Pharmacological and Parenteral Therapies

The nurse should teach the client that signs of digoxin toxicity include:

visual disturbances such as seeing yellow spots.

A client is started on digoxin. The health care provider (HCP) prescribes IV push doses of 0.5 mg now, 0.25 mg in 8 hr., and another 0.25 mg in another 8 hr. The client has a 1,000 mL bag of normal saline infusing at 25 mL/hr. What action should the nurse perform?

Administer each dose of medication over 5 minutes via IV push.

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect? in the morning and at bedtime with each meal and snack every 4 hours, at specified times three times daily between meals

with each meal and snack - Explanation: In chronic pancreatitis, destruction of pancreatic tissue requires pancreatic enzyme replacement. Pancreatic enzymes are prescribed to facilitate the digestion of proteins and fats and should be taken in conjunction with every meal and snack. Specified hours or limited times for administration are ineffective because the enzymes must be taken in conjunction with food ingestion.

A child with nephrosis is placed on prednisone. The dose is 2 mg/kg per day to be administered twice a day. The child weighs 25 lb (11.3 kg). How many milligrams will the child receive at each dose? Record your answer using one decimal place.

11.3

A client with deep vein thrombosis (DVT) has an IV infusion of heparin sodium infusing at 1,500 units/hr. The concentration in the bag is 25,000 units/500 ml. How many milliliters should the nurse document as intake from this infusion following an 8-hr shift? Record your answer using a whole number.

240 mL

A client is about to be discharged with a prescription for the antipsychotic agent haloperidol, 10 mg by mouth twice per day. During a discharge teaching session, a nurse should provide which instruction to the client?

Apply a sunscreen before exposure to the sun.

A nurse receives a report that a client has had an overdose of heparin. Which action by the nurse is most important in managing the overdose?

Obtain an order to give protamine sulfate.

A client is taking phenelzine 15 mg PO three times a day. The nurse is about to administer the next dose when the client tells the nurse about having a throbbing headache. Which action should the nurse do first?

Obtain the client's vital signs.

A client is taking doxorubicin and is distressed about hair loss. What should the nurse do?

Provide resources for a wig selection before hair loss begins.

A nurse is caring for a 3-year-old child admitted to the pediatric unit with acetaminophen poisoning. The nurse administers acetylcysteine every 4 hours for 72 hours. Which laboratory findings confirm the effectiveness of the drug therapy?

alanine aminotransferase and aspartate aminotransferase

A client with rheumatoid arthritis has been on aspirin therapy for an extended time. Which assessment is the most important for the nurse to obtain?

hearing

A nurse is monitoring a client for adverse reactions to dantrolene. Which adverse reaction is most common? slurred speech muscle weakness excessive tearing urine retention

muscle weakness Explanation: The most common adverse reaction to dantrolene is muscle weakness. The drug also may depress liver function or cause idiosyncratic hepatitis. Muscle weakness is rarely severe enough to cause slurring of speech, drooling, or enuresis. Although excessive tearing and urine retention are adverse reactions associated with dantrolene use, they aren't as common as muscle weakness.

A 62-year-old female is taking long-acting morphine 120 mg every 12 hours for pain from metastatic breast cancer. She can have 20 mg of immediate-release morphine every 3 to 4 hours as needed for breakthrough pain. The health care provider (HCP) should be notified if the client uses more than how many breakthrough doses of morphine in 24 hours?

seven

A client who is receiving multiple medications for a myocardial infarction reports severe nausea. Assessments reveal that the heartbeat is irregular and slow. The nurse should recognize these symptoms as toxic effects of which medication? aminosalicylic acid (ASA) morphine sulfate digoxin meperidine hydrochloride

digoxin Explanation: Signs of digitalis toxicity include cardiac dysrhythmias, anorexia, nausea, vomiting, and visual disturbances. Cardiac dysrhythmias result from the inhibition, by digitalis, of myocardial Na+ and K+. Extra cardiac effects may be caused by central nervous system or local disturbances. The common side effect associated with aminosalicylic acid (ASA) is tinnitus. A common side effect of morphine is of a respiratory depression, and meperidine causes hypotension.

What instructions should the nurse give to the parents of an 8-year-old child with asthma who is being switched from parenteral steroid therapy to a daily dose of oral prednisone?

"Have the child take the dose with meals to prevent gastric irritation."

A child with osteomyelitis is to receive nafcillin IV every 6 hours. Before administering the drug, the nurse calculates the appropriate dosage. The recommended dosage is 50 to 100 mg/kg daily; the child weighs 22 lb (10 kg). Which dosage is acceptable? 50 mg every 6 hours 250 mg every 6 hours 500 mg every 6 hours 100 mg every 6 hours

250 mg every 6 hours Explanation: To determine the correct dose, multiply 10 kg by 50-100 mg/kg. If the nurse is multiplying 10 kg by 50 mg/kg, the daily dose would be 500 mg. To give every 6 hours, divide 500 mg by 4; each dose would be 125 mg. If using 100 mg, then multiply 100 mg/kg by 10 kg. The maxiimum daily dose would be 1,000 mg daily, or (when divided over 4 doses) 250 mg per dose.

A nurse is preparing a dose of amoxicillin for a 3-year-old with acute otitis media. The child weighs 33 lb (15 kg). The dosage prescribed is 50 mg/kg/day in divided doses for every 8 hours. The concentration of the drug is 250 mg/5 ml. How many milliliters would the nurse administer? Record your answer using a whole number.

5 Explanation: The nurse should calculate the daily dosage for the child:50 mg/kg/day × 15 kg = 750 mg/day.To determine divided daily dosage, the nurse would know that "every 8 hours" means three times per day. So, the nurse would perform that calculation in this way:Total daily dosage ÷ 3 times per day = Divided daily dosage750 mg/day ÷ 3 = 250 mgThe drug's concentration is 250 mg/5 ml, so nurse would administer 5 ml.

A child diagnosed with tinea is being treated with griseofulvin. What instructions should the nurse give the parents? Give the medication before a meal. Give the medication for 10 days. Have the child avoid intense sunlight. Encourage increased fluid intake.

Have the child avoid intense sunlight. Explanation: Griseofulvin is associated with photosensitivity reactions. Therefore, the nurse should instruct the parents to have the child avoid intense sunlight. Griseofulvin is best absorbed when administered after a high-fat meal. Treatment with griseofulvin typically lasts for at least 1 month. There are no indications that increased fluid intake affects absorption.

What nursing action is appropriate when caring for a child receiving steroids in therapeutic doses over a long period of time? Monitor the child's temperature to assess for infection. Monitor the child's serum glucose level. Give the drug on an empty stomach. Decrease the child's ingestion of potassium-rich foods.

Monitor the child's serum glucose level. Explanation: Steroid use tends to elevate glucose levels. The child should be monitored for increases.Potassium intake should be increased.The drug should be taken with food or milk to reduce GI upset.Because steroids suppress the inflammatory response, temperature measurement is not an effective assessment tool for identifying infections.

The client, who is taking fluoxetine 20 mg at bedtime, tells the nurse the drug is interfering with his sleep. What conclusion should the nurse make?

The client should take fluoxetine in the morning.

A new nurse is preparing to dispense medications to the assigned clients. The medications are provided by the pharmacy in individualized single-dose packaging. Which step is most important to ensure that each client receives the correct medication? Compare the prescriber's original order with the label on the pharmacy package. Ask the client if the medications are the same as those taken at home. Double check the medication in the package with a resource on the internet. Have a second nurse verify the medications to be given.

Compare the prescriber's original order with the label on the pharmacy package. Explanation: The only way to determine the accuracy of the medication on hand is to verify it against the original order. The other options do not check the original order with the medication that is to be administered to the client.

A nurse is preparing to administer digoxin elixir to a client. Which principle regarding this medication is correct?

Liquid digoxin should be measured with a calibrated dropper or syringe.

The client was diagnosed with hypertension 7 years ago. In the last 6 months, after diet and exercise, the client's blood pressure has consistently ranged around 160/95. What should the nurse include in the client's teaching about the side effects of clonidine? Select all that apply. "Clonidine may cause low blood pressure when you stand up." "Clonidine may cause pain in your joints." "Clonidine may cause fatigue." "Clonidine may cause dry mouth." "Clonidine may cause blood in your urine."

"Clonidine may cause low blood pressure when you stand up." "Clonidine may cause fatigue." "Clonidine may cause dry mouth." Explanation: The nurse should explain that side effects of clonidine include orthostatic hypotension, drowsiness, peripheral edema, fatigue, urinary retention, dry mouth, and constipation. Hematuria and arthralgia are not side effects of clonidine.

A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication?

sodium

A client being discharged after treatment for a compound fracture asks why antibiotics are needed for a broken bone. Which response by the nurse is most appropriate?

"This prophylactic antibiotic therapy is required because your bone broke through your skin."

A client with deep vein thrombosis has been receiving warfarin for 2 months. The client is to go to an anticoagulant monitoring laboratory every 3 weeks. The last visit to the laboratory was 2 weeks ago. The client reports bleeding gums, increased bruising, and dark stools. What should the nurse should instruct the client to do? Decrease the dose of the warfarin. Decrease the amount of vitamin K in the diet. Return to laboratory for analysis of prothrombin times. Notify the health care provider (HCP) about the bleeding.

Return to laboratory for analysis of prothrombin times. Explanation: These symptoms suggest that the client is receiving too much warfarin; the client should return to the laboratory and have a blood sample drawn to determine the prothrombin levels and have the dosage of warfarin adjusted. The diet can influence clotting, but the client needs to first have the prothrombin levels checked. It is not necessary to contact the HCP; the client should return to the laboratory first, and the results of the prothrombin time will be reported to the HCP.

