Pharm exam 2, #2

The nurse is preparing discharge instructions for a client receiving baclofen. Which instruction should be included in the teaching plan? 1. Restrict fluid intake 2. Avoid use of alcohol 3. Stop the medication if diarrhea occurs 4. Notify the health care provider (HCP) if fatigue occurs

Answer: 2 Rationale: Baclofen is a skeletal muscle relaxant. The client should be cautioned against the use of alcohol and other CNS depressants because baclofen potentiates the depressant activity of these agents. Constipation rather than diarrhea is a side effect. Restriction of fluids is not necessary, but the client should be warned urinary retention can occur. Fatigue is related to a central nervous system effect that is most intense during the early phase of therapy and diminishes with continued medication use. The client does not need to notify the HCP about fatigue.

A nurse manager is supervising the student nurse as they are preparing to administer meds with an order for Novolin N, when they note that the nurse is about to make a med error. What did the nurse manager observe that alerted them to the error. A. The insulin was clear. B. The insulin was a milky white color. C. The student nurse was about to administer the med via IM route. D. The student nurse used an alcohol swab on the site of injection before administration.

Answer: A Novolin N is characterized by its milky white color. Being that the insulin being administered is clear indicates that the wrong insulin is being administered.

Which drug would be contraindicated with administration of Potassium Chloride? (select all that apply) A) Spironolactone B) Lisinopril C) Novolin N D) Furosemide

Answer: A and B. Rationale: Ace inhibitors and Potassium sparing diuretics should be given with caution when administered with Potassium Chloride.

Question 2) The nurse is teaching a patient who is newly diagnosed with type 2 diabetes about their new insulin medications. What response by the patient indicates that the patient needs more teaching? A. "Insulin glargine is my short-acting insulin." B. "I will take my short-acting insulin with my meals." C. "I can choose to inject my insulin shots in my abdomen, arm, or thigh." D. "Insulin aspart peaks at 1-3 hours."

Answer: A. Rationale: Insulin glargine is a long acting insulin.

2. Your patient is admitted to the ICU with diabetic ketoacidosis. You know that your patient will be placed on an IV insulin drip. the only type of insulin which can be administered through IV is... A) Lantus B) Glyburide (Diabeta) C) Novolin R D) Novolin N

C Rationale: Only regular insulin can be administered IV

A nurse is caring for an older adult client in a long-term care facility who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? A. The client will start at a high dose, and the dose will be tapered as needed. B. The client will remain on the initial dosage during the course of the treatment C. The client's dosage will be adjusted daily based on blood levels. D. The client will start on a low dose, which will be gradually increased.

D. CORRECT: The nurse should expect that levothyroxine will be started at a low dose and gradually increased over several weeks. This is especially important in older adult clients to prevent toxicity.

A patient is taking spironolactone for the treatment of hypertension. The nurse notices EKG changes on the heart monitor. What side effect of spironolactone may be causing these changes? A. Hyperkalemia B. Hypocalcemia C. Hypokalemia D. Leukocytosis

Hyperkalemia. Spironolactone is a potassium-sparing diuretic that can cause hyperkalemia, potentially resulting in cardiac arrhythmias.

A patient came in to the emergency room with an acetaminophen overdose, the nurse is prepared to give them what antidote? A- vitamin K B- acetylcysteine C- naloxone D- protamine sulfate

2. B, the reversal agent for acetaminophen is acetylcysteine.

2. A nurse is teaching clients in an outpatient facility about the use of insulin to treat type I diabetes. For which of the following types of insul should the nurse tell the clients to expect a peak effect of 2 to 4 hours after administration? A. Insulin glargine B. NPH insulin C. Regular insulin D. Insulin lispro

2. C - Regular insulin has a peak effect around 2 to 4 hours following administration

The nurse learns a client who is scheduled for a tonsillectomy has been taking 40 mg of oral prednisone daily for the last week for a poison ivy on the leg. What should the nurse do FIRST? 1). Document the prednisone with current medications. 2). Notify the surgeon of the poison ivy. 3). Notify the anesthesiologist of the prednisone administration. 4). Send the client to surgery.

2. The nurse should notify the anesthesiologist because supplemental prednisone suppresses the adrenal cortex's natural ability to produce increased corticosteriods in times of stress such as surgery. The anesthesiologist may need to prescribe supplemental steroid coverage during the perioperative period. The nurse should document the prednisone with the current medications, but it is a priority to inform the anesthesiologist. Because the poison ivy is not in the surgical field, the surgeon does not need to be called regarding the skin disruption.

2. The nurse explains to a patient that aspirin suppresses blood clotting by a. inactivating thrombin b. promoting fibrin degradation c. decreasing synthesis of clotting factors d. decreasing platelet aggregation

ANS: D

1. A client has been given Ondansetron (Zofran). For which condition should the nurse administer this medication to the postoperative patient? A. Vomiting B. Incision pain C. Abdominal infection D. Atelectasis

Answer: A Rationale: Ondansetron is a antiemetic and decreases nausea.

A nurse is caring for a young adult client whose serum calcium is 8.8mg/dL. Which of the following medications should the nurse anticipate administering to this client? A. Calcitonin-salmon B. Calcium Carbonate C. Zoledronic acid D. Ibandronate

B is correct. The client's serum calcium level is below the expected reference range. Calcium carbonate is an oral form of calcium used to increase serum calcium to the expected reference range.

A nurse provided instructions to a client regarding the administration of prednisone and instructs the patient that the best time to take the medication is: A. any time of the day B. early morning C. lunch D. before bedtime

B. Prednisone is a corticosteroid and is administered early in the morning because it helps in reducing adrenal insufficiency and stimulates the burst of glucocorticoids released naturally by the adrenal glands each morning.

If a person is scheduled to have breakfast at 7:00 am when should the patient receive their regular dose of Lispro? a) 7:00 am b) 6:00 am c) 6:45 am d) 6:20 am

C Rational: Lispro is rapid acting with an onset of 15min. For it to be effective, it should be given 15 min. before breakfast.

2. The nurse is teaching a client about to discharge with a prescription for Fosamax. What statement by the client indicates that more teaching is needed? A. I will take the medication on an empty stomach. B. I should lay down, flat on my back after taking this medication. C. I should take the medication with a full glass of water. D. It is best to take the medication by itself without other medications at the same time.

Correct Answer: B You should remain upright for at least 30 min following administration.

A female client with interstitial lung disease is prescribed prednisone (Deltasone) to control inflammation. During client teaching, the nurse stresses the importance of taking prednisone exactly as prescribed and cautions against discontinuing the drug abruptly. A client who discontinues prednisone abruptly may experience: A. Hyperglycemia and glycosuria. B. Acute adrenocortical insufficiency. C. GI bleeding. D. Restlessness and seizures.

Correct answer: B

A patient is prescribed ibuprofen 800 mg every 4 hours for the treatment of rheumatoid arthritis (RA). Which of these clinical manifestations should the healthcare provider anticipate observing if the patient is developing an adverse effect from the medication? A. Patient report of epigastric pain B. Positive fecal occult blood test C. Decreased serum albumin D. Increased blood urea nitrogen (BUN) E. Increased serum hematocrit

Correct answers: A, B, and D

Which of the following would be appropriate to include in teaching your patient with type 2 diabetes? "Until you need to start insulin injections, you do not have to check your blood sugar." "If you drink alcohol, it may be necessary to increase your oral anti-diabetic medication." "Patients with type 2 diabetes always progress to insulin injections if they do not follow dietary guidelines." Which of the following would be appropriate to include in teaching your patient with type 2 diabetes?

