Pharma 2

The postoperative client on hydromorphone becomes hypoxic, and naloxone is administered per protocol. What is most important for the nurse to consider in the follow-up care of this client? 1. Client's respiratory status 60 minutes later 2. Documenting the client's hypoxic event 3. Obtaining an order for a different analgesic 4. Potential for drug-drug interaction now

1

Which client finding would be a contraindication for the nurse to administer dicyclomine hydrochloride for irritable bowel syndrome? 1. Bladder scan showing 500 mL urine 2. Hemoglobin of 11 g/dL (110 g/L) 3. History of cataracts 4. Reporting frequent diarrhea today

1

A community health nurse is preparing to administer influenza vaccines. Which clients should receive the intranasal influenza vaccine? Select all that apply. 1. 3-year-old who is afraid of needles 2. 15-year-old with hemophilia 3. 24-year-old who is 4 weeks postpartum 4. 32-year-old who is at 12 weeks gestation 5. 45-year-old with Crohn disease taking infliximab

1,2,3

The clinic nurse evaluates a client's response to levothyroxine after 6 weeks of treatment. The nurse will note which therapeutic responses to the medication. Select all that apply. 1. Apical heart rate of 88/min 2. Elevation of mood 3. Improved energy levels 4. Skin is cool and dry 5. Slight weight gain

1,2,3

The health care provider prescribes amoxicillin/clavulanate (liquid) twice a day for a child with acute sinusitis. What instructions are most important for the parents? Select all that apply. 1. Administer it with food if nausea or diarrhea develops 2. Complete the medication course even if the child is better 3. Expect a rash, which is normal, as a side effect 4. Shake the medicine well before use 5. Use a household spoon to measure the dose

1,2,4

A post-surgical client is unresponsive to painful stimuli and is given naloxone. Within 5 minutes, the client is arousable and responds to verbal commands. One hour later, the client is again difficult to arouse, with minimal response to physical stimuli. Which actions should the nurse take? Select all that apply. 1. Administer oxygen 2. Assess respiratory rate 3. Initiate rapid response or code team 4. Notify the health care provider 5. Prepare a second dose of naloxone

1,2,4,5

The nurse reviews an elderly client's medication administration record and identifies which prescriptions as having the potential for injury in the elderly? Select all that apply. 1. Amitriptyline 2. Chlorpheniramine 3. Docusate 4. Donepezil 5. Lorazepam

1,2,5

The nurse admits a client to the unit who reports taking high doses of aspirin to ease the pain of chronic headaches. The nurse should monitor for which adverse effects? Select all that apply. 1. Black tarry stools 2. Bradycardia 3. Bruising 4. Hypertension 5. Ringing in the ears

1,3,5

A client diagnosed with trichomonal vaginal infection (trichomoniasis) is prescribed metronidazole. Which of the following is essential for the nurse to teach? Select all that apply. 1. Avoid alcohol while taking this medication 2. Perform vaginal douche for 7-10 days 3. Use birth control pills to prevent recurrence of infection 4. Your partner(s) must be treated simultaneously 5. Your urine can change to a deep red-brown color

1,4,5

A client with ulcerative colitis is prescribed the drug sulfasalazine. Which information should the nurse discuss with the client concerning this drug? Select all that apply. 1. Drinking 8 glasses of water daily 2. Stopping the medicine if blood is present in stool 3. Stopping the medicine if urine turns an orange-yellow color 4. Taking folic acid supplements 5. Wearing sunscreen when outdoors

1,4,5

A diabetic client is prescribed metoclopramide. Which of the following side effects must the nurse teach the client to report immediately to the health care provider? Select all that apply. 1. Excess blinking of eyes 2. Dry mouth 3. Dull headache 4. Lip smacking 5. Puffing of cheeks

1,4,5

A child with cystic fibrosis is to receive a dose of pancrelipase at 12:00 PM. The client states that he is not hungry and will eat his lunch in an hour. Which action is appropriate for the nurse to take? 1. Administer the prescribed pancrelipase 2. Hold the pancrelipase until the client eats 3. Notify the health care provider 4. Skip this dose of the pancrelipase

2

A client is being discharged on enoxaparin therapy following total knee replacement surgery. Which teaching instruction does the nurse include in the teaching plan? 1. "Eliminate green, leafy, vitamin K-rich vegetables from your diet." 2. "Mild bruising or redness may occur at the injection site." 3. "You can take over-the-counter drugs such as ibuprofen to relieve mild discomfort." 4. "You will need PT/INR assessments at regular intervals while on enoxaparin therapy."

