pharm ati

A nurse is caring for a client who is has a pulmonary embolism and has a new prescription for enoxaparin 1.5mg/kg/dose subcutaneous every 12 hr. The client weighs 245 lbs. How many mg should the nurse administer per dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

167

A nurse in the ICU is caring for a client who has heart failure and is receiving a dobutamine drip. The nurse should identify that which of the following findings indicates that the medication is effective?

Increased urine output Dobutamine is administered to clients who have heart failure to improve their hemodynamic status. The nurse should identify an increase in client's urine output as an indication that the medication is effective.

A nurse is teaching a client who is in her first trimester of pregnancy about over-the-counter medications that are a pregnancy risk category B. Which of the following medications should the nurse include?

Acetaminophen MY ANSWER Acetaminophen is a pregnancy risk category B. Animal studies do not show fetal risk or controlled studies in women do not show a fetal risk.

A nurse is caring for a client who is in her third trimester of pregnancy. The client asks the nurse about over-the-counter medications. The nurse should recognize which of the following medications is a pregnancy risk category B?

AcetaminophenAcetaminophen is pregnancy risk category B. However, clients who are pregnant should not take over-the-counter medications without consulting the provider.

A nurse is assessing an older adult client who is receiving digoxin. The nurse should recognize that which of the following findings is a manifestation of digoxin toxicity?

Anorexia Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity.2

A nurse at a provider's office receives a phone call from a client who reports unrelieved chest pain after taking a nitroglycerin (Nitrostat) tablet 5 minutes ago. Which of the following is an appropriate response by the nurse?

Instruct the client to call 911. MY ANSWER Tell the client to take an aspirin is incorrect. While taking an aspirin may not cause additional harm, with unrelieved chest pain this is not an appropriate response by the nurse.Instruct the client to call 911 is correct. The standard dosing regimen for nitroglycerin is one tablet sublingually. If anginal pain is not relieved after 5 min, the client should call 911 or go to the emergency department. An additional two tablets can be taken at 5 min intervals while awaiting emergency care. Have the client take another nitroglycerin tablet in 15 min is incorrect. This response delays needed treatment for the client, and is not appropriate.Advise the client to come to office is incorrect.This response delays needed treatment for the client, and is not appropriate.

A nurse is caring for a client who has a bacterial infection and is receiving gentamicin. Which of the following actions should the nurse take to minimize the risk of an adverse effect of the medication?

Monitor the serum medication levels. MY ANSWER A disadvantage of gentamicin, an aminoglycoside, is the association with nephrotoxicity and ototoxicity, both of which are a result of elevated trough levels. Monitoring the serum medication levels is an important action to minimize the risk of an adverse effect of gentamicin.

A nurse is caring for a client who has thrombophlebitis and is receiving a continuous heparin infusion. Which of the following medications should the nurse have available to reverse heparin's effects?

Protamine sulfate MY ANSWER Protamine sulfate reverses the effects of heparin by binding with heparin to form a heparin-protamine complex that has no anticoagulant properties.

A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider?

The client has a history of bronchial asthma. MY ANSWER Beta-adrenergic blockers can cause bronchospasm in clients who have bronchial asthma; therefore, this is a contraindication to its use and should be reported to the provider.

A nurse is teaching a client about the adverse effects of cisplatin. Which of the following adverse effects should the nurse include in the teaching?

Tinnitus MY ANSWER Tinnitus and hearing loss are adverse effects of cisplatin.

A client who has primary hypothyroidism is prescribed levothyroxine (Synthroid). Which of the following client educational materials should the nurse provide about the medication.

Tremors, nervousness, and insomnia may indicate your dose is too high." MY ANSWER Tremors, nervousness, and insomnia may indicate an overdose of the medication and the provider should be contacted.

​A nurse is instructing a client in the use of a patient-controlled analgesia (PCA) pump. The nurse should explain that the client is unlikely to receive an overdose of medication because of which of the following features of the PCA pump?

​Timing control MY ANSWER ​A feature of client-controlled analgesia devices is the timing control or lockout mechanism, which enforces a preset minimum interval between medication doses. This safety feature is one means of preventing an overdose, as the client cannot self-administer another dose of medication until that time interval has passed.

A nurse is teaching a client who has a new prescription for lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements?

Sodium MY ANSWER Lithium is a salt. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity.

A clinic nurse is giving instructions to a mother on the proper technique of applying ophthalmic ointment to her preschool-age child who has conjunctivitis. Which of the following should the nurse include in the instructions?

"Discard the first bead of ointment before each application." MY ANSWER The parent should discard the first bead of ointment from the tube because it is considered contaminated.

A nurse is caring for a client who has thrombophlebitis and is receiving heparin by continuous IV infusion. The client asks the nurse how long it will take for the heparin to dissolve the clot. Which of the following responses should the nurse give?

Heparin does not dissolve clots. It stop new clots from forming.

A nurse gives a client morphine sulfate 2 mg IV push after the client reports pain. The nurse evaluates the client 15 min after the injection. Which of the following findings represent an adverse effect?

espiratory rate of 8 breaths per minute.( The nurse's evaluation of the client's displaying respiratory depression of 8 per minutes represents an adverse effect of the morphine.

A nurse is providing teaching to a client who has oral candidiasis and a new prescription for nystatin suspension. Which of the following statements by the client indicates an understanding of the teaching?

"I will store the medication at room temperature." Nystatin oral suspension should be stored at room temperature.