The nurse is instructing a sexually active female who is taking isoniazid (INH). What should the nurse tell the client? Isoniazid:

decreases the effectiveness of hormonal contraceptives.

A client admitted for treatment of a gastric ulcer is being prepared for discharge on antacid therapy. Which statement made by the client indicates understanding of discharge teaching? "I'll take my antacid in the morning with my other medications." "I'll continue to take my antacid even if I feel better." "I should not take antacids with magnesium, because I have a heart problem." "My antacid will work best if I take it with my meals."

"I'll continue to take my antacid even if I feel better." Explanation: Antacids decrease gastric acidity and should be continued even if the client's symptoms subside. Because other medications may interfere with antacid action, the client should avoid taking antacids concomitantly with other drugs. If cardiac problems arise, the client should avoid antacids containing sodium, not magnesium. For optimal results, the client should take an antacid 1 hour before or 2 hours after meals.

The client has a history of migraine headaches and has tried various drug therapies without success. The healthcare provider has decided to start the client on ergotamine tartrate. Which information should the nurse teach the client about ergotamine tartrate? Select all that apply.

"You should report numbness and tingling in your fingers or toes." "Take medication as soon as you feel a migraine starting." "Make sure your blood pressure is measured routinely." Information the nurse should teach includes starting the medication as soon after the onset of a migraine attack as possible, having his/her blood pressure checked routinely, and reporting numbness and tingling in fingers/toes. Additionally the nurse should explain that the cliebt should not increase the dosage without consulting the healthcare provider first. Photophobia is usually secondary to migraine, and doubling the dosage will cause more adverse effects from the drug. Remediatio

A client with severe pain is prescribed hydromorphone 10 mg by mouth every 4 hours as needed for pain. The client rates the pain as eight on a one-to-ten scale, so the nurse prepares to administer a dose. The oral liquid contained in the unit's opioid stock contains 5 mg/5 ml. How many milliliters of solution should the nurse give to the client? Record your answer using a whole number.

10 mL

A client undergoing cancer chemotherapy has been prescribed epoetin alfa. The client is to receive 150 units/kg subcutaneously three times per week. The client weighs 90 kg. How many units will the nurse administer at each dose? Record your answer using a whole number.

13500

A client is receiving warfarin for newly diagnosed atrial fibrillation. Which laboratory result would indicate that the nurse should withhold the medication and contact the health care provider?

an INR of 4.8

The nurse has administered promethazine intravenously to a client in active labor. The drug has had the desired effect when the nurse notes which finding?

decreased nausea and vomiting

The client with a major burn injury receives total parenteral nutrition (TPN). What is the expected outcome of TPN? Provide supplemental vitamins and minerals. Correct water and electrolyte imbalances. Ensure adequate caloric and protein intake. Allow the gastrointestinal tract to rest.

Ensure adequate caloric and protein intake - Explanation: Nutritional support with sufficient calories and protein is extremely important for a client with severe burns because of the loss of plasma protein through injured capillaries and an increased metabolic rate. Gastric dilation and paralytic ileus commonly occur in clients with severe burns, making oral fluids and foods contraindicated. Water and electrolyte imbalances can be corrected by administration of IV fluids with electrolyte additives, although TPN typically includes all necessary electrolytes. Resting the gastrointestinal tract may help prevent paralytic ileus, and TPN provides vitamins and minerals; however, the primary reason for starting TPN is to provide the protein necessary for tissue healing.

An older adult takes two 81-mg aspirin tablets daily to prevent a heart attack. The client reports having a constant "ringing" in both ears. How should the nurse respond to the client's comment? Schedule the client for audiometric testing. Refer the client to have a Weber test. Tell the client that "ringing" in the ears is associated with the aging process. Explain to the client that the "ringing" may be related to the aspirin.

Explain to the client that the "ringing" may be related to the aspirin. Explanation: Tinnitus (ringing in the ears) is an adverse effect of aspirin. Aspirin contains salicylate, which is an ototoxic drug that can induce reversible hearing loss and tinnitus. The nurse should explain this to the client and then encourage the client to inform the health care provider (HCP) of the symptom. Tinnitus is not a function of aging. The Weber test and audiometric testing are useful for determining hearing loss but are not necessarily helpful in the management or diagnosis of drug-induced tinnitus.

The nurse is administering packed red blood cells (PRBCs) to a client. What should the nurse do first? Stay with the client during the first 15 minutes of infusion. Flush PRBCs with 5% dextrose and 0.45% normal saline solution. Discontinue the IV catheter if a blood transfusion reaction occurs. Administer the PRBCs through a percutaneously inserted central catheter line with a 20-gauge needle.

Stay with the client during the first 15 minutes of infusion. Explanation: The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 ml of the infusion. If a blood transfusion reaction does occur, it is imperative to keep an established I.V. line so that medication can be administered to prevent or treat cardiovascular collapse in case of anaphylaxis. PRBCs should be administered through a 19-gauge or larger needle; a peripherally inserted central catheter line is not recommended, in order to avoid a slow flow. RBCs will hemolyze in dextrose or lactated Ringer's solution and should be infused with only normal saline solution.

A nurse is teaching a client who has a severe allergy to bee stings how to manage a reaction. What medication does the nurse encourage the client to take first after being stung by a bee? diphenhydramine epinephrine albuterol (salbutamol) prednisone

epinephrine Explanation: A client who develops anaphylaxis may take all the listed medications, but epinephrine, a non-selective adrenergic agonist, should be administered intramuscularly first. The client may then use the albuterol to help open airways. Diphenhydramine, an H1 antihistamine, may also be taken, but this is only effective to reduce itching and will not help with airway symptoms. Finally, prednisone is not generally prescribed PRN and would be taken only under advice of the healthcare provider once the client reaches medical attention.

Which results would indicate that levothyroxine sodium is effectively resolving the symptoms of a client with hypothyroidism? elevated blood pressure, reduced pulse rate, and lower oxygen saturation levels decreased edema, stable temperature, and decreased respiratory rate improved appetite, weight gain, and sleeping fewer hours increased energy, weight loss, and a higher temperature and pulse rate

increased energy, weight loss, and a higher temperature and pulse rate Explanation: The thyroid replacement medication will result in an increased rate of metabolism, indicated by the increase in temperature and pulse rate. As the metabolic rate increases, the client will have more energy and should lose the excess edema associated with myxedema or hypothyroidism. Vital signs will increase from the effects of thyroid hormone. A higher metabolic rate will burn more calories, so gaining weight will not usually occur. Lower oxygen saturation levels should not occur.

The nurse is preparing a client for a cardiac catheterization. Which client statement would the nurse need to report to the healthcare provider immediately? "I am allergic to penicillin and midazolam." "I took my metformin this morning." "I have not been able to eat since yesterday." "I am very claustrophobic in small spaces."

"I took my metformin this morning." Explanation: The priority would be to notify the healthcare provider of the metformin because it cannot be taken 48 hours before or after contrast, as there is an increased risk of lactic acidosis and acute renal failure with iodinated contrast material. It would be appropriate for the client to take nothing by mouth. It is important to determine the client's allergies; however, it is not the priority. Claustrophobia would not be an issue during a cardiac catheterization.

A client with acquired immunodeficiency syndrome (AIDS) is ordered zidovudine, 200 mg P.O. every 4 hours. When teaching the client about this drug, the nurse should provide which instruction? "Take zidovudine on an empty stomach." "Take over-the-counter (OTC) drugs to treat minor adverse reactions." "Take zidovudine with meals." "Take zidovudine every 4 hours around the clock."

"Take zidovudine every 4 hours around the clock." Explanation: To be effective, zidovudine must be taken every 4 hours around the clock. Food doesn't affect absorption of this drug, so the client may take zidovudine either with food or on an empty stomach. To avoid serious drug interactions, the client should check with the physician before taking OTC medications.

A client who is using a patient-controlled analgesia (PCA) pump after bowel surgery states, "I'm afraid that I'll become addicted if I use too much morphine." Which would be the best response by the nurse? "Morphine is not addicting in these circumstances. Why are you worried about it?" "When morphine is used to alleviate severe pain for 2 to 3 days, there is little likelihood of becoming addicted." "Have you had problems with drug addiction before?" "You need to take the morphine to help you rest and recuperate from the surgery; you can deal with the addiction later."

"When morphine is used to alleviate severe pain for 2 to 3 days, there is little likelihood of becoming addicted." Explanation: Morphine is a narcotic. Clients need to understand that when pain is present and morphine is used therapeutically, there is less likelihood of addiction. If morphine is taken in the absence of pain, addiction can result. Telling the client that morphine is not addicting is incorrect because, although it acknowledges the addictive nature of morphine, it does not inform the client regarding its effect in pain management. It is also nontherapeutic because it asks a "why" question. Asking about prior drug addiction is not appropriate at this time.

The client comes to the clinic for shoulder pain related to muscle strain. Which analgesics would be appropriate for the nurse to teach the client about? Select all that apply "You are having pain related to muscle strain so acetaminophen is appropriate." "You are having pain related to muscle strain so hydrocodone is appropriate." "You are having pain related to muscle strain so fentanyl is appropriate." "You are having pain related to muscle strain so naproxen is appropriate." "You are having pain related to muscle strain so ibuprofen is appropriate."

"You are having pain related to muscle strain so ibuprofen is appropriate." "You are having pain related to muscle strain so acetaminophen is appropriate." "You are having pain related to muscle strain so naproxen is appropriate." Explanation: Non-opioid analgesics for mild pain include naproxen, ibuprofen, and acetaminophen. Fentanyl and hydrocodone are opioids and are used for moderate to severe pain.

