Weeks 5-8 Assessment

A nurse is caring for a client with bacterial conjunctivitis of the right eye, for which an antibiotic ophthalmic ointment has been prescribed. Which of the following is an appropriate statement by the nurse?

"Apply the ointment in a thin line into the conjunctival sac" This is the correct procedure for applying ophthalmic ointment. The medication should be administered (in a thin line) into the conjunctival sac, rather than being placed directly on the globe of the eye. This ensures that more of the medication comes in contact with the surfaces of the eye when the client blinks.

A client who is taking nitrofurantoin (Macrodantin) for a urinary tract infection voices a concern to a clinic nurse about voiding brown-colored urine. Which of the following is an appropriate response by the nurse?

"Brown-colored urine is a harmless side effect of the medication" Since nitrofurantoin imparts a harmless brown color to the urine, the nurse should inform the client of this harmless effect.

A nurse is reinforcing reaching for a client who takes pain medication and recently prescribed docusate sodium (Colace). Which of the following statements indicates the client understands the information?

"I am to have 1-2 soft stools each day" The client's understands docusate sodium is a stool softener and the therapeutic effect is achieved when having 1 to 2 soft stools each day.

A nurse is reinforcing teaching about the use of nystatin (Mycostatin) suspension with a client who has oral candidiasis. Which of the following statements by the client should indicate that the client understands how to take the medication?

"I will swish the solution around my mouth, then hold it there for as long as possible" This statement indicates that the client recognizes that nystatin provides only a local antifungal effect; therefore, it should be in contact with the fungus for as long as possible. Nystatin is not absorbed through intact skin or mucous membranes.

A provider prescribes fluoxetine (Prozac) for a client who reports frequent periods of extreme sadness. The nurse reinforcing teaching with the client know he understands how to take this medication when he makes which of the following statements?

"Ill take this medicine first thing in the morning" he usual recommendation is to take fluoxetine as a single dose in the morning.

A nurse is reinforcing teaching for a client who is about to start therapy with methotrexate (Rheumatrex) to treat rheumatoid arthritis. Which of the following should the nurse review with the client?

-Do not drink alcoholic beverages is correct. Alcohol ingestion can increase the risk of liver damage. -Report unexplained bruising to the provider is correct. Methotrexate can cause thrombocytopenia. Clients should report bruising or petechiae as they may indicate a low platelet count. -Avoid people who have infections is correct. Methotrexate causes bone marrow suppression and increases the risk for infection.

A nurse is talking with a client who has peptic ulcer disease and is starting therapy with sucralfate (Carafate). The nurse should instruct the client to take the medication

1 hr before meals Sucralfate is a mucosal protectant. The client should take it on an empty stomach, 1 hr before meals, for maximum effectiveness.

A nurse administers a clients daily dose of NPH insulin (Humulin N) at 0730. If the client reports anorexia and refuses breakfast following the dose, the nurse will plan to observe the client closely for a hypoglycemic reaction at

1330 NPH insulin, an intermediate-acting insulin peaks at 6 to 14 hr following administration. This is when the nurse should plan to observe the client for a hypoglycemic reaction.

A nurse is preparing to administer 250 mg of an antibiotic IM. Available is 3 g/mL. How many mL should the nurse administer to the client?

3 g = 3,000 mg Desired x Quantity ————————— = Amount to give Have 250 mg x 5 mL ——————— = X mL 3,000 mg 1,250———— = 0.416 mL 3,000 X (after rounding) = 0.4 mL

A nurse receives a new prescription from the provider which reads "give 14 units of regular insulin and 28 units of long-acting insulin to be given subcutaneously at the breakfast hour". What is the total number of units of insulin that the nurse will prepare in the insulin syringe?

42 units Each order of for units of insulin is combined in the same syringe and added together for a total amount in the syringe.

A nurse is preparing to administer aspirin 10 gr PO. Available is aspirin 325 mg tablets. How many tablets should the nurse administer? (Round to the nearest whole number)

60 mg = 1 gr X mg = 10 gr Cross multiply: X = 60 x 10 X = 600 mg Desired x Quantity ————————— = Amount to be given Have 600 mg x 1 tablet ——————— = X tablets 325 mg 600———— = 1.8 tablets 325 X = 2 tablets (after rounding)

"The nurse is administering lactulose 30 mL to a patient with hepatic encephalopathy. Which of these outcomes should receive priority as the nurse plans care with this patient?

?

"What is the primary reason why Lomotil, an antidiarrheal drug, contains atropine in addition to diphenoxylate?"

?

A postoperative patient is prescribed IV prochlorperizine (Compazine) as needed for nausea and vomiting. After being transferred from the bed to a chair with the assistance of three people, the patient vomits and requests the medication. What should the nurse do?

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A nurse is preparing to teach a client how to draw up Regular insulin and neutral hagedorn (NPH) insulin into the same syringe. Which of the following instructions is appropriate?

? Discard any NPH insulin that appears cloudy ​NPH insulin has a cloudy appearance. Regular insulin should be clear.