A nurse is providing instructions about bowel cleansing with polyethylene glycol-electrolyte solution (PEG) for a client who is going to have a colonoscopy. Which of the following information should the nurse include?

"Abdominal bloating might occur." MY ANSWER While PEG is well-tolerated, adverse effects include nausea, bloating, and abdominal discomfort.

A nurse is caring for a client who is receiving magnesium sulfate to treat severe preeclampsia and asks the nurse "Is the medication working?" Which of the following responses should the nurse make?

"The medication is working, because there is no seizure activity." Magnesium sulfate can be used for various reasons, including antacid, antiarrhythmic, anticonvulsant, electrolyte replacement and laxative. The primary indication for the client who is being treated for preeclampsia is the anticonvulsant properties. It is the preferred drug to prevent seizures in preeclampsia and treat seizures associated with eclampsia.

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate?

Evaluating the client for nausea, vomiting, and anorexia Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity.

A nurse is providing teaching to a client who is prescribed lisinopril (Zestril). Which of following client statements should indicate to the nurse effective teaching?

I can have blueberries on my cereal in the morning." ACE inhibitors can cause an increase in serum potassium. Clients should be instructed to avoid foods high in potassium and make appropriate substitutions, such as blueberries instead of bananas. Clients should also avoid the use of salt substitutes. The increase in potassium is related to a mild reduction in serum aldosterone.

A nurse is preparing to administer insulin lispro (Humalog) to a client who has type 1 diabetes mellitus. Which of the following nursing actions is appropriate?

Inject the insulin 15 min before a meal. MY ANSWER The appropriate nursing action is to administer the insulin 15 min before a meal because insulin lispro is a rapid-acting insulin and the client may develop hypoglycemia quickly if they don't eat.

A nurse in a provider's clinic is caring for a client who reports erectile dysfunction and requests a prescription for sildenafil. Which of the following medications currently prescribed for the client is a contraindication to taking sildenafil?

Isosorbide Clients who are on nitrates including isosorbide and nitroglycerin preparations cannot take sildenafil, because of the serious medication interaction. There is the possibility of sudden death due to hypotension.

A client is scheduled to receive digoxin (Lanoxin). Which of the following laboratory data is most important for the nurse to review?

Potassium MY ANSWER Digoxin is a cardiac glycoside medication used to improve myocardial contractility, increasing stroke volume and cardiac output in a client who has heart failure. During therapy, the nurse should closely monitor the narrow therapeutic index of digoxin (0.8 to 2.0 ng/mL) and potassium (3.5 to 5.0 mEq/L). Hypokalemia increases the risk of digitalis toxicity and cardiac arrhythmias. High potassium foods include oranges, bananas, raisins, prunes, spinach, potatoes, tomatoes, and black licorice.

A nurse is caring for a client who is receiving heparin by continuous IV infusion. Which of the following medications should the nurse plan to administer in the event of an overdose?

Protamine Protamine reverses the effects of heparin and is used in the event of an overdose.

A nurse is caring for a client who is prescribed diphenhydramine to relieve pruritus. The client asks the nurse how he can minimize the daytime sedation he is experiencing. Which of the following responses should the nurse give?

ake most of the daily dose at bedtime." MY ANSWER Taking most of the dose at bedtime will allow the client to obtain the benefit of maximum relief of manifestations and rest without itching.

​After receiving TPN at 84 ml/hr continuously for five days, a client in a state of confusion pulled out their central line. Prior to notifying the provider, the nurse should start a peripheral IV and do which of the following?

​Hang an infusion 10% dextrose. ​The sudden withdrawal from the TPN (hypertonic solution) can cause the client to be experiencing hypoglycemia. Administering an infusion of 10% dextrose will adjust the client's blood glucose levels.

​A nurse is caring for a client who has a new prescription for hydroxychloroquine (Plaquenil) to treat mild symptoms of rheumatoid arthritis. Which of the following baseline examinations should the client have prior to taking this medication?

​Vision testing ​Prior to initiating treatment with hydroxychloroquine, the client should undergo baseline vision testing with 6-month followups because this medication can cause retinal damage.

A nurse is teaching a client who takes warfarin daily. Which of the following statements by the client indicates a need for further teaching?

"I have started taking ginger root to treat my joint stiffness." MY ANSWER Ginger root can interfere with the blood clotting effect of warfarin and place the client at risk for bleeding. This statement indicates the client needs further teaching.

A nurse is teaching a client who has a new prescription for colchicine to treat gout. Which of the following instructions should the nurse include?

"Monitor for muscle pain." MY ANSWER This medication can cause rhabdomyolysis. The client should monitor and report muscle pain.

A nurse in a clinic is caring for a client who has a prescription for digoxin. Which of the following statements indicates the client is experiencing digoxin toxicity?

"My vision seems yellow." MY ANSWER Blurred and yellow vision is an indication of digoxin toxicity.

A nurse is teaching a client who has angina pectoris about starting therapy with SL nitroglycerin tablets. The nurse should include which of the following instructions regarding how to take the medication?

"Take one tablet at the first indication of chest pain." The client should take nitroglycerin as soon as he feels pain, pressure, or tightness in his chest and not wait until his chest pain is severe.

A nurse is preparing to administer 0.9% sodium chloride 1,200 mL IV to infuse over 24 hr. The drop factor of the manual IV tubing is 15 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

13gtt/min

A nurse is caring for a client who is prescribed 15 units of NPH insulin to be administered at 0700. At which of the following times of day should the nurse plan to offer a snack?

