitis is an intra-abdominal severe infection that has a significant mortality rate. Peritonitis may originate from perforation (appendix, intestine, etc.), which causes a significant amount of fluid and bacteria to shift into the peritoneum. The priority treatment in peritonitis is administering prescribed antibiotics such as ciprofloxacin, metronidazole, or ceftriaxone.

The nurse is caring for a client who has just been diagnosed with peritonitis. Which of the following medications should the nurse anticipate the primary health care provider (PHCP) will prescribe? A. Pantoprazole B. Ciprofloxacin C. Lactulose D. Loperamide

Choice A is correct. All of these manifestations are associated with an aspirin overdose. Pulmonary edema is the most concerning and is caused by a lung injury induced by aspirin. A treatment for aspirin overdose is an infusion of sodium bicarbonate to correct metabolic acidosis. During the infusion, the nurse must be sensitive to the potential lung injury caused by aspirin; thus, auscultating lung sounds and assessing for pulmonary edema will be essential. Manifestations of pulmonary edema include tachypnea, tachycardia, and crackles in the lung fields.

The nurse is caring for a client who ingested a lethal dose of aspirin (ASA). Which assessment finding is most concerning? A. Pulmonary edema B. Tinnitus C. Nausea and vomiting D. Tachycardia

Choice C is correct. Cimetidine is an H2 receptor antagonist indicated in treating peptic ulcer disease, gastric esophageal reflux disease, or H. pylori infections. This older medication has widely been replaced with newer H2 receptor antagonists because this medication is known to cause significant drowsiness. Cimetidine is combined with antibiotics (amoxicillin, metronidazole) for effective treatment.

The nurse is caring for a client who is newly prescribed cimetidine. The nurse understands that this medication is prescribed to treat which condition? A. Cystic fibrosis B. Clostridium difficile C. H. pylori D. Crohn's disease

Choice C is correct. Salmeterol is a long-acting beta-agonist indicated in the maintenance treatment of chronic respiratory illnesses. This medication causes bronchodilation by stimulating the beta-adrenergic receptors. Blocking these receptors by beta-adrenergic blockers is contraindicated because it may lead to bronchospasm. Labetalol is a combined alpha and beta-adrenergic receptor blocker, therefore antagonizing salmeterol's therapeutic effect. Thus, labetalol would be contraindicated because of this adverse action.

The nurse is caring for a client who is receiving newly prescribed salmeterol. Which of the following prescribed medications requires notification to the primary healthcare provider (PHCP)? A. lithium B. captopril C. labetalol D. clonidine

Choice D is correct. Aspirin is an anti-inflammatory medication for acute myocardial infarction, rheumatic fever, and Kawasaki disease. The biggest concern with aspirin is its anticoagulant effects and ability to cause gastrointestinal bleeding associated with gastrointestinal ulcers.

The nurse is caring for a client who is receiving prescribed aspirin. Which of the following findings would indicate the client is having an adverse effect? A. Polyuria B. Hypokalemia C. Venous thromboembolism D. Black, tarry stools

Choice A is correct. Isotretinoin is indicated in the treatment of moderate to severe acne vulgaris. This medication may raise triglyceride levels; thus, a baseline lipid panel is necessary, along with periodic monitoring.

The nurse is caring for a client who is receiving prescribed isotretinoin. Which laboratory data is essential prior to the initiation of this therapy? A. lipid panel B. c-reactive protein C. hemoglobin A1C D. international normalized ratio (INR)

Choice A is correct. Metoclopramide is a dopamine antagonist in treating gastroparesis, nausea, and vomiting. Dopamine antagonists may induce dystonia which is depicted in this option. This finding is highly concerning.

The nurse is caring for a client who is receiving prescribed metoclopramide for gastroparesis. Which of the following findings require immediate notification to the primary healthcare provider (PHCP)? A. Muscle rigidity of the neck B. Hyperactive bowel sounds C. Frequent diarrhea D. Abdominal distention

Choices D and E are correct. Hydromorphone is a potent opioid indicated for pain. Side effects include constipation, altered level of consciousness, pupil constriction, and urinary retention.

The nurse is caring for a client who is receiving the prescribed hydromorphone. Which of the following side effects should the nurse look for in the client? Select all that apply. Urinary incontinence Pupil dilation Diarrhea Altered level of consciousness (LOC) Constipation

Choice B is correct. For a client who has had a dosage increase of levothyroxine, the nurse should assess the client for hyperthyroidism. Signs and symptoms of hyperthyroidism include tachycardia, weight loss, increased temperature, and increased motor activity. Assessing the client's heart rate is a priority because tachydysrhythmias may occur. An elevated heart rate may indicate an adverse reaction to the medication, such as a thyroid hormone overdose.

The nurse is caring for a client who recently had a dosage increase of prescribed levothyroxine. Which of the following is a priority? A. Weight B. Heart rate C. Activity status D. Oral temperature

Choice B is correct. Saw Palmetto is an over-the-counter supplement purported to decrease symptoms of benign prostatic hyperplasia. This medication should be used with caution if it is administered with warfarin. Warfarin is an anticoagulant; if the client takes both concurrently, it may potentiate the anticoagulant effect. The primary healthcare provider (PHCP) must be made aware of this interaction.

The nurse is caring for a client who was newly prescribed warfarin. Which medication on the client's medication list requires follow-up with the primary healthcare provider (PHCP)? A. Loratadine B. Saw Palmetto C. Furosemide D. Pantoprazole

Choice A is correct. The nurse should provide appropriate pain management during procedures that can be painful. For the client with extensive burns, it is highly appropriate to administer a prescribed opioid by a route that will provide expedient pain control. Hydromorphone is a potent opioid indicated for severe pain.

The nurse is caring for a client with a 27% total body surface area burn. The burns are a combination of second and third-degree. Prior to the prescribed dressing change, the nurse should administer which medication? A. Hydromorphone 1 mg intravenous (IV) push B. Oxycodone extended-release (ER) 10 mg by mouth (PO) C. Ketorolac 15 mg intravenous (IV) push D. Fentanyl transdermal patch 12 mcg/hr

Choices A, B, and C are correct. The liver extensively metabolizes Isoniazid, valproic acid, and amiodarone which have been implicated in causing hepatotoxicity. Thus, the nurse should clarify these medications with the PHCP if the client has an existing hepatic injury, such as advanced cirrhosis. Isoniazid is indicated in the treatment of pulmonary tuberculosis. Valproic acid is a mood stabilizer and antiepileptic, and amiodarone is an antidysrhythmic.