2

A client with fibromyalgia refuses to take the prescribed drug duloxetine. When the nurse asks, why, the client responds, "Because I'm not depressed!" What is the nurse'smost appropriate response? 1. "Depression is common with fibromyalgia, but a low dose of this drug can prevent it." 2. "It can relieve your chronic pain and help you sleep better at night." 3. "It helps to relieve the adverse effects of your other prescribed drugs." 4. "You have the right to refuse. I will notify your health care provider (HCP)."

2

A client with latent tuberculosis has been taking oral isoniazid (INH) 300 mg daily for 2 months. The client tells the nurse that for the past week she has had numbness, a burning sensation, and tingling in her hands and feet. Additional intake of which of the following would most likely have prevented this? 1. Folic acid 2. Vitamin B6 3. Vitamin B12 4. Vitamin D

2

A client with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been receiving IV vancomycin for the last 3 days. Which blood test trend is most importantfor the nurse to review when preparing to administer this medication? 1. Blood cultures 2. Creatinine levels 3. Magnesium levels 4. White blood cell (WBC) count

2

A client with type I diabetes mellitus is prescribed an insulin pump. The nurse reinforces the diabetic educator's teaching regarding transitioning from multiple daily injections to continuous subcutaneous insulin infusion (CSII) therapy. Which statement indicates that the client understands the advantages of using this therapy? 1. "I won't need a bolus dose of insulin before my meals anymore." 2. "I'm glad my blood sugars won't go way up and way down, like they did before." 3. "I'm so glad I don't have to stick my finger 4 times a day to test my sugar anymore." 4. "It'll finally be easier for me to lose some weight."

2

A hospitalized client with thyrotoxicosis receives atenolol 50 mg PO daily. Which statement by the nurse accurately reinforces the client's understanding of this medication's purpose? 1. "Atenolol is an iodine-based medication that blocks the release of thyroid hormones." 2. "It is used to treat some of the symptoms of hyperthyroidism, such as increased heart rate." 3. "This drug is radioactive and damages or destroys the thyroid tissue." 4. "This first-line antithyroid drug inhibits the synthesis of thyroid hormones."

2

A nurse is observing a nursing student reinforce teaching to a client on how to take sucralfate. Which statement made by the student would require intervention by the nurse? 1. "Take this in the morning 1 hour before breakfast." 2. "Take this with your other stomach medications." 3. "Take your heart medication 2 hours after sucralfate." 4. "You might experience constipation while taking this."

2

A parent calls the after-hours triage nurse about a 3-year-old who is sick with the flu. Which report by the parent would necessitate intervention by the nurse? 1. Acetaminophen being given every 4 hours for fever 2. Bismuth subsalicylate being used for nausea 3. Ibuprofen being given every 6 hours for body aches 4. Popsicles and gelatin desserts being used for hydration

2

The emergency department nurse prepares a male client for surgery. The client was admitted with a traumatic open fracture of the femur, hematocrit of 36% (0.36), and hemoglobin of 12 g/dL (120 g/L). Which prescription should the nurse validate with the health care provider before administration? 1. Cefazolin 2. Enoxaparin 3. Morphine 4. Tetanus toxoid

2

The nurse administers 15 units of aspart insulin subcutaneously to a hospitalized client with type 1 diabetes mellitus at 7:00 AM for a fasting blood glucose of 180 mg/dL (10 mmol/L). Which nursing action is a priority? 1. Ensure that the client continues to fast for at least 30 more minutes 2. Give the client breakfast within 15 minutes 3. Recheck the blood glucose in 1 hour 4. Teach the client about the signs and symptoms of hyperglycemia

2

The nurse administers 8 units of regular insulin subcutaneously at 11:30 AM to a client with type 1 diabetes mellitus and serves the client lunch 30 minutes later. The client eats a few bites, becomes nauseated, and is unable to finish the meal. When is the client at highest risk for experiencing an insulin-related hypoglycemic reaction? 1. 12:30 PM 2. 2:00 PM 3. 5:00 PM 4. 6:00 PM