1500 Eight hr after NPH administration is the middle of the peak time for intermediate acting insulins. The client is at greatest risk for hypoglycemia and this may require a snack at this time. Clients should be educated to check blood glucose about 8 to 10 hr after administration of NPH insulin, and if hypoglycemic, consume a small snack of 15 grams of carbohydrates, followed by rechecking of the blood glucose in 15 min. If the blood glucose has returned to normal at this time, the client should then consume a small amount of protein to maintain a steady-state glucose level. All clients should receive education on signs and symptoms of hypoglycemia and hyperglycemia.

A nurse is caring for a 1-month-old infant who weighs 3500 g and is prescribed a dose of cephazolin 50 mg/kg by intermittent IV bolus three times daily. How many mg should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

175 mg

A nurse is preparing to administer benztropine (Cogentin) 2 mg IM to a client who is experiencing an extrapyramidal reaction. Available is benztropine 1 mg/mL for injection. How many mL should the nurse administer? (Round to the nearest whole number.)

2

A nurse is preparing to administer amoxicillin 250 mg PO every 8 hr. The amount available is amoxicillin 125 mg tablets. How many tablets should the nurse administer with each dose? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

2 tablets

A nurse is to preparing to administer cefazolin 1 g by intermittent IV bolus over 30 min. Available is cefazolin 1 g in 100 mL dextrose 5% in water (D5W). The drop factor of the manual IV tubing is 10 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

33gtt/min

A nurse is preparing to administer hydromorphone 2.5 mg. The amount available is 5 mg/5 mL elixir. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

2.5

A nurse is caring for a client who has diabetes insipidus and is receiving vasopressin. The nurse should identify which of the following findings as an indication that the medication is effective?

A decrease in urine output MY ANSWER The major manifestations of diabetes insipidus are excessive urination and extreme thirst. Vasopressin is used to control frequent urination, increased thirst, and loss of water associated with diabetes insipidus. A decreased urine output is the desired response.

A nurse is preparing to administer amoxicillin 30 mg/kg/day divided equally every 12 hr to a toddler who weighs 33 lb. Available is amoxicillin 200 mg/5 mL suspension. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

5.6 ml

A nurse is caring for a client who is postoperative following an appendectomy and is prescribed D5 lactated Ringer's at 150 mL/hr by continuous IV infusion for 12 hr. The drop factor of the manual IV tubing is 20 gtt/mL. The nurse should set the manual IV infusion to deliver how many gtt/min? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

50

A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

75

A group of nurses are reviewing several client's medical history. Which of the following clients may develop extrapyramidal symptoms from medication therapy?

A client who has schizophrenia and is taking antipsychotic medication.( MY ANSWER This may develop into extrapyramidal symptoms, which mimics an idiopathic disease when certain medications are prescribed for short-term, such as symptoms of Parkinson's disease.

A nurse is preparing to administer phenytoin IV to a client who has a seizure disorder. Which of the following actions should the nurse plan to take?

Administer a saline solution after injection. The nurse should flush the injection site with a saline solution after the injection of phenytoin to reduce and prevent venous irritation.

A nurse on a telemetry unit is caring for a client who has unstable angina and is reporting chest pain with a severity of 6 on a 0 to 10 scale. The nurse administers 1 sublingual nitroglycerin tablet. After 5 min, the client states that his chest pain is now a severity of 2. Which of the following actions should the nurse take?

Administer another nitroglycerin tablet.Administration guidelines for sublingual nitroglycerin indicate that it is appropriate to administer another tablet 5 min after the first one if the client is still reporting pain.

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects?

Adrenocortical insufficiency MY ANSWER Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.

A nurse is caring for four clients for whom she has to administer oral medications in the morning. The nurse should administer which of the following medications before breakfast?

Alendronate The client must take alendronate first thing in the morning on an empty stomach and wait at least 30 minutes before eating, drinking, or taking other medications

A nurse caring for a client who has hypertension and asks the nurse about a prescription for propranolol. The nurse should inform the client that this medication is contraindicated in clients who have a history of which of the following conditions?

Asthma MY ANSWER Propranolol, a beta-blocker, is contraindicated in clients who have asthma because it can cause bronchospasms. Propranolol blocks the sympathetic stimulation, which prevents smooth muscle relaxation.

A nurse is assessing a client after administering IV vancomycin. Which of the following findings is the nurse's priority to report to the provider?

Audible inspiratory stridor MY ANSWER When using the airway, breathing, circulation approach to client care the nurse determines the priority finding is inspiratory strider. The client is at risk for bronchospasms, hypotension and circulatory collapse due to anaphylaxis. The nurse should contact the rapid response team, discontinue the vancomycin, and administer epinephrine.

A nurse is caring for four clients. After administering morning medications, she realizes that the nifedipine prescribed for one client was inadvertently administered to another client. Which of the following actions should the nurse take first?

Check the client's vital signs. MY ANSWER The first action the nurse should take using the nursing process is to assess the client. The nurse should know that the action of nifedipine is to lower blood pressure. Immediately upon realizing the error, the nurse should check the client's vital signs (especially the client's blood pressure) to ensure that the client is not hypotensive as a result. Only after ensuring that the client is safe and has stable vital signs should the nurse take other actions.

A postoperative client is receiving hydromorphone HCL (Dilaudid) via a PCA pump and reports continuous pain. Which of the following should be the nurse's initial action?

Check the display on the PCA pump. The nurse needs to assess the display to determine how much medication has been administered. Some clients are fearful of developing an addiction to narcotics and may be reluctant to use the PCA.