The nurse is caring for a client with advanced liver cirrhosis receiving prescribed medications. Which medications would the nurse clarify with the primary healthcare provider (PHCP)? Select all that apply. isoniazid valproic Acid amiodarone lithium thiamine

Choice A is correct. Patient-controlled analgesia (PCA) is an effective means to provide client-centered pain control. This device may allow an individual to get prescribed basal (continuous) pain medication, on-demand pain medication, or both. Hydromorphone is a potent opioid (one milligram of hydromorphone equates to six milligrams of morphine). Thus, this would be an effective pain medication for this type of pain.

The nurse is caring for a client with cancer experiencing chronic pain and episodes of breakthrough pain. Which prescription should the nurse request from the primary healthcare provider (PHCP) to provide effective pain control? A. Hydromorphone via patient-controlled analgesia (PCA) B. Morphine intramuscular (IM) as needed (PRN) for pain C. Oxycodone extended-release (ER) by mouth (PO) D. Ketorolac via intravenous (IV) push

Choice D is correct. Sevelamer is a phosphate binder indicated in the treatment of hyperphosphatemia associated with chronic kidney disease. This medication is purported to decrease serum phosphorus levels by binding to food. Thus, this medication is given with meals. Combined with a low phosphorus diet, the goal of this medication is to decrease serum phosphate levels.

The nurse is caring for a client with end-stage renal disease who receives prescribed sevelamer. Which of the following findings would indicate a therapeutic response? A. Decreased serum calcium levels B. Increased hemoglobin and hematocrit C. Decreased serum potassium levels D. Decreased serum phosphorus levels

Choice C is correct. In cases when the gastrointestinal system must be bypassed, total parenteral nutrition (TPN) must be used to provide the client with parenteral nutrients. In general, serum albumin is one laboratory value that may be decreased in the presence of undernourishment. The therapeutic range for albumin is 3.5-5 g/dL. Amino acids are essential to TPN, helping increase the client's serum albumin levels. Thus, the client's result of 3.6 g/dL would indicate that the client is responding to treatment.

The nurse is caring for an undernourished client who recently began receiving total parenteral nutrition (TPN). Which laboratory value would indicate that the client is responding to treatment? A. Fasting blood glucose: 129 mg/dL B. White blood cell (WBC) count: 12,000 mm3 C. Albumin: 3.6 g/dL D. Urine specific gravity: 1.040

Choices C, D, and E are correct. For clients with a metered dose inhaler (MDI), after a dose is administered, they should hold their breath for ten seconds to allow for the medication to be dispersed in their lungs. The client should only administer one dose (or press the button once) per breath. Before the client administers a dose of the medication from the inhaler, the client should hold the MDI away from their mouth, take a deep breath, and exhale completely. This is necessary to empty any residual lung volume and prepares the airway to receive medication.

The nurse is counseling a client about a metered-dose inhaler. Which of the following statements by the client indicates effective teaching? Select all that apply. "I will be careful not to shake the canister before using it." "I will inhale the medication through my nose." "After I deliver a dose, I will hold my breath for 10 seconds." "I will only inhale one spray with one breath." "While holding the mouthpiece away from my mouth, I will take a deep breath and exhale completely."

Choice A is correct. Multimodal analgesia is when drugs from two or more medication classes target different pain mechanisms. For example, a client has been prescribed gabapentin (anti-convulsant), naproxen (NSAID), and duloxetine (SNRI) to achieve appropriate pain control. The benefit of this approach to pain management is that it reduces the reliance on a single medication. A multimodal approach also provides the same relief as a single agent and may delay medication tolerance. A multimodal approach may also involve nonprescriptive interventions such as biofeedback, yoga, etc.

The nurse is planning a staff development conference about multimodal analgesia. Which of the following information should the nurse include regarding the purpose of this approach? A. This treatment involves the use of two or more classes of analgesics or interventions B. Drugs that have a primary indication other than pain but are analgesics for some painful condition C. Dosing of analgesics for pain that is of a continuous nature D. Allows clients to treat their pain by self-administering doses of analgesics

Choice D is correct. Following adrenalectomy, a client is at risk for an adrenal crisis because the adrenal gland (specifically, the cortex) supplies the body with the cortisol necessary for fluid balance, glucose regulation, and inflammation. The stress of the surgery will demand the body produce more cortisol. When it cannot be provided, the client may go into an adrenal crisis (hypotension, tachycardia, hypoglycemia, lethargy). Parenteral corticosteroid replacement with hydrocortisone will be necessary to prevent this from occurring to the client. For a client recovering from bilateral adrenalectomy, lifelong steroid replacement will be required.

The nurse is planning care for a client following bilateral adrenalectomy. The nurse should anticipate a prescription for which postoperative medication? A. Pantoprazole B. Propylthiouracil (PTU) C. Propranolol D. Hydrocortisone

Choice C is correct. A large leg abscess will need significant time for incision and drainage (I&D). Children who are not yet adolescents are not mature enough to cooperate adequately during such surgical procedures. Children undergoing most surgeries require general anesthesia because this minimizes their fears of intrusive or mutilating procedures. General anesthesia provides necessary sedation so the surgery can be safely performed.

The nurse is preparing a 3-year-old child for an incision and drainage of a large left leg abscess. The nurse understands which of the following types of anesthesia will be administered to the child? A. Peripheral nerve block B. Spinal anesthesia C. General Anesthesia D. Local Anesthesia

Choice C is correct. Polyethylene glycol 3350 is an osmotic laxative commonly used before a colonoscopy. This powder is typically dissolved in a sports drink and can be consumed by the client. Efficacy is usually within one hour. Fluid and electrolyte disturbance is unlikely as the powdered solution contains electrolytes.

The nurse is preparing a client for a scheduled colonoscopy. Which prescription should the nurse anticipate from the primary healthcare provider (PHCP) while the client is preparing for this procedure? A. docusate B. loperamide C. polyethylene glycol 3350 D. famotidine

Choice C is correct. To solve this problem, the client's weight needs to be converted to kilograms. 242 lbs / 2.2 = 110 kg. Next, multiply the ordered dose of 0.1 units by the weight of 110 kg. This should equate to 11 units.

The nurse is preparing to administer a regular insulin IV bolus to a client. The primary health care provider (PHCP) has prescribed an initial bolus dose of 0.1 unit/kg. The client weighs 242 lbs. How much regular insulin should the nurse administer to the client as an IV bolus? A. 9 units B. 10 units C. 11 units D. 12 units

Choice D is correct. Eye drops are often prescribed for their topical effects in relieving local eye conditions. Occasionally, side effects may occur due to systemic absorptionof the active medication in the eye drop solutions. Certain precautions can help reduce systemic absorption and minimize side effects. Mucous membranes of the eye serve as the routes of systemic absorption. Placing a finger over the inner canthus occludes the nasolacrimal duct preventing the eye drop solution from reaching the mucous membranes and being absorbed into the systemic circulation.