A nurse needs to give a pediatric client furosemide orally before one unit of packed red blood cells. How many mL should the nurse give? Record the answer using a whole number. Order: Furosemide 3 mg/kg/dose orally Dose on hand: Furosemide 40 mg/5 mL Client's weight: 40 kg

15 Explanation: Required dose = (Desired dose/dose on hand) = (3 mg/kg x 40 kg) divided by 40 mg/5 mL. Required dose = 15 mL. The nurse should give the client 15 mL orally one time.

A nurse is caring for a client with a prescription for hydromorphone 2 mg I.V. as needed for pain. The client is reporting pain at a 10/10 and is requesting to be medicated. When trying to retrieve the prescribed hydromorphone, the nurse is unable to access the computerized automated dispensing cabinet (ADC) because of an expired password. What is the most appropriate action by the nurse? Administer the medication to the client after having another nurse obtain the medication from the computerized ADC. Ask another nurse to administer the medication to the client while contacting information services to reset password. Ask another nurse for their user name and password and then obtain the medication from the computerized ADC. Explain to the client there will be a delay in receiving pain medication and then contact information services to reset password.

Ask another nurse to administer the medication to the client while contacting information services to reset password. Explanation: Managing pain in a client with a pain rating 10/10 is a priority and care should not be delayed. The nurse should ask another nurse to medicate the client while contacting information services to reset the password as soon as possible to prevent delay in care for other clients. Hydromorphone is a Schedule II controlled substance and by federal law a record must be kept of the name of the nurse who obtained and administered the substance. The nurse who obtains the medication from the computerized ADC is the nurse who is required to administer it. A nurse's user name and password is a secure identification code equivalent to a nurse's signature and should never be given to another staff member.

A nurse is preparing to administer diazepam 1 mg I.V. The available dose is diazepam 2 mg/ml vial. After drawing 0.5 ml of medication into a syringe, what is the next action by the nurse? Place the vial containing the remaining 0.5 ml in the sharps container. Return 0.5 ml medication to client's medication drawer for later use. Perform safety checks and administer the medication to the client. Ask another nurse to witness 0.5 ml medication waste into the sink.

Ask another nurse to witness 0.5 ml medication waste into the sink. Explanation: Diazepam is a controlled substance. Federal law requires close monitoring of all controlled substances to prevent diversion or misuse. After drawing up the ordered dose, the nurse would ask another nurse to witness the waste of the remaining medication into the sink or other approved waste container per the facility policy. Controlled substances are not placed in the sharps container to prevent diversion. Controlled substances require double-locked storage to prevent diversion and would not be stored in the client's medication drawer. The nurse would complete safety checks and administer the medication after another nurse witnessed waste of the remaining controlled substance.

During a shift report for a client with heart failure, the nurse going off shift reports that the client had sinus bradycardia during the shift and a creatinine of 3.5 mg/dL. Which action does the nurse perform when administering digoxin to this client? Assess the digoxin level. Evaluate the B-type natriuretic peptide level (BNP). Measure the urine output. Monitor the radial pulse.

Assess the digoxin level. Explanation: After digoxin is metabolized, the kidneys eliminate the remaining digoxin. Kidney disease will prevent elimination of digoxin causing potential toxicity; measuring the digoxin level, especially in the presence of bradycardia, a side effect of digoxin, is indicated. The nurse monitors the apical pulse when administering digoxin, as atrial fibrillation or other dysrhythmia that causes a pulse deficit may lead the nurse to hold the medication when the true pulse is above 60 beats/min. Renal impairment does not always decrease urine output; therefore, monitoring for toxicity is the priority. Although the BNP level will correlate to the client's heart failure, the most important assessment is for digoxin toxicity.

The nurse is preparing the prescribed fentanyl 25 mcg I.V. After obtaining a fentanyl 50 mcg/ml vial, what is the priority action by the nurse?

Draw 0.5 ml medication into a syringe, draw the remaining 0.5 ml into another syringe, and ask another nurse to witness the waste of 0.5 ml into the sink.

A nurse enters a client's semiprivate room and prepares to administer the 0900 medications. Place the steps in chronological sequence indicating the measures to take in order to safely administer these medications. All options must be used. 1 Check the client's medication administration record (MAR) for the 0900 medications. 2 Open the unit-dose packages. 3 Obtain the correct unit-dose medications. 4 Confirm the client's identity. 5 Administer the medications

Check the client's medication administration record (MAR) for the 0900 medications. Obtain the correct unit-dose medications. Confirm the client's identity. Open the unit-dose packages. Administer the medications. Explanation: Following sequential steps helps ensure safe medication administration. The nurse would first check to see which medications the client is due to receive at 0900 and then obtain them. Next, the nurse would confirm the client's identity in the semiprivate room according to facility protocol. Once the client is properly identified, the nurse would open the drug packages at the bedside, administer the medications to the client, and document administration.

A nurse is caring for a 7-year-old client receiving cyclophosphamide. In addition to administering mesna, which action should the nurse take? Encourage the child to void frequently. Transfuse platelets before administering the drug. Give the child cranberry juice to drink. Limit the child's fluid intake.

Encourage the child to void frequently. Explanation: Hemorrhagic cystitis can result when the by-products of cyclophosphamide metabolism remain in the bladder; therefore, emptying the bladder at least every 2 hours when the child is awake can help prevent this painful condition. The child should be encouraged to void as soon as the urge is felt. Bacteria or low platelets do not cause the condition, so transfusing platelets and giving cranberry juice aren't correct. Fluids should not be limited. The child should be given liberal amounts of fluid, usually by I.V. infusion.

The nurse is starting a peripheral intravenous line. Place the steps in the order that the nurse should perform them. All options must be used. 1 Fill the extension tubing with normal saline and apply slide clamp. 2 Place sterile transparent dressing over venipuncture site. 3 Perform venipuncture. 4 Cleanse site with antiseptic solution. 5 Apply a tourniquet 3 to 4 in (7.5 to 10 cm) above the venipuncture site. 6 When blood returns through lumen of the needle, advance catheter into vein.

Fill the extension tubing with normal saline and apply slide clamp. Apply a tourniquet 3 to 4 in (7.5 to 10 cm) above the venipuncture site. Cleanse site with antiseptic solution. Perform venipuncture. When blood returns through lumen of the needle, advance catheter into vein. Place sterile transparent dressing over venipuncture site. Explanation: The first step is to fill the extension tubing with normal saline, so it is primed and the air in the extension tubing is removed. The slide clamp is applied to prevent the normal saline from leaking out of the extension tubing. The second step is to apply a tourniquet 3 to 4 in (7.5 to 10 cm) above the venipuncture site to obstruct blood flow so the veins become distended, easy to locate, and insert the intravenous needle. The third step is to cleanse the site with antiseptic solution that the needle will be inserted to prevent organisms on the skin from entering the body through tissues or the bloodstream. The fourth step is to perform the venipuncture, so the needle with the catheter enters the vein. The fifth step is to advance the catheter into the vein when blood returns through the lumen. Blood return indicates the needle with the catheter is in the vein. The sixth step is to place a sterile transparent dressing over the venipuncture site so the site can be visually assessed and provide additional stabilization of the catheter.

Which of the following should the nurse include in the teaching plan for the parents of a child who is receiving methylphenidate? Allow concurrent use of any over-the-counter medications with this drug. Give the medication at the same time every evening. Have the child take two doses at the same time if the last dose was missed. Give the single-dose form of the medication early in the day.

Give the single-dose form of the medication early in the day. Explanation: The single-dose form of methylphenidate should be taken 10 to 14 hours before bedtime to prevent problems with insomnia, which can occur when the daily or last dose of the medication is taken within 6 hours (for multiple dosing) or 10 to 14 hours (for single dosing) before bedtime. It is recommended that a missed dose be taken as soon as possible; the dose is skipped if it is not remembered until the next dose is due. Any other medication, including over-the-counter medications, should be discussed with the health care provider (HCP) before use to eliminate the risk of a possible drug interaction.

A client is typed and cross-matched for three units of packed cells. What are important precautions for the nurse to take before initiating the transfusion? Select all that apply. Initiate an IV with dextrose. Initiate an IV with normal saline. Warm the blood to room temperature. Take baseline vital signs. Have two nurses check the blood type and identity.

Have two nurses check the blood type and identity. Initiate an IV with normal saline. Take baseline vital signs. Explanation: Prior to administering blood, the unit must be checked by two registered nurses. Baseline vital signs are obtained before the transfusion is started so any changes would be identified. Blood is always transfused with normal saline as other IV fluids are incompatible with blood. Warming to room temperature is not necessary.

A client who received massive packed red blood cell (PRBC) blood transfusions due to trauma has a potassium level of 7.1 mEq/L (7.1 mmol/L). Which medication should the nurse expect to administer?

I.V. insulin

A client who received massive packed red blood cell (PRBC) blood transfusions due to trauma has a potassium level of 7.1 mEq/L (7.1 mmol/L). Which medication should the nurse expect to administer? I.V. insulin oral spironolactone I.V. potassium chloride oral lisinopril

I.V. insulin Explanation: The client is experiencing transfusion-associated hyperkalemia. Storing packed red blood cell increases the potassium concentration. I.V. regular insulin pushes potassium from the blood into the cell decreasing the serum potassium level. Severe cases require hemodialysis. I.V. potassium chloride and spironolactone, a potassium-sparing diuretic, will further increase the potassium. Angiotensin-converting enzyme (ACE) inhibitor such as lisinopril causes hyperkalemia.

Atropine sulfate is included in the preoperative prescriptions for a client undergoing a modified radical mastectomy. What is the expected outcome of this drug? Decrease nausea. Decrease pulse and respiratory rates. Inhibit oral and respiratory secretions. Promote general muscular relaxation.