D- Exercise is perhaps the best therapy for the prevention of both type 2 diabetes and the metabolic syndrome. Exercise is an extremely strong hypoglycemic agent. Alcohol should be avoided.

A client with a potassium level of 5.5 mEq/L is to receive Kayexalate. After administering the drug, the priority nursing action is to monitor Urine output. Blood pressure. Bowel movements. ECG for tall, peaked T waves.

a) bowel movements kayexalate causes potassium to be exchanged for sodium in the intestines and excreted through bowel movements. If client does not have stools, the drug cannot work properly. Blood pressure and urine output are not of primary importance. The nurse would already expect changes in t waves with hyperkalemia. Normal serum potassium is 3.5 to 5.3 meq/l.

A patient comes to ER complaining of moderate shoulder pain. You notice a history of IBS. What order for pain medication will you question? A. Tylenol B. Ibuprofen C. Aspirin D. Oxycodone

d because opioids can cause constipation which this patient is at even higher risk for with IBS.

1. Which type of insulin would the nurse administer that has an onset of 15 mins, peak of 1 hr and duration of 3 hrs? A) Rapid Acting B) Short acting C) Intermediate acting D) Long acting

1- A- this describes a rapid acting insulin

A. The nurse is providing discharge teaching for a client newly diagnosed with type 2 Diabetes mellitus who has been prescribed metformin. which client statement indicates a need for further teaching? 1. "It is okay if I skip meals now and then." 2. "I need to constantly watch for signs of low blood sugar". 3. "I need to let my healthcare provider know if I get unusually tired." 4. " I will be sure to not drink alcohol excessively while on this medication."

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2. A nurse in an emergency department is performing an admission assessment for a client who has severe aspirin toxicity. which of the following findings should the nurse expect? A. Body temperature 35C (95F) B. Lung crackles C. Cool, dry skin D. Respiratory depression

2. Correct answer is D. Respiratory acidosis is an expected manifestation of severe aspirin toxicity

A nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. Which of the following findings should the nurse report to the provider? Blood glucose 150 mg/dL Urine output 40 ml/hr Dyspnea Bilateral equal pupil size

3- Dyspnea is a manifestation of heart failure, an adverse effect of mannitol. The nurse should stop the medication and notify the provider.

B. The nurse is caring for a client in the emergency department who has been diagnosed with Bell's Palsy. The client has been taking acetaminophen, an acetaminophen overdose is suspected. Which antidote should the nurse prepare for administration if prescribed? 1. Pentostatin 2. Auranofin 3. Fludarabine 4. Acetylcysteine

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A patient being prescribed propylthiouracil (PTU) should be instructed to reduce dietary sources of: A. Iodine B. Iron C. Potassium D. Vitamin K

A-iodine. Iodine is used in the synthesis of thyroid hormones and will interfere with the action of PTU; therefore, it should be reduced or eliminated.

A nurse is caring for a cancer patient receiving subcutaneous morphine sulfate for pain. Which of the following nursing actions is most important in the care of this patient? A. Monitor urine output. B. Monitor respiratory rate. C. Monitor heart rate. D. Monitor temperature.

Answer: B Morphine sulfate can suppress respiration and respiratory reflexes, such as cough. Patients should be monitored regularly for these effects to avoid respiratory compromise. Morphine sulfate does not significantly affect urine output, heart rate, or body temperature.

1. A patient's current condition requires rapid reduction of blood sugar levels. Which of the following types of inulin will have the most rapid onset of action. A) 70/30 B) Lispro (humalog) C) NPH D) Metformin (glucophage)

B Rationale: Humalog has a 15 min onset of action. the rest have a longer onset, later peak, and longer duration.

Question 2: The client taking glyceride 5mg orally once daily presents in the ED with headache, flushing, nausea, and abdominal cramps. The client's fingerstick blood sugar result is 56 mg/dl. Which question is the MOST important to ask the client? 1. "How many grams of protein do you normally eat?" 2. "What time did you eat your dinner last night?" 3. "How often do you check your blood sugar level?" 4. "What was your alcohol intake like this past week?"

1. Carbohydrate intake, not protein, is more important to consider in diabetic clients in relation to blood sugar levels. 2. Gluberide once daily dose is taken with breakfast, so asking the client about dinner is not consistent with drug administration. 3. Asking the client frequency of checking blood sugar levels will not help determine the possible causes of the client's symptoms. Answer: 4- Alcohol use while taking sufonylureas such as glyburide (DiaBeta, Micronase) can cause a disulfiram-like reaction, manifested by abdominal cramps, nausea, headache, flushing, and hypoglycemia.

1. A nurse us teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A. Increase intake of protein- rich foods B. Expect muscle twitching to occur C. Take this medication with food D. Anticipate relief of manifestations in 24 hr

1. Correct answer is C. The client should take this medication with food to reduce GI effects The client should avoid protein-rich food, muscle twitching can indicate toxicity, medication takes several weeks to months to be effective

1. A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: a) in the morning to prevent insomnia b) only when the client complains of fatigue and cold intolerance c) at various times during the day to prevent tolerance from occurring d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

1.) A- Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level.

2. The nurse is administering Synthroid for hypothyroidism, which of the following vital signs would contraindicate administration? A) Glucose 120 mg/dl B) Ca 8.7 C) HR 110 bpm D) K+ 3.8

2- C, synthroid should be held for any hr above 100 bpm

A client with cerebral palsy is taking dantrolene (Dantrium). A nurse evaluates that the medication is effective when noting the client has: (SELECT ALL THAT APPLY) a. increased muscle spasticity b. increased urinary frequency c. increased mobility d. increased ability to maintain balance e. increased alertness

2. Answers: c, d Rationale: Dantrolene acts directly on skeletal muscles to inhibit muscle contraction, improving mobility and the ability to maintain balance. Increased muscle spasticity indicates that the medication is not effective. Common adverse affects include urinary frequency, drowsiness, orthostatic hypotension, and diarrhea. Dantrolene does not increase alertness.

A patient is scheduled to start taking insulin glargine (Lantus). On the care plan a nurse should include which of these outcomes related to the therapeutic effects of the medication? A) Blood glucose control for 24 hours B) Mealtime coverage of blood glucose C) Less frequent blood glucose monitoring D) Peak effect achieved in 2 to 4 hours D. Hepatic damage.

A) Blood glucose control for 24 hours Insulin glargine is administered as a once-daily subcutaneous injection for patients who have type 1 diabetes. It is used for basal insulin coverage, not mealtime coverage. It has a prolonged duration up to 24 hours with no peaks. Blood glucose monitoring is still an essential component to achieve tight glycemic control.

12. Which of the following adverse effects is associated with levothyroxine (Synthroid) therapy? Tachycardia Bradycardia Hypotension Constipation

Answer A. Levothyroxine, especially in higher doses, can induce hyperthyroid-like symptoms including tachycardia. An agent that increases the basal metabolic rate would not be expected to induce a slow heart rate. Hypotension would be a side effect of bradycardia. Constipation is a symptom of hypothyroid disease.

The client with MS is prescribed baclofen. Which information is most important for the nurse to evaluate when caring for this client? 1. Serum baclofen levels 2. Muscle rigidity and pain 3. Intake and urine output 4. Daily weight pattern

ANSWER: 2 Baclofen (Lioresal) is used primarily to treat spasticity in MS and spinal cord injuries. The nurse should assess for muscle regidity, movement, and pain to evaluate medication effectiveness.

When the nurse hands the client a second dose of oxycodone/acetaminophen for incisional pain, the client says, "This medication makes me feel sick." Which statement is the most appropriate initial response by the nurse? a."I'll call your doctor to see if another medication can be ordered for your pain." b. "Describe what you feel when you say that the medication makes you feel sick." c. "The doctor ordered an antacid. I can give you this along with the medication." d. "The aspirin in the pain med is hard on your stomach. Eating a cracker may help."