The nurse is providing discharge education regarding the client's eye drop medications. Which of the following actions does the nurse instruct the client to implement to minimize the eye drops' systemic effects? A. Instill the eye drops before meals. B. While instilling the eye drops, swallow several times. C. Blink vigorously after instilling the eye drops. D. Place a finger over the inner canthus for 30 - 60 seconds after instilling the eye drops.

Choice A is correct. Bisphosphonates should be taken first thing in the morning with a full glass of water. Patients should also wait 30 minutes to eat any food and should remain sitting or standing during that time. This prevents esophageal damage that may occur when this medication is taken improperly.

The nurse is providing patient teaching in the clinic. The patient is prescribed a bisphosphonate to treat osteoporosis. Which information should the nurse inform this patient about? A. Take this medication sitting upright first thing in the morning with a full glass of water. B. Take this medication at night, just before bed. C. This medication should be taken along with a full meal. D. This medication is the best alternative if an esophageal disorder is present.

Choice A is correct. Pancrelipase is a digestive enzyme that is given to the client with meals. This allows the client to digest the food and absorb the vitamins and minerals. This medication will show effectiveness when the client starts to gain weight and has less episodes of steatorrhea. Choice D is correct. Malnutrition is a common concern with cystic fibrosis (CF). It is common for individuals with CF to be recommended a multivitamin to decrease vitamin deficiencies. As a reminder, the diet for a client with CF is high calorie, increase protein, sodium rich, and with no fat restrictions.

The nurse is reviewing a client's list of medications who has cystic fibrosis. The nurse anticipates a prescription for which medication? Select all that apply. Pancrelipase Aspirin Lactulose Multivitamin Clopidogrel

Choice C is correct. Treatment for diabetes insipidus includes medications such as desmopressin, thiazide diuretics, and anti-inflammatories. Hydrocortisone is a short-acting corticosteroid and is indicated in the treatment of adrenal insufficiency. This requires follow-up because DI is not treated with hydrocortisone.

The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. Furosemide for a client with hyperparathyroidism B. Methimazole for a client with hyperthyroidism C. Hydrocortisone for a client with diabetes insipidus D. Prazosin for a client with pheochromocytoma

Choice B is correct. Hyperparathyroidism causes hypercalcemia, and the treatment for hyperparathyroidism is a combination of 0.9% saline infusion followed by furosemide. Hydrochlorothiazide is a thiazide diuretic and causes the retention of calcium. This would be detrimental for a client experiencing hypercalcemia. This prescribed medication requires follow-up with the prescriber.

The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question? A. Levothyroxine for a client with a myxedema coma B. Hydrochlorothiazide for a client with hyperparathyroidism C. Hydrocortisone for a client with adrenal insufficiency D. Regular insulin for a client with diabetic ketoacidosis

Choices A, B, D, and E are correct. These statements are incorrect and require follow-up. Insulin glargine is a long-acting insulin that has no peak effect. Thus, it is not taken with meals. It is dosed once a day to provide glucose control for 24 hours. Insulin glargine is not a suspension; thus, it does not need to be rolled like NPH. This insulin is not mixed with any other insulin. Insulin glargine does not have to only be injected into the abdomen.

The nurse is teaching a client about newly prescribed insulin glargine. The nurse recognizes the need for further instruction when the client makes the following statement? Select all that apply. "I will take this insulin right before my meals." "I should roll this vial of insulin before removing it with the syringe." "This insulin will help control my glucose for 24 hours." "I can only inject this insulin into my abdomen." "I'm glad to know I can mix this with my regular insulin."

Choice B is correct. Metoclopramide is a dopaminergic medication indicated in the treatment of nausea and vomiting. An adverse effect of this medication is neuroleptic malignant syndrome (NMS). Classic NMS features include muscle rigidity, tachycardia, and fever. This idiosyncratic reaction is commonly associated with antipsychotics (haloperidol, aripiprazole, olanzapine, etc.). However, this may be seen in other dopaminergic medications such as metoclopramide.

The nurse is teaching a client about newly prescribed metoclopramide for nausea and vomiting. It is a priority for the nurse to discuss which potential adverse reaction? A. dystonia B. fever C. drowsiness D. diarrhea

Choice D is correct. Etanercept is a biologic intended to treat specific autoimmune conditions such as plaque psoriasis, psoriatic arthritis, and rheumatoid arthritis (RA). This medication decreases the inflammatory process by blocking tumor necrosis factor. This medication is administered subcutaneously on a specified dosing schedule depending on the condition it is intended to treat.

The nurse reviews newly prescribed medications from the primary healthcare provider (PHCP). The nurse understands that the prescribed etanercept is intended to treat which condition? A. Osteoarthritis B. Diabetes mellitus C. Infective endocarditis (IE) D. Rheumatoid arthritis

Choice B is correct. Of all the choices in the question, the best expected client outcome when the client's pain is managed effectively is that "The infant will not demonstrate any behavioral indications of pain." This expected outcome is client-oriented, specific, and measurable. Firstly, it is important to understand a nursing care plan and its components to answer this question appropriately. A nursing care plan provides direction on the type of nursing care the client may need. Six components include Assessment, Diagnosis, Outcomes/Planning, Interventions, Rationale, and Evaluation. Assessment includes both subjective and objective assessment of the client. The diagnostic component of the care plan determines the most likely reason for the client's problems based on the history, assessment, and lab tests. The Outcomes/Planning column of the care plan is client-oriented - a list of measurable goals for the client is set; for example, managing pain with enough medication. Interventions refer to a set of actions that a nurse can undertake to achieve the outcomes. Interventions are nurse-oriented and are aimed at addressing the diagnoses to achieve the desired outcomes. While addressing

You are evaluating a nursing care plan for a 6-month-old infant with severe post-operative pain. Which of the following is the best expected client outcome when the client's pain is managed effectively? A. The nurse will assess pre and post analgesic client responses. B. The infant will not demonstrate any behavioral indications of pain. C. The nurse will evaluate pre and post analgesic client responses. D. The infant will not demonstrate any physiological indications of pain.

Choices A, B, and E are correct. Levothyroxine is indicated for hypothyroidism. Careful monitoring is necessary to ensure that the client does not develop hyperthyroidism due to over-correction. Manifestations include heat intolerance, palpitations, and insomnia. These findings would be adverse responses because the client is being overcorrected and requires the provider to intervene.

The nurse is evaluating a client taking levothyroxine for hypothyroidism. Which findings indicate that the client is experiencing an adverse effect? Select all that apply. Heat intolerance Palpitations Bradycardia Constipation Insomnia Weight gain

Choice D is correct. Pancreatitis is a condition that is triggered by cholelithiasis or acute alcoholism. This condition causes severe epigastric pain, persistent vomiting, and fluid volume depletion. The client with pancreatitis will require TPN because of the length of time it takes for recovery and the need for the client to stay NPO. TPN provides the client with nutrition without worsening the pancreatitis symptoms.

