SI quiz reviews

The nurse knows that sympathomimetic decongestants (such as Pseudoephedrine) should be avoided by people with which conditions or situations? A. Hypertension and coronary artery disease B. Wide-angle glaucoma C. Breast-feeding women D. Elderly clients

A. Hypertension and coronary artery disease All sympathomimetics, whether prescription or OTC are CNS stimulants and can increase blood pressure and cause dysrhythmias in people with coronary artery disease. Option 2 is incorrect because wide- angled glaucoma is one contraindication for the use of antihistamines, not decongestants. Option 3 is incorrect because, while some drugs may secrete in breast milk, others may be safe, so taking these should be discussed with the health care provider. Option 4 is incorrect because elderly clients may be more sensitive to any drug, but decongestants are not contraindicated for them.

What are the main symptoms/ cardinal signs of Parkinson's disease? A. Tremor- resting shaking of hands and head B. Muscle rigidity- resistance to passive movement of arms and legs, mask of facial expression C. Bradykinesia- slowness of voluntary movement and speech D. Postural instability- stumbling, stooped over E. Coughing

A, B, C, and D PPt, slide 38

An 89-year-old client calls the clinic and is complaining of being constipated and having abdominal discomfort. Which interventions should the nurse implement? Select all that apply. A. Tell the client to go to the emergency department as soon as possible. B. Instruct the client to take an OTC laxative as recommended on the label. C. Recommend the client drink clear liquids only, such as tea. D. Ask the client what other medications are currently being taken. E. Determine when the client last had a bowel movement.

B & E Nursing interventions: Increase dietary fiber intake and fluid intake, if indicated, encourage a regular toilet routine, with time on the toilet after meals and/or physical activity, administer laxatives as indicated, encourage early physical mobility, educate the patient and family about the use of opioid analgesics, and encourage them to avoid long-term use of laxatives.

A nurse in a provider's clinic is assessing a client who has cancer and a prescription for methotrexate PO. Which of the following actions should the nurse take when the client reports bleeding gums? A) Explain to the client that this is an expected adverse effect B) Check the value of the clients current platelet count C) Instruct the client to use an electric toothbrush D) Have the client make an appointment to see the dentist

B) Check the value of the clients current platelet count The nurse should recognize that the bleeding is likely due to the adverse effect of the chemotherapy and needs to be evaluated further. Bleeding gums is a sign of thrombocytopenia (decreased platelet count) secondary to bone marrow suppression, which can be life-threatening in a client who is receiving chemotherapy. Normal platelet count ranges from 150,000 to 450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called Thrombocytosis; having less than 150,000 is known as Thrombocytopenia. PPt, slide 8. Adverse effects: bone marrow suppression ( Myelosuppression), photosensitivity, Stevens-Johnson syndrome.

he nurse is evaluating the client who is receiving chemotherapy to determine the risk for infection. Which laboratory values would prompt the nurse to implement protective isolation measures for this client? A) High uric acid level B) Low neutrophil count C) High red blood cell count D) Low platelet count

B) Low neutrophil count A low neutrophil count means that the client has a decreased immune system, thus placing the client at risk for an infection. Protective isolation measures would be initiated to shelter the client from microorganisms. Options A, C, and D are incorrect. A high uric acid level places the client at risk for renal problems. A high red blood cell count does not impair the immune system. A low platelet count places the client at risk for bleeding complications but does not affect the immune system.

A nurse is caring for a client who is experiencing severe nausea and vomiting after a course of chemotherapy. The nurse should monitor the client for which of the following clinical manifestations? A) Metabolic acidosis B) Metabolic alkalosis C) Respiratory acidosis D) Respiratory alkalosis

B) Metabolic alkalosis Metabolic alkalosis can occur in clients who have excessive vomiting because of the loss of hydrochloric acid and where the body's pH is elevated to greater then 7.45 secondary to some metabolic process such as vomiting. The pH of the human body ranges between 7.35 to 7.45.

he nurse is preparing to administer cyclophosphamide (Cytoxan) and knows that the client will experience a nadir in approximately 9 to 14 days. Which laboratory value(s) will indicate to the nurse that the client has reached the nadir? A) Blood urea nitrogen and creatinine B) White blood cell count and absolute neutrophil count C) Ionized calcium D) Serum albumin

B) White blood cell count and absolute neutrophil count The nadir indicates that myelosuppression has occurred and is indicated by decreased blood cell counts. WBC and ANC (absolute neutrophil count) are sensitive indicators of the nadir. Option A,C, and D are incorrect. BUN( blood urea nitrogen), creatinine, ionized calcium, and serum albumin are not indicators of the nadir and myelosuppression. PPt slide 9 Nadir is the term that basically means low point. When a person with cancer reaches their: nadir" following each chemotherapy cycle, it means that the person's blood cell counts are the lowest they will be during that treatment cycle. Each chemotherapy comes with a nadir period.

A nurse is educating a patient who is beginning therapy with acarbose and tells the patient to take the medication with the first bite of each main meal to help prevent what adverse effect? A. Dizziness B. Bloating and diarrhea C. Nausea and vomiting D. Chest pain

B. Bloating and diarrhea Patients who take acarbose should take the medication with the first bite of each main meal to prevent bloating and diarrhea. PPt- slide 69 MOA: Lower glucose by interfering with carbohydrate absorption from GI tract. Adverse effects: hypoglycemia, hyperglycemia, bloating and diarrhea.

The patient has a history of hypertension and is currently taking medication to control his/her blood pressure. Which of the following objective data should the nurse consider when evaluating the effectiveness of the drug therapy? A. Absence of headache for 3 days B. Blood pressure ranging from 120/70 to 135/90 mmHg C. Absence of cough for 5 days D. Absence of running nose

B. Blood pressure ranging from 120/70 to 135/90 mmHg A blood pressure of 120/70 to 135/90 mmHg shows effective hypertension management.

The client is undergoing treatment for hyperlipidemia with gemfibrozil (Lopid). When educating the client about this medication, which adverse effects should the nurse be mindful of? Select all that apply. A. Insomnia B. Shortness of breath C. Cholelithiasis (gall stones) D. Abnormal liver functions

C and D C. Cholelithiasis (gall stones) D. Abnormal liver functions Adverse effects of gemfibrozil (Lopid) are cholelithiasis (gall stones) and abnormal liver functions. PPt45 Nurse concerns: report abnormal cramping, avoid breastfeeding, follow low-cholesterol diet, monitor blood glucose level if diabetic.

A nurse is providing teaching to a client who has breast cancer about the adverse effects of chemotherapy. Which of the following client statements indicates an understanding of the teaching? A) " I will take the antiemetic as soon as the chemotherapy infusion is complete." B) " I will run my toothbrush in the dishwasher every month." C) " I'II call my doctor if I notice any unusual menstrual bleeding D) "I will avoid crowds to keep from infecting others."

C) " I'II call my doctor if I notice any unusual menstrual bleeding Clients should be taught bleeding precautions and to report bruising or excessive bleeding to the MD

Tamoxifen citrate is prescribed for a client with metastatic breast carcinoma. The client asks the nurse if her family member with bladder cancer can also take this medication. The nurse most appropriately responds by making which statement? A) "This medication can be used only to treat breast cancer." B) Yes, your family member can take this medication for bladder cancer as well." C) " This medication can be taken to prevent and treat clients with breast cancer." D) "This medication can be taken by anyone with cancer as long as their health care provider approves it."

C) " This medication can be taken to prevent and treat clients with breast cancer." Tamoxifen is an antineoplastic medication that competes with estradiol for binding to estrogen in tissues containing high concentrations of receptors. PPt slide 38 and slide 6. Tamoxifen blocks substances necessary for continue growth of tumors. It limited to hormone-sensitive tumors - breast or prostate.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which signs and symptoms are associated with this diagnosis? Select all that apply A. Tremors B. Weight loss C. Feeling cold D. Loss of body hair E. Persistent lethargy F. Puffiness of the face

C, D, E, and F Feeling cold, hair loss, lethargy and facial puffiness are signs of hypothyroidism. PPt- slide 21 Fatigue, weakness, weight gain or increased difficulty losing weight, coarse, dry hair, dry, rough pale skin hair loss, cold intolerance, muscle cramps and frequent muscle aches, constipation, depression, irritability, memory loss, abnormal mistrial cycles, decreased libido.

Which of these statements, if made by a client, would indicate that further instruction is needed about alprazolam (Xanax)? A. " I will stop smoking by undergoing hypnosis." B. " I will not drive immediately after I take this medication." C. I will stop taking the medication when I feel less anxious." D. " I will take my medication with food if my stomach feels upset."

C. I will stop taking the medication when I feel less anxious." This medication must be gradually reduced, not abruptly terminated. Abrupt termination may cause withdrawal symptoms (nausea, vomiting, abdominal cramps, diaphoresis, confusion statements and indicate that the client understands the teaching).

A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include a fasting blood glucose level of 70mg/dl ( 3.9mmol/L), temperature of 101F (38.3C), pulse of 82 beats per minutes, respirations of 20 breaths per minutes, and blood pressure of 118/68mmHg. Which finding would be the priority/concerns to the nurse? A. Pulse B. Respiration C. Temperature D. Blood pressure

C. Temperature In the client with type 2 diabetes, an elevated temperature may indicate infection. Infection is a leading cause of hyperosmolar hyperglycemic syndrome in the client with type 2 diabetes mellitus. TO remember: infection, stress and fever all cause insulin resistance, increasing insulin requirements and causing higher blood sugars.

A nurse is caring for a client who is taking montelukast. Which of the following outcomes indicates a therapeutic effect of the medication? A. The client experiences less muscle pain B. The client's seizure threshold is reduced C. The client experiences an increased ease of breathing D. The client's platelet count is increased

C. The client experiences an increased ease of breathing Montelukast is a bronchodilator that is prescribed for clients who have chronic asthma or seasonal rhinitis. Therapeutic effects of the medication are an increased ease of breathing.

For which clients or conditions Lorazepam (Ativan) medication may be prescribed? Select all that apply. A. Routinely used to manage anxiety B. Reduce anxiety prior to surgical/medical procedure C. Reduce anxiety in patient with ventilator D. Off- label use for insomnia, seizure, ETOH withdrawal, status epilepticus E. Reduce coughing

A, B, C, D Lorazepam is routinely used to manage anxiety and reduce anxiety prior to surgical/medical procedures, rescue anxiety in patients with ventilators, Off-label use for insomnia, ETOH withdrawal, status epilepticus, and reduce coughing. relaxation-sleep-coma) MOA: Potentiate GABA, depress CNS at different levels ( relaxation- sleep- coma) PPt slides 25, 26, 27, and 28

A nurse is teaching a client who is taking atorvastatin daily. Which of the following statements by the client indicates an understanding of the teaching? A. " I will avoid drinking grapefruit juice." B. " I should take this medication without food." C. " I should expect my stools to turn clay-colored." D. " It is not necessary to have routine lab tests done."

A. " I will avoid drinking grapefruit juice." Grapefruits and grapefruit juice can reduce metabolism of atorvastatin, which increase the risk for toxicity.

The mother of the child scheduled to receive a measles, mumps, and rubella vaccination asks the nurse, What could happen to my child if I don't let you give the vaccination?" What statement is the nurses best response? A. " If your child gets one of the diseases, it could lead to serious complications." B. Your child will not be allowed to attend any public school in the country." C. "Nothing can happen to you or the child if you don't get the vaccination." D. "You sound worried. Have you heard of problems associated with the shot."

A. " If your child gets one of the diseases, it could lead to serious complications." Potential complications of measles include blindness and deafness. Potential complications of mumps include aseptic meningitis; for adolescent and adult males, orchitis is another complication. Potential complications for rubella include arthritis in woman and birth defects or miscarriage for pregnant women.