Answer: B. The nurse is using the therapeutic communication technique, known as clarifying, to determine the effects of the medication on the client. This focuses on the client's feelings. Without first questioning the client, the nurse has insufficient information to give the HCP about the client's reaction. Offering an antacid assumes that the client has a GI reaction. Oxycodone/Acetaminophen (Percocet) does not contain aspirin. Offering a cracker assumes the client has a GI reaction.

Question 1) Which of the following insulins can be administered intravenously?* A. NPH B. Lantus C. Humulin R D. Novolog

Answer: C Rationale: regular insulin is the only type of insulin that is available intravenously.

2) A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for: A) gingival hyperplasia and lycopenemia. B) dyspnea and a dry cough. C) blurred vision and nystagmus. D) fever and sore throat.

D) fever and sore throat.

An adult client has regular insulin ordered before breakfast. The nurse notes that the client�s blood glucose level is 68 mg/dL, and the client is nauseated. Which of the following actions should the nurse take? A. Immediately give the client orange juice to drink. B. Administer the insulin on time. C. Withhold the insulin and notify the physician. D. Return the breakfast tray to the kitchen.

(B) correct - take insulin or oral agent as ordered, check blood glucose or urine ketones every 3-4 hours, sip 8-12 oz liquid per hour, substitute easily digested soft foods, liquids if solids not tolerated Reply to Thread

1) A nurse is teaching a client who has a new prescription for omeprazole for management of heartburn. Which of the following information should the nurse include in the teaching? a) Take this medication a bedtime b) This medication decreases the production of gastric acid c) take this medication 2 hour after eating d) This medication can cause hyperkalemia

1) Correct answer B: omeprazole reduces gastric acid secretion by inhibiting the enzyme that produces gastric acid

The nurse administers morphine sulfate 4 mg IV to a client for treatment of severe pain. Which of the following assessments requires immediate nursing interventions? a.) Blood pressure 110/70 b.) The client is drowsy. c.) Pain is unrelieved in 15 minutes. d.) Respiratory rate 10/minute

1) d.) Respiratory rate 10/minute Opioids activate mu and kappa receptors that can cause profound respiratory depression. Respiratory rate should remain above 12. The BP is not significantly low. Drowsiness is an expected effect of morphine. Unrelieved pain warrants further assessment, but not as immediately as do decreased respirations.

The nurse is monitoring a client receiving levothyroxine (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. a) Insomnia b) Weight loss c) Bradycardia d) Constipation e) Mild heat intolerance

1. A, B, E - Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication, and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

A client with MS is prescribed baclofen (Lioresol). Which information is most important for a nurse to assess when caring for this client? a. Serum baclofen levels b. Muscle rigidity and pain c. Intake and output d. Weight

1. Answer: b Rationale: Baclofen is primarily used to treat spasticity in MS and spinal cord injuries. The nurse should assess for muscle rigidity, movement, and pain to evaluate medication effectiveness. There is no serum baclofen level. Baclofen can cause urinary urgency. Measurement of I&O and weight are aspects of daily nursing care.

A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A. 2-4 hours after administration B. 6-14 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration

1. B. peak for 6-14 hrs for this

1. A nurse in an emergency department is performing an admission assessment for a client who has sever aspirin toxicity. which of the following findings should the nurse expect? A. body temperature of 95 degrees F B. Lung crackles C. Cool, dry skin D. Respiratory depression

1. D - Respiratory depression due to increasing respirator acidosis is an expected manifestation of severe aspirin toxicity

1.) Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? a. Sulfonylureas b. Meglitinides c. Biguanides d. Alpha-glucosidase inhibitors

1.)c. Biguanides Biguanides, such as metformin, lower blood glucose by reducing the amount of glucose produced by the liver. Sulfonylureas and Meglitinides stimulate the beta cells of the pancreas to produce more insulin. Alpha-glucosidase inhibitors block the breakdown of starches and some sugars, which helps to reduce blood glucose levels

1. A nurse is teaching a child care class to prospective grandparents. Which of the following medications is contraindicated in children? A- ibuprofen B- acetaminophen C- amoxicillin D- aspirin

1: D- aspirin. Aspirin is contraindicated in children due to the risk of Reyes Syndrome.

A postoperative patient has an epidural infusion of morphine sulfate (Astramorph). The patient's respiratory rate declines to 8 breaths/min. Which medication would the nurse anticipate administering? A) Naloxone (Narcan) B) Acetylcysteine (Mucomyst) C) Methylprednisolone (Solu-Medrol) D) Protamine sulfate

2) A) Naloxone (Narcan) Naloxone is a narcotic antagonist that can reverse the effects, both adverse and therapeutic, of opioid narcotic analgesics. Reply to Thread

2) A nurse is teaching a client who has a new prescription for levodopa/carbidopa for Parkinson's disease. Which of the following instructions should the nurse include? A) Increase intake of protein rich foods B) Expect muscle twitching to occur C) Take this medication with food D) Anticipate relief of manifestations in 24 hours

2) Correct answer C: Client should take this medication with food to reduce GI effects

A nurse is teaching a client who has a new prescription for baclofen to treat muscle spasms. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply). I will stop taking this medication right away if I develop dizziness I know the doctor will gradually increase my dose of this medication for a while I should increase fiber to prevent constipation from this medication I won't be able to drink alcohol while I'm taking this medication I should take this medication on an empty stomach each morning

2- The client should increase fluids and fiber to reduce the risk for constipation 3- The intake of alcohol and other CNS depressants can exacerbate the CNS depressant effects of baclofen. Therefore, the client is instructed to avoid CNS depressants while taking baclofen.

Your patient's blood glucose level is 215 mg/dL. The patient is about to eat lunch. Per sliding scale, you administer 4 units of Insulin Lispro (Humalog) subcutaneously at 1130. As the nurse, you know the patient is most at risk for hypoglycemia at what time? A. 1145 B. 1230 C. 1430 D. 1630

2. B. Peak is at 1 hr.

2. A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for: a) relief of pain b) signs of renal toxicity c) signs and symptoms of hyperglycemia d) signs and symptoms of hypothyroidism

2.) D- Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity. Reply to Thread

2.)A patient with cirrhosis is being treated with spironolactone (Aldactone) tid and furosemide (Lasix) bid. The patient's most recent laboratory results indicate a serum sodium of 134 mEq/L (134 mmol/L) and a serum potassium of 3.2 mEq/L (3.2 mmol/L). Before notifying the physician, the nurse should A. administer only the furosemide B. administer both drugs as ordered C. administer only the spironolactone D. Withhold the furosemide and spironolactone

2.)C. administer only the spironolactone The potassium level is dangerously low. Lasix is potassium depleting, while spironolactone is potassium sparing. You would hold the Lasix and call the physician. This is a good NCLEX question that integrates this course with pharmacology.

2. An 18-year-old man is having an open reduction external fixation of a hip following a football injury. During surgery, he develops a fever of 105F. Which of the following medications is administered? A-cyclobenzaprine hydrochloride (Flexeril) B- dexamethasone sodium phosphate (Decadron) C- phenytoin (Dilantin) D- dantrolene sodium (Dantrium)

2: D- dantrolene sodium (Dantrium). Dantrium is used to treat malignant hyperthermia.