2

The nurse assesses a client 5 minutes after initiating a blood transfusion. The client has shortness of breath, itching, and chills. The nurse immediately turns off the transfusion. What action should the nurse take next? 1. Check vital signs 2. Maintain IV access with normal saline 3. Notify the health care provider 4. Recheck identification tags and numbers

2

The nurse is caring for a client on IV heparin infusion and oral warfarin. Current laboratory values indicate that the client's aPTT is 5 times the control value and the PT/INR is 2 times the control value. What action does the nurse anticipate? 1. Clarify vegetable consumption with client 2. Decrease the heparin rate 3. Decrease the warfarin dose 4. Obtain an order for vitamin K injection

2

The nurse is caring for a client who had surgery yesterday. When administering omeprazole, the client asks "What is that for? I don't take it at home." Which reply by the nurse is most appropriate? 1. "Omeprazole helps prevent nausea by making your stomach empty faster." 2. "Omeprazole helps prevent you from developing an ulcer due to the stress of surgery." 3. "Omeprazole protects you from getting an infection while on antibiotics." 4. "This medication will treat your gastroesophageal reflux disease (GERD)."

2

The nurse is caring for a client with cirrhosis who has hepatic encephalopathy. The client is prescribed lactulose. Which assessment by the nurse will most likely indicate that the medication has achieved the desired therapeutic effect? 1. Higher potassium level 2. Improved mental status 3. Looser stool consistency 4. Reduced abdominal distension

2

The nurse is preparing to administer medications due at 1800 to a client who had an aortic valve replacement 5 days ago. The client also has a urinary tract infection and hypercholesterolemia. Which action should the nurse implement first? Click on the exhibit button for additional information. Exhibit: Medication administration record Allergies: None Medication || Time Levofloxacin: 500 mg PO, daily || 0900 Potassium chloride: 20 mEq PO, daily || 0900 Docusate sodium: 100 mg PO, daily || 0900 Warfarin: 5 mg PO, daily || 1800 Simvastatin: 20 mg PO, daily || 1800 1. Assess the client's complete blood count and potassium (K+) level 2. Check the client's international normalized ratio (INR) 3. Measure the client's vital signs 4. Verify the client's name and date of birth

2

The nurse prepares to administer a dose of radioactive iodine (RAI) to a 39-year-old female client with Graves' disease. Which action is most important for the nurse to take? 1. Ask client when her last menstrual cycle occurred 2. Confirm pregnancy test result is negative 3. Obtain a baseline assessment of the mouth and throat 4. Teach the client the signs and symptoms of hypothyroidism

2

The nurse provides medication teaching to a client with primary adrenal insufficiency (Addison's disease) who is prescribed hydrocortisone 10 mg by mouth 3 times a day. Which instructions should be included in the client's teaching plan? Select all that apply. 1. "Discontinue hydrocortisone if you note mood changes or disruptions in behavior." 2. "Make an appointment with an optometrist yearly to assess for cataracts." 3. "Report even a low-grade fever to the health care provider (HCP) immediately." 4. "Report signs of hyperglycemia, including increased urine, hunger, and thirst." 5. "Take the medication on an empty stomach." 6. "The dose of hydrocortisone may need to be decreased during times of stress."

2,3,4

Which herbal supplements pose an increased risk for bleeding in surgical clients and should be discontinued prior to major surgery? Select all that apply. 1. Black cohosh 2. Garlic 3. Ginger 4. Ginkgo biloba 5. Hawthorne

2,3,4

The nurse administers a prescribed oral dose of radioactive iodine (RAI) to a female client with hyperthyroidism. The nurse should instruct that the client utilize which of the following home precautions during the first 3-7 days after ingestion? Select all that apply. 1. Continue breastfeeding if applicable; RAI is not secreted through breast milk 2. Do not use bare hands to handle food that is to be served to others 3. Isolate personal clothing, towels, and linens; wash them separately from the rest of laundry in the home 4. Stop using any prescribed antithyroid drugs or beta-adrenergic blockers 5. Use a separate toilet and flush 2-3 times after each use

2,3,5

The nurse is administering IV hydromorphone to a client every 3-4 hours as needed for postoperative pain. Which interventions should the nurse implement? Select all that apply. 1. Administer IV hydromorphone over 5-10 seconds 2. Administer PRN stool softener with daily medications 3. Hold hydromorphone if client is not practicing deep breathing exercises 4. Perform reassessment an hour after administration 5. Tell the client to call for assistance before getting out of bed