Inhibit oral and respiratory secretions. Explanation: Atropine sulfate, a cholinergic blocking agent, is given preoperatively to reduce secretions in the mouth and respiratory tract, which assists in maintaining the integrity of the respiratory system during general anesthesia. Atropine is not used to promote muscle relaxation, decrease nausea and vomiting, or decrease pulse and respiratory rates. It causes the pulse to increase.

The nurse administers the first dose of warfarin to an older adult client. Which important client teaching point(s) should the nurse emphasize regarding this new medication? Select all that apply. Take extra care to avoid injuries. Limit intake of foods high in vitamin K. Watch for signs and symptoms of bleeding. Eat a diet high in fiber. You can take an extra dose of this medication if you feel like you need it.

Limit intake of foods high in vitamin K. Watch for signs and symptoms of bleeding. Take extra care to avoid injuries. Explanation: Warfarin is an anticoagulant medication that helps prevent the formation of blood clots. Important client teaching considerations for this medication include limiting the intake of foods high in vitamin K, as too much vitamin K can inhibit the action of warfarin. Clients must also be taught to watch for signs and symptoms of bleeding and to take precautions to avoid injury while taking an anticoagulant. There is no need to increase fiber intake while on this medication, as it does not cause constipation. The client should never take an extra dose of any medication without being instructed to by the provider, and doing so with this medication could cause dangerous bleeding.

The nurse is preparing discharge instructions for a client taking lithium. What is the most important information for the nurse to give the client? Limit sodium intake to 2 to 3 grams per day to prevent fluid retention and increased blood pressure. Maintain a consistent fluid intake each day, avoiding great fluctuations in volumes consumed. Include nonpharmacological treatments for depression such as vigorous caridovascular exercise. Reduce fat and calorie intake to decrease the risk for weight gain associated with lithium.

Maintain a consistent fluid intake each day, avoiding great fluctuations in volumes consumed. Explanation: Clients taking lithium need to maintain a consistent fluid and sodium intake and not restrict either water or salt to avoid fluctuations that could alter lithium plasma levels. Vigorous exercise can increase water and sodium loss through perspiration and should not be done without the health care provider's guidance. Although lithium is associated with weight gain, not all clients are equally affected. Dieting can alter how lithium levels are balanced and should only be done with medical supervision.

What is the most important information for the nurse to include when teaching a client about metronidazol? Urine may develop a greenish tinge while the client is taking this drug. Breathlessness and cough are common adverse effects. Mixing this drug with alcohol causes severe nausea and vomiting. Heart palpitations may occur and should be immediately reported.

Mixing this drug with alcohol causes severe nausea and vomiting. Explanation: When mixed with alcohol, metronidazole causes a disulfiram-like effect involving nausea, vomiting, and other unpleasant symptoms. Urine may turn reddish brown, not greenish, from the drug. Cardiovascular or respiratory effects are not associated with this drug.

A 6-year-old child with autism has been prescribed risperidone to treat aggression and self-injury behaviors. When educating the family about risperdone, the nurse should include which information? Notify the child's health care provider if a dose of risperdone is missed. The child will have improved behavior about one week after starting risperdone. Notify the child's health care provider if the child is exhibiting lip smacking behaviors. The child may experience weight loss after beginning risperdone.

Notify the child's health care provider if the child is exhibiting lip smacking behaviors. Explanation: Notify the health care provider if the child exhibits lip smacking behavior as it may be an indication that the child is developing tardive dyskinesia. If the child misses a dose of risperdone, give the missed dose as soon as possible. If it is near the next scheduled dose, skip the missed dose. Weight gain is a common side effect of risperdone. It takes about 3 to 4 weeks of treatment with risperdone to see major changes in behavior.

A unit of packed red blood cells is done infusing. Place the steps in order the nurse needs to perform postprocedure. All options must be used.

Obtain vital signs and breath sounds and compare with the baseline measurement. Dispose of the blood bag and tubing materials properly. Document client assessments and tolerance to infusion. Monitor client for response to and effectiveness of the procedure.

A nurse is teaching a client about taking antihistamines. Which information should the nurse include in the teaching plan? Select all that apply. Increase fluid intake to 2,000 mL/day. Do not use alcohol with antihistamines. Continue taking antihistamines even if nasal infection develops. Operating machinery and driving may be dangerous while taking antihistamines. The effect of antihistamines is not felt until a day later.

Operating machinery and driving may be dangerous while taking antihistamines. Do not use alcohol with antihistamines. Increase fluid intake to 2,000 mL/day. Explanation: Antihistamines have an anticholinergic action and a drying effect and reduce nasal, salivary, and lacrimal gland hypersecretion (runny nose, tearing, and itching eyes). An adverse effect is drowsiness, so operating machinery and driving are not recommended. There is also an additive depressant effect when alcohol is combined with antihistamines, so alcohol should be avoided during antihistamine use. The client should ensure adequate fluid intake of at least 2,000 ml (about eight glasses) per day due to the drying effect of the drug. Antihistamines have no antibacterial action, and are not used to treat nasal infections.. The effect of antihistamines is prompt, not delayed.

A client is using an over-the-counter nasal spray containing pseudoephedrine to treat allergic rhinitis. Which instruction about this medication would be most appropriate for the nurse to provide for the client? Prolonged use of nasal spray can lead to nasal infections. Pseudoephedrine is an addictive drug and must be used cautiously. A common side effect of pseudoephedrine nasal spray is thrush. Overuse of pseudoephedrine can lead to increased nasal congestion.

Overuse of pseudoephedrine can lead to increased nasal congestion. Explanation: Overuse of nasal spray containing pseudoephedrine can lead to rhinitis medicamentosa, which is a rebound effect causing increased swelling and congestion. Use of pseudoephedrine nasal spray does not cause infections or thrush. Pseudoephedrine is not addictive.

During the intravenous administration of a chemotherapeutic vesicant drug, the nurse observes that there is a lack of blood return from the intravenous catheter. What should the nurse do first? Irrigate the catheter with normal saline. Reposition the client's arm and continue with administration of the drug. Continue to administer the drug and assess for edema at the IV site. Stop the administration of the drug.

Stop the administration of the drug. Explanation: An intravenous catheter with no blood return is most likely occluded and not patent. A chemotherapeutic vesicant drug extravasates into the surrounding skin tissue and causes tissue necrosis. The nurse stops administration of the drug immediately. Repositioning the arm does not improve patency. Irrigating the catheter may cause the medication to enter tissue. It is inappropriate to wait and see if the arm becomes edematous because of the vesicant action of the drug.

The nurse is teaching a client and the client's family about the total parenteral nutrition (TPN) that the client is receiving. What information should the nurse include in this teaching? Select all that apply.

TPN is administered through a large central blood vessel. The solution contains sugar, protein, and fat for increased calories. Tests to monitor blood and urine glucose levels will be done.

The nurse is teaching a client and the client's family about the total parenteral nutrition (TPN) that the client is receiving. What information should the nurse include in this teaching? Select all that apply. The solution contains sugar, protein, and fat for increased calories. Tests to monitor blood and urine glucose levels will be done. TPN is administered through a large central blood vessel. The client will need insulin to prevent diabetes. The client may experience constipation.

TPN is administered through a large central blood vessel. The solution contains sugar, protein, and fat for increased calories. Tests to monitor blood and urine glucose levels will be done. Explanation: There is a possibility of abdominal cramping and diarrhea, not constipation, from TPN. Glucose levels will need to be monitored, and some clients may need insulin to regulate blood glucose levels during TPN, but the client will not develop diabetes from TPN.

A client has a throbbing headache when nitroglycerin is taken for angina. What should the nurse instruct the client to do? Take the nitroglycerin with a few glasses of water. Limit the frequency of using nitroglycerin. Take acetaminophen or ibuprofen. Rest in a supine position to minimize the headache.

Take acetaminophen or ibuprofen. Explanation: Headache is a common side effect of nitroglycerin that can be alleviated with aspirin, acetaminophen, or ibuprofen. The sublingual nitroglycerin needs to be absorbed in the mouth, which will be disrupted with drinking. Lying flat will increase blood flow to the head and may increase pain and exacerbate other symptoms, such as shortness of breath.

A client is experiencing an acute hemolytic reaction while receiving 1 unit of packed red blood cells. What actions should the nurse take first? Select all that apply. Take the client's temperature. Assess for anxiety and mental status changes. Dispose of the blood container and tubing. Maintain the intravenous line with normal saline using new intravenous tubing.

Take the client's temperature. Assess for anxiety and mental status changes. Maintain the intravenous line with normal saline using new intravenous tubing. Explanation: A fever is a symptom of acute hemolytic reaction. The blood container and tubing should not be disposed of. They need to be sent back to the blood bank for repeat typing and culture. Anxiety and mental status changes are symptoms of acute hemolytic reaction. Maintaining the intravenous line with normal saline needs to be done to give medications quickly. New tubing needs to be used because the blood being infused in the tubing is causing the reaction.

A client with suspected myasthenia gravis is to undergo a test with edrophonium. The client asks if edrophonium can be used to treat myasthenia gravis. What is the nurse's best response? Dry mouth and abdominal cramps may be intolerable adverse effects. With repeated edrophonium use, immunosuppression may occur. It isn't available in an oral form. The short half-life of edrophonium makes it impractical for long-term use.

The short half-life of edrophonium makes it impractical for long-term use. Explanation: Edrophonium is not available in an oral form and the duration of action is 1 to 2 minutes, making it impractical for the long-term management of myasthenia gravis. Immunosuppression with repeated use is an adverse effect of steroid administration. Dry mouth and abdominal cramps are adverse effects of increased acetylcholine in the parasympathetic nervous system.