A nurse is providing teaching for a client who has a new prescription for metformin. Which of the following adverse effects of metformin should the nurse instruct the client to report to the provider? A. Somnolence B. Constipation C. Fluid retention D. Weight gain

A. CORRECT: Somnolence can indicate lactic acidosis, which is manifested by extreme drowsiness, hyperventilation, and muscle pain. It is a rare but very serious adverse effect caused by metformin and should be reported to the provider.

Which of the following medications decreases their actions when taking thyroid hormone? A. Metformin B. Warfarin C. Zoloft D. Epinephrine

A. Metformin, an oral hypoglycemic drug when taken with a thyroid hormone decreases their action. Options B (anticoagulant), C (antidepressant), and D (sympathomimetic) all increase their actions. Reply to Thread

The client who is 28 weeks pregnant and experiencing heartburn is prescribed to take omeprazole. The nurse educating the client about omeprazole should explain that it reduces heartburn by which action? a. Blocks the action of the enzyme that generates gastric acid b. Blocks the H2 receptor located on the parietal cells of the stomach c. Neutralizes the gastric acid of the stomach d. Coats the upper stomach and esophagus to decrease irritation from stomach acid

A. Omeprazole (Prilosec), a PPI, produces irreversible inhibition of H+, K+-ATPase, which is the enzyme that induces gastric acid production.

Why might a nurse anticipate administering propranolol (Inderal) to a patient presenting with severe hyperthyroidism? SELECT ALL THAT APPLY. A. Beta blockers can work quickly to reduce potentially dangerous symptoms in various organs, especially the heart. B. Thioamide drugs are given as well, but their effects are delayed. C. Radioactive Iodine is given as well, but the effect is delayed. D. Levothyroxine is given as well, but the effect is delayed. E. Beta blockers can increase the rate of thioamide drug absorption.

AB&C. Beta blockers help by moderating the stimulation of various organs by they overactive sympathetic nervous system in Hyperthyroidism. Radioactive Iodine and Thioamide drugs such as PTU are given, but their effects take longer. Levothyroxine is NOT given. Beta blockers do NOT increase the rate of thioamide drug absorption.

2/A client is taking docusate sodium (Colace). The nurse monitors which of the following to determine whether the client is having a therapeutic effect from this medication? A) Abdominal pain B) Reduction in steatorrhea C) Absence of hematochezia D) Regular bowel movements

ANS: D

Question: The client with CP is taking dantrolene. The nurse evaluates that the medication is effective when noting that the client has an increase in which findings? (SELECT ALL THAT APPLY) 1. Muscle Spasticity 2. Urinary Frequency 3. Level of mobility 4. Ability to maintain balance 5. Level of alertness

ANSWER: 3 & 4 RATIONALE: 1. increased muscle spasticity indicates the medication is not effective. 2. Common adverse effects include urinary frequency. 3. Dantrolene acts directly on skeletal muscles to inhibit muscle contraction, improving mobility. 4. Dantrolene acts directly on skeletal muscles to inhibit muscle contraction, improving the ability to maintain balance. 5. Dantrolene does not increase alertness.

The client is receiving multiple medications for treatment of PD. Which signs and symptoms should the nurse recognize as adverse effects or carbidopa-levodopa? 1. Dystonia and akinesia 2. Bradykinesia and agitation 3. Muscle rigidity and cardiac dysrhythmias 4. Orthostatic hypotension and dry mouth

ANSWER:4 Rationale: 1. Although dystonia is an adverse effect of carbidopa-levodopa, akinesia is a symptom associated with PD. 2. Bradykinesia is a symptom associated with PD; agitation in an adverse effect of carbidopa-levodopa. 3. Muscle rigidity is a symptom associated with PD; cardiac dysrhythmia is an adverse effect of carbidopa-lovedopa. 4. Orthostatic hypotension and dry mouth are common adverse effects of carbidopa-levodopa(Sinemet). These can be minimized by slow position changes and sucking on sugarless candy or chewing gum.

A nurse is giving discharge instructions to a client who is receiving a bulk-forming laxative as part of the home medications. All of which are examples of bulk-forming laxative, except? A. Docusate Sodium (Colace). B. Methylcellulose (Citrucel). C. Polycarbophil (Fibercon). D. Psyllium (Metamucil).

Ans. A Option A is an example of surfactant laxative.

A patient who is taking Lasix knows that he should increase intake of what food? 1. Cantaloupe. 2. Plums. 3. Iceberg lettuce. 4. Apples.

Ans: 1. Cantaloupe has high levels of potassium in it, which tends to be lower in a patient taking Lasix.

A patient has been taking a heavy aspirin regimen for the past two months. Which side effects, if noted by the patient, are directly related to overdose of aspirin? SELECT ALL THAT APPLY: 1. Confusion. 2. Tinnitus. 3. Edema. 4. Blood in stools. 5. Increased INR.

Ans: 2. Tinnitus. 4. Blood in stools. 5. Increased INR (bleeding time). Aspirin can increase bleeding time (INR) and can also cause some GI bleeding (resulting in the bloody stools). It can also lead to tinnitus. Aspirin does not generally cause confusion or edema.

1. A patient who has been treated with Sinemet for Parkinson disease (PD) tells the healthcare provider, "I'm worried because don't think the drug is helping me anymore." Which of the following is the best response by the healthcare provider? "It is unlikely that the Sinemet has stopped being effective." "Now that the medication isn't working, we can consider surgery." "It can be disappointing when the medications don't work like they used to." "It looks like your liver is not able to metabolize the drug as well as it used to."

Answer "It can be disappointing when the medications don't work like they used to." The drug Sinemet will stop working after awhile.

The client taking NPH insulin at 0800 reports feeling anxious and shaky in the mid-afternoon. Which intervention is best for the nurse to initiate? 1. Have the client rate the level of anxiety. 2. Give the client's prn dose of lorazepam. 3. Check the client's fingerstick blood glucose level. 4. Advise the client to sit in a recliner and relax.

Answer #3 1. Having the client rate the level of anxiety will delay obtaining a fingerstick blood glucose; the problem may not be anxiety but hypoglycemia. 2. The problem may not be anxiety but hypoglycemia; administering lorazepam (Ativan) should not be considered until hypoglycemia is ruled out. 3. The best intervention is to check a fingerstick blood glucose level because anxiety and shakiness in the mid-afternoon when taking NPH insulin (Humulin N) could indicate hypoglycemia; NPH insulin peaks in 6-8 hours after administration. 4. The problem may not be anxiety but hypoglycemia; having the client sit in a recliner to relax should not be considered until hypoglycemia is ruled out.

1. A 65-year old client with a history of coronary artery disease is admitted with fluid volume overload. Bumetanide (Bumex) is administered and the client's serum potassium level drops to 3.0 mEq/L; intravenous (IV) potassium replacement is ordered. Which factor should a nurse consider when preparing to administer the IV potassium replacement? A. The potassium Concentration should not exceed 20 mEq/L. B. Ice or warm packs may be needed to reduce vein irritation. C. The potassium should be administered IV push. D. The potassium should be added to the IV solutions that is infusing.

Answer 1: B. Potassium can be irritating to the vein, and the client may complain of burning. Strategies to minimize pain and inflammation include ice or warm packs Although the usual replacement dose is 20 mEq/100mL with administration of 10 to 20 mEq/hr, concentrations can safely range from 10 to 40 mEq/L. Potassium is never administered as an IV push; it will cause cardiac dysrhythmias. Adding medication to an already-infusing IV solution is unsafe and can result in a faster or slower rate of administration, depending on the volume of solution remaining.