A nurse is assessing a patient before administering atenolol. What finding should prompt the nurse to withhold the medication? A. Heart rate 46/bpm B. Oxygen saturation 95% C. Respiratory rate 18bpm D. Blood pressure 160/94mmHg

A. Heart rate -46/bpm The nurse should check the client's heart rate prior to administering a beta-blocker. If the client's heart rate is less than 60bpm, the nurse should hold the medication and contact the provider. Atenolol is a beta-blocker and is used in the treatment of hypertension, angina and myocardial infarction. This medication works by slowing the heart rate, decrease the speed of electrical impulses through the atrioventricular node, and decreasing the force of contraction. Rn closely monitors a client for signs of hypotension and bradycardia. Shortness of breath and wheezing are adverse effects seen in patients with COPD and Bronchial Asthma who take beta-adrenergic blockers.

A nurse is caring for a patient who has tuberculosis and new prescriptions for rifampin and pyrazinamide. Which of the following laboratory tests should the nurse instruct the patient will be required while on the medication regimen? A. Liver function tests B. Gallbladder studies C. Blood glucose levels D. Thyroid function studies

A. Liver function tests Pyrazinamide and rifampin can both cause hepatotoxicity; the provider will monitor liver function regularly

A client who is receiving intravenous lidocaine (Xylocaine) for ventricular dysrhythmias exhibits confusion and anxiety. The appropriate response by the nurse would be to: A. Withhold the drug and notify the health care provider immediately. B. Increase the infusion rate and calm the client. C. Discontinue the infusion and administer the antidote. D. Decrease the infusion rate and monitor for confusion.

A. Withhold the drug and notify the health care provider immediately.

The nurse who is caring for a client receiving cyclosporine (Sandimmune) will discontinue the medication immediately and call the provider if which of the following occurs? A. Red blood cell count above 8.5million/mm3 B. White blood cell count below 4,000/mm3 C. Platelet count about 100,000/mm3 D. Serum creatinine level less than 1.0mg/100ml

B. White blood cell count below 4,000/mm3 Cyclosporine is toxic to bone marrow although less so than other immunosuppressants. A decrease in WBC to below 4,000/mm3 should be reported to the provider. Option1, 3 and 4 are incorrect. Cyclosporine does not cause elevation RBCs. The provider should be notified if platelet counts below 75,000/mm3, but creatine level of less than 1.0mg/100ml is within normal limits.

A nurse is caring for a client who is taking sucralfate (Carafate). Which of the following outcomes indicates a therapeutic effect of the medication? A. Alleviate Helicobacter pylori. B. Relief of gastrointestinal pain C. Prevention of opportunistic infections D. Improvement of impaired vision.

B. Relief of gastrointestinal pain Sucralfate, an anti-ulcer medication, is prescribed for acute or maintenance therapy of duodenal ulcers. A therapeutic effect of the medication is relief of gastrointestinal pain associated with gastric ulcers. Sucralfate also promotes ulcer healing.

A nurse is providing teaching to a client who has hypertension and a new prescription for hydrochlorothiazide. Which of the following instructions should the nurse provide? A. Weigh weekly to monitor therapeutic effect B. Take the medication on an empty stomach C. Take the medication early in the day D. Muscle pain is an expected adverse effect

C. Take the medication early in the day The nurse should instruct the client to take hydrochlorothiazide early in the day to avoid nocturia.

A nurse is caring for four patients. After administering morning medications, she realized that Nifedipine prescribed for one patient was accidentally administered to another patient. Which of the following actions should the nurse take FIRST? A. Notify the patient's provider B. Check the patient's vital signs C. Fill out an occurrence form D. Administer the medication to the correct patient

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

A nurse is providing discharge teaching to a patient who has asthma and a new prescription for fluticasone/salmeterol (Advair HFA). For which of the following adverse effects should the nurse instruct the patient to report to the provider? A. Sedation B. Increase appetite C. White coating in the mouth D. Dry oral mucous membranes

C. White coating in the mouth Fluticasone/salmeterol is an inhaled glucocorticoid and long-acting beta2 adrenergic agonist combination inhalation medication used for daily asthma management. It is not a rescue medication. An adverse effect of the medication is oropharyngeal candidiasis. The nurse should instruct the patient to gargle after each use; use a spacer to reduce the amount of drug in the mouth and throat and any white patches inside the mouth or on the top of the tongue.

A nurse is preparing to administer medications to a patient who states, "I don't want to take those drugs." Which of the following actions should the nurse take? A. Tell the patient the physician wants him to take the medications B. Ask the patient why he is refusing to take the medications C. Explain the purpose for the medications D. Document that the patient refuses the medications

D. Document that the patient refuses the medications The patient has the right to refuse the medication, it is appropriate for the nurse to document the patient's refusal of the medications. The nurse should then inform the provider of the patient's refusal.

A nurse is completing a medication history for a client who reports using over-the- counter calcium carbonate antacid. Which of the following recommendations should the nurse make about taking this medication? A. Decrease bulk in the diet to counteract the adverse effect of diarrhea. B. Take the medication with dairy products to increase absorption C. Reduce sodium intake D. Drink a glass of water after taking the medication

D. Drink a glass of water after taking the medication Calcium carbonate is a dietary supplement used when the amount of calcium taken in the diet is not enough. Calcium carbonate may also be used as an antacid to relieve heartburn, acid indigestion and stomach upset. The client should drink a full glass of water taking an antacid to enhance its.

The patient is currently taking antiseizure medication. What are the nursing concerns associated with this group of medications? Select all that apply. A. Complete neurologic assessment including pupil response, LOC, orientation, motor response, verbal response, and cognition. B. Obtain baseline data-history, previous drug reactions, vital signs, electrolytes, CBC C. Monitor seizure activity, assess serum level of drugs and watch for blood dyscrasia ( nonspecific term that refers to a disease or disorder in the blood) D. Ensure environmental safety issues

A, B, C, D PPt, slide 37 Medications Phenytoin, Carbamazepine, Valproic Acid. PPt, 34,35 and 36 MOA: Phenytoin- delay influx of SODIUM ions in neurons. Adverse effects- lethargy, HA, drowsiness, dizziness; nystagmus, confusion etc, slide 34 MOA: Carbamazepine- Inhibit SODIUM channels and block repetitive sustained firing of neurons, slide 35 MOA: Valproic Acid- Increase concentration of GABA in brain and suppress abnormal neuronal discharge. Slide 36

A patient with rheumatoid arthritis has been taking prednisolone. The nurse is teaching the patient how to gradually reduce the dosage of prednisolone to prevent any potential adverse effects. The nurse should explain to the patient the importance of tapering the dosage gradually to avoid the following adverse effects (select all that apply) A. Osteoporosis B. Adrenal insufficiency C. Infection D. Elevated glucose E. Fluid and electrolyte change F. Adipose tissue redistribution (Cushing's syndrome) G. Diarrhea

A, B, C, D, E, and F The most common adverse effects of prednisolone are osteoporosis, ADRENAL INSUFFICIENCY, infection, elevated glucose, fluid and electrolyte change ( causes salt and fluid retention, which may lead to blood pressure elevation and increased potassium excretion and calcium execration is also increased), and adipose tissue redistribution ( Cushing's syndrome)

When teaching a patient about anti-TB agents, what advantage of these agents should a nurse include in their instructions/teaching? Select all that apply A. Kill or inhibit mycobacterial organism B. Often gives in combination C. Long and complex D. Directly observed therapy (DOT) E. Evaluation F. Keep the patient lying on the bed all day.

A, B, C, D, and E Kill or inhibit mycobacterial organism, Often given in combination: decrease drug resistance (mutation) and increase adverse effects; Long and complex: 6 MONTHS to 2 YEARS; DIRECTLY OBSERVED THERAPY (DOT)- health care provider directly observe patient swallowing pills everywhere all the time and provide education; Evaluation- NEGATIVE on SPUTUM CULTURE or CXR

What Safety Concerns should a nurse be aware of when caring for a patient taking anticoagulant or antiplatelet medication? Select all that apply. A. Bruising from venipuncture B. Monitor for subclinical bleeding (Gums, urine, stool) C. Use soft toothbrush D. No ASA or NSAID E. avoid cabbage, cauliflower, kale, spinach, some cheeses, egg yolks, liver and tomatoes. F. Blurry vision

A, B, C, D, and E Safety concerns for anticoagulants and antiplatelet are Bruising from venipuncture, monitor for subclinical bleeding (gums, urine, stool), use soft toothbrush, no OTC drugs without physician approval, no ASA or NSAIDs, for WARFARIN, avoid cabbage, cauliflower, kale, spinach, some cheeses, egg yolks, liver and tomatoes. PPT 34

A nurse is caring for a client who has a new prescription for Atropine. The nurse should monitor the client for which of the following adverse reactions to this medication? Select all that apply. A. Drying of oral/nasal mucosa B. Constipation C. Urinary retention D. Increase HR and arrhythmias E. Blurred vision and photophobia F Vomiting

A, B, C, D, and E ppt 33

A client is being treated with Magnesium hydroxide (Milk of Magnesia) for indigestion. When instructing the client about this medication. Which potential adverse effects of medication should the nurse communicate to or discuss with the client? Select all that apply. A. Fatigue B. Hypotension C. Diarrhea D. Dysrhythmias E. Hypermagnesemia in renal disease F. Constipation

A, B, C, D, and E A. Fatigue B. Hypotension C. Diarrhea D. Dysrhythmias E. Hypermagnesemia in renal disease Magnesium hydroxide is an antacid and can cause fatigue, hypotension, diarrhea, dysrhythmias, and hypermagnesemia in renal disease. It can be used as a laxative. PPt, slide 30th. P.S. Some combination of two antacids can cause metabolic alkalosis. PPt, slide 19th.

A client is being treated with Calcium carbonate (Titralac, Tums) for indigestion. When instructing the client about this medication. Which potential adverse effects of medication should the nurse communicate to or discuss with the client? Select all that apply. A. Constipation B. Aggravated kidney stones C. Milk-alkali syndrome, rebound hyperacidity D. Metabolic alkalosis E. Diarrhea

A, B, C, and D A. Constipation B. Aggravated kidney stones C. Milk-alkali syndrome, rebound hyperacidity D. Metabolic alkalosis Calcium carbonate is an antacid and can cause constipation, aggravated kidney stones, milk-alkali syndrome, rebound hyperacidity and metabolic alkalosis. P.S. Some combination of two antacids can cause Metabolic Alkalosis. PPt, slide 19th

What are adverse effects of nitroglycerin? Select all that apply A. Hypotension- Reflex tachycardia B. Headache and syncope C. Blurred vision D. Tolerance E. Morning cough and congestion

A, B, C, and D Ppt 17

A nurse is preparing to administer nitroglycerine to a client who has chest pain. Which of the following actions is appropriate? Select all that apply A. Check blood pressure and document before administration B. Assess chest pain location, duration, intensity and precipitating factors C. Protect nitroglycerin from light by keeping it in a brown bottle and wearing gloves when administering medication. D. Give nitroglycerin every 5 minutes for chest pain as needed x 3 times, then call 911 if not relieved. E. Tell client that increase exercise can help with chest pain

A, B, C, and D Ppt 19 and 21

A client with hyperlipidemia is being treated with lovastatin (Mevacor). When instructing the client about this drug, which possible adverse effects should the nurse be cautious about? Select all that apply. A. Diarrhea B. Constipation C. Rhabdomyolysis D. Cough

A, B, and C Adverse effects are diarrhea, constipation and rhabdomyolysis (myoglobin into blood-kidney damage). PPT 41

The nurse knows that what are the goals of antianginal drug therapy? Select all that apply A. To relieve acute anginal pain B. To prevent anginal episodes C. To prevent MI and sudden cardiac death D. To increase the vascularity of the heart

A, B, and C The goals of antianginal drug therapy are to relieve acute anginal pain, to reduce the number and severity of acute anginal attacks, to improve exercise tolerance and quality of life, to delay progression of CAD, to prevent MI, and to prevent sudden cardiac death. Antianginal drug therapy does not increase the vascularity of the heart.

The clinic nurse has administered several recommended vaccinations to a 2-month-old infant. Which discharge instructions should the nurse give to the patients? Select all that apply A. Notify the health-care provider if the infant has a high-pitched cry B. Use a humidifier in the infant's room to reduce congestion C. Give the infant the prescribed amount of acetaminophen for comfort D. Keep the infant in the patients' room at night for a few days E. Explain research does not support immunizations cause autism

A, C and E A high-pitched cry is a sign the infant has discomfort or problem with immunization. Acetaminophen is the treatment to manage the side effects of sore injection site and fever. Research in various countries has found no link between vaccines and autism spectrum disorders.