The nurse plans a staff developmental conference on total parenteral nutrition (TPN). It would be appropriate for the nurse to identify which indications for using TPN? A. Appendicitis B. Gastroesophageal reflux disease (GERD) C. Diverticulosis D. Pancreatitis

Choice A is correct. Albuterol is a bronchodilator that is used for asthma exacerbations. Adversely, this medication may lower serum potassium levels. The nurse should question this order as this medication may decrease the potassium further.

The nurse reviews prescriptions for assigned clients. Which prescription should the nurse question? A. Albuterol via nebulizer for a client with hypokalemia. B. Clozapine for a client with severe schizophrenia. C. Lisinopril for a client with congestive heart failure. D. Verapamil for a client with migraine headaches.

increases the risk for infection; negative purified protein derivative (PPD) test; assess for an injection site reaction

The nurse should instruct the client that the prescribed etanercept ___ Prior to the first dose, the nurse should ensure the client has had a ____ After administering the medication, the nurse should ___

Choice D is correct. This client has likely experienced orthostatic hypotension caused by the prior administration of fentanyl. Fentanyl is an opioid and causes vasodilation. This vasodilation, combined with the client's movement, triggered this response. The nurse should assess vital signs to determine the client's stability.

The nurse transfers a client who received fentanyl 50 mcg IV push 10 minutes ago from the bed to a chair when the client becomes dizzy and falls into the chair. Which of the following actions would be appropriate for the nurse to take? A. Administer prescribed naloxone B. Assist the client back to bed C. Call a code blue D. Assess the client's vital signs

Choices A and D are correct. Ketorolac is a medication used to treat pain and pyrexia. A client exhibiting a decrease in pain and having a decrease in temperature would be a therapeutic response.

The nurse is caring for a client who is receiving prescribed ketorolac. Which of the following client findings would indicate a therapeutic response? Select all that apply. Decreased pain Increased urinary output Decreased blood pressure Decreased temperature Increased muscle coordination

Choice B is correct. Montelukast is a leukotriene receptor antagonist indicated in managing asthma, allergic rhinitis, and exercise-induced asthma. This medication has a serious adverse reaction to neuropsychiatric alterations, including depression, hallucinations, aggression, and thoughts of suicidality. Any of these neuropsychiatric changes should be reported immediately to the physician.

The nurse is caring for a client who is receiving prescribed montelukast. Which of the following findings would indicate the client is having an adverse effect? A. hypertension B. hallucinations C. constipation D. urinary retention

Choice D is correct. After taking this medication, the urine may become discolored. The nurse should provide teaching that this is an expected finding, and the client should be advised that this is a normal effect associated with the medication.

The nurse is providing discharge instructions to a client prescribed phenazopyridine. Which of the following instructions should the nurse include? A. Discontinue this medication if urinary discoloration occurs B. Take this medication on an empty stomach C. Only take the medication before bed D. Urine may have a reddish or orange coloration after taking this medication

Choice A is correct. Potassium supplements can be distasteful, even in capsule form. To improve palatability, the nurse may sprinkle the contents of the potassium capsule on apple sauce, and the client can then swallow it. This also should be used for those who have difficulty swallowing. The client must not chew on a capsule or tablet.

A client diagnosed with acute gastroenteritis is prescribed a 40 mEq potassium chloride capsule for hypokalemia. Which action should the nurse take when administering this medication? A. Open the capsule and sprinkle on a spoonful of applesauce B. Instruct the client to chew the capsule C. Give separate from other medications D. Give the medication two hours before meals

Choice D is correct. Reinforcement of client teaching is needed. The nurse must re-educate the client on the importance of completing the entire course of this medication regardless of the perceived symptom improvement to ensure the bacterial organism is eradicated, thereby decreasing the likelihood that bacteria will develop resistance and not be treatable by antimicrobials.

A nurse is assigned to care for a client with pneumonia. The health care provider (HCP) has prescribed "amoxicillin/clavulanate potassium 500 mg PO TID" for treatment. The medication is available in 250 mg tablets. After calculating the dosing, the nurse finds that the client will receive two tablets every 8 hours. When verifying the client's understanding, the client states, "I should take the medication with food, and if I feel fine before I finish the prescription, I can stop it and save the rest of the pills for the next time I get pneumonia." After rechecking the dosage calculation, the nurse decides to do which of the following? A. Hold medication administration and clarify the dosage with the HCP B. Administer one tablet only C. Administer the medication as prescribed and monitor the client's cardiac function D. Reinforce client teaching and administer the medication as prescribed

Choice C is correct. Around the clock, doses of analgesics are more useful for the management of chronic pain.

Chronic pain is most effectively relieved when analgesics are administered in what manner? A. On a PRN basis B. Conservatively C. Around the clock D. Intramuscularly

Medical history congestive heart failure Laboratory results BUN 23 mg/dL (10 - 20 mg/dL); Creatinine 1.5 mg/dL (0.6 - 1.2 mg/dL)

The nurse cares for a client with rheumatoid arthritis (RA), newly prescribed meloxicam Vital signs T 99° F (37° C), P 98, RR 18, BP 138/88, pulse oximetry reading 95% on room air. Pain pain rated as 5 on a scale of 0 (no pain) to 10 (severe pain) Allergies doxycycline Medical history congestive heart failure Laboratory results BUN 23 mg/dL (10 - 20 mg/dL); Creatinine 1.5 mg/dL (0.6 - 1.2 mg/dL)

hypokalemia; regular insulin infusion

The client is at highest risk of developing _____ caused by the prescribed ____

Choice A is correct. Due to their local action, intranasal sympathomimetics produce few systemic effects. However, one side effect associated with their use is rebound congestion. Prolonged use causes hypersecretion of mucus and worsened nasal congestion once the drug effects wear off. This rebound effect sometimes leads to a cycle of increased drug use as the condition worsens. Because of the risk of rebound congestion, intranasal sympathomimetics should be used for no longer than 3-5 days. Prolonged use of decongestant drops (3 to 5 days) can lead to rebound congestion, which is relieved by discontinuing the medication for 2 to 3 weeks. Nasal congestion results from dilation of nasal blood vessels due to infection, inflammation, or allergy. With this dilation, there is a transudation of fluid into the tissue spaces, resulting in swelling of the nasal cavity. Nasal decongestants (sympathomimetic amines) stimulate the alpha-adrenergic receptors, producing vascular constriction (vasoconstriction) of the capillaries within the nasal mucosa. The result is a shrinking of the nasal mucous membranes and a reduction in fluid secretion (runny nose). Decongestants can make a client jittery, nervo

The client using over-the-counter nasal decongestant drops reports unrelieved and worsening nasal congestion. What is the appropriate instruction for this client? A. Discontinue the medication for several days B. Use a combination of oral decongestant medications and drops for better results C. Switch to a stronger dose of the decongestant drops D. Increase the frequency of the nasal decongestant drops

Choice A is correct. Isotretinoin is indicated in the treatment of moderate to severe acne vulgaris. This medication is highly teratogenic, and a negative pregnancy test is essential prior to the initiation of therapy.