2,5

A 64-year-old client is prescribed ciprofloxacin for a urinary tract infection (UTI). The nurse instructs the client to observe for and notify the health care provider (HCP)immediately about which of the following? 1. Brown-colored urine 2. Hearing and balance problems 3. Pain in the Achilles tendon area 4. Sunburn

3

A client has been on long-term therapy with esomeprazole. What is essential for the nurse to ask the client? 1. "Are you drinking plenty of water with the medication?" 2. "Are you taking the medication after meals?" 3. "Have you had a bone density test recently?" 4. "Have you had your blood pressure taken regularly?"

3

A client has nausea, abdominal cramping, and persistent mucus-like, watery diarrhea that is positive for Clostridium difficile. The nurse anticipates the client will be prescribed which medication to treat this condition? 1. Ceftriaxone 2. Fluconazole 3. Metronidazole 4. Pantoprazole

3

A client in the intensive care unit is receiving IV vancomycin and gentamicin. The nurse should monitor for which potential complication with the administration of these medications? 1. Blood in nasogastric tube drainage 2. Decrease in red blood cell (RBC) count 3. Increase in serum creatinine level 4. Onset of muscle aches and cramping

3

A client recovering from femoral-popliteal bypass surgery performed yesterday reports a pain level of 5 on a 0-10 scale. At 2400, the night shift nurse reviews the client's medication administration record, shown in the exhibit. Which medication should the nurse administer? Click on the exhibit button for additional information. Exhibit: https://drive.google.com/open?id=0B40rfZ_HhbqwcGZpQlBBWUlzM3c 1. Acetaminophen 2. Alprazolam 3. Hydrocodone/acetaminophen 4. Morphine

3

A client with deep vein thrombosis (DVT) is receiving a continuous infusion of unfractionated heparin. The client asks the nurse what the heparin is for. How should the nurse respond? 1. "Heparin is a blood thinner that will help to dissolve the clot in your leg." 2. "Heparin will help stabilize the clot in your leg and prevent it from breaking off and traveling to your lungs." 3. "Heparin will keep the current clot from getting bigger and help prevent new clots from forming." 4. "I'm sorry. This is something that your health care provider (HCP) can answer better upon arriving."

3

A nurse is caring for a client with an exacerbation of chronic obstructive pulmonary disease (COPD) and a history of type 2 diabetes mellitus requiring insulin. The client has been prescribed prednisone. The nurse anticipates which need? 1. Close monitoring for hypotension 2. Gradually increasing the prednisone dose 3. Increasing the insulin dose 4. Monitoring and recording intake and output

3

The nurse develops a teaching plan for a client prescribed isoniazid, rifampin, ethambutol, and pyrazinamide to treat active tuberculosis (TB). Which of the following instructions associated with the adverse effects of rifampin is most important for the nurse to include? 1. Notify the health care provider if your urine is red 2. Take acetaminophen every 6 hours for drug-associated joint pain while taking this medication 3. Wear eyeglasses instead of soft contact lenses while taking this medication 4. You can stop taking the medications as soon as one sputum culture comes back normal

3

The nurse in an outpatient clinic cares for a client with primary adrenal insufficiency (Addison's disease) who has been taking hydrocortisone 20 mg/day for the last 8 years. Which client data is most important to report to the primary healthcare provider (PHCP)? 1. Development of moon face 2. Heart rate increase from 75 to 84/min 3. Low-grade fever of 100 F (37.7 C) 4. Weight gain of 6 lb (2.7 kg) in 3 months

3

The nurse in the urology clinic is scheduling a laboratory appointment for a client with symptoms of benign prostatic hyperplasia (BPH) to have a prostate-specific antigen (PSA) blood test done. Which statement by the client may cause the nurse to delay the blood draw? 1. "I have an intense fear of needles." 2. "I use aspirin daily." 3. "I use saw palmetto daily." 4. "I was treated for a urinary infection 6 weeks ago."

3

The nurse is caring for a client receiving IVPB azithromycin. Which client data obtained by the nurse should be reported to the health care provider (HCP) prior to administering any additional doses? 1. Currently nauseated and vomited once 2. Decreased white blood cell (WBC) count 3. Prolonged QT interval 4. Temperature of 101.4 F (38.6 C)

3

The nurse is caring for a client taking tamoxifen for breast cancer. Which client statement is most concerning and a priority to report to the health care provider? 1. "I don't have much interest in sex lately." 2. "I feel like I might be getting a cold." 3. "My periods have been heavy lately." 4. "These hot flashes are occurring a lot."