The use of corticosteroids in older adults may aggravate which conditions? Select all that apply A. Congenital heart failure B. Gout C. Diabetes mellitus D. Arthritis E. Contact dermatitis

A, C, and D A. Congenital heart failure C. Diabetes mellitus D. Arthritis Corticosteroids are used for the same conditions in older adults as in younger ones. Older adults are especially likely to have conditions that are aggravated by the drugs (e.g. congenital heart failure, hypertension, diabetes mellitus, arthritis, osteoporosis, increase susceptibility to infection, etc.). Consequently, risk-benefit ratios of systemic corticosteroid therapy should be carefully considered, especially for long-term therapy. It is used as a treatment for contact dermatitis.

The nurse determinate that the client understands an important principle in self-administration of hydralazine (Apresoline) when the client makes which of the following statements? A. " I should not drive until the response to drug therapy is determined." B. "I can stop taking this medication once I begin to feel better." C. "If I experience dizziness, I should take only half the dose." D. "I should avoid air travel while taking this medication."

A. " I should not drive until the response to drug therapy is determined." Clients who have recently been prescribed Hydralazine (Apresoline) may experience dizziness initially and should be instructed not to engage in activities that may be hazardous. Clients should always consult their health care providers before discontinuing antihypertensive medications (option B). Clients should report dizziness to the healthcare provider and should not adjust the dosage until the etiology of the problem is determined (option C). Client on this drug have no restriction on air travel (option D)

A nurse is providing teaching to a client who takes opioid pain medication and has a new prescription for docusate sodium. Which of the following statements by the client indicates an understanding of the teaching? A. " It might take up to 3 days for the medication to work." B. " I will take the medication for diarrhea." C. " I should drink 4 ounces of water when I take the medication." D. "I can take this medication along with mineral oil."

A. " It might take up to 3 days for the medication to work." The client understands docusate sodium is a stool softener, and the therapeutic effect might take up to 2 to 3 days to achieve. ppt slide 32

A nurse is caring for a client who has deep vein thrombosis and has been on heparin continuous infusion for 5 days. The provider prescribes warfarin PO without discontinuing the heparin. The client asks the nurse why both anticoagulants are necessary. Which of the following statements should the nurse make? A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." B. " I will call the provider to get a prescription for discontinuing the IV heparin today." C. " Both heparin and warfarin work together to dissolve the clots." D. " The IV heparin increases the effects of the warfarin and decreases the length of your hospital stay."

A. "Warfarin takes several days to work, so the IV heparin will be used until the warfarin reaches a therapeutic level." Heparin and warfarin are both anticoagulants that decrease the clotting ability of the blood and help prevent thrombosis formation in the blood vessels. However, these medications work in different ways to achieve therapeutic coagulation and must be given together until therapeutic levels of anticoagulation can be achieved by warfarin alone, which is usually within 1 to 5 days. When the client's PT and INR are within therapeutic range, the heparin can be discontinued.

The client with deep vein thrombosis is being treated with a HEPARIN infusion. The nurse would monitor for therapeutic effectiveness by noting which of the following? A. Activated partial thromboplastin time (aPTT) B. Prothrombin time (PT) C. Platelet counts D. International normalized ratio (INR)

A. Activated partial thromboplastin time (aPTT) An activated partial thromboplastin time (aPTT) is the appropriate laboratory value that should be monitored with HEPARIN infusions. When the client is receiving this drug, the results should be 1.5 to 2.0 times the client's baseline, or 60-80 seconds. This is typically performed every 6-8 hours. PPT 31 Option B is incorrect. A prothrombin time is used to monitor the effectiveness of WARFARIN. The normal prothrombin time is 11-15 seconds, although there is some variation depending on the source of the thromboplastin used in the test. For this reason, laboratories report a normal control value along with the client's results. Option C is incorrect. Another name for platelets is thrombocytes. They are involved in the cellular mechanism that leads to the formation of a blood clot. However, platelets are not affected by anticoagulants and are therefore not used in the monitoring of these drugs. Option D is incorrect. An INR is essentially the same as a prothrombin time (PT) and is used for WARFARIN monitoring. PPT 29

Methyldopa (Aldomet) is being initiated for a client with hypertension. Which of the following health teachings would be most appropriate for this drug? A. Avoid hot baths and showers and prolonged standing in one position. B. This drug may discolor the urine to a pinkish-brown color. C. You may experience bloating and weight gain. D. The tablet should be taken only with food or milk.

A. Avoid hot baths and showers and prolonged standing in one position. Hot baths and showers, prolonged standing in one position, and strenuous exercise may enhance orthostatic hypotension. Methyldopa does not discolor the urine (option 2). Bloating and weight gain are not typical adverse effects of methyldopa (option 3). Methyldopa can be taken without food (option 4). PPT 10 Adverse effects: Drowsiness, depression, sedation, decrease libido/impotence, hepatotoxicity, positive coombs test-anemia.

A nurse provides dietary teaching for a client who takes furosemide. The nurse should recommend which of the following foods as the best source of potassium? A. Bananas B. Cooked carrots C. Cheddar cheese D. 2% milk

A. Bananas The nurse should determine that bananas are the best food source to recommend because 1 cup of bananas contains 806mg of potassium. In addition to the potassium supplements the provider might prescribe, the client should increase his daily intake of foods that have high potassium content, such as bananas, orange juice, and spinach.

A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first? A. Check the client's vital signs B. Request a dietitian consult C. Suggest that the client rests before eating the meal D. Request an order for an antibiotic

A. Check the client's vital signs It is possible that the client's nausea is secondary to digoxin toxicity. By obtaining vital signs, the nurse can assess for bradycardia, which is a symptom of digoxin toxicity. The nurse should withhold the medication and call the provider if the client's heart rate is less than 60 bpm.

A nurse is teaching a client who has a new prescription for aluminum hydroxide to treat heartburn. The nurse should instruct the client to monitor and report which of the following adverse reactions? A. Constipation B. Flatulence C. Palpitations D. Headache

A. Constipation Aluminum hydroxide can cause constipation. The nurse should tell the client to increase fluid and fiber intake to reduce the risk for constipation.

A 23-year-old client has received Esomeprazole (Nexium)for peptic ulcer disease (PUD). What information should be included in the client's teaching regarding Esomeprazole? Select all that apply. A. Take 20-30 mins before first meal B. Takes 4 days to achieve maximal effects C. Reduce dyspepsia D. Reduce the cry

A. Take 20-30 mins before first meal B. Takes 4 days to achieve maximal effects C. Reduce dyspepsia Protonic pump inhibitors (PPIS) such as Esomeprazole, Pantoprazole and Lansoprazole should be taking 20-30 mins before first meal (proton pump activated by food), have short half life (about 1.5hr) but suppress acid for 24 hrs (irreversible), four days to achieve maximal effects (not all pump inactivated by first dose), and beneficial effects continued for 3-5 days after discontinued. Adverse effects of PPIs are headache, dizziness, nausea, vomiting, diarrhea and flatulence. PPT slides 12, 13, and 14.

A nurse is teaching a client who has asthma about how to use an albuterol inhaler. Which of the following actions by the client indicates an understanding of the teaching? A. The client holds his breath for 10 seconds after inhaling the medication. B. The client takes a quick inhalation while releasing the medication from the inhaler. C. The client exhales as the medication is released from the inhaler D. The client waits 10 min between inhalations

A. The client holds his breath for 10 seconds after inhaling the medication. The medication should be retained in the lungs for a minimum of 10 seconds so the maximum amount of the dosage can be delivered properly to the airways. To use the inhaler, the client exhales normally just prior to releasing the medication, inhales deeply as the medication is released, then holds the medication in the lungs for approximately 10 seconds prior to exhaling.

A nurse in a mental health clinic is caring for a client who has bipolar disorder and a prescription for an antipsychotic medication. The provider and nursing staff suspect the client is not adhering to his medication therapy. Which of the following interventions should the staff use to encourage the client's adherence? Select all that apply. A. Perform mouth checks following the administration of the medication B. Providing for once daily dosing C. Use sustained release forms D. Engage the client in conversation following medication administration E. Rotate staff that administer the medication

B,C,D B. Providing for once daily dosing C. Use sustained release forms D. Engage the client in conversation following medication administration Performing mouth checks following the administration of medication is incorrect. Mouth checks may not find pills that the client has hidden in his mouth. Providing for once-daily dosing is correct. Once-daily dosing of medications simplifies the therapy, making it easier for the client to comply. Use sustained-release forms to remain in the client's system longer, requiring less frequent dosing. Engaging the client in conversation following medication administration is correct. If the client is speaking, he will be less likely able to hide the medication in his mouth. The rotating staff that administers the medications is incorrect. Rotating treatment providers is an obstacle that increases the risk of a client's nonadherence to therapy.

A nurse is providing discharge teaching to a client who has asthma and new prescriptions for cromolyn and albuterol, both by nebulizer. Which of the following statements by the client indicates an understanding of the teaching? A. " If my breathing begins to feel tight, I will use the cromolyn immediately." B. " I will be sure to take the albuterol before taking the cromolyn." C. " I will use both medications immediately after exercising." D. " I will administer the medications 10 minutes apart."

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

A nurse is teaching a client who has a new prescription for docusate. Which of the following information should the nurse include in the teaching? A. " Do not take this medication before bedtime." B. " Take the medication with a full glass of water." C. " Expect abdominal pain with this medication." D. " Take this medication on an empty stomach."

B. " Take the medication with a full glass of water." The nurse should instruct the client to take this medication with a full glass of water, unless contraindicated, to reduce the risk for constipation. MOA: cause more water and fat to be absorbed into stool. Often used for prevention not treatment for constipation ( surgery, injury and MI) Adverse effects after taking this medication for a long time are abdominal cramping and diarrhea. PPt slide 32

A nurse is caring for a client who reports taking bisacodyl to promote a daily bowel movement. Which of the following assessment questions should be the nurse's priority? A. "What do your bowel movements look like?" B. "How long have you been taking the bisacodyl? C. "Do you take the bisacodyl with glass of milk? D. How often do you have a bowel movement?"

B. "How long have you been taking the bisacodyl? The most significant risk to this client is injury from dependency on laxatives, as bowel tone can be lost; therefore, the priority questions the nurse should ask the client is how long he has been using bisacodyl.

The community health nurse visits a client who has been prescribed atorvastatin (Lipitor). Which of the following statements, if made by the client, indicates that further teaching is necessary concerning this drug therapy? A. " I should try to maintain my body weight at an optimal level." B. "Most clients with lipid disorders have chest pain or shortness of breath." C. The best time for me to take this medication is before I go to bed." D. " I will avoid beverages that contain grapefruit juice."

B. "Most clients with lipid disorders have chest pain or shortness of breath." Most clients with lipid disorders are asymptomatic. A client should be instructed that maintenance of optimal body weight will help reduce unhealthy lipid level (option A). Because cholesterol biosynthesis in the liver is higher at night, statins with short half-lives such as lovastatin should be administered in the EVENING (option C). Grapefruit juice inhibits the metabolism of statins, allowing them to reach high serum levels (option D).

The client with rheumatoid arthritis is prescribed prednisone, a glucocorticoid, for an acute episode of pain. The client asks the nurse, Why can't I be on this forever since it helps the pain so much? Which statement is the nurse's best response? A. "The medication will cause you to have a buffalo hump or moon face." B. "The medication has long-term side effects, such as osteoporosis." C. " If you continue taking the medication, it may cause an Addisonian crisis." D." There are other medications that can be prescribed to help the pain."

B. "The medication has long-term side effects, such as osteoporosis." Prednisone has serious long-term side effects that can lead to possible life-threatening complications. Therefore, the client cannot take prednisone forever.

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion.