The nurse is caring for a female client who is receiving prescribed isotretinoin. Which laboratory data is essential prior to the initiation of this therapy? A. Pregnancy test B. C-Reactive Protein C. BUN and Creatinine D. Prothrombin time (PT)

Choice B is correct. Sevelamer is a medication used to lower phosphate levels in the blood, particularly in clients with chronic kidney disease (CKD). Taking sevelamer with meals is the correct instruction because it binds to dietary phosphate in the gastrointestinal tract, preventing its absorption. By taking it with meals, the medication can effectively reduce phosphate levels.

The nurse is teaching a client about the newly prescribed medication, sevelamer. Which statement, if made by the client, would indicate a correct understanding of the teaching? A. "This medication will help lower my calcium level." B. "I should take this medication with my meal." C. "I may experience bad diarrhea with this medication." D. "My blood pressure may increase while I take this medication."

Choice B is correct. Tolvaptan is a vasopressin antagonist and is indicated in treating the syndrome of inappropriate antidiuretic hormone (SIADH). In SIADH, the client retains water which causes fluid retention without edema. Classic manifestations of SIADH include polydipsia, hemodilution, and oliguria. This medication promotes free water excretion, normalizing sodium levels and increasing urine output. This urine-specific gravity is normal (1.005 - 1.025) and indicates that the medication is having its therapeutic effect because a client with SIADH would have a high USG from the limited water spilled into the urine.

This nurse is caring for a client who is receiving prescribed tolvaptan. Which of the following findings would indicate a therapeutic response? A. Fasting blood glucose 100 mg/dL B. Urine specific gravity 1.010 C. Total cholesterol 176 mg/dL D. BUN 5 mg/dL

Choice C is correct. Oxybutynin is used to treat urinary bladder urgency and incontinence. Anticholinergics are drugs that have actions opposite those of the parasympathetic branch. Their action mimics the fight-or-flight response.

Which of the following anticholinergics does the nurse recognize as appropriate for a patient diagnosed with urinary bladder urgency and incontinence? A. Dicyclomine B. Ipratropium C. Oxybutynin D. Scopolamine

Choice B is correct. Colfosceril palmitate is a medication used as a pulmonary surfactant to treat and prevent respiratory distress syndrome (RDS). A fetus's lungs start making surfactants during the third trimester of pregnancy, or around 26 weeks gestation through labor and delivery. Surfactant coats the insides of the alveoli reducing the surface tension of fluid in the lungs, which helps make the alveoli more stable. This keeps the lungs from collapsing when the newborn exhales. Respiratory distress syndrome (RDS) is a type of neonatal respiratory disease that is most often caused by a lack of surfactant in the lungs. Prevention of RDS is generally desired in babies born at a gestational age less than 32 weeks. In an infant with RDS, colfosceril palmitate may be given via endotracheal tube in two to four doses during the first 24-48 hours after birth. Research shows that these surfactant medications improve respiratory status and decrease the incidence of pneumothorax.

Which of the following would the nurse expect to be administered to treat a newborn with Respiratory Distress Syndrome (RDS) ? A. Theophylline B. Colfosceril C. Dexamethasone D. Albuterol

Choice D is correct. The most severe adverse effect of aspirin is an anaphylactic shock, which is life-threatening. Other side effects of aspirin include gastrointestinal ulcerations and hemolytic anemia.

While reviewing the side effects of adjuvant analgesic medications, the nurse understands which of the following drugs is accurately paired with its most serious adverse side effect? A. Acetaminophen: Gastrointestinal tract bleeding B. Ibuprofen: Hepatic failure C. Clonidine: Renal failure D. Aspirin: Anaphylaxis

Choice B is correct. Allopurinol is prescribed to patients with gout or kidney stones and works by reducing the amount of uric acid produced by the body. Patients taking this medication should be encouraged to drink plenty of water, at least 3,000 mL per day.

A client is receiving allopurinol and asks what they should know about taking this medicine. The nurse would be most correct in stating which of the following? A. "Facial swelling is expected in the first few days of therapy." B. "Drink at least 3000 mL of water per day." C. "Do not eat while taking this medication." D. "This medication begins working immediately."

Choice B is correct. Metformin, a medication used to treat type 2 diabetes, should be held 24 hours before an iodine dye procedure to reduce the risk of lactic acidosis. The drug may be resumed about 48 hours after the procedure.

A client is scheduled to undergo a computed tomography scan with iodine-based contrast dye. Which of the following medications may cause interaction and should be withheld for 24 hours before the procedure? A. Labetolol B. Metformin C. Levodopa D. Ondansetron

Choice D is correct. Aspirin disrupts the normal mucosal defense and repair, making the mucosa more susceptible to acid. The nurse should instruct this client on the importance of avoiding aspirin and all other nonsteroidal anti-inflammatories (NSAIDs) now and in the future.

A client recently diagnosed with peptic ulcer disease is being discharged. While the nurse provides discharge teaching, which of the following over-the-counter medications should the client be instructed to avoid? A. Calcium B. Magnesium C. Sodium D. Aspirin

Choice C is correct. The client has been prescribed lactulose for portal-systemic encephalopathy (PSE), not for constipation. Lactulose promotes ammonia excretion in the stool by cleansing the bowels and ridding the intestinal tract of the toxins that contribute to encephalopathy. Lactulose increases osmotic pressure to draw fluid into the colon and prevents the absorption of ammonia in the colon. The drug's desired effect is the production of two or three soft stools per day and a decrease in the client's confusion caused by increased ammonia. When observing for a response to lactulose, the client may report intestinal bloating and cramping. Serum ammonia levels may be monitored but do not always correlate with symptoms.

A client with portal-systemic encephalopathy is prescribed lactulose 20 grams orally QID. The medication is available in 3.33 grams per 5 mL oral solution. The nurse is preparing to administer a 30 mL dose of lactulose to this client. When the nurse approaches the client, the client states, "I understand that I cannot take other laxatives with lactulose." Which of the following actions should the nurse perform next? A. Withhold the lactulose B. Give only 3 mL of lactulose instead of 30 mL C. Give 30 mL of lactulose with juice and monitor blood ammonia D. Correct the client's statement by stating additional laxatives may be taken

Choice C is correct. This action by the newly hired nurse requires follow-up because when a client receives TPN, it should have tubing with an in-line filter. The tubing should be changed every 24 hours when hanging a new bag of TPN.