A client receives clopidogrel (Plavix) after placement of a cardiac stent. Which of the following should the nurse recognize as a therapeutic response to the medication?

Client denies difficulty swallowing. Clopidogrel is provided to clients following a cardiac stent placement to prevent stent closure. The best evidence of therapeutic response to the antiplatelet therapy is absence of angina. Angina symptoms include chest pain that may radiate to upper extremity, neck, jaw, and shoulder. Pain that radiates to the neck and jawline tightens the muscles and causes difficulty speaking and/or swallowing.

A nurse is assessing a client who is receiving IV vancomycin. The nurse notes a flushing of the neck and tachycardia. Which of the following actions should the nurse take?

Decrease the infusion rate on the IV. This client is experiencing Red man syndrome, which includes a flushing of the neck, face, upper body, arms and back along with tachycardia, hypotension and urticaria. This can lead to an anaphylactic reaction if the IV infusion rate is not slowed down to run greater than 1 hour.

A nurse is caring for a client who is exhibiting signs of alcohol withdrawal. Which of the following medications should the nurse plan to administer?

Diazepam MY ANSWER Diazepam is prescribed to treat the symptoms and prevent complications of alcohol withdrawal.

A nurse is caring for a client who is in premature labor and is receiving terbutaline. The nurse should monitor the client for which of the following adverse effects that should be reported to the provider?

Dyspnea The presence of dyspnea is a manifestation of pulmonary edema, which is a potentially life-threatening complication of terbutaline. This finding should be reported to the provider immediately.

A nurse is assessing a client who is receiving a parental lipid infusion. Which of the following findings is a manifestation of fat overload syndrome?

Elevated temperature MY ANSWER An elevated temperature is an early manifestation of fat overload syndrome. The client is at risk for coagulopathy and multi-organ system failure due to fat overload syndrome.

A client experiences anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first?

EpinephrineMY ANSWEREpinephrine does reverse the most severe manifestations of anaphylactic shock; therefore, should be the treatment of choice.

A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. Which of the following instructions should the nurse provide regarding this type of insulin?

Insulin glargine has a duration of 18 to 24 hr. Insulin glargine is a long duration insulin that has a duration of 18 to 24 hr. It is only dosed once a day.

A nurse is preparing to administer bisacodyl suppository to a client. Which of the following actions should the nurse take? (Select all that apply.)

Lubricate index finger. the rounded end of the suppository is lubricated with a sterile water-soluble lubricating jelly. Insert suppository just beyond internal sphincter is correct. The nurse should gently retract the buttocks with the nondominant hand. Insert the suppository gently through the anus, past the internal sphincter, and against the rectal wall. Following the administration of the medication, the nurse should apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place.

A nurse is caring for a newborn who has respiratory depression. Which of the following medications should the nurse anticipate administering?

Naloxone Naloxone is an opioid antagonist and is administered to reverse opioid toxicity or reverse neonatal respiratory depression. Dosage for a newborn is 0.01 mg/kg, and is repeated every 2 to 3 min until adequate respiratory function returns.

A nurse is preparing to administer orlistat (Xenical) to a client for treatment of obesity. Which of the following is an adverse effect should the nurse monitor?

Oily fecal spotting The client may expect the adverse effect of oily fecal spotting because of the GI tract's decreased absorption of fat.

A nurse is planning care for a client who has a detached retina and is preoperative for a surgical repair. The nurse should prepare to administer which of the following medications?

Phenylephrine Mydriatic medications, such as phenylephrine, are used preoperatively to dilate pupils to facilitate intraocular surgery.

A nurse is preparing to instill eardrops to a 5-year-old child. Which of the following techniques should the nurse use?

Pull the auricle up and out. The nurse should pull the auricle up and out to instill eardrops to a 5-year-old child. This technique is used for children 4 years of age and older, and adults.

A nurse is preparing to administer a unit of packed red blood cells to a client. Which of the following actions should the nurse plan to take?

Remain with the client for the first 15 minutes of the transfusion. MY ANSWER The nurse should remain with the client for the first 15 to 30 minutes of the transfusion to monitor for a transfusion reaction, which occurs often during the first 50 mL of the transfusion.

A nurse is talking to a client who is taking a calcium supplement for osteoporosis. The client tells the nurse she is experiencing flank pain. Which of the following adverse effects should the nurse suspect?

Renal stones MY ANSWER Hypercalcemia due to calcium supplements can cause renal stones. Clients should increase their water intake while taking calcium supplements to hydrate the kidneys and should report any blood in the urine or flank pain.

A nurse is reviewing the medication list for a client who has a new diagnosis of a small bowel obstruction. The nurse should withhold which of the following medications?

Senna Laxatives are contraindicated in clients who have fecal impaction, bowel obstruction, and acute abdominal surgery to prevent perforation. Because the bowel does not allow for any passage of stool with a complete small bowel obstruction, laxatives will cause increased abdominal cramping and discomfort.

A nurse is teaching a client about taking an expectorant to treat a cough. The nurse should explain that this type of medication has which of the following actions?

Stimulates secretions MY ANSWER Expectorants act by increasing secretions to improve a cough's productivity.

A nurse in a substance abuse clinic is assessing a client who recently started taking disulfiram. The client reports having discontinued the medication after experiencing severe nausea and vomiting. Which of the following reasons should the nurse suspect to be a likely cause of the client's distress?