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

A nurse provides teaching to a client who has seizures and a new prescription for phenytoin. Which of the following information should the nurse provide? A. Phenytoin turns urine blue B. Alcohol increase the chance of phenytoin toxicity C. Avoid flossing the teeth to prevent gum irritation D. Take an antacid with the medication if indigestion occurs

B. Alcohol increase the chance of phenytoin toxicity The nurse should include in the home instructions that alcohol alters the blood level of phenytoin. It can increase the effect of phenytoin level. MOA: delay influx of sodium ions in the neurons and slow propagation and spread of abnormal discharges, Do not elevate seizure threshold. Adverse effects: CNS- lethargy, headache, drowsiness and dizziness; nystagmus (alteration of extraocular movements), confusion, ataxia, coma and seizure of high doses. PPt side 34

Which class of medications is identified by generic names ending in lol? A. Calcium channel blockers B. Beta-blockers C. Muscarinic antagonist D. Nonsteroidal anti-inflammatory drug NSAID

B. Beta-blockers The generic names for drugs of a particular type (class) usually have the same ending. For example, the names of all beta-blockers used to treat such disorders as high blood pressure end in "lol" (such as metoprolol and propranolol).

The nurse is talking with a group of clients with cardiac conditions who are taking diuretic therapy. The nurse explains that individuals prescribed furosemide (Lasix) should: A. Avoid consuming large amounts of cabbage, cauliflower, and kale B. Rise slowly from sitting or lying positions C. Count their pulse for 1 full minute before taking the medication D. Inject the medication subcutaneously around the umbilicus

B. Rise slowly from sitting or lying positions As a diuretic, Lasix may dramatically reduce the clients circulating blood volume thus producing episodes of orthostatic hypotension. Clients may minimize this effect by rising slowly from sitting or lying positions. The foods listed in option A are high in vitamin K but Lasix does not restrict the consumption of these foods. Monitoring pulse rate prior to administration of Lasix is not required (option C). Lasix is never administered subcutaneously (option D)

A nurse is reviewing the health history for a client who has angina pectoris and a prescription for propranolol hydrochloride PO 40 mg twice daily. Which of the following findings in the history should the nurse report to the provider? A. The client has a history of hypothyroidism B. The client has a history of bronchial asthma C. The client has a history of hypertension D. The client has a history of migraine headaches

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

A nurse is providing instructions about bowel cleansing with polyethylene glycol-electrolyte solution (MiraLAX, PEG) for a client who is going to have a colonoscopy. Which of the following information should the nurse include? A. " To prevent dehydration, drink an additional liter of fluid during preparation time." B. " Expect bowel movements to begin 3 hrs following completion of solution." C. " Abdominal bloating might occur." D. " Drink 400ml every hour until bowel movements are clean."

C. " Abdominal bloating might occur." While (MIRALAX, PEG) is well-tolerated, highly effective for colonoscopy prep. Adverse effects include dehydration, fluid and electrolytes depletion, nausea, bloating, and abdominal discomfort. ppt slide 30

A nurse is evaluating teaching on a client who has a new prescription for montelukast to treat asthma. Which of the following statements by the client indicates an understanding of the teaching? A. " I'll rinse my mouth after taking this medication." B. " I'II take this medication when I get an asthma attack." C. " I'II take this medication once a day in the evening." D. " I'II use a spacer device when I inhale this medication."

C. " I'II take this medication once a day in the evening." Montelukast, a leukotriene modified, is used to prevent asthma exacerbations. The client should take it on daily basis once a day in the evening.

A client is prescribed beclomethasone (Qvar), a glucocorticoid inhaler. Education by the nurse will include: A. "Check your heart rate because this may cause tachycardia." B. "Limit your coffee intake while on this drug." C. "Rinse your mouth out well after each use." D. "You may feel shaky and nervous after using this drug."

C. "Rinse your mouth out well after each use." Glucocorticoids can decrease the beneficial oral flora that will allow for an overgrowth of fungal infections such as candida. Rinsing the mouth removes any glucocorticoid drug deposited there, and prevents it from being swallowed. Thus it decreases the likelihood of toxicity through systemic absorption. Option 1 is incorrect because it is the bronchodilators (e.g., adrenergic agonists, anticholinergics, and xanthines) that are likely to cause tachycardia, not glucocorticoids. Option 2 is incorrect because it is the xanthines (e.g., aminophylline and theophylline) that are chemically related to caffeine, not the glucocorticoids. It would not be restricted with a glucocorticoid. Option 4 is incorrect because it is the bronchodilators (e.g., adrenergic agonists, anticholinergics, and xanthines) that are likely to cause the client to feel shaky and nervous.

What is the drug suffix for angiotensin-converting enzyme (ACE) inhibitors? A. -LOL B. -STATIN C. -PRIL D. -PARIN

C. -PRIL The suffix for ACE inhibitors is -pril. Examples: captopril and lisinopril.

What is the lab value which could be used for HEPARIN titration? A. WBC (White Blood Cells) B. Hemoglobin (Hgb) C. Activated partial thromboplastin time (aPTT) D, Potassium (K)

C. Activated partial thromboplastin time (aPTT) The most widely used laboratory assay for monitoring HEPARIN therapy is the activated partial thromboplastin time (aPTT)

A nurse provides teaching to a client who has emphysema and a new prescription for theophylline. Which of the following instructions should the nurse provide? A. Consume a high protein diet B. Administer the medication with food C. Avoid caffeine while taking this medication D. Increase fluids to 1 L/per day

C. Avoid caffeine while taking this medication The nurse should instruct the client that caffeine should be avoided while taking theophylline, as it can increase central nervous system stimulation.

The nurse is caring for a postrenal transplantation client taking cyclosporine. The nurse notes an increase in one of the client's vital signs, and the client is complaining of a headache. What vital sign is most likely increased? A. Pulse B. Respiration C. Blood pressure D. Pulse oximetry

C. Blood pressure Hypertension can occur in a client taking cyclosporine, and because this client is also complaining of a headache, the blood pressure is the vital sign to be monitored most closely. Other adverse effects include infection, nephrotoxicity, and hirsutism.

A female patient self-administers magnesium antacids. She presents to the office with symptoms of dizziness and weakness. The nurse knows that these symptoms are secondary to what common adverse effect of magnesium antacids? A. Hypercalcemia B. Hypocalcemia C. Diarrhea D. GERD

C. Diarrhea Magnesium antacids have high neutralizing capacity and may cause diarrhea and hypermagnesemia.

A nurse is reviewing the medical record of a client who reports taking pseudoephedrine (Sudafed) for sinus congestion as needed. The nurse should identify that pseudoephedrine is contraindicated for which of the following client condition? A. Eczema B. Migraines C. Hypertension D. Diverticulitis

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

A nurse is providing teaching to a client who has a new diagnosis of Parkinson's disease. On which of the following medications should the nurse prepare to instruct the client? A. Piperacillin/tazobactam B. Levothyroxine C. Levodopa/carbidopa D. Carbamazepine

C. Levodopa/ carbidopa Levodopa/carbidopa is the cornerstone of Parkinson's treatment. The nurse should prepare to instruct the client on the use of this medication. It is important that the medication be given to the patient on time. Timing of medication administration is critical for optimal therapeutic effect. The nurse also assesses the patient's blood pressure in the sitting and standing positions to identify signs of orthostatic hypotension. PPt 41 and 42 it is DOPAMINERGIC agent, monitor Dystonia as serious adverse effect.

A client who is taking an anticoagulant states, "I wake up every morning with arthritis pain, and I always take aspirin or ibuprofen." The nurse's response would be based on which of the following physiologic concepts? A. Aspirin and ibuprofen (Motrin) will counteract the therapeutic effects of many anticoagulants. B. Anticoagulants will reduce the half-life of drugs such as aspirin and ibuprofen C. Many substances such as aspirin and ibuprofen will increase the risk of bleeding D. The combination of aspirin products with anticoagulants will worsen arthritis pain

C. Many substances such as aspirin and ibuprofen will increase the risk of bleeding Many drugs such as aspirin and ibuprofen have strong anticoagulant effects. When the client on Warfarin (Coumadin) takes these drugs, essentially more anticoagulant (bleeding) effects can be hazardous. Option A is incorrect. Drugs such as aspirin and ibuprofen do not neutralize the effect of an anticoagulant. These drugs enhance the bleeding tendencies of anticoagulants. Option B is incorrect. Anticoagulants do not influence the half-life of any drugs. Option D in incorrect. The pain associated with arthritis is not worsened by the combination of these drugs.

A nurse is caring for a client who has a new prescription for propranolol. The nurse should monitor the client which of the following adverse reactions to this medication? A. Ototoxicity B. Tachycardia C. Postural hypotension D. Hypokalemia

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

A male patient present to the physician 's office for the results of his exercise-tolerance test and for modification of his medication regimen. The physician informs the patient that he experiences tachycardia that, based on his history, may precipitate anginal episodes. Based on this information, what would the nurse expect the physician to order? A. Nifedipine B. Acetaminophen C. Propranolol D. Aspirin

C. Propranolol Propranolol, the prototype beta-blocker, is used to reduce the frequency and severity of acute attacks of angina, used to reduce blood pressure and is especially useful in preventing exercise-induced tachycardia., which can precipitate angina attacks.

The physician prescribes Nifedipine calcium channel blockers for a patient who is diagnosed with angina pectoris. What is the action of calcium channel blockers? A. Induce coronary artery vasospasm B. Increase blood pressure to increase oxygenation to the myocardium C. Reduce coronary artery disease and hypertension and improve blood supply to the myocardium. D. Prevent anginal episodes

C. Reduce coronary artery disease and hypertension and improve blood supply to the myocardium. In angina pectoris, calcium channel blockers improve blood supply to the myocardium, by dilating coronary arteries and decrease the workload of the heart by dilating peripheral arteries and reduce coronary artery vasospasm.

Nitroglycerin topical ointment is being initiated for a client with angina. Which of the following health teachings would be most appropriate? A. Keep the medication in the refrigerator. B. Only take this medication when chest pain is severe. C. Remove the old paste before applying the next dose. D. Apply the ointment on the chest wall only.

C. Remove the old paste before applying the next dose.

A nurse is providing teaching to a client who has asthma and a new prescription for inhaled beclomethasone (Qvar). Which of the following instructions should the nurse provide? A. Check the pulse after medication administration B. Take the medication with meals C. Rinse the mouth after administration D. Limit caffeine intake

C. Rinse the mouth after administration Use of glucocorticoids by metered dose inhaler can allow a fungal overgrowth in the mouth. Rinsing the mouth after administration can lessen the likelihood of this complication.

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following actions is appropriate? A. Withholding the medication if the heart rate is above 100 bpm B. Instructing the client to eat foods that are low in potassium C. Measuring apical pulse for 30 seconds before administration D. Evaluating the client for nausea, vomiting, and anorexia

D. Evaluating the client for nausea, vomiting, and anorexia Loss of appetite, nausea, vomiting, and blurred or yellow vision may be signs of digoxin toxicity. Digoxin is a frequent cause of adverse effects in older adults. Reduced dosages because of decreased liver and kidney function, decreased lean body weight, and advanced cardiovascular disease. Impaired renal function leads to slower drug excretion and increased risk of accumulation.

Which type of food should be avoided while taking Isoniazid (INH) medication? A. Foods containing vitamin A B. Foods containing vitamin C C. Foods containing omega 3 D. Foods containing Tyramine

D. Foods containing Tyramine Avoid foods containing Tyramine ( aged cheeses, smoked or pickled fish, chocolate, and red wine) to prevent flushing, palpitation, and blood pressure elevation.

Which medication is classified as an Expectorant? A. Metoprolol B. Acetaminophen C. Rifampin D. Guaifenesin

D. Guaifenesin Guaifenesin (Robitussin) reduces the viscosity of tenacious secretions and EASIER mobilization and expectoration of respiratory secretions.