A nurse is caring for a client with osteomyelitis who is being treated with large doses of IV vancomycin (Vanocin). The client states that his arm is sore at the IV site. Which of the following is an appropriate action by the nurse?

Determine the latency of the IV line Vancomycin, an antibiotic, is irritating to tissues and can cause damage if allowed to infiltrate. The nurse should evaluate the patency of the current IV, and if it is infiltrated, secure a new site prior to hanging the next dose of vancomycin.

When talking with a patient about cimetidine (Tagamet), the nurse should reinforce which of the following instructions?

Do not take this medication if you are taking blood-thinning medications ​Cimetidine can interfere with the absorption of warfarin (Coumadin) and several other medications, including phenytoin (Dilantin) and propranolol (Inderal).

A nurse is to administer subcutaneous short-acting insulin combined with long acting insulin to the client before he eats breakfast at 8:00 am. Which of the following should the nurse do?

Give the insulin at 7:30 am after checking the blood glucose level results ​Short-acting insulin has an onset of 30 minutes. Insulin should be given at a specific time before meals, usually one half hour. The nurse should always check the blood glucose levels prior to administering short-acting insulin.

The nurse is aware that anticholingeric adverse effects of drugs can be more common and a greater problem in older adults than in your younger adults. Which anticholingeric effects would be a priority to the prescriber?

Has not voided in 16 hrs

A nurse is reviewing medications for a client who has a diagnosis of a small bowel obstruction. This nurse should withhold senna (Senoket) prescribed orally based on understanding of which of the following?

Laxatives are contraindicated in clients who have a small bowel obstruction ​Laxatives are contraindicated in clients who have fecal impaction, bowel obstruction, and acute abdominal surgery to prevent perforation. Because the bowel does not allow for any passage of stool with a complete small bowel obstruction, laxatives will cause increased abdominal cramping and discomfort. Bulk-forming laxatives such as psyllium (Metamucil) also are contraindicated in small bowel obstructions because they soften the fecal mass and increase the bulk of the stool.

A nurse plans to administer ceftriaxone (Rocephin) 1 mL to an older adult client. Which of the following indicate the correct technique?

Locates the vastus lateralis injection site ​The ventrogluteal or vastus lateralis are the safest injection sites for this medication. The nurse locates the vastus lateralis muscle by placing one hand below the greater trochanter of the femur and one hand's width above the knee. This creates an imaginary border where the nurse prepares to inject lateral to midline of the upper portion of the quadriceps muscle.

A nurse is caring for a client after a course of chemotherapy and experiences severe nausea and vomiting. The nurse monitors for which of the following clinical manifestations?

Metabolic Alkalosis Metabolic alkalosis occurs when there is excessive vomiting and there is a loss in hydrochloric acid.

A nurse is caring for a newly admitted client diagnosed with diabetes mellitus. The nurse notes that the client is confused, flushed, and has an acetone odor on his breath. Based on her findings, the nurse suspects diabetic ketoacidosis and should anticipate using which of the following types of insulin to treat the client?

Regular (Humulin R) Regular insulin is classified as a short-acting insulin. It has the advantage that it can be given IV with an onset of action of less than 30 min. Regular insulin is the most appropriate insulin to use in emergency situations of hyperglycemia.

A nurse is preparing to administer hydrocode/acetaminophen (Lortab) 5 mg. Is it available in 7.5 mg/500 mg/15 mL elixir. How many mL should the nurse administer? (Round to the nearest whole number)

STEP 1: What is the dose needed? Dose needed = Desired STEP 2: What is the dose available? Dose available = Have STEP 3: Do the units of measurement need to be converted? Convert the unit of measurement of what is desired to the unit of measurement of what is available. STEP 4: Determine the quantity of the dose available. This refers to how the medication is provided, such as 15 mL. STEP 5: Set up an equation using knowledge about basic equivalents and solve for X. Have__ = Desired Quantity X Step 6: Reassess to determine whether the amount to be given makes sense. 7.5 mg = 5 mg 15 mL X mL 7.5 mg = 5 mg 15 mL X mL 7.5X = 75 75 = 10 mL 7.5

A nurse is to administer a rectal suppository to a client. The nurse should instruct the client to lie in which of the following position's while in the bed?

Sim's Position ​The Sim's position exposes the anus and helps the client relax the external sphincter while lying in bed. This allows for easier insertion of the suppository.

The nurse is planning to administer ear drops to an adult client. Which is the correct method for the nurse to do it?

The auricle is pulled up and back The ear canal should be straightened prior to instillation of medications. For the adult, the auricle should be pulled up and out. For the child, the auricle should be pulled down and back.

A nurse is visiting a client who has end-stage liver cancer and is homebound. The client tells the nurse that she has not been taking morphone sulfate (Duramorph) for pain relief because it does not seem to be working. The nurse understands that this is due to which of the following?

The client has developed a tolerance to the medication. Morphine sulfate is an opioid analgesic used for the treatment of severe pain. Tolerance is an undesirable side effect of opioids and occurs when a larger dose is needed to produce the same response.