The client visits the health care provider reporting a red, swollen, and painful right great toe and is subsequently diagnosed with gouty arthritis. Which drug does the nurse anticipate the healthcare provider to order? zaroxolyn furosemide phenytoin allopurinol

allopurinol Explanation: Allopurinol is used to manage and prevent gout attacks and is also used for the treatment of calcium oxalate kidney stones. Phenytoin is used to treat and prevent seizures. Zaroxolyn is used to treat blood pressure and edema. Furosemide treats fluid retention and swelling caused by congestive heart failure, liver disease, and kidney disease.

A 6-year-old child is admitted to a pediatric unit for the treatment of osteomyelitis. Which essential medication classification would the nurse anticipate as documented on the medication report? anti-inflammatory antibiotic analgesic antipyretic

antibiotic Explanation: Staphylococcus. aureus is the most common causative pathogen of osteomyelitis; the usual source of the infection is an upper respiratory infection (URI) or skin lesion. The nurse anticipates an intravenous antibiotic as the essential medication. The nurse may have an anti-inflammatory medication as adjunct therapy. By decreasing the infection, the client may experience decreased pain; thus, not needing an analgesic. The nurse would administer an antipyretic if the child was febrile.

A client who is sexually active asks the nurse about using PreExposure Prophylaxis (PrEP) for HIV. The nurse should tell the client the drug, a combination of 300 milligrams tenofovir disoproxil fumarate and 200 milligrams emtricitabine (TDF/FTC) can be used for which group of people who are at risk for becoming infected with HIV? a person who has a sexually transmitted disease that is not being treated someone who has a compromised immune system anyone who is in an ongoing sexual relationship with an HIV-infected partner people who do not use condoms when in a sexual relationship

anyone who is in an ongoing sexual relationship with an HIV-infected partner Explanation: PrEP is primarily available to anyone who is in an ongoing sexual relationship with an HIV-infected partner. Others at risk, such as those who are having sex with partners who are at risk for HIV such as drug users or who are themselves sharing equipment with people who are at risk for HIV, may also receive PReP. The drug is not used for people who do not use condoms, have untreated sexually transmitted diseases, or a compromised immune system.

A client undergoing a bilateral adrenalectomy has postoperative prescriptions for hydromorphone hydrochloride 2 mg to be administered subcutaneously every 4 hours as needed for pain. Why should the nurse administer hydromorphone in small doses? A small dose is: less irritating to subcutaneous tissues in small doses. excreted before accumulating in toxic amounts in the body. as potent as morphine in larger doses. less likely to cause dependency.

as potent as morphine in larger doses. Explanation: Hydromorphone hydrochloride is about five times more potent than morphine sulfate, from which it is prepared. Therefore, it is administered only in small doses. Hydromorphone hydrochloride can cause dependency in any dose; however, fear of dependency developing in the postoperative period is unwarranted. The dose is determined by the client's need for pain relief. Hydromorphone hydrochloride is not irritating to subcutaneous tissues. As with opioid analgesics, excretion depends on normal liver function.

A nurse in a psychiatric inpatient unit is caring for a client with generalized anxiety disorder. As part of the client's treatment, the psychiatrist orders lorazepam, 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to: stay out of the sun. avoid aged cheeses. avoid caffeine. maintain an adequate salt intake.

avoid caffeine. Explanation: Ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for clients receiving lithium.

A client with chest pain doesn't respond to nitroglycerin. When the client is admitted to the emergency department, the healthcare team obtains an electrocardiogram and administers I.V. morphine. The physician also considers administering alteplase. This thrombolytic agent must be administered how soon after onset of myocardial infarction (MI) symptoms?

wthin 6 hours

Which foods should the nurse teach the client not to consume when taking phenelzine? Select all that apply. yogurt chocolate smoked meats pasta strawberries

chocolate smoked meats yogurt Explanation: When taking phenelzine, the client should not consume foods and beverages containing tyramine or tryptophan, or drugs containing pressor agents. Tyramine-containing foods/fluids include aged cheeses, tofu, beer, and smoked meats. Tryptophan-containing foods include chocolate, cottage cheese, milk, and yogurt. Strawberries and pasta are safe for this client to consume.

A client is taking methotrexate for severe rheumatoid arthritis. The nurse instructs the client that it will be necessary to monitor:

complete blood count (CBC) with differential and platelet count.

Metoprolol is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension who has been initially treated with furosemide and ramipril. The nurse should evaluate the client for which expected therapeutic effect? decrease in heart rate. improvement in blood sugar levels. increase in urine output. lessening of fatigue.

decrease in heart rate. Explanation: The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output.

The nurse is caring for a client with a serum sodium level of 128 mEq/L. Which order for intravenous fluids should the nurse should question? dextrose 5% in water (D5W) normal saline solution 0.9 dextrose 5% in half-normal saline solution D5.45 lactated Ringer's solution

dextrose 5% in water (D5W) Explanation: A serum sodium level of 128 mEq/L indicates a hypotonic state. Administering a hypotonic I.V. solution. D5W, also referred to as free water, will cause further hemodilution. Dextrose 5% in half-normal saline solution is slightly hypertonic; normal saline solution is isotonic; and lactated Ringer's solution is isotonic. The latter three are more appropriate choices to restore normal tonicity of the blood.

A client with heart failure is taking furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. What other sign should the nurse assess next? hyperkalemia. digoxin toxicity. fluid deficit. pulmonary edema.

digoxin toxicity. Explanation: Early symptoms of digoxin toxicity include anorexia, nausea, and vomiting. Visual disturbances can also occur, including double or blurred vision and visual halos. Hypokalemia is a common cause of digoxin toxicity associated with arrhythmias because low serum potassium can enhance ectopic pacemaker activity. Although vomiting can lead to fluid deficit, given the client's history, the vomiting is likely due to the adverse effects of digoxin toxicity. Pulmonary edema is manifested by dyspnea and coughing.

An auto mechanic accidentally has battery acid splashed in their eyes. The coworkers irrigate the eyes with water for 20 minutes, then take the mechanic to the emergency department of a nearby hospital, where the mechanic receives emergency care for corneal injury. The physician orders dexamethasone, two drops of 0.1% solution to be instilled initially into the conjunctival sacs of both eyes every hour; and polymyxin B sulfate, 0.5% ointment to be placed in the conjunctival sacs of both eyes every 3 hours. The nurse knows that dexamethasone exerts its therapeutic effect by: inhibiting the action of carbonic anhydrase. decreasing leukocyte infiltration at the site of ocular inflammation. producing a miotic reaction by stimulating and contracting the sphincter muscles of the iris. increasing the exudative reaction of ocular tissue.

ecreasing leukocyte infiltration at the site of ocular inflammation. Explanation: Dexamethasone exerts its therapeutic effect by decreasing leukocyte infiltration at the site of ocular inflammation. This action reduces the exudative reaction of diseased tissue, lessening edema, redness, and scarring. Dexamethasone and other anti-inflammatory agents don't inhibit the action of carbonic anhydrase or produce any type of miotic reaction.

Assessment of a client taking a nonsteroidal anti-inflammatory drug (NSAID) for pain management should include specific questions regarding which body system? cardiac pulmonary gastrointestinal renal

gastrointestinal Explanation: The most common toxicities from NSAIDs are gastrointestinal disorders (nausea, epigastric pain, ulcers, bleeding, diarrhea, and constipation). Renal dysfunction, pulmonary complications, and cardiovascular complications from NSAIDs are much less common.

Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside: in a few days. immediately. in 3 to 4 months. in 1 to 2 weeks.

in 1 to 2 weeks. Explanation: Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol.

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia? decreased appetite Cheyne-Stokes respirations increased urine output diaphoresis

increased urine output Explanation: Glucose supplies most of the calories in TPN; if the glucose infusion rate exceeds the client's rate of glucose metabolism, hyperglycemia arises. When the renal threshold for glucose reabsorption is exceeded, osmotic diuresis occurs, causing an increased urine output. A decreased appetite and diaphoresis suggest hypoglycemia, not hyperglycemia. Cheyne-Stokes respirations are characterized by a period of apnea lasting 10 to 60 seconds, followed by gradually increasing depth and frequency of respirations. Cheyne-Stokes respirations typically occur with cerebral depression or heart failure.

A client has been taking intravenous furosemide for congestive heart failure. The client is ordered to start intravenous gentamicin. What intervention is the priority for the nurse? monitor serum BUN and creatinine levels assess the I.V. site for phlebitis assess urine hourly output monitor serum furosemide level

monitor serum BUN and creatinine levels Explanation: Concurrent furosemide and gentamicin administration have a potential to increase both drugs' toxicity. This increases the risk of ototoxicity and nephrotoxicity. The nurse should monitor renal labs including BUN and creatinine, tinnitus, and balance/gait. Urine output should be monitored, however, the BUN and creatinine will be impacted before there is a change in urine output. The I.V. site should be assessed regularly as part of routine nursing care, not as a priority for the administration of these drugs. A serum furosemide is not a routine lab during the administration of these medications.

When administering naloxone, the nurse should monitor the surgical client closely for which clinical manifestation? dizziness restlessness bleeding urine retention

restlessness Explanation: The nurse should monitor the client who has received naloxone for side effects such as restlessness, agitation, and potential cardiac arrhythmias. Bleeding, dizziness, and urine retention are not typical side effects of naloxone.

The nurse is reconstituting a powdered medication in a vial. After adding the solution to the powder, the nurse should: stir the liquid with a sterile applicator. shake the vial vigorously. invert the vial and let it stand for 2 to 3 minutes. roll the vial gently between the palms.

roll the vial gently between the palms. Explanation: Rolling the vial gently between the palms produces heat, which helps dissolve the medication. Stirring the medication with a sterile applicator isn't accepted practice. Inverting the vial wouldn't help dissolve the medication. Shaking the vial vigorously could cause the medication to break down, altering its action.