A newly hired nurse is caring for a client who is receiving prescribed total parenteral nutrition (TPN) therapy. The nurse preceptor should intervene if the newly hired nurse A. wears a surgical mask while changing the client's central vascular access dressing. B. obtains the client's capillary blood glucose every four to six hours. C. spikes and primes a new bag of TPN without an inline filter. D. continues the infusion via an infusion pump while the client is downstairs getting a computed tomography scan.

oice C is correct. Bumetanide is a loop diuretic, and leg cramping may occur because loop diuretics may cause potassium depletion. Hypokalemia is a common complication of loop diuretics.

The nurse administers bumetanide to a client with pulmonary edema. Which assessment would indicate that the client is experiencing an adverse response? A. Distended neck veins B. Adventitious lung sounds C. Leg cramps D. Increase in urine output

Choices A, B, and D are correct. These statements require further teaching. Sucralfate is a medication indicated in peptic ulcer disease. This medication should be taken one hour before meals as the medication will coat the ulcer allowing a client to eat meals without pain. The client is not required to be upright 30 minutes after taking this medication. This would be applicable instruction for a client prescribed a bisphosphonate. This medication has no indication for nausea and vomiting treatment. Appropriate treatment for nausea and vomiting would be ondansetron or metoclopramide.

The nurse has provided medication instruction to a client prescribed sucralfate. Which of the following statements, if made by the client, would require further teaching? Select all that apply. "I should take this medication one hour after meals." "I will remain upright for 30 minutes after taking this medicine." "This medication will help with my peptic ulcer disease." "I know this medication works when my nausea and vomiting are gone." "I may dissolve this medication in warm water."

Choice A is correct. The most common side-effect associated with Metformin is gastrointestinal upset. This side-effect typically occurs at the start of the therapy and subsides over time. To minimize these effects, the client should take this medication with meals, or they may be prescribed the extended-release form.

The nurse has provided medication instruction to a client who has been prescribed metformin. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching? A. "This medication may cause me to have bloating or loose stools." B. "I will need to take my blood glucose prior to taking this medication." C. "If I eat fewer carbohydrates in a day, I should skip a dose." D. "The goal of this medication is to increase my hemoglobin A1C."

Choice C is correct. Phantom limb pain (PLP) is a form of complex pain syndrome that can be treated with medications such as pregabalin, gabapentin, amitriptyline, or propranolol. Amitriptyline is a tricyclic antidepressant (TCA), and its activity related to PLP may be associated with the blockade of serotonin-norepinephrine uptake. Choosing a non-opioid analgesic with proven efficacy is always critical before using an opioid analgesic.

The nurse is assessing a client with a recent history of an above-the-knee amputation presenting with phantom limb pain. The nurse anticipates a prescription for A. aripiprazole B. oxycodone C. amitriptyline D. hydroxyzine

Choice A is correct. A rapid-acting insulin is the most common insulin used in insulin pumps. A rapid-acting insulin is correctional insulin and should be appropriately dosed 5-10 minutes before a client's meal or while actively eating. Short-acting (regular) insulin may be alternatively loaded into an insulin pump.

The nurse is assisting a client with their insulin pump. The nurse understands which insulin is commonly loaded into the pump? A. Rapid acting B. Ultra long-acting insulin C. Intermediate acting D. Long acting

Choice C is correct. Isotretinoin (Accutane) is a synthetic retinoid that is frequently prescribed for severe acne that does not respond to other topical and oral treatments. This medication is usually given for 4 to 6 months or until significant improvement is noticed. Effects can include dry skin and changes in the appearance of the skin. However, oral isotretinoin can cause severe side effects. The FDA required that the labeling of isotretinoin be changed to add that there is a possible association between isotretinoin and critical mood changes. At every visit, the nurse should review symptoms such as depression, irritability, altered sleep patterns, and suicidal ideation with the client. The nurse should educate the family members to monitor for such mood changes and report them to the primary healthcare provider (PHCP).

The nurse is caring for a 17-year-old client who has been taking isotretinoin for the past three months. The nurse knows that the most critical assessment for this client is: A. Improvement in the appearance of the skin B. Dry skin on the face C. Mood changes D. Problems remembering to take the medication

Choice B is correct. Aspirin is an over-the-counter pain reliever that should be avoided in children and is associated with Reye's Syndrome. Reye's Syndrome causes swelling of the liver and the brain and usually presents with vomiting, a change in the level of consciousness, and seizures.

The nurse is caring for a client diagnosed with Reye's syndrome. The nurse understands that this illness is caused by which medication? A. Ibuprofen B. Aspirin C. Acetaminophen D. Diphenhydramine

Choice B is correct. Albumin is a colloid commonly used to prevent post-procedure hypotension after a large-volume paracentesis. Large-volume paracentesis is when at least five liters or more of ascitic fluid is removed. This large amount of removal may cause a fluid shift creating an intravascular fluid deficit. Albumin would be helpful because of its ability to assist in restoring fluid balance without causing fluid volume overload.

The nurse is caring for a client following a large volume paracentesis. To prevent hypovolemic shock, the nurse anticipates the primary healthcare provider (PHCP) to prescribe an infusion of A. 0.9% saline. B. Albumin. C. Mannitol. D. 0.45% saline.

Choice A is correct. Dicyclomine is an antispasmodic agent used in the treatment of irritable bowel syndrome (IBS). This may provide the client with relief from the spasms and cramping associated with IBS.

The nurse is caring for a client who is receiving prescribed dicyclomine. Which of the following client findings would indicate a therapeutic response? A. Decreased abdominal cramping B. Absence of nausea and vomiting C. Decreased urinary retention D. Less burning with urination

Choice A is correct. Simethicone is intended to treat excessive flatulence and its discomforts. The drug works by releasing the gas via the mouth or rectum, thus, relieving the cramping sensation.

The nurse is caring for a client who reports excessive flatulence and abdominal cramping. The nurse anticipates a prescription for A. simethicone. B. omeprazole. C. ferrous sulfate. D. cimetidine.

Choice A is correct. Corticosteroids should be taken in the morning, preferably before 9 AM. This mimics the natural release of glucocorticoids from the adrenal glands in the morning. Further, corticosteroids have an activating effect that, if taken late afternoon or at night, would cause insomnia.

The nurse is caring for a client who was prescribed prednisone. The nurse should instruct the client to take this medication at what time? A. In the morning B. Around noon C. Before bed D. Anytime, but at the same time every day

Choice A is correct. Hypokalemia (potassium less than 3.5 mEq/l) produces manifestations such as hypoactive bowel sounds, muscle cramping, weakness, and electrocardiogram changes such as flattened T-waves. Bowel sounds that are normoactive indicate a therapeutic finding because of the restoration peristalsis.