Which of the following laboratory findings would cause the nurse to be concerned about digoxin (Lanoxin) toxicity? A. Hypocalcemia B. Hypermagnesemia C. Hyperbilirubinemia D. Hypokalemia

D. Hypokalemia A low potassium level, or hypokalemia, can increase the likehood of toxicity. Hypercalcemia tends to increase the client's sensitivity to digoxin preparations, not hypocalcemia (option A). Hypomagnesemia, not hypermagnesemia, could potentiate the possibility of digitalis toxicity (option B). Hyperbilirubinemia does not potentiate the action of digoxin (option C)

The client with deep vein thrombosis is being treated with a heparin infusion. Which of the following indicates the appropriate nursing care need to be reinforced? A. Inject medication in the deep fatty layer of the abdomen B. When assessing blood pressure, release cuff pressure as soon as possible C. Hold direct pressure on venipuncture sites for 10 minutes D. Instruct client on the importance of using dental floss daily

D. Instruct client on the importance of using dental floss daily Dental flossing is prohibited while the client is receiving anticoagulants. The flossing can cause gum irritation and excessive bleeding. Option A is incorrect. When heparin is given subcutaneously it is routinely given in the subcutaneous fat found on the abdomen. The reason for this action is twofold. First, the absorption rate is ensured when this location is used. Secondly, most people have sufficient subcutaneous tissue in the abdominal area. Option B is incorrect. Client receiving heparin must be protected from injury. When taking a blood pressure, the cuff pressure must be released as soon as possible to avoid bruising of the upper arm. Option C is incorrect. It is critical that the nurse carefully monitor all venipuncture sites for bleeding. When venipuncture is done for laboratory or diagnostic tests, it is important that direct pressure be applied to the site to avoid bleeding into the tissue.

A patient is difficult to arouse after IV administration of morphine. The patient has a respiratory rate 7 breaths/min. Which drug should the nurse have on hand to counteract an overdose? A. Tramadol (Ultram) B. Acetaminophen (Tylenol) C. Ketorolac (Toradol) D. Naloxone (Narcan)

D. Naloxone (Narcan) Naloxone is the preferred medication to treat respiratory depression caused by opioids, with a RESPIRATORY RATE LESS THAN 10bpm.

A nurse is assessing a client who is on long term omeprazole therapy. Which of the following findings should indicate to the nurse that the medication is effective? A. Increased appetite B. Regular bowel movements C. Absence of headache D. Reduced dyspepsia

D. Reduced dyspepsia Omeprazole, a proton pump inhibitor, reduces gastric acid secretion and treats duodenal and gastric ulcers, prolonged dyspepsia, gastrointestinal reflux disease, and erosive esophagitis.

A nurse is teaching a client about taking an expectorant such as Guaifenesin ( Robitussin, Mucinex) to treat a cough. The nurse should explain that this type of medication has which of the following actions? A. Reduces inflammation B. Suppresses the urge to cough C. Dries mucous membranes D. Stimulates secretions

D. Stimulates secretions Expectorants act by increasing secretions to improve cough productivity ( reduce thickness or viscosity of bronchial secretions)

A nurse is providing discharge instructions to a client who has asthma and is about to start taking theophylline (Theo-24). The nurse should tell the client that this medication might cause which of the following adverse effects? A. Drowsiness B. Constipation C. Oliguria D. Tachycardia

D. Tachycardia Theophylline can increase cardiac stimulation and cause tachycardia. Also, the rate of metabolism of theophylline is increased substantially in cigarette smokers. In addition, caffeine reportedly produces additive cardiac and CNS stimulation.

What are the contraindications and precautions that nurses need to be aware of when administering corticosteroid medications? (Select all that apply) a. Do not administer live virus (vaccines) to a patient taking steroids. b. Never administer corticosteroids with known fungal infection c. Keep the patient in bed while administering the oral dose of corticosteroids. d. Tell the patient that he/she can continue smoking while taking corticosteroids.

a & b a. Do not administer live virus (vaccines) to a patient taking steroids. b. Never administer corticosteroids with known fungal infection Contraindications and precautions with corticosteroids are never administer corticosteroids with known fungal infection. Do not administer live virus vaccines to clients taking steroids (suppressed immune response). When given to a patient with a history of tuberculosis, it may reactivate diseases: increase pre-existing hypertension, worse pre-existing peptic ulcers, mask infection, elevate glucose in diabetes, and worsen obesity, osteoporosis in the elderly, preexisting eye infection.

A nurse is caring for a child who is experiencing status asthmaticus. Which of the following interventions is the priority for the nurse to take? A. Administer a short acting B2-agonist (SABA) Sort acting beta2 agonist B. Obtain a peak flow reading C. Administer an inhaled glucocorticoid D. Determine the cause of the acute exacerbation

A. Administer a short acting B2-agonist (SABA) Sort acting beta2 agonist When using the urgent versus non-urgent approach to client care, the nurse should determine that the priority action is to administer a nebulized high-dose SABA to relieve bronchoconstriction and improve ventilation. Albuterol ( Proventil) is a medication that is commonly used as a rescue inhaler. Adverse effects are Tachycardia, angina, and tremors.

Which clients should the nurse question administering a live virus vaccine? Select all that apply. A. The child who is afraid of needles and health-care personnel. B. The child who lives with a grandparent undergoing chemotherapy. C. The child who has not received an immunization previously D. The child whose parents are Jehovah's Witnesses E. The child on prednisone who is immunosuppressed

B & E B. The child who lives with a grandparent undergoing chemotherapy. E. The child on prednisone who is immunosuppressed The child will shed the vaccine in the urine and feces. The grandparent is immunocompromised as a result of the chemotherapy and could become ill. This child should receive an inactivated vaccine. The nurse should question this vaccine. This child is immunocompromised and could become ill and should receive an inactivated vaccine.

A nurse is providing discharge teaching to a client who has pulmonary tuberculosis and a new prescription for rifampin. Which of the following information should the nurse provide? A. " Treatment with this medication will last for 1 month." B. " This medication can cause insomnia." C. " It is best to take the medication with meals." D. " Urine and other secretions might turn orange."

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

The patient of a child who received an immunization for varicella earlier in the day calls the clinic and tells the nurse that the child now has chickenpox because the child has a fever of 101F. Which statement is the nurse's best response? A. "You signed a permit knowing this might happen as a result." B. "You need to take the child to the emergency department now." C. "Has the child been exposed to any illness recently?" D. "This is a reaction to the injection, but it is not chickenpox."

D. "This is a reaction to the injection, but it is not chickenpox." The varicella vaccine can cause a fever spike to 102F, a mild rash with a few lesions, and pain and redness at the injection site. The nurse should tell the patients how to care for the child.

A nurse is instruction a client who is receiving tacrolimus (Prograf) following a liver transplant. Which point should be included in the teaching plan? A. Take a "baby" strength aspirin every day B. Increase physical activity to avoid weight gain C. Record radial pulse rate every morning in the journal D. Avoid raw fruits and vegetables and eat only fully cooked meals

D. Avoid raw fruits and vegetables and eat only fully cooked meals Tacrolimus (Prograf) is a potent immunosuppressant and clinicals should decrease their risk for infection by taking precautions such as avoiding raw fruits and vegetables that may harbor pathogens on the skin or inside, and by eating fully cooked meals after the heat of cooking has destroyed pathogens. Option 1,2 and 3 are incorrect. Aspirin may increase GI irritation, placing the client at risk for GI infections gaining entry through the inflamed mucosa. Physical activity is important to overall health but this drug has no direct connection with weight gain. Tacrolimus (Prograf) is not known to have significant cardiac effects, although HTN is a possible adverse effect, and the blood pressure should be monitored.

A nurse is teaching a client who has a new prescription for prednisone to treat rheumatoid arthritis. The nurse should inform the client that which of the following is a therapeutic effect of this medication? A. Reduces risk of infection B. Improves peripheral blood flow C. Increases bone density D. Decreases inflammation

D. Decreases inflammation Prednisone is used to treat rheumatoid arthritis because it produces anti-inflammatory and immunosuppressive effects, which reduces inflammation, decreases pain, and increases mobility.

A client is being treated with Aluminum hydroxide for indigestion. When instructing the client about this medication. Which potential adverse effects of medication should the nurse communicate to or discuss with the client? Select all that apply. A. Diarrhea B. Constipation C. Hypophosphatemia (phosphate depletion) D. Cough

b & c B. Constipation C. Hypophosphatemia (phosphate depletion) Aluminum hydroxide (AlternaGel) is an antacid and can cause constipation and hypophosphatemia (phosphate depletion). PPt- slide 19th P.S. Some combinations of two antacids can cause Metabolic Alkalosis.

A nurse is caring for a patient who has a prescription for potassium chloride (KCL) 20mEg PO daily. The nurse reviews the patient's most recent laboratory results and finds the client's potassium level is 5.2mEq/L. Which of the following actions should the nurse take? a. Give the ordered KCL as prescribed b. Omit the KCL dose and document it was not given c. Call the prescribing physician and inform her of the patient's serum potassium level results d. Call the lab to verify the patient's results.

c. Call the prescribing physician and inform her of the patient's serum potassium level results As a potassium level of 5.2mEq/L is above the expected reference range, the nurse should hold the medication and notify the provider of the patient's serum potassium level. Normal serum potassium level is 3.5to 5.0 mEq/L

A nurse is caring for a patient who is receiving subcutaneous insulin injections. What are the important teaching points a nurse should cover when providing discharge instructions to a patient? Select all that apply. A. Rotate injection sites B. Insulin doses must be adjusted with stress, infection, or pregnancy C. Teach patient with S/S of hypoglycemia and hyperglycemia D. Do not give Insulin when blood sugar less that 70 mg/dl or with the signs of hypoglycemia ( anxious, nervous, confusion, weakness) E. Emphasize the importance of compliance to regimen F. Do not check the blood glucose level before administering Insulin.

A, B, C, D, and E PPt- slide 33

The nurse determines that the client understands an important principle of chemotherapy when the client makes which statement? A) " The use of multiple chemotherapy drugs affects different stages of the cancer cell's life cycle." B) " Staging describes the process of determining how responsive the cancer is to the prescribed chemotherapy." C) " Antineoplastic drugs kill the entire tumor, including the clones, and prevent repopulation." D) Combination chemotherapy requires higher dosages of each individual agent and increases toxicity."

A) " The use of multiple chemotherapy drugs affects different stages of the cancer cell's life cycle." The use of multiple drugs affects different stages of the cancer cell's life cycle and attacks the various clones within the tumor via several mechanism of action, thus increasing the percentage of cell kill. Combination chemotherapy also allows lower dosages of each individual agent, thus reducing toxicity and slowing the development of resistance. Option B, C, and D are incorrect. Staging describes the process of determining the extent of cancer in the body and where the cancer is located. Antineoplastic drugs may kill only a small portion of the tumor, leaving some clones unaffected and able to repopulate the tumor with resistant cells.

The nurse is collaborating with the interdisciplinary team regarding the care of a client with a brain tumor. The nurse knows that the most common reason that subsequent rounds of chemotherapy may be delayed is due to what condition? A) Myelosuppression B) Alopecia C) Mucositis D) Cachexia

A) Myelosuppression Myelosuppression is the most common dose-limiting adverse effect of chemotherapy, and the one that most often causes discontinuation or delays of chemotherapy. Although alopecia may be distressing for the client, its presence does not determine when the next round of chemotherapy can be administered (option B). Mucositis is not a reason that subsequent rounds of chemotherapy should be delayed ( option C). Cachexia is the physical wasting with loss of weight and muscle mass caused by disease. Although it is considered, it is not the most common reason for delaying chemotherapy (option D)

The nurse is reviewing the history and physical examination of a client who will be receiving asparaginase, an antineoplastic agent. The nurse contacts the primary health care provider before administering the medication if which disorder is documented in the client's history? A) Pancreatitis B) Diabetes mellitus C) Myocardial infarction D) Chronic obstructive pulmonary disease

A) Pancreatitis Asparaginase is contraindicated if hypersensitivity exists, in pancreatitis or if the client has a history of pancreatitis. The medication impairs pancreatic function, and pancreatic function tests should be performed before therapy begins and when a week or more has elapsed between dose administration. PPt slide 39 and slide 5. Adverse effects are impaired pancreatic functions, hyperglycemia and pancreatitis.