A 21-year-old female client takes clonazepam. What should the nurse ask this client about? Select all that apply. cigarette smoking pregnancy status alcohol use intake of caffeine and sugary drinks seizure activity

seizure activity pregnancy status alcohol use Explanation: The nurse should assess the number and type of seizures the client has experienced since starting clonazepam monotherapy for seizure control. The nurse should also determine if the client might be pregnant because clonazepam crosses the placental barrier. The nurse should also ask about the client's use of alcohol because alcohol potentiates the action of clonazepam. Although the nurse may want to check on the client's diet or use of cigarettes for health maintenance and promotion, such information is not specifically related to clonazepam therapy.

A client is taking paroxetine 20 mg PO every morning. The nurse should monitor the client for which adverse effect?

sexual problems

The nurse instructs the client in mixing and administering regular and NPH insulin. Which statement indicates that the client needs additional instruction?

shake the bottle like an idiot - ALEX DOES NOT AGREE WITH PASS POINT

A client is refusing to take the prescribed oral medication. Which measure by the nurse can be used to get the client to take the medication? Select all that apply. asking the client the reason for not taking the medication explaining the purpose of the medication to the client crushing the medication and hiding it in apple sauce having a family member give the medication suggesting a liquid form of the medication instead of a pill

suggesting a liquid form of the medication instead of a pill asking the client the reason for not taking the medication explaining the purpose of the medication to the client Explanation: The correct answers provide an alternative solution for the client and provide the client an opportunity to consent to taking the medication in another form, neither of which would be considered abuse. Providing health education regarding the medications to ensure the client has all the information needed to make an informed consent would be appropriate. Hiding medication or disguising it in food knowing that the client has refused the medication would be considered abuse. The client has the right to refuse care, including medication, and a family member should not be placed in a position of having to give the medication.

When positioned properly, the tip of a central venous catheter should lie in the

superior vena cava.

A client has a throbbing headache when nitroglycerin is taken for angina. What should the nurse instruct the client to do?

take acetaminophen

A client with refractory angina pectoris is scheduled for a percutaneous transluminal coronary angioplasty (PTCA). The cardiologist orders an infusion of abciximab. Before beginning the infusion, the nurse should ensure the client has: continuous electrocardiogram (ECG) monitoring. up-to-date partial thromboplastin time (PTT) result in his record. ampule of naloxone at the bedside. negative history of tonic-clonic seizures.

up-to-date partial thromboplastin time (PTT) result in his record. Explanation: Clients undergoing PTCA receive abciximab because it inhibits platelet aggregation and, thereby, reduces cardiac ischemic complications. Before abciximab is administered, the client should have an up-to-date PTT result available. The drug isn't contraindicated in clients with a seizure history. Abciximab isn't an opioid; therefore, an opioid antagonist doesn't need to be at the bedside. Any client with refractory angina should be on continuous ECG monitoring; however, monitoring isn't a requirement for administering abciximab.

A client was admitted to the hospital because of a transient ischemic attack (TIA) secondary to atrial fibrillation. The nurse anticipates that the provider will prescribe digoxin. diltiazem. quinidine gluconate. warfarin.

warfarin. Explanation: Atrial fibrillation may lead to the formation of mural thrombi, which may embolize to the brain. Warfarin will prevent further clot formation and prevent clot enlargement. The other drugs are used in the treatment and control of atrial fibrillation, but won't affect clot formation.

A client with a positive Mantoux test result is taking isoniazid (INH) and rifampin (RIF) for an initial treatment over a 2-month period for confirmed tuberculosis. The nurse should assess specifically for which finding during the clinic visit? shortness of breath yellowing of the skin or eyes fatigue peripheral edema

yellowing of the skin or eyes Explanation: Clients who are taking these medications need to be closely monitored for jaundice or yellowing of the sclera. The other choices are not side effects of these medications.

A client with peptic ulcer disease is taking ranitidine. What is the expected outcome of this drug? Limit gastric acid secretion. Reduce acid concentration. Protect the ulcer surface from acids. Heal the ulcer.

Limit gastric acid secretion. Explanation: Histamine2 (H2) receptor antagonists, such as ranitidine, reduce gastric acid secretion. Antisecretories, or proton-pump inhibitors, such as omeprazole, help ulcers heal quickly in 4 to 8 weeks. Cytoprotective drugs, such as sucralfate, protect the ulcer surface against acid, bile, and pepsin. Antacids reduce acid concentration and help reduce symptoms.

A client with symptoms of acute asthma is ordered I.V. aminophylline 350 mg in 100 ml to be administered over 30 minutes. The nurse has vials of I.V. aminophylline labeled 250 mg/5 ml. How many milliliters of fluid contain the dose ordered? Record your answer using a whole number.

7 mL

A client with rheumatoid arthritis is being discharged with a prescription for aspirin, 600 mg P.O. every 6 hours. Which statement by the client indicates understanding of the adverse effects of the medication?

"I'll call my physician if I have ringing in the ears."

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?

"I'm able to sleep and rest at night."

A client taking clozapine states, "I don't like feeling so sedated during the day. I can hardly keep my eyes open." Which response by the nurse would be most appropriate?

"Let's talk to your health care provider about taking most of the drug at bedtime."

The nurse instructs a child's parents to administer the pescribed ferrous sulfate with a citrus juice. The parents ask why they need to do this. Which response by the nurse is the best?

"The citrus juice helps with the absorption of ferrous sulfate."

Which statement by the client indicates an understanding of teaching regarding use of corticosteroids during preterm labor?

"The corticosteroids may help my baby's lungs mature."

A nurse is providing health teaching about pediatric immunizations to the parents of a child. Which of the following is the most appropriate information for the nurse to give the parents about immunizations? "The fear of needles is usually overcome after the first shot." "Refusal of vaccinations is very common among children." "Your child may need medication for a low-grade fever." "Children rarely experience pain at the injection site."

"Your child may need medication for a low-grade fever." Explanation: Fever with most vaccines begins within 24 hours, lasts 2 to 3 days, and may require pharmacologic intervention. The other options are incorrect.

An infant who weighs 7.5 kg is to receive ampicillin 25 mg/kg intrvenously every 6 hours. How many milligrams would the nurse administer per dose? Record your answer using one decimal place.

187.5 mg Explanation: The nurse would calculate the correct dose using the following equation:25 mg/kg × 7.5 kg = 187.5 mg

The nurse is counseling a client regarding treatment of the client's newly diagnosed depression. The nurse emphasizes that full benefit from antidepressant therapy usually takes how long?

2 to 4 weeks

The nurse is caring for a client with an order for an intravenous infusion of dextrose with 5% normal saline at 1500 mL over 8 hrs. The drip administration is set at 10 drops/mL. How fast will the IV infuse (drops/minute)? Record your answer using a whole number.

31 Explanation: 1500 × 10 gtts = 15,000 gtts/8 hr = 1875 gtts/60 min = 31.25 gtts/min=31 gtts/min.

A client had surgery 6 hours ago. The client has a prescription for a narcotic for pain every 3 to 4 hours. The last dose was administered at 1500. When the nurse enters the room at 1800, the client is restless and grimacing. What action should the nurse take first?

Assess the client to determine the cause of the grimacing.

Propranolol is ordered for a client that has Type 1 diabetes mellitus. Which client statement indicates understanding of a common side effect of this therapy?

I will check my blood glucose at least twice a day

A client arrives in the emergency department with an ischemic stroke. What should the nurse do before the client receives tissue plasminogen activator (t-PA)?

Identify the time of onset of the stroke.

A nurse prepares a client's medication by reconstituting a multi-dose vial of medication. What other nursing interventions should the nurse take? Select all that apply.

Initial the vial as the person reconstituting the medication. Label the vial with the strength of the medication. Store the multi-dose vial in a secure place.

The nurse understands that assessment of blood pressure in clients receiving antipsychotic drugs is important. What is a reason for this assessment? Orthostatic hypotension is a common side effect. Most antipsychotic drugs cause elevated blood pressure. This provides additional support for the client. It will indicate the need to institute antiparkinsonian drugs.

Orthostatic hypotension is a common side effect. Explanation: Orthostatic hypotension is common during the first few weeks of treatment with antipsychotic drugs. An elevated blood pressure usually results from MAOI antidepressants. Additional support should be through therapeutic communications. A problem with the blood pressure is not indicative of antiparkinsonian drugs.

When caring for a client receiving haloperidol, the nurse should assess for which problem? extrapyramidal symptoms hypersalivation orthostasis oversedation

extrapyramidal symptoms Explanation: Haloperidol, a traditional antipsychotic drug, is associated with a high rate of extrapyramidal adverse effects.At therapeutic dosages, haloperidol is associated with a low incidence of sedation and orthostasis.Hypersalivation is an adverse effect of clozapine.

A client with cirrhosis begins to develop ascites. Spironolactone is prescribed to treat the ascites. The nurse should monitor the client closely for which drug-related adverse effect?

hyperkalemia Explanation: Spironolactone is a potassium-sparing diuretic; therefore, clients should be monitored closely for hyperkalemia. Other common adverse effects include abdominal cramping, diarrhea, dizziness, headache, and rash. Constipation and dysuria are not common adverse effects of spironolactone. An irregular pulse is not an adverse effect of spironolactone but could develop if serum potassium levels are not closely monitored.

A primiparous client, 48 hours after a vaginal birth, is to be discharged with a prescription for vitamins with iron because she is anemic. To maximize absorption of the iron, the nurse instructs the client to take the medication with which liquid?

orange juice

A primigravida in active labor is about 10 days postterm. The client desires a pudendal block anesthetic before childbirth. After the nurse explains this type of anesthesia to the client, which location if identified by the client as the area of relief would indicate to the nurse that the teaching was effective?

perineum

When teaching a client how to take a sublingual tablet, the nurse should instruct the client to place the tablet

on the floor of the mouth.