2. The client calls a clinic to renew the prescription for insulin being administered subcutaneously via an insulin pump. Which insulin type, if prescribed by the HCP, should the nurse question? A. Insulin lispro(Humalog) B. Insulin aspart(Novolog) C. Insulin glulisine(Apidra) D. Insulin glargine(Lantus)

Answer 2-D-The nurse should question if glargine(Lantus) is prescribed. Lantus is long-duration insulin not suited for delivery by an infusion pump. Lispro, Aspart, and Glulisine can be delivered via an insulin pump.

2. A nurse is preparing a child for abdominal irradiation. Which medications should the nurse plan to administer to prevent nausea and vomiting? A. Ondansetron (Zofran) and dexamethasone (Decadron). B. Promethazine (Phenegran) and cyclophosphamide (Cytoxan) C. Metoclopramide (Reglan) and methotrexate (Amethopterin) D. Marijuana and L-asparaginase (Elspar)

Answer 2: A. Ondansetron is an antiemetic used to control nausea and vomiting. Dexamethasone is a corticosteroid anti-inflammatory agent used in the adjunctive management of nausea and vomiting from chemotherapy. Promethazine is a phenothiazine-type antiemetic, but cyclophosphamide is a chemotherapeutic agent. Metoclopramide is an antiemetic, but it causes extrapyramidal reactions in children. Methotrexate is a chemotherapeutic agent. Marijuana is not approved for use in throughout the United States, but synthetic cannabinoids are now being used in children. L-asparaginase is a chemotherapeutic agent.

Question 2: A clinic nurse evaluates that a client's levothyroxine (Synthroid) dose is too low when which findings are noted? Select all that apply. Increased appetite Decreased sweating Apathy and fatigue Paresthesias Fine tremor of fingers and tongue Slowed mental processes

Answer : 2, 3, 4, 6 Levothyroxine is used in treating hypothyroidism. Symptoms of hypothyroidism appear if the dose is too low and include decreased sweating, apathy and fatigue, paresthesia's, and slowed mental processes. Increased appetite and fine tremors are signs of hyperthyroidism and can indicate the dose is too high.

Walter, teenage patient is admitted to the hospital because of acetaminophen (Tylenol) overdose. Overdoses of acetaminophen can precipitate life-threatening abnormalities in which of the following organs? Lungs Liver Kidney Adrenal Glands

Answer B. Acetaminophen is extensively metabolized by pathways in the liver. Toxic doses of acetaminophen deplete hepatic glutathione, resulting in accumulation of the intermediate agent, quinine, which leads to hepatic necrosis. Prolonged use of acetaminophen may result in an increased risk of renal dysfunction, but a single overdose does not precipitate life-threatening problems in the respiratory system, renal system, or adrenal glands.

Question 1: The nurse knows that the most common cause for subclinical hyperthyroidism is.... A. Taking central nervous system depressants B. Untreated osteoporosis C. Excess Thyroid Hormone Therapy D. Previous neck radiation

Answer for Question 1: C Rationale for Question 1: The most common cause for subclinical hyperthyroidism is excess thyroid hormone therapy.

Question 2: Symptoms such as tachycardia, fever, dehydration, heart failure, and coma are consistent with which of the following health problems? A. Thyroid Storm B. Hashimoto's disease C. Subclinical hyperthyroidism D. Myxedema

Answer for Question 2: A Rationale for Question 2: Thyroid storm is a life-threatening condition characterized by an exaggeration of the normal symptoms seen in hyperthyroidism. Myxedema and Hashimoto's disease are forms of hypothyroidism.

1. The client taking glyburide 5 mg orally once daily presents in the ED with headache, flushing, nausea, and abdominal cramps. The client's fingerstick blood sugar result is 56 mg/dL. Which question is most important for the nurse to ask the client? A. "How many grams of protein do you normally eat?" B. "What time did you eat our dinner last night?" C. "How often do you check your blood sugar level?" D. "What was your alcohol intake like this past week?"

Answer question 1-D-Alcohol use while taking sulfonylureas such as glyburide (Diabeta) can cause a disulfiram-like reaction, manifested by abdominal cramps, nausea, headache, flushing, and hypoglycemia. Asking the client frequency of checking blood sugar levels will not help determine the possible causes of the client's symptoms. Glyburide once daily dose is taken with breakfast, so asking hte client about dinner is not consistent with drug administration. Carbohydrate intake, not protein, is more important to consider in diabetic clients in relation to blood sugar levels.

The client taking NPH (intermediate) insulin at 0800 reports feeling anxious and shaky in the midafternoon. Which intervention is best for the nurse to initiate? A) Have the client rate the level of anxiety B) Give the client's prn dose of lorazepam C) Check the client's fingerstick blood glucose level D) Advise the client to sit in a recliner to relax

Answer- C

A patient with increased ICP is being monitored in the intensive care unit (ICU) with a fiber-optic catheter. Which order is a priority for you? A. Take a complete set of vital signs. B. Administer the prescribed Spironolactone. C. Administer the prescribed mannitol (Osmitrol). D. Administer an H2-receptor blocker.

Answer- C..... Because the patient is experiencing increased ICP treating the known problem is a priority over additional assessments. H2-blockers are given when corticosteroids are administered to help prevent gastrointestinal bleeding, but they are not a priority compared with the treatment of ICP. Reply to Thread

A client is prescribed with Omeprazole (Prilosec). The nurse determines that the client is receiving its therapeutic effect if which of the following is stated by the client: a. "I don't feel like I'm going to throw up anymore!" b. "I'm glad I don't have to run to the bathroom for those loose stools anymore" c. "I was finally able to poop!!!" d. "After I eat, I don't get heartburn anymore"

Answer- D..... Omeprazole is used to treat symptoms of gastroesophageal reflux disease (GERD) and other conditions caused by excess stomach acid. It is also used to promote healing of erosive esophagitis (damage to your esophagus caused by stomach acid). Options A, B, and C are not related to this medication.

Question 2) A client with diabetes mellitus visits a health care clinic. The client's diabetes mellitus previously had been well controlled with glyburide daily, but recently the fasting blood glucose level has been 180-200 mg/dL. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia? 1. Prednisone 2. Atenolol 3. Phenelzine 4. Allopurinol

Answer: 1 - Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Option 2, a beta blocker, and option 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4, decreased urinary excretion of sulfonylurea agents, causing increased levels of the oral agents, which can lead to hypoglycemia.

Question 1: A clinic nurse is teaching a client who has been diagnosed with hypothyroidism. Which instructions should the nurse provide regarding the use of levothyroxine sodium (Synthroid)? Select all that apply Take the medication 1 hour before or 2 hours after breakfast Obtain a pulse rate before taking the medication and call the clinic if the pulse rate is greater than 100 beats per minute Report adverse effects of the medication, including weight gain, cold intolerance, and alopecia Use levothyroxine sodium (Synthroid) as a replacement hormone for diminished or absent thyroid function Have frequent lab monitoring to be sure your levels of T3 and T4 decrease

Answer: 1, 2, 4 Taking the medication on an empty stomach promotes regular absorption. It should be taken in the morning to mimic normal hormone release and prevent insomnia. During initial dosage adjustment, tachycardia could indicate a dose that is too high. The replacement hormone is used in primary or secondary atrophy of the gland, after thyroidectomy, after excessive thyroid radiation, after the administration of antithyroid medications, or in congenital thyroid defects. Weight gain and cold intolerance could indicate that the dose is too low. Alopecia may indicate that the dose is too high. T3 and T4 should rise with treatment.

The nurse is providing discharge teaching for a client newly diagnosed with type 2 diabetes mellitus who has been prescribed metformin. Which client statement indicates the need for further teaching? 1. "It is okay if I skip meals now and then." 2. "I need to constantly watch for signs of low blood sugar." 3. "I need to let my health care provider know if I get unusually tired." 4. I will be sure to not drink alcohol excessively while on this medication."