A client has been receiving vincristine (Oncovin) as one of the drugs in a chemotherapy regimen. What important finding will the nurse monitor to prevent or limit the main dose-related toxicity for this client? Select all that apply A) Numbness of the hands or feet B) Angina and dysrhythmias C) Constipation D) Diminished reflexes E) Dyspnea and pleuritis

A, B and D The main dose-limiting toxicity to occur with vincristine is neurotoxicity. Numbness of the hands and feet, constipation related to decreased peristalsis, and diminished reflexes are all signs of neurotoxicity.

The patient is currently taking benzodiazepine medication. What are the nursing concerns associated with this group of medications? Select all that apply. A. Assess baseline vital signs and LOC B. Slow IV push or infusion C. Avoid driving or operating machinery D. Warning for taking alcohol together E. Benzodiazepines not address pain issues F. Taper needed; sudden withdrawal causing status EPILEPTICUS G. I can do it, I just need to study a little bit more

A, B, C, D, E, and F PPt, slide 28th Medications from PPt are Diazepam, Alprazolam, and Chlordiazepoxide.

The nurse is monitoring the intravenous (IV) infusion of an antineoplastic medication. During the infusion, the client complains of pain at the insertion site. On inspection of the site, the nurse notes redness and swelling and that the infusion of the medication has showed in rate. The nurse suspects extravasation and should take which actions? Select all that apply. A) Stop the infusion B) Prepare to apply ice and heat to the site C) Restart the IV at a distal part of the same vein D) Notify the primary health care provider (PHCP) E) Prepare to administer a prescribed antidote into the site F) Increase the flow rate of the solution to flush the skin and subcutaneous tissue

A, B, D, and E If the nurse suspects extravasation during the IV administration of an antineoplastic medication, the infusion is stopped and the PHCP is notified. Ice heat may be prescribed for application to the site. Increasing the flow rate or restarting an IV in the same vein can increase damage to the tissue PPt slide 51

The nurse is monitoring a client who was diagnosed with type 1 diabetes mellitus and is being treated with NPH and regular insulin. Which manifestations would alert the nurse to the presence of a possible hypoglycemic reaction? Select all that apply. A. Tremors B. Anorexia C. Irritability D. Nervousness E. Hot, dry skin F. Muscle cramps

A, C, and D Decreased blood glucose levels produce autonomic nervous systems, which are manifested classically as nervousness, irritability, and tremors. PPt- slide 33

What is the best site for subcutaneous injection of heparin? A. Abdomen B. Upper chest C. Hands D. Hip

A. Abdomen To minimize the pain and bruising associated with heparin injections, the medication is given subcutaneously on the right or left side of the abdomen, at least 5 cm (2 inches) away from the umbilicus.

A client with non-Hodgkin's lymphoma is receiving doxorubicin. Which finding would indicate to the nurse that the client is experiencing an adverse effect related to the medication? A) Fever B) Sores in the mouth and throat C) Complaints of nausea and vomiting D) Crackles on auscultation of the lungs

D) Crackles on auscultation of the lungs Cardiotoxicity noted by abnormal electrocardiographic finding or cardiomyopathy manifested as heart failure ( lung crackles) is an adverse effect of doxorubicin. PPt side 37 and slide 3

A nurse is assessing an elderly patient who is taking digoxin. The nurse should be aware of which of the following symptoms could indicate digoxin toxicity? A. Anorexia B. Ataxia C. Photosensitivity D. Jaundice

A. Anorexia GI assessment is crucial in determining the onset of digoxin toxicity. Anorexia, vomiting, confusion, headache, and vision changes are manifestations of digoxin toxicity.

Which of the following assessment findings would the nurse not attribute to the effects of thyroid hormone replacement therapy? A. Constipation and weight gain B. Increased heart rate and cardiac output C. Decreased reports of fatigue D. Decreased blood cholesterol levels

A. Constipation and weight gain The effects of thyroid hormone replacement therapy include diarrhea and weight loss, not constipation and weight gain, which are likely to be present due to a deficiency in thyroid hormone ( Option A). All the other options: increased heart rate and cardiac output ( Option B), decreased reports of fatigue (Option C), and decreased blood cholesterol levels (Option D), are actual effects of thyroid hormone replacement.

Which of the following assessment findings would indicate therapeutic goals have been achieved for a client with diabetes insipidus being treated with vasopressin? A. Decreasing signs of dehydration B. Increasing pulse and urine output C. Decreasing urine specific gravity D. Decreasing hyperglycemia

A. Decreasing signs of dehydration A client with DI who is responding to therapy with vasopressin would have decreasing signs of dehydration. DI is characterized by large volume urine output with a very low urine specific gravity accompanied by signs of dehydration, including complaints of thirst and an increased pulse rate. Therefore option B is incorrect because the client responding to vasopressin therapy would see a lowered pulse rate related to a decrease in urine output. Vasopressin therapy would cause the urine specific gravity to increase, not decrease ( Option C). Blood glucose levels are not affected by vasopressin (Option D). PPt slide 61 Vasopressin is an Antidiuretic hormone (ADH) MOA: supply ADH to maintain correct vascular tones and urine output.

A nurse is teaching a client who has a new prescription for diazepam, Which of the following information should the nurse include in teaching? A. Diazepam can cause drowsiness B. This medication must be swallowed whole C. It is important to avoid foods that contain tyramine D. Grapefruit juice inactivates this medication

A. Diazepam can cause drowsiness Diazepam has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam.

A client who is taking an Alpha-adrenergic antagonist for hypertension complains of dizziness when first getting out of bed in the morning. The nurse should advise the client to A. Move slowly from the recumbent to the upright position B. Drink a full glass of water before rising to increase vascular circulatory volume. C. Avoid sleeping in the prone position D. Stop taking the medication

A. Move slowly from the recumbent to the upright position The nurse should suspect that the client is describing orthostatic hypotension caused by medication intake (First dose orthostatic phenomenon) ppt 18. Medications Prazosin (Minipress) and Phentolamine (Regitine). Most clients find moving slowly from a recumbent position helpful to avoid dizziness and syncope. Option B is incorrect because although drinking a full glass of water with the medication is a health promotion activity that the nurse might suggest, this action does not eliminate orthostatic hypotension.

A nurse is monitoring a client newly diagnosed with diabetes mellitus for signs of complications. Which sign or symptom, if frequently exhibited in the client, indicates that the client is at risk for chronic complications of diabetes if the blood glucose is not adequately managed? A. Polyuria B. Diaphoresis C. Pedal edema D. Decreased respiratory rate

A. Polyuria Chronic hyperglycemia, resulting from poor glycemic control, contributes to the microvascular and macrovascular complications of diabetes mellitus. Classic symptoms of hyperglycemia include polydipsia,( excessive thirst) polyuria (excessive urine), and polyphagia ( excessive hunger). PPt- slides 29, and 31

A nurse is taking a health history of a client who reports occasionally taking several over-the- counter medications, including an H2 receptor antagonist (H2RA). Which of the following outcomes indicates the H2RA is therapeutic? A. Relief of heartburn B. Cessation of diarrhea C. Passage of flatus D. Absence of constipation

A. Relief of heartburn H2RAs are used to treat duodenal ulcers and prevent their return. In over-the-counter strengths, these medications, such as cimetidine and famotidine, are used to relieve or prevent heartburn, acid indigestion, and sour stomach.

The client taking atorvastatin (Lipitor) reports decreased urine output, edema, and weight gain. The nurse initially assesses the client for which of the following conditions? A. Rhabdomyolysis B. Rhabdomyoma C. Rhabdomyosarcoma D. Rhinorrhea

A. Rhabdomyolysis Rhabdomyolysis is a serious adverse effect of the statins. During rhabdomyolysis, contents of muscle cells spill into the systemic circulation, causing potentially fatal acute renal failure. Early signs of renal failure include decreased urine output, edema, and weight gain. Option 2, rhabdomyoma, is a benign tumor derived from striated muscle. Option 3, rhabdomyosarcoma, is a malignant tumor derived from striated muscle. Option 4, rhinorrhea, is the free discharge of thin nasal mucus.

A nurse is teaching a client who has a new prescription for Lithium to treat bipolar disorder. The nurse should instruct the client to ensure an adequate intake of which of the following dietary elements? A. Sodium B. Potassium C. Vitamin K D. Vitamin C

A. Sodium Lithium is a salt. It is an alkaline earth element that is used medicinally in the form of salts such as lithium chloride and lithium carbonate. If sodium level falls, the client will retain lithium and have an increased risk for lithium toxicity. Baseline electrolyte studies are also necessary. PPt, slide 52

A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects? A. Tardive dyskinesia B. Parkinsonism C. Dystonia D. Akathisia

A. Tardive dyskinesia These findings indicate tardive dyskinesia, which can develop in clients during long-term therapy with chlorpromazine (topazine). For many clients, the manifestations are irreversible. Patient may experience lip smacking, tongue protrusion, and facial grimaces and may have chronic movements of trunk and limps. PPt slide 56

A male patient presents to the physician's office for a regular visit. He takes nitrates on a regular schedule for his anginal episodes and has done so for 3 years. Which statement would the nurse expect from the patient about the action of the nitrates? A. " They eliminate my chest pain as they always have." B. "They do not work as well to manage my chest pain as they used to." C. "They're causing dizziness, which I haven't experienced in the past." D. "They're causing increased chest pain and discomfort."

B. "They do not work as well to manage my chest pain as they used to." Patient who takes long-acting dosage forms of nitrates on a regular schedule develop tolerance to the vasodilating effects of the drug.

What is generic drug suffix for proton pump inhibitor? A. -Lol B. -Prazole C. -Tidine D. -Terol

B. -Prazole The general drug suffix for proton pump inhibitor is Prazole, for Histamine 2 antagonist is Tidine.

A client was started on rosiglitazone (Avandia) for type 2 diabetes. He tells the nurse that he has been taking it for 5 days, but his glucose level are unchanged. The nurse's best response is: A. " You should double the dose. It should start helping." B. " You need to give the drug more time. It can take several weeks before it becomes effective." C. " You will need to add a second drug since this one has not been effective." D. " You most likely require insulin now."

B. " You need to give the drug more time. It can take several weeks before it becomes effective." It can take several weeks for this drug to provide therapeutic effects, so the appropriate response would be to give this drug more time to reach effectiveness. It would not be appropriate for the nurse to change a client's dose (Option 1), and a second drug (Option 3), or tell the client he will be needing insulin (Option 4). PPt- slide 70

A client with type 1 diabetes mellitus who takes NPH (neutral protamine hagedorn) daily in the morning calls the nurse to report recurrent episodes of hypoglycemia with exercising. Which statement by the client indicates an adequate understanding of the peak action of NPH insulin and exercise? A. "I should not exercise since I am taking insulin." B. "The best time for me to exercise is after breakfast." C. "The best time for me to exercise is mid to late afternoon." D. "NPH is a basal insulin, so I should exercise in the evening."

B. "The best time for me to exercise is after breakfast." A hypoglycemic reaction may occur in response to increased exercise, so clients should exercise either an hour after mealtime or after consuming a 10 to 15 g. carbohydrate snack, and they should check their blood glucose level before exercising. PPt- slide 60

During the first postoperative day following a craniotomy, a client is noted to have produced 2,400 ml of urine with a specific gravity of 1,001. The nurse suspects that the client has developed: A. Syndrome of inappropriate antidiuretic hormone B. Diabetes insipidus C. Excessive urination from fluid given during surgery D. Adverse effects of opioids used for pain management

B. Diabetes insipidus The nurse would suspect diabetes insipidus (DI), which manifests as large amounts of very dilute urine with a specific gravity of less than 1.005 due to a lack of antidiuretic hormone. This can occur as an acute problem following surgery or head injury. SIADH ( Syndrome of Inappropriate Antidiuretic Hormone Secretion) occurs as a result of the excretion of excess antidiuretic hormone, which results in marked fluid retention (option A). Excessive use of fluid during surgery would produce an increased amount of urine, but the excess fluids would be eliminated more gradually than 2400ml and would have a normal specific gravity level (Option C). Opioid analgesics do not cause a large urine output; they are more likely to cause urine retention and difficulty voiding. (Option D)

Which of the following health teaching concepts should the nurse review with a client receiving anticholinergic drug therapy? The client should be taught to: A. Exercise daily to avoid muscle atrophy B. Increase dietary fiber and water intake to avoid constipation C. Consume foods high in iron to increase red blood cell production D. Monitor the heart rate for bradycardia

B. Increase dietary fiber and water intake to avoid constipation (ppt. 31,2,33,34) Anticholinergic drugs can cause constipation. Therefore increases in dietary fiber and water intake will help avoid constipation. Option A is incorrect because although daily exercise helps in avoiding muscle atrophy, anticholinergic agents are not related to muscle atrophy. Option C, consuming foods high in iron to increase red blood cell production, is not related to anticholinergic drugs. Option D is incorrect because anticholinergic drugs cause tachycardias not bradycardia.