The nurse is caring for a client with a potassium of 3.1 mEq/L(3.5-5 mEq/L). The primary healthcare provider (PHCP) prescribed 40 mEq of intravenous (IV) potassium over four hours. Which assessment finding would indicate a therapeutic effect? A. Normoactive bowel sounds B. Flattened T-waves C. Reduced deep tendon reflexes D. Muscle cramping

Choice B is correct. Enoxaparin is a low-molecular-weight heparin (LMWH). Bleeding is the major risk associated with the use of enoxaparin. The client has anemia and active occult gastrointestinal bleeding. Enoxaparin is contraindicated in clients with any active clinically significant bleeding, including gastrointestinal bleeding. Clients with occult blood in their stool should avoid any type of anticoagulant therapy until the cause of the bleeding is identified and addressed.

The nurse is caring for a client with anemia and occult blood in the stool. Which of the following medications should the nurse question? A. Iron sucrose B. Enoxaparin C. Sucralfate D. Hydroxyurea

Choice A is correct. For clients with difficulty consuming adequate fiber to manage their diverticulitis, a bulk-forming laxative, such as psyllium, is recommended. Adding bulk to stools is established by drawing water into the stool and making it easier to pass. Increasing the fecal mass and softening the stool causes less constipation. Less constipation will cause less pressure on the diverticula, decreasing the risk of diverticulitis. Bulk-forming laxatives may take two days to work and must be taken with adequate water intake for maximum efficacy.

The nurse is caring for a client with diverticulosis who reports difficulty getting enough dietary fiber. The nurse should anticipate the physician will prescribe A. psyllium. B. oil-retention enema. C. codeine. D. bisacodyl.

Choices A, B, and E are correct. The prescribed vancomycin, furosemide, and ketorolac are all medications that should be clarified with the PHCP based on the BUN and creatinine being elevated. These elevations represent renal insufficiency. All three of these medications are nephrotoxic. Vancomycin is an antibiotic indicated for MRSA infections. Furosemide is used for cardiovascular disorders such as congestive heart failure, and ketorolac is a non-steroidal anti-inflammatory (NSAID) indicated for mild to moderate pain.

The nurse is caring for an assigned client. Which prescription requires clarification based on the laboratory data? See the exhibit. Select all that apply. View Exhibit vancomycin 1-gram IVPB Daily furosemide 40 mg PO Daily 500 ml of 0.9% Saline IV Bolus x 1 diltiazem XR 120 mg PO Daily ketorolac 15 mg IV Q 8 hours

Choices A and E are correct. Cystic Fibrosis is a multisystem disorder that causes gastrointestinal disturbances such as malabsorption of essential fat-soluble vitamins (A, D, E, and K). A multivitamin is prescribed to help mitigate these vitamin deficiencies. Salmeterol is a long-acting bronchodilator and has utility in cystic fibrosis as the airways may become narrowed or obstructed.

The nurse is reviewing a client's list of medications who has cystic fibrosis. The nurse anticipates a prescription for which medication? Select all that apply. Multivitamin Aspirin Warfarin Simvastatin Salmeterol

Choice D is correct. Extra vials (unopened) of insulin may be stored in the refrigerator. Insulin should never be frozen or administered cold.

The nurse is teaching a client about storing their prescribed insulin. Which statement, if made by the client, would indicate a correct understanding of the teaching? A. Opened vials of insulin may be kept in the freezer." B. "My opened vial of insulin is good for 45 days." C. "If I travel, I can keep a vial of insulin in my car." D. "Unopened vials of insulin may be stored in the refrigerator."

Choices A, C, and D are correct. These statements are incorrect and require follow-up. Esomeprazole is a proton pump inhibitor (PPI) in treating esophageal erosion, GERD, and peptic ulcer disease. The medication should be taken one hour before meals and with an ample amount of water. The medication does not fortify an existing ulcer, like sucralfate. The client does not require frequent laboratory testing while on this medication.

The nurse is teaching a client about the newly prescribed medication, esomeprazole. Which statement, if made by the client, would require further teaching? Select all that apply. "I should take this medication with meals." "I should not take this with any other medication or food." "The medication will coat my ulcer so I can eat without pain." "I will need frequent laboratory tests while taking this medication." "I may need to take magnesium supplements while on this medication."

increased myocardial oxygen demand; 12-lead EKG

The nurse understands that the chest pain was caused by the albuterol because this medication ____ It was appropriate for the nurse to discontinue the nebulizer and the nurse should immediately obtain a prescription for _____

Choice D is correct. The nurse should evaluate the character of the pulse since one of the toxic effects of theophylline is cardiac arrhythmias. If the pulse rate is significantly increased or erratic, it may alert the nurse regarding a potential arrhythmia from theophylline drug toxicity. Severe adverse events, including arrhythmias, seizures/ status epilepticus, nausea with vomiting, and hypotension, usually occur when the theophylline is at a toxic level in the body (drug toxicity). If such signs are detected, the nurse should hold the next dose of theophylline and immediately notify the healthcare provider.

You are caring for an 80-year-old woman with a long-standing history of asthma. You are preparing to give a dose of theophylline to the patient. You know that the most critical sign to assess before giving this dose is: A. Temperature B. Blood Pressure C. Urinary Output D. Pulse

Choice C is correct. "You are getting the NSAID, so the effects of the narcotic analgesic to combat your pain are more effective" is an appropriate response to the client's query. An NSAID is an "adjuvant" medication used in combination with narcotic analgesics to treat moderate to severe pain. Adjuvant pain medications are used to enhance pain relief provided by other analgesics. The primary function of NSAIDs is to reduce inflammation. Therefore, NSAIDs are helpful in treating the pain caused by inflammation.

Your client is receiving a non-steroidal anti-inflammatory drug (NSAID) in addition to a narcotic analgesic. The client wonders why an NSAID is necessary since the narcotic analgesic offers better pain relief. How would you respond to the client's question? A. I don't know and I suggest that you ask your doctor when you see her the next time. B. You are getting the NSAID because we are trying to wean you off the narcotic analgesic for moderate to severe pain. C. You are getting the NSAID, so the effects of the narcotic analgesic to combat your pain are more effective. D. You are getting the NSAID because it is a placebo, and it is proven to be effective for severe pain.

Choice A is correct. Isotretinoin is approved for the treatment of moderate to severe acne vulgaris.

The nurse is caring for a client who has just been diagnosed with severe acne vulgaris. Which of the following medications should the nurse anticipate the primary health care provider (PHCP) will prescribe? A. Isotretinoin B. Acyclovir C. Ketoconazole D. Ethambutol

Choice A is correct. Acetylcysteine is given to convert toxic metabolites to nontoxic ones. Acetaminophen is one of the most commonly used oral analgesics and antipyretics. The maximum dose for an adult is four grams in a 24-hour period. Toxicity starts after the consumption of seven grams.