Answer: 2 Rationale: Metformin is classified as a biguanide and is the most commonly used medication for type 2 diabetes mellitis initially. It is also often used as a preventive medication for those at high risk for developing diabetes mellitus. When used alone, metformin lowers the blood sugar after meal intake as well as fasting blood glucose levels. Metformin does not stimulate insulin release and therefore poses little risk for hypoglycemia. For this reason, metformin is well suited for clients who skip meals. Unusual somnolence, as well as hyperventilation, myalgia, and malaise, are early signs of lactic acidosis, a toxic effect associated with metformin. If any of these signs or symptoms occur, the client should inform the health care provider immediately. While it is best to avoid consumption of alcohol, it is not always realistic or feasible for clients to quite drinking altogether; for this reason, clients should be informed that excessive alcohol intake can cause an adverse reaction with metformin.

A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Contipation

Answer: 2 Rationale: Omeprazole is a proton pump inhibitor classified as an anti ulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in options 1,3 and 4.

A nurse administers 15 units of glargine (Lantus) insulin at 2100 hours to a Hispanic client when the client's fingerstick blood glucose reading was 110 mg/dL. At 2300 hours, a nursing assistant reports to the nurse that an evening snack was not given because the client was sleeping. Which instruction by the nurse is most appropriate? 1. "You will need to wake the client to check the blood glucose and then give a snack. All diabetics get a snack at bedtime." 2. "It is not necessary for the client to have a snack because glargine insulin is absorbed very slowly over 24 hours and doesn't have a peak." 3. "The next time the client wakes up, check a blood glucose level and then give a snack." 4. "I will need to notify the physician because a snack at this time will affect the client's blood glucose level and the next dose of glargine insulin."

Answer: 2 Rationale: The onset of glargine is 1 hour, it has no peak, and it lasts for 24 hours. Glargine lowers the blood glucose by increasing transport into cells and promoting the conversion of glucose to glycogen. Because it is peakless, a bedtime snack is unnecessary. Options 1 and 3 are unnecessary and option 4 is incorrect. Glargine is administered once daily, the same time each day, to maintain relatively constant concentrations over 24 hours.

A nurse administers a usual morning dose of 4 units of regular insulin and 8 units of NPH insulin at 7:30am to a client with a blood glucose level of 110 mg/dL. Which statements regarding the client's insulin are correct? 1. The onset of the regular insulin will be at 7:45am and the peak at 1:00pm. 2. The onset of the regular insulin will be at 8:00am and the peak at 10:00am. 3. The onset of the NPH insulin will be at 8:00am and the peak at 10:00am. 4. The onset of the NPH insulin will be at 12:30pm and the peak at 11:30pm.

Answer: 2 Rationale: The onset of regular insulin (short-acting) is one-half to one hour, and the peak is 2 to 3 hours. The onset of NPH insulin (intermediate-acting) is 2 to 4 hours, and the peak is 4 to 12 hours. All other options have incorrect medication onset and peak times.

Question 1) A client has been taking omeprazole for 4 weeks. The ambulatory care nurse evaluates that the client is receiving the optimal intended effect of the medication if the client reports the absence of which symptom? 1. Diarrhea 2. Heartburn 3. Flatulence 4. Constipation

Answer: 2 - Omeprazole is a PPI classified as an anti-ulcer agent. The intended effect of the medication is relief of pain from gastric irritation, often called heartburn by clients. Omeprazole is not used to treat the conditions identified in the other options.

The client with MS is prescribed baclofen. Which information is MOST important for the nurse to evaluate when caring for this client? 1. Serum baclofen levels 2. Muscle rigidity and pain 3. Intake and output 4. Daily weight pattern

Answer: 2--Baclofen (Lioresal) is used primarily to treat spasticity in MS and spinal cord injuries. The nurse should assess for muscle rigidity, movement, and pain to evaluate medication effectiveness.

The client is receiving multiple medications for treatment of Parkinson's Disease. Which signs and symptoms should the nurse recognize as adverse effects of carbidopa-levodopa? 1. Dystonia and akinesia 2. Bradykinesia and agitation 3. Muscle rigidity and cardiac dysrhythmias 4. Orthostatic hypotension and dry mouth

Answer: 4 Orthostatic hypotension and dry mouth are common adverse effects of caridopa-levodopa (Sinemet). These can be minimized by slow position changes and sucking on sugarless candy or chewing gum.

Alendronate is prescribed for a client with osteoporosis and the nurse is providing instructions on administration of the medication. Which instruction should the nurse provide? 1. Take the medication at bed time 2. Take the medication in the morning with breakfast 3. Lie down for 30 minutes after taking the medication 4. Take the medication with a full glass of water after rising in the morning

Answer: 4 Rationale: Precautions need to be taken with the administration of alendronate to prevent gastrointestinal adverse effects (especially esophageal irritation) and to increase absorption of the medication. The medication needs to be taken with a full glass of water after rising in the morning. The client should not eat or drink anything for 30 minutes following administration and should not lie down after taking the medication.

The unresponsive client with DM is admitted to the ED with a serum glucose level of 35 mg/dL. Which medication should the nurse plan to administer? 1. Exenatide 2. Pramlintide 3. Miglitol 4. Glucagon

Answer: 4. Glucagon--The nurse should plan to administer glucagon (GlucaGen). Glucagon, administered intramuscularly, intravenously, or subcutaneously, is used in unconscious clients with diabetes to reverse severe hypoglycemia from insulin overdose. Normal serum glucose is 70-100 mg/dL.

A Patient has a history of severe allergic reaction to glyburide. A nurse would also expect a reaction to which of the following medications? (select all that apply) A. Sulfasalazine B. Trimethoprim/sulfamethoxazole C. Cefazolin D. Linezolid E. Hydrochlorothiazide

Answer: A,B,E Glyburide is a sulfa containing medication for type 2 diabetes. Sulfa allergies are common and all sulfa-containing medications and drug combinations can potentially cause allergic reactions.

A patient with hyperthyroidism is placed on propylthiouracil to reduce thyroid hormone synthesis. The patient asks the nurse when the drug wll start working. What should be the nurse's response? A. 2-3 months B. 1-5 days C. 1-3 weeks D. 4-6 weeks

Answer: C. 1-3 weeks The therapeutic affect of propylthiouracil has an onset of 10-21 days and a peak of 6-10 weeks. The patient should receive a symptomatic treatment with a beta blocker until their thyroid levels have returned to normal.

2. A client is prescribed Omeprazole (Prilosec). The nurse determines that the client is receiving its therapeutic effect if which of the following stated by the client. A. Relief of nausea and vomiting B. Decrease diarrheal episodes C. The absence of constipation D. Relief from GERD

Answer: D Rationale: Omeprazole is used to treat symptoms of GERD and other conditions caused by excess stomach acid. Reply to Thread

1. A nurse has administered a dose of ibuprofen (Motrin) to an adult patient. The nurse should be aware that this drug can be used in the treatment of which of the following? Select all that apply. a. Hyperuricemia b. Moderate pain c. Fever d. Pruritus e. Inflammation

Answer: b, c, and e. Rationale: Ibuprofen is used to relieve mild to moderate pain, including dysmenorrhea (painful menstruation). It is also used to treat inflammation related to rheumatoid arthritis and osteoarthritis. In addition, it is effective in reducing fever. During initial attacks of acute gout, NSAIDs such as ibuprofen may be administered but it does not directly reduce uric acid levels.