Which statement best describes how methotrexate (MTX) can be used for the treatment of cancer clients? A. Inhibit pyrimidine pathway of cancer cells B. Prohibit folic acid synthesis of cancer cells C. Block DNA synthesis by intercalation D. Disrupt purine synthesis of cancer cell

B. Prohibit folic acid synthesis of cancer cells Methotrexate (MTX) (folate antagonist) blocks some of the actions of folic acid, which can lead to side effects such as mouth sores, abdominal pain, liver problems, hair loss, and anemia. PPt- slide9

A nurse is caring for a patient who is taking glyburide as treatment for type 2 diabetes mellitus. The physician has added a corticosteroid to this patient's medication regimen for treatment of a severe allergic reaction. The nurse knows that this drug combination may cause what adverse effect on this patient? A. The patient is at risk for hypoglycemia B. The patient is at risk for hyperglycemia C. The patient will experience nausea and vomiting D. The patient will experience rash and fever.

B. The patient is at risk for hyperglycemia Corticosteroids increase insulin needs so the patient may develop hyperglycemia. PPt- slide 67 Glyburide- oral diabetic drugs (Sulfonylureas) MOA: Stimulate release of insulin from pancreatic beta cells and increase sensitivity of peripheral tissues to insulin Contraindicated to someone who is allergic to Sulfa.

The nurse is providing education to a patient prescribed spironolactone (Aldactone) and furosemide (Lasix). What information does the nurse explain to the patient? A. Using two drugs increases blood osmolality and the glomerular filtration rate. B. This combination promotes diuresis but decreases the risk of low levels of potassium. C. The lowest dose of two different types of diuretics is more effective than a large dose of one type. D. This combination maintains water balance to protect against dehydration and electrolyte imbalance.

B. This combination promotes diuresis but decreases the risk of low levels of potassium. This combination promotes diuresis but decreases the risk of low levels of potassium. Correct Spironolactone is a potassium-sparing diuretic; furosemide is a potassium-losing diuretic. Giving these together minimizes potassium loss. PPT 18, 19, and 21

What are 4 cardinal (major) symptoms of Parkinson's disease?

Bradykinesia: slow movements Rigidity: stiffness of the arms, legs or neck Tremors Postural instability: balance issues

A client has received chemotherapy 3 days a week every 4 weeks for the past 9 months. The client's current lab values are Hgb 10.3, Hct 31, WBC 3000, neutrophils 50, and platelet 189,000. Which information should the nurse teach the client? (Select all that apply) A. Use a soft-bristled toothbrush and electric razor. B. Plan for periods of rest to prevent fatigue. C. Do not allow the patient to eat raw fruit or have plants/flowers in the room. D. Maintain nutritional status with supplements. E. Avoid individuals with colds or other infections.

C & E A patient has neutropenia because their WBC count is low. The normal range of WBC is less than 5,000 to 11,000. The normal range of hematocrit is 36 to 48. The normal range of hemoglobin is 12 to 16. The normal range of platelets is 150,000 to 450,000. The normal range of neutrophils is between 2,500 to 6, 000.

A clinic nurse prepares a teaching plan for a client receiving an antineoplastic medication. When implementing the plan, the nurse should make which statement to the client? A) "You can take aspirin as needed for headache." B) "You can drink beverage containing alcohol in moderate amounts each evening." C) "You need to consult with the primary health care provider (PHCP) before receiving immunization." D) " It is fine to receive a flu vaccine at the local health fair without PHCP approval because the flu is so contagious."

C) "You need to consult with the primary health care provider (PHCP) before receiving immunization." Because antineoplastic medications lower the resistance of the body, clients must be informed not to receive immunizations without the PHCP's approval. Clients also need to avoid contact with individuals who have recently received a live virus vaccine. Clients need to avoid aspirin and aspirin-containing products to minimize the risk of bleeding, and they need to avoid alcohol to minimize the risk of toxicity and side/adverse effects.

The nurse is monitoring the laboratory results of a client receiving an antineoplastic medication by the intravenous route. The nurse plans to initiate bleeding precautions if which laboratory result is noted? A) A clotting time of 10 minutes B) An ammonia level of 15mcg/dl ( 6mcmol/L) C) A platelet count of 50,000 mm3 D) A white blood cell count of 5000 mm3

C) A platelet count of 50,000 mm3 Bleeding precautions need to be initiated when the platelet count decreases. The normal platelet count is 150,000 to 450,000 mm3. When the platelet count decreases, the client is at risk of bleeding. Normal clotting time in a person is between 8-15 minutes. Normal ammonia level is 15 to 50 mcg/dl. Normal range white blood cells is between 5,000 to 10,000.

A nurse on an oncology unit is preparing to administer doxorubicin to a client who has breast cancer. Prior to beginning the infusion, the nurse verifies the client's current cumulative lifetime dose of the medication. For which of the following reasons is this verification necessary? A) An excess amount of doxorubicin can lead to myelosuppression B) Exceeding the lifetime cumulative dose limit of doxorubicin might cause extravasation C) An excess amount of doxorubicin can lead to cardiomyopathy D) Exceeding the lifetime cumulative dose limit of doxorubicin might produce red tinged urine and sweat

C) An excess amount of doxorubicin can lead to cardiomyopathy Doxorubicin is an antitumor antibiotic used in the treatment of various cancers. Irreversible cardiomyopathy with congestive heart failure can result from repeated doses of doxorubicin, and prolonged use can also cause severe heart damage, even years after the client has stopped taking it. The maximum cumulative dose a client should receive is 450 mg/m2 or 550mg/m2 with a history of radiation to the mediastinum. Cumulative dose is the total dose resulting from repeated exposure of ionizing radiation to an occupationally of the body or to the whole body, over a period of time. PPT, slide 37 and slide3: Adverse effects are Bone marrow suppression (myelosuppression), alopecia, cardiotoxicity. Doxorubicin uses for treatment of Neuroblastoma and solid tumors of bone, bladder, breasts, ovary, and lungs

Chemotherapy is being initiated for a client with prostate cancer who is experiencing mucositis. Which of the following health teaching would be most appropriate for this drug? A) Use an over-the counter mouthwash to eliminate bacteria B) Increase intake of citrus-containing foods and beverages C) Eat a bland diet and use a soft toothbrush for oral care D) This adverse effect is expected and will disappear within a few days

C) Eat a bland diet and use a soft toothbrush for oral care Mucositis is the painful inflammation and ulceration of the mucous membranes lining the digestive tract, that is an adverse effect of chemotherapy and radiotherapy treatment for cancer. Client experiencing this adverse effect should be instructed to eat a bland diet and use a soft toothbrush for oral care. Most OTC mouthwashes contain a significant amount of alcohol which will further inflame the oral issue and should be avoided ( option A). Citrus feeds and beverages should be avoided since the acidic nature of these foods would cause the client pain(option B). Mucositis can last the duration of the chemotherapy treatment and should be treated rather than ignored. This condition will prevent intake of adequate nutrition to build new cells (option D).

A client receiving carboplatin (Paraplatin) is also receiving filgrastim (Neupogen). The nurse will explain to the client that the filgrastim is used for what effect? A) It boosts the effects of the carboplatin, so a decreased dosage is needed B) It prevents the development of secondary cancers related to the carboplatin C) It shortens the duration of neutropenia and associated infection risk related to the carboplatin D) It prevents bone loss and osteoporosis

C) It shortens the duration of neutropenia and associated infection risk related to the carboplatin Filgrastim increases neutrophil production and decreases the duration of neutropenia with associated infection risk. Options A, B, and D are incorrect. Filgrastim does not boost the action of carboplatin, prevent the formation of additional cancers or prevent bone loss. PPt slide 55. Filgrastim stimulates neutrophils (WBC) production.

A nurse is caring for a client who has chronic renal disease and is receiving therapy with epoetin alfa. Which of the following laboratory results should the nurse review for an indication of a therapeutic effect of the medication? A) The leukocyte count B) The platelet count C) The hematocrit (Hct) D) The erythrocyte sedimentation rate (ESR)

C) The hematocrit (Hct) Epoetin alfa is an Anti-anemic medication that is indicated in the treatment of clients who have anemia due to reduced production of endogenous erythropoietin, which may occur in clients who have end-stage renal disease or myelosuppression from chemotherapy. The therapeutic effect of epoetin alfa is enhanced red blood cell production, which is reflected in an increased RBC, Hgb, Hct PPt, slide 55 and Slide 6. Epoetin alfa is Colony Stimulating Factors (CSFs)- stimulate RBC production

A client with acute lymphoblastic leukemia has started therapy with doxorubicin (Adriamycin). The nurse will assist the client with what important intervention during the course of this treatment? A) Perform active or assisted range- of -motion (ROM) exercises to maintain strength B) Participate in relaxation therapy to control pain C) Use daily mouth rinses as prescribed D) Maintain bed rest during treatment

C) Use daily mouth rinses as prescribed As with many chemotherapy drugs, doxorubicin is associated with mucositis. Daily mouth rinses will be prescribed to decrease the risk of opportunistic infections from yeast and mouth bacteria. Options A, B, and D are incorrect. Performing active or assisted ROM in an important intervention associated with drugs that cause neurotoxicity. Controlling pain is associated with chemotherapy that may cause pain as an adverse effect. Maintaining bed rest is not related to the use of chemotherapy but may be required for other reasons.

A nurse is educating a newly diagnosed diabetic who must learn how to give himself insulin injections. The nurse tells the patient that insulin is absorbed faster from which area of injection? A. Deltoid B. Thigh C. Abdomen D. Hip

C. Abdomen Studies indicate that insulin is absorbed fastest from the abdomen, followed by the deltoid, thigh, and hip

The nurse who is caring for a client with gastroesophageal reflux disease (GERD)should question the order for which drug? A. H2-receptor antagonists B. Proton pump inhibitors C. Antibiotics D. Antacids

C. Antibiotics Antibiotics have no role in the treatment of GERD. Certain antibiotics are used in treating peptic ulcer Dx (PUD) to eradicate the organism H. pylori. H2-receptor antagonists (option 1) and proton pump inhibitors (option 2) are used routinely to relieve symptoms of GERD. OTC antacids (option 3) provide intermittent relief for mild cases.

A nurse should advise a client who is receiving lorazepam (Ativan) about the adverse effects of this medication, which include: A. Tachypnea B. Astigmatism C. Ataxia D. Euphoria

C. Ataxia Ataxia, weakness, restlessness, dizziness or other motor problems can occur with lorazepam. None of the other options, A, B, or D will occur with lorazepam Ataxia means without coordination, patients with ataxia lose muscle control in their arms and legs. Astigmatism is imperfection in the curvature of the eye that causes blurred distance and near vision. Euphoria is the experience of pleasure or excitement and intense feeling of well-being and happiness.

A nurse is providing dietary teaching for a client who has a new prescription for monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A. Glass of whole milk B. Celery sticks C. Bologna sandwich D. Sliced apples

C. Bologna sandwich Clients who are receiving an monoamine oxidase inhibitor ( MAOI) should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided. The most serious adverse effect associated with MAOI is hypertensive crisis. which can be precipitated by intake of food containing tyramine. Foods that increase the effects of MAOI are game meats, soy products, seafood, seaweed, aged cheese and meats. PPt, slide 49

A client diagnosed with Type 2 diabetes with the order accuchek achs and sliding scale regular insulin subcutaneously. At 1100, the client's glucometer reading is 148. Which intervention should the nurse implement? <60 notify HCP <150 - 0 unit 150-180- 3 units 180- 210- 5 units A. Have the laboratory verify the glucose results. B. Notify the health care provider of the results. C. Hold regular insulin administration. D. Recheck the client's glucometer reading at 1130.