The client consumed alcohol while taking the medication. MY ANSWER Disulfiram is given to clients who have a history of alcohol abuse. It produces a sensitivity to alcohol that results in a highly unpleasant reaction when the client ingests even small amounts of alcohol. When combined with alcohol, disulfiram produces nausea and vomiting.

A nurse is assessing a client prior to administering a seasonal influenza vaccine. The client says he read about an influenza vaccine that is given as a nasal spray and wants to receive it. The nurse should recognize that which of the following findings is a contraindication for the client receiving the live attenuated influenza vaccine (LAIV)?

The client's age is 62. Clients must be between the ages of 2 and 49 to receive the LIAV; therefore, it is contraindicated for this client. Pregnancy and immunocompromised status are also contraindications.

A nurse is preparing to administer heparin to a client. Which of the following actions should the nurse plan to take?

The nurse should inject the medication into the abdomen above the level of the iliac crest, at least 2 inches from the umbilicus.

A nurse is caring for a client receiving ciprofloxacin (Cipro) for the treatment of an uncomplicated UTI. Which of the following should the nurse recognize as the most reliable indicator of therapeutic effect?

Urinalysis shows decreasing pyuria and bacteriuria. Normal urinalysis results should have no pyuria (pus in the urine) and bacteriuria (bacteria counts) less than 100,000 colony forming units. Evidence of pyuria and bacteriuria indicates that a UTI is present. As treatment progresses, urinalysis should return to normal, but as results are improving, this is evidence of effective therapy.

A nurse is caring for a client who is on warfarin therapy for atrial fibrillation. The client's INR is 5.2. Which of the following medications should the nurse prepare to administer?

Vitamin KVitamin K reverses the effects of warfarin.

​A nurse is caring for a client who received an injection of penicillin G procaine (Bicillin). The client experiences dyspnea and states, "My tongue feels swollen." Which of the following should be the nurse's priority action?

​Administer epinephrine (Adrenalin) subcutaneously. MY ANSWER ​Epinephrine (Adrenalin) is the drug of choice in response to anaphylaxis that occurs in a non-acute setting. Because this medication is given subcutaneously, the nurse can administer this medication. It can be given subcutaneously in the upper arm or in the thigh. The location should be above the location of the injection that resulted in the anaphylaxis. Epinephrine can be given through clothing to prevent delay of administration. The effect of the epinephrine is to act on adrenergic receptors, causing bronchodilation of the lungs and an elevation of blood pressure. By stimulating both alpha and beta adrenergic receptors to cause these effects, it accomplishes more of the goals of treatment of anaphylaxis than any other single therapy. This action is the priority action of the nurse to save the client.

​A nurse is preparing a presentation for coworkers about the various herbal remedies clients might report using. Which of the following should she include as an herbal supplement clients might use to treat menopause-related hot flashes?

​Cimicifuga racemosa (black cohosh) ​Although evidence is inconclusive, black cohosh may relieve menopausal symptoms, such as hot flashes.

​A nurse is preparing to administer prednisone (Deltasone) to a client for treatment of rheumatoid arthritis. Which of the following indicates effective therapy?

​Improved range of motion MY ANSWER ​This is an expected response of prednisone administration. Prednisone is a glucocorticoid that produces anti-inflammatory and immunosuppressive effects. When used for rheumatoid arthritis, the client should experience a reduction in pain and inflammation, and improved range of motion in joints. Local injections can be highly effective, and clients should be warned against overactivity in the affected joint to prevent overuse, which can lead to injury. Because of the risk for complications, long-term systemic use should be avoided.

A nurse is talking with the parents of a child who is about to start using a metered-dose inhaler to treat asthma. The nurse should explain that the child will be using a spacer for which of the following reasons?

​Increases the amount of medication delivered to the lungs MY ANSWER ​A spacer increases the amount of medication that reaches the lungs.

A nurse is assessing a client who is receiving dopamine IV to treat left ventricular failure. Which of the following findings should indicate to the nurse that the medication is having a therapeutic effect?

systolic blood pressure is increased MY ANSWER When dopamine has a therapeutic effect, it causes vasoconstriction peripherally and increases systolic blood pressure.

A nurse is teaching a client who has a new prescription for clopidogrel. Which of the following instructions should the nurse include?

"You might have to stop taking this medication 5 days before any planned surgeries." Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding.2

A nurse is reviewing the medical record of a client who reports taking pseudoephedrine for sinus congestion as needed. The nurse should identify that pseudoephedrine is contraindicated for which of the following client conditions?

Hypertension MY ANSWER Clients who have hypertension or acute coronary syndrome should speak with their provider prior to taking decongestants, because of the potential for vasoconstriction, which would aggravate the chronic condition.

​A nurse is teaching an adolescent about medication therapy with oral acetylcysteine (Mucomyst). Which of the following is included in the teaching?

​"This medication has a very unusual odor." MY ANSWER ​This medication has an odor similar to rotten eggs due to the presence of disulfide linkages.

​A nurse is admitting a client who has acute heart failure following myocardial infarction (MI) and is reviewing the provider's orders. Which of the following prescriptions by the provider requires clarification?

​0.9% normal saline IV at 50 mL/hr continuous MY ANSWER ​0.9% sodium chloride is isotonic and will not cause the fluid shift needed in this client to reduce circulatory overload. This prescription requires clarification.

​A nurse is preparing to administer a bisacodyl (Dulcolax) 10 mg suppository. Which of the following are correct administration guidelines for the nurse to implement? (Select all that apply.)