2. A nurse had administered an IV dose of morphine to a patient who was rating her pain at 8/10. The nurse should assure the patient that maximum relief of pain will occur in: a. 30 to 45 minutes b. 10 to 20 minutes c. 3 to 5 minutes d. 5 to 10 minutes

Answer: b. 10 to 20 minutes Rationale: After IV injection of morphine, maximal analgesia and respiratory depression usually occur within 10 to 20 minutes.

2. One of the benefits of Glargine (Lantus) insulin is its ability to: a. Release insulin rapidly throughout the day to help control basal glucose. b. Release insulin evenly throughout the day and control basal glucose levels. c. Simplify the dosing and better control blood glucose levels during the day. d. Cause hypoglycemia with other manifestation of other adverse reactions.

Answer: b. Release insulin evenly throughout the day and control basal glucose levels

2. The physician has ordered aspirin therapy for a client with severe rheumatoid arthritis. A sign of acute aspirin toxicity is: a. Anorexia b. diarrhea c. Tinnitus d. Pruritis

Answer: c: Tinnitus is a symptom of aspirin toxicity.

1) A client receiving chemotherapy for breast cancer has an order for Zofran (ondansetron) 8mg PO to be given 30 minutes before induction of the chemotherapy. The purpose of the medication is to: a. Prevent anemia b. Promote relaxation c. Prevent nausea d. Increase WBC counts

Answer: d Zofran is an effective anti-nausea medication commonly used by chemotherapy patients.

The clinic nurse is assessing the client. The nurse evaluates that the client's levothyroxine dose is too low when which findings are noted on assessment? 1. Increased appetite 2. Decreased sweating 3. Apathy and fatigue 4. Parasthesis 5. Finger and tongue tremors 6. Slowed mental processes

Answers 2,3,4,6 1. Increased appetite - indicates hyperthyroidism and can indicate the dose is too high. 2. Decreased sweating - Symptom of hypothyroidism appear if the dose is too low and include decreased sweating. 3. Apathy and fatigue -Symptom of hypothyroidism appear if the dose is too low and include apathy and fatigue. 4. Parasthesis - Symptom of hypothyroidism appear if the dose is too low and include paresthesias. 5. Finger and tongue tremors - indicates hyperthyroidism and can indicate the dose is too high. 6. Slowed mental processes - Symptom of hypothyroidism appear if the dose is too low and include slowed mental processes.

Question 1: The nurse is assessing the client. Which findings indicate that the client may be experiencing physical changes from long-term prednisone use? Select all that apply. 1. Weight gain 2. increased muscle mass 3. Fragile skin 4. Acne vulgaris 5. alopecia

Answers are....1,3,4 1. Weight gain and muscle atrophy are are body changes that may occur with long-term glucocorticoid therapy. 2. Muscle wasting (not increased muscle mass ) is a side effect of prednisone. 3. Fragile skin is possible body change that may occur with long-term glucocorticoid therapy. 4. Acne vulgaris may occur with long-term glucocorticoid therapy. 5.Hirsutism (not alopecia) is a side effect of prednisone.

2- A patient has been taking a heavy aspirin regimen for the past two months. Which side effects, if noted by the patient, are directly related to overdose of aspirin? A. Confusion. B. Tinnitus. C. Increased INR. D. Blood in stools. E. Edema.

Answers: B, C, and D Rationale: Aspirin can increase bleeding time (INR) and can also cause some GI bleeding (resulting in the bloody stools). It can also lead to tinnitus. Aspirin does not generally cause confusion or edema.

1- A patient has been prescribed the medication spironolactone (aldasterone). When preparing the patient for discharge, the nurse should include which of the following instructions? A. "It is important to increase your intake of dark leafy greens." B. "Be sure to take this with meals." C. "Remember to eat salt substitutes instead of actual sodium." D. "Do not take this medication before bedtime." E. "This medication will make you urinate more often." F. "Check your weight daily and keep a record to bring with you to your next appointment."

Answers: B, D, E, and F Rationale: This patient should be avoiding salt substitutes because they are generally made of potassium. Spironolactone is a potassium-sparing diuretic. Therefore, the patient should eat a normal potassium diet and regular salt intake. The other four answers are correct.

The nurse is administering medications to lower the inter cranial pressure of a patient. Which medication would the nurse administer? A. Prilosec (Omeprizole) B. Mannitol (Osmitrol) C. Docusate (Cholase) D. Baclofen (Lioresal)

B mannitol can be used to decrease ICP.

A nurse is teaching a client who has a new prescription for baclofen to treat muscle spasms. Which of the following statements by the client indicates an understanding of the teaching? (Select all that apply.) A. "I will stop taking this medication right a way if I develop dizziness." B. "I know the doctor will gradually increase my dose of this medication for a while." C. "I should increase fiber to prevent constipation from this medication." D. "I won't be able to drink alcohol while I'm taking this medication." E. "I should take this medication on an empty stomach each morning."

B, C, and D are correct. The provider starts the client on a low dose, and the dose is increased gradually to prevent CNS depression. The client should increase fluids and fiber to reduce the risk for constipation. The intake of alcohol and other CNS depressants can exacerbate the CNS depression while taking baclofen.

1) The nurse assesses that the client with ARF has a serum potassium level of 6.8mEq/L. Which medications, if prescribed, should the nurse plan to administer now? Select all that apply A) Erythropoietin B) Regular insulin C) 0.45% saline bolus D) Calcium gluconate E) Sodium polystyrene sulfonate (kayexalate)

B, D, E

The nurse is evaluating a client with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which statement from the client indicates the drug is effective? A). "I have excess energy throughout the day" B). "I am able to sleep and rest at night" C). "I have lost weight since taking this medication" D). "I do perspire throughout the entire day"

B-PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormone and peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be able to sleep and rest well at night since the level of thyroid hormones is reduced in the blood. Excess energy throughout the day, loss of weight, and perspiring throughout the day are symptoms of hyperthyroidism indicating the drug has not produced its outcome.

A 60 year old diabetic patient has been taking glyburide (DiaBeta) to control his blood glucose for several years. His physician recently ordered metoprolol for him as well, to manage hypertension. What effect could this added drug have? A. Higher risk for developing hypoglycemia. B. Raise blood glucose levels. C. No effect, D. Managing hypertension helps improve negative effects of diabetes.

B. Beta blockers decrease the effects of glyburide, so patient will have less of a hypoglycemic effect, meaning his blood sugar level will rise.

1. A 5 year old has a temperature of 103.6F and is brought to the ED by his mother. Which statement by the mother is cause for concern? A. I gave him a sponge bath to help with the fever B. I've tried to encourage fluid intake every hour C. I administered Aspirin to help with the fever 3 hours ago D. I re-took his temperature one hour after I administered the medication and it was still 101.7F

C

2. The patient asks how stool softeners relieve constipation. Which of the following would be the best response by the nurse? Stool softeners relieve constipation by: A. stimulating the walls of the intestine B. promoting the retention of sodium in the fecal mass C. promoting the retention of water in the fecal mass D. lubricating the intestinal walls

C

#1 A patient refused her scheduled dose of Metformin because she is concerned about becoming hypoglycemic because her blood glucose levels are currently 66 mg/dl. What should the nurse tell the patient regarding Metformin? a) Overuse of Metformin creates a risk of hyperglycemia, not hypoglycemia b)Hypoglycemia is only a risk for patients with type 1 diabetes c) Metformin does not cause hypoglycemia d) As long as the patient takes Metformin regularly, there will not be a risk of hypoglycemia.

C Doctors prefer to call Metformin an antihyperglycemic vs. a hypoglycemic because there is no connection with hypoglycemia. Metformin does not cause hypoglycemia if used with other medication.