A healthcare provider prescribes an antibiotic for a 6-year-old client with an upper respiratory tract infection. For what prescribed antibiotic will the nurse seek clarification from the healthcare provider?

tetracycline

The client is being monitored by the healthcare provider for ulcerative colitis (UC). The healthcare provider orders hydrocortisone therapy. What information should the nurse include in the teaching of a client receiving hydrocortisone therapy? Select all that apply. "Consume foods low in potassium." "Wear a medical alert." "Take medications in the evening." "Do not abruptly stop taking the medication." "Avoid exposure to infections."

"Do not abruptly stop taking the medication." "Avoid exposure to infections." "Wear a medical alert." Explanation: The client taking hydrocortisone therapy should be taught not to abruptly stop medication, to wear a medical alert, and to avoid exposure to infections. The client should consume foods high in potassium and take the medication with food/fluid.

The nurse is caring for a client who is receiving parenteral nutrition. Which assessment is most important for the nurse to make to detect early signs of metabolic complications? lung sounds urine output vital signs daily weights

urine output Explanation: Monitor urine output to detect signs of hyperosmolar hyperglycemia. Hyperosmolar hyperglycemia is a metabolic complication of parenteral nutrition. Expansion of the blood volume combined with hyperglycemia can cause osmotic diuresis, presenting as increased urine output. Intake and output should be recorded so that a fluid imbalance can be readily detected. Urine can also be tested for hyperosmolar diuresis. Each of the other assessments is important, but do not indicate metabolic complications.

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect?

with each meal and snack

A young adult client with severe depression and suicide ideation has been started on the selective seratonin reuptake inhibitor (SSRI) sertraline. Which client statement would indicate the client needs further teaching about seratraline? "I can take this medicine with food." "Sexual side effects are pretty common with sertraline." "It may take several weeks for depression to get better " "Being on sertraline will significantly decrease the chances that I might hurt myself."

"Being on sertraline will significantly decrease the chances that I might hurt myself." Explanation: SSRIs reduce the risk of suicide in the long run, but they are associated with an increased risk of suicide during the initial phase of treatment, especially in young adults. Thus, clients need to be monitored closely for unusual behavior or worsening depression.SSRIs may be taken with food to reduce nausea. SSRIs take anywhere from 2 to 8 weeks to improve mood. Sexual side effects are common with SSRIs, so clients should be encouraged to discuss these with their health care provider should they occur.

A client diagnosed with glaucoma and receiving beta-adrenergic blocking ophthalmic drops makes each of these comments. Which one requires immediate follow-up by a nurse?

"My pulse rate is a little low today because I take digoxin." Beta-adrenergic blocking agents may decrease heart rate and blood pressure, and should be used cautiously in clients receiving digoxin. The other statements do not require immediate follow-up.

A nurse is to administer 10 mg of morphine sulfate to a client with three fractured ribs. The available concentration for this drug is 15 mg/mL. How many milliliters should the nurse administer? Record your answer using one decimal place.

0.7 mL

A client receiving an intravenous infusion states that, "My arm is feeling cool." Which priority action should be taken? Remove the intravenous catheter. Teach the client about expected side effects of intravenous infusion. Assess the intravenous site. Provide a blanket.

Assess the intravenous site. Explanation: The statment that the client's arm is "feeling cool" could be an indication of infiltration; therefore, assessment of the I.V. site is indicated and should be completed first, as this poses a potential risk to the client. The other actions should be acted on but are not the highest priority.

The nurse is caring for a client being discharged following kidney transplantation. The client is ordered mofetil to prevent organ rejection. Which nursing instruction is essential regarding medication use?

Contact the health care provider at first signs of an infection.

Which principle should a nurse consider when administering pain medication to a client? Morphine and hydromorphone shouldn't be used to treat severe pain. Use opioid combination drugs or nonopioid analgesics only for severe pain. Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain. I.V. pain medications may take as long as 2 hours to relieve pain.

Sustained-release oral formulations should be given around the clock, if possible, for control of chronic pain. Explanation: Administering sustained-release oral formulations around the clock provides better relief of chronic pain by keeping blood levels within therapeutic range. Opioid combination drugs and nonopioid medications are most effective in the treatment of mild to moderate pain. I.V. medications usually act within 1 hour of administration. Morphine and hydromorphone are drugs of choice for severe pain.

A nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to order which psychotropic drug regimen on a short-term basis? benztropine, 2 mg orally twice per day chlorpromazine, 25 mg orally three times per day alprazolam, 0.25 mg orally every 8 hours buspirone, 15 mg two times per day 200 mg orally twice per day

alprazolam, 0.25 mg orally every 8 hours Explanation: Alprazolam's antianxiety properties make it the most appropriate medication for this client. It should only be given very short term because of its addictive potential and the client should be weaned off of it. Benztropine is an antiparkinsonian agent used to control the extrapyramidal effects of antipsychotic agents such as chlorpromazine hydrochloride and thioridazine hydrochloride. Chlorpromazine is used to control the severe symptoms (hallucinations, thought disorders, and agitation) seen in clients with psychosis. Buspirone is an antianxiety agent but takes several weeks before it is effective in reducing anxiety. Thus it would not help this client who needs immediate assistance. Alprazolam provides immediate relief.

The client with depression is taking a prescribed antidepressant that can cause anticholinergic side effects. The nurse anticipates that this client is at particular risk for developing which anticholinergic side effect? vomiting constipation weight loss diarrhea

constipation Explanation: The anticholinergic effects of the client's medication may cause blurry vision, urine retention, constipation and dry mouth. Gastrointestinal motility may be further compromised by a decreased level of activity associated with depression. Constipation needs to be addressed to prevent additional gastrointestinal problems. Anticholinergic effects do not result in vomiting, diarrhea, or weight loss.

A client with schizophrenia comes to the outpatient mental health clinic 5 days after being discharged from the hospital. The client was given a 1-week supply of clozapine. The client tells the nurse that she has too much saliva and frequently needs to spit. The nurse interprets the client's statement as being consistent with which factor? unusual reaction to clozapine unresolved symptom of schizophrenia delusion, requiring further assessment expected adverse effect of clozapine

expected adverse effect of clozapine Explanation: Excessive salivation, or sialorrhea, is commonly associated with clozapine therapy. The client can use a washcloth to wipe the saliva instead of spitting. It is an expected adverse effect of the drug, not a delusion, an unusual reaction, or an unresolved symptom of schizophrenia.

A client with severe inflammatory bowel disease is receiving total parenteral nutrition (TPN). When administering TPN, the nurse must take care to maintain the ordered flow rate because giving TPN too rapidly may cause

hyperglycemia.

In the first 12 hours after starting a patient-controlled analgesia (PCA) infusion to administer an opioid, what should the nurse should monitor every 1 to 2 hours? Select all that apply.

level of sedation oxygen saturation vital signs

A physician orders albuterol for a client with newly diagnosed asthma. When teaching the client about this drug, the nurse should explain that it may cause hyperkalemia. nervousness. lethargy. nasal congestion.

nervousness. Explanation: Albuterol may cause nervousness. The inhaled form of the drug may cause dryness and irritation of the nose and throat, not nasal congestion; insomnia, not lethargy; and hypokalemia (with high doses), not hyperkalemia. Other adverse effects of albuterol include tremor, dizziness, headache, tachycardia, palpitations, hypertension, heartburn, nausea, vomiting, and muscle cramps.

Which action is a priority when a nurse is preparing to administer a transfusion of platelets?

obtaining a written informed consent Special transfusion sets should be used when administering platelets. A written consent should be obtained and this is the priority before obtaining equipment. Vital signs should be taken before administration and may be delegated. Platelets are stored at room temperature and a blood-warming device should not be used.

The nurse administers fat emulsion solution during TPN to a malnourished client. What should the nurse tell the client about the purpose of this solution? Fat emulsion solution: promotes effective metabolism of glucose. maintains a normal body weight. provides essential fatty acids. adds extra carbohydrates.

provides essential fatty acids. Explanation: The administration of fat emulsion solution provides additional calories and essential fatty acids to meet the body's energy needs. Fatty acids are lipids, not carbohydrates. Fatty acids do not aid in the metabolism of glucose. Although they are necessary for meeting the complete nutritional needs of the client, fatty acids do not necessarily help a client maintain normal body weight.

A client diagnosed with idiopathic thrombocytopenia purpura needs a peripherally inserted central catheter (PICC) placed. When explaining the catheter to the client, the nurse explains that one advantage of a catheter is that it can be used: for 2 weeks without being replaced. to administer only blood products and I.V. fluids. in clients with infections in the blood. to provide long-term access to central veins.

to provide long-term access to central veins. Explanation: A PICC provides long-term access (longer than 2 weeks) to central veins. It can be used to administer blood products, medications, I.V. fluids, and total parenteral nutrition. Moreover, the PICC can be used to obtain blood specimens. As with any other central venous catheter, this catheter shouldn't be inserted when systemic infection (infection in the blood) is present.

A client recently gave birth. Two minutes before breast-feeding the baby, she administers one nasal spray (40 units/ml) of oxytocin into each nostril. Why is the client using this drug? to treat eclampsia to stimulate lactation to reduce postpartum bleeding to treat erythroblastosis

to stimulate lactation Explanation: Oxytocin is administered as a nasal spray before breast-feeding to stimulate lactation. When oxytocin is used to treat eclampsia, reduce postpartum bleeding, or treat erythroblastosis fetalis, the drug is administered parenterally.

A client has been ordered vancomycin 1400 mg I.V. The medication is placed in 250 mL of normal saline. At which rate should the nurse set the pump to infuse the medication over 90 minutes? Record your answer using a whole number.