C. Hold regular insulin administration. Sliding scales - subcutaneous insulin doses adjusted by glucose levels. It can be done several times daily (q4h or q6h), before meals, and before bed (PPt -slide 34).

A nurse is caring for a client who has atrial fibrillation and receives digoxin daily. Before administering this medication, which of the following actions should the nurse take? A. Offer the client a light snack B. Measure the client's blood pressure C. Measure the client's apical pulse D. Weigh the client

C. Measure the client's apical pulse Digoxin decreases the heart rate, so the nurse should count the APICAL pulse for at least 1 minute before administering. The nurse should hold the medication and notify the provider if the client's heart rate is below 60/min or if a change in heart rhythm is detected.

A nurse is providing discharge teaching to a client who has a new prescription for Lithium. Which of the following information should the nurse include in the teaching? A. Follow a low-sodium diet B. Limit daily fluid intake C. Obtain a daily weight D. Avoid floods that have a high tyramine content

C. Obtain a daily weight Clients who are taking lithium should monitor their daily weight due to the risk of fluid imbalance. Therefore, if a patient with renal impairment or unstable renal function receives lithium, it is essential the dose be markedly reduced, and that plasma serum level be closely monitoring. Before beginning lithium, it is important to obtain baseline studies of renal, cardiac, and thyroid status because drug adverse effects involve those organ systems. A low-sodium (salt-restricted) diet can decrease lithium elimination, leading to increased lithium level and risk of toxicity in lithium users who reduce their salt intake. Baseline electrolyte studies are also necessary.

A nurse is reviewing the medication list for a client who has a new diagnosis of type 2 diabetes mellitus. The nurse should recognize which of the following medications can cause glucose intolerance? A. Cimetidine B. Dextromethorphan C. Prednisone D. Atorvastatin

C. Prednisone Steroid-induced hyperglycemia is when steroids cause high blood sugar levels in patients with pre-existing diabetes. MOA Lower glucose by stimulating insulin release from pancreatic beta cells PPt- slide 62

What is the most commonly prescribed class of antidepressants? A. Tricyclic antidepressants (TCAs) B. Monoamine oxidase inhibitors (MAOIs) C. Selective serotonin reuptake inhibitors (SSRIs) D. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

C. Selective serotonin reuptake inhibitors (SSRIs) Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe, and typically cause fewer side effects than other types of antidepressants.

A nurse is caring for a client who has a fractured ulna and a new prescription for cyclobenzaprine. Before administering, which of the following explanations should the nurse provide to explain the purpose of the medication? A. The medication will kill microorganisms that can cause infection at the fracture site B. Cyclobenzaprine will reduce itching that might occur as the fracture begins to heal C. The medication will relieve muscle spasms that might occur with a fracture D. Cyclobenzaprine will relieve any nausea associated with a fracture

C. The medication will relieve muscle spasms that might occur with a fracture The nurse should explain that the provider prescribed cyclobenzaprine to relieve muscle spasms that can accompany the acute pain of fractures. The medication is well absorbed by the GI tract. Common adverse effects of cyclobenzaprine are drowsiness, dizziness, and anticholinergic effects (e.g., dry mouth, constipation, and urine retention). Act directly on skeletal muscle to relieve spasticity. PPt slide 14, Skeletal Muscle relaxants.

The nurse is preparing to administer an MMR vaccination to a 15-month-old child. What would cause the nurse to hold the injection and recheck this order with the provider? A. The mother tells the nurse that the family will be going to the beach for the next few weeks. B. The mother states that she was told that she had a reaction to the injection when she was a child. C. The mother tells the nurse that her husband is having chemotherapy for Hodgkin's lymphoma. D. The mother tells the nurse that the child's older brother is home with a cold virus.

C. The mother tells the nurse that her husband is having chemotherapy for Hodgkin's lymphoma. The MMR vaccination is an attenuated (live) virus and there is a slight risk that the virus could be transmitted to the child father because he is immunocompromised from the chemotherapy. The nurse would check with the provider about delaying the vaccine until he is finished with the chemotherapy.

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

C. To report weight loss, anxiety, insomnia, and palpitations The nurse needs to teach the client the symptoms of hyperthyroidism, including weight loss, anxiety, insomnia, and palpitations, because these may indicate over-replacement and require adjustments to therapy. The nurse would also teach the client that therapy will be lifelong, not just for 6 months (Option A), and that periodic monitoring of TSH and T3 levels will be required, but not on a weekly basis ( Option B). Synthroid should be taken on a daily basis, optimally at the same time each day (Option D). PPt-slide 16

The nurse teaches the client that which type of over-the-counter cough preparations is not effective with coughs associated with the common cold and allergic rhinitis? A. Dextromethorphan ( Benylin DM) B. Diphenhydramine (Benadryl) C. Mucolytics such as Guaifenesin (Mucinex) D. Pseudoephedrine (Sudafed)

D. Pseudoephedrine (Sudafed) Pseudoephedrine is a sympathomimetic and is used only for nasal decongestion. Dextromethorphan and diphenhydramine are both effective for some coughs associated with allergic rhinitis and the common cold (options 1 and 2). Mucolytics are found in some OTC cough preparations used in colds, but are best used to treat chronic productive coughs (option 3)

A client with cancer is started on a chemotherapeutic agent that is a known vesicant. The nurse performs which priority activity related to this drug? Monitor the clients: A) Response to antinausea drug B) Intake of calcium-rich foods C) Respiratory status for cough D) IV site for swelling and pain

D) IV site for swelling and pain Many antineoplastics are classified as vesicant agents that can cause serious tissue injury if they escape from an artery or vein during an infusion or injection. The nurse should closely monitor the infusion site for swelling and pain. Option A is incorrect. Vesicants do not necessarily cause nausea. Option B is incorrect. It would be inappropriate for the nurse to monitor the client's intake of calcium-rich foods since it is not related to receiving chemotherapy classified as a vesicant. Option C is incorrect. Respiratory status is not related to the administration of a vesicant type chemotherapy agent. PPt slide 51

A client with ovarian cancer is being treated with vincristine. The nurse monitors the client, knowing that which manifestation indicated an adverse effect specific to this medication? A) Diarrhea B) Hair loss C) Chest pain D) Peripheral neuropathy/ neurotoxicity

D) Peripheral neuropathy/ neurotoxicity An adverse effects specific to vincristine is peripheral neuropathy, which occurs in almost every client. Peripheral neuropathy can be manifested as numbness and tingling in the fingers and toes. PPt slide 40 and 7.Adverse effect is neurotoxicity, which may take several months to resolve.

A nurse is performing discharge teaching for a client who has seizure and a new prescription for phenytoin. Which of the following statements by the client indicates a need for further teaching? A. " I will notify my doctor before taking any other medications." B. " I have made an appointment to see my dentist next week." C. " I know that I can not switch brands of this medication." D. " I'll be glad when I can stop taking this medicine."

D. " I'll be glad when I can stop taking this medicine." Phenytoin is an anticonvulsant used to treat various types of seizures. Clients on anticonvulsant medications commonly require them for lifetime administration, and phenytoin should not be stopped without the advice of the client's provider. PPt, slide 34

A nurse is teaching a client who has a new prescription for fluoxetine to treat depression. Which of the following statements by the client indicates an understanding of the teaching? A. " I should expect to feel better after 24 hours of starting this medication." B. " I should not take this medicine with grapefruit juice." C. " I'll take this medicine with food." D. " I'll take this medicine first thing in the morning."

D. " I'll take this medicine first thing in the morning." The client should take fluoxetine in the morning to reduce the risk for insomnia. MOA: Block uptake of serotonin at neuronal presynaptic membrane. Adverse effects: GI upset, anorexia, sexual dysfunction. Full therapeutic effects appear in 2 - 6 weeks. PPt, slide 50

A nurse is teaching a client who has a new prescription for cyclobenzaprine. Which of the following information should the nurse include in teaching? A. Discontinue medication if nausea occurs B. Expect urine to turn orange C. Monitor for increased muscle spasms D. Avoid driving until effects are known

D. Avoid driving until effects are known Cyclobenzaprine can cause drowsiness and dizziness. They are the most common adverse effects. Instruct the client to avoid driving if these effects occur.

A nurse is caring for a client who has diabetes and plans to administer his regular insulin subcutaneously before he eats breakfast at 0800. After checking the client's morning glucose level, which of the following actions should the nurse take? A. Give the insulin at 0700 B. Give the insulin when the breakfast tray arrives. C. Give the insulin 30 min after breakfast with the client's other routine medicines. D. Give the insulin at 0730

D. Give the insulin at 0730 Regular insulin has onset of 30 to 60 minutes and should be given at a specific time before meals, usually within 30 min. The nurse should always check the blood glucose levels prior to administering short-acting insulin. Three types of Insulins: rapid acting (Novolin R), Intermediate acting (NPH), and Long acting (Lantus and Levemir) Combination insulins of intermediate and short acting insulins. PPt- slide 31.

A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine (Lantus). Which of the following instructions should the nurse provide regarding this type of insulin? A. Insulin glargine has a duration of 3 to 6 hrs B. Insulin glargine has a duration of 6 to 10 hrs C. Insulin glargine has a duration of 16 to 24hrs D. Insulin glargine has a duration of 18 to 24hrs

D. Insulin glargine has a duration of 18 to 24hrs Insulin glargine is a long-duration insulin that has a duration of 18 to 24 hr. It is only dosed once a day. The onset of insulin effect in 1 @1/2-2 hr PPt- slide 31

Is it true or false that the teaching plan would be best for the client who recently started on lithium carbonate (Eskalith) as a regular diet, including foods such as bacon, ham, tomato juice, and salted peanuts?

True

Is it true or false that the "Synergism" term means the net effect of two drugs exceeds the summative effect of each drug?

True Two or more drugs that individually produce overtly similar effects will sometimes display greatly enhanced effects when given in combination- the combination is said to be synergistic

A client is being treated with Sodium bicarbonate for indigestion. When instructing the client about this medication. Which potential adverse effects of medication should the nurse communicate to or discuss with the client? Select all that apply. A. Fluid retention B. Contraindicated with congestive heart failure C. Rhinitis D. Rash

a & b A. Fluid retention B. Contraindicated with congestive heart failure Sodium bicarbonate is an antacid that can cause fluid retention and is contraindicated with congenital heart failure. P.S. Some combinations of two antacids can cause metabolic alkalosis. PPt, slide 19th

A nurse is teaching a client who has a new prescription for cimetidine to treat peptic ulcer disease. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply A. " I can take this medication with or without food." B. " I will take this medication in the morning." C. " I should expect my stools to turn black." D. " I will take this medication with an antacid." E. " I will take this medication when I need it for pain." F. " I will eat five small meals each day."

a & f A. " I can take this medication with or without food." F. " I will eat five small meals each day." Food slows the rate of absorption of cimetidine, but beneficial effects will be prolonged. Cimetidine can be taken with meals, after meals, or at bedtime. The client should eat 5 to 6 small meals each day to enhance the therapeutic effects of cimetidine. Due to rapid absorption from small intestine (30 mins onset of action), recommended that the client should to eat 5 to 6 small meals each day to enhance the therapeutic effects. PPt slide 15

A nurse is providing teaching to a client who has a new diagnosis of hypothyroidism. On which of the following medications should the nurse prepare to instruct the client? a. Radioactive iodine b. Levothyroxine c. Sumatriptan d. Levofloxacin

b. Levothyroxine Levothyroxine is a synthetic thyroid hormone that is chemically identical to thyroxine (T4). It is used in the treatment of hypothyroidism. The nurse should prepare to instruct the client on the use of this medication. MOA: Supply thyroid hormones to correct hypothyroidism. Adverse effects: 1. Overdose- hyperthyroidism -thyroid crisis. 2. Thyroid crisis, including angina, tachycardia, palpitations, hypertension, cardiac dysrhythmia, nervousness, irritability, weight loss, and fever. PPt- slide 59

Is it true or false that digoxin increases preload by increasing the strength of contraction?

true