​Lubricate index finger. ​Use a rectal applicator for insertion. ​Position client supine with knees bent. ​Insert suppository just beyond internal sphincter. Lubricate index finger is correct. The rounded end of the suppository should be lubricated with a sterile water-soluble lubricating jelly. In addition to lubricating the suppository, the index finger of the nurse's dominant hand should be lubricated with a water-soluble lubricant to promote insertion.Use a rectal applicator for insertion is incorrect. The nurse should administer the suppository with the dominant index finger, which has been lubricated. The nurse should not use an applicator to insert a suppository. The nurse should be aware that vaginal applicators are used to deposit medication such as vaginal creams or foams into the vagina.Position client supine with knees bent is incorrect. To avoid the unlikely event of rupturing the rectum, the client should be assisted to a left lateral position. When lying on the right side, the descending and sigmoid colon and rectum transition to the right due to gravity. When lying on one's left, these end structures of the gastrointestinal tract are more or less aligned, resulting in an easier suppository insertion. The client who is receiving a vaginal suppository should be positioned supine with knees bent, feet flat on the bed and close to hips (modified lithotomy position).Insert suppository just beyond internal sphincter is correct. The nurse should gently retract the buttocks with the nondominant hand. The suppository should be inserted gently through the anus, past the internal sphincter, and against the rectal wall. Following the administration of the medication, the nurse should apply gentle pressure to hold the buttocks together momentarily if needed to keep medication in place. The internal sphincter is constantly contracted and prevents small amounts of stool from leaking from the rectum and will hold the suppository in place.

​A nurse is talking with a client who is about to start taking alendronate (Fosamax) to treat osteoporosis. When the nurse instructs the client to remain sitting or standing for at least 30 min after taking the medication, the client asks why. The nurse should tell the client that this will help prevent

​esophagitis. ​A sitting or standing position will reduce prolonged contact of the medication with the lining of the esophagus and help prevent esophagitis.

A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching?

"I will be sure to take the albuterol before taking the cromolyn." The client should always use the bronchodilator (albuterol) prior to using the leukotriene modifier (cromolyn). Using the bronchodilator first allows the airways to be opened, ensuring that the maximum dose of medication will get to the client's lungs

A nurse is providing discharge teaching to a client who has pulmonary tuberculosis and a new prescription for rifampin. Which of the following information should the nurse provide?

"Urine and other secretions might turn orange." MY ANSWER Rifampin might turn the urine and other secretions reddish-orange. This includes sputum, tears, and sweat.

Mannitol 25% Cushing's Triad is an indication that the client is experiencing increased intracranial pressure. The nurse should administer mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema.

"You should report any tendon discomfort you experience while taking this medication." The nurse should instruct the client to report any tendon discomfort as well as swelling or inflammation of the tendons due to the risk of tendon rupture.

A nurse in the emergency department is caring for a client who took 3 nitroglycerin tablets sublingually for chest pain. The client reports relief from the chest pain but now he is experiencing a headache. Which of the following statements should the nurse make?

A headache is an expected adverse effect of the medication." MY ANSWER The vasodilation nitroglycerin induces increases blood flow to the head and typically results in a headache.

A nurse is providing teaching to a client who has a new prescription for metoprolol succinate (Toprol XL). Which of the following should be of most concern to the nurse?

A history of left-sided heart failure MY ANSWER The presence of heart failure should be of concern to the nurse. Beta blockers are frequently prescribed after a myocardial infarction to help prevent heart failure. However, they should be used with great caution when clients already have heart failure. Once the nurse is confident that the provider has considered the existing heart failure, extra care should be taken to teach the client to watch for signs of increasing left heart failure, such as shortness of breath and weight gain indicating fluid retention. Positive findings by the client should be reported immediately to the provider.

A nurse is teaching a client who has a new prescription for transdermal nitroglycerin to treat angina pectoris. Which of the following instructions should the nurse include in the teaching?

Apply the transdermal patch in the morning. MY ANSWER The client should apply the patch every morning and leave it in place for a 12 to 14 hr, then remove it in the evening.

A nurse is caring for a client who has active pulmonary tuberculosis (TB) and is to be started on intravenous rifampin therapy. The nurse should instruct the client that this medication can cause which of the following adverse effects?

Body secretions turning a red-orange color MY ANSWER Rifampin is used in combination with other medicines to treat TB. Rifampin will cause the urine, stool, saliva, sputum, sweat, and tears to turn reddish-orange to reddish-brown.

A home health nurse is making a home visit to a client who takes a daily diuretic for heart failure. Which of the following manifestations should the nurse identify as indicating the client is hypokalemic?

Fatigue MY ANSWER The nurse should expect to find the client with fatigue due to muscle weakness with hypokalemia.

A nurse is caring for a client who has heart failure and has a potassium level of 2.4 mg/dL. An adverse effect of which of the following medications is a possible cause of this potassium level?

Furosemide (Lasix) MY ANSWER Furosemide (Lasix) is correct. Furosemide is a loop (high-ceiling) diuretic that inhibits the reabsorption of sodium and chloride and results in diuresis. Potassium is lost through excretion in the distal nephrons when the patient receives the drug. The lab result is interpreted as hypokalemia, which is an adverse effect associated with the administration of furosemide.Nitroglycerin (Nitro-Bid) is incorrect. A potassium level of 2.4 mg/dL is not an adverse effect of nitroglycerin.Metoprolol (Lopressor) is incorrect. A potassium level of 2.4 mg/dL is not an adverse effect of metoprolol.Spironolactone (Aldactone) is incorrect. A potassium level of 2.4 mg/dL is not an adverse effect of spironolactone.