A client has been taking omeprazole (Prilosec) for the past 4 weeks. The nurse determines that the medication is effective when the client reports relief from

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

An older adult client's provider prescribes aspirin 650 mg/q6h PO to treat rheumatoid arthritis. The nurse should reinforce with the client that a possible adverse effect of aspirin therapy is

bleeding aspirin can cause bleeding, tinnitus, gastric ulceration, nausea, and heartburn

Following surgery a client has a prescription for nalbuphine (Nubain) for moderate to severe pain. The nurse caring for the client should check for possible adverse reactions by evaluating the client for which of the following findings?

blurred vision Nalbuphine can cause blurred vision as well as mitosis.

A client is about to start taking aluminum hydroxide (Amphojel) to treat heartburn. The nurse should explain to the client that this medication can cause

constipation ​This type of antacid can cause constipation, so the nurse should tell the client to increase fluid and fiber intake and to exercise more to help prevent this effect.

A nurse is caring for an older adult who is 5 days postoperative for a total hip arthroplasty and has been receiving meperidine (Demerol) for pain. While taking vital signs the client begins to experience a seizure. Which of the following should the nurse recognize as the possible cause for this seizure?

cumulative effect A cumulative effect occurs when a medication is given too often, at too high a dose, or is not metabolized as fast as it is being given. Due to older adults decreased kidney function, meperidine can quickly reach a toxic level when given over several days and cause seizures.

A nurse is caring for a client who is receiving liothyronine (Cytomel) for treatment of hypothyroidism. Which of the following should the nurse recognize as a therapeutic response?

improvement of overall mood Depression, lethargy, and fatigue are symptoms of hypothyroidism. Effective treatment will improve these symptoms, and the client will report an improvement in mood. Liothyronine is a synthetic preparation of triiodothyronine (T3), a naturally occurring thyroid hormone. Liothyronine is used to treat and improve the symptoms of hypothyroidism, which include anorexia, depression, lethargy, fatigue, cold and dry skin, a pale and puffy face, brittle hair, decreased heart rate, decreased temperature, weight gain, and intolerance to cold.

A client tells the nurse she took a dose of dimenhydrinate (Dramamine) before coming to the health care clinic. The nurse determines that the medication is effective when the client reports relief of

nausea Dimenhydrinate helps prevent and treat motion sickness. It also treats vertigo and reduces nausea and vomiting from radiation sickness.

A charge nurse and a newly licensed nurse are providing care for a client who reports nausea and has a presciption for metoclopramide (Reglan) as an antiemetic. Which of the following statements by the newly licensed nurse indicates a correct understanding of the actions of the medication. "Metoclopramide":

promotes gastric emptying Metoclopramide is a gastrointestinal stimulant used to relieve nausea, vomiting, heartburn, stomach pain, bloating, and a persistent feeling of fullness after meals. Metoclopramide works by promoting gastric emptying.

A nurse who is reinforcing teaching for a client who is about to start taking docusate (Colace) should make sure that the client understands that this medication should result in

regular bowel movements The intended outcome of docusate therapy is to produce stool that is softer in consistency and easier for the client to pass. That should improve the regularity of the client's bowel movements.

A nurse is caring for a client who is postoperative and receiving fentanyl (Sublimaze) via patient controlled analgesia (PCA). The client has a prescription for naloxone (Narcan). The nurse understands that naloxone is given to

reverse the effects of narcotics on the central nervous system Narcan is a narcotic antagonist that combines competitively with opiate receptors and blocks or reverses the action of narcotic analgesics. By blocking the effects of narcotics on the central nervous system (CNS), it prevents CNS and respiratory depression.

A nurse is talking with a client about taking diphenhydramine (Benadryl). The nurse should explain that the most common side effect of this medication is

sedation ​The most common adverse effect of diphenhydramine, a first-generation antihistamine, is sedation. In fact, this medication is sometimes used as a sleep aid.

A nurse is reinforcing teaching to a client who has hypothyroidism and has a new prescription for levothyroxine (Synthroid). The nurse instruct the client to avoid which of the following herbal supplements?

soy isoflavones The nurse should instruct the client to avoid taking soy isoflavones due to the possibility of reducing the absorption of the medication.

A nurse is caring for a client with type 2 diabetes mellitus who is prescribed glipizide (Glucotrol). When reinforcing reaching fo the client about this medication, the nurse should tell the client that glipizide.

stimulates the pancreas to release adequate insulin Glipizide is a sulfonylurea agent. It helps lower blood glucose levels by increasing insulin secretion from the beta cells of the pancreas.

A nurse is monitoring the flow rate of an IV solution prescribed to infuse at 100 mL/hr using a drop factor of 15 get/mL. The nurse should ensure the flow rate is set to infuse how many gtt/min?

​STEP 1: What is the volume to be infused? 100 mL STEP 2: What is the time for the infusion? 1 hr STEP 3: What is the drop factor for the IV tubing? 15 gtt/mL STEP 4: Set up the equation. mL (volume to infuse) x gtt factor = gtt/min Time in minutes 1 mL 100 mL x 15 gtt = 1,500 gtt = 15 gtt/mL 60 min 1 mL 60 min