3

The nurse is caring for a client who started receiving chemotherapy 10 days ago. Today, the health care provider prescribes filgrastim. Which of the following is an expected outcome of this medication? 1. Decrease in serum uric acid 2. Increase in hemoglobin level 3. Increase in neutrophil count 4. Increase in platelet count

3

The nurse is preparing to administer IV cefazolin to a client who is newly admitted with cellulitis. The client's allergies include amoxicillin, ciprofloxacin, and sulfa drugs. What should the nurse do first? 1. Administer the medication as ordered 2. Clarify the order with the health care provider (HCP) 3. Get more information from the client about the client's allergies 4. Notify the pharmacy that the drug is inappropriate for this client

3

The nurse on the neurosurgery step-down unit is assigned to a stable client with a closed-head injury who is 1 day postoperative craniotomy. The nurse prepares to administer the 7:00 AM medications and reviews the client's medication administration record. Which prescription prompts the nurse to contact the prescribing health care provider (HCP) for prescription clarification? Click on the exhibit button for additional information. Exhibit: Medication Administration Record Allergies: None Medications || Time Gabapentin: 300 mg orally, every 8 hours || 0700, 1500, and 2300 Hydrocodone/acetaminophen: (5 mg/325 mg) orally, every 4 hours || Every 4 hours prn Acetaminophen: 1,000 mg IV, every 6 hours || 0600, 1200, 1800, and 2400 Phenytoin: 100 mg orally, every 12 hours || 0700 and 1900 1. Acetaminophen 1000 mg IV every 6 hours 2. Gabapentin 300 mg orally every 8 hours 3. Hydrocodone/acetaminophen (5 mg/325 mg) orally, every 4 hours PRN 4. Phenytoin 100 mg orally, every 12 hours

3

The nurse provides teaching about methotrexate to a 28-year-old client with rheumatoid arthritis (RA). Which client statement indicates the need for further instructionregarding this drug? 1. "I know my resistance to germs will be lower, so I should get a flu shot this year." 2. "I should not become pregnant while I take this medicine." 3. "I will make sure to have my eyes checked every 6 months." 4. "It will be hard for me not to have wine with my dinner!"

3

A client has received the PRN prescription 5 mg hydrocodone/500 mg acetaminophen 2 tablets every 4 hours for moderate postoperative pain for a total of 4 doses since 0700. The nurse assesses the vital signs and pain level prior to each medication administration. Based on the vital signs at 2300, which interventions would the nurse implement? Select all that apply. Click on the exhibit button for additional information. Exhibit: https://drive.google.com/open?id=0B40rfZ_HhbqwUUlrX003Yk42UlU 1. Administer the requested medication 2. Check the chart for a naloxone order 3. Contact the health care provider (HCP) 4. Decrease the dose to 1 tablet 5. Hold the requested dose of medication

3,5

A client comes to the emergency department following a bee sting. The client has a diffuse rash, hypotension, and throat tightness. One injection of IM epinephrine does not improve the client's condition. What action should the nurse take next? 1. Administer IV fluid bolus 2. Administer methylprednisolone 3. Prepare for emergency cricothyrotomy 4. Repeat IM epinephrine injection

4

A client has a deep vein thrombosis and is receiving a heparin drip. The client's activated partial thromboplastin time (aPTT) has been in the therapeutic range for the past 24 hours. The most recent laboratory value shows that the current aPTT equals the control value. What explanation should the nurse consider? 1. The client became tolerant to heparin 2. The client consumed spinach 3. The client developed thrombocytopenia 4. The client's intravenous (IV) line is infiltrated

4

A client has received a new prescription for nystatin to treat oral candidiasis. Which instructions should the nurse give this client? 1. Apply the ointment inside the mouth with a cotton-tipped applicator 2. Chew, then swallow the lozenge 3. Swish liquid in mouth for as long as possible, then spit it out 4. Swish liquid in mouth for several minutes, then swallow it