A client's IV bag of total parenteral nutrition (TPN) is empty, and the new bag has not arrived from the pharmacy. Which of the following is the most appropriate intervention for the nurse to make?

Hang a bag of dextrose 10% in water (D10W) until the new bag of TPN is delivered. If TPN runs out or is not available to hang, then the protocol requires that D10W is infused. D10W is a hypertonic solution that will maintain glucose level and prevent rebound hypoglycemia.

A nurse is assessing a client prior to administering atenolol. Which of the following findings should prompt the nurse to withhold the medication?

Heart rate 46/min MY ANSWER The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 50/min, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension and angina, and following a myocardial infarction. This medication works by slowing the heart rate, decreasing the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction.

A nurse is preparing to administer verapamil by IV bolus to a client who is having cardiac dysrhythmias. For which of the following adverse effects should the nurse monitor when giving this medication?

Hypotension MY ANSWER Verapamil, a calcium channel blocker, can be used to control supraventricular tachyarrhythmias. It also decreases blood pressure and acts as a coronary vasodilator and antianginal agent. A major adverse effect of verapamil is hypotension; therefore, blood pressure and pulse must be monitored before and during parenteral administration.

A nurse is caring for a client who is receiving a continuous IV infusion of dopamine hydrochloride (Intropin). Which of the following should the nurse recognize as a therapeutic effect?

Increased urine output Dopamine is a vasopressor used in the treatment of shock and heart failure. It increases cardiac output by increasing myocardial contractility. This medication also dilates renal blood vessels, which increases renal perfusion and leads to an increase in the client's urine output. This should indicate to the nurse a therapeutic effect has been achieved.

A nurse is assessing a client who is receiving a continuous IV infusion of dopamine. Which of the following findings should the nurse recognize as a therapeutic effect?

Increased urine output Dopamine is used for the treatment of shock and heart failure. It increases cardiac output by increasing myocardial contractility. This medication also dilates renal blood vessels, which increases renal perfusion and leads to an increase in the client's urinary output. This finding should indicate to the nurse a therapeutic effect has been achieved.

"You might have to stop taking this medication 5 days before any planned surgeries." Clopidogrel inhibits platelet aggregation and can cause bleeding. The client should report taking this medication to providers to determine whether to discontinue the medication prior to elective procedures to reduce the risk for bleeding.

Infuse the medication with an IV pump. Theophylline should be administered slowly on an infusion pump. Rapid administration may cause hypotension and death.

The nurse is planning an educational program on sildenafil (Viagra) to a group of older male clients. Which of the following statements should the nurse include in the educational program?

Ingestion of the medication with nitrates causes hypotension. MY ANSWER Taking nitrates with sildenafil may cause hypotension due to the vasodilation effect of each medication.

A client who has been taking losartan (Cozaar) has a hoarse voice, swollen lips and tongue. (Move the nursing actions into the box on the right, placing them in the selected order of performance. All steps must be used.)

Maintaining an adequate airway and oxygen status is critical in any ACE or ARB treated patient experiencing angioedema. Continuous pulse oximetry should be applied to the client, and oxygen administered as indicated by pulse oximetry status. Intubation or tracheotomy should be considered if adequate oxygenation cannot be maintained.After oxygenation status and airway have been evaluated, the nurse should administer SQ epinephrine at 1:1000 (usually 0.3 to 0.5 ml). This dose may be repeated one time if no response is achieved.After initiation of an IV access and isotonic IV fluids at a keep vein open rate, IV antihistamines and corticosteroids should be administered. Antihistamines are generally administered first as onset of action takes a bit longer. By administering the antihistamines first, then followed by IV corticosteroids (which have an onset of action of generally less than 10 min), the antihistamines have begun to work while immediate relief is being offered by the corticosteroids. If no response is seen at this time, fresh frozen plasma (FFP) may be administered to help reverse the angioedema. FFP has been shown to substantially improve outcomes associate with angioedema.After stabilization, the causative agent should be permanently discontinued, and the client transferred to a monitored bed as applicable. Most clients who have experienced angioedema will remain hospitalized for 12 to 24 hr post event, and the nurse should transfer the client upon stabilization to the critical care unit.

A nurse is caring for a client who is experiencing Cushing's Triad following a subdural hematoma. Which of the following medications should the nurse plan to administer?

Mannitol 25% Cushing's Triad is an indication that the client is experiencing increased intracranial pressure. The nurse should administer mannitol 25%, an osmotic diuretic that promotes diuresis to treat cerebral edema.

A nurse is educating a client who is being treated for metastatic colorectal cancer with bevacizumab (Avastin). Which of the following information should the nurse include?

May expect to have swelling of the legs. MY ANSWER A nurse should include in the information that the client may have swelling of the legs and should report the finding to the provider, because Avastin can cause heart failure.

A nurse is caring for a client who is receiving total parenteral nutrition via a peripherally inserted central catheter (PICC). When assessing the client, the nurse notes swelling of the client's arm above the PICC insertion site. Which of the following actions should the nurse take first?

Measure the circumference of both upper arms. The first action the nurse should take using the nursing process is to assess the client. The nurse should measure the arm and compare the result with the circumference of the other arm. If the arm is swollen, the nurse should notify the provider who inserted the PICC line. Swelling could indicate formation of a clot above the site or even catheter rupture.