167 Explanation: 250 mL over 90 minutes equals 167 mL/hour.

The nurse is providing dietary instructions for a client who is taking warfarin. Which menu choice would be most appropriate for this client?

tuna fish sandwich, French fries, and a baked apple

A client with iron deficiency anemia was prescribed ferrous sulfate. Which statement by the caregiver would indicate a need for further instruction on proper administration?

"I mix the medication in milk to make it taste better."

A 2-month-old infant is seen in the emergency department for symptoms of infection. The healthcare provider has prescribed an antibiotic via the IM route. In which location should the nurse administer the injection?

vastus lateralis

A laboring client with preeclampsia is prescribed magnesium sulfate 2 g/h IV piggyback. The pharmacy sends the IV to the unit labeled magnesium sulfate 20 g/500 ml normal saline. To deliver the correct dose, the nurse should set the pump to deliver how many milliliters per hour? Record your answer using a whole number.

50 mL/hr

The client was found not breathing and was transported to the hospital. A family member states the client may have taken too much pain medication because the client frequently forgets if the medication was taken. Which observation(s) by the nurse indicates therapeutic effect of naloxone hydrochloride in the client? Select all that apply.

Reverses decreased respiratory rate of 10. Reverses decreased level of consciousness. Reverses blood pressure of 90/58.

A physician writes a medication order for meperidine 500 mg. The nurse's appropriate action would be to

clarify the order with the physician.

A client states, "I have never taken a yellow pill before for my blood pressure. Why are you giving me this pill?" After verifying that the nurse has prepared the correct medication, which statement by the nurse would be accurate? "I think you must be confused; this is the right medication." "You can refuse to take this medication if you wish." "We use all kinds of brands at the hospital so I am sure it is correct." "This is the same medication that you take at home but in generic form."

"This is the same medication that you take at home but in generic form." Explanation: Once the nurse has verified that the medication is correct, the client can be informed that it looks different because it is in generic form. The other options may hinder the development of trust in the nurse. Stating that the client can refuse the medication is not appropriate in this situation.

A pediatric client is to receive an oral antibiotic dose. The client's meal tray is due to be delivered in 30 minutes. Which action shows how the nurse should coordinate the antibiotic dose with the client's meal? Give the dose now before the tray arrives. Wait to give the medication when the food arrives. Retime the medication, and administer 2 hours after the meal. Give the medication 15 minutes before the client receives the meal.

Give the dose now before the tray arrives. Explanation: Most oral pediatric medications are administered on an empty stomach. They are not usually administered with milk or formula because these can affect gastric pH and alter drug absorption. Because a child's meals usually contain milk or a milk product, the nurse would not administer the drugs with meals or even ½ hour after meals.

What is the rationale that supports multidrug treatment for clients with tuberculosis? Multiple drugs reduce development of resistant strains of the bacteria. Multiple drugs potentiate the drugs' actions. Multiple drugs reduce undesirable drug adverse effects. Multiple drugs allow reduced drug dosages to be given.

Multiple drugs reduce development of resistant strains of the bacteria. Explanation: Use of a combination of antituberculosis drugs slows the rate at which organisms develop drug resistance. Combination therapy also appears to be more effective than single-drug therapy. Many drugs potentiate (or inhibit) the actions of other drugs; however, this is not the rationale for using multiple drugs to treat tuberculosis. Treatment with multiple drugs does not reduce adverse effects and may expose the client to more adverse effects. Combination therapy may allow some medications (e.g., antihypertensives) to be given in reduced dosages; however, reduced dosages are not prescribed for antibiotics and antituberculosis drugs.

When assessing a client who is receiving tricyclic antidepressant therapy, the nurse should be alert for which finding that could suggest the client is experiencing anticholinergic effects?

urine retention and blurred vision

When assessing a client's I.V. insertion site, a nurse notes normal color and temperature at the site and no swelling. However, the I.V. solutions haven't infused at the ordered rate; the flow rate is slow even with the roller clamp wide open. When the nurse lowers the I.V. fluid bag, no blood returns to the tubing. What should the nurse do first? Irrigate the I.V. tubing with 1 ml of normal saline solution. Check the tubing for kinks and reposition the client's wrist and elbow. Discontinue the I.V. infusion at that site and restart it in the other arm. Elevate the I.V. fluid bag.

Check the tubing for kinks and reposition the client's wrist and elbow. Explanation: The nurse should check for common causes of a decreased I.V. flow rate, such as kinks in the tubing and poor positioning of the affected arm. The nurse should discontinue the I.V. infusion only if other measures fail to solve the problem. Irrigating I.V. tubing may dislodge any clots that are present. Elevating the I.V. fluid bag may help if the nurse finds no kinks and if repositioning doesn't resolve the problem.

A 1-year-old child is admitted to the hospital with sickle cell crisis. Which intervention does the nurse anticipate will be included in the child's plan of care? parenteral iron therapy fast-acting anticoagulant therapy IV fluid therapy exchange transfusion

IV fluid therapy Explanation: During a sickle cell crisis, increasing the transport and availability of oxygen to the body's tissues is paramount. Administering a high volume of IV fluid and electrolytes to help compensate for the acidosis resulting from hypoxemia associated with sickle cell crisis is one way to accomplish this. Fluid administration also helps overcome dehydration, a possible predisposing factor common in children with sickle cell crisis.Iron therapy is contraindicated for this condition.Exchange transfusions are used only in certain situations, such as severe hyperbilirubinemia. Small amounts of blood are removed from the infant and replaced with whole blood. This helps to correct the anemia and lower bilirubin levels.Although anticoagulants have been suggested, they are not included in the usual treatment of sickle cell crisis.

Which statement by a client taking valproic acid for bipolar disorder indicates that further teaching about this medication is necessary? "I need to take the pills at the same time each day." "I can chew the pills if necessary." "I can take the pills with food." "I need to call my health care provider if I start bruising easily."

"I can chew the pills if necessary." Explanation: Chewing the pill or capsule form of valproic acid can cause mouth and throat irritation and is contraindicated. Taking the pills at the same time each day is important to maintain therapeutic effectiveness of the drug. Taking the pills with food is appropriate if the client is experiencing gastrointestinal upset. Valproic acid may cause clotting problems; therefore, bruising should be reported.

A physician orders preoperative medication to be administered to a client by the I.M. route: meperidine, 50 mg; hydroxyzine pamoate, 25 mg; and glycopyrrolate, 0.3 mg. The medications are dispensed this way: meperidine, 100 mg/ml; hydroxyzine pamoate, 100 mg/2 ml; and glycopyrrolate, 0.2 mg/ml. How many milliliters in total should the nurse administer? 3.8 ml 2 ml 5 ml 2.5 ml

2.5 mL

The nurse should seek clarification about which prescription? Give 5000 units of heparin IV piggyback every 4 to 6 hours. Give 5,000 units bolus dose of heparin IV push. Give 200,000 units heparin by IV drip, and infuse over 24 hours. Give 40,000 units of heparin by IV drip, and infuse over 24 hours.

Give 200,000 units heparin by IV drip, and infuse over 24 hours. Explanation: 200,000 units of heparin is too large of a dose. Heparin may be given in a 5,000-unit bolus dose IV; then 20,000 to 40,000 units infused over 24 hours with a dose adjusted to maintain desired APTT, or 5,000 to 10,000 units IV piggyback every 4 to 6 hours.

A nurse preparing to administer a scheduled dose of phenytoin intravenous (I.V.) push verifies that the client has a patent venous access site in the right hand with an infusion of dextrose solution at a rate of 50 mL/hour. In addition to following the rights of medication administration, which actions will the nurse take to give this drug safely? Select all that apply. Initiate a new I.V. site in the forearm. Calculate the I.V. rate. Monitor for diarrhea. Dilute the drug with sterile water. Stop the I.V. infusion and flush with saline.

Calculate the I.V. rate. Initiate a new I.V. site in the forearm. Dilute the drug with sterile water. Explanation: The rights of medication administration include giving the right drug and dosage to the right client at the right time through the right route. In addition, there are specific actions needed to safely administer certain medications. Phenytoin must be diluted in saline or sterile water because it will precipitate in dextrose solution. It will also cause hypotension and circulatory collapse if administered too quickly, thus a slow push rate is needed. Hand-vein access should be avoided to prevent discoloration.

The nurse is flushing a peripheral intravenous access device. Place the steps in the order that the nurse should perform them. All options must be used. 1 Instill saline solution over 1 minute. 2 Pull back on saline flush syringe to aspirate the catheter for blood return. 3 Remove gloves and perform hand hygiene. 4 Cleanse the end cap with an antimicrobial swab. 5 Remove the syringe and reclamp the extension tubing. 6 Insert the saline flush syringe into the cap on the extension tubing.

Cleanse the end cap with an antimicrobial swab. Insert the saline flush syringe into the cap on the extension tubing. Pull back on saline flush syringe to aspirate the catheter for blood return. Instill saline solution over 1 minute. Remove the syringe and reclamp the extension tubing. Remove gloves and perform hand hygiene. Explanation: The first step is to cleanse the end cap with an antimicrobial swab to reduce the risk for contamination. The second step is to insert the saline flush syringe into the cap on the extension tubing to prepare to flush the intravenous site. The third step is to pull back on saline flush syringe to aspirate the catheter for blood return to confirm patency. The fourth step is to instill saline solution over 1 minute to maintain patency of the peripheral intravenous access device site. The fifth step is to remove the syringe from the peripheral intravenous access device because the normal saline has been administered and reclamp the extension tubing to prevent air from entering the peripheral intravenous access device. The sixth step is to remove gloves and perform hand hygiene to reduce the risk of transmission of microorganisms.