The emergency department (ED) nurse is caring for a client with acetaminophen toxicity. The nurse anticipates a prescription for which medication? A. Acetylcysteine B. Deferoxamine mesylate C. Succimer D. Flumazenil

Choice B is correct. Sitagliptin is a DPP-4 Inhibitor used in managing diabetes mellitus type II. This medication reduces blood glucose levels by delaying gastric emptying and slowing the rate of nutrient absorption into the blood.

This nurse is caring for a client who is receiving prescribed sitagliptin. The nurse understands that this medication is intended to treat which condition? A. Hyperlipidemia B. Diabetes mellitus C. Hypothyroidism D. Hypertension

Choice B is correct. Sitagliptin is a DPP-4 Inhibitor used in managing diabetes mellitus type II. This medication reduces blood glucose levels by delaying gastric emptying and slowing the rate of nutrient absorption into the blood. The most common adverse effect associated with this medication is pancreatitis. Pancreatitis is manifested by abdominal pain, nausea, and persistent vomiting.

This nurse is caring for a client who is receiving prescribed sitagliptin. Which assessment findings indicate the client is experiencing a severe adverse effect? A. Nasal stuffiness B. Abdominal pain C. Headache D. Occasional dry cough

Choice D is correct. Topical lidocaine is a co-analgesic. Co-analgesics are also referred to as adjuvant analgesics. It is crucial to use adjuvant analgesics for adequate pain control before moving to initiate opioid analgesics ( according to the World Health Organization's pain ladder). Topical lidocaine is very useful in local control of post-herpetic neuralgia pain. The lidocaine patch provides analgesia by reducing the abnormal firing of sodium channels on injured pain nerve fibers directly under the patch. Topical patches are considered relatively safe because only less than 5% of the topically applied lidocaine is absorbed.

Your 75-year-old female client complains of pain due to post-herpetic neuralgia. She is taking Naproxen. Which of the following analgesics should additionally be added to her pain management regimen? A. Oxycodone B. Acetaminophen C. Ibuprofen D. Topical lidocaine

Choice C is correct. The nurse should question the health care provider's (HCP) order written for radioactive iodine (I-131) for this 16-year-old female client, as this client is of childbearing potential, and there is no evidence that the provider concurrently ordered a beta-hCG test. A client of "childbearing potential" is defined as any biological female who has begun menstruation and is capable of conception (typically, female clients between 12 years to 50 years). When given radioactive iodine (also referred to as RAI), RAI is taken up by the thyroid, destroying thyroid tissue. Radioactive iodine is highly effective and is the treatment of choice for Graves' disease in nearly all clients except pregnant clients, breastfeeding clients, or clients who hope to become pregnant within the next 12 months. Iodine, including radioactive isotopes, is readily transferred across the placenta, thus affecting the developing thyroid gland of a developing fetus. Therefore, in any female of childbearing potential, the American Thyroid Association recommends obtaining a beta-hCG test within 72 hours before RAI therapy initiation to rule out pregnancy. As such, the nurse should question the health ca

A 16-year-old female client was recently diagnosed with Graves' disease and subsequently admitted. Which of the following orders, if written by the health care provider (HCP), should the nurse question? A. Atenolol B. Propylthiouracil C. Radioactive iodine (I-131) D. Methimazole

Choice B is correct. The ceiling for acetaminophen dosing is no more than 4,000 mg every 24 hours. The symptoms of APAP toxicity may peak within 72-96 hours after ingestion.

The nurse is reviewing acetaminophen (APAP) toxicity with students. The nurse should remind students that the maximum acetaminophen dosage for an adult is A. 2,000 mg per day B. 4,000 mg per day C. 5,000 mg per day D. 6,000 mg per day

methylprednisolone; capillary blood glucose

The prescribed ____ puts the client at risk for complications such as hyperglycemia. To recognize this complication the nurse should monitor the client's ____

Choice C is correct. Beta-adrenergic agonists may cause a client to develop insomnia because the medication has the propensity to activate the client and their adrenergic receptors. Drugs in this class (albuterol, salmeterol) share the same effect, insomnia.

The nurse has provided medication instruction to a client who has been prescribed formoterol. Which of the following statements would indicate a correct understanding of the teaching? A. "I will take this medication if I experience shortness of breath." B. "I will need to rinse my mouth out after using this medication." C. "This medication may make it hard for me to fall asleep." D. "I should take this medication two hours before I go exercise."

Choice C is correct. Celecoxib is a nonsteroidal anti-inflammatory drug (NSAID) used to treat osteoarthritis, gout, dysmenorrhea, and migraine headaches. NSAIDs cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction(MI) and stroke.

The nurse has received a prescription for celecoxib. Which finding in the client's medical history should prompt the nurse to question the administration of this medication? A. osteoarthritis B. gout C. recent myocardial infarction D. migraine headaches

Choice C is correct. The nurse should confirm the fat emulsion infusion is infusing at the prescribed rate and subsequently maintain the prescribed rate until the infusion is complete.

The nurse assesses a client receiving total parenteral nutrition (TPN) and fat emulsions. The nurse observes that the fat emulsion infusion is one hour behind schedule. The nurse should take which action? A. Adjust the infusion rate to make up the difference over the next hour, then revert the infusion rate back to the prescribed rate. B. Increase the infusion rate to ensure that the infusion finishes at the correct time. C. Ensure the fat emulsion infusion rate is infusing at the prescribed rate and maintain the rate at the prescribed rate. D. Stop the infusion and inform the primary health care provider (PHCP).

Choice C is correct. Prednisone is a corticosteroid that increases aldosterone and is responsible for sodium retention and the elimination of potassium. Therefore, a client's potassium level will decrease while taking this medication. If a client is taking prednisone, the recommendation is that they reduce dietary sodium and increase dietary potassium.

The nurse cares for a client with a potassium of 3.2 mEq/L (3.5-5 mEq/L). Which of the following medications may cause this abnormality? A. spironolactone B. triamterene C. prednisone D. lisinopril

Choice D is correct. Aspart insulin is a rapid-acting insulin that should be administered to the client no greater than 5-10 minutes prior to the meal or while the client is actively eating. Before administering this insulin, the client's blood glucose should be obtained.

The nurse is educating a client about newly prescribed aspart insulin. The nurse should instruct the client to self-administer this insulin A. 30-45 minutes before a meal B. one hour after a meal C. 20-30 minutes before a meal D. 5-10 minutes before a meal

Choice C is correct. The new RN should not shake the vial but gently rotate it to ensure uniform suspension of insulin. Shaking the vial of insulin would cause excessive air bubbles.

The nurse observes the newly hired registered nurse prepare to administer neutral protamine hagedorn (NPH) insulin to a client. Which action by the newly hired nurse requires follow-up? The newly hired nurse A. asks the client which site the insulin was last injected. B. checks the client's blood glucose levels prior to administering the insulin injection. C. shakes the insulin vial before withdrawing insulin. D. reminds the client to report symptoms of clammy skin and disorientation.