1) In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client: A) That therapy typically lasts about 6 months. B) That weekly laboratory tests for T4 levels will be required. C) To report weight loss, anxiety, insomnia, and palpitations. D) That the drug may be taken every other day if diarrhea occurs.

C) To report weight loss, anxiety, insomnia, and palpitations.

You are caring for a patient taking insulin. You realize the patient is experiencing symptoms of hypoglycemia when he displays which of the following symptoms? Decrease respiratory rate and hot, dry skin Increased pulse rate and fruity smelling breath Weakness, sweating, and decreased mentation Increased thirst and increased urine output

C- Symptoms of hypoglycemia include shakiness, dizziness, or lightheadedness, sweating, nervousness or irritability, sudden changes in behavior or mood, weakness, pale skin, and hunger.

A nurse is caring for a client who has increased intracranial pressure and is receiving mannitol. Which of the following findings should the nurse report to the provider? A. Blood glucose 150 mg/dL B. Urine output 40 mL/hr C. Dyspnea D. Bilateral equal pupil size

C. Correct. Dyspnea is a manifestation of heart failure, an adverse effect of mannitol. The nurse should stop the medication and notify the provider.

A nurse is caring for an older adult client in a long term care facility who has hypothyroidism and a new prescription for levothyroxine. Which of the following dosage schedules should the nurse expect for this client? A. The client will start at a high dose, and the dose will be tapered as needed B. The client will remain on the initial dosage during the course of treatment C. The client's dosage will be adjusted daily based on blood levels D. The client will start on a low dose, which will be gradually increased

D. Correct. the nurse should expect that levothyroxine will be started at a low dose and gradually increased over several weeks. This is especially important in older adult clients to prevent toxicity

1. A client is receiving omeprazole (Prilosec) for esophageal reflux. The nurse makes a priority to monitor the results of which of the following laboratory studies? a. Blood urea nitrogen (BUN) b. Uric acid c. Liver enzymes d. White blood cell (WBC) count

Q 1 ANS: C Rationale: omeprazole can cause an increase in liver enzyme levels (AST, ALT, alkaline phosphatase, and bilirubin), leading to adverse reactions of the liver necrosis and hepatic failure.

2. Metformin (Glucophage) has been prescribed for a client newly diagnosed with type 2 diabetes mellitus. The nurse evaluates that the client understood medication teaching when the client states that this medication does which of the following? a. Decreases sensitivity of peripheral tissue to insulin b. Stimulates glucose production in the liver c. Treats unstable type 2 diabetes mellitus d. Decreases production of glucose by the liver.

Q 2 ANS: D Rationale: Metformin is given to clients with stable type 2 diabetes mellitus to inhibit glucose production by the liver and increase sensitivity of peripheral tissue to insulin.

The provider orders mannitol IV for a client admitted to the ICU with a closed head injury. Following the administration of mannitol, the nurse expects which of the following? A) Decreased WBC B) Decreased LOC C) Increased ICP D) Increased Urinary output

Question 1 answer: D Rationale: Mannitol is an osmotic diuretic. Osmotic diuretics make the blood hypertonic, which creates a concentration gradient to pull fluid away from the intracellular compartment (including the intracranial space, where the brain cells are swelling) into the intravascular compartment. Excess fluid volume in the blood increases pressure of the glomerular filtrate leading to diuresis.

The nurse is monitoring a client receiving levothyroxine sodium (Synthroid) for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply a. insomnia b. weight loss c. brady cardia d. constipation e. mild heat intolerance

Question 1: a, b, e Rationale: Insomnia, weight loss, and mild heat intolerance are side effects of levothyroxine sodium. Bradycardia and constipation are not side effects associated with this medication and rather are associated with hypothyroidism, which is the disorder that this medication is prescribed to treat.

The nurse is preparing to administer regular insulin, 10 units SQ, before mealtime. How long before mealtime should the nurse administer the insulin? A) 15min B) 30min C) 45min D) 60min Reply to Thread

Question 2 answer: B Rationale: Regular insulin is short-acting with a 30-minute onset, a peak of 2-4 hours, and a duration of 8-12 hours. The nurse should administer regular insulin 30 minutes before mealtime in order to be sure the medication is active when the meal is eaten.

Prednisone is prescribed for a client with diabetes mellitus who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? a. an additional dose of prednisone daily b. a decreased amount of daily Humulin NPH insulin c. an increased amount of daily Humulin NPH insulin d. the addition of an oral hypoglycemic medication daily

Question 2: c Rationale: Glucocorticoids can elevate blood glucose levels. Clients with diabetes mellitus may need their dosages of insulin or oral hypoglycemic medications increased during glucocorticoid therapy. Therefore, options a, b, and d are incorrect.

The nurse is educating the patient on the importance of following proper medication administration. The nurse determines the more teaching is needed when the patient makes this statement. A. I need to eat potassium rich food since i'm taking furosemide. B. I need to take care when taking Acetaminophen as it has hepatoxic effects with over use. C. I need to take my saline cathartics every day to maintain soft stools as long as I am taking morphine. D. A likely side effect of taking morphine is constipation so I should pay close attention to my bowel movements.

Saline Cathartics are not for long term usage.

1. Your patient's blood glucose level is 215 mg/dL. The patient is about to eat lunch. Per sliding scale, you administer 4 units of Insulin Lispro (Humalog) subcutaneously at 1130. As the nurse, you know the patient is most at risk for hypoglycemia at what time? A. 1145 B. 1230 C. 1430 D. 1630

The answer is B. If you gave the Lispro at 1130, the patient is at most risk for hypoglycemia 1 hour after administration, which is 1230.

Your patient's blood glucose level is 215 mg/dL. The patient is about to eat lunch. Per sliding scale, you administer 4 units of Insulin Lispro (Humalog) subcutaneously at 1130. As the nurse, you know the patient is most at risk for hypoglycemia at what time? A. 1145 B. 1230 C. 1430 D. 14450

The answer is B. If you gave the Lispro at 1130, the patient is at most risk for hypoglycemia 1 hour after administration, which is 1230.

A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication: a) in the morning to prevent insomnia b) only when the client complains of fatigue and cold intolerance c) at various times during the day to prevent tolerance from occurring d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

a) in the morning to prevent insomnia Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.

The nurse is assessing a patient with hyperkalemia. To decrease the high levels of potassium quickly, the nurse would most likely administer which medication? 1) Novolin R 2) Kayexalate 3) Novolin N 4) Lispro

answer: 1 rationale: To quickly decrease potassium, administer IV insulin. Novolin R is the only insulin which can be given IV. Kayexalate is a good choice to rid the body of potassium, but will not work as rapidly as Novolin R.

2) A client is admitted with sever back pain and is requesting pain medication. During her assessment, the nurse notes the client has been taking acetaminophen 650 mg every 4 hours at home with minimal relief. Based on the information, which of the following PRN- ordered drug(s) should the nurse consider administering? a) Hydrocodone with acetaminophen b) Acetaminophen c) Ibuprofen d) Acetaminophen

c) Ibuprofen is the only medication that does not contain acetaminophen and acetaminophen has a 3g daily maximum

1) The nurse assesses a client with a history of Addison's disease who has received steroid therapy for several years. The nurse could expect the client to exhibit which of the following changes in appearance? a) Buffalo hump, girdle- obesity, gaunt facial appearance b) Tanning of the skin, discoloration of the mucous membranes, alopecia, and weight loss c) Emaciation, nervousness, breast engorgement, hirsutism d) Truncal obesity, purple striations on the skin, moon face

d) Truncal obesity, purple striations on eht skin, moon face- Due to excess glucocorticoids are all expected finding from long term steroid use