4

A client is receiving chemotherapy for acute myeloid leukemia. The health care provider prescribes allopurinol to prevent tumor lysis syndrome (TLS). Which laboratory value indicates a therapeutic response to the medication? 1. Serum calcium 9.5 mg/dL (2.38 mmol/L) 2. Serum phosphate 4.0 mg/dL (1.29 mmol/L) 3. Serum potassium 4.5 mEq/L (4.5 mmol/L) 4. Serum uric acid level 6.0 mg/dL (357 µmol/L)

4

A client just diagnosed with methicillin-resistant Staphylococcus aureus septic arthritis is receiving the first dose of IV vancomycin. Which finding is most concerning to the nurse? 1. Diffuse muscle pain 2. Flushing and pruritus 3. Low blood pressure 4. Wheezing and hives

4

A client taking morphine sulfate for acute pain has not voided in 6 hours. The nurse suspects the client has developed urinary retention. What is the priority nursing intervention? 1. Ask if the client needs to use the bedpan 2. Assess the client's fluid intake 3. Assess the client's skin turgor 4. Palpate the client's suprapubic area

4

A client with cancer is to receive a third dose of cisplatin. The client's laboratory results are shown in the exhibit. Which factor would be important for the nurse to assess before confirming the dose with the health care provider? Click on the exhibit button for additional information. Exhibit: Laboratory results Hemoglobin 12 g/dL (120 g/L) Creatinine 2.2 mg/dL (194.5 µmol/L) Blood urea nitrogen (BUN) 28 mg/dL (10.0 mmol/L) 1. Blood pressure 2. Capillary refill 3. Skin turgor 4. Urine output

4

A client with chronic rheumatoid arthritis (RA) says, "I am so frustrated, tired, and stiff. I just can't keep up with my young children anymore." The client is prescribed adalimumab, a tumor necrosis factor (TNF) inhibitor. What is the priority nursing diagnosis (ND) for this client regarding the new prescription? 1. Disturbed body image 2. Hopelessness 3. Impaired physical mobility 4. Risk for infection

4

A client with primary hypothyroidism has been taking levothyroxine for 1 year. Laboratory results today show high levels of thyroid stimulating hormone (TSH). Which teaching should the nurse plan to implement? 1. "A new prescription will be issued for a decreased dose of levothyroxine." 2. "Discontinue levothyroxine immediately; we will reassess TSH levels in 3 months." 3. "Start taking your levothyroxine with dietary fiber or calcium to increase its effectiveness." 4. "You will need to get this new prescription filled for an increased dose of levothyroxine."

4

During shift report it was noted that the off-going nurse had given the client a PRN dose of morphine 2 mg every 2 hours for incisional pain. What current client assessment would most likely affect the oncoming nurse's decision to discontinue the administration every 2 hours? 1. Client reports burning during injection into the IV line 2. Client reports dizziness when getting up to use the bathroom 3. Client's blood pressure is 106/68 mm Hg 4. Client's respiratory rate is 11/min

4

The clinic nurse is teaching a client about levothyroxine, which the health care provider has prescribed for newly diagnosed hypothyroidism. Which statement made by the client indicates that further teaching is needed? 1. "I will need to get my blood drawn to see if I'm taking the right dose." 2. "I will probably need to take this the rest of my life." 3. "I will take this once a day in the morning." 4. "If this makes my stomach upset, I will take it with an antacid."

4

The clinic nurse reviews the medical record of a client who was prescribed etanercept, a tumor necrosis factor (TNF) inhibitor. Which test result is most important for the nurse to check before initiating this treatment? 1. C-reactive protein (CRP) 2. Prothrombin time (PT) 3. Serum LDL cholesterol 4. Tuberculin skin test (TST)

4

The home health nurse reviews the laboratory results for 4 clients. Which laboratory value is most important for the nurse to report to the health care provider? 1. Client with Clostridium difficile infection receiving metronidazole has a white blood cell count of 15,000/mm3 (15.0 x 109/L) 2. Client with liver cirrhosis has an International Normalized Ratio of 1.5 3. Client with mild asthma exacerbation receiving prednisone has a blood glucose of 250 mg/dL (13.9 mmol/L) 4. Client with rheumatoid arthritis taking adalimumab has a white blood cell count of 14,000/mm3 (14.0 x 109/L)

4

The nurse is caring for a client with an inflammatory bowel disease exacerbation. The client is prescribed sulfasalazine. Which finding would require a priority follow-up by the nurse? 1. Elevated erythrocyte sedimentation rate 2. Hemoglobin 10.5 g/dL (105 g/L) 3. Urine with yellow-orange discoloration 4. Urine specific gravity 1.035

4

The nurse teaches a client about the use of regular and neutral protamine Hagedorn (NPH) insulin. Which statement by the client indicates that further teaching is needed? 1. "I will always check my blood glucose prior to using the sliding scale." 2. "I will eat breakfast 30 minutes after taking my morning NPH and regular insulin." 3. "I will use a new insulin syringe each time I give myself an injection." 4. "I will use the sliding scale to determine my NPH dose 4 times a day."

4

The nurse teaches a parent how to administer an oral liquid medication to a 2-month-old client. The nurse knows that the parent understands the teaching when the parent does which of the following? 1. Allows the client to sip the medication from a cup 2. Expels the medication from a dropper onto the back of the tongue 3. Mixes the medication in the infant's bottle of formula 4. Using a syringe, administers the medication in small amounts into the back of the cheek

4

Which client is at greatest risk for respiratory depression when receiving opioids for pain control? 1. 20-year-old client with bronchitis receiving inhaled bronchodilator therapy every 4 hours 2. 30-year-old client with heroin addiction with rotator cuff repair surgery this morning 3. 50-year-old client with sleep apnea and left foot cellulitis and scheduled for a bone scan 4. 70-year-old client with chronic obstructive pulmonary disease (COPD) with knee replacement this morning

4

A client is receiving a continuous heparin infusion and the most recent aPTT is 140 seconds. The nurse notices blood oozing at the surgical incision and IV insertion sites. What interventions should the nurse implement? Select all that apply. 1. Continue heparin infusion and recheck aPTT in 6 hours 2. Prepare to administer vitamin K 3. Redraw blood for laboratory tests 4. Review guidelines for administration of protamine 5. Stop infusion of heparin and notify the health care provider (HCP)

4,5

A client with active pulmonary tuberculosis is prescribed 4-drug therapy with ethambutol. The community health nurse instructs the client to notify the health care provider immediately if which adverse effect associated with ethambutol occurs? 1. Blurred vision 2. Dark-colored urine 3. Difficulty hearing 4. Yellow skin

1

A client in the emergency department is being discharged with a prescription for trimethoprim-sulfamethoxazole. Which statement by the client would indicate a need for further evaluation? 1. "I developed a whole-body rash while on glyburide." 2. "I drink at least 5 large bottles of water daily." 3. "I had to stop using lisinopril due to a bad cough." 4. "I have a birth control implant in place."

1

A client is prescribed long-term pharmacologic therapy with hydroxychloroquine to treat systemic lupus erythematosus. Which intervention related to the drug's adverse effects should the nurse include in the teaching plan? 1. Have an ophthalmologic examination every 6 months 2. Take the medication on an empty stomach 3. Take vitamin D and calcium supplements 4. Wear a MedicAlert bracelet

1

A client who has been on long-term omeprazole therapy for gastroesophageal reflux disease is admitted to the hospital for a urinary tract infection. The nurse recognizes that this client is at highest risk for which complication due to omeprazole use? 1. Clostridium difficile infection 2. Gait disturbance 3. Jaw necrosis 4. Tremor

1

A nurse is assessing a client with type 2 diabetes mellitus who was recently started on pioglitazone. Which client data obtained by the nurse is most important to bring to the attention of the health care provider? 1. Bilateral pitting edema in ankles 2. Blood pressure is 140/88 mm Hg 3. Most recent HbA1c is 6.7% 4. Retinal photocoagulation in right eye

1

A client with cancer pain is prescribed oxycodone. Which teaching is most essential to help prevent long-term complications? 1. Teach the client how to assess blood pressure daily 2. Teach the client how to prevent constipation 3. Teach the client how to prevent itching 4. Teach the client how to prevent nausea

2

The nurse should call the primary health care provider to obtain a new prescription prior to administering which medication to a client with type 1 diabetes mellitus? 1. 10 units regular insulin IV push for blood glucose >250 mg/dL (13.9 mmol/L) 2. 14 units glargine insulin subcutaneous injection every night at 8:00 PM 3. 18 units aspart insulin subcutaneous injection 15 minutes before breakfast 4. 20 units NPH insulin IV push administered every morning at 7:00 AM

4