A nurse is reviewing the laboratory data on a client who has a new prescription for heparin for treatment of a pulmonary embolism. Which of the following data should the nurse report to the provider?

Platelets 74,000/mm3 MY ANSWER Heparin-induced thrombocytopenia is a disorder characterized by low platelet counts. It is an adverse effect of heparin that causes the activation of platelets, resulting in widespread clot formation and depletion of platelets. The expected reference range for platelets is 150,000-400,000/mm3.

A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client for which of the following adverse reactions to this medication?

Postural hypotension MY ANSWER Propranolol can cause postural hypotension. The client should change positions slowly and the nurse should monitor the client's blood pressure from a lying to sitting to standing position.

A client is preparing to receive a blood transfusion. Which of the following should the nurse expect to document? (Select all that apply.)

Pre-transfusion vital signs obtained: Blood pressure 128/68 mm Hg, heart rate 64/min, respirations 20/min, temperature 36.7 ° C (98.2° F) is correct. The nurse should document the client's vital signs immediately before starting the transfusion.20-gauge IV catheter patent and primed with 0.9% sodium chloride (0.9% NaCl) is correct. The nurse should ensure IV patency and the IV cannula in place is no smaller than a 20 gauge.Assistive personnel (AP) at bedside monitoring vital signs every 5 min for adverse reactions is incorrect. An AP should not monitor the client for adverse reactions. Instead, the RN should remain at the bedside for the first 15 to 30 min, which is the time when a reaction is most likely to occur. After the initial 15 to 30 min, a PN may monitor the blood transfusion.Blood product verified by two licensed practical nurses (LPNs) is incorrect. The blood product should be verified by two RNs. A PN can only monitor the transfusion of a blood product after the initial 15 to 30 min.Client denies chills and low back pain is correct. Prior to beginning the transfusion, the patient should be instructed on the procedure and asked to report any unusual sensations such as chills, shortness of breath, hives, back pain, or itching.

A nurse is planning to apply a transdermal analgesic cream prior to inserting an IV for a preschool-age child. Which of the following actions should the nurse plan to take? (Select all that apply.)

Spread the cream over the lateral surface of both forearms is incorrect. The nurse should apply the smallest amount of cream to the smallest area required to reduce the risk for systemic toxicity. Systemic effects of the anesthetic include bradycardia, heart block, and seizures.Apply to intact skin is correct. The nurse should apply cream over intact skin to reduce the risk for systemic toxicity. The nurse should wear gloves while applying the cream to reduce the risk of absorbing the anesthetic.Apply the medication an hour before the procedure begins is correct. The nurse should allow 30 min to 1 hr for the topical analgesic to take effect.Cleanse the skin prior to procedure is correct. Apply the topical analgesic to clean skin to increase absorption.Use a visual pain rating scale to evaluate effectiveness of the treatment is correct. A child's response and understanding of pain depends on the child's age and stage of development. A preschooler might be unable to describe pain due to a limited vocabulary. Use a visual scale (FACES or OUCHER Scale) with faces or colors to assess evaluate the effectiveness of the treatment.

A nurse at a family practice clinic receives a call from a client who is prescribed oral contraceptives but forgot to take one dose. The client reports she is in the first week of a 28-day cycle pack. Which of the following instructions should the nurse provide?

Take the missed dose now, then continue the medication as ordered." MY ANSWER The nurse should tell the client to take the missed dose immediately, then continue with the pack as ordered. The nurse should also tell the client to use an additional form of contraception for 7 days.

A nurse is providing education to a client who is in labor and has a prescription for a continuous IV infusion of oxytocin. Which of the information should the nurse include?

Your contractions will become stronger and more frequent." Oxytocin is diluted with sodium chloride and administered IV via an infusion pump device to induce or strengthen uterine contractions during labor. The client who is receiving an oxytocin drip is closely monitored to promote a safe delivery and prevent maternal and/or fetal complications. The desired concentration of oxytocin medication is determined by the desired labor contraction pattern that should increase in frequency, duration, and intensity. The nurse closely monitors risks of continuous IV infusion of oxytocin to determine when to discontinue the medication. Risks include fetal distress (fetal bradycardia) caused by hyper-stimulation of the uterus compromising blood flow to the fetus. Uterine contractions lasting longer than 90 seconds should prompt the nurse to discontinue the medication.

A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning the infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary?

c. An excess amount of doxorubicin can lead to cardiomyopathy Doxorubicin is an antineoplastic antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 550 mg/m2 or 450 mg/m2with a history of radiation to the mediastinum.

​A provider prescribes cyclobenzaprine (Flexeril) for a client who has a fractured ulna. When the client asks the nurse what this medication is supposed to do for him, the nurse should explain that cyclobenzaprine will

elieve muscle spasms. MY ANSWER ​The nurse should explain that the provider prescribed cyclobenzaprine to relieve muscle spasms that can accompany the acute pain of fractures.

A nurse is preparing to administer a continuous IV infusion of heparin sodium (Heparin). Which of the following actions is appropriate for the nurse to take?

heck activated partial thromboplastin time (aPTT) every 4 hr. MY ANSWER Heparin sodium is an anticoagulant. The activated partial thromboplastin time (aPTT) should be monitored every 4 hours until the effective dose has been determined. A normal aPTT is 40 seconds. When a client is on heparin therapy, the ideal aPTT level is 1.5 to 2 times the control level. In other words, the aPTT for a client receiving heparin should be 60 to 